Canice E. Crerand, PhD

MA 2001 College of Nursing and Health Professions & PHD 2004 College of Arts and Sciences

As the saying goes, "A picture is worth a thousand words." But the portraits of eight patients at Children's Hospital of Philadelphia (CHOP) prove that a picture can be worth so much more.

In 2007, Dr. Canice Crerand '01, '04, psychologist in CHOP's Division of Plastic and Reconstructive Surgery and Assistant Professor of Psychology in the Department of Surgery at the University of Pennsylvania's School of Medicine, was presented with an exciting opportunity. She was approached by two of her colleagues, Drs. Scott Bartlett and David Sarwer, who were moved by an exhibit from the United Kingdom called Saving Faces, a collection of paintings that portrayed patients before, during, and after their facial reconstructive surgeries due to traumatic injuries or cancer. The purpose of Saving Faces was to convey to the public the possibilities of facial reconstructive surgery as well as the strength of the patients.

As a psychologist at CHOP, Canice's patients are children and adolescents born with craniofacial conditions or who have sustained injuries that affect the form and function of their head and face. Canice helps her patients and their families cope with the stresses of multiple surgeries, absences from school, and the stigmatization that comes with being what society considers 'different'.

"People stare, or ask them what's wrong with them," she said. "The social implications are often very painful and distressing to our patients."

Canice and her colleagues at CHOP were especially impressed with the fact that the patients who participated in Saving Faces reported they felt better about themselves and that the project gave them a sense of pride. The doctors decided to conduct a similar project with their own young patients, hoping to yield the same results.

With the help of Dr. Linton Whitaker, plastic surgeon and founder of the Craniofacial Program at CHOP, his good friend, world-renowned portrait artist Nelson Shanks, and a grant from the Edwin and Fannie Gray Hall Center for Human Appearance at the University of Pennsylvania, the doctors embarked on Face to Face: The Craniofacial Program Portrait Project.

After going through an extensive screening process, four artists from Nelson Shanks' Philadelphia-based art academy, Studio Incamminati, were partnered with eight child and adolescent patients from CHOP's Craniofacial Program. Each artist worked with two patients and met with them over the course of several months to paint their portrait.

Approval from the hospital's Institutional Review Board was obtained in order to ensure that patients were protected. According to Canice, patients were primarily nominated by their surgeons to participate in the project. She then approached the patients and their parents about Face to Face, careful to spell out any potential risks.

"It didn't seem likely, but there was always the possibility of something going wrong, like a patient being unhappy with their finished portrait," she said, noting that this was the first project of its kind ever done in the United States. "I made it clear that they could drop out at any time if they wanted to. I wasn't sure how they would react when I told them about it, but their responses were overwhelmingly positive."

Canice explained that one patient was so excited she was screaming and jumping up and down, while others were more reflective and looked at it as an opportunity to educate their peers and share their story.

Nine-year-old Avery was thrilled to have her portrait painted and couldn't wait to show it to her friends. In spite of her condition – one which has required several surgeries to reshape her skull and facial bones – Avery remained optimistic.

"Maybe God put me here to teach people," she said.

"Overall, they felt honored and flattered to be part of the project," said Canice.

Canice conducted interviews with the patients and artists at the conclusion of the project, and her findings, as hoped, were extremely positive.

"Think about the types of people who have their portraits painted – kings, presidents, people who signify power, beauty and success," said Canice. "Going through this experience elevated our patients so they were able to recognize some of their own strength and beauty."

It was important to let the patients decide what they wanted to wear, choose their pose, as well as what items they wanted in the portrait with them.

Ten-year-old Anthony was born with a craniofacial condition called Apert's syndrome and has already endured more than 20 surgeries to his face and skull. Anthony wanted to focus not on his condition, but rather on his love of sports. Wearing his Flyers T-shirt and holding football action figures in his portrait, Anthony said, "I'm just a boy who likes to do things every kid enjoys."

Gracie, who at 11-years-old has had a number of reconstructive surgeries to treat cleft palate and premature fusion of the plates in her skull, included the family dog, Harley, in her portrait. Gracie also wore a T-shirt that read, "Small But Mighty" to reflect her larger-than-life personality.

"Face to Face gave the patients an opportunity to sit back and say 'I may have been through a lot, but I thrived in spite of all these challenges.' It promoted their sense of resilience," said Canice.

Canice went on to say that when the patients look at themselves in the mirror they often don't like what they see. Seeing themselves through the eyes of the artist was a nice change. The artists succeeded in putting the disfigurements into perspective, rather than putting the focus on them.

One patient said, "It was like seeing myself, but not in the mirror. I liked what I saw."

Face to Face also had a profound effect on the artists.

As said by one artist, "I wanted to put the facial difference in the context of the whole person...to capture the spirit and beauty of this child, the hope and energy in her eyes."

Another hoped that the portraits would serve as something the patients could look back on to be reminded of their strength and confidence.

The project began in 2008 and celebrated its premiere on October 6, 2010, when the portrait exhibit was unveiled in a ceremony at CHOP's Ruth and Tristram Colket, Jr. Translational Research Building. The portraits will find a permanent home somewhere on CHOP's main campus so they can be enjoyed by hospital visitors and patients every day.

Canice explained that while the original portraits remain at CHOP, each patient received their very own print. It is her hope that with additional funding, Face to Face will become an integral part of the Craniofacial Program at CHOP for years to come.

"I definitely think it was a success," she said. "The goal was to see if this novel intervention could impact how our patients viewed themselves. We hoped they would come away feeling better about who they are, and I believe we achieved that."

Nelson Shanks once said that showing someone’s character is the highest level that he can attain in his art. The portraits in the Face to Face portrait project not only showed the character, but also the strength and the spirit of eight inspiring young individuals.

View a gallery of portraits from Face to Face.