MK Czerwiec

Steve Thomas:
M. K., welcome to Circulating Ideas.

MK Czerwiec:
Thank you very much for having me.

Steve Thomas:
I had Matthew Noe on the show previously, but to get all the listeners on the same page, can you give an overview of what graphic medicine is?

MK Czerwiec:
Yeah. Graphic medicine refers to kind of everything happening at the intersection of comics, the medium of comics, and kind of a discourse, practice and lived experience of illness, health care, wellness, medicine, nursing, all of the professions and all of us who are dealing with issues around our bodies. So there’s a lot there, and anything in that area that is done in comic form is what we call graphic medicine.

Steve Thomas:
And, why do you feel that graphic novels are a particularly good medium for telling these types of stories?

MK Czerwiec:
Yeah, there’s a lot of answers to that question. I think the one that I’m most really drawn to is the idea of, you know, what your writing teacher used to teach you in school, which is “show don’t tell.” And graphic medicine gives us the ability to show a wealth of information in a very efficient way, and then, you know, so that’s a really powerful tool when it comes to teaching, you know, the kinds of teaching we do as health care providers who need to get people to get information when they’re under stress all the way to a very, I think, therapeutic and helpful way to communicate information about caregiving and illness and experiences with those as well as, a great way to reflect on our experiences. So it’s beneficial to draw about what we’re going through as well as read other peoples’ accounts of what they’re going through.

Steve Thomas:
A lot of times you can express an emotion in a drawing in a very special way that doesn’t really come across through text like you can draw, like, the tears coming out of the head for crying and things like that. So there’s different ways of doing that.

MK Czerwiec:
Right. And it’s such a highly efficient medium, you know, just look on the face can convey so much information that it would take, you know, a thousand words to try to capture, but you know, the, the look on someone’s face can be so revealing and then bring into that all the different tools that the medium has, you know, thought bubbles versus speech bubbles. If you think about just an encounter with a healthcare provider, how powerful that could be to show what someone’s thinking as well as what they’re saying.

Steve Thomas:
I think a lot of people don’t think about how evocative lettering style can be. In prose, you’re reading, like, typed text, whereas in a comic you can have a character saying, “I’m queasy,” and have that written in a wavy font, so you’re getting the feeling as well as reading the words, whereas on the typed text on the page, obviously, and you can use different fonts but it’s not quite the same thing as like a hand- drawn or really well done computer-generated lettering.

MK Czerwiec:
Right, right, right, right, so that I could answer that question for forever. I mean, there’s so many interesting things that comics do within the realm of health.

Steve Thomas:
You are also a nurse and go by the pseudonym, Comic Nurse. So which came first drawing or nursing? Did you like drawing when you were young?

MK Czerwiec:
You know, when I was little I liked to draw and I liked reading the newspaper comics, but I was not the kid who could draw and in grade school was discouraged from doing that as many of us unfortunately are, and so I left that behind. But then, so the nurse came first in terms of, in the term Comic Nurse, and I picked it up later and kind of out of necessity.

Steve Thomas:
Can you talk a little more about that necessity there? What led to this career of combining drawing and nursing?

