“The blood is always too cold,” she told me. “I wish they would let it warm up before they started.” A heating pad from home rested on her forearm, covering a tube of crimson red that snaked out from underneath, winding its way up to its source. Dangling from a hook, a bag of red blood oozed its chilled contents into her arm.
This was my patient, Mrs. M, receiving a blood transfusion. She needed them every three weeks. Often, I would have the opportunity to join her in the hospital. As a first-year medical student, I was assigned to follow her in her care, to better understand and appreciate what it meant for her and her family to grapple with the chronic medical condition she faced. Our days began with that same ritual: cross-check the blood type; hang the bag, fresh from the fridge, on its perch; place the IV; start the drip; and see that same grimace as the cold blood started to flow. One of those days, she turned to me, chiding, “This hotel art they have hanging in every room sure isn’t doing much good.” I gathered that she wished the doctors, nurses, and hospital administrators had noticed the small things—the cold blood, the tasteless art—that might make all the difference.
There has arguably been no better observer of those details than Leonardo da Vinci, the Renaissance painter-turned-scientist responsible for painting the Mona Lisa, credited with the definition of atherosclerosis, and acknowledged as the creator of the first form of engineering technical drawing. Leonardo was a man of broad interests and incredible talent across disciplines ranging from the fine arts to the natural sciences. The root of that broad success was his incredible skill of observation.
Trained as a painter, Leonardo learned to see the world around him with unmatched acuity and curiosity. To paint faces, he would converse with people in the streets of Florence, study their expressive muscles, their wrinkles, their contours, seeing how light and shadows played off of each other as their faces twisted into smiles and frowns. He would draw these faces, from memory, in incredible detail in a notebook that never left his side. He would do the same for plants, landscapes, and the world around him. He was obsessed with detail. One of the items on a to-do list from his surviving journals asks him to “Describe the tongue of a woodpecker”—a detail that most of us would be fine missing.1
Leonardo built upon this curiosity-driven observation skill from painting in his endeavors as a scientist. In his era, much of science in Europe was rooted in superstition as the continent emerged from the Dark Ages. Leonardo believed that science should be rooted in observation and experimentation based on testable hypotheses. He created detailed anatomical drawings, some of the first of their kind, based on careful dissection and study. These illustrations depicted arteries, veins, nerves, and muscles from different angles and perspectives in order for surgeons to better understand the intricate anatomy of their patients. He even revised his depiction of a man’s neck in his painting Saint Jerome in the Wilderness when he discovered that the sternocleidomastoid was, in fact, a pair of muscles and not just one.2 Taking this skill even further, Leonardo was able to deduce many natural laws later published during the Enlightenment. In what began as studies for his paintings, he observed the wings of birds as they flew, noting the varying velocity with which they beat on the air. Combining this with experiments conducted on fluid flow, he inferred Newton’s Third Law of action and reaction—formally published centuries later.
But what does this painter-turned-scientist have anything to do with healthcare delivery in the 21st century? It was by a chance recommendation that I picked up a Leonardo biography to read in my (little) free time in medical school. I had no idea that what was originally intended to be a distraction from studying physiology and pharmacology could prove so rich in skills and inspiration for becoming a better doctor in the future. Studying Leonardo has inspired me to become a better noticer, to slow down, to look deeper—despite how quickly the days fly by. In the lab, this means being more curious and using close observations from experiments to drive better hypothesis development. In the clinic, this has heightened my awareness of the expressions and body language of my patients—to see beyond the words coming out of their mouths, to more clearly understand their hopes and desires for their treatment. Noticing is seeing the human details, that cold blood drip or that tacky wall art, that matter more to our patients than most of us realize.
Many of the frustrating details of medical care for patients, unfortunately, cannot be changed. Temperatures for blood transfusions are tightly regulated, for instance. I recently visited Mrs. M before another transfusion. We joked about the frigid blood she was about to get and how this transfusion room had borrowed its wall art from a different hotel. As the nurses were cross checking the blood, I offered to heat up her warming pad for her. “That’s the first time any of you have ever offered. Thank you.”
And she smiled.
1. Windsor, RCIN 919070; Notebooks/J. P. Richter, 819.
2. Martin Clayton, “Leonardo’s Anatomical Drawings and His Artistic Practice,” lecture, September 18, 2015, https://www.youtube.com/watch?v=KLwnN2g2Mqg.
J. Reed McGraw is an MS1 at the Perelman School of Medicine. Reed can be reached by email at [email protected].
