Caroline Wellbery, MD, PhD
Dept. Family Medicine, Georgetown University, Washington, DC
Robert Pope (1956-1992)
Charcoal on paper, 184 x 80.7 cm, 1991
Robert Pope, early in childhood a student gifted in science, chose art as his career, and no one better melds the observing eye with the understanding heart. The shadow of cancer hung over him during the most productive years of his life: he died of Hodgkin’s lymphoma at the age of 35. He created a major body of work exploring his own illness, the illness of others, and the nature of illness itself. Towards the end of his life, he completed Aesculapius, which in size and scope represents the conclusion of his struggle against death. Even if the drawing did not bear a date, the viewer would know upon close analysis that death was near. The following essay provides such an analysis, and goes further to show how, in the observation of an artwork, description, interpretation and emotional connection form a continuum. Careful observation is now recognized as relevant to the development of a range of professional skills, including clinical description and diagnosis in medicine.1 Thus this analysis offers both a close visual ‘reading’ of Pope’s drawing and a demonstration of how the process of looking leads to a nuanced and engaged understanding of the afflicted other.
Perhaps the most striking formal feature of Pope’s drawing is its geometry. A single line bisects the image into two fields of light and dark. Within this polarity there are small variants. The lighting around the head of the central figure is reversed, and at the top of the pole, a horizontal line bisects the vertical one, creating the shape of a cross. So immediately we see that this image, psychologically speaking, deals with division. Yet another formal feature, equally powerful, suggests a different psychological framework altogether. The image displays a series of folds, all of which flow from the periphery towards the single unifying center of the drawing, where they converge. That the flow represents an extracorporeal, life-giving energy rather than movement confined to the folds of the robe is subtly suggested by the furrowed IV bag hanging above the figure’s right shoulder. Thus within the drawing’s primary contrast of light and dark, we encounter a secondary contrast between the ‘hard’ or stark polarity of the IV’s horizontal and vertical cuts and the soft flow of confluent folds, suggesting conflict and reconciliation respectively.
Symbolically these polarities invoke different explanatory models of life and death, healing and redemption. The point where the folds converge coincides with the figure’s navel region, the omphalos representing the beginning of the world. The navel is the center, or axis mundi, connecting heaven and earth. This mythological allusion introduces a view of death as an integral part of life, offered perhaps as an alternative to the harsh suffering of the crucifixion. That Pope deliberately interwove mythological and Christian allusions is obvious from the drawing’s central symbol. The bisecting poles form a Christian cross, while the snake wending its way up the vertical pole clearly illustrates the Aesclepian symbol of the Caduceus. These two symbols whose matrix is the IV apparatus merge, since the vertical pole of the cross and the Aesclepian rod are one and the same. By superimposing these two traditions the artist implies that he has found enrichment or comfort in both; but he could just as readily mean to say that neither tradition has fully addressed his experience.
So what about the central figure, who behind the IV pole stands cut in half, head bowed? We know he is a patient, for he is dressed in a robe and, of course, the IV pole reinforces this interpretation. His head is shorn, or more likely even, hairless from chemotherapy, while strong hands wrap themselves firmly and symmetrically around the body of the snake. Behind him, a dark fluid drips from the IV bag. It could be blood, but it could also be doxorubicin, a chemotherapeutic agent known for its bright red hue. Either way, the fluid indicates that a beneficial, life-sustaining treatment is underway. Or is it? Perhaps here, as elsewhere in this nuanced drawing, ambiguity reigns, given the known toxicity of chemotherapy. This ambiguity is yet another expression of the drawing’s psychological complexity, as it keeps exploring the meeting of opposites, beginning and end, comfort and agony.
Part of that complexity stems from the patient’s internal struggle with the prospect of death. Take for example the patient’s lowered head. Given the Christian iconography of the cross, this gesture could represent prayer. At the same time, the presence of the snake as the harbinger of death implies that the bowed head is a sign of depression or defeat. The drawing’s formal contrasts underscore these deeper emotional ambiguities. Light and dark, hard and soft—these elements frame the interplay of conflicting emotions. Even the use of charcoal itself seems to add to this series of visual and emotional contrasts—charcoal’s black-and-white emphasizes the binary constructs previously mentioned while also mitigating them with a comforting softness. In short, all aspects of this drawing, in form and content, suggest an ambiguity arising from the patient’s assumed battle with hope (light, integration, medicine, prayer) and despair (darkness, separation, death, depression).
