Earlier this month, the entire 3rd year Class of CUNY medical students assembled virtually to look at art. One exercise they performed together was observing John Singleton Copley’s painting, Watson and the Shark. Considered the first known visual representation of a shark attack, the painting was Copley’s attempt to capture a real-life event: a shark attack in the Havana harbor in 1749 that cost the young swimmer in the painting his leg. After being given some context for the painting, the medical students began to volunteer their observations and interpretations of the painting: the varying emotions of the men in the rescue boat; the apparent levels of class based upon the dress of the members of the rescue party; the elevated presence of a black sailor positioned at the apex of a triangular composition who also happened to be holding the lifeline to the victim; the total absence of women; and the victim’s pallor suggestive of significant blood loss and pending hemodynamic shock and possible death.
This exercise was just one part of OBSERVARE, a course created and directed by Dr. Jeffrey Lazar, medical director and vice chair of the Department of Emergency Medicine, and a working artist, for CUNY’s fall
intersession. The purpose of the course was to strengthen and develop medical students’ visual literacy through the appreciation and interpretation of art. Dr. Lazar’s intention was that the students would bring “clinical observation skills to the observation of art, and artistic interpretation skills to the clinical observation of patients.” The course gains its title from the Latin OBSERVARE: Intersection of Art and Medicine word for “observe:” to watch over, note, heed, look to, attend to, guard, regard, comply with, and in his lecture Dr. Lazar pointed out that many of those words apply both to how a viewer approaches a piece of art, and how a physician might approach a patient.
The course consisted of a primary lecture focusing on the work of a number of artists whose work was shaped by medical experiences, including Frida Kahlo and Jean Michel Basquiat. Basquiat was seven when he was struck by a car, sustaining multiple internal injuries and requiring a splenectomy. His mother gifted him a copy of the classic anatomical textbook, Gray’s Anatomy, while he recovered. Anatomical drawings and phrases would later appear widely in Basquiat’s graphic and textual images; also keeping alive an artistic tradition that dates back to Da Vinci.
In discussing Frida Kahlo, Dr. Lazar not only touches upon the sequelae of her traumatic accident while a university student (pointing out that before her accident Kahlo had intended to become a physician) but that she was believed to have become addicted to opiates used to treat her pain after myriad surgeries and infections.
Dr. Lazar also had the students observe Gustav Klimt’s Portrait of Adele Block-Bauer and soon had the students speculating as to whether the redness on her face could have been indicative of a malar rash, and whether the bluer shade of her extremities might have been a sign of peripheral cyanosis. He also had the students attempt to pose their hands in the same pose of the model so that they might discover that the post both looked and felt awkward and unnatural. “There is a strong belief that the model chose that pose to hide a deformed finger,”
Dr. Lazar then informed the class. The students also spent time looking at
Picasso’s Head of a Warrior sculpture and discussing/examining the sculpture’s accentuated features from a clinical diagnostic perspective. The sculpture’s bulging eyes were picked up upon by one student. “Graves Disease!” volunteered another, as Dr. Lazar discussed possible etiologies, including Graves Disease or perhaps, being a warrior, the sculpted figure sustained a facial injury with a retrobulbar hematoma. The screen changed from the image of Picasso’s sculpture to a CT scan demonstrating a retrobulbar hematoma.
“What would we do to treat this?” Dr. Lazar asked the students, before showing the next slide which illustrated an emergent lateral canthotomy. “We do this a few times a year in our department,” Dr. Lazar told the students, in his attempt to continue drawing a connection from a sculpture by Picasso to the practice of emergency medicine in the Bronx.
Dr. Lazar first became aware of similar courses being offered at Cornell and
Yale and was excited to be able to create a similar offering at CUNY. He recalls reading a line by the Frick Museum’s director of education who worked with Cornell on their course: “We have a very indirect goal – to make doctors better observers.” That sentiment stuck with Dr. Lazar, who points out that in the age of the electronic medical record, too often the clinician’s attention is directed at a computer screen.
Dr. Lazar points to an article in the Journal of Ethics, which states that “visual literacy can inform clinicians about things the patient is not directly telling them that might be relevant to a diagnosis or to good communication.” The same observational skills we bring to every patient encounter, he tells them, might also be brought to every art encounter.
The second half of the course involved the students breaking up into small groups that were precepted by SBH faculty and residents who have a strong
interest in the arts. The CUNY students in each group were given the assignment of visiting a New York City museum (either in person or virtually) and selecting an artwork, and then asked to compile and share 20 observations about the work. The goal, according to Dr. Lazar, was to challenge the students to move beyond the obvious and immediately apparent, and to learn to spend time and be patient with their chosen subject. “The most interesting and revealing observations,” shared Dr. Lazar, “are often those that require time, patience, and attention … three things that can sometimes be in short supply when we are with our patients.”
One small group leader was Dr. Razia Rehmani from SBH’s Department of Radiology. Dr. Rehmani commented on how the artwork her students picked was “quite moving, and relevant to today’s sociopolitical environment … with topics including social isolation in the era of Covid; women’s rights and the struggles around it; Black Lives Matter and the situations one faces based on the color of their skin.” Dr. Rehmani went on to state that “being a neuroradiologist as well as an art lover, observance of minute detail is both my hobby and my expertise. I believe the ‘art of observing art’ is very much akin to my reading a brain MRI and observing the key findings while keeping an open mind when I am entertaining various differential diagnoses accounting for the significant findings.”
“The relationship between medicine and art is an old one,” shares Dr. Blanca Grand, an SBH emergency medicine physician who also served as an
instructor for the course. “I think it’s essential for them to be able to stop and take a break from their usual forms of learning. Art can bring inspiration, reflection and spark creativity. It’s also great for processing the ups and downs of life we all experience. It can be a powerful addition, not only through medical school, but throughout the rest of their careers as physicians.” Dr. Angela Regina, another ER physician, commented on how her students in the course chose “art that demonstrated their individual personalities and the wonderful diversity in the class, and in the future of medicine.”
“Visual literacy,” states Dr. Lazar, “is arguably one of the most fundamental skills required of any physician: the ability to generate meaning from an image viewed. I certainly hope that this course further emphasized to our
CUNY students just how powerful the act of observation can be in the clinical setting, and what a gift and joy it can be in a museum.”
And as for the pallid victim in the Watson and the Shark: the young swimmer Brook Watson whom Copley painted would not only survive the
attack but go on to one day serve as the mayor of London, and include a drawing of his severed leg in his family’s coat of arms. The painting was ultimately gifted by Watson to a Children’s Hospital in the U.K., as a message of resilience and hope.