For a growing number of artists whose work falls under the umbrella of graphic medicine—and the readers who make up their audiences—words and drawings in short- or long -form works, the genre provides an effective platform for not only exploring these questions, but for understanding and education, advocacy and activism. In publications that include single frame cartoons, self-published zines or “floppies” (comic-book-style publications) as graphic memoirs and novels, the message is often both less and more complex than text alone. In a single cartoon frame portraying, for example, the relaying of a prognosis, the expression on the face of a patient, the body language of a physician, and even the choice of lettering in the thought or speech bubbles that accompany the drawing, can create an emotional impact that resonates deeply and immediately. (For some graphic medicine cartoonists, what’s left unsaid appears to be just as important as the language they include.)

Those newer to the art form, may find the Graphic Medicine Manifesto (Pennsylvania State University of Press, 2015 and 2025) a fine place to start. Authored by a group of six creators* made up of clinicians and caregivers as well as those working in the medical humanities, the volume serves as a kind of bible for the community. Co-author Ian Williams, a physician and graphic novelist, coined the term graphic medicine to describe comics and graphic novels with medical content. The field is variously described by other members of the informal collective behind the manifesto as including, but not limited to, “the intersection of the medium of comics and the discourse of healthcare”, a “movement for change that challenges the dominant methods of scholarship in health care offering a more inclusive perspective [on medicine and caregiving]” and comics that “give voice to those who are not often heard”. While a significant segment of the work produced focuses on the physical and emotional aspects of illness, medicine, and caregiving, graphic medicine also serves as a means of demystifying disease and injury, professional and lay education, and even patient advocacy.

Creators in the broader graphic medicine community frequently cite its reputation for friendliness and inclusivity; numbered among their ranks are clinicians, researchers, allied health professionals, educators, public health experts, patients, medical illustrators, and others.

A quick survey of the virtual or actual graphic medicine bookshelves reveals the seemingly inexhaustible array of subject matter, with entire sub-genres devoted to specific diseases and conditions. For those on either side of the healthcare divide – providers and patients—these documents can create a bridge to understanding.

Drawing styles employed in graphic medicine are as various as in other art forms. Political cartoonist Peter Dunlap-Scholl, for example, uses a “jangly” drawing style in My Degeneration, which depicts life with Parkinson’s and the effect the illness has had on the way he makes art. Moka Onmae’s graphic novel, Good Morning, Good Night, and See you Tomorrow, based in part on her experience as a cancer patient, adheres to many of the conventions of manga (Japanese comic books and graphic novels with distinctive visual characteristics) to great effect.

Complementing the vast body of patient narratives is an abundance of graphic medicine content that focuses on medical education and clinical practice, including memoirs specific to illnesses that were once thought to be untreatable and diagnoses/conditions that have recently emerged or been identified. Graphic medicine pioneer, MK Czerwiec’s Taking Turns, for example, describes her experience as a nurse in a Chicago hospital caring for patients on an AIDs unit, and includes oral accounts from patients, family members, and staff. The book serves as a historic document as well as a memoir. Palliative care physician Nathan A. Gray’s forthcoming graphic memoir, The Human Remains: Drawing Out Compassion in Medicine, addresses the author’s efforts to maintain his humanity through residency in a system that doesn’t always allow the time and space to do so, and his continued striving while working with patients approaching the end of life.

Use of graphic medicine in the medical school setting has also grown in recent years. Penn State physician and bioethicist Michael J. Green, was among the first group of educators to teach graphic medicine; in his case, introducing the curricula to fourth year medical students in 2009. Writing on this topic in the Graphic Medicine Manifesto, Green elaborated, “[Comics] can tell compelling stories about illness and demonstrate the complexity of medical culture. Reading comics can help students think critically about the environment in which they learn and work, and making their own comics can help students communicate more clearly and precisely.” Moreover, Green wrote, “Being challenged to tell a story by drawing pictures can be an uncomfortable and often daunting exercise…. a reminder that they (and doctors in general) seldom have all the answers or skills to solve every formidable problem that comes before them.”

