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Commentary on Chemotherapy

Shankar, P. Ravi MD

doi: 10.1097/01.ACM.0000511910.04349.56
Medicine and the Arts

P.R. Shankar is assistant dean for medical education and professor of medical education, Xavier University School of Medicine, Oranjestad, Aruba;; Twitter: @drprshankar.

“She looks very scared and is holding up her blankets to her chin trying to cover and protect her body. Her hand is holding the blanket tightly. She has wrapped a towel around her head trying to reduce her headache.”

These are a student’s comments on the painting Chemotherapy by the Canadian artist Robert Pope. My cofacilitators and I have been using Chemotherapy and other Pope paintings for over nine years in medical humanities modules, first in Nepal, and then in Aruba, Dutch Caribbean. We believe that paintings, poems, and literature serve to provide an indirect experience of illness, suffering, and death to students who often have limited life experiences; thus, interpreting paintings is among different activities we use during the module.1,2 Specifically, we ask students to comment on “What they see and what they feel” when they view this or another painting, and to create a 100-word story about the scene depicted.

Robert Pope died at the young age of 36 of Hodgkin Disease after a 10-year period of illness and remission. He created “a significant body of work exploring his experience with healthcare and healing as a cancer patient.”3 He wanted to use his skill as a painter to provide a voice for other cancer patients undergoing similar experiences,4 and he believed modern medicine focused on diagnosis, treatment, and technology, marginalizing the patient.3,5 While some doctors have struggled to understand the patient’s perspective, Pope worked to accurately portray what being sick means for a patient.

Pope knew that a hospitalized cancer patient has to adapt to the hospital routine, contend with partial loss of privacy, undergo various procedures (many of them painful), and wait anxiously for test results which may bring either hope or despair. He depicts the restrictive bedbound perspective and the disrupted lives of the patient in many of his paintings.

Often, Pope does not sharply delineate features or characteristics that could limit the protagonists in his painting to a particular country, region, or ethnic group, which increases the universality of his work. The sparseness of the scene depicted in Chemotherapy ensures it translates well across cultural barriers. In Nepal students have had little difficulty in describing the scenario and then identifying with the patient depicted in the painting.

They note that in contrast to many of Pope’s other paintings, the patient in Chemotherapy is alone without the support of family and friends. The patient’s view is of a drug, likely to be soon administered. The bright red drug in the syringe in the foreground occupies center stage and grabs the viewer’s attention. The viewer can also discern a bright red tattoo of a heart on the patient’s forearm offering hope, companionship, love, and color in the bleak atmosphere. Red is the color of life and of blood but also signifies danger and distress. The patient’s face shows apprehension and fear but perhaps also acceptance. The patient seems to be using the blanket as a barrier against the harsh outside world, creating a personal zone of comfort as a defense against the loss of privacy and familiarity. The pillow seems to be arranged like a cradle around the neck, offering an additional measure of protection against the harsh reality of sickness and death.

Doctors consider the effect of medica tions to be mainly positive, relieving suffering and curing disease. But for a cancer patient—like Pope or the woman depicted in Chemotherapy—medications may offer long-term hope of a cure but also cause short-term suffering, pain, nausea, and other adverse effects. In fact, Pope has described his own experiences with chemotherapy which motivated him to create the painting Chemotherapy. He wrote that waiting for the doctor to begin the injections was “even more difficult psychologically than the taxing physical reactions to follow.”6

In this painting, Pope evokes both the positive and negatives aspects of chemotherapy as a treatment for cancer. The physical isolation of the patient, her bedbound perspective, and the dull colors in the painting highlight the negative aspects. The red tattoo of a heart on the forearm, the light bathing the left side of the patient’s face, and her strong grip on the blanket underline her life, love, and determination to fight and conquer her illness. Chemotherapy offers a powerful introduction to the patient perspective, visually transports viewers to a hospital room, and encourages reflection on the effect of sickness and cancer on a patient’s life and hopes.

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1. Shankar PR, Piryani RM, Upadhyay-Dhungel K. Student feedback on the use of paintings in Sparshanam, the medical humanities module at KIST Medical College, Nepal. BMC Med Educ. 2011;11:9.
2. Shankar PR, Rose C, Toor A. Student feedback about the medical humanities module in a Caribbean medical school. Educ Med J. 2016;8:4153.
3. Robert Pope Foundation. About Robert Pope. The artist. 2010. Accessed September 26, 2016.
4. Murray TJ. Pope R. Introduction to the 10th anniversary edition. In: Illness and Healing: Images of Cancer. 2002.10th anniv ed. Hantsport, Nova Scotia: Robert Pope Foundation.
5. Langley R. Pope R. Foreword. In: Illness and Healing: Images of Cancer. 2002.10th anniv ed. Hantsport, Nova Scotia: Robert Pope Foundation.
6. Pope R. Illness and Healing: Images of Cancer. 200210th anniversary ed. Hantsport, Nova Scotia: Robert Pope Foundation.
Copyright © 2016 by the Association of American Medical Colleges