We Live

Sara Kenney Looks to the Medical Future with Surgeon X

SX01 cover lgSet against the backdrop of a medical apocalypse in near-future London, Surgeon X weaves a story of ordinary people from all walks of life striving to survive in a society constantly threatened by ever-looming disease and a government headed by the Lionheart Party.

It’s the year 2036 and there are great futuristic advancements available in medicine and surgery, yet a simple infection can kill. Rosa Scott, a brilliant and obsessive surgeon becomes Surgeon X, a vigilante doctor who uses experimental surgery and black market drugs to treat patients. AsSurgeon X, Rosa develops a godlike-complex, deciding who will live and who will die. Risking everything to save lives, she believes that to survive in this compromised world her own moral code is the one she must follow, ultimately warping her Hippocratic Oath to suit her own decisions—even if it endangers those closest to her.

Written by Sara Kenney, with art by John Watkiss, and edited by Karen Berger, Surgeon X is a future that asks what if we do nothing about some of the issues facing today’s healthcare system and medical field.

I got a chance to ask Sara some questions about the series before its debut in late September.

Graphic Policy: Where did the concept of Surgeon X come from?

Sara Kenney: I’ve worked on quite a few medical documentaries and the longest running medical drama series in the world – BBC’s Casualty. During my time, I’ve been fascinated by the medical dilemma’s that the doctors and surgeons face. They have to treat all sorts of people and in a wild range of situations. While working on Casualty a few of my stories were commissioned and I was hooked on medical drama from that point. So many people cut their teeth on Casualty by the way Orlando Bloom, Kate Winslet, David Walliams, Minnie Driver, Kathy Burke, Martin Freeman, Alfred Molina, Ray Winstone and Pete Postlethwaite!

Since then I’ve been playing with the idea of a female surgeon character for quite a few years. But the first time I wrote something down was over 10-years ago. I was digging through some old documents a few weeks back and I found the genesis document, which I’d totally forgotten about! I’ve wanted to write for comics for a while and I’d written a story for 2000AD’s Future Shock. The legendary British publication, home of Judge Dredd, invites new writers to submit a 4-page story with a twist. My story was called ‘The Medic’ – about a female surgeon who has incredible surgical abilities and uses future tech to save someone from a plane wreckage. It’s actually a love story with a messed-up twist. I never sent the idea to 2000AD, I must have chickened out… That was 10-years ago. I’ve been tweaking and playing with the idea ever since.

I think 2014 was a pivotal year for me, when I really started writing down the ideas for Surgeon X. My life was changing in so many ways, I had one-year-old twin girls and I was thinking about the future a lot. Thinking about the world and society my daughters would grow up in. I don’t think having children suppresses creativity as a lot of people suggest – for me it ignited a fire. Looking back that year I worked for the BBC Current Affairs Department, for Imperial College Tech Foresight and I guess all those experiences feed into Surgeon X.

It was time to tell my story and it was very much inspired by all the female scientists and experts I met. The feisty ones who were interested in politics and the world around them. Rosa Scott is a woman who has taken the law into her own hands and who does want to save people but on her terms. Her sister is a scientist who does want to save the world, but doesn’t quite know how. Rosa must help her. Lewis Scott wants to fight for the cause and will support his family in achieving their goals. The antagonists are many and varied and they serve to mess things up considerably.

GP: You tackle a lot of real world issues in the first two issues, the British health system, sexism aimed at female doctors, antibiotics losing their effectiveness. That’s a lot to pack in.

SK: Yes it is but I think it works because all these things aren’t bolt-ons to the story they are the story. The set up is that Rosa Scott is a surgeon in London, 20-years in the future, trying to save lives when most of the antibiotics are no longer working. Everything else plays out of that set-up and so inevitably the obstacles she faces are related to this world.

GP: You also have a character who’s schizophrenic. There’s a lot of groups who think mental health isn’t depicted well in entertainment. Did you talk to people to get that character right and depict him accurately?

