A 30×80” courtroom display showcasing the onset of shoulder dystocia. Part of the denfence attorney’s demonstartive evidence presented to the judge and jury.
Dr. Leila Lax
Pregnant with a large baby, the plaintiff was under the care of the defendant, a family physician. During the final stage of the delivery, the baby’s shoulder became lodged in the mother’s pelvis, a condition known as shoulder dystocia. The physician broke the baby’s arm in order to deliver the baby, who was also asphyxiated during shoulder dystocia onset. The asphyxiation eventually lead the baby to develop cerebral palsy. The plaintiff says that the damage to the baby was caused by the defendants’ negligence. They question if our defendant should have anticipated shoulder dystocia and whether she should have consulted with another specialist before the final stage of the delivery.
This courtroom display was to help demonstrate that the defendant’s management of labor and delivery was within the standard of care.
Part of coursework for MSC2002H (Medical Legal Visualization): illustrative demonstrative evidence for use in a medical malpractice or personal injury case.
Through literature review was conducted to ensure that the illustration is anatomically, medical and scientifically accurate (in accordance with general principles of the discipline), and satisfy all legal admissibility criteria.
Series of sketches to address the dynamic baby positions. Comprehensive style sheets to enforce render consistencies among multiple team members and overall harmony with other design elements.
Effective delegation of research and render tasks using a co-design plan and style sheets. Completion of supporting documents including retainer invoice, cover letter, reference list, print management, hardware and software list, and style sheets.
Knowledge scaffolding achieved through clear storytelling. Visualizations can be easily interpreted by the Judge and jury, while the linear flow of concepts allows easy interpretation by the litigation team.
As a medical-legal illustrator, you are in charge of providing communication tools that can clarifies a personal injury or malpractice case with accuracy and impact. The visuals you create could support a medical expert’s testimony at trial, help the litigation team explaining the complex technical details, or educate the judge and jury on the medical interventions involved in a case.
Leila will mention “co-design”
too many times in the course of 12 weeks. And believe me, you WILL codesign the S*** of this project — to the point where you would ask your partner to hold down the ‘alt’ for you, since your drawing tablet is way too big and you guys are sitting way to close to raise you left hand. In all seriousness, medical-legal benefits immensely from teamwork. Here’s a little preview at a late-stage team-work process:
So why and how you break the work down? Every case is unique (Leila has a ton of cases to choose from*), and everyone’s workflow is different, but for our case:
Stage 1: Working as a team makes sure that your visualization is as defensible as possible. Making your visualization defensible means that 1) an expert should be able to back up every aspect of your visualization with a medical fact, and 2) your visuals does not work against your client.
Here’s a quick summary of our case: Pregnant with a large baby, the plaintiff was under the care of the defendant, a family physician. During the final stage of the delivery, the baby’s shoulder became lodged in the mother’s pelvis, a condition known as shoulder dystocia. To deliver the baby, the baby’s arm was broken. The baby was also asphyxiated during the onset of shoulder dystocia, and the asphyxiation eventually lead the baby to develop cerebral palsy. The plaintiff says that the damage to the baby was caused by the defendants’ negligence. They question if our defendant should have anticipated shoulder dystocia and whether she should have consulted with another specialist before the final stage of the delivery.
Our job was to help to defend the defendant. To the plaintiff’s claims, our client says that her management of the labor and delivery was within the standard of care; the specialist’s attendance at the delivery would not have changed the outcome of the delivery.
We began our co-design by reading the case together and mapping out the necessary events we should illustrate, as well as the best ways to organize these illustrations:
We decided on the format of an illustrated timeline. It is the most intuitive way to help the audience understand how long and difficult the labor was, and how unexpected and sudden shoulder dystocia onset is.
Remember, our illustrations must show that the defendant has adhered to the standard of care. This means that instead of focusing on the breaking of the baby’s arm, i.e., the outcome of the delivery, we focus on the onset of shoulder dystocia. We use the sagittal view to educate the audience on what shoulder dystocia is (aka, this baby is BIG and he’s REALLY stuck), and a doctor’s view to help the audience to understand how difficult predicting and relieving shoulder dystocia is from the defendant’s perspective.
Stage 2: Now that you have the overall picture, distribute the work in a way so that everyone becomes a content expert on something.
We each are in charge of a key panel. Because the visualizations need to stand up to high levels of scrutiny, we act as each other’s content reviewers. The initial task assignment might have been C’s in charge of the first panel, A the second, and T the third, by the end it evolved to C knew a lot about the angle of the pelvis, A was the go-to for notochord positioning, and I drew a lot of pelvis.
Stage 3: Be stylish, be consistent.
From the sketches above, you can clearly see that my partners and I have a very different style of rendering. This means that once we know what’s going to be on our final board, we need to make sure the final product does not look like it came from three different hands. So first, everybody swore an oath on the collective maintenance of the sanctity that is the style sheet:
We of course, test-drove the stylesheet on a full-scale board:
The next was to render the actual panels. This step started with A taking on inking all of the final sketches, C masking all the render areas, and T adding the overall shading and tones.
I wish our work ended at my render. Alas, from the workflow video you would see that the first complete color render was passed back and forth many times between the partners. One major strength of our visualization was the continuity of the storytelling, and the dynamic baby positions used. However, this also means that we cannot reuse most of the assets —— i.e., we must render a new baby each time the baby switches positions across the board. To enforce consistency, we made sure that everyone had a hand in the final render, such as A refined the outlines of uterus, C added crosshatching to address hue variations in some of the shadowed areas, and A and T together adjusted the hue of the baby so that the hues final renders better complement that of the timeline.
Stage 4: Money matters.
Overall, I was happy with our final product. Compare to the other teams, our storytelling is definitely more linear and minimal, as we removed many information visualization elements such as the icons illustrating labor progression and event color coding. However, I think the storytelling benefitted from this simplicity and the timeline helps to put the medical terminology into the context of reaction time, thus enhanced our litigators’ argument. Also, did I mention that we stayed within our client’s budget? That’s right, one of the restrictions Leila gave to all the codeisgn team was a max budget of $4500, or $1500 per panel (or per artist) —— though I must admit that for a student project, this apparently-generous budget affected our design decisions MUCH less than it would have o a professional one.