91av

Imagine having a tumour the size of a cricket ball removed from your cheek, your jaw split to correct a childhood deformity or your face rebuilt using bone from your hip after an assault with a baseball bat. Would having your portrait painted help you get over the trauma? Maxillofacial surgeon Iain Hutchison had a hunch it might. So he called in Glasgow artist Mark Gilbert, who spent a year at St Bartholomew’s and the Royal London Hospital painting his patients before, after and during their surgery. The results will be exhibited at the National Portrait Gallery in London later this month. Michael Bond hears how the psychological effects on the patients exceeded all expectations.

Why did you think an artist might help your patients?

IH: Firstly, I wanted a way of informing the public about what is and what isn’t possible with modern facial surgery. I couldn’t have done that with photography because it’s too harsh. Secondly, I wanted to show that people with facial disfigurement often lead full and rewarding lives. The public has a major difficulty with facial disfigurement: they either look away or they stare. It’s a major barrier that has to be overcome. Thirdly, I wanted to allow a portrait artist to paint faces they would never otherwise paint-faces in transition, physically and emotionally. Finally, I thought having the paintings done might have a cathartic effect on the patients.

What did you think of the idea when Iain approached you?

MG: I was excited by it because I knew it would be much more highly charged than anything I’d dealt with before. A lot of art involves taking something mundane and creating something special out of it-think of Tracy Emin’s bed. But at the same time I was nervous. I worried that I’d be focusing on the patients’ deformities, and that the last thing they’d want was to be painted. I thought I’d be focusing on things they’d rather forget. I was also worried about the responsibilities I was going to have to take on that you don’t normally have to as a painter.

How did the patients cooperate?

IH: You had to be careful how you approached them. For example, you can’t just say to a patient, “You’ve got cancer, and by the way I’d really like you to have your portrait painted.” I’d talk to them about it after seeing them several times. Not a single patient I asked said no.

Did anybody drop out?

MG: Two patients couldn’t make their appointments with me and therefore never started the process. But once we started, nobody dropped out. Not only that, but I’d be making more and more demands on them as the painting progressed and they were always cooperative and stayed with it right to the end.

How did they differ in attitude to the people you usually paint?

MG: They were completely different. It takes a certain amount of courage at the best of times for people to sit for a portrait. Quite often people are genuinely offended if they think you’ve misrepresented them. But with these patients that wasn’t an issue. They were all so positive about being painted. I realised I couldn’t go off at too many artistic tangents, but at the same time I wasn’t going to flatter or sanitise. I just tried to be as straight as possible. And even those patients whom I portrayed in surgery with their skulls smashed in loved the results.

The project is about faces, so why are many of the paintings of the whole person?

IH: I had told Mark that I didn’t want bodies, I just wanted faces. “This is facial surgery, you’ll only distract from the process if you show the whole body,” I said. But he rewrote the rules and changed the parameters. It happened because of Mazeeda, a little girl who came to me when she was not quite three. She’s from Bangladesh and her parents don’t speak much English. She had a huge malignant yolk-sac tumour, which I took out.

She liked being painted?

MG: She loved it. She came to her first session after the operation with a pink ribbon in her hair and wearing an amazing bottle-green velvet dress and I thought, we’re not going to miss out on this. So I did a full-length figure and it gave me the opportunity to move away from the mug-shot approach that I’d been following until then.

What is the advantage of showing more than their face?

IH: Mark managed to capture much more about the patients and demonstrate their emotions. So you see Henry de Lotbinière, the barrister who has undergone 15 operations in 13 years for salivary gland cancer, completely relaxed and at ease with himself, with half his face missing. You see Mazeeda with a little Mona Lisa smile on her face. You can see their emotions in a way you can’t in photographs.

Did you get to know the patients more than you do your usual subjects?

MG: Yes, this was another way in which it was so different. I was actively trying to create a strong connection with them because I needed their opinion. That made the pictures richer. In many cases I got to know them very well. Normally you have to be quite dispassionate about the subjects you’re painting, and when it comes to assessing whether a painting is good or bad, the last person you’d ask is the model. With this it was the complete opposite.

Iain, how close do you get to your patients?

IH: The nature of the surgery means that I have long relationships with them. With cancer patients I’m reviewing them for the rest of their lives. I enjoy having close relationships with them, I think it’s very important.

Is that unusual among surgeons?

IH: I can think of general surgeons who do form strong relationships with their patients, though I’d say they were the exception. Being professional and being dispassionate in the sense of being able to treat people doesn’t mean that you’re cold and you don’t show warmth and emotion. It just means that when you come to the crunch of operating on someone, you don’t go to pieces emotionally. You have to understand people in order to treat them. It isn’t enough to say, “Right, you need this operation and we’re going to do it tomorrow.” If I have to tell a patient that their problem is cancer, in that moment their whole life changes. You have to communicate, to see the person as a whole and not as a walking cancer. Facial surgery is probably the most dramatic thing these patients will have encountered. Any surgery is a terrifying experience, but imagine surgery where you know your jaw is going to be split, where you’re having half your tongue removed, where you’re having bone taken from your hip and put in your face. These are huge operations. Personally, I’d be scared if I had to have an in-growing toenail removed.

Did that intimacy feed into the art?

MG: Absolutely. They were all very frank and open. But it was also to do with the strong relationship that I was having with them. This was as much to my benefit, because I wouldn’t have been able to do the paintings if I’d felt I might be upsetting them. I needed them to reassure me that I was doing the right thing, especially since the images I was dealing with were so graphic. I felt incredibly anxious that I might be stepping over the mark, so that familiarity between me and the patients was crucial.

How much of a cathartic effect did the paintings have?

IH: It has been incredibly dramatic, so much so that we got a psychologist in to study the changes. I thought that seeing the paintings might have some kind of cathartic effect, but I didn’t account for the effect that would come from simply sitting for the artist.

How do you explain that?

MG: They were in a safe environment, working on a one-to-one basis with somebody who was incredibly interested in them. They found that pleasing. They could talk to me about their experiences, and I could talk to them about what it was like seeing them in the operating theatre-what was happening around them, the music that was playing in the background, and so on. They always asked about the other people I had already painted, they enjoyed hearing about them. Obviously I had a different kind of relationship with them to Iain’s, and in many cases they were telling me things that they hadn’t told him about the treatment. I could go to Iain and tell him about their anxieties.

How much did they want to know about what happened to them during surgery?

IH: Some patients like to see photographs or a video of their operation because they become curious after discussing it with Mark. The psychologist says it’s a kind of coping mechanism. It’s the patient saying, “I can hack this.” Some patients carry around a photograph of their painting and when they go into a pub and someone asks about the scar, they’ll bring out the photograph and show them.

It’s one thing to have your portrait painted, quite another to have it exhibited. How do the patients take to that?

MG: As far as they’re concerned, the more people who get to see the paintings the better. They seem to feel that the paintings are doing a job on their behalf. Some patients don’t like looking in a mirror and they don’t like looking at photographs of themselves, but they love the paintings. They look at the picture of them painted during their operation and say, “That’s the lowest point of my life and I’ve got through it.” Because they feel that way about them, they’re happy about them being exhibited. It gives them a sense of empowerment: not only is it going in an exhibition, it’s also touring the country.