Editor’s Note: A lovely account that gives credit to patients and their families for inspiring a stimulating and gratifying career.
“I went from being ‘the worst resident who had ever lived during my home institution-based orthopaedic rotations to being the best resident who ever lived on my away rotations.’” I was very discouraged until I encountered some positivity about the quality of my work. This change in feedback helped inspire me to complete my orthopaedic residency training which I had considered leaving. In fact, I so loved the work I did on my off-site pediatric rotation that I impressed my preceptors, and they offered a post-residency fellowship during my PGY 3 year! I knew then that I would finish my residency and that I would make pediatric orthopaedics the focus of my career.
Two patients especially underscored my love of what I do. The first was a child with arthrogryposis. She had bilaterally hyperextended knees, bilateral club feet and one dislocated hip. There was no upper extremity involvement. She had an extraordinary family who kept bringing her back to see me consistently over time. Casting her was a real challenge because her deformities favored her casts falling off. My colleagues did not appreciate having to frequently replace her casts, so I arranged for her family to bring her in only when I was available to work with her. They followed through and so did I.
Eventually I realized that using ultrasound, as I did with pediatric hips, could help me identify and mark the axis of her knee joints. It can be hard to distinguish between the patella and the medial femoral condyle in an arthrogrypotic child because of the inherent external rotation deformities. If the wrong area is chosen as the joint axis, the immature bones can be forced into a valgus deformity. This innovation improved the accuracy of my castings for correction.
Another idea I came up with was to cut off the foot supports from a Pavlik Harness and then incorporate the remaining leg straps into her casts. The straps acted like suspenders or a garter belt for her casts. This allowed longer periods of continuous correction between cast changes. She eventually required surgery to finalize bringing her feet to plantigrade.
The patient is now age 6 and her family recently sent me a video of her climbing a wall, dancing, and doing theater-related activities. She has the ability to do wall squats for lengthy periods of time due to her knee ROM of 0-90 degrees. She repeatedly challenges and beats her brothers in wall squat competitions! Eventually, they will figure out why.
The other child that “inspired me to keep swinging” was a teenager with phocomelia and fibular hemimelia. Back when children were admitted for the duration of operative care and recovery, in her case a leg lengthening procedure, we spent long weekends at the hospital attending to them. This patient and I played video games; she, using her feet and me, my hands. She could also, amazingly, put her contact lenses in with her toes. Thankfully, the leg lengthening procedure did not lead to a loss of flexibility, so she retained her skills. My understanding is that today, she is an attorney.
These children inspired me and taught me to have faith in my innovations and my clinical as well as my operative skills. Through my experience with them and other patients, here is what I have learned:
• We all have self-doubt and maybe imposter syndrome. Step back and look at the work you have done. If it is good, acknowledge it, and allow it to enhance the enjoyment of your craft.
• Self-doubt wastes time and can rob you of joy in professional and personal life.
• Learn from your history of successes and believe in yourself.
• A note about leadership: if you have attained a department leadership role, do not step down in midcareer. Wait until your career’s end. Otherwise, you may still be asked to stay in charge of some things but without the necessary authority. It may also impose on your clinical time.