Last week our Graphic Sex event offered a taste of sexuality, desire and disease in comics and graphic novels: from the ripped shirts of Doc Savage to Adam Hughes’ ‘Wonder Woman’ to gay marriage in ‘Astonishing X-Men’. The speaker, Stephen Lowther, tells us about some ways in which sex and sexuality have been represented in comics.
The humble comic book has evolved since its early days as a cheap, throwaway entertainment medium aimed squarely at children, whose images helped them to learn to read. Just as books, films and television cater to a wide audience and age ranges, so do 21st century comic books and graphic novels, as diverse today as they have ever been.
By now it was 1pm and a good time to head back to the Grant Museum. On entering, you are welcomed by some friendly-looking skeletons looming over the second floor balcony. Inside, it very much feels like a teaching collection with chairs and tables in the centre and an area where UCL students and staff can opt to curate small displays on art and science, in line with the Wellcome Collection ethos. Attempts to engage with the public are also evident and done well, like the QRator project (complete with iPads for visitors to use) and the opportunity to ‘adopt’ your very own animal or specimen. I won’t reveal the chosen object for the Grant Museum, but let’s just say it is so odd that it apparently made Darwin question the existence of God!
Outside again, passing several blue plaques, I made my way to the next stop. This museum was a far cry from the publicly accessible atmospheres of the first five; I had trouble finding the entrance and on entering needed a visitor pass from the security guards. Nonetheless, I was pleasantly surprised that you can visit this very grand building, the Freemason Museum, at any time. The curator (and podcast narrator) here, Mark Dennis, is not a Freemason, which may surprise those who think of this organisation as a secretive sect. He chooses to discuss an 18th century ‘Freemason lodge in a bottle’. At first glance, it looks like an earnest portrayal of a Freemason lodge in action, but the curator speculates that the maker was probably mocking the lodge master by depicting him as very short and with wildly red bushy hair, helpfully highlighting the human side of the Freemasons, which I would not have thought about otherwise. However, I still couldn’t refrain from worrying that people would be suspicious of my note-taking!
Back out on the street, I headed to the London Transport Museum. With all the free museums in London, the £13.50 entrance charge was a bit surprising, but the museum could certainly provide a whole day’s entertainment; I spent my fleeting visit frustrated that I didn’t have longer to clamber on the buses or drive a tube train. The colourful entrance is excellently designed too, and full of examples of underground systems from all over the world that make you question to what extent maps are based on geography and how much their design is cultural or arbitrary. However, as Oliver Green points out on the podcast, London is the only city defined by its transport. Nowhere else has such iconic transport symbols as the underground sign, black cabs, red buses or the user friendly but geographically inaccurate tube map. The cafe and shop are also lovely places to visit if you want a snapshot of what’s in the museum without having to pay! I’ll definitely be back.
Institution number 8 was a far cry from the interactive London Transport museum and very much an art collection – the Courtauld gallery. As Tim Marlow says, you would be forgiven for thinking this is a world famous tourist destination with all its Botticellis, Van Goghs, Renoirs and Gauguins. But the Courtauld is better known as a teaching collection. Indeed, Marlow comically describes his own experience of classes there – he was shown some slides by a lecturer which caught fire and immediately turned into an example of abstract expressionism! The highlighted piece on the podcast is suitably famous, but I was helped to see it in a new light. The celebrity nature of the pieces on display does have the adverse effect of making you feel like a heathen for just running in to look at one painting while ignoring the rest of this important collection! The good news is, it’s free on Monday mornings, so I can come back for a less sacrilegious visit soon.
I was getting to grips with navigating by now and the Hunterian Museum in the Royal College of Surgeons felt easier to find than I had anticipated; it’s such a pleasure getting to know London’s streets. We often suggest the Hunterian for Wellcome Collection visitors expecting a more traditional medical museum with pickled body parts in jars, but I had never actually visited myself. As expected, there were lots of things in jars – at random I spotted the ovaries, kidney and impregnated oviducts of a viper – and the content is accordingly quite old fashioned, but the design and layout of the collection is impressively modern. It also felt great to be in a working institution that serves a purpose way beyond housing a museum and therefore had a ‘behind the scenes’ feeling, just like the Freemason building.
