November 2015

Surgeon finds himself on other end of scalpel

feature-perspective

By Cary Groner

“The most consistent advice I’ve received is that I have to come up with a better story about how this happened,” said David Armstrong, DPM, MD, PhD.

He was talking on the phone at his desk, his feet up, an ice bag on his mending left knee. Armstrong, a professor of surgery and codirector of the Southern Arizona Limb Salvage Alliance (SALSA) at the University of Arizona College of Medicine in Tucson, was a month out from serious injury, but all things considered he seemed fairly jolly. Not that this would come as a huge surprise to anyone who knows him.

“Sitting really is the new smoking,” he said with a laugh. “It’s a serious hazard to your health. I was sitting at my desk, writing a paper, when I got called down to the operating room [OR]. I leapt up from the chair like Athena springing fully formed from Zeus’ brow—I’m sure that’s how it must have looked, one of those really awesome things. But instead of tearing my Achilles tendon, which would have been the Greek thing to do, I ended up tearing my meniscus.”

Armstrong felt the sear of pain and knew something was seriously wrong, but he’s a surgeon; he still had to go to the OR. The bucket-handle tear kept his knee from extending past 30°, so he went looking for some form of support to make his way downstairs.

A meniscal injury gave one practitioner new insight into the patient experience and renewed his belief that healing isn’t just about what happens physically.

“You’d think in the top place in the world for pressure relief on extremities, I’d be able to find something to protect and offload my leg,” he said. “But here I was, hopping around on my other leg, and the only thing I could find was a four-leg walker, the kind octogenarians use. So I grabbed it and went clacking down the hallway on one foot, heading for the OR.”

He finished the surgery, then did another one, mainly by sitting down. Afterward, he left the OR and drove over to the orthopedic clinic, where he found the kind of empathetic response he’d been hoping for.

“My buddies were just merciless,” he said. “No sympathy at all. I got an MRI—then we knew the meniscus was torn—but of course this was a Friday and that night we were having a party for sixty or seventy people, to welcome the new residents and fellows, at our house.”

By then, at least, he could save face by showing up on crutches instead of teetering in on the walker. He enjoyed the party—which doubled as a send-off for his longtime assistant Sandy Perry—then went back to the OR the next day, this time as a patient.

Under the knife

He’d done thousands of surgeries in his career, but this was his maiden voyage on the other end of the scalpel. It was quite a trip, in fact, and like all good voyages ended up taking him someplace he’d never expected to go.

“They say don’t have surgery at your own hospital because everyone knows you,” Armstrong continued. “Everyone was making fun of me—‘How could you be so fragile that you fall apart standing up from your desk?’—and all the circulating nurses were stopping by. Then the anesthesiologist, Wally Nogami, came in, and with his flat Hawaiian affect, said, ‘David, you are really hard to kill.’ That’s the last thing I remember.”

The meniscal repair surgery went well, although when he awoke, the anesthesia had left him so nauseated that he began to vomit. His wife and daughters told him he looked like Linda Blair in The Exorcist, letting the green goop fly. Fortunately, a scopolamine patch forestalled the need for intervention by Max von Sydow.

Day two, home from the hospital: Armstrong was wearing an “awesome RoboCop leg brace,” but soon noticed aspects of it that suggested opportunities for improvement, as he tactfully put it. So in characteristic fashion, working with a phone and a laptop from his chair, he began the process by calling his friend Marvin Slepian, MD, a world-renowned Arizona cardiologist who designed the first artificial heart. They chatted on FaceTime, then Armstrong filed a patent application for several modifications to the brace to improve the wearer’s mobility and the ease of donning and doffing, among other things.

“That chair now has a serious butt print because I’ve spent so much time in it in the past few weeks,” he said, laughing. “I felt like I was in Rear Window, except my window was a computer screen.” The transition from Linda Blair to Jimmy Stewart had to feel like an improvement, anyway.

When it was time to remove the stitches, Armstrong enlisted a little help from his wife, Tania, and his daughter Alexandria, and did it himself at home.

“I’d never trust an orthopedist to take out my stitches,” he joked. “There’s an old saying: Those guys are strong as an ox and twice as smart.”

At four weeks out, Armstrong reported seeing advances in his mobility and motion every day.

