Feature: Professor Kneebone and the remarkable pop-up operating theatre
You may find a surgeon in the theatre, but you do not usually expect to see one on the stage. Professor Roger Kneebone, however, seems equally at home with both. Professor Kneebone, a Wellcome Trust Engagement Fellow, brings surgery into the public domain, creating unique events that champion open communication between medicine, science and the public. Holly Story went to the Cheltenham Literature Festival to find out more.
From my place in the theatre audience I see the whole episode, from beginning to end.
In a busy auditorium, a woman collapses, clutching her chest. As she struggles to breathe, she manages to reach a phone and dials for an ambulance. I watch nervously as two paramedics arrive on the scene, giving her oxygen and taking her by ambulance to the emergency unit at the local hospital. There, she is whisked into surgery and a skilled surgeon performs a coronary angioplasty to remove a blockage in her artery and insert a stent, alleviating her pain and preventing cardiac arrest.
It is uncomfortable to watch, but the woman is not in any danger. This is the opening of Professor Roger Kneebone’s sell-out live performance at the 2012 Cheltenham Literature Festival.
A tale of the unexpected
Entitled ‘Emergency Room: Cardiac arrest’, Roger Kneebone’s show uses simulation to give the audience an insight into what happens, inside and out, when a person suffering from a heart attack is taken into hospital: what happens after the ambulance disappears into the distance carrying your relative, your friend, or you.
He has been creating a stir with such staged simulations since 2007, when he produced an event for the Royal Society Summer Science Exhibition in London. Over the next five years, Kneebone and team toured the show to venues and festivals up and down the country, performing for audiences of all ages and abilities. They have appeared on television and performed at the Science Museum in London, and they are booked for their first music festival next year.
For Kneebone, “these events are a way of deliberately opening up the closed worlds of surgery or coronary care, or indeed scientific research, to members of the public.”
Central to the show is the ‘igloo’. Placed on stage, this semi-circular inflatable room becomes the ‘pop-up’ operating theatre where Kneebone’s team conduct their simulated surgeries. It is an ideal touring performance space, but Kneebone originally designed the igloo as a training tool.
“I’ve always been interested in education, right from the beginning,” he says. “I spent a year teaching anatomy when I was practising as a surgeon early in my career. Then, after moving into general practice in the early ’90s, I became involved in developing the national training programme for minor surgery.
“At that time simulation was just beginning to be used. I’m now Professor of Surgical Education at Imperial College London and a lot of my research is around the use and development of simulation.”
In the UK, surgical teams can be trained in high-tech, high-cost simulation facilities that replicate, as closely as possible, real operating theatres. This may be effective, but access to such facilities is severely limited. In comparison, the igloo is inexpensive and can be transported in the back of a van.
To keep costs and equipment to a minimum, the designers focused on creating a space that gave a ‘powerful sense’ of the operating theatre, rather than producing a detailed reconstruction. Kneebone likens it to painting a picture in broad brush strokes: “It’s not about the detail. It’s about the impression of the picture when viewed as a whole and at a glance.”
This is what makes the pop-up theatre such an effective setting for staged simulations. In its blue-tinged space are arranged a few 2D props, some high-tech imaging equipment and an operating table complete with realistic prosthesis. Absorbed in the performance, the audience does not see a cardboard cutout and a dummy on a trolley. They see and hear a heart-rate monitor bleeping in the background and flinch as the surgeon makes her first incision.
Although the surgery is performed on a prosthetic torso, the medics themselves are the genuine article. In all of his events, Kneebone endeavours to bring real experts into contact, and conversation, with the public.
He says, “If they look like a surgeon, [to an audience] they are a surgeon. In our case all the clinicians you see are actually clinicians. They bring with them expert knowledge, energy and enthusiasm, and that has an electric effect on audiences. They’re the magic ingredient. The people who take part in public engagement work need to be passionate; they need to love doing it. But they need to know what they’re talking about as well.”
And it is not just the audience who reap the benefits. Kneebone regards the events as an opportunity to test out developing research with different audiences and get their feedback. Many of the practicing medics on Kneebone’s team are students or alumni of his Master’s programme at Imperial, and he encourages them to use the events to learn something themselves.
“Traditionally, I think public engagement has been very much about showing the public things they didn’t already know, but it hasn’t worked so much in the other direction. I’m passionate about using public engagement as a two-way process, which I hope will illuminate the clinicians and the scientists, and make them think differently, as well as the public.”
In addition to clinicians, Kneebone’s team includes experts from other fields: psychologists, designers, engineers, the media, social scientists. He also collaborates with a network of other professionals from dancers to bomb disposal experts. One of his most enduring partnerships has been with bespoke tailor Joshua Byrne.
“Both of us have been very surprised at how closely our worlds coincide. At first, you might not think there was anything in common between a tailor and a surgeon. But as soon as you think about it, you begin to see the parallels. There are technical things, of course – sewing and joining – but there are also professional things. The relationship between a tailor and his customer is really very similar to that between a surgeon and his patient. It’s about trust, high standards, perfectionism. Talking about these parallels has made us see our own worlds differently.”
The exchange of ideas and perspectives between the pair has lasted several years. Byrne delivers an annual lecture for Kneebone’s students at Imperial and regularly contributes to his events. Both men value the opportunity to consider their profession from a fresh perspective.
“As a surgeon, or a scientist, or anything really, you tend to be contained within the closed world of your expertise,” Kneebone says. “It’s difficult to look beyond it and see yourself as others see you.”
With this in mind, he has begun exploring the notion of surgery as a craft. “Surgeons do things with their hands that require great dexterity and precision, and to them that’s a very important part of their identity and what they do,” he explains.
“But surgeons aren’t the only people who feel that. I’ve been talking to sculptors and stonemasons and musical instrument makers and boot makers and tailors and a whole lot of people who work with their hands. It is these different kinds of discussions that can really change your perspective. Undoubtedly, they’ve changed the way I see my world; they’ve also, for some of them at least, changed the way these other craftspeople see their worlds.”
Much of Kneebone’s work is driven by his desire to generate discussion and challenge people to think afresh. His events teach people about biology, surgical procedures and the skilful work of medical practitioners. They may inspire children to study science or encourage someone to give up smoking. But above all, they aim to open your mind and make you think.
He recalls asking one group of primary school pupils the question: what is a heart attack? “It’s when your heart attacks you!” answered one girl, enthusiastically. She wasn’t wrong, he says. It was just an interesting way of looking at it.