My next famous narrator was Stephen Fry who introduces one of his favourite places, the Sir John Soane’s museum. The home of Sir John Soane is the ultimate time capsule and has a fantastically eccentric collection of curios, including an Ancient Egyptian coffin that John Soane outbid the British Museum for, from an eccentric circus strongman-cum-archaeologist called Giovanni Belzoni. Be warned, this beautiful house is very atmospheric and potentially quite spooky, though this didn’t seem to have daunted the animated house stewards or the students sketching in the many dark shadows of the burial crypt.
Sadly, having only just squeezed through the last entry at the Sir John Soane’s museum at 4.30pm, I found I was too late to reach my final destinations of the Charles Dickens Museum and the Foundling Museum. I was surprisingly upset at being unable to complete the Museum Mile quest. Forlornly listening to the audio segments for the Dickens and Foundling museums, without actually visiting them, just wasn’t the same.
Aside from this absurd consequence of feeling like I’d ‘failed’ in some way, I thought the day had been a success. I would argue ten museums in a day is still an achievement, as well as being a fun way to make a proper adventure out of museum going – I had battled against the February cold, sprained my hand through frantic note taking and lost one pair of earmuffs along the way. On reflection, the Museum Mile podcast, while perhaps not complementary to a social outing, is perfect for a solo day trip. I had enjoyed a lovely walk in the fresh air, been introduced to unfamiliar objects in familiar museums and finally made those trips to the smaller museums, like the Grant Museum, that I had always been meaning to visit. Also, I have subsequently overcome my personal aversion to audio guides and very much look forward to using them more in future, starting with the Wellcome Collection ones in our Medicine Man gallery.
Natalie Coe is a Visitor Services Assistant at Wellcome Collection.
Last year, Wellcome Collection’s Natalie Coe attempted to visit all twelve museums on the Museum Mile in a single day, but was distracted by student occupiers, good quality espresso and too much culture in general. With greater resolve this year, she set off again…
After my first measly attempt at a two hour version of Museum Mile last year, I recently hit the museum road again on a cold February morning to try it out properly, this time using the Museum Mile’s own downloadable audio guide podcast where various notable narrators shed some light on particular objects in each of the 12 museums featured. Coincidentally, our own new audio guide was launched at Wellcome Collection recently, so it was a good time to be exploring museums via an audio guide.
The podcast introduced Museum Mile as a way to discover the lesser known gems not found in your average guidebook. While I’m not entirely convinced that any of these museums have escaped all guidebooks, it did stay true to its claim to feature big, small, quirky and mainstream museums and inspire me to re-look at museums I thought I’d already ‘done’. The podcast also helpfully guides you on a logical route from one museum to the next, unlike the scheme’s leaflet. I recommend downloading each museum track individually if you’re using a device without a forward or rewind function (unless you want to hear ‘Welcome to Museum Mile’ one too many times)!
The first stop was the ‘Cathedral of Knowledge’, the British Library, with my first guide, David Starkey. I love the ‘cathedral’ description: there is currently much discussion over whether museums are the new temples where people come to worship art and objects. After marvelling at the central old Royal library, Mr Starkey introduced me to the 13th century Magna Carta. Could there be a more famous object to begin with? I admittedly had no idea it was there and had never been in the John Ritblatt ‘treasures’ gallery that holds it, so it was wonderful to be directed to an object that Starkey described as no less than the ‘beginning of liberty and freedom’. And the British Library display was great at demonstrating how monumental it was in reining in the power of the King. It also conveyed the more mundane nuggets of interest, like how words were abbreviated to save on expensive parchment. It is interesting to think about how it was re-interpreted, too; from applying only to ‘free men’ to being used to call for the right to a free trial for all men. Amazingly, it’s still cited in courtrooms today and a copy sits proudly alongside the Bill of Rights in Washington.
So already I’d discovered something new in a place I’d visited before. On to the next destination and the discovery that the podcast punctuates your walk between institutions with little facts about the area. Did you know that the Euston Road was the first urban bypass in Europe?