The relatively recent explosion of graphic medicine comics, zines, novels and memoirs, notwithstanding, it’s worth noting that there’s also a much earlier tradition of cartooning that centered on illness, the medical profession and the public. British caricaturist James Gillray’s The Cow-Pock—or—the Wonderful Effects of the New Inoculation (1802) memorably depicts the wildly imagined consequences of inoculation against smallpox among contemporary anti-vaxxers. William Hogarth (1697-1764), who famously skewered politicians, the upwardly mobile, and the morally dissolute, did not spare physicians his merciless critique in his engravings. In A Consultation of Physicians, or The Company of Undertakers, the artist depicts a gathering of doctors led by three notorious “quacks”, including John Taylor, the “oculist” said to have performed botched eye surgeries on Handel and JS Bach. More on Hogarth and his role as a member of the board of governors and muralist at St. Bartholomew’s Hospital in London, can be found on www.drawing-blood.org, a website associated the Billy Ireland Cartoon Library & Museum at Ohio. Those wishing to go even farther down the rabbit hole on the history of medical cartoons, may be fascinated by Professor Jared Gardner’s piece on the Gumps (a long-running comic strip from 1917 to 1959) in which family members contend with the threat of the Spanish flu epidemic.

State of the Art

Among those graphic medicine creators approaching the complexity of the human body, disease, and delivery of care from a distinctive perspective, are Kriota Willberg and Gianna Paniagua. Willberg, who has worked as a dancer, massage therapist, and anatomical illustrator, and holds certificates in bioethics, medical humanities, and gerontology, is the creator of numerous pieces including the Cadaver Diaries, in which she documents her experience as a student and later as a co-teacher of a drawing class for medical students in a cadaver lab. The booklet not only offers a nuanced description of this work, but also explores how Willberg grew to view bodies in other contexts, as when she sat at her father’s bedside at the end of his life, her understanding of anatomy and physiology making his death more real. “Learning …from textbooks and models taught me perfect anatomy. Dissection taught me how a body’s anatomy can vary and survive illness,” she notes in Cadaver Diaries.

Currently a part-time adjunct professor at Parsons School of Design and an instructor for Art and Anatomy at NYU Langone, Willberg’s time as the Artist in Residence at the New York Academy of Medicine led to the creation of her comic, Silver Wire. Placing herself in the story as a character, a technique that allows her to represent the naïve and curious layperson, Willberg gets a hands-on lesson on ligatures and suturing techniques (her use of fruit as “patients” makes for some intentionally humorous moments) from her friend Mollie, a palliative care physician. Throughout this section, Willberg draws the parallel to stitching techniques used for centuries by needleworkers.

The narrative then advances to a discussion of medical knowledge acquired via unethical and sometimes deeply disturbing practices over the centuries, including experiments on servants, enslaved people, and prisoners by Galen, Paré, and Bell. Willberg’s focus on J. Marion Sims and his experimentation on enslaved women—which included surgeries performed without anesthesia—in his work on vesico-vaginal fistula, serves to illustrate how the surgical techniques and advances that benefit so many women grew out of this history. The title of the comic refers to the silver wire Sims used during surgery to reduce infection. “Because Sims findings were shared internationally, individuals of all genders in countries where there was no legacy of slavery benefited,” Willberg notes. “In fact, he probably saved the lives of some of my ancestors. I think it’s important to share this information.”

Gianna Paniagua, an artist who has been both a painter and a papercutting sculptor, and is a two-time heart transplant recipient, is making another unique contribution as a graphic medicine cartoonist and patient advocate. In both mini-comics and several pieces published in Bonus Days, a magazine by and for transplant patients, among other publications, Paniagua has documented her complicated history. After receiving an initial transplant at 14 months of age due to hypertrophic cardiomyopathy, she then required another as a young adult to address transplant coronary artery disease that developed after a period of non-compliance with her treatment.

Finding an institution that would approve her for a second surgery proved challenging, and it took a great deal of perseverance to find the team at Vanderbilt University where her second transplant surgery was performed. Even with the highly supportive team in place, Paniagua says, “I thought I would die in the surgery, because it was very high risk. I was trained for years not to expect something good to happen [and] I was trying to find something where I could quickly leave a legacy and tell a story others could learn from.” Although she had focused on oil painting as an art major at the University of Pittsburgh, it was important to avoid exposure to toxins in the medium. Paper cutting was also too strenuous at the time. Graphic medicine turned out to be the natural fit for someone who had spent much of her childhood drawing. Her comic about life after surgery and the expectations of others regarding her health are powerfully shown in “Are We Ever Really Recovered?” published in Literature and Medicine in 2023.

