‘A picture worth a thousand words’: Art meets medicine at CHOP’s in-house studio of medical illustrators

The walls of Eo Trueblood’s office are covered in images of body parts, medical devices, and surgical procedures.

He pointed to a black and white graphite sketch of a human heart, exposed in the chest cavity, ready for a coronary artery bypass. It’s an image he captured while being embedded with a medical team in the operating room.

“So, the number one rule of sketching in the O.R. — no erasers,” Trueblood said with a laugh. “You don’t want to be putting sprinkles everywhere.”

Trueblood, a certified medical illustrator at Children’s Hospital of Philadelphia, has another rule for himself.

“If a person looks at the illustration and has no idea what’s going on, I’ve completely failed,” he said. “A few words or a couple of labels can add to what they’re understanding, but ultimately, you should be able to look at it and say, ‘Two [conjoined] twins, they’re separated right down the middle and there’s some vascular anatomy,’ and that’s it.”

In a digital age where most people have thousands of images of human hearts or lungs right at their fingertips, it may come as a surprise that hospitals like the Children’s Hospital of Philadelphia employ an in-house team of medical illustrators.

But Trueblood said their work often goes far beyond the static images found online.

“You have to be able to tell a story and understand how to tell a story visually,” Trueblood said, “simplifying really complex concepts and procedures and diagnoses and distilling them into a visual that anyone can look at and understand.”

Trueblood, co-founder of CHOP’s Stream Studios, said medical illustration is a small, but unique field that has a lot of offer.

There are only an estimated 2,000 certified professionals worldwide, according to the Association of Medical Illustrators. Unlike other kinds of artists, they study anatomy, physiology, and other biomedical subjects in addition to taking courses on drawing, graphics, and design.

They assist with cadaver dissections, learn how to translate very detailed scientific research, and sit in on medical procedures in order to create illustrations with accuracy and specificity.

Sometimes that involves capturing what’s known as a “surgical moment,” which can later be used as a teaching tool.

“It’s the moment that is most didactic. It teaches a technique,” Trueblood said. “It’ll inform the surgeon who’s looking at that illustration about tissue reaction, how things are being moved and stretched, what instrumentation is being used.”

Other times, Trueblood and his colleagues are there to document history being made. One of his most well-known illustrations depicts the world’s first bilateral hand transplant in a child at CHOP in 2015.

Another notable one is the 2017 “lamb in a bag” experiment, when scientists were able to keep alive premature lamb fetuses in an artificial womb, which raised hope that something similar could one day be created to help very premature human fetuses survive.

“I always joke that I get to illustrate science fiction sometimes,” Trueblood said, “because it is amazing what people are able to figure out and kind of the care that they’re able to provide.”

The studio’s illustrations are used in scientific journals, manuscripts, for hospital websites, and pamphlets. They’re also used to help patients and their families understand what’s happening.

“The families have no idea what’s on the inside and they don’t understand the gibberish that we’re talking,” said Dr. Brian Dunham, a pediatric ear surgeon at CHOP. “So, the picture is worth a thousand words every time.”

Dunham and Trueblood co-founded Stream Studios in 2013. Since then, they’ve added a third illustrator to the team, Brittany C. Bennett, and have taken on more 3D and animation work. They have plans to expand their portfolio even more by partnering with medical school programs.

These days, Dunham is just as comfortable with a stylus pen or sketching pencil in his hand as he is with a scalpel.

“The act of surgery is, you’re trying to cognitively build a map of the anatomy you’re traveling through,” Dunham said. “It’s the same process that you do when you’re making a drawing. You’re trying to discover the form and understand it.”

The content of the work can be quite serious and scientific, but the illustrators find ways to have fun with it.

For example, when choosing a likeness for an illustration, they often use family members and friends for inspiration.

In Dunham’s office, various medical illustrations displayed on the wall have familiar faces. A young girl with a mark on her neck closely resembles his youngest daughter. Another image of a child’s head showing a transparent view of a cochlear implant was modeled after a partner’s daughter.

“My kids have crawled all over me in my studio at home,” Dunham said. “They’ve seen all of this stuff as it comes off the production line.”

Trueblood has his own collection of illustrations modeled after his cousin’s two children, a close friend, his dad, his real-life partner, and even himself.

“Most people are tickled,” he said. “They get to see a version of themselves in a cool situation.”

Neither of the studio’s co-founders initially envisioned careers as medical illustrators, or imagined that this could be a way to make a creative living. Both said they are grateful to have found this niche where art, science, and medicine meet.

“I get paid to draw every day,” Trueblood said. “It’s incredible science and incredible medicine. And ultimately, I feel like there are times where I’m able to give back to the community, which feels great.”