Listen: Cardiologist Nazanin Moghbeli '96 on Brush Strokes and Treating Folks
This fall, Nazanin Moghbeli '96 spoke on her dual career as an artist and a physician. Moghbeli is assistant professor of cardiology at the University of Pennsylvania Health System and the associate director of the Women's Cardiovascular Center. She is also an accomplished painter whose work is currently on display at the Inn at Swarthmore. In her lecture, Moghbeli discusses her career journey and how she has combined her two passions.
At Swarthmore, Moghbeli was a double major in studio art and biology. She went on to earn her M.D. and her masters of public health at Johns Hopkins University.
Nazanin Moghbeli: Hi everybody. Thank you so much for having me, I'm delighted to be back here at Swarthmore to talk to you all today. I sat at the bedside of a dying man, who was hooked up to several life-prolonging intravenous medications, a monitor, and an oxygen tank. We were talking about a surgery, that would implant a mechanical heart into his body, to help his own failing heart pump blood to his organs, and keep him alive. The surgery was risky, particularly given his age, and other medical problems. He had to make a choice between a high-risk surgery, that had a chance of improving and prolonging his life, but could have serious complications, or to continue on medications knowing that he would not live much longer.
I asked him what his thoughts were about these choices, and what it was that he really wanted in the remainder of his life. He told me that he was fixing an old car in his garage, and he really wanted to go home, and finish the repairs so that he could drive it around the neighborhood. After more exploration of this and other things that he was hoping to do, he decided against the surgery, wanting to focus on improving the quality of his remaining days, and getting him out of the hospital.
I walked out of the hospital that night, after two weeks of being on call in the intensive care unit, and having other, similar conversations, with critically ill patients and families. The air felt fresher, my head was clearer. After days of being given the privilege to care for people in a time of extreme vulnerability, both medical and personal, I felt not empty, as some might describe, after so many long hours in the hospital, but filled with bits of conversations, emotional moments with families, and critical junctures with patients.
I took this feeling into my studio the next morning, when I returned to painting after two weeks of being away. How did I get to this point? How is that I can take these incredible moments of doctoring into the studio, and use them in my artwork? How is it that my own experience as a painter, helps me to understand when my patient tells me that he wants to go home and finish his project in the garage? This is the journey that I hope to share with you today.
I've always been fascinated by biology, because it is such a visual field. Learning about cell structure, embryogenesis, and the physiology of the circulatory system, often involves visualizing processes that we do not see with our eyes. It requires a curiosity about how things work, a desire to understand the mystery of nature. This curiosity for biology started at an early age, when my dad would take me to the hospital to make his rounds. At the same time, I was constantly drawing, painting, making art in my spare time, encouraged by my mother, who was an artist, who is also here today.
When it was time to apply to college, I told my parents that I wanted to go to art school. They questioned my desire to devote my whole life to art, asking how I would feel to never do science again, and what it would feel like to give up on my idea that I had talked about, about becoming a doctor. At that time, although I loved biology, and was extremely curious about the human body, I was more interested in cultivating my skills in the arts, of delving really deeply into my creative side.
We compromised. In other words, they didn't allow me to apply to art school. I chose a college that would enable me to explore simultaneously, my interest in biology and in art. One where I would not be required to drill down immediately on one subject, and leave the rest of myself at the door. I ended up where you are all now sitting, 20 some years ago.
I spent my days going from the biology lab to the art studio, from McCabe, to Beardsley, to the Crum Creek with my paints. I remember one afternoon, I called my parents from the library in tears. There were probably several, but I remember this one in particular, panicked about an upcoming organic chemistry test, what else? I don't remember what they said to encourage me to leave the library, but I did, and I do remember walking out of there, my books all spread on some cubicle in McCabe, and heading to my studio to paint.
