This picture is busy, full of colour and movement, the style of the background is influenced by the graffiti movement. The chest X-ray comes from a young man with a congenital heart disease that causes cardiac failure by affecting cardiac rhythm. I was taught as a student; “The heart is just a ‘bloody’ pump” the thing must be capable of running 24/7 continuously for some 70 – 80 years at least. This links with the base image which comes from a 1950s diesel pump engine. Those old pumps had a beautiful rhythmic thrumming, as a child on my grandfather’s farm I would waken at night and hear the sound of the pumps working through the night in the dark sheds. The philosophy of a pump is “The pump must run” the equipment must be reliable.