The second museum was somewhere you would think I’d already seen from every angle, the Wellcome Collection. But the podcast proved me wrong. I was delighted to hear my place of work described as an elegant respite; perhaps the contrast of Euston Road actually enhances the visitor experience. Francis Wells, a heart scientist and artist, described an illuminated manuscript in the Wellcome Library which I hadn’t come across before despite the fact that it sat by Queen Elizabeth I’s bed. Objects with such celebrity associations always raise the question: does their value come from aesthetics or their provenance? I would vouch for celebrity provenance if the success of our Wellcome’s Hall of Fame tour is anything to go by!
So far so good. But the next museum proved more problematic: the Grant Museum is only open 1-5pm and it was still the morning. (I thought this implied Museum Mile was not meant to take all day but this later proved to be wishful thinking!) So I skipped onto the Brunei Gallery at SOAS instead. Last time I was here, I was stopped in my quest by a picket line of protestors, so I was pleased that I could actually go in. On the way there, Aly Mir, indmidtown’s walks guide, informed us that the area’s famous Bloomsbury group was known for living in squares but loving in triangles – a reference to their complicated sexual relationships! The SOAS collections are accurately described as ‘extensive, diverse, and surprising’. Nonetheless, it was satisfying to just be looking for one specific object, an approach I’ve not really taken before. In this case, a missionary portrait of David Livingstone that John Hollingworth, from the Brunei Gallery, explained was routine for missionaries who weren’t necessarily expected to make it home. He also shed some light on the origins of the phrase ‘Dr Livingstone, I presume’, but I’d better not give the whole of the podcast away…
Back outside I battled through the cold to my next stop, the biggest and most ‘mainstream’ institution on my route, the British Museum.
I was, as always, in awe of the magnificent Grand Court at the heart of this epic building, even more so with the acquired knowledge from the podcast that it is the largest covered square in Europe. Having recently taken a ‘highlights’ approach to the British Museum with relatives visiting from abroad, I was hesitant to go again to see perhaps the most famous object there, the Rosetta Stone. Also, as Grayson Perry referenced in his exhibition ‘The Tomb of the Unknown Craftsman’, Ancient Egyptian collections are almost too famous – it is the first thing that children learn to associate with the museums and he sometimes ‘dread[s] seeing the crumbling stage sets of popular imagination’. But my resistance proved unwarranted as I was delighted to actually be able to see the Rosetta Stone this time, away from the weekend crowds. Plus, for the first time, I really understood how important it was in unlocking Ancient Egyptian culture. I found having someone ‘bringing alive’ the object for me on the podcast conveyed a far more memorable message than reading the label on the wall.
We must leave Natalie here for now. Will she succeed in her ambition of visiting all twelve museums in one day? All will be revealed in Part 2…
Natalie Coe is a Visitor Services Assistant at Wellcome Collection.
How does a fish see where there’s no light? To find out, you have to join them in the gloomy nether reaches of the ocean. At a recent Packed Lunch, Professor Ron Douglas described his life as a visual science researcher, and Lydia Harriss was there to hear tales of the deep sea…
Out of the watery gloom, there comes a small, dark shape. It looks rather like a small fish. A tasty snack, perhaps? It’s definitely worth a closer look… Before you know it, something clamps on to you with sucker-like lips, digs in with razor sharp teeth, and twists to cut out a circular plug of flesh!
It sounds like the stuff of nightmares, but it’s not. It’s the cookie-cutter shark, and, as I discovered at a recent Wellcome Collection event, it’s real.
Speaking to Wellcome Trust’s Dr Daniel Glaser at a Packed Lunch session entitled ‘The Deep’, Professor Ron Douglas opened a window onto the secretive world of deep sea biology. He is Professor of Visual Science at City University and an expert on the visual systems of deep sea creatures.
The ‘deep sea’ describes the region from 200 metres below the surface down to the seabed, which can be 11 000 metres deep in some places. This means that his lab is the ocean and he does many of his experiments on board boats in warm and exotic locations. Costa Rica, Nicaragua, Samoa, New Zealand, Hawaii… his gleeful list of research destinations had me contemplating a dramatic change in career direction.