I had large canvases going at that time, and was making abstractions of landscapes that I had painted, and the [inaudible 00:04:45] sketches I had started, and then taken into my studio. I remember feeling, literally, rescued by the painting. The feeling of the paint on my brush and on the canvas, undid knots of stress that hours of studying had created. On the flip side, I remember feeling stuck in the studio, unable how to figure out how to make the next painting, and heading to the bio building to talk with Scott Gilbert about my upcoming embryology test. He retired a few years ago, so I don't know if you've had the chance to have him.
Inevitably, we would diverge into conversations about the mysterious, and beautiful process of creating an embryo. He talked to me for hours about the close link between art and science, and embryology specifically. He recently sent me an article that he had published, that summarized these hours of conversations, and I was so delighted to read them. I want to share with you the opening paragraph. The article is called, Looking At Embryos, The Visual And Conceptual Aesthetics of Emerging Form.
And I quote, "The title of this article, implies that there is an aesthetic of living organisms, and that the aesthetic of embryology differs from those of other areas of biology. First, we believe that one can seriously discuss the aesthetics of the embryo, much as one would discuss the aesthetics of an artist's creation. Terms such as symmetry, balance, pattern, rhythm, form, and integration are crucial in both disciplines, and are used in similar fashions. The scientist observing the embryo, can act analogously to a critic, and the different sub-disciplines of biology, are not unlike different schools of literary or art criticism.
Indeed, all of our knowledge of the cell is based on interpretations of visual abstractions. Different stains and lenses, emphasize different structures in the cell, and autoradiograms are used to imply functional relationships. Centrifugation analysis of cell components, also gives us radioactive and enzymologic data, that are then placed onto a map of the cell."
You guys should read this article, I'll send it to [GiGi 00:06:59], and she can post it, it's a fantastic article. While these disciplines seem to complement each other at my time at Swarthmore, I often felt torn between the two. I wanted to have more time in the studio to paint. More time to go into the city, and go to museums, and galleries, but my time was really constrained by my pre-med studies.
As this co-existence of science and art continued for me in medical school, by day I took anatomy, and dissected the human cadaver at Hopkins in the lab, and in the evenings, I went to the Maryland Institute of Art, and took life drawing classes, or open studio sessions, or whatever else fit around my crazy schedule. My parents, to their credit, really encouraged me to do this, which was insane, but I did do that.
I sketched pictures of what I was seeing in the hospital, and what was experiencing, and one thing that really, really profoundly had an impact on me both in terms of the medicine, and the art was childbirth. I got to deliver babies in medical school, and this was a really powerful experience for me. I did some drawings about this process, and these are really sketches that I did in medical school, while I was doing my variance rotations.
After medical school, I got married and started an internal medicine residency in Boston. I still took occasional art classes, but this became almost impossible to do with my call schedule. For years, I painted very little, and almost none, but I was always going to museums, galleries, and studios, keeping myself very engaged, in looking at, and thinking about art, even when I had no time to make art. This was really key for me, and a lesson that I carried with me throughout, because it showed me how to stay connected, even if by a very thin line, by continuing to train my eye, and stay engaged.
Even now, when I have very little time some weeks, when I'm busy with work or family, I remember that time in residency, which was probably the most challenge with terms of demands, and how I was able to really continue my engagement with art, just by looking at art, and experiencing it that way. Today, I have a family, I have three little kids, and a career as a cardiologist. I have always chosen a work situation in which I could work part-time.
At first, couple days a week, and this was mainly to be with my kids when they were younger, to be able to be with them several days a week, to be there in the afternoons, and to build my practice at a pace that was sustainable, keeping up with the 80, 90 hour workweeks of residency when I had young family, really wasn't sustainable. My motivation initially, was to work part-time, to allow more time for my family.
As my kids have grown, and my situation has changed, I now still work part-time, but I spend Mondays and Tuesdays in the studio, and Wednesday, Thursday, Friday seeing patients. It's a perfect balance. For four weeks out of the year, I work every day. I'm on all call every day for two week blocks, in the intensive care unit. This is still my favorite part of cardiology, despite the long hours, because I find a contrast between being immersed in the world, exact science, and the critical moments with patients, really complementary to the quiet stillness of my studio, and the work in my studio.
