Illuminating the Art of Medical Illustration

I have always been intrigued by the artwork featured in anatomy, physiology, and surgical books. The unique beauty of a feline humerus, a cross section of intestinal epithelium, a depiction of the differentiation of bone marrow cells - who is responsible for these brutally accurate portrayals? How would one begin to draw the equine digestive system, esophagus to colon? I for one can't even manage an image that remotely mimics a hoof or nostril, let alone the intimate details of the greater trochanter of the femur. This set of skills and embodiment of artistic talent lies in a very special group of people: medical illustrators.

Last week I had the great pleasure of talking to one of the few certified medical illustrators in the country who is also a veterinarian, Dr. Lauren Sawchyn. Owner and creative director of Sawchyn Medical Illustration, Lauren shared with me her background, her inspirations, and her artistic process.

"Many Paths, One Profession" by L. Sawchyn

Lauren started drawing from an early age and her mother, a veterinary technician and practice manager, was a strong inspiration. "My mother was always very creative, so I guess I got that gene from her," says Lauren. When Lauren was young, her mother brought home a copy of Hill's Atlas of Veterinary Clinical Anatomy. Lauren was entranced. "It was made so that you could take it into the exam room and write on it with a dry erase marker. It was cool. I kept it all through the years and I loved it. It was fascinating -- all these disease drawings of dogs and cats. Kind of gruesome for a little kind, but I was like: whoa! That connected with me as I grew older and discovered the field of medical illustration."

"AIEC Invades Canine Intestinal Epithelium" by L. Sawchyn

After struggling with the notion that she might have to choose between art and veterinary medicine as a vocation, Lauren earned her Bachelor's degree in studio arts with a minor in zoology at the University of Maine. After that, she gained entrance into one of only five medical illustration master's programs in the country then rounded out her education at Cornell's vet school, where she began to sow the seeds of her business. "I ended up doing a lot of illustrations for my professors while I was at Cornell," she says. "That led to connections I later had when I opened my business."

After graduation from Cornell, Lauren dove into small animal practice and since has slowly started to weave medical illustration into the milieu. She now practices a few times a week and spends the other days in her studio.

From her portfolio, it's easy to see that Lauren has worked on numerous projects but when asked for a favorite, there's delightfully no answer. "The question of which project is my favorite is a really hard question for me because I love all of them," she says. "I wish I did have a favorite so that way I could specialize more, but I just love them all. Most of my work, based on what I've done in the past and where my connections are, is for veterinarians doing research. I've done a little bit of textbook work. Most clients are doing really interesting research projects and they call me to draw and help visualize the research."

"Measuring the equine optic nerve sheath diameter" by L. Sawchyn

Many clients will come to Lauren with a project and commission her for the accompanying artwork. Other times, Lauren works on creating a portfolio of stock images she can use and refer to in the future. With so many facets to medical illustration, even though she needs to be medically accurate, there are still plenty of ways for Lauren to put her own creative spin--her own style--on her work. But because of the nature of copyright laws in the art world, Lauren licenses the use of her work to clients instead of selling the art outright. "If I draw a picture of a dog heart and I give that to someone who has commissioned me and I give that copyright to them, then I can never draw another dog heart that looks like that again in that particular style without infringing on that," she explains.

"Feline Lateral Skeleton" by L. Sawchyn

The amount of personal style Lauren puts in a project depends on the project itself. "If it's an editorial piece, you can be more creative than if it's a surgical drawing for a textbook. With that, you can't get too wild with the color and designs, unfortunately, because you want it to be really clear and really accurate because someone is going to be doing surgery after they look at your picture. But all that presents a challenge and it's fun. It's fun to take it to both extremes. There has to be an element of creativity to all of it."

My memory jumps back to the "old days" where textbooks showed standard colors, standard views. Where will modern science take the medical art world? "Where we are right now in scientific discovery, there are still so many unknowns that it gives the artist a lot of liberty to just go with it. We don't truly exactly know the color of some cells and things like that. It can be challenging and sometimes frustrating but also really fun because you can create and visualize a whole environment. There are some people who are like: THE VEINS MUST BE BLUE AND THE NERVES MUST BE YELLOW. There's very standard stuff, but you can play with that and that's fun."

