Solving the Mysteries of Heart Disease

by Gerald D Buckberg

  CHAPTER 27

  Life: My Art and My Science

  “My Art and My Science” is the final chapter of my memoir, and reveals how art has interwoven with my lifelong scientific pursuits. It identifies how such artistic connections have surprisingly guided me toward uncovering solutions to the unsolved medical conditions.

  The fields of art and science have more in common than one might think. Both involve goal selection, drive, development of the pursuit, and perseverance… long-standing qualities that are similarly reflected in other areas, such as my preparing for and then completing marathons in running and swimming.

  These strides toward innovation in art and science have a remarkable similarity. The first actions are conventional, as we must “walk where others walked before.” The artist observes and copies the masterful works of others, with a mentor looking over their shoulder as they learn how others have done things. This bears close resemblance to the learning curve in medical school and in specialty training that is needed before self-starting your scientific future. The cardiac surgeon mimics the known work of others as he or she trains with a mentor surgeon that directs the placement of every stitch.

  First Art, then Science

  I began drawing when I was ten years old, but had no formal art training. A fun adventure unfolded for me as I began by copying pictures. My wall today still displays a portrait of my father, made at age thirteen. Looking back, I can see the mindset of the researcher surfacing early in myself, as my subsequent drive to investigate new medical areas may have been mirrored during my untrained childhood. For example, my desire to play in new artistic arenas led to me buying an oil color set so that I could explore ways to amplify a picture’s depth.

  Though the artistic seeds were planted early, my drive to become a doctor became my total focus and would overshadow my artistic interests. I did no drawings in college, medical school, or during the beginning of my residency training at Johns Hopkins Hospital. Leisure time finally came into my life for the first time when I transferred to UCLA. My initial medical chores did not require long hours. Instead, I worked a typical eight-hour day during my six-month rotation in pathology (to learn about disease patterns), and during six more months in the outpatient clinic.

  I sought activities to fill this free time, and my stimulus would come from a dear friend and colleague, Don Paglia. We met during my rotation in the Department of Pathology, where he was an assistant professor. He was an established painter and sculptor whose work had appeared in numerous shows. Don took a three-month voyage to Japan, acting as a physician on a Coast Guard cutter. During this time, I had the opportunity to live in his home. It was an astounding experience to be surrounded by his artwork, whose excellence burst from the pictures that covered his walls. My fascination with his artistic activity made me think, “If he can make this part of his life, perhaps I can have art as an aspect of mine as well.”

  I had found a world that I wanted to play in again. But to follow this path, I needed to learn if my childhood love of drawing had endured.

  Promising Start

  My first drawing would be a surgeon’s hand. It was an interesting first choice, especially since many artists steer away from drawing the hand due to the difficulty of accurately portraying its many angles, twists, and turns. But modeling was easy. I looked at my own hand, imagining it making an incision. I created a slew of paper sketches to improve and overcome these inherent challenges before beginning an oil color painting. The challenge of having no trained knowledge in oils did not deter me from vigorously chasing this artistic objective.

  I was delighted. I had my first completed picture in almost 20 years. (Figure 1) Don Paglia returned home and complimented the work, with his only critique relating to my rendering of anatomy. He was disturbed by my very flat thumb. It seemed abnormal and needed a more natural angulation. Solving this problem was easy, as I simply “exchanged” his thumb for mine in the painting, a maneuver that also reflected my deep gratitude to him for supplying the enticement to re-engage with art.

  Figure 1: A surgeon’s hand.

  Don suggested I submit the painting to The Festival for Arts competition at The Los Angeles Physicians Art Society. I was flattered and took his advice, but was unable to attend the festival’s award ceremony because I was in the operating room. So we came downtown the next day, but found the building closed. We asked a janitor, who happened to have a strong accent, if he knew who had won. He wasn’t sure of the winner’s name, but told us that a “bigga hand wit a bigga knife” had a gold ribbon around it. We all laughed, overjoyed at the unexpected reward for my first venture.

  Back to the Back Burner

  Despite this encouraging recognition, I had to abandon my artwork once more, due to the long hours required for patient care. But my residency was immediately followed by two years in the Air Force. I was stationed in Dayton, Ohio, where I lived in an off-base cabin at the corner of a large state park. This allowed me to walk into a backyard surrounded by nature, and let me focus again upon art.

  My fascination with the hands remained. I tried painting from the viewpoint of a patient on the operating table, encircled by the operating team. The patient is touched by the graceful hands of the caregivers, whose bodies appear smaller as they fade into the background. As the doctors and nurses perform a surgical procedure, their hands dominate the foreground while the team’s masked faces focus upon the patient. Illumination comes from the central surgical light above the operating table. (Figure 2)

  Figure 2: The patient’s view.

  The final challenge was framing the circular image that naturally arose from the patient’s point of view. I used my clinical experience to help me capture this spherical view. I envisioned it as if peering through a sigmoido-scope to blend depth, perspective, and record the foreground and background to amplify the drama of a surgical scene. This imagery permitted the viewer to focus on the intensity of the operating room as the background’s various details melted away to emphasize the surgical team’s concentration upon patient care.