SK: Yes I talked to my family, extensively – schizophrenia has been all around me for over 20-years. I have an older and younger brother and they both experienced psychosis at various points in their lives and were diagnosed with schizophrenia. From talking to scientists I guess we just have a heavy genetic loading in our family. It’s not one gene, but a range of genes that lead to the manifestation of the illness along with environmental factors.

My older brother became ill, about 20-years ago and then my younger brother became ill about 7-years ago. They are both doing really well now, but we’ve been through some wild times. My short film Angels and Ghosts, narrated by Samantha Morton (Minority Report, Synecdoche New York) was about this very subject. You can view it on-line here.

I wrote the character Lewis as homage to my brothers if you like. Although the character Lewis Scott has schizophrenia it doesn’t define him. That’s not his purpose in this story; he’s got other stuff going on! He’s probably one of the most grounded characters in the comic. And a lot of fun!

GP: What research did you do in working on the book on antibiotics and medical procedures? I know you were a scientist for the Environment Agency. Where you doing work in this area there?

SK: I don’t have a medical background, but I do have a biological sciences background with a degree in Ecology and an MSc. in Science Communication.  When I worked at the Environment Agency I worked in Water Quality and Flood Warning, so again not related to this story. But working as a documentary filmmaker over the last 16-years I’ve specialised in science journalism.

For Surgeon X I’ve spoken to probably well over 50 experts from microbiologists to ethicists, philsophers to surgeons. Several of them I’ve been in constant contact with during the writing of the comic. All the medical dialogue is informed by conversations with surgeons. Also when working on the surgery scenes with the brilliant John Watkiss, I’d have to get references for John although in many cases he didn’t need them. He’s got an excellent knowledge of anatomy having taught it at the Royal College of Art.

The research was vital for making the stories a success, I think it makes the storyworld feel more authentic and believable. I hope it does!

GP: I was intrigued by the stat about the percent of female surgeons to see if that was right! And it’s pretty close to the US stats. I assume yours is the UK stats? Are you peppering the series with stats like that? It feels like subtle (and really smart) advocacy.

SK: Yes these are based on real stats. So in the UK, currently 50% of all medical students are women but only 10% of surgeons are women. There are some stats suggesting that this will only rise to 15% by 2036. It’s been really interesting talking to surgeons and historians about why that is. Surgery, historically was seen as a very physical and male pursuit. There were a lot of amputations and dissections and this just wasn’t seen as a very ladylike thing to do. Culturally this vision of the older, white male surgeon in a white coat has pervaded, although it is starting to change.

I’m a nerd so I love a fact and a figure and I enjoy sharing them with other people – so yes, you will see a few of them peppered throughout the comic and they will have been researched!

GP: There’s some interesting politics in the comic, with a rise of a rightwing leader and some pretty alarming rhetoric. I know comics take a while to be created, was it coincidence that there was a rightwing lurch in UK (and US) politics?

SK: I started thinking about the storyworld in more detail in 2014. We’ve seen the rise of the far right across Europe and I began thinking about what that would look like if we experienced it in the UK. I think during difficult economic times we often look for people to blame and we want to protect what is ‘ours’. There have definitely been tensions bubbling away beneath the surface in both the UK and US. Over the past year clearly what we’ve seen is those tensions exploding through the surface and up into the stratosphere.

In the UK the vicious and backstabbing machinations of politics on both the left and the right have been laid bare. The thin veneer of ‘gentlemanly’ politics has been broken and we’re all witnessing what politicians are prepared to do and sacrifice (their souls) for a bit of power. It’s ugly and I’m sure a lot of us on the left and the right, are not sure what the future holds right now. So I wasn’t’ expecting it to get so extreme so quickly, but given our social and political landscape I think we could sense the tensions, which is why I wanted to include them in the story.

GP: The outlook on healthcare in this comic is really grim. Are there folks who foresee this as possibly happening?

