Getting graphic in medicine: using comics to tell health stories

As I was growing up, I thought I understood nursing by watching my mom excel in the profession. But I realized I had a lot more to learn when, as a new nurse, I worked in a dedicated AIDS unit in a Chicago hospital in the 1990s.

At that time — the height of the AIDS crisis in the U.S. — the amount of suffering and death on the unit was overwhelming. I didn’t know how to process losing so many friends and patients. In nursing school, our professors told us to “take care of ourselves” emotionally and mentally, but I never was clear about exactly what that meant.

One day, after the death of another long-term patient I had gotten to know well, I was at a loss for how to continue in my work.

Staring at a blank piece of white paper, I sketched a simple, childlike drawing of myself in the upper left-hand corner and wrote over it “I feel miserable.” I drew a box around it all to connect the image and the words.

Since the box was in the upper left-hand corner of the page and the rest of the page was blank, I drew a second box next to the first one and filled it with another image and more text. I kept going. Nine panels later, I realized I had taken the static state of feeling miserable and converted it into a story that took me to a place of hope. My first comic was born. I later came to realize I wasn’t the only one doing this.

I created more and more comics, many of which helped me explore ethical, emotional, and logistical aspects of my work as a nurse. This was the “taking care of myself” that worked best for me.

I eventually wanted to make better comics, and wanted them to be informed with theories about how and why stories can work to help us heal. To achieve this goal, I earned a master’s degree in health humanities and bioethics. During that work, I came across the amazing graphic memoir, “Mom’s Cancer,” by Brian Fies. This insightful and brilliantly executed book inspired me to consider more broadly the impact that the medium of comics could have as a tool in health care.

After finishing my degree, I created my own graphic memoir/oral history, “Taking Turns: Stories from HIV/AIDS Care Unit 371.” One of the reasons for doing that was to bear witness to the amazing work that nurses do at important historical moments, like during the AIDS crisis.

I came to understand that comics have a lengthy history in health care. They’ve long been used to teach, particularly in the public health arena. Recall the posters, leaflets, and comics given to soldiers during World War II to educate them about avoiding sexually transmitted diseases. Picture patient handouts that use text and images in sequential boxes. Even physical assessment texts are sometimes accompanied by sequential images. These are all comics.

Stories do important work in health care and can even help people heal. Comics are a great way to access and share those stories.

The community of comic artists focusing on health has been building. About 10 years ago, physician and artist Ian Williams coined the term “graphic medicine” in an attempt to explore his thinking that comics could have a serious role in the discourse of health, illness, disability, and caregiving.

In 2010, I joined fellow cartoonists to hold the first graphic medicine conference in London. We continue to raise awareness online at graphicmedicine.org and at annual conferences. The field has expanded to include patients and practitioners from many countries and widely varied disciplines.

The large body of health-related comics is now being highlighted in an exhibit called “Graphic Medicine: Ill-Conceived and Well Drawn!” sponsored by the National Library of Medicine, the world’s largest biomedical library.

Artist, educator, and New York Times best-selling author Ellen Forney — her “Marbles: Mania, Depression, Michelangelo, and Me” is a classic — guest curated the exhibition. A recent videocast discussion about the exhibit included Dr. Michael Green, a physician, bioethicist, and professor at Penn State who has co-authored articles and publications about graphic medicine.

The exhibit explores the meaning of medical literature that combines the art of comics and narratives of health, illness, caregiving, disability, and adaptation. These stories can be essential to understanding illness and health care and to effective treatment, healing, and understanding. The exhibit is now on display at the National Institutes of Health campus in Bethesda, Md. If you can’t make it to Bethesda, you can view it online or see a banner exhibit that will be travelling to 50 sites during the next four years.

Comics can make us laugh. They can help us connect, and they can help us learn. Most of all, they can help us see things in a new light. This is exactly what patients and caregivers need when facing the big challenges of life.

MK Czerwiec, R.N., is a cartoonist, senior fellow at George Washington University School of Nursing’s Center for Health Policy and Media Engagement, artist-in-residence at Northwestern University Feinberg School of Medicine, and co-manager of www.graphicmedicine.org.