  The selection of hands became an important ingredient within the many pictures I drew then and in those I continue to create. Hands have always appealed to me, as they seem to be a true reflection of the individual, unlike facial expression or body language, which are constantly being modulated. Further, they reflect the union of thinking and acting. Michelangelo said, “The eye and the mind create with the hands.” His profound vision certainly describes how I have used my hands during my lifelong ventures into art and science.

  Creation was the focus of Michelangelo’s comment, and it remains the driving force in art — and science. Many descriptions for creation exist. Mine is that it “fills an empty room with new ideas, then tests them with ongoing change during learning.” This process uses your spirit to contribute fresh input into the vacant space, all the while knowing it is just the first step of an innovative exploration. We must retain the freedom to learn new things during its pursuit. This is the hallmark of the artist, the physician, and anyone else that is inventive.

  The Artistry of Discovery

  Learning always brings challenges.

  The only choice is to walk toward such new things, even though the road may appear to lead to a dead end. Ignoring a problem or turning around to go elsewhere is not an option. The goal must be to determine what that “dead end” means, and then to determine how to change it. Such curiosity creates leaders, rather than the passive acceptance that defines the traditionalists in both the world of art — and of science. This was demonstrated previously when we abandoned simply congratulating ourselves for a medical treatment that yielded a 80 to 90% survival rate… and moved toward the next phase, where we asked the fundamental question, “Why are 10 to 20% still dying?”

  The early example of this in my own career occurred in 1975, when ventricular fibrillation was routinely used during operations to replace the aortic valve. This mechanical method kept the heart quiet so that cardiac
surgeons could more easily operate. Yet patients who had thick heart walls did not fare well, and when they died, these losses were simply deemed to be part of that percentage in which the operation wasn’t successful. But I wanted to know why, and our research revealed the answer (the left ventricle’s inner shell becomes damaged when a thickened heart undergoes induced ventricular fibrillation). Such treatments on those types of patients were abandoned.

  I remember presenting these scientific results at a major meeting in New Orleans. A surgeon from Chicago sought me out afterward. He told me how much he appreciated my talk, but did so in a unique way. He stated that while he watched my presentation, he thought of Renoir making another beautiful canvas. He enjoyed seeing the evolution of my thinking, and compared it to how Renoir kept working to make a painting more and more beautiful, each step a progression.

  What a lovely comment that bridged my two worlds.

  Momentous Mentors

  An underappreciated aspect of art-making is the perseverance to complete a project. This requires an uninterrupted span of time. As I’ve described, the availability of such extended periods would fluctuate during my life, as my cardiac surgeon responsibilities did not let me fully focus upon another time-consuming endeavor. Yet my preoccupation with choosing only larger, demanding art projects was self-generated. Moreover, having had no artistic training or mentor, I thought you started directly with a painting and ended up with a canvas, correcting your numerous mistakes and revising your painting until its final form.

  I hadn’t learned that sketching was an integral part of the process in producing a painting and that making such simpler drawings can be fulfilling on their own — until I enrolled in a UCLA Extension Program. I did this with Don Paglia, as we started from scratch in a beginner’s drawing class. Though already an accomplished artist, Don always wanted to learn new things. This capacity to never be afraid to learn further blends perfectly with my approach to science.

  Through this class, Joe Blaustein and Jan Stussy became the two giant mentors of my artistic life, each teaching me lessons that also profoundly impacted my scientific career. Through them, I found how meticulous step-by-step sketches could play an essential role in the ultimate discovery of a completed painting.

  Most importantly, for the first time… I learned how to see rather than simply how to look.

  Joe had us look at the paintings of Rembrandt to see the grandeur of his talent. How easy it is to become enthralled by the beauty of each of Rembrandt’s dashing images that exist within the larger painting. But if you stop there, you miss appreciating the majesty of his vision. These compelling, yet separate parts, do not tell the picture’s deeper story. He taught us that they are vital accessories within the grand design, as Rembrandt takes us on the journey of foreground, mid-ground, and background space within the total canvas. Focusing only upon the small lovely images will deprive us of a greater vision that is the power of what Rembrandt had given to us. For therein lies the full depth and meaning of his work.

  My eyes truly opened, as I could clearly see how this translated to my medical research. All too often, the medical field focuses on the individual “pieces” of an illness — its assortment of symptoms — and tries to correct those with medications or a procedure. But if we can see the whole picture — the whole disease — and correct that, many symptoms will fall away as we rectify the grander issue.

  It is easy to list all the things wrong with someone, but you have to figure out why they went wrong. You have to bring it down to something simple, for that is elegance. Conversely, many will typically say it’s too complicated. But that’s because they don’t understand it. “Complexity” conveys lack of understanding. This is the essence of my mantra that “elegance is simplicity, confusion is complexity.”

