Time In The OR

January 8, 2013

DaVinci Robotic Surgery, Maine General Medical Center

DaVinci Robotic Surgery, Maine General Medical Center

One of my recent assignments was to shoot some high-profile photographs for Maine General Medical Center:  the DaVinci robotic surgery system in action in a surgical suite, and a group portrait of the DaVinci surgeons. The DaVinci allows a surgeon to operate sophisticated surgical instruments by remote control through very small incisions with very precise small movements impossible to do by hand. The surgeon views the operation in high-resolution, magnified stereo vision on a separate console, on the right above.

Time Is Everything

Going in to any surgery suite is challenging, fun, exciting – but time is limited. It’s rare to have an OR empty and available, and at any time that availability will change as medical necessity arises. Further, doctors are scheduled so tightly now that having them available together for a group shot is nearly impossible.

It takes time to get photography and lighting gear in place in an OR; my gear travel cases, some of which have literally been around the world and through hundreds of grimy airports and factories, are not clean enough to enter a sterile site. Every piece of equipment I needed had to be unpacked outside the clean areas and every surface wiped with anti-bacterial pads. This included the light banks, umbrellas, stands, tripod, booms, cables, cameras and lenses. My client, my assistant and I had to be suitably gowned and masked, and there are no pockets on typical hospital scrubs! How many pieces of gear could I safely juggle in my (gloved) hands? Deciding what to bring in was an exercise in minimalism.

OR’s are not arranged for photography. Sterile techniques require disposable clear plastic bag covers on much of the equipment, which look messy to the camera. Supplies are stacked on carts. Nurses and surgical techs must approve the moving of any hospital machinery, and staff is scarce if there is no procedure happening. Once a camera set-up is approved, it simply takes time to position and balance my strobe lighting. Time we did not have for this shoot.

There’s a learning curve for photographers in health care shooting, and I’ve invested a good deal of time on it. There’s a client-education learning curve, too; it’s essential for the hospital personnel to be properly briefed about how much time is needed to get in, set up and be ready when the doctors are available. Clear expectations must be communicated in advance. But even then, everything must bend to medical necessity at the time of the shoot; after all, they’re saving lives.

Invest Your Time Wisely

I’ve learned that the time needed to make things look good will be spent either while I’m setting up in the OR, or in post-production afterward. Time spent setting up is an investment that always pays off in better shots. But sometimes every contingency comes out on the wrong side of what I need (remember, medical necessity), but still I must deliver. That’s what happened with this OR shoot for MGMC; prior surgeries ran late and the doctors were almost out the door just as we got access to the surgical suite.

We had one bit of luck in that the DaVinci tech rep was on site and available to move and set up the machinery for us. While he was doing that, my client corralled a few doctors to step into the scene. My assistant became the patient, swaddled under surgical drapes, which of course meant she could not get up to help me with my lights. I scrambled to set up three lights, without a chance to color balance my lighting to match environmental conditions. Then I had to shoot it or lose it.

Those fast-thinking moments are when experience comes into play. I knew I was going to have to add some drama in post, so in my dash to set up I created broad but distinct areas of brightness in the center with lighting fall-off toward the far edges of the room. Control was not as precise as I would have preferred given more time, but workable.

Silos, Then Race The Night

After making the DaVinci shot, we herded the doctors to a side room where I had seamless paper set up for silos. I shot three surgeons individually, having captured four others earlier in the day when they were available. On top of all that, my client and I then raced out the door and twenty-six miles to another location. There, I shot the new MGMC hospital under construction by the twilight of a full moon.

Building It In Post

This was a case where the final vision could only become real in post-production. A chosen frame of the DaVinci surgery was acquired twice in Photoshop:  one white-balanced with the correct exposure and one dark and cool-colored. I stacked the white-balanced version over the darker version, then used hard and soft masks to let only portions of the white-balanced version be visible. The final effect created a layering of light for the key parts of the DaVinci, with the rest of the OR muted into the background.

Two Versions Of The Choice Frame

Slight cropping and local retouching of distracting elements then improved the shot.

For the group surgeons portrait, I re-purposed the left-hand side of the final DaVinci OR shot as the backdrop. The seven individuals shot separately on seamless paper were silhouetted with added shadows and tone balancing to make this composite. For each surgeon, we shot a single frame with the client standing next to them as a reference measure; I then built the group with the correct relative height of each individual. Time, as always, was the essential ingredient.

DaVinci Surgeons, Maine General Medical Center. Group assembled in post.

DaVinci Surgeons, Maine General Medical Center.Each surgeon was shot separately and the group was assembled in post.

The Moonlight Shot

The new Maine General Medical Center under construction by moonlight.

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