Image courtesy of ArtScience Museum, Singapore
Frida Kahlo is celebrated not only for her vivid and emotive paintings, but also for her resilience in the face of physical and emotional challenges. Born in Mexico City, Frida contracted polio at the age of six, leaving her with a limp. A subsequent streetcar accident when she was 18 caused multiple fractures, leading to a lifetime of chronic pain and medical complications that profoundly impacted her work and legacy.
The Changi General Hospital (CGH) care team offers a contemporary diagnosis of Frida’s health conditions in Laid Bare: Frida’s Inner World, an ArtScience Museum exhibition that features her medical documents, photographs and contemporary artwork.
Dr Terry TeoConsultant, Department of Orthopaedic Surgery
Spinal fusion is a process where the spine bones are joined together into one bone with metal plates and screws. It is done when the spine is unstable, due to either fractures or degenerative causes, and may not be able to support the body or protect the nerves. From the radiograph image of what appears to be Frida’s lumbar spine, there was fusion of the spine with a plate and screws, possibly due to the spinal fractures incurred as a result of the accident.
In addition, to help in Frida’s spinal fusion process at that time, a bone graft from the pelvic bone was also likely required — this can be seen in the two incisions in Frida’s back in her famous painting, Tree of Hope (1946).
Dr Kinjal MehtaSenior Consultant, Department of Orthopaedic Surgery
As a result of childhood polio, Frida’s right foot was shorter than her left one, and she would likely have tiptoed on the shorter leg, resulting in what is known as an equinus deformity, which is the tightening of the Archilles tendon or calf muscles due to limited toes-to-shin movement.
Based on records of the accident, Frida probably had a crush injury that damaged the nerves and blood vessels in her feet. This resulted in vascular insufficiency or inadequate blood flow to the leg, and combined with nerve injuries, would have caused her to lose sensation in the foot. This also led to the development of trophic ulcers over time, that became infected and required subsequent amputations to prevent spreading to other parts of the body.
Frida likely had difficulty walking after her accident. Due to her shortened leg, subsequent amputations, and chronic pain, mobility would be difficult. Frida likely spent a lot of time in her room and bed, which was reflected in her paintings.
Dr Zheng ZhongxiConsultant, Department of Anaesthesia and Surgical Intensive Care
The modern definition of pain acknowledges an unpleasant sensory and emotional aspect to pain, and that pain can occur even after apparent injuries have healed.
Frida’s battles with chronic pain are well-documented: from musculoskeletal pain stemming from polio; to abdominal and back pain as a consequence of the accident; right up towards her end of life following multiple surgeries to her spine, right limb infection and even possibly phantom limb pain with the subsequent amputation of her infected leg.
The available treatment modalities then were largely limited to a single-treatment therapy with the use of strong analgesia, particularly the use opioids such as morphine, heroin and pethidine. It is widely reported these were eventually of limited benefit to her, and also fuelled her subsequent addiction to them.
Ms Constance PngSenior Principal Clinical Psychologist, Department of Clinical Psychology
A patient with chronic pain differs from one who suffers from acute pain. Chronic pain typically lasts beyond the healing phase of an injury that is three months or more. The duration changes the person’s responses — they may feel frustrated, helpless and even hopeless or worried if the condition is going to improve, and this may change their way of living their life, and the emotional responses the person would experience.
It is notable that Frida had expressed her pain experiences throughout her life through her journal entries, as well as in her paintings, which is akin to one of the goals of art therapy for chronic pain patients today. Painting as an art form is a good way for a person to express their inner experience on paper, giving them the opportunity to explore and make sense of the world for them in a very directed way. This allows them to feel less encumbered with the sense of pain and isolation that Frida may have experienced.
Today, a person with major trauma from an accident is treated by a specialised multi-disciplinary group of physicians, nurses and allied health professionals.
From medical care administered on scene by paramedics, to a trauma team of nurses and specialists activated on standby upon arrival at the Emergency Department, treatment is carried out early to stabilise the patient’s condition and prevent complications.
The patient would be brought into surgery to prevent the injuries from worsening, where improvements in surgical techniques and modern anaesthesia play a significant role in improving outcomes. The use of a combination of different types of painkillers, coupled with regional anaesthesia techniques such as nerves blocks and infusions, helps to reduce acute pain and the subsequent risk of chronic pain post-trauma.
There is also a greater importance placed on recovery, with multi-disciplinary teams comprising rehabilitation physicians, physical and occupational therapists, and even psychologists helping to improve the chances of survival and reduce risk of complications while managing pain and enhancing functional recovery.
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