With her second heart surgery now five years behind her, Paniagua is still immersed in the transplant world, not only as an artist, but as a patient coping with chronic pain and the demands of remaining vigilant against rejection. Her work as an advocate for other young adult heart transplant patients also takes center stage. “Dealing with the side effects of immunosuppressive drug regimens and noncompliance remain major concerns [for this population]”, Paniagua says. She also notes the importance of adequately educating female transplant recipients about issues specifically related to gender, including the impact of their condition on childbearing.

“I think there are creative solutions for this. It’s important to hear true stories about other transplant patients. It’s a way of feeling less isolated. Graphic medicine breaks barriers of education and language,” Paniagua adds. “If you see an image, it can cling to you. There’s a magic in it.”

Her commitment to helping clinicians communicate clearly and empathetically to those in their care is another driving force behind her comics. When possible, she attends conferences and participates on panel discussions on graphic medicine as well as on care for young heart transplant patients.

Paniagua also acknowledges the role of graphic medicine comics in helping her process a lifetime spent in the medical world. While enrolled at Columbia University in the Narrative Medicine program, Paniagua conceived of a capstone project depicting a heart transplant surgery for a Medical Education comic that would benefit other young transplant patients. Already in the process of founding a support group for this population, she had maintained a connection to her own transplant team and with strict adherence to HIPAA guidelines she was granted permission to be present during a transplant surgery. Although one of her advisors had expressed some reservations, thinking that Paniagua might be unsettled by the experience, she was amazed and inspired and plans to co-create more work in the future with other transplant recipients. She is also deeply gratified to know that the patient whose surgery she observed is doing well.

Owing in great part to the efforts of Graphic Medicine International Collective (www.graphicmedicine.org), comic artists like Willberg and Paniagua, among numerous others, continue to receive exposure and opportunities to network with their peers in cities around the world, both through the organization’s conferences and on their website. The widely attended Comic-Con in California has also hosted programs in graphic medicine, bringing awareness to mainstream comics audiences, while smaller conferences hosted by universities and professional societies are proliferating.

As many in the graphic medicine community will acknowledge, there is still resistance to the value of the genre in some quarters. But this, too, appears to be changing, as demonstrated by the online exhibition maintained by the National Library of Medicine: Graphic Medicine: Ill-Conceived and Well Drawn! With the imprimatur of the National Institutes of Health lending support for graphic medicine – and a growing number of published titles by physicians and other healthcare professionals receiving glowing reviews, there’s surely more widespread acceptance to come.

Selected Notes and Resources
The book alluded to in the beginning of this article is Memento Mori by Tiitu Takalo, which chronicles the artist’s recovery from a ruptured cerebral aneurysm, its effect on her life as an artist and on her personal relationships. In her introduction she also notes that citizens in her home country of Finland are spared the added burden of medical debt as they recover from a serious medical event.

The Graphic Medicine Manifesto was authored by M.K. Czerwiec, Ian Williams, Susan Merrill Squier, Michael J. Green, Kimberly R. Myers, and Scott T Smith

More of Kriota Willberg’s work can be viewed at http://kriotawelt.blogspot.com and on Instagram at @kriotawillberg. Her full-length memoir, Over My Dead Body, will be published in 2027 by Fantagraphics.

Gianna Paniagua’s website, https://giannapaniagua.squarespace.com, showcases her work in various media. She is on Instagram as @tragicdarling.

Web image created by Medhum.

AIDS in the Comics: The Graphic Memoir Taking Turns with MK Czerwiec

Russell Teagarden 08.27.26 60

A nurse’s graphic memoir reveals the human stories, suffering, and compassion behind the AIDS crisis.

Hours later, after she has tried all the methods known to her, Agnes is asleep next to Judith’s pallet. Hamnet, overwrought that he is about to lose the “other side to him,” crawls from his pallet to Judith’s side, beginning to feel poorly also. He arranges himself next to Judith in a way that made it almost impossible for people to tell them apart, hoping as Death came to take her, it would be fooled into taking him instead. “And if either of them is to live, it must be her. He wills it. He grips it…He, Hamnet, decrees it. It shall be.” (p. 169) 

When Agnes awakens, she eventually discerns that “her daughter has been spared…but, in exchange, it seems that Hamnet may be taken.” (p. 208) She reinitiates the treatments she had tried on Judith, but nothing works. Hamnet takes his last breath. Agnes wonders how she could have saved him, how she could have missed Hamnet being at risk before she is able to comprehend: “he is dead, he is dead, he is dead.” (p. 219) 

From this event on, O’Farrell constructs the trajectory of the family’s grief with a particular focus on Agnes. Her grief is amplified by resentment and incredulousness over her husband’s return to London soon after the burial because he feared his work as an actor and playwright would lose irretrievable ground with a prolonged absence. These emotions and grievances reach a crescendo over a period of years before understandings are reached and catharsis experienced. 