My artwork becomes about releasing exactness, about being in the moment, trusting my intuition, and trying to remind myself that the stakes are not so high. If I make that painting, no one will die. I find that one of the most challenging parts of being an artist, is putting so much pressure on yourself to create the perfect piece; the one drawing or painting that really says it all, right? That the body of work that will be recognized forever as something worth seeing. We bring these pressures to ourselves when we face an empty piece of paper, or a canvas.
I remind myself that there are hundreds of thousands of artists with way more talent than me, spending every minute of their waking life at work in their studio, and feeling that pressure. They have the advantage of having all this time to really delve into it, but also the pressure of having to express, and having to create. I feel at a disadvantage that I can't spend all of my time and mental energy on art, but I value the distance that this creates for me, and that allows me to be more experimental, more free, and to really put the process of art-making at the center of my work as an artist, and less emphasis on critical success, although that would be nice too.
Making art gives a sense of meaning to my life, that I believe makes me a better doctor too, and helps me to connect with people. To hear their goals, and integrate these personal goals into their care plan, and not just forge ahead with a treatment plan that I think is best for them. Art provides respite for me, and keeps me from being burnt out. As a physician, I have a large community of colleagues with whom I work and talk regularly, about complex patients, or recent scientific advances.
As an artist, I'm more isolated, without the advantage of a community to readily draw on. I spend a lot of time and energy cultivating relationships with people, with fellow artists, and mentors, and old professors that I had, to really try and stay engaged in the community as much as I can. For example, I have a standing monthly crit with a friend who is a photographer turned painter, by the name of Rita Bernstein. We get together a few hours every month, we commit to a two or three hour block every month, where we talk about each other's work, give each other critiques, share artists that we like, articles that we've enjoyed reading, and really try to help each other stay intellectually connected to our work, and to the community around us.
I'm also fortunate to maintain some relationships with former art professors and mentors, for example Andrea, who's here, Andrea Packard from List, Randy Exon, and Celia Reisman, who are former professors in the art department. They periodically look at my work, and give me constructive feedback, which is invaluable to my process. I'll put Andrea on the spot here, and give you an example.
A few years ago, I was showing her some of my work, and she was giving me feedback about what I was doing, to help me identify what I was doing, what I was hoping to do, and where I was going with this body of work. She said to me that my lines were weak, they were quiet, they were not strong, they didn't seem tuned, as in a ... She gave me the example of a musical instrument, that when you tune an instrument, you can really hear the note that is tuned, once it's tuned, right? It vibrates until you hit the right tune, and lines are the same.
She gave me this great analogy that really resonated with me, and helped me understand that yes, it's true, that my lines are very ... They're beginning, they're starting, and I need to really tune them, and really practice them. It actually reminded me of some of my mom's work too, and I'll show you a couple examples. My mom's a calligrapher, and she spends hours, hours, on every single letter, perfecting it, practicing it, until she captures the essence, and then making the line with confidence. That's really at the heart of calligraphy, is the repetition, and then the confidence with which you write what you're going to write.
With that, I'm going to show you a couple of examples of my work. This is my mom's piece, and it's a word in Farsi, which is the Persian language. This kind of work has really inspired me, because of the linear beauty, the fact that it's simple, it's lyrical, and so I use the same calligraphy materials that have been used for centuries by Iranian calligraphers, and I abstract the letters to create drawings. This is an example of that.
I take one letter at a time, and I practice it, and I really try to get the essence of the form. Once I feel like I've gotten the form, I let it go, and see what it becomes. I'm not trying to write anything, I'm not trying to copy a gorgeous piece of calligraphy, I'm trying to use that movement in a way that's expressive for me.
This is another example of what traditional calligraphy looks like. It's a very rigid discipline. There's a lot of practicing that goes in, and all the spacing, and the way the lines are drawn are scripted, so you have to follow the rules in order to write it in a way that's been passed down, century after century.
