Browse the images on the website of photographer Patrick Pfister and you might be in for a bit of a shock. Past the commercial photos of executives and tower blocks, and beyond the aerial shots of Louisville and Kentucky, you reach a black and white picture of a surgeon holding a heart. Next to it is a color shot of a hand attached to an arm by little more than a strip of bone. For more than twenty years, Pfister’s list of professional services has included medical photography, the shooting of images of doctors, hospitals and medical scenes.
Some of those scenes have been pretty momentous. Pfister was in the operating room to photograph Kentucky’s first heart transplant. He was standing next to the anesthesiologist during the world’s third installment of an artificial heart, and he was present throughout America’s first hand transplant, performed at Louisville’s Jewish Hospital. It’s a difficult job that combines photographic skill with medical knowledge and, to some extent, a high threshold for squeamishness.
The limited field of view can be helpful in tackling the sight of blood. The only part of the operating table that’s undraped and visible is the field on which the surgeon is operating. Pfister can’t tell the patient’s age, gender or identity as he shoots, and he knows that he’s not photographing an operation that’s being performed on anyone he knows. That helps to deliver the necessary distance for most jobs, although not all.
“That is not me or a family member on the table, so I really don’t get very emotional about it at all,” says Pfister. “The only time I was taken aback was when I was covering a neurosurgeon and came into the OR. Seeing the human skull open and a brain was somewhat arresting.”
Stay Out the Way
An operating room isn’t a studio and doing a photographic job in a place where medical professionals are trying to do their job does pose challenges — beyond the difficulties of staying upright while looking at the contents of someone’s skull. Pfister tries to limit the amount of equipment he carries with him and cleans everything down with alcohol wipes to reduce the risk of infecting the patient. He also tries to stay out of everyone’s way unless invited to get closer for a shot. The anesthesiologist usually has the best view for open heart surgery, and Pfister tries to stay next to him.
The images are generally used for external communication, to illustrate the work of the hospital or to include in brochures. But some medical photography can have even more important uses. Mike Samuels was the Head of Photography at St. Bartholomew’s Hospital Medical College in London whose library of medical conditions and pioneering use of art and photography have led some to call it the home of medical photography. He was later Head of Medical Illustration at the UK’s merged UCL and Royal Free Medical Schools, and now runs a business that trains doctors, dentists and healthcare professionals to take medical photographs.
Working in a country whose hospitals are publicly funded, Samuels’ photographs may be used to support the hospital’s publicity goals but they’re more frequently used for medical purposes. Samuels specializes in mole mapping, recording the presence and growth of moles to identify malignant melanomas in people whose family history may suggest a predisposition to skin cancer.
“Some of the first changes that occur to a mole are visual. Photographic record is therefore ideally suited to assisting this monitoring process and patients find it useful to have a record of their skin condition so they can self examine for change,” says Samuels. “By using a structured protocol of views, medical photographers assist dermatologists in ensuring patients are seen at the earliest possible time when any change occurs.”
Other uses of the images are no less practical. The photos can provide a document of a patient’s progress, especially for plastic and reconstructive surgery. They may also help to train and educate staff, while other images can be used in medical litigation and even forensics, particularly in the case of abuse.
Know When the Patient Will be Sewn Up
In addition to technical skills, medical photographers need to be aware of the special issues surrounding patient consent and the confidentiality concerning the storage and use of the photos. An understanding of physiology helps too. Samuels did have aspirations of becoming a doctor but was able to learn about the body as a trainee medical photographer at the Radcliffe Infirmary in Oxford, first in the pathology department and later in the clinical department.
Experience can help as well. Patrick Pfister’s presence in the operating room has given him a good idea of what to expect when someone is about to have their heart removed.
“Having shot heart transplants a number of times, I know how the body will be transferred from the defective heart to a heart lung machine that takes over the pulmonary function of the heart and lungs,” he explains. “I know when the donor organ will be sewn into the patient and the process of rewarming the blood causes the new heart to beat on its own, hopefully. You sort of learn as you go in the OR environment.”
Picking up that experience though isn’t easy. Pfister’s reputation as a medical photographer began when he was freelancing in the late 1980s. His clients included both the local newspaper, the Courier-Journal and Louisville’s Jewish Hospital. When the hospital announced that it would perform the state’s first heart transplant, Pfister asked the hospital’s director of communications if he could shoot the stills. The images — the result of fourteen hours of shooting in the operating room — ran above the fold in two newspapers for a week and put him in demand from other hospitals in the area for five years. Today, he says, hospitals tend to have photographers on staff who shoot everything from hospital activities to portraits and medical work. Meeting one of those photographers to supply non-medical images might provide a connection that could lead to an opportunity to shoot in an operating room.
It’s also possible to pick up some professional training. The Rochester Institute Technology has a program in Biomedical Photographic Communications, and in the UK, the Institute of Medical Illustrators runs a part-time, distance course conducted while working in a hospital. The University of Wales also has a postgraduate degree in Medical Photography.
However you decide to break into medical photography though, just make sure you’re prepared for the contents of the operating room.
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