Monday, 31 January 2011

Modern surgical practice: more fruit than phalanges

The following article about Operation Orange is by Heather Casey and appears in the February 2011 issue of the Royal College of Surgeons of England journal, Bulletin. The issue is dedicated to John Hunter, the "father of modern surgical practice". The cover features a portrait by Joshua Reynolds, from which Hunter, in fashionable ear-muff curls and deep red velvet, looks out with a Mona Lisa smile (possibly thinking of the giant toe phalanges on the shelf behind him). The Hunterian museum is named after the surgeon and is full of weird and wonderful — and sometimes revolting — medical and anatomical artifacts from Hunter's own eighteenth-century collection. Fast forward a couple of hundred years...

Operation Orange
A wave of laughter ripples around the table when it becomes clear that the consultant surgeon in the group is struggling to remove the ‘nipple’ of his orange with his pink craft knife. Before long Kelly Stevens, workshop host and patient of Sheikh Ahmad, interrupts saying: ‘the next step will be to scoop out the flesh of our oranges, if Sheikh gets a move on.’ Sheikh holds his hands up in response: ‘Give me a break; I’ve been awake for 32 hours straight!’

Ann R Coll Surg Engl
(Suppl) 2011; 93:52–53

Sheikh Ahmad and Kelly Stevens
Photo courtesy of Catherine Leyshon

This friendly, informal exchange between patient and surgeon epitomises Operation Orange, a breast cancer awareness group-cum-craft workshop established with the mission of helping women in Cornwall understand breast surgery and reconstruction. The initiative is the brainchild of Kelly Stevens, an avid blogger who has brought together her experience of surgery, open and honest conversations with her surgeon and an inspirational visit to the Hunterian Museum, to set up a forum in which patients and their families and friends can learn about breast surgery using craft.  

Kelly was diagnosed with high-grade ductal carcinoma in situ (DCIS) in December 2009 and after referral and discussion with Sheikh Ahmad at the Mermaid Centre in the Royal Cornwall Hospital, was advised to have a mastectomy and immediate reconstruction in February 2010. At the time of surgery she was studying for a MA in professional writing and had come across the work of Edward Humes, a journalist who had written a book on a neonatal intensive care unit in California.  Kelly decided that she would ‘do a Humes’ on reconstructive and oncoplastic surgery for breast cancer, approaching Sheikh to help her explain DCIS and reconstructive surgery.

During research, Kelly grew confused about a slow-healing wound in her back – during her breast reconstruction tissue was replaced with the latissimus dorsi muscle – so she asked Sheikh to describe the procedure she had in detail. ‘Three months after surgery I had a hole in my back that just refused to heal and Sheikh started drawing some pictures to help show me my surgery. The way he described it to me sounded like an orange being scored,’ she explains. ‘I had been given the patient literature and seen the diagrams about what was going to be done but it really went over my head and didn’t sink in at all. It wasn’t until I’d had this visual experience with an idea of an orange that I started to get it.  Knowing this, Sheikh went out and bought an orange and sculpted it to show me exactly how the hole in my back was created.’ 

Elated to finally understand her operation, Kelly posted pictures of the carved fruit on her blog and began researching the craft of surgery. Through a friend she read an article in The Guardian previewing All Stitched Up!, a craft event held in the Hunterian Museum in which craftspeople and surgeons swapped suturing skills. ‘I had just started to think about how my surgeon had closed up my breast – was it glued? Or was it blanket stitched? And then I read about this event. It seemed like a great opportunity to go and ask the surgeons how they did my breast,’ explains Kelly. ‘So literally the next day I got on a plane and flew to London. The trip was really inspiring because it opened my eyes to seeing surgery in a completely different way.’

During the event in May, Kelly read a display in the Hunterian Museum on Wendy Jobber, a textile artist who said that she found it cathartic to stitch while undergoing treatment for breast cancer, and took part in a suturing class run by Akan Emin, a clinical research fellow at the College. She explains: ‘As a heart surgeon, Akan couldn’t tell me exactly which stitches had been used for my surgery but what he did say was that he had a huge amount of respect for oncoplastic surgeons because they had an amazing eye for shape and proportion. That got me thinking differently about Sheikh; no longer did I think of him as the person who mutilated my breast but I saw him as a craftsman and a healer, and started to feel much better about myself. I vowed there and then to do something and the next stage was starting my classes.’ 

Sheikh Ahmad (foreground) carving an orange
Photo courtesy of Catherine Leyshon

In July 2010, Kelly invited a group of friends and patients to her house to do some orange carving with Sheikh and hasn’t looked back. She has been invited to run workshops at creative festivals, speak at NHS events and has made links with Made For Life, a Cornish charity supporting people with cancer.

It is clear from watching the workshop that Kelly and Sheikh have a great doctor–patient relationship, which instantly puts those attending at ease.  Patients and non-patients alike feel comfortable to ask questions about breast surgery and enjoy the challenge of a practical task from a world to which they do not normally have access. But what does the consultant oncoplastic surgeon take away from the classes? ‘The workshops are enjoyable because I get to come out and speak to women who have undergone surgery away from the clinical setting and hear their opinions about things,’ Sheikh says. ‘For example, I’ve just flown back from the San Antonio Breast Cancer Symposium to this workshop and it’s exciting to be able relay the advances that are being made in breast cancer research and discuss with these women how that research could change treatment in the future.’

He adds: ‘Kelly is unique; she’s a very curious patient and amazing to work with. Plastic surgery is not easy to understand and most people whom we tell are going to have a reconstruction with the muscle, that’s it for them, full stop. But not for Kelly, she wants to know how exactly it is done and I think it’s good that she’s asking questions because through her work she’s creating this awareness of breast cancer and DCIS.’

Copyright The Royal College of Surgeons of England. Reproduced with permission.


  1. You are amazing, Ms. Stevens.

  2. Cor. Thank you! I've been overwhelmed by people's lovely comments.