Monday, August 6, 2012

Graphic Medicine: Disrepute and DNR

The Welsh physician who uses the nom de plume of Thom Ferrier created the term "graphic medicine" to refer to comics about the practice of and participation in the field of medicine. The equivalent of a general practitioner in the US, his comics detail the daily life of a family doctor who has to see every kind of ailment imaginable, as well as his own mental state in performing these sorts of duties. The cartoonist "Mister V" is a former medical transporter (ie, a gurney and wheelchair pusher) at a hospital in Denver who's at the lowest end of the totem pole in patient care, yet his keen eye allowed him to document what it was like to live in a perpetual state of crisis in a health care setting. Both artists emphasize the raw, naked truth of stress on the job, dealing with difficult and flat-out insane patients, and living with life and death. Both artists create a narrative of sorts through a series of short vignettes. Neither artist is a remarkable draftsman, yet they both get their point across.  Let's take a closer look at Ferrier's book Disrepute first.

One of the most striking images in Disrepute is a photo of Ferrier with the phrase "I am a shit doctor" scrawled on top of it. It gets at the heart of Ferrier's overall project: humanizing the medical profession and getting the kind of mental illness that can haunt healthcare providers out in the open. Ferrier goes on to discuss his being a "sensitive" child who fainted at the sight of blood and how he overcame it as a surgeon. A recurring feature throughout the book are profiles of his "regular attenders": the patients who see him the most. He admits, for example, that he holds antipathy toward one patient because he reminds him of a man who stole one of his girlfriends, while at the same time admitting that patients who are extra nice to him certainly doesn't hurt in how he interacts with them. Another strip finds Ferrier about to give an apparently drug-seeking patient what for when he finds him on his schedule, when the patient just came by to give him a bottle of liquor as a thank-you for helping him feel better. Ferrier is candid and every bit as hard on himself as he is on others.

Ferrier also spends a lot of time talking about mental health. In a fictional story, his stand-in was obviously shattered to hear that one of his patients had committed suicide after the doctor disclosed his own battles with depression and finding life meaningless.  Ferrier was also saddened in real life when another patient never returned after Ferrier declined to talk about his own experiences with depression. A GP having to deal with mental illness on a regular basis must be astonishingly difficult, especially when there's often so little that they can do about it. In terms of the art, Ferrier is at his best when he's cartoony and lets his pages breathe a bit. His more realistic strips feel cluttered and choppy as he frantically tries to cram as many panels and as much information on the page as possible. On the other hand, his looser, scribbly and airier pieces have a much better flow as comics without losing any of their impact. Ferrier's work is important because so little has been written in comics from a provider's perspective, years after a wave of illness-specific comics done from the point of view of the patient. Ferrier is still getting his legs under him as a cartoonist, but both his draftsmanship and his storytelling chops have evolved as he's continued to write his stories.

From the opposite end of the medical world's pecking order comes "Mister V" and DNR. This is a funny, profane, gross and cynical look at the experience of being a patient transporter in a busy hospital. The job is pretty much exactly what it sounds like: taking patients via gurney or wheelchair from their hospital room or spot in the ER to someplace else (usually for a radiological study like a CT scan). Of course, this doesn't account for mentally unstable patients, patients who are too big to push easily or lift, puking patients, patients soiling themselves (sometimes intentionally), weird patients hitting on him, etc. Though the book is broken up into vignettes and jumps back and forth in time a bit, Mister V creates a narrative centered around the unrequited crush he has on a CT tech named Kim. Being around her is about the only thing he likes about his job and is one of the reasons he elects to keep it, even as it starts to interfere with college.

The potential romantic narrative is probably the least interesting thing about the book, even if it gives all of this craziness structure. That said, the bitterly unhappy ending to that story was interesting and certainly informed the tone of the rest of the book. Where Mister V does his best work is when he does an incendiary profile on one of his co-workers. The story of one CT tech he calls the "Enemaster" for her proclivity for giving unnecessary barium enemas was funny enough, but pairing her with her arch-enemy, an abusive nurse, was even funnier when the nurse was forced to get an emergency CT. Mister V's stories about his own nemesis, a fellow transporter named Rodney, were also some of the funniest stuff in the book, in part because Rodney's laziness always got the best of "Matt's" (his stand-in's name) conscientiousness. Mister V's art is all manic scrawl, with every character possessing huge, cartoony eyes. It's a perfect match for the subject matter even if it is a little wearying to look at for nearly 300 pages. What's interesting is that despite the cynicism of the author, it's clear that moments when his actions might have saved a patient's life or possibly contributed to the death of a patient clearly shook him up. It's the adrenaline rush of a life-or-death situation without the training or hands-on approach with which the adrenaline can dissipate; instead, there was just the body-shaking experience of being so close to a tough situation. The same thing went for patients in the hospital whom he struck up friendships with who either died or managed to bounce back. Mister V was in a very interesting experience because many patients strike up such friendships because transporters are the most approachable of all health care professionals, providing a service that goes far beyond their job description. I'll be curious to see the next two volumes of this series, as Mister V movies into other jobs at the hospital.

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