Although the locations sound idyllic, the research itself can be pretty tough. Catching the deep sea creatures that Professor Douglas studies is a “lucky dip” exercise. Despite dragging nets the size of a football goal behind the boat for up to ten hours at a time, a catch will often barely cover the bottom of a domestic-sized bucket.
As boats cost £25 000 per day to hire and run, scientists work as close to non-stop as they can manage, on trips that last for four to six weeks. In vision research, it’s important to minimise the amount of light that the animals come into contact with, so they usually fish at night and try to persuade the captain to switch off the deck-lights (captains are normally reluctant to oblige, as “people tend to fall off the back”). Weather conditions can also be very rough, so good sea legs are a must. And then there are the other scientists…
To spread the research costs, a single boat may carry 20 scientists from, say, 10 different labs. Living and working at such close quarters with collaborators, and perhaps potential rivals, is bound to be difficult at times. Although cruises are carefully planned to avoid having multiple scientists with the same research focus, there’s likely to be competition over who gets first dibs on what’s in the bucket.
This is where Professor Douglas has the advantage, as his experiments require the animals to be kept in the dark. Thus, the first port of call for the bucket and its contents is his dark room. “I get to see what’s there first, and then I hand the bucket out into the light and I say ‘no, there’s nothing of interest in there’”, he jokes. His particular expertise is finding out what colours animals can see, by extracting and analysing the chemicals found within their eyes.
There’s an intriguing and rather enchanting alternative to fishing for “a few mangled creatures in the bottom of a bucket” (Professor Douglas’ choice of words). Namely, going down to observe these animals in their natural environment.
The conversation between Professor Douglas and Dr Glaser carried us into a submersible and down through clear blue Caribbean water. The deeper we went, the darker and bluer it became, as though we were descending through a cathedral of blue light. This is because water more readily absorbs light of longer wavelengths, such as red and yellow, than light of shorter wavelengths, such as blue. The blue component of sunlight therefore penetrates further into the ocean than other colours of light and is the last to fade out.
By 700 metres, we were beyond the reach of sunlight, but it was not completely dark. Many of the creatures living in the deep sea make their own light through a chemical process called bioluminescence. This light is almost always blue, probably because it can travel further through water than light of longer wavelengths. The chemical reactions that produce it are similar to those found in fireflies or glow sticks (the sort that you activate by bending, which breaks an internal glass separator and allows different chemicals to mix and react).
Bioluminescence occurs in tiny pits known as ‘light organs’, which may be covered with filters that are used to expose or hide the light. Often located under an animal’s eyes or on their forehead, light organs can help to illuminate the way ahead. They are also distributed across the bodies of some fish, in characteristic patterns that may help the fish to identify each other.
In the case of the cookie-cutter shark, which can migrate between the surface and depths of as much as 3700 metres on a daily basis, light organs act as camouflage. They produce a glow that helps the cookie-cutter to blend in with sunlight from the surface, rather than appearing as an ominous silhouette likely to scare away its prey. Light organs are absent from a dark patch around the shark’s neck, which is shaped roughly like a small fish. It’s thought that this may lure the shark’s prey, who are themselves hunting for food. Many fish, whales and dolphins have been found with circular ‘crater wounds’ characteristic of cookie-cutter bites. Although these sharks have been known to attack humans, they are not usually considered a serious threat.
The majority of the deep sea creatures that we know about only see blue light, enabling them to detect most bioluminescence and any residual sunlight from the surface. Single-colour vision is also more sensitive than multicolour vision, which is a real advantage where light levels are so low.
In this mostly monochrome world, there is at least one animal exploiting the evolutionary niche of multicolour vision. Dragon fish, named for their monstrous teeth, are able to bioluminesce and see both red and blue light. A large light organ beneath their eyes produces red light, effectively giving these fish their own private wavelength. The potential advantages are huge. Imagine being able to flash your lights as a signal to potential mates without drawing unwelcome attention from your predators, or hunting with a bright searchlight that you can see but your prey cannot.
