medical illustration pen & ink image from Rutherford's Atlas of a visceral rotation vascular operation procedure
medical illustration pen & ink drawing from Rutherford's Atlas of a surgical operation cross-clamping the Aorta

Emergency cross-clamp of the Aorta

medical illustration pen & ink drawing from Rutherford's Atlas of a surgical operation transecting the anterior scalenus muscle in the neck

Anterior Scalenus transection

medical illustration pen & ink drawing from Rutherford's Atlas of a surgical operation transecting the middle scalenus muscle in the neck

Middle Scalenus transection


Visceral Rotation
Rutherford's Atlas of Vascular Surgery

TEXTBOOK ILLUSTRATION
  • Client:
    W.B. Saunders / Elsevier
    Amsterdam, Netherlands
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 ...my presence in the operating room during surgery was not helpful at all...


The essence of medical illustration

Modern medical illustration is essentially concept art. It requires the ability to visualize, or draw from the mind's eye in order to depict images and concepts that can't be captured with a camera. A thorough understanding of the subject matter is required, as is the guidance and approval of experts. 

My drawing table is large, with a taboret on either side. Not always for paper or paint, but for books. When I draw, I have open reference books fanning around me, and I constantly use them to double-check the accuracy of what I am conceiving. At times it feels like I'm playing a pipe organ, accessing multiple levels of controls as I turn thought and concept into an image that is precise, clear and instructional.

ballpoint pen doctor's drawing of a surgical illustration for Rutherford's Atlas

The source material for the visceral rotation piece above, as sketched out for me by Dr. Robert Rutherford. We enjoyed coffee and donuts while discussing the procedures for his book – a much more pleasant setting than the operating room.

It begins with concepts

The image above shows the starting point – Dr. Rutherford and I met every other week in Denver to go through his surgical techniques on a legal pad. Red ink seemed strangely appropriate.

From there I consulted my references: the Rohen/Yokochi photo atlas of dissection, several illustrated anatomical atlases, radiological atlases, and a 3D anatomical atlas. It's important to use as many references as possible in order to rule out the anomalies that are common to us all as humans. Multiple references also help guard against the misconceptions that have been perpetuated in medical drawings through the ages.

Visual accuracy is secondary

We quickly found that my presence in the operating room during surgery was not helpful at all, primarily because I couldn't see much and the photos we took were of little help. It may come as a surprise to some, but modern medical illustration isn't all about visual accuracy – it's about effectively communicating concepts. Toward that goal, visual accuracy is often purposefully compromised in favor of conceptual accuracy.

Each drawing was critiqued and refined by Dr. Rutherford. Sometimes endlessly. One afternoon he lifted up a sketch and proudly proclaimed that he intended to frame it – the entire page was covered with questions, comments and corrections. It was a thing of beauty – the amount of thought and discourse contained on that page was stunning. A true testament to the gathering and sharing of knowledge.

medical illustration pen & ink drawing from Rutherford's Atlas of Dr. Robert Rutherford

All great men seem to have a good sense of humor. Dr Rutherford agreed to the use of his likeness for this orientation drawing. He felt it would give his associates around the world a chuckle.

A great man

I have been blessed to work with a number of prominent doctors, and find that nearly all are incredible human beings. Several stand out, and you'll find their names on this site. Dr. Rutherford was such a man... a football linesman at Harvard, an expert skier at Vail, and a man whose impact on the medical world is still felt.

He also had a great sense of humor; I proposed that we use his likeness in the orientation drawing for the approach to the carotid artery. He thought for a minute and then said it would be a great prank for his colleagues around the world. The image above is the result. I'm so glad I had the chance to secretly include his likeness in this work of passion.

Exceptional Talent

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