The Plague Comes for the Twins 

Easily lost in the gripping story O’Farrell tells and the emotional torrents she evokes is the chapter explaining how the plague reached the twins. She takes the modern-day, biomedical understanding of the complex chain of events involved in the spread of plague and weaves it into how she imagines it could happen amidst everyday life in the countryside outside London during the 1590s.  

A basic biomedical reference O’Farrell could have consulted in piecing together a credible sequence of events leading to the twins’ infections would likely include the same details provided in a summary of plague spread published in the 2021 volume of the American Journal of Medicine*: 

An ancient disease, its bacterial agent (Yersinia pestis) is an aerobic, gram-negative coccobacillus in the family Enterobacteriaceae. Its primary vector for transmission is the Xenopsylla cheopis flea, although roughly 80 species of fleas can carry it. During the Black Death, the flea was transported by the black rat or Rattus. A controversial new theory argues that ectoparasites such as human fleas and lice also spread the disease during the second plague pandemic [1347-1665]. Fleas can also survive in infected clothing or grain. The bacteria multiply in infected rodents and block the fleas’ alimentary canal, causing the fleas to regurgitate the Y. pestis bacteria into its animal host…Plague transmission is generally from infected fleas by rodent vectors or, rarely, in clothing or grain but may also occur through ingesting contaminated animals, physical contact with infected victims, or direct inhalation of infectious respiratory droplets. 

O’Farrell could also find plenty of well-researched historical accounts of the plague impacts at the time and place she set the novel. The plague affecting Stratford then is thought to have first entered England in 1348 from ships docking in cities along the southwestern coastline. England struggled with it almost constantly for more than 300 years until it dissipated after 1665. From this biomedical and historical background, O’Farrell created a realistic framework for the story, and a reasonable representation of the all the factors needed for the infection to find the twins in 1596 Stratford.   

She starts her explanation of how the twins got infected by specifying that,  

two events need to occur in the lives of two separate people, and then these people need to meet. The first is a glassmaker on the island of Murano in the principality of Venice; the second is a cabin boy on a merchant ship sailing for Alexandria on an unseasonably warm morning with an easterly wind. (p. 140) 

The glassmaker is filling an order for decorative glass beads received from a dress shop in Stratford, England. But, because of a recent hand injury, a fellow worker is given the job of packing the order. This worker doesn’t know that the glassmaker “usually pads and packs the beads with wood shavings and sand to prevent breakage. He grabs instead a handful of rags from the glassworks floor and tucks them in and around the beads.” (pp. 140-141).  

Meanwhile, the merchant ship has docked in Alexandria, and the cabin boy has been sent ashore for provisions. He quickly encounters a man with a monkey, and the monkey quickly jumps on the cabin boy, and then all over the boy, passing along three infected fleas. One of them accompanies the boy back onboard ensconced “in the fold of the red cloth tied around the boy’s neck, given to him by his sweetheart at home.” (p. 144) The flea doesn’t stay there long. It jumps into the fur of one of the ship’s cats the boy picks up and nuzzles. Soon after the cat is sickened by its passenger and seeks comfort on the hammock of a midshipman, who upon approaching his hammock for a night’s sleep, finds a dead cat. The flea, now needing a new place to live “makes its way, by springing and leaping, to the fecund and damp armpit of the sleeping, snoring midshipman, there to gorge itself on rich, alcohol-laced sailor blood.” (p. 144) Three days later, the midshipman is dead. 

The ship arrives in Murano to pick up cargo including the glass beads. The cabin boy and the glassmaker come eye to eye as the glass beads are loaded onto the ship. And at that moment, the monkey flea, which had found a way back to the boy after time with some of the ship’s rats and its chef, leaped onto the glassmaker. He and many others in his factory subsequently succumb to “a mysterious and virulent fever.” (p. 149) 

In the hold of the ship now heading to England, the progeny of the monkey flea leap from dying rats to cats lying on top of the boxes filled with the glass beads until the cats die. The fleas eventually “crawl down into these boxes and take up residence in the rags padding the hundreds of tiny, multi-coloured millefiori beads (the same rags put there by the fellow worker of the master glassmaker…)”. (p. 148) The ship arrives in London and the boxes of glass beads are taken to a wharfhouse where they are stored for about a month before picked up for further transport. 