Unlike dragon fish, the humans investigating the deep sea are far less stealthy. Professor Douglas likens going into the deep sea with a submersible to going into the savannah with a Land Rover to see lions. At night. With the headlights on, the stereo blasting, and a blue flashing light on the roof. “All you really see are the deaf, the blind, the stupid and the old. In other words: the things that can’t get out the way.” Despite this, researchers reckon that roughly one in three dives find an entirely new animal that no one has ever seen before. “Deep sea biology is one of the few fields where you really can just be an explorer.”
At present, submersibles can go down as far as about 4000 metres. As we develop technology that will take us further into the depths of the ocean, allow us to stay down there for longer and enable us to switch off the metaphorical stereo, we are likely to discover more incredible creatures. Creatures that are already lurking out there in the deep, just waiting to be discovered…
Lydia Harriss is a graduate trainee at the Wellcome Trust.
Greenwood Space Travel Supply Co. by WordRidden, on Flickr
Space travel might sound glamorous, but it’s not all playing golf on the moon. For a start, in zero gravity your bone and muscle start to rot. February’s Packed Lunch featured a scientist whose speciality is keeping spacemen healthy. Benjamin Thompson found out more…
Fong discussed a variety of topics, including why being in space is bad for our health, whether astronauts really do have ‘The Right Stuff’ and why humanity needs to continue exploring the heavens.
The lunch began with Dr Fong describing an experiment he participated in at the Johnson Space Centre, Houston. It involved being strapped to a plank and spun at 45 rpm for an hour, watching a Harry Potter film. The point of this? To experience an artificial gravity. Being spun like this forces the blood to your feet, making you feel bent over for the time you’re spinning. The reason for Harry Potter? That was the only DVD available.
While this might seem a bit daft, it’s all preparatory work for sending people to Mars. It turns out that over long periods of time, weightlessness is very bad for our bodies. As humans we are entirely designed to live under the Earth’s gravitation pull of one g (what are the chances?), so as soon as we encounter zero gravity, Fong explained, we basically we begin to rot. This might sound extreme, but it makes sense. When weightless our skeleton and muscles no longer need to support our weight so they begin to degrade. Add to this an inability to sleep or eat healthily (no refrigerators in space) and the astronaut has a multitude of problems to deal with both in space and when re-acclimatising after returning home.
Health maintenance of astronauts is very important and this is the role of a space doctor, or flight surgeon. Space is not an easy place to practice medicine, with many of the procedures we take for granted on terra firma not working under zero g. There’s not much spare room in a rocket to take medical supplies with you on a mission, and everything has to be thoroughly tested in weightless conditions on Earth using the delightfully titled ‘vomit comet’, an aeroplane that through clever flying can provide short periods of zero g.
Thus far, doctors haven’t been specifically sent on space missions. Fong explained that given the relatively short distance between here and the International Space Station, if you are taken ill, you can be home in a few hours and cared for by the cream of the US Army Medical Services. Currently the biggest danger from spaceflight is the travelling. Either everyone returns safe, or no one does…
This will all change, though, if/when humans are sent to Mars. If you’re a year and a half away from home, becoming seriously ill is bad news. Fong explained that risk analysis from activities carried out in extreme environments, such as Antarctica, or in submarines, suggests that it is more likely than not that something will go wrong. This suggests it’s best to send a doctor on the mission. But what if the doctor gets sick? Do you send one or two? The debate is raging, and is likely to for a while.
Fong was asked if, in today’s testing economic climate, he thought that space exploration could still be justified. He wondered whether space travel be viewed in future times in the same way as we do the pyramids now, a one-off project achieved at massive cost, both human and economic? Or will commercial bodies step in, reducing the cost and boosting the speed of knowledge creation?
He explained that although expensive and dangerous, manned space travel can teach us things that robotic missions simply can’t. For example, we only know how old the rocky planets in the solar system are by studying and ageing moon rocks brought back from the Apollo missions and counting the numbers of craters seen on the other planets to extrapolate their ages. In total, all the robotic missions have brought back a sum total of 37 grams of rock, whilst manned missions have brought back around 500 kilos. If we truly want to look for evidence of life – extinct or otherwise – beyond our own planet, we’re going to have to send people.
