Spot 12 is what is called the long comic book or graphic novel. This type of novel is described in the accompanying article by M. K. Czerwiec. Spot 12, the novel, a unique combination of text and remarkable drawings, was able to completely hold my interest. The topic of parenting a critically ill newborn in the NICU is not a new one. It has been well written about by parents such as Dianne Maroney, Deborah Alecson, Rochelle Barsuhn, and William Woodwell.1-4 But Spot 12 was matchless in its comic book format associating pictures with feelings. Spot 12 is the bed number that Jenny Jaeckel's daughter held in the NICU. The pictures express the feelings of this parent, such as on the page showing the outside of the NICU, with 6 different signs saying "do not enter" and "please go away." The pictures of her daughter after birth consist of a small alien-type creature with lines going everywhere and a circle of doctors around her. Every setback is a new crisis. The author's picture of her motherhood experience is of a broken doll whose head and arm are disconnected from the body. The drawings are perfectly expressive of the feelings. When infants in Spots 10 and 11 die, the pictures show little cartoon angels with teddy bear-like parents waving goodbye. One picture has a long line of large figures (a giraffe, a frog, a rabbit, a goat, and a bear)-all standing and explaining to the mother about the need for a tracheotomy. The explanations include a demonstration table with 25 large bottles, 40 small bottles, 3 packages of tape, 10 gloves, 5 IV bottles and tubing, 20 syringes, 3 suction machines, 5 cannulas, 28 salines capsules, 3 baby bottles, 1 IV pump, a heart monitor all drawn within a small 3 x 5 inch box.... The parents' overwhelmed feelings just pour out of that picture. There most compelling pictures in this 110-page grapic novel are those of the mother, so emotionally distraught that she has a brain split in half and is often seen in the dark or crying into a pillow at night.
I have heard of posttraumatic stress from NICU experiences; I have read about it and studied psychologist Michael Hynan and colleagues' work on the topic.5 But I have never seen the distress, fear, and nightmarish qualities that the NICU instills in parents until I viewed the pictures (and read the accompanying one-line texts) in this novel. It is very impressive.
If I managed a neonatal unit, I would buy a copy of the book and pass it around. For physicians and nurses, the very direct gut impact of how parents feel is brilliantly shown. For parents, it will be either harder than their own experience and they will be happy, or easier than their own experience but they will find comfort in how the author expresses their pain.
This is my first introduction to the graphic novel or long comic. If all medical comics have the same whollop that this one did, I think this art form is here to stay.
You can purchase Spot 12 from the author, Jenny Jaeckel. Jenny Jaeckel is the author and illustrator of 3 graphic novel memoirs. Spot 12, The Story of a Birth was her first book and won a 2008 Xeric Grant. Jenny lives in British Columbia with her husband and daughter. Web site: http://jennyjaeckel.tumblr.com/.
References
1. Maroney DI. Helping parents survive the roller coaster of the NICU. J Perinatol. 1994;14(2):131-133.
2. Alecson DG. Lost lullaby. Berkeley, CA: University of California Press; 1995.
3. Barsuhn R. Growing Sophia: The Story of a Premature Birth. St Paul, MN: A Place to Remember (subsidiary of deRuyter Nelson); 1996.
4. Woodwell WH Jr. Coming to Term: A Father's Story of Birth, Loss, and Survival. Jackson, MS: University Press of Mississippi; 2001.
5. DeMier R, Hynan MT, Harris H, Manniello R. Perinatal stressors as predictors of symptoms of post-traumatic stress in mothers of infants at high-risk. J Perinatol. 1996;16:276-280.
THE LONG FORM COMIC BOOK AS ART FORM FOR NURSING
M. K. Czerwiec, RN, MA
M. K. Czerwiec, RN, MA, also known as Comic Nurse, has been making comics about her experiences as an AIDS nurse since 2000. Czerwiec also teaches a seminar course called "Drawing Medicine" at Northwestern Medical School, where she is the artist-in-residence. You can learn more about her work at http://www.comicnurse.com.
Jenny's book Spot 12 is a rich example of a growing subgenre of graphic novels (long form comic books) that take as their subject experiences in illness, health, and caregiving. Study of these works in the health humanities is known as "Graphic Medicine." The term was coined and defined by doctor and comics artist Ian Williams1 as "the intersection of comics and the discourse of medicine." Williams established the Web site http://www.graphicmedicine.org in 2007 to serve as an online resource devoted to graphic works that address issues of physical and mental health. Dr Williams and I now corun the site, which includes a weekly podcast, a blog, and a searchable medically themed comic review database. Four international conferences on Comics & Medicine have brought comics artists, health educators, literature scholars, and fans together to explore the use of comics in public health, patient education, and much more.
In a British Medical Journal article in 2010, Dr Michael Green of Penn State Hershey Medical School coined the term graphic pathographies to describe memoirs of illness in comic form. Dr Green has been using such books as Brian Fies' Mom's Cancer, Harvey Pekar and Joyce Brabner's Our Cancer Year, and Sarah Leavitt's Tangles, to teach fourth-year medical students about the real-life experiences of illness and caregiving. The benefits of comics in medicine go beyond reading these texts and extend to actually making them-Dr Green has his students create their own comics about an aspect of or experience from their medical education.
Why comics in health care? There are many reasons. The first and most convincing may be neurologic. Comics are the perfect marriage of text and image. When reading and creating comics, the left brain, employed when reading letters, numbers, and words, is joined by the right brain, communicating through patterns and pictures.2 As Betty Edwards (1979) wrote in Drawing on the Right Side of the Brain, "Half a brain is better than none, but a whole brain would be even better.3" Education activist Jonathan Kozol4 wrote, "Words and pictures, when commingled with a skillful artistry, lead... to a dazzling dance of the dialectic that propels us to ask questions we have never asked before." By incorporating both image and text, comics have a unique power to generate understanding about the lived experience of illness. Comics creator Hannah Berry (2012) wrote, "Pictures have the ability to define those things that are without definition-those indescribable emotions for which we have no name, that can't be adequately described with words."5 The comics form is a highly efficient method for conveying metaphors, often helpful in conveying complex information, more than common in health care, to patients and practitioners.
Comics also appear to have a unique empathic bonding pathway for readers. As comics historian Paul Gravett (in Comics & Medicine conference keynote address, Chicago, Illinois, June 10, 2011) has said, "There's all sorts of educational, lofty, worthwhile, professional, training sorts of sides to comics, but the keyword in all of this, the reason I'm drawn to comics, is empathy, being able to understand other people's lives and experiences and hopefully finding a connection in yourself."
The wide array of benefits of comics in medicine is particularly clear in Spot 12. Doctors and nurses have written to Jenny in response to her book, including one physician at British Columbia Children's Hospital who encouraged her to join the staff, to teach them about the patient's experience of the care they provide. Jenny also received the following e-mail from a reader,
...[a friend] sent me her copy of your book to read last year when our daughter Paige was born. Paige got GBS pneumonia and had a rough go of it for the first few months, and your book was the most incredible gift. It was like you were speaking the thoughts I didn't know I had. I read the whole thing through in one day and had some really good cries for your baby girl and what you went through, and rejoiced when you finally got to bring her home. It felt like a weight had been lifted off me. Your story is so inspiring and I really appreciated the honesty about what you were thinking and feeling during your hospital journey. It wasn't until after I read your book that I recognized the PPD symptoms I had been having. Thank you so much for writing it.
Learn more about this fascinating and growing field at http://www.graphicmedicine.org.
References