Collecting Oneself

Laura Ferguson's beautiful but disturbing exposition of her deformed anatomy evokes emotional reactions that are conditioned by the life experience of the viewer. What follows are the reactions of a pathologist who has spent much of his career dissecting the bodies of more than 6,000 individuals, most of whom were infants and children. A life immersed in the tragedy of premature death has been a scarifying experience, but like disease itself, it has also revealed unexpected oases of light and beauty.The lesions responsible for disease and deformity, when viewed in isolation, can sometimes appear beautiful to the trained eye. It is not uncommon for physicians to exclaim about a "beautiful specimen," just as a climatologist might become excited by the "beauty" of a spectacular tornado, disconnecting for the moment from any havoc and personal tragedy it may be causing. On countless occasions I have waxed enthusiastic over a microscopic slide of an interesting or aesthetically pleasing arrangement of cells within a tumor, despite knowing the patient and being all too aware of the emotional and physical agony wrought by those same cells. It is a refreshing experience to see how one image can convey the "beauty" of disease in isolation, without allowing us to forget the awfulness of that disease in situ.

William Osler, one of the greatest physicians of any age, said that "the good physician treats the disease, but the great physician treats the patient."This statement could also be applied to medical art, which usually focuses upon the lesion rather than the patient. Images of disease in textbooks, journals, and lectures are a major tool for the education of all physicians, and these tend to be as devoid of humanity as a distant photograph of the mushroom cloud over Hiroshima. Some images are created to demonstrate the effects of a lesion or disease upon the body, but in these the cause is often not visible. Over the centuries, the link between anatomy and art has been a close and essential symbiosis, enhancing both art and medicine. But few artists have succeeded as well as Laura Ferguson in depicting in a single image both the anatomy of the lesion and its impact upon the patient. Her marvelous figures bring life and emotion into the traditionally cold science of clinical anatomy.

In many of her images, Ferguson's skeleton is exposed through a window of skin and superficial tissues made transparent. Transparent Laura is revealed as a composite of sensitive, sensuous softness conflicted and molded by hard, implacably deforming bone. This technique communicates, more effectively than anything I have seen before, the contrast between the hardness of bone and the delicacy of the overlying tissues. It is this contrast in texture, the friction between harder and softer structures, that is the ultimate cause of much of the pain experienced by patients, particularly those with orthopedic problems.

The pathologist in me has other reactions. That horrendous angulation of her lumbar spine, labeled Lumbar Vertebrae, Anterior View (Figure 3), evokes a particularly strong response. Those crushed and displaced vertebrae, resembling derailed subway cars or a multiple-car collision, are not depicted using the "transparent woman" technique to communicate pain. Instead, the delicate tracery of red and purple applied to the uppermost three vertebrae reminds us that these are living, sensitive, painful structures we are observing, not the cold white bones of an articulated skeleton or spinal radiograph. That same image also manages to communicate, at least to my eye, a sense of progression over time.The slow, inexorable, and asymmetrical collapse of the second and third lumbar vertebrae reminds me of the folding and deformation of geological strata that one often sees on canyon walls. Hopefully, her physicians will be able to arrest or reverse that process before the collapse causes catastrophic damage to the spinal cord and adjacent nerves.

Having spent much...