Benjamin Thompson is a writer at the Wellcome Trust.
When Simon had his brain switched off by SBishop, on Flickr
Packed Lunch returns soon with more tales of research from local scientists. To get you in the mood, we’re catching up with some of last year’s, via the Packed Lunch podcast. In November, Benjamin Thompson went along to hear about a scientist whose work involves using a giant magnet to stop you thinking…
The theme of November’s first Packed Lunch at the Wellcome Collection was the neurological basis of language recognition. Dr Joe Devlin from the UCL Division of Psychology and Language Sciences came by to talk about a technique he uses to investigate the inner workings of the brain.
Joe’s research involves using strong magnetic fields to stimulate different areas of the brain known as Transcranial Magnetic Stimulation (TMS). The machine used to provide the magnetic field looked fairly innocuous, two doughnut shaped rings of wound copper covered with insulating tape. But as Joe described what it was capable of initially, it seemed rather terrifying…
In order to create the magnetic field a huge current needs to be passed through the coil. This current is lethal, so it is imperative that the insulating tape is checked frequently! The magnetic field that is created is as strong as those used in junkyards to pick up cars, but it only lasts a fraction of a second and extends for a few centimetres.
So what can this strong magnetic field achieve? By placing the TMS machine next to a volunteer’s head Joe is able to externally stimulate a very precise area of the brain. The magnetic pulse causes brain cells to fire, interrupting the task they would normally be doing and introducing ‘noise’ to that particular brain area. This noise only lasts for a fraction of a second before returning to normal, but this time period allows for some interesting experiments.
The experiment that Joe described showed how the understanding of spoken words and the ability to read are linked. The experiment involved playing a volunteer a list of words, some of which were real and some which were false, but sounded real. The volunteer had to press one button when they heard a real word and another when they heard a false word. This allowed Joe to measure how quickly and accurately the volunteer responded to the words.
Typically the volunteers were highly accurate and had a response time of around one second. This included half a second needed to hear the word and about half a second to respond to it. When subjected to TMS, the response time of the volunteer increased by about a third of a second, but only for certain words.
Amazingly, it was simple words with a regular spelling that the volunteers were slower to recognise during TMS. This seems totally counterintuitive so I asked Joe if he could explain it to me a bit more. He told me that adding brain noise using the TMS machine makes normally easy to understand words not so easy to understand.
He likened the recognition of a word to being on a hill. The word is found at the foot of the hill and you have to descend the slope in order to recognise it. With difficult words, that are spelt differently to how they sound, you’d begin at the top of the hill, with a long distance to travel, but with easy words you begin much lower down the hill so the time needed for recognition is much lower.
During TMS, you get pushed back up the hill when recognising simple words which results in the increase in time seen in the button pressing experiments.
It turns out that learning to read changes the way we recognise speech. We get better at recognising speech when the word and its spelling correspond closely. This increase in speed is not down to visualising the words, as using TMS to disrupt the visual recognition centres has no effect on the speed of word recognition, it’s all down to the way in which you hear the words themselves.
Joe’s talk really clicked with the audience, who raised many questions about a variety of topics, such as adult illiteracy, Alzheimer’s disease and synaesthesia – associating colours with sounds. People were also intrigued by the potential of using TMS for therapeutic purposes. The one question that everyone was thinking, but only one asked was “Are you looking for volunteers?”
Benjamin Thompson is a writer at the Wellcome Trust.
I have a guilty pleasure: British medical TV series. I love the melodrama of ‘Casualty’, and ‘Holby City’s’ intense-but-predictable storylines. So imagine my delight when Isabel Jones, consultant burns and plastic surgeon at Chelsea and Westminster Hospital, was announced as the next Packed Lunch interviewee. A chance to experience a real-life account of the drama of medicine, I hoped.