MK Czerwiec:
Yeah. So I was working as a nurse during the AIDS crisis in Chicago on a dedicated AIDS unit. So all of my patients, at that time, in the mid-, basically through most of the 90s, all of my patients were really struggling and suffering and were young and were dying of their disease. We didn’t have anything really that would stop the virus and so stop the infections that they would die of. And that was really hard as a provider of care. I was very connected to the community and to my patients and their families. And to know that, that every one of them was going to be going through such a difficult thing, it got to a point of me thinking like, how do I stay connected and still provide care in this arena? And so I would write, you know, my bachelor’s degree was in English and philosophy and I would write to try to process those experiences, and then I would sort of do these drawings, but neither one of them felt like they were doing the job. And then one day I stumbled into making comics, and I kind of just drew myself and put some words and put a box around it and then made another box, and I thought about Lynda Barry, who was a big influence on me in college. I just have always loved her work, and I remembered that those comics were not always funny and that this could work. And then really literally, I’m doing what I’m doing today, this many years later because that day, a nine panel comic really helped me figure out how I was going to cope with what we were all going through at that time. I would just keep making comics about it and it was very powerful and it helped me discover the power of the medium. And so then when our unit closed, when we had drugs that can keep people out of the hospital, I kind of thought, well, what’s next for me? And I went to grad school and studied things about story and why story works in healthcare and the importance of story in healthcare. And during that time came across, Brian Fies’s “Mom’s Cancer.” And that just put it all together for me because he does such an amazing job in that book of showing the potential for the medium when you talk about health care. And that was it. The rest is really the last 10 years. When I graduated from my masters, with the field I was in, was medical humanities and bioethics, I thought I would, you know, keep making comics and I wanted to study that to make better comics. I had no idea that this field was going to just kind of explode. So for the last 10 years, it really has been my next thing. It’s been my kind of full time job, you know, teaching and lecturing and making comics. It’s just been an amazing, amazing experience to see how it’s really just taken off.

Steve Thomas:
Those original comics you did sound like they were very therapeutic to you personally. So why did you decide to start sharing them and when did you decide to start sharing them?

MK Czerwiec:
Yeah, some of them were, a lot of them were just for me, like how am I going to process the grieving or process the confusion or frustration? But then I kind of realized like, you know, I had always wanted to have a place in the arts. I thought I was going to be a writer when I got that first degree, but that didn’t really happen, and plus I realized I kind of hated writing, but I enjoyed the process of making comics and I felt like I kind of had a little bit of a knack for it. And so I had, you know, when you first could set up your own websites, probably like the later end of when you could set up your own websites, I had set up this site, Comic Nurse. And so I started putting a few of my favorite ones on there. And then I really realized like, to get better, I had to just do the work. And so having that, you know, kind of a weekly comic and developing a following, helped me make sure I had some accountability to get the work done. And so I would just keep doing that. And yeah, it’s just kind of evolved from there.

Steve Thomas:
When did you decide you wanted to put them together into a book? Your first book was called Taking Turns. When did that… when did you decide to put that together?

MK Czerwiec:
That was kind of an aspirational project. I always knew that I wanted to make comics about the kind of caregiving that we were able to do during the AIDS crisis that was very connected and very kind of community-oriented. There was something very unique about the way we provided care there. And I knew I wanted to make comics about that. And so that’s why I… a big part of why I was enrolled in my masters program because I knew I wanted to do a project like that, but it was in kind of doing research for the book that I discovered that the history of this particular unit that I worked on in Chicago where thousands of people had come through and so many of our patients died. I discovered that the history of this place hadn’t been formally recorded anywhere. And so that was what really drove me on. I conducted an oral history. And then I figured out a way to integrate that oral history, which was my thesis project, with the memoir comic that I wanted to do. And I kind of put those two things together.

Steve Thomas:
You talked about reading things like Mom’s Cancer. When did you realize that graphic medicine was, like, its own thing? Like a subgenre of graphic novels?

MK Czerwiec:
Yeah. So interestingly, it was in parallel with my colleague Ian Williams in the UK, his book is called the Bad Doctor, and he just released his second book called the Lady Doctor. He, believe it or not, this is such an amazing parallel, was in the UK working as a doctor and getting a degree in medical humanities also right around the same time. And he had come across Mom’s Cancer also and it made him realize the same thing. And so he set up a website and through that website, he was contacted by a doctor and a literature scholar at Penn State who had also been thinking along those lines. And then, I discovered him, and it was sort of a bunch of momentum started from there. And then, you know, he coined the term “graphic medicine” when he set up a website to sort of catalog the question that all of us had asked that number one, could this be a thing, right? Could you seriously contemplate the use of comics in the healthcare arena and two, are there more books out there? Like, so, Mom’s Cancer is amazing. What else is out there? Are there other books that are nonfiction that really kind of convey the lived experience of illness and caregiving, that we could use in health care? And so that kind of all came together and then, you know, we didn’t invent it by any stretch of the imagination. It was something that I think already had momentum, but people were doing it in their own kind of quiet way, and maybe were a little sheepish about the idea of talking about it. And then the snowball just started gathering. They had our first gathering of people in London in 2010 I believe it was, and then since then we’ve had annual conferences where people come from all over the world to talk about, you know, what this means where they’re from and how they’re using this in healthcare or how their comics are being used and things like that.

