Doctor, It Hurts When I Tell a Story!

The evolution of an illustration with Adam Koford


I’ve long admired Adam Koford’s cartoons. His handle around the online world is apelad, and he created a wonderful collision between LOLcats and Krazy Kat: the Laugh-Out-Loud Cats. The mild conceit, which he doesn’t push too hard, is that he discovered a stash of ancient cartoons created a century ago by his alleged great-grandfather, Aloysius “Gorilla” Koford.

Fail wail

The LOL Cats, Kitteh and Pip, wander the cities and countryside of what seems to be the 1930s, producing literal renditions of Internet memes, popular culture, and the like. They are charming rogues, polite while thieving.

You might also recognize Adam’s style and name from the “700 Hoboes” project suggested by Mark Frauenfelder from a list that appears in one of John Hodgman’s books. It was an ambitious and ridiculous effort, and thus wonderful.

When I read the draft of a story for The Magazine by Saul Hymes about narrative medicine, “Script Doctor,” I immediately thought of Adam’s storytelling ability. Saul, a pediatrician, studied this relatively new approach to helping medical professionals understand their patients by learning to tell a story themselves.

The hope is that reading and writing stories about disease told from the first person allows them to become more attuned to patients: better diagnosticians while also upping the potential magic of a good ear on health outcomes.

Adam agreed to take on the commission and quickly came back with several ideas. Artistic collaboration involves creative give and take, and the best kind of it typically requires an interactio of ideas. There’s the tension of the editor trying to squeeze in as much meaning as possible (often too much), the issue of someone’s hand on a checkbook, and an artist’s need to exercise control of his or her mode of self-expression even while appeasing a client. Oh, and deadlines, too. (Remarkably, not a problem in this case, because I was organized enough to give Adam enough lead time, and I hit a sweet spot in his schedule.)

The first sketch was a classic comics treatment:

A nice mash-up of Snoopy and Schroeder—a classic callback to Peanuts! But there was no position for the patient’s role.

The second had more detail and a bit of cheesecake, even:

This sketch brought out the observational elements of narrative medicine. Doctors observing a patient and attempting to describe what they saw. But it, too, seemed more observational and less interactive. The patient here is an artist’s model, and passive—she’s at the center, but has no voice. And I thought it might take away slightly from the nature of the piece to show a glimpse of buttocks.

The third sketch was the charm:

The patient’s story becomes the doctor’s notes. He is translating her experience, but it remains hers. Her posture even indicates the sort of comfort and control she has over her narrative.

Adam developed this further, but, looking at a final draft in color, I realized a couple of narrative problems, appropriate given the story:

My inner art director had several reactions:

  • Should the doctor be male? This seems like buying into a stereotype, especially given that women represent nearly half of the graduates from medical school. (Fewer go into specialities; they’re over-represented as general practitioners and in specific fields.) However, the author is male and he is describing a first-person experience.
  • The type on the screen was greeked in the sketch, but flat lines here. The Magazine can be read on any device (via our iOS app or any Web browser), but we aim for our top resolution to be 2,048 pixels wide so that it fills a Retina iPad screen without resampling. This reveals so much details, that it might seem as if the doctor had a series of blanks instead of taking in her story.
  • Should the patient be female and young? In the medical world, women and the elderly have the most trouble being heard. In discussion with Adam, we decided he should make the patient older, which also echoes a point in Saul’s article, as he quotes from an early bit of writing he did about his grandfather’s failing mental acuity.

Adam took all of this to heart, and created a revision:

And that’s what we’ll publish later today.


Thanks to Adam for being part of discussing how the sausage is made!

Glenn Fleishman is the editor and publisher of The Magazine, the host of The New Disruptors podcast, and a continuous contributor to the Economist. Adam Koford creates the Laugh-Out-Loud cats, hobos, and many other wonderful cartoons and drawings that you may find in books available for purchase.

This article was produced by The Magazine, an electronic periodical that commissions original articles and essays. We publish regularly at Medium, and produce an issue of five long-form features every other week. A subscription to our issues costs $1.99 per month for two issues or $19.99 per year for 26, and includes free access to over 160 past articles — our full archive. You can get a free, seven-day trial via our iOS app or our Web site to try us out.