Graphic publications help explain medical conditions to families, health care providers

Doctor with stethoscope
Valley News - Health

Mexican physician Dr. Cesar M. Alvarado and comics historian Ron Coleman collaborated for a March 6 San Diego Comic Fest panel called “Graphic Medicine: Using Comics to Understand Illness and Death.”

Alvarado and Coleman said that the intent of the panel – and the graphic books themselves – is to help family members and caregivers understand death or potentially terminal medical illness.

“The focus on modern medicine is putting aside all of these patients,” Alvarado said.

Alvarado, who is a general practitioner, explained that the focus of modern medicine is on healing rather than on dealing with patients who cannot be saved or the families of those patients. Medical professionals and other caregivers must also face patients who cannot be healed.

“Patients have very individual and unique experiences,” Alvarado said.

In addition to helping family members and caregivers deal with the death or terminal illness at hand, graphic medicine publications also prepare the readers for their own end of life which is inevitable in the future.

“You never save someone’s life. It’s always being extended,” Coleman said. “Ultimately, life’s a fatal condition.”

Coleman said that the graphic medicine publications provide human care rather than medical care.

Terminal illness or mortal injury often involves grief by the patient as well as by family members.

“It’s always something different for each patient,” Alvarado said. “We have to acknowledge that every patient has their own stories to tell. Humans are complex, so we have a lot of dimensions that need to be addressed.”

Coleman is originally from Los Angeles and now lives in Oceanside. He is currently a senior research scientist for Lifeline Cell Technology in Oceanside with a doctorate in biology, and before obtaining his bachelor’s degree, he was an emergency medical technician in Orange County. Coleman said that a patient being transported by an emergency vehicle is uncertain of their future even though medical personnel may consider the injury or illness moderate.

“For this person, this is the very worst thing that can happen to them,” Coleman said.

Medical personnel must balance the need for empathy with the need to provide healing.

“You can almost care too much that it breaks you apart, and you can’t care for the next patient,” Coleman said.

With an illness the grief phase is often prolonged, but in some cases patients and their families can’t work through the full grief process.

“Sometimes it’s really sudden,” Alvarado said.

Even if the patient himself or herself is unable to go through grief, others do when death occurs quickly.

“It affects people around the patient, not just the patient,” Alvarado said. “Grief is also about the family, about the health care team, and we need to be aware of that.”

Coleman added that he would like to see more education for first responders about dealing with grief.

The book “Mom’s Cancer” by Brian Fies is the author’s account of his mother’s terminal illness.

“When you’re reading it, you feel like you’re sitting with her,” Coleman said.

A comic book format allows that.

“They are, I think, one of the most personal media you can use to tell stories,” Alvarado said. “It’s easy to tell their story. We can better understand how to help you, and that’s what comic books can bring.”

Alvarado said that the comic book format also provides visual assistance to the reader.

“We want to respond with images they capture,” he said. “You can read the books, but you don’t get that same cathartic experience by seeing a picture.”

Mexicans and those of Mexican descent honor the dead with the annual Dia de Los Muertos festivities at the beginning of November but do not necessarily address the possibility of death.

“Mexican culture is about hiding death. We don’t talk about it. It’s taboo,” Alvarado said. “Eventually it’s going to be you. You have to be prepared for that.”

The graphic medical publications allow the reader to understand what might happen to them in the future.

“When you read this, you have to understand that you’re going,” Alvarado said. “We can project that mortality into ourselves and we can start preparing ourselves.”

Ross Mackintosh wrote “Seeds” after his father was diagnosed with cancer. “Seeds” places emphasis on the role of the caregivers.

“When care is given properly, it can be a positive experience,” Alvarado said.

Coleman’s father served in the Vietnam War, was exposed to Agent Orange and developed cancer.

“It was very important for me to go to a lot of the meetings with his oncologist,” Coleman said.

That appointment allowed Coleman’s father to obtain information from Coleman rather than from doctors.

“They didn’t have the touch,” Coleman said.

Doctors are not immune from emotions regarding seriously ill or injured patients.

“I want to forget all about that, but I can’t,” Alvarado said. “If that is hard for me, imagine the patient.”

Marisa Marchetto wrote “Cancer Vixen” after dealing with her own breast cancer, which she survived.

“This particular comic talks about how you have to deal with cancer being an active young adult,” Alvarado said.

Fies’ mother had lung cancer and was older, so “Mom’s Cancer” has a different focus.

“It’s more about the family and the social aspect of cancer,” Alvarado said.

Although the books are in comics format, they may utilize a serious tone.

“You have to know it’s your experience,” Alvarado said.

“These stories aren’t trying to say that you should feel happy or you should feel sad,” Coleman said. “They’re not trying to tell you how to feel. They’re just telling you how they feel.”

“Mom’s Cancer” is about learning to understanding the illness.

“They don’t understand it, and that creates anxiety and fear,” Alvarado said.

Humor may allow the reader to have positive emotions, and that is the case with “Mom’s Cancer.”

“It has that range of funnier moments and sadder moments,” Coleman said.

“You immediately get the sense of what’s going on,” Alvarado said.

The graphics are more important than the words.

“You’re telling a story with sequential images. It’s a unique language,” Alvarado said.

“You can give the family a common language,” Coleman said.

“I can identify myself with their story even though it’s not my own,” Alvarado said. “You can feel that emotion.”

In pages following the diagnosis of cancer “Mom’s Cancer” includes the reflections of Fies’ mother on what she might have done to avoid lung cancer.

“You don’t have to see every second of this progress,” Alvarado said.

“You see the flip from the healthy to the sick,” Coleman said. “The comic allows you to do that. In a page you can see her from being diagnosed to shaved head and chemo.”

Graphic books also allow for eye contact.

“Humans have this neurological drive to see eyes, to see people’s eyes,” Coleman said. “There’s definitely a strong ability to create an empathetic bond.”

Pennsylvania State University Medical School professor Michael Green now edits the graphic medicine section of Annals of Internal Medicine. Green and illustrator Ray Rieck produced “Betty P” about the ethics of resuscitating a terminally ill woman when standard medical procedure calls for cardiopulmonary resuscitation.

“It’s intensely personal,” Coleman said of CPR.

The CPR process included a noise which sounded like the woman’s ribs were cracked but was actually pressure on the cartilage between the sternum and the ribs, and the protagonist feared that he broke his patient’s ribs during the CPR process.

“They invite us to reflect about our approach to care,” Alvarado said. “It’s not your responsibility to save a patient. You have to treat.”

Joe Naiman can be reached by email at