Steve Thomas:
And then in 2015, you and Ian and some others got together to write the Graphic Medicine Manifesto.

MK Czerwiec:
Right, right. Yeah. We had had the idea that, you know, we wanted to kind of put a stake in the ground and say this is what we think this could do. We’d like to be taken seriously even though we’re using comics, but also the idea was that we wanted to kind of have a little bit of a theoretical background, which you find in there and then each person approaching it from their own perspective and then some samples. Right? So we had thought about doing an anthology and then thought, well, what about if we just tie a few examples and show from those graphic memoirs, you know, share those examples with our chapters talking about how we’d like to see this done. Yeah.

Steve Thomas:
In your chapter of the book, you talk about drawing as a social practice. Can you talk a little bit about that?

MK Czerwiec:
Yeah, so my chapter is called the Crayon Revolution. And I say that because kind of tying back to what I was saying earlier, I feel like so many of us left images behind using images and drawing and thinking in images behind in school. Because we had words and we were, you know, we were told to use our words and there’s this primacy of texts through our schooling. And I think that we leave something really important behind. And so the reason I used crayons because I think people, it takes people back to that place in childhood where they felt comfortable and safe, and also it takes a lot of pressure off, you know, the ones expected to create Picasso with a crayon, but the truth is we all still have a basic visual language that’s ours and ours alone. And what I want to do is encourage people to use it in a way that will help us teach and learn and reflect through images. And I think that, you know, there is something you come to understand through drawing that you might not have really come to or thought about in the same way because of the time it takes because of the, again, engaging with images, you know, our memories are images, the way we process the world in many ways is through images. And so, yeah, that’s kind of what I’d like to see people do. You know, in healthcare, in medical school specifically, I teach at – one of my teaching gigs is at a medical school – and we often use reflective writing to get people to kind of think about the struggles of having, you know, in being a healthcare provider, in becoming a healthcare provider. But I liked the idea of reflective drawing as well, and the two together are really powerful. And so that’s what I do, that’s what I tried to get people to use crayons to again, start contemplating an image. And I hope that, you know, it may not work for everyone and I accept that, but my hope is that it will come as a surprise that for some people, it may be a welcome way to get in, in a way that they couldn’t find a way into something difficult that they’re struggling with.

Steve Thomas:
Yeah, that’s a really good point. And from a few of your comments mentioning that, “Oh, it’s not funny!”, I assume that you get the comment a lot of, “Oh, it’s a comic, so it must be funny. Tell me some jokes. Hahaha.” The name comics has really more about the history of the form, of the medium more than it is about the content itself being comic funny.

MK Czerwiec:
Right. And, and you want to kind of bring that history along, right? Like you, no matter what kind of fancy names you come up with it. I like the idea that we always just admit that it’s a comic and that’s good. You can have very serious comics, right? And we’re living in such an amazing age where we have so many examples of how very serious topics can be handled in this medium.

Steve Thomas:
Yeah. Comics are really my preferred term too, but, since this is a library podcast, let’s take a turn to that. Why do you think libraries should collect graphic medicine titles? What’s the value to a library’s collection?