I work while listening to traditional Iranian music, so there is a musical quality to the forms on the paper. I pay attention to the rhythm of the line, its tempo, its overall melody, and the spaces between the phrases. I return to the ancient Arabic metaphor, which is that calligraphy is music for the eyes. These are some examples that I share with you.
Recently, I've been experimenting with working with clayboard, which is a great surface for ink, because you can really build on it, you can scratch away, you can wipe down with water, and really create a lot of different consistencies and textures, without losing the form. These two are clayboard. I've also been experimenting with scanning and printing some of my work, and then working on top of them to see what happens over time, when you layer lines on top of each other using different media.
Switch gears here, my current series is based on the blood circulation of the human heart. My daughter, who's 12, read this talk, and she said, "Mom, this gets too technical, you need to explain it." So I'm going to break it down for you here. When someone has a pain in their chest, suggestive of a heart attack, they have what's called a coronary angiogram, which is what this is. It's a moving X-ray of the arteries of the heart. A contrast dye is injected into an IV that's either in the arm or in the leg, and an X-ray camera is placed above the patient who is lying flat on the bed. When the dye is injected, and it moves through the arteries, the cameras take a picture, and this is what you see.
The ink is opacifying the blood vessels in the path that blood is going. Wherever there's blood, the ink goes, and opacifies. If the arteries are normal, the dye goes and fills all of the arteries, and every single part of it. If the arteries are not normal ... I guess I did need a mouse after all. See where it says 75%, how it's narrowed, do you see that area? If someone has a heart attack, it means that there's an aclusion of either clot, or plaque, cholesterol build up, different things that can stop the flow of blood, and that causes the pain, and that causes the heart attack.
With these angiograms, we can identify when that pain is related to an actual narrowing in the artery. This is another example. You see where the arrows are, and there's no blood flow there, so that's an example of a heart attack, or a myocardial infarction. My work as a heart specialist, I look at all these images many times in a given day, and I use the findings to guide my diagnosis and treatment. As an artist, I see these angiograms as drawings, and I want to render my own version of these drawings.
The flow of ink, and how quickly it moves on the paper, depends on the tool, on the absorbency of the paper, and the thickness of the ink. This is very true and analogous to the flow of blood in the heart. The factors being speed, how fast the blood is moving, and the thickness of the blood, so whether there's a disease that is causing the blood to be thicker, and the blood vessel itself, and whether it allows blood to flow freely, or if there's a blocked artery that causes the flow of blood to stop. There's a real parallel for me, between the movement of the ink on paper, and the movement of the blood through the arteries.
This new work that I'm doing is really reflecting some of these thoughts. Let me show you ... This one was the first one that I did, and I did it in a trance, I wasn't really thinking. I stepped back, and I did another one, and it was this one. I hadn't really thought about this idea of doing these drawings based on the angiograms until I did these two, and I realized that actually, there was some part of my subconscious that was ready to make these drawings. I really did make them, and then step back and say, "Oh yes, this is what these drawings are."
That was a great moment for me, because I felt like I came to the images very naturally, without a lot of thought, but that they were based on hundreds of hours of looking at angiograms, and integrating them into my practice. I've now started to do a lot of these. There are also a lot of conceptual parallels. The movement of ink on paper, is what gives the paper life. Quite literally, the drawing comes to life when you draw on it with ink. Similarly, the movement of blood through the arteries gives live to the angiogram, to the drawings, the X-rays, and also to the patient. There are a lot of common conceptual themes that I'm exploring. Visually, this very much follows my calligraphy series, because of the exploration of different kinds of line.
What did I learn so far in my attempts to engage in both science and art? Well, I'm learning to trust the seemingly divergent paths that present themselves in my life. I'm learning to stay open to opportunities that come up, even if they don't fit into my pre-determined notion of what my life should look like, and I'm learning not to finish this story with the narrative that seems most desirable, or even logical, but to leave it open, and to approach my life with curiosity and creativity. Thank you guys very much.