"Feline Portosystemic Shunt" by L. Sawchyn

When describing her technique and the tools she uses, Lauren discusses the balance of classical art techniques with today's technology. "When I was in art school, we used a lot of the old techniques, like pen and ink, but now, there are a lot of computer software programs. You're not so much relying on the computer; the computer doesn't make it easier. It's just a different tool. Instead of using a pen with ink on a piece of paper, I'm using a tablet that draws a line directly into a software program. It's a different tool but I'm still drawing a line."

"I still create what I call fine art on the easel," she continues. "People commission me to do pet portraits. That technique is still there and it needs to be there. People think of art as: you're just born with it. I think you're born with an aptitude and then you have to do years and years of training to get the technical skills right."

"Toggle Pin Stabilization of Bovine Left Displaced Abomasum" by L. Sawchyn

Obviously, an in-depth knowledge of anatomy and pathology weigh heavily in Lauren's work. She still dissects when she needs to, for reference. "I have enough of a reference library and background built up that for many drawings, I can reference my own photos, my own sketches, and check them with peer-reviewed data and published text books," she says. "But let's say someone contacted me tomorrow and asked me to draw the anatomy of a sugar glider. I would probably have to get more resources and even go to a school or museum and do a dissection in order to review that. It's really important for a medical illustrator to be as accurate as possible."

"I find ruminants especially challenging," she continues. "There's a lot with camelid anatomy compared to sheep and goats that for some reason people want to lump all together and they really do not have the same anatomy. That to me is fun. Camelid anatomy that I've done has been more challenging than others."  

"Clinical Anatomy of the Camelid Stomach" by L. Sawchyn

Although being in private practice as stolen some of Lauren's doodling time away, she still finds ways to be loose with her art. "I come from a fine art background. I did some really funky paintings. And then you go into realism with those highly accurate drawings that are really cool but sometimes you need to let your brain float away from that. Most of my doodles are actually of my own pets. I'll also have various paintings going on in my studio. Sometimes they sit on my easel for a long time while I work on other projects, but I come back to them. Sometimes I go outside; I live by the ocean. A lot of that inspires what I do, what colors I choose. That's a more relaxing form of artwork. I won't say I like one more than the other, it just uses a different part of my brain."

Going back to the pet portraiture Lauren finds herself commissioned to do, she says that part of her business wasn't planned but it's a nice extra. "Just by being in practice, you see pets from birth to death and I have owners approach me and ask if I'd do a portrait of their pet that passed away. That's nice. It means a lot to people and it's a nice thing for me to get involved in. People approach me with the most fantastic ideas."

Speaking of fascinating.... how about body art? "I cannot tell you how many people have approached me to design their tattoos!" Lauren laughs. "Which I would totally do! I've told every single person: tell me what you would like and I'll do it. But, so far, no one has followed through. It cracks me up."

Stay creative and stay tuned for my next blog, Monday, April 6.

The Writing Way

If you think about it, veterinarians are writers in their own right. If we practice medicine, we write medical records; if we do research, we write study protocols and publish our results. We also provide information to the public via webpages, blogs, brochures, magazine articles, and of course books.

But what about writing for pleasure? How often do we do that? (Not enough!)

A few weeks ago I had the pleasure to talk to Dr. Courtney Diehl, a veterinarian in a mixed practice (mostly horses, with some small ruminants, alpacas, and cats and dogs thrown in to keep things exciting) in Steamboat Springs, CO. A practice owner and mother of two, Courtney has found the time to write, and in fact published her first book just a year ago, in February 2014: Horse Vet: Chronicles of a Mobile Veterinarian. I wanted to catch up with Courtney and steal some of her secrets.

"I wasn't very organized at all," Courtney says of her writing process for her book. "I just sort of wrote down the stuff I would think about, or I'd have a run-in with someone and it would trigger my memory and then I would think of all the other stories that relate, so then I'd have to sit down and write them all out."

Horse Vet, in Courtney's own words, is a compilation of tales from the vet's perspective. "Good, bad, and ugly," she says. "A lot of it related to how I dealt with some of the more difficult personalities. We are all aware of the pretty high rate of suicide in our profession and I was actually struggling. Not with suicide, but I was definitely feeling down. I was just trying to feel like where I was at was OK."