MK Czerwiec:
Yeah, I think, you know, I recently moved to southwest Michigan and I walked into our community library, and I asked the librarian if, you know, they carried any kind of adult graphic titles, adult comics. And they say, no, they’re all in kind of young adult section. And they said, well, you know – I told him what I do, that I work in health care – and they said, well, you know, the one thing people come in asking for is health care related stuff, you know, people in the community want health care related information and resources and the reason that it’s so important for libraries is just accessibility, right? You might not be able to get to the store and, or you might not be able to access getting these graphic novels and there’s so many out there, but it’s because it’s something that people need and people want. And, you know, one of the things I often say is that when people are under stress, which is when you’re worried about an illness or health or someone else’s illness or health, when you’re under stress, it’s often hard to sit down and read a solid text, and you know, we often within health care giving people pamphlets that they may never read. When you can do it in an engaging medium that can be a not-unpleasant experience to read. I think that’s a huge advantage for communicating, for teaching and for learning. And so I think libraries are a terrific place for graphic medicine collections because it’s what people are looking for often.

Steve Thomas:
Yeah. I think people are starting to realize that adult graphic novel doesn’t mean “adult” graphic novel. So, there are still some conservative communities that may feel like this kind of collection isn’t for them, but there are plenty of good titles out there that don’t have cursing or adult situations or like, bare breasts in a, as might be the case in a memoir about breast cancer.

MK Czerwiec:
Absolutely. I mean, one that comes to mind that I think is just amazing is, it’s called My Degeneration: a Journey Through Parkinson’s. And I could imagine someone coming into the library and wanting to learn about Parkinson’s, whether it’s something that they’ve been diagnosed with or a loved one, a family member and this book, you know, would be such a revelation to come across because I think it does an incredible job of being a teaching tool and an encouragement. And it’s just an amazing text, and it’s in comic form. It’s very engaging, very colorful, and I would love to see libraries be stocking that in the health section. You know, you might not go looking in the graphic novel section for something like this, but it’d be great to see, and I know that that becomes an issue of where do you put it, right? Because it’s kind of, it’s graphic, it’s a comic, but it’s also, you know, a comic about living with Parkinson’s, this is not something aimed at kids. There’s nothing obscene or anything in it, but it’s just not something that you’d think would be of interest to kids. It certainly would be targeted at adults. So yeah.

Steve Thomas:
Can you talk about how the graphic medicine website got started and who all’s involved with that?

MK Czerwiec:
Yeah, so as I mentioned, Ian Williams, in the UK set the site up initially, and then when I hosted the second international graphic medicine conference, we kind of merged the content from that and realize that we wanted the site to become this wonderful resource so that patients and families and providers, if they had an area of interest, and they wanted to know if there was a comic or graphic novel about it, they could go there and use this as a resource. And also academics who might be interested in really looking at this field, and so we kind of rebooted the site with a searchable capacity. And we’ve then in the last two years brought on two amazing medical librarians. Matthew Noe who you had on your show, he had started doing This Week In Graphic Medicine, which is amazing because there’s so much going on, and if you go to our website and just look at one of those posts, that’s all something that happened in a week in this area. It’s just unbelievable to keep up, and so thank God he brought his fantastic libraryan skills to us. And then recently Alice Jaggers has joined us as well, another medical librarian, and they are helping to curate the site, kind of keep the list up to date of what’s out there, help us to organize, they’ve just been such a gift to the site. And so that’s our goal, really, is to just serve as as much as possible a resource for what’s out there and kind of a community. So it’s not just that the site is this resource and it is, and I also, I do a podcast, the graphic medicine podcast where I tried to interview people who are working in this area, but we also are this amazing community. As I said, we’ve been having annual meetings for for almost 10 years now. And, it feels like just a family of people that are all kind of interested in this. And so we use our social media outlet to kind of be resources in conjunction with the website to help one another with the kind of projects we’re interested in and promote things, and again, just kind of do what a community of people who are like minded and interested in things are doing.