We are now ready to explore the meaning of the caduceus as represented in the image. There is controversy not only about the symbol’s origin, but confusion about its actual representation—one version shows a pair of snakes on a winged rod and another depicts just one snake on a simple staff. Pope’s version has two: the serpentine IV tubing and the actual snake, alluding perhaps to the story of Aesclepius’ encounter with two snakes in mortal combat, one of whom kills and then revives the other.2 The Latin spelling of Pope’s title, however, suggests that his caduceus draws on Ovid’s account of Aesculapius, who comes to Rome in the form of a giant serpent in order to free its people from the plague.3 While recognizing the snake as a healing force, we must not forget that in both Greco-Roman and Christian traditions the snake is also a formidable symbol of danger and death. The combination of IV tubing and the snake’s literal figuration draws on this dual origin—the snake’s life-giving medicinal properties as well as its association with mortality.
Perhaps the most important clue to the artist’s relationship to death resides in way the figure interacts with the snake. The patient’s head is lowered—he is not looking at it. But the snake looks directly at him. It seems clear that the snake represents ‘death looking the patient in the face,’ even when the patient cannot bring himself to return the gaze. And yet, the patient is intimately engaged with the snake. He is in fact, embracing the snake, a verb that gains descriptive precision through another Pope painting depicting a couple behind an IV pole locked in each other’s arms.4 In spite of the fact that the patient is avoiding the snake’s gaze, the artist has done something quite unusual and quite powerful: he has made the snake into a benign creature. The eyes and snout are rounded and sweet like a stuffed animal’s. There are no fangs; there is no flickering tongue. This snake, as much as it bodes death, does not frighten.
What does this representation of a kindly snake tell us about the artist’s state of mind? Does hope, in this vision of contrasts, win out over despair? Of course, it is impossible to know what the artist was thinking, but I submit that this wonderful drawing represents Pope’s struggle and final reconciliation with death. True, Pope does not go gentle into the good night, to borrow Dylan Thomas’ words, but he does not rage, either, against the dying of the light. He is not quite ready to look at death directly, but it is there, for the viewer plainly to see. Indeed, the snake practically wraps itself around him, almost lovingly. This drawing evokes a fascinating dance between two deeply intimate figures, merging conflicting beliefs and emotions in a final acceptance of death’s inevitability. It does seem as though the omphalos mundi wins out over the crucifixion. Emotional pain no longer crucifies the patient but rather returns him to his origins, Pope seems to wish to convey, reuniting beginning and end.
This analysis of Pope’s drawing illustrates several steps in an interpretive process that can be applied more generally when looking at art. The interpretive act begins with a careful description of the image. In the descriptive process, meanings accrue, and can be justified by virtue of echoing elements intrinsic and extrinsic to the image. As the observation deepens, the emotional connection with the image deepens also. At least part of that emotional connection relates to a foundational act of engagement with the image, through which the artwork’s themes and subject matter enhance the viewer’s sense of relationship in varying degrees. Thus, art observation can be a useful educational tool, particularly as an alternative model of interaction in clinical settings where description is so often divorced from subjective investments. Art observation demonstrates not only subtle and encompassing awareness of artistic and thematic elements within the work, but also the seamless passage from objective understanding to compassionate engagement.
- Wellbery C, McAteer R. The art of observation: A pedagogical framework. Academic Medicine. In press.
- Wilcox R, Whitham, E. The symbol of medicine: why one snake is more than two. Annals of internal medicine. 2003;138: 673.
- Ovid. Book 15. In: Metamorphoses, Ed. Griffith T. Wordsworth Classics of world Literature. London; 1998.
, MD, PhD, received her medical degree from the University of California at San Francisco in 1991 and completed her family medicine residency at Community Hospital, Santa Rosa, California in 1994. She had previously received a PhD in comparative literature from Stanford University in 1982 and has devoted her career to the integration of art, literature and medicine. She engages students through art exhibits, performances and workshops and has published on topics both in medicine and the arts. She is founder and director of an arts-in-medicine fellowship program and is committed to nurturing reflection and creativity in a professional environment.