About anaesthetists and artists

I always thought that many of us were artists. In this context, I do not think so much about writers, musicians, dancers or actors but about visual arts: painters, sculptors or photographers. I am not quite sure where this belief has come from, as I do not consider myself to be an artist. However, I felt justified in my perhaps naïve belief when I read in an anonymous essay: ‘Some of my colleagues are real polymaths. There are painters, musicians, novelists …’.1 It was obvious that other anaesthetists felt as I do. However, where is the evidence that some anaesthetists are also artists? Could we even believe, or hope, that anaesthetists who are also artists are better anaesthetists? A search in the literature is definitely disappointing. In January 2018, the search terms Art[Title] AND Anaesthesia[Title] in PubMed revealed only 34 hits. Nevertheless, going through these titles proved to be informative. First, some early titles, mainly text books or review articles, suggested that anaesthesia was an art.2–5 One monograph about the ‘art of anaesthesia’ was published as long as 90 years ago.6 To use art as a description of our profession is actually strange and it may be challenged. The Oxford Dictionaries describe ‘Art’ as The expression or application of human creative skill and imagination, typically in a visual form such as painting or sculpture, producing works to be appreciated primarily for their beauty or emotional power.7 It is actually difficult to find the practice of anaesthesia (or actually any kind of medical activity) covered by this definition. Undoubtedly, the practice of anaesthesia requires skills, mainly technical but also nontechnical skills. However, are creative skills needed? As to imagination, it may be argued that this very specific part of art may actually be unwarranted in daily anaesthesia practice. Imagination means creativity, vision, inspiration, dreams. Sometimes, some degree of imagination may be required, for instance, during a life-saving emergency operation. However, one may wonder whether imagination has its place in preoperative patient consultation and preparation, in the use of intra-operative monitoring and the administration of anaesthesia techniques, or in postoperative surveillance in high-dependency units including the utilisation of sophisticated multimodal analgesic techniques. This is as if we would expect the pilot of our flight to use his imagination to bring us from A to B. As to beauty and emotion, some may indeed perceive the practice of anaesthesia as beautiful and sometimes even emotional, for instance, when the anaesthetist manages a perfect spinal block in a parturient during a complicated delivery and eventually assists at the birth of a healthy child. The comparison between art and anaesthesia may be understood as a historical attempt of our precursors (who were often surgeons) to draw attention to the fact that anaesthesia also, similarly to surgery, was an art. Significantly, contemporaneous titles still continue suggesting that the art and the science of anaesthesia are inseparable.8,9 Clearly, insisting that the practice of anaesthesia is an art does not mean that it actually is one, and, more importantly, it does not automatically mean that anaesthetists are artists, or that artists are better anaesthetists. This begs the question as to why we still continue to compare our activity with that of artists. Second, more recently, the term ‘state of the art’ has become popular, and today it can be found throughout the medical literature. In the anaesthesia literature, this would be about ‘state of the art’ of simulation in anaesthesia,10 or ‘state of the art’ anaesthesia for specific interventional procedures11,12 or ‘state of the art’ of anaesthesia techniques.13–15 ‘State of the art’ conveys the impression of authority and knowledge. Such essays reassure readers and may, in the time of evidence-based medicine, satisfy those who are still reluctant to adhere to scientific rules, epidemiological facts and guidelines but who prefer intellectual freedom, liberal thinking, imagination and improvisation. Third, sometimes relevant information responding to complex medical questions may be found in art.16 An example is the hypothesis of Digitalis-induced xanthopsia of Vincent van Gogh (1853 to 1890), which may explain why this famous expressionist perceived the world with a yellow tint. Or Leonardo da Vinci (1452 to 1519) who may be considered a compulsive anatomist and who combined art and science; the ‘Mona Lisa syndrome’, for instance, that describes the yellow, irregular plaque in the medial aspect of Mona Lisa's left upper eyelid, is consistent with xanthelasma.16 Again, although tracking clues and symbols in artworks and paintings is likely to help physicians develop their observational skills and thus challenge their diagnostic and therapeutic capacity, this still does not provide any evidence that artists are better clinicians. And it does not either allow for the link between clinicians, including anaesthetists, and artists. Finally, the practice of anaesthesia has been made immortal through art. Perhaps the most famous picture witnessing the practice of anaesthesia is the painting by Robert Hinckley entitled ‘The First Operation Under Ether’ showing William Morton's triumph in 1846 enabling a surgeon to remove, under the effects of ether, a young man's vascular tumour from the neck. Other artists specialised in the drawing of clinical scenes. For instance, Dorothy Kay, an Irish-born artist who married a surgeon in South Africa, and who produced in 1937 a large painting, ‘Surgery’, shows a patient undergoing an abdominal operation. The painting captures the skill and care exhibited by the anaesthetist, together with the anaesthetic equipment used at that time.17 In conclusion, the literature does not tell us much about a potential co-existence of artists and anaesthetists. But we all know that artists are among us. Some of those know that they are artists, but they stay discreet; perhaps they do not want to combine their professional activity with their passion, or they fear that they may be misunderstood or ridiculed. Some may feel their love for art but do not dare to experiment with it. And the majority ignore it. For all of our readers who do produce art, for instance paintings, photographs or sculptures, the European Journal of Anaesthesiology has started a new initiative and aims to offer a platform. Artists–anaesthetists are invited to submit high-quality photos of their work. It is our aim to reproduce those works on the front cover of the Journal, accompanied by a short text inside the Journal presenting the artist and describing the artist's interpretation of the work. Acknowledgements relating to this article Assistance with the Editorial: none. Financial support and sponsorship: none. Conflicts of interest: none. Comment from the Editor: this editorial was checked by the editors but was not sent for external peer review. MRT is the Editor-in-Chief of the European Journal of Anaesthesiology.