SK: Most scientists are more hopeful that we’ll be able to solve this problem and if we get politicians working on solutions and give more money to the scientists to work on new antibiotics then perhaps things will not be so bleak. However, there are some scientists who don’t believe we have what it takes as a species to deal with this problem and that things will get very bad. It’s not just a problem of science, it’s politics, sociological, cultural, economics and we need to attack it from all angles.

The outlook in the comic is based on two workshops and regular conversations with scientists particularly microbiologists, surgeons and medical humanities consultants. I’ve extensively researched every aspect of the comic from the policies of the Lionheart Party to the details of the surgical procedures. I’ve spoken to several experts about each element of the story – that’s what you do when you make a documentary and I wanted to bring this same authenticity to the storyworld of this comic.

Rosa Scott has a little of all the female surgeons and scientists I met in her – probably minus the god-like tendencies to make decisions on who will live and who will die!

GP: How did the legendary Karen Berger come on to the comic?

SK: Back in 2014, I was applying to Wellcome Trust for funding to create this comic and as a first time comic writer I knew I had to have a really experienced editor to get the funding. Having worked in TV for over 16-years I’ve learnt that it never hurts to ask – people can always say no or ignore you as a freelancer you learn to be thick-skinned. So I contacted Karen via LinkedIn, with a brief summary of the idea. Of course I expected her to say ‘thanks but, no thanks’, but the idea piqued her interest.

We arranged to talk and next she asked to see some of my writing samples and Karen was really positive about the idea. This was an absolute dream come true. Karen said that even if I didn’t get the funding she wanted to work with me. That gave me real courage and belief in the idea. It’s also clear that Karen enjoys working with new talent, with helping them to develop and evolve. I may not be a Jedi in the world of comics, but I feel like I’m strengthening my grip on the light-sabre and could floor a few storm troopers now. That’s thanks to Karen for sure!

GP: The comic was funded by a Society Award from Wellcome Trust. How’d that come about and your working with the charitable foundation? Do you see them using the comic in their work?

SK: Back in 2010 I was working in TV and I was a bit disillusioned to be honest. I love filmmaking and storytelling, but I also love looking at a story from a variety of angles mixing science with philosophy, art, politics, sociology etc. A lot of science TV is quite whiggish – celebrating science, which is fine, but there are so many more stories to tell, so many more viewpoints to take. So I was looking around for other jobs and I was scanning the Guardian jobs board and there was an advert for ‘Broadcast Manager’ at the Wellcome Trust, covering the current postholder’s maternity leave.

I’d heard about the Wellcome Trust but didn’t know a lot about the organisation. The role was to work with the broadcast sector in documentary, drama and gaming in order to tell stories about biomedical science. I looked up some of the stuff they funded and it’s just so diverse. From Zombie Science: Brain of the Dead spoof lectures looking at the science of the undead and in doing so helping people to engage with brain science; to a game called Hellblade, which follows the personal journey of a Celtic warrior who experiences psychosis; Quacks a historical comedy series about pioneering Victorian doctors for the BBC; Cosmoscope a group of artists and scientists working together to create beautiful pieces of art, which are projected onto landmark buildings. The list goes on and on – they fund millions of pounds of public engagement projects every year.

So I got the job and spent a year at the Trust – the work they do blew my mind. Most of what they fund is scientific research, but they do so much more. I went back to work in TV, but I started applying for grants from the Trust. I received money to develop some ideas for TV and to make a short film Angels and Ghosts, but I’d always wanted to write a comic. So I talked to Wellcome Trust about the idea and it went from there. As a first time comic writer I had to get a good team around me both scientists and people from the comics world.

The application process is long and extensive and you really have to prove yourself. Then there’s that interview in a wooden paneled room, with about 15-people quizzing you – scientists, artists, experts from all areas! I was really scared – fear can be good if you channel it! Luckily there’s a lot of left-field thinkers in the Wellcome Trust who are happy to take risks as long as they are calculated risks.

I’m not sure that the Wellcome Trust will directly use my work – they kinda expect stuff they fund to find its audience through the producers of the work. However, I think the power of comics for storytelling is a natural fit for the Wellcome Trust, it combines science and art – so I’d love to continue working with them on projects.

