Wesley Puttrich was born with two thumbs on his right hand, limiting his hand movement.
Fishman had drawn the dinosaur on his cast immediately after the surgery.
He kept the cast on for about four weeks, and he loved his T. rex so much that he cried when it was time to cut it off last month.
“He wanted to keep the dinosaur with him, so we decided to save the cast, and it’s now in his room where Wesley can look at it whenever he wants,” said his mother, Katie Puttrich, who lives in Crest Hill, Ill.
To Fishman, that is the ultimate compliment.
“If they can look at my drawing and remember a positive experience, that’s wonderful to me,” she said. “Anything you can do to connect with a child during the course of a surgery is helpful in maintaining that relationship.”
Fishman’s best work — repaired joints, placing prosthetic bones and carefully inserting metal plates — can’t be seen with the naked eye, but she said she decided nearly three years ago to start making something fun for her young patients to wake up to after their operations.
“No matter how beautiful of a surgery you do, all the family is looking at for several weeks is the cast,” said Fishman, 43. “I thought it would be nice to turn it into something more positive for everyone to look at.”
Fishman, who specializes in pediatric hand and arm surgery, initially decorated casts with colorful striped tape or glitter glue, she said. Then a doctor in training suggested that she try to find some colored pens with weatherproof ink.
“We found some pens [online] that could be used on anything, even rocks,” she said. “If they would hold up on a rock, I figured they would also hold up on a cast.”
For her first drawing, Fishman said she drew Minnie Mouse on a girl’s arm cast.
She soon realized that the whimsical artwork was about more than surprising her young patients with a drawing of a mouse, a princess or a snowman, she said.
“It was about giving them a little bit of control in a situation they otherwise couldn’t control,” said Fishman, explaining that she started asking children what kind of artwork they would like on their casts.
“We talk about what they’d like at the beginning of the process, and that gives them something to look forward to,” she said. “I show them pictures on my phone of things other kids have picked, and we go from there.”
“It’s all based on what the child wants — I’m up for drawing anything,” Fishman added. “Some drawings might be more challenging than others, but we’ve been pretty good at accommodating every wish.”
Fishman said she has left colorful artwork on about 60 casts so far, drawing everything from unicorns and sharks to dinosaurs and dump trucks. One child woke up to a long train winding down his arm, while another got an illustration of his elaborate story of a shark eating a fish.
“Probably my most difficult drawing was for a girl who wanted a very specific character of Japanese anime,” Fishman said, noting that many of her requests are for superheroes, Disney princesses and cartoon characters.
“Because a cast curves, I sometimes have to get a little creative drawing on the mesh, depending on how big the kid is,” she said. “If a dinosaur is requested, I might have to wrap the T. rex’s tail around the corner.”
Once a surgery is over and cast material has been applied, Fishman said she looks at her phone and closely examines the image her patient has requested.
She then calls out for light blue, bright yellow or dark green in the same way that she might request a scalpel or scissors, and one of her nurses will hand her the appropriate colored marker.
“First, I draw an outline, then I’ll color it in,” she said. “The whole process usually takes about 15 minutes.”
Drawing was not a particular interest to her while growing up, Fishman said, noting that in elementary school she enjoyed coloring circus animals, but was more drawn to athletics.
“Art wasn’t a big part of my existence, so I’m learning as I go along,” she said.
But she’s pretty good at studying an image online first, then carefully drawing an outline in black before filling it in with color. There’s not much room for error or do-overs on a cast, so she takes her time and tries to get it just right.
“I have never messed up,” said Fisherman, explaining that she now has years of experience in drawing outlines.
“The surgical case starts and ends with art,” she said. “Pretty much every surgeon draws their proposed incision with a marker prior to actually incising the skin.”
To the families of Fishman’s patients, her signature artwork on casts has made a big impact, said Stacie Stokes of Oak Creek, Wis. Her son, Michael Stokes, 13, has had seven surgeries to correct congenital bone-length differences in his arms.
“Dr. Fishman does such detailed work that Michael usually doesn’t want anyone to sign his cast,” said Stokes, 43.
Each time he awakens after surgery at Shriners Children’s Chicago, Michael said, the first thing he does is look at his cast and see the customized artwork left by his doctor.
After one surgery, Fishman decorated his arm with a chicken wearing sneakers. Another time, Michael requested that she make his arm look like Thanos — an immortal Marvel supervillain, resistant to injury, poison and disease, who wears gauntlets with powerful infinity stones embedded in the knuckles.
“Her artwork is really cool and makes me happy — it’s awesome to see what she draws every time,” Michael said.
“The fact that she’s willing to add this special touch is so meaningful,” Stacie Stokes said. “During a stressful time in the hospital, it really means a lot.”
Fishman said it’s a small gesture.
“The beauty of treating children is that even if we didn’t do anything to intervene, they would still be rock stars,” she said. “I love doing the artwork. But watching kids interact with the world in a way that wasn’t possible before is the ultimate reward.”