O’Farrell ends her tale of how the plague found the twins through the delivery of the box with infected fleas to their final destination. The box of beads “still wrapped in rags from the floor of the Venetian glassworks” is transported to an inn located near the northern reaches of London. (p. 149) Then, a messenger collects the box and takes them by horseback on a two-day journey to another inn near Stratford. O’Farrell adds how during this ride the mass of infectious plague vectors and organisms intensifies. 

The fleas in the rags crawl out, hungry and depleted by their hostless stay in the wharfhouse. Soon, however, they are recovered, rejuvenated, springing from horse to man and back again, then out on to the various people the rider encounters along the way…By the time the rider reaches Stratford, the fleas have laid eggs: in the seams of his doublet, in the mane of the horse, in the stitching of the saddle, in the filigree and weave of the lace, in the rags surrounding the beads. These eggs are the great-grandchildren of the monkey flea.  

The box with the beads and the fleas is now in the town where the twins live. An innkeeper there has it, and gives a boy a penny to deliver the box to the dress shop that ordered it many months before. The fleas have found Hamnet. 

Judith is at the dress shop helping out when the box is delivered.  

The seamstress holds aloft the box. ‘Look,’ she says to the girl, who is small for her age, and fair as an angel, with a nature to match. 
        The girl clasps her hands together. ‘The beads from Venice? Are they here?’ 
        The seamstress laughs. ‘I believe so.’ 
        ‘Can I look? Can I see? I cannot wait.’ 
The seamstress puts the box in her counter. ‘You may do more than that. You may be the one to open them. You’ll need to cut away all these nasty old rags. Take up the scissors there.’ 
 She hands the girl the box of millefiori beads and Judith takes it, her hands eager and quick, her face lit with a smile. (pp. 150-151) 

The fleas have found Judith. 

When Literary Narrative Serves as Biomedical Text 

O’Farrell’s narrative, fictional model of plague spread embedded in her story imagining what could have caused the death of an eleven-year-old boy in 1596 takes into account both the virulence of the infection and the many and varied ways it can spread. To make that point, she, much as would any epidemiologist, tells of others killed as the fleas made their way from Murano to Stratford, such as workers in the glassmaker’s factory, midshipmen on the boat, and various people encountering land-based messengers carrying the box of beads to those awaiting it. In that way, her model also explains how the mortality estimates of one-tenth to one-third of the populations from frequent plague visitations over three centuries could be generated. 

O’Farrell could have left this part out of the novel without losing much of the core storyline or emotion and drama of it. Indeed, the movie version gives it only a few seconds of attention showing the twins’ father walking by a street puppet show during a scene representing the spread of and death from plague delivered from a ship. By including the chapter, however, O’Farrell compounds the drama and emotion, and reveals the complexities involved in our fates.  

And, as I recall the drudgery of reading and mastering the intricacies of infectious disease spread and pathology such as those of bubonic plague, I wish I had O’Farrell’s novel Hamnet at the time. The experience would have been enjoyable and memorable where the experience with biomedical texts were not in either way. Perhaps this application was not in O’Farrell’s mind for the book, but it could go a long way in ridding us of the plague of turgid, mind-numbing, and indecipherable biomedical prose. Whether or not she knows it, O’Farrell has in this novel brought attention to a plague of another house.  

Hamnet
Maggie O’Farrell
Alfred A Knopf; 2020

*From: Glatter JA, Finkelman P. History of the Plague: An Ancient Pandemic for the Age of COVID-19.  American Journal of Medicine 2021; 134(2): 176–181. 

Image Credits

The path of infection of plague from rats via fleas to man, by A.L. Tarter from the Wellcome Collection. Attribution 4.0 International (CC BY 4.0). 
A rat on board a ship, carrying the plague further afield, by A.L. Tarter from the Wellcome Collection. Attribution 4.0 International (CC BY 4.0) 
The word plague hovers above a victim’s face, by A.L. Tarter from the Wellcome Collection. Attribution 4.0 International (CC BY 4.0)