Florence Gelo
Philadelphia, Pennsylvania, United States

On a recent excursion to the Philadelphia Museum of Art for a themed tour, medical students gathered to look at paintings of suffering and healing. For this medical humanities elective, led by faculty members, each small group viewed these images, using a discussion guide to elicit their responses.

Our tour began with Prometheus Bound, an oil painting by Peter Paul Rubens. Prometheus is being punished by Zeus for giving the secret of fire to man. On his back, Prometheus is chained to a rock on Mount Caucasus, naked and exposed. Prometheus is stretched across a rock while a gigantic eagle, a symbol of Zeus, hovers above the full length of his body. The angle of his body appears precarious, as if he could fall headfirst. His left hand is chained to a rock on a mountain top. The talons of the eagles’ right claw are forcefully gripping Prometheus’ creased forehead. A second talon grips his lower torso. The eagle is tearing and eating at Prometheus’ liver by day, which will grow back each night.

What is often not mentioned or described by viewers are Prometheus’s legs and particularly his feet. The heel of his right foot is pressed against the rock, the big toe is tensed and stretched apart from other toes. Prometheus’ ankle is bent, and his other foot is flexed upward. The position of Prometheus’ feet expresses intense pain.

I asked students to look carefully at Prometheus’ extended right foot. I invited them to assume that position with their own foot. I asked, “what is that foot telling you?” One student said his foot was trying to “get away.” Another student recognized that his foot was “tense.” I offered specific examples of patient pain caused by removing stitches, inserting an IUD, or when assessing an injured joint. A patient may grip the sides of the examination table and toes may tense and curl until the procedure is over and pain is diminished. These nonverbal expressions of the body and feet portrayed in a painting can teach medical students how pain appears and shapes the body of their patient.

What began as a tour about suffering and healing in works of art focused on how the body and nonverbal gestures can communicate powerfully to clinicians who have learned to notice. Though expressions of pain are individual, a physician who sees movements that might signal pain or discomfort can then ask the patient, “Are you okay?”

The next painting on the tour was Massacre of the Innocents by Pacecco de Rosa (Francesco de Rosa). The painting depicts the biblical story of King Herod’s order to kill all boys under the age of two born near Bethlehem to prevent the reign of the Savior and “King of the Jews.”

We approach a large canvas about six feet tall and ten feet wide. At the top of the painting, a grey blue sky holds a few brown colored clouds. The rest of the canvas is crowded with the savagery of slaughter, powerful soldiers killing and mothers shielding, fighting, or mourning the slaying of their infants.

In the lower left corner, a mother cradles her child on her knee, her left arm tightly stretched upward, her fingers spread out as if bargaining, pleading, or shielding her son. Her anguished face looks upwards. To the right, a mother holds the limp arm of her infant. Her head is turned downward toward her infant pierced by the sword. At the far right, another mother is fighting with a soldier, her right hand behind his head, her left hand gripping the blade of the sword suspended in the air and pointed down to her infant, who is forcefully held down beneath the blade by the soldier.

The painting’s large size, imposing composition, and dramatic portrayal summoned students’ responses. One student commented on the paradoxical beauty of the painting given its chaos and horror. Another commented on the terror on the faces of the mothers protecting their babies from slaughter. Another remarked on “how easy it looks for the soldiers to kill.” Student comments focused on the faces and actions of the mothers and soldiers, not on hands or other parts of the body.

Later in the tour, we approached The Crucifixion, with the Virgin and Saint John the Evangelist Mourning, a painting displayed on two side-by-side panels with a vibrant red background on each serving to highlight the figures. In the right panel, Jesus is presented with head lowered, eyes closed, nailed to the cross. A crown of thorns sits on his head. His arms and torso are stretched and stressed with the weight of his hanging body. He bleeds from a wound to his side. On the left panel, the collapsing Virgin Mary faces her tortured son, hands clasped as if in prayer or pleading; she is held up by the arms of John. A red background intensifies the image and action.

I asked the students to describe Mary’s face in the left panel. Students recognized pain and anguish. Then I asked students to focus on her hands and what they might be communicating. Responses included clasped hands, hands praying, nervousness. I then asked students to compare Mary’s hands to images of hands we had seen only minutes ago in the painting Massacre of the Innocents.

One student summarized the event by saying that it was a “conflict between the soldiers and mothers.” When discussing the conflict depicted in this painting, students recalled several images of women’s hands trying to stop or block soldiers, shielding their children, or cradling their dead infant.

Together, we discussed the importance of recognizing gestures, movement or position. Gestures tell us something that is crucial to whole-person care. Gestures communicate the body’s physical and emotional relationship to pain.

In the practice of medicine, body language is a crucial tool to understand a patient’s nonverbal communication. Looking at art can cultivate this essential clinical skill.