  This approach to appreciating vision is exemplified by my early work within the world of reperfusion damage. Rather than simply trying to note and counter each of the various symptoms, I explored the larger picture to develop an answer that would solve the core disease. This opened a broad new universe of learning not only about heart surgery, but also heart attacks, lung damage, blue babies, liver injury, leg injury, and brain damage. All of this flowed from seeing the hidden yet greater scheme that existed in a new world that contains previously unappreciated connections.

  The same concept proved true with congestive heart failure. If you focus only on the symptoms, you miss the bigger answer of addressing the ventricle — its source. Conventional medicine still looks at smaller issues and uses drugs to treat dilated hearts. But that doesn’t work. Why? The heart’s geometry is the problem. The natural elliptical football shape has changed to a circular basketball contour. Hearts simply cannot get better while they stay circular. Correct the wrong anatomy, which returns the natural elliptical form, and the problem is solved.

  Over 50 years of my life have been spent in education (as both teacher and learner), and how grateful I am to have had Jan Stussy as my artistic mentor. Jan’s rare blend of support and challenge were his yin and yang. He spent many hours setting up the artistic environment (model and background) for each class, yet we were never allowed to come in and begin our artistic work. Instead, we had to take time to walk around the studio to see the model and his or her surroundings in order to select where we wanted to start to draw. We were encouraged to consider what our particular talents might be and the paints we could best employ. In other words, he forced us to become more than an artist that only arrived for a night of rendering, and expanded our thinking by making us integrate the complete process. It was like with Rembrandt’s paintings — the whole is greater than the sum of its many parts. You were no longer simply an instrument, but would become the orchestra, focusing beyond the various parts of a medical illness to perceive the fuller picture. This innovative scheme enabled us to not just look, but to see… mirroring the scientific work described throughout this volume.

  Gently and firmly, Jan evaluated the output of each student. He chastised those who did what they had done before. “You know this, why are you here? Do not show up if you need credit for work accomplished previously. Grow, expand, have fun.” We used these newly uncovered talents to fill the empty rooms of our canvas — we continued to learn. The rigid approach of traditionalists would impair their capacity to grow from Jan’s teaching.

  Jan’s mandate to his students — “Never remain comfortable with what you do; you’ve already done it, move on” — is really the story of life. Never be satisfied with only what you did yesterday. Choose something else for tomorrow.

  Moving Beyond Self-Limiting Beliefs

  A staggering spread of talent (with students possessing different levels of prior experience) existed within our classes, yet every one of us was astounded by how we grew artistically during each session. Jan taught us how to demand more from ourselves, and through this, we achieved more than we could imagine. This passion also translated directly into my research work, where I aimed beyond what the medical world presumed was possible. This drive formed a significant role in igniting the adventures that characterize my scientific career as chronicled here. I never knew where we would end up, but I always believed it would be in the right place.

  Foreground, Mid-ground… Background

  Working with Don Paglia and Elyse Wyman (another friend and colleague from the Stussy course), we developed inventive ways to place water in an oil pan, and add turpentine and oil colors to create a mixture of hues. Sliding a sheet of drawing paper through this mélange produced an array of tints and shapes on the paper’s surface. Each of us looked at the whirling patterns, then glimpsed an idea for a picture. This imagery created a new vision, an intrinsic treasure that now existed but without the need to utilize a model placed into provocative surroundings. Instead, the painter’s mind became the source of inspiration, as we took a breathtaking expedition into the unknown. (Figure 3)

  Figure 3: Cat and aquarium (top), Harp Seal (bottom)

  Many unique pictu
res were made in this fashion, and I was as surprised as others to see the outcomes. Joy filled me during the rendering as I applied the new techniques I had learned with each painting, which then built toward my next endeavor.

  For my sketching, my favorite subjects were Albert Einstein and Arturo Toscanini (acclaimed Italian conductor), as a spectacular grace and worldliness characterized their faces. (Figure 4, 5) Their wrinkles were the result of many years of curiosity and learning, and their resulting beauty reigned wonderfully over their gentle images.

  Figure 4: Einstein (left), Rabbi (right).

  Figure 5: Toscanini

  This led me to combine the faces of aging men with their hand motions. This composition had completeness, as these hands with their soft, pliable, purposeful, and elegant posture — paired together with these radiant faces — kindled a candid portal into their personality. A complete message arose from an image containing only hands and faces, as our brain now allowed us to understand and appreciate how they portrayed their human source.

  Life in Reverse

  From those colorful fertile backgrounds created by Don Paglia, Elyse Wyman, and myself, emerged spontaneous pictures containing depths that could not be intended, but were very powerful. The wonder of surprise creates the added thrill that arises when new directions are explored.

  This experience occurred in dramatic fashion to me one evening while I was on Catalina Island with my children. After they had gone to bed, I had a beer and decided to draw. I wiped black charcoal across the paper surface to create a rough monochromatic background, then used an eraser to rub away portions of this dark backdrop to reveal the facial features of Toscanini. The process took less than five minutes, but the face was delightfully captured! Not only that, but the rubbed out areas unveiled two more heads, one on each side. (Figure 6)