“It’s fun—it’s like watching your kids grow up, only it’s you instead,” he said. He hasn’t needed much in the way of painkillers, though he did take a Motrin in anticipation of the phone interview with this reporter, as a prophylactic against inflammation of the vocal chords.

Taking time

Perhaps not surprisingly, one thing he’d noticed was how long it took him to get around.

“I usually have everything timed,” he said. “I know exactly how long it takes me to get from point A to point B in the hospital. It usually takes two minutes and forty seconds to get from my desk to Pre-Op; it’s a little bit of a distance but I walk quickly and say hello to people on the way. Now it takes twenty minutes, so I have to factor that in.”

Figure 1: Armstrong speeds down to the OR minutes after sustaining a high- energy knee injury by leaping from his chair.

Figure 1: Armstrong speeds down to the OR minutes after sustaining a high- energy knee injury by leaping from his chair.

Not all of the delay is physical; Armstrong is beloved by colleagues and gets stopped so often that he’s considered making a recording of his explanation and playing it as he limps along. Trips to the main university campus require a short drive instead of a 10-minute walk, and he won’t be able to do stairs, except in peg-leg fashion, for another couple of months.

Rehab has been relatively uneventful, mercifully.

“I had my first real physical therapy appointment today,” he said. “I’ve been working on a sled machine and I’m going to start some bicycling. I’ve been doing leg lifts and all these things you have to do if you’re extremely decrepit. But the therapist down there is like: ‘Oh come on now, sir, just a little bit more,’ and boy do I feel old.”

He was finally able to dress himself for the first time the day before we spoke.

“The last challenge was the sock on my left foot,” he said. “It’s deceptively difficult. I’m sure millions of people have gone through this and understand it, but I haven’t. So I finally got my sock on and was so proud of myself—the big achievement!”

Figure 2: Armstrong is sympathetically assisted to the men’s restroom by (L-R) trauma physician Rifat Latifi, MD, heart surgeon Zain Khalpey, MD, PhD, and bioengineer Bijan Najafi, PhD, at the University of Arizona Medical Center.

Figure 2: Armstrong is sympathetically assisted to the men’s restroom by (L-R) trauma physician Rifat Latifi, MD, heart surgeon Zain Khalpey, MD, PhD, and bioengineer Bijan Najafi, PhD, at the University of Arizona Medical Center.

Armstrong usually keeps a busy travel schedule but it’s on hold for the time being. A trip to lecture in Mexico had to be canceled. He’s lecturing to University of Arizona surgical students in person, though, and to students at Cardiff University in Wales via the Web.

“Next week I’m supposed to travel, but we’ll see,” he said. “I may violate someone’s explicit instructions.” [Editor’s note: At press time, in late October, Armstrong was back on the road in Toronto.]

Bringing things full circle

With the doctor on crutches for a change, Armstrong’s patients have developed a new appetite for selfies with him, and many of them want him to try their gear.

“One guy had this fancy automatic wheelchair, and I couldn’t drive it for hell. I kept banging into all the walls and nearly wrecked the clinic,” he said. “But the whole thing’s been a blessing, really,
because it’s allowed me to experience what it’s like from the patient’s side. As doctors and nurses and physical therapists and pedorthists and orthotists, we think we know that, we act like we know. But it’s a whole different thing when you really know. It brings things full circle.”

Figure 3: Armstrong gets tips on driving a motorized wheelchair from his patient Steve Frederick.

Figure 3: Armstrong gets tips on driving a motorized wheelchair from his patient Steve Frederick.

From that new perspective, Armstrong feels more strongly than ever that healing isn’t just about what happens physically.

“What I’ve found is that outlook and affect are inexorably associated with outcome,” he said. “I’m not just talking about myself and my knee, I’m talking about my patients. Every time this hurts a little bit, I look at my patients. These people have been through so much—orders of magnitude more significant than this—and they handle it with such grace and dignity. I look at the dignified way people heal and age, and frankly, the dignified and brave way people die. These are things I see every day because our patients are really sick. So I think about the three little holes in my knee, and it’s like: Come on, man, big deal. I’m doing great, I had a great doctor, I have it easy.”

Cary Groner is a freelance writer based in the San Francisco Bay Area.

(Visited 432 times, 1 visits today)

Leave a Reply

Your email address will not be published. Required fields are marked *

Spam Blocker * Time limit is exhausted. Please reload CAPTCHA.