Difficult personality types, whether in client (or animal!) form, colleagues, neighbors, or family, can be trying for even the most stoic of souls.

"I was giving these personalities way too much power in my life," Courtney continues. "They would not only wreck my day, but also my month and make me feel bad about myself. Finally, I was like: nobody can make me feel bad about myself. I thought maybe it would also be helpful to some of my colleagues who were dealing with the same things for me to say, hey, I struggle, too, and I still struggle, of course, but here are some of the tools I use to help cope with these people without losing my sanity."

Many scenarios that Courtney writes about contain elements of the dynamic and multifaceted vet-client-patient relationship. There are good days and there are bad days in these relationships and Courtney felt the need to express the full spectrum of what this means. "I wasn't writing to make friends," she says. "I was writing because it was real and that's what we have to deal with. It was time somebody told the story from the vet's perspective and how we make our lives work."

In the end, Courtney found the process immensely therapeutic, keying into one of the greatest benefits of writing for pleasure. On a side note, as I struggle to continue a journal, something I've done since senior year in vet school, I have to cue myself in to the known benefits to personal writing. Look here for a wonderful collection on great writers' reasons for keeping a diary.

"It was cathartic for me in so many ways, just to get it down," Courtney says. "After writing through some of the difficult parts and really looking at myself, I was like: whoa, I really have changed. I've gotten better and stronger and wow. Before, I hadn't really stopped to measure my own progress. Writing this book was instrumental in helping me do that."

After finishing the book, Courtney describes it as having a new best friend, a confidant who knew her strengths and when she faced something challenging, she knew she had faced something similar before, and documented it. The book was saying: don't worry, you got this.

Courtney's target audience was her veterinary colleagues as well as people who were thinking about going into the veterinary world. "I wrote this book to say hey, here's a cross-section of my life as a reality check."

One of the most telling aspects of my conversation with Courtney (telling about the veterinary profession, that is) was when she elaborated on her intended then omitted chapter on finances. "I had a whole chapter in there about numbers and finances," she says. "It was so grim and miserable. I couldn't find a way to make it fun or even readable and I finally gave up and took it out. It was all just lists of numbers and I was like, OK, this isn't working. Unless someone finds a fun way to write about this, no one will want to read it."

Student loan debt, often in the neighborhood of six figures, along with an average salary that isn't increasing comparatively with tuition and a mismatch between the increasing numbers of vets being produced without a workforce that can employ them all are grim realities of the industry. Are these issues that bad that we can't even find a way to express them on paper in a compelling manner?

But enough about the doom and gloom. We're here to celebrate creativity, not roll in self-pity. Go ahead, put your party hats back on.

I like to talk to veterinarians who are writers about the venerable James Herriot because I feel he is the quintessential veterinarian in literature. Read and beloved by millions in a fandom than now spans generations, is it time for a 21st century version? Is that even possible?

Courtney makes an interesting point: it may not be possible. "A modern version of James Herriot, with so many modern concerns like student loan debt, the supplement industry, crazy horse lady stuff... old Herriot would have gone: what in the world? What am I doing here?"

It's all fun and games until someone steps in the cow pie.

"We're just not the martyred figure that he was," she continues. "The man just worked around the clock, had no time off, and worked for peanuts. In this day and age, we just can't be that martyred figure anymore. We have to say: look, we have to charge more and we're worth it and here's why. I think in a firm voice, an advocate for the indebted veterinarian needs to happen."

So, maybe James Herriot did have a few crazy horse ladies to deal with (and sounds like some crazy pig owners and cattle owners and dog owners thrown in there, too) but one thing's for certain: he wasn't competing with Dr. Google. Perhaps the vets of today are to James Herriot what apples are to oranges. Yeah, we're all a little fruity, but there are now fundamental differences in the way we are cultivated and what we are exposed to.

Looking to the future is sometimes the most exciting thing to a writer, with the possibilities just multiplying on the horizon right in front of your eyes. For Courtney, oh yeah--she's got plans. A second book on her vet adventures is two-thirds written and a fiction book about anthropomorphic animals is in draft as well. Courtney has also started a monthly column in the magazine Horse Illustrated called "Vet Adventures." Of course she continues to practice as well, allowing for a continual production line of experiences to draw on for future book chapters, columns, and other venues.

Stay tuned for the next blog, Monday, March 16.