GP: How did John Watkiss come on board the comic for the art?

SK: Karen worked with John on Sandman and I was keen to work with someone in the UK so I could meet them and talk to him or her about ideas. Karen was over from New York so we met John and talked through the idea. It was nerve wracking because I’d seen John’s art and I knew he had knowledge of anatomy, so I thought he would be a great fit. He was totally into the idea and so easy to talk to, so we took it from there.

We went through quite an extensive development phase; we needed to because I had a lot of experts I had to talk to before I started writing. In this time John created some of the most incredible development art. I can’t wait to start sharing that with you all! His work is stunning and I’m so lucky to be collaborating with him.

GP: There’s a lot of technology and specific bugs thrown around in the comic. How are you coming up with the tech and deciding what superbugs to mention?

SK: In terms of medical stuff I sit down with my comic consultant Dr Gavin Jell who’s a tissue engineer working in nanotechnology and regenerative medicine and also a comics fan. I also work with surgeon Nick Newton, who’s currently doing surgery research at UCL, but is also a Royal Navy surgeon operating on the front line. We’ll sit there with a pen and paper and design Rosa Scott’s surgical table or diagnostics device. We’ll talk about how it works and what might be possible in 20-years-time. It’s worth noting I’m in geek heaven at this point. If you check out our Instagram (Surgeonxcomic), I’ll start posting more of these sketches.

In terms of the bacterial infections – I spend a lot of time researching what these are and what they do and I pick ones that will work for the story! I’ve also chosen ones such as Gonorrhea, for which we are close to losing all working antibiotics. This is terrifying, but it’s happening now. I’ve got a team of microbiologists I talk to Dr Adam Roberts (UCL), Prof Laura Bowater (UEA), Dr Matthew Avison (University of Bristol) among others. I also dig deeper and talk to the specific disease experts, so if I’m covering say TB, I’ll talk to 2 or 3 TB experts. Any good journalist knows you need several points of view – I don’t make life easy for myself! I also love talking to scientists.

In terms of the tech, I spend a lot of time on the internet researching what tech we might see 20-years in the future, so cars, phones, holograms, VR tech etc. etc. In 2014, I spent a bit of time working for Imperial College of Science Technology and Medicine (which is where I studied my masters degree for 2-years). I worked for their Tech Foresight division, which explores the future of science and technology and my job was to help their experts tell stories about their work.

In particular I was inspired by Prof Eric Yeatman and his research on future cities, Prof David Klug and his work on future medical devices, Prof Chris Hankin and digital identity (this inspired some of my digital characters), Prof Esther Rodriguez Villegas and personal diagnostics, Prof Gregg Offer and autonomous cars, Prof Julie McCann and her ideas about ‘smart dust’. I coined the phrase ‘dust drive’, which is in the comic and is directly inspired by McCann’s work. I wanted it to be the next version of ‘The Cloud’. So you can see I’ve been embedded with scientists and living this world for a while! All of this feeds into the Surgeon X world and characters.

Check them out here.

Our character Lewis Scott is the tech geek in the story and he uses a lot of references, which I’ve researched over the past couple of years.

GP: Can you give us any glimmer of hope in the medical world?

SK: The story of Surgeon X is a ‘what if we do nothing’ story. It’s a thought experiment if you like on what we could face if we aren’t able to organise ourselves. It’s also a world where a far-right government is in power.

I’m hoping our world won’t descend into this sort of chaos! Most, but not all, of the scientists I’ve spoken to don’t believe it will get this bad. They believe that we will come up with solutions. We do have the technological knowhow; we just need the political will and funding.

I hope this story will entertain, but also get people talking and thinking about these solutions. I’m building on the Surgeon X storyworld and there’s more to come. There will be real opportunities for the audience to explore and engage with the Surgeon X world and all our wonderful and eclectic characters. I hope you pick up a copy of Surgeon X and join us on our journey into a world we hope will never come to pass…

GP: Thanks for the time and can’t wait to read more of the series!