I wasn’t disappointed. Isabel arrived at the Wellcome Collection straight from an operation that had started at 8.30 in the morning. Her day had begun at half past midnight, when she received a call to say a young woman had been brought in to the hospital with severe burns to her chest – caused by a fire she had accidentally set in her house after a drunken night out.
There was a tingling sense of shock in the audience, yet Isabel spoke matter-of-fact. She explained that Chelsea and Westminster Burns Unit is a specialist referral centre for Greater London and the South-east, meaning anyone within the M25 with significant burns comes to them for treatment. Dealing with this kind of injury is a regular part of her job.
Any burn over 15 per cent of the body’s surface is life-threatening. Isabel’s patient had 25 per cent. When skin cells are damaged and die, the body’s barrier to the outside world is breached. Risk of infection increases, fluid is lost. The body undergoes a massive inflammatory response that can be fatal. The first 24 hours are crucial to the long-term outcome of the patient. At this stage, Isabel’s job is to remove the dead skin tissue causing this response. Previously, burns were left until a scar began to demarcate, nowadays, early excisions of burns is one of the most important modern progressions in the treatments of burns and is ‘critical for survival’.
Isabel prefers to plan a surgical procedure in advance, hence the midnight call. At 04.30 she went back to bed, waking again in time for the start of the procedure. She set the scene of the operation: three consultant surgeons, scrub nurses, intensivists. Sometimes, music is played in theatre. Not today though, as a lot of communication between the team is required during a procedure on a patient with injuries that could cause them to die.
Isabel is one of many in a team dedicated to the patients on the 20-bed burns unit. There are microbiologists, focused on the threat of infection; physiotherapists who get the patients back on their feet; psychotherapists to help them through the psychological consequences of their injuries. Isabel had spoken to the woman she was operating on this morning. She told us this woman knew her actions caused the injuries that will stay with her for the rest of her life. If she lives. When Isabel told us that the psychotherapists are available to staff too, you could see, and hear from her voice, that however much steely resolve and professional detachment she has, she is strongly affected when a patient she has cared for loses their battle for life.
When a critical patient comes in to the unit, the first priority is the quick and safe healing of their burn. Cosmetic outcome is kept in mind, but can be improved later with grafts and reconstruction. Another concern is the cause of the burn – why did this patient faint into the bonfire they built? Is this child’s scald the result of carelessness in the kitchen, or something more sinister? The burns unit works closely with social services. In the case of Isabel’s patient today, the large amount of alcohol she had drunk caused the careless lighting of a match and too slow a response to the resulting flames that burned her body.
It is likely that Isabel’s patient will need skin grafts to replace her damaged tissue. Grafts cannot come from another person, as this skin is antigenic: the body will recognize it as foreign and reject it. When performing a skin graft, Isabel will take a layer of skin from the thigh, buttock or scalp where there is minimal visibility of scarring. This is then carefully stitched onto the ‘wound bed’, using the wound as a template. A murmured laughter went through the audience when Isabel revealed her mother was a seamstress.
Artificial skins and skin substitutes are being developed, but the technology has not been perfected. The problem is creating something that is non-antigenic and can work universally for all skin types. Biotechnology is used, however, in the form of dermal replacements that enable a thinner graft to be used on the wound. This means less skin needs to be taken from the healthy site, and there is less scarring. I can only imagine the scars that Isabel’s patient will have when her trauma is over.
Reconstruction takes place long after a patient has received initial treatment. This is done to improve the cosmetic appearance of burns, and functionality. Sometimes contractures of the skin will form around joints, where the healed skin becomes very tight and restricts movement. Isabel will release these contractures, and perhaps move scar tissue around from one site to another, where there is more movement. The relationship between a patient and a surgeon can be lifelong.
At the end of the interview, Isabel was asked if she felt frustration about the cosmetic outcome of some burns. Her answer was yes, but the satisfaction of taking a seriously ill patient back to full health outweighs that. “The human level of positive feedback from patients is very rewarding,” she said. And as Isabel left the room, I could only hope that the young woman she was returning to operate on would live to thank her fantastic surgeon.
Louise Crane is a Project Officer at the Wellcome Trust.