Steve Thomas:
Oh, that’s great. You’ve given a lot of great suggestions already throughout the show, but do you have any other recommendations for graphic medicine titles, especially for librarians who might want to start building up a collection like this?

MK Czerwiec:
Yeah, yeah. I don’t even know where to. I’m sitting here staring at my giant book shelves and so I’m teaching a course right now at the University of Chicago and we’ve decided – it’s a graphic medicine course – we’ve decided to teach it like along the lifespan. And it was kind of an experiment to see are there, is there a graphic memoir that will be a great resource in each of the kind of life areas, right? So, like, reproduction and childhood and young adulthood. And there is, is the answer. So that tells you how much is out there. Yeah. So, a wonderful one that we’ve used in talking about childhood, and it’s not necessarily aimed at children, but it captures interesting things about childhood is called Stitches by David Small. David Small is a children’s book illustrator who did his first graphic memoir. And it’s about, all kinds of interesting things: a difficult family, but also being diagnosed with cancer as a young man and being treated for that, and that’s really amazing. And there’s a wonderful book called Tangles by Sarah Leavitt. It’s called Tangles: a Story About Alzheimer’s, My Mother and Me, and when she was a young adult, her mother was diagnosed with Alzheimer’s and it’s just a beautiful account of that experience that their family had. And then moving towards, oh, one more I want to just throw in, sort of dealing with mental illness. There’s an amazing graphic memoir called Marbles: Mania, Depression, Michelangelo and Me by Ellen Forney. And then, my particular clinical focus area in comics right now, because it’s what I ended up doing in my career, is hospice and end of life care. And a couple of years ago, an amazing graphic memoir came out called Last Things, by Marissa Moss, a Graphic Memoir of Loss and Love. And it’s a beautiful story about a very, very difficult diagnosis and how it impacts the family in a very difficult death. It’s not a story of redemption, of how a family gets closer. It’s how a family survived a very difficult illness and very difficult death.

Steve Thomas:
I think it’s important to have titles like these because it helps people feel not so alone to be connected to a community of people who’ve all been through similar experiences like this. You know, you might feel like if you’re going through an illness or you’re helping a family member or loved one through illness, that you’re the only one you’re the only one feeling like this. But it’s not, and lots of people have gone through this and it’s nice to find a similar people going through similar experiences.

MK Czerwiec:
Absolutely. And then the other thing is, you know, what we talk about in the health humanities, we talk about counternarratives and when you’ve gone through something, you know, the prevailing narrative is that you go through something difficult, that it brings you closer and you have a beautiful, you know, deathbed scene with your loved ones. When you go through something that isn’t like that and it’s much more painful and difficult, you sort of end up more stigmatized because you feel like, oh, I didn’t have the kind of experience I was supposed to have, whether that’s in childbirth or, or end of life, you know, when it goes really badly and it’s really ugly, those aren’t stories people want to read or tell. And so having them out there done as beautifully as Last Things is done is really important for those people to feel like, like you say, I’m not alone too.

Steve Thomas:
Yes, life is much messier than a lot of fiction makes out.

MK Czerwiec:
Right. And, you know comics, I have this long history of kind of telling us stories about things that are stigmatized, and making, kind of, showing you that things can be ugly but it’s still, you know, it’s still going to be okay and you’re going to be okay.

Steve Thomas:
MK, if listeners wanted to follow up with you, how can they get in touch with you?

MK Czerwiec:
Yeah, go to my website comicnurse.com there’s a contact link there, and I would welcome any questions that people might have.

Steve Thomas:
Thank you so much for coming onto the show and I hope librarians who were interested in building up their graphic medicine collections got some good input here.

MK Czerwiec:
Yes. And I definitely want to say that if someone is interested in doing that and they have particular health issues in their community that they think that their library would like to serve, we would love to serve as a resource for that and kind of say, here’s what’s out there in this arena, so please be in touch through graphicmedicine.org

Steve Thomas:
All right, thanks again.

MK Czerwiec:
Thank you!