A Lesson (Not Just a Joke) From an Orthopedic Surgeon

Ben Bryner -- Most specialists have some kind of stereotype associated with them, perhaps none more so than orthopedic surgeons. One of the predominant stereotypes about them is that they’re into power tools and carpentry and things like that, and are less intelligent than other doctors. It makes sense when you walk into an orthopedic OR, and it looks like someone took an old guy’s garage and dumped it on the table, then sterilized the mess.

On your surgery rotation, you will be expected to learn at least three jokes about orthopedic surgeons (nobody loves the jokes more than the orthopods themselves). Here’s one: Q. How can you tell that a chart note was written by an orthopedic surgeon? A. It’s written in crayon.

Of course, not all people within any given specialty fit the stereotypes, and given how competitive it is to get into an orthopedic surgery residency, the stereotype about intelligence is false. But on one occasion in particular, it was a good thing that the stereotype of orthopods being mechanically inclined held true.

One night during my surgery rotation I was on call at another hospital, finishing up examining a patient in the ER and chatting with a friend who was in his last year of orthopedic residency. (This guy was actually one of my favorite people I’ve worked with in all of med school, very smart and competent as well as nice to students and excellent with patients.) A patient came in who had broken his femur doing some kind of extreme sport under the influence of cocaine. (He’d apparently done this once before.)

The orthopedic surgeon wheeled over his cart and got his supplies ready to put the patient in traction (fixing the patient’s leg to the bed to prevent his leg muscles from pulling the femur-pieces past each other) while the ER staff tried to track down the power drill to place the traction pin. For some reason, nobody could locate the power drill, and all they could find was an old (but sterile) hand drill. We asked the guy a few questions while we waited, and finally the surgeon gave up and said he’d use the hand drill, or more precisely, that I would use it. I injected some anesthetic into each side of his leg, and the surgeon showed me how to put the drill together. Maybe he’d had some kind of training for the hand drill in his residency, but it was a pretty weird setup and I got the impression that he was relying on outside knowledge. Either way, it was good that he knew how to put it together, because if I’d put it together I probably would have drilled into my own hand.

He drew a little x where the pin was supposed to go and told me I’d have to put my weight against the drill to provide enough force. I’ll be honest, I had faith in my friend, but with the first few turns of the drill, I was skeptical that this was going to work. It took a lot of pressure, but eventually it went through the bone and out the other side. It was a spectacle, even by ER standards. The combination of the old-school implement and the fact that the patient was awake made it feel like something out of the Civil War. I half expected to look behind me and see Matthew Brady making a daguerrotype in the corner.

The surgeon said “nice job,” hooked the leg up to the frame over the bed and that was it. While my friend filled out some paperwork (in pen), I thought about the fact that although technology offers us unparalleled advantages in diagnosis and treatment, doctors will always have to improvise and fall back on the knowledge of simpler medicine when things don’t go exactly as planned.