Dr. J. Tracy Watson

“We are insane, ” says Dr. Tracy Watson of himself and his fellow traumatologists. Dr. Watson, a Professor of Orthopaedic Surgery at St. Louis University in Missouri, explains, “My non-trauma colleagues don’t understand why we trauma folks do what we do or why we think it is so ‘cool.’ On paper it doesn’t look like a great sell: crazy hours and the inability to make concrete plans in one’s personal life. But for me, there’s nothing quite as intellectually stimulating as an open tibia…I still get an adrenaline rush. If someone told me I had to do knee scopes and look at a TV monitor all day I think I would find an ‘out.’ Thank God people like different things.”

A Rural Upbringing

While now exposed to the wider world, Dr. Watson grew up in a remote region with a strong culture all its own. “I was raised in Worland, Wyoming, a mountain area where fishing, hunting, and skiing were regular activities. My college-educated grandparents had homesteaded there as little children in the late 1800s and my parents stayed on because of the lifestyle. My dad, who flew C-47’s and B-17’s with the Army Air Corps in WWII, earned his business degree after WWII and then moved to Los Angeles to help manage LAX. My mom, an accomplished pianist who graduated from the Oberlin College Conservatory of Music, was also from Wyoming. She and my father grew fatigued by the lifestyle in L.A. after awhile and fled back to Wyoming.”

Musing about the effect of his upbringing, Dr. Watson notes,

If I had grown up in a city I would probably be less interested in the welfare of the type of people in the rural area of my youth, namely, hardworking ranchers and farmers. These people are worthy of our respect as they work extraordinarily hard, don’t rely on pain medications, and go without disability. It is a culture of extreme self-reliance.

Introduced to medicine by his aunt, a nurse, Tracy Watson says, “She worked in a rural hospital that served 18, 000 people. A gregarious individual, she enthusiastically hauled things such as a jarful of tonsils and old stethoscopes home for me to examine. Her encouraging manner helped facilitate my interest in pursuing a medical career.”

Medical Training in the “Big City” and Beyond

After graduating from the University of Wyoming with a degree in Zoology and Physiology, Tracy Watson entered Creighton University School of Medicine in Omaha, Nebraska. He laughs, “This was the big city where I was exposed to students from both the east and west coasts. With the former being very ‘in your face’ and the latter more interested in ‘sun and fun, ’ I learned quite a lot about human nature…and made great friends. On the academic front it was news to me just how much information I was expected to process in medical school—and that I couldn’t just do it the night before an exam. I wanted to walk away the first semester, but my dad said, ‘At least finish one year. Then, if the content is not to your liking, you may leave.’”

Having found his medical stride, Dr. Tracy Watson undertook a general surgery internship in 1981 at the Cleveland Clinic Foundation and then stayed on for an orthopedic surgery residency. “I was seeking a different environment and lifestyle and was pleased to learn that I was accepted to this program, my top choice. The winters were pretty vigorous, however. At least in Wyoming it would snow three days, then the sky would open into a bright blue panorama. In contrast, Cleveland weather can be extremely gray and dreary. The primary bright spot was that I met my wife while there.”

Hunkered down inside, however, Dr. Watson found several rays of sunshine. “The eminent Dr. Bernie Stulberg, a total joint surgeon, inspired me to learn the ins-and-outs of research. He taught me how to plan a project and write it up properly. And he conveyed how important it was to ensure that the research addressed a question that interests you. My path also crossed with that of Dr. John Bergfeld, the chief of the sports medicine service, who served as a role model for how to interact with patients. He had an engaging bedside manner and knew the value of comporting oneself and dressing in an appropriate, professional manner. There was also Dr. Art Steffe, a renaissance surgeon who thoroughly enjoyed the residents and was instrumental in my pursuit of internal fixation and subsequent implant design. Regarding the program itself, I got a great feel for many areas of orthopedics. I felt very comfortable coming out of there knowing that I could operate well and figure things out along the way if I had to.”

One of the things he figured out was that trauma was his bailiwick.

In 1986 I headed to the University of Texas Health Science Center/Parkland Hospital in Dallas, Texas for an orthopedic traumatology fellowship, one of only three or four such programs in existence at the time. The chief of the orthopedic trauma service was Dr. Ken Johnson, a no nonsense surgeon who insisted that we achieve perfection on each case. It was during this time that I felt drawn in by the variety inherent in trauma work. I could see that every fracture was different, as opposed to total hips, which can become somewhat routine.

He then connected with Europeans for advanced training, on, among other things, the ability to handle soft tissues with Swiss precision. “I had two AO Foundation fellowships, the first involving five months in St. Gallen, Switzerland with Professor Fredrick Mageral where I learned techniques for soft tissue handling. Also emphasized there was detailed preoperative planning. Following this I went to Munich for five months to work with Dr. Berndt Claudi, who taught me the challenge of dealing with a high volume of blunt trauma patients.”

Dr. Watson further expanded his mind by learning to extend bones. “In 1987 I returned to the U.S. and began working at the Cleveland Clinic. During my European fellowship, I snuck away to France to learn the Ilizarov technique for bone lengthening from Professor Jean Marie Hardy. He was doing amazing things in bone transportation and limb lengthening, both rare at the time. The company that had been supplying him with frames gave me a set, but upon my return to the U.S., customs was having none of it because the product was from a foreign manufacturer. I ended up getting the equipment via French Canada.”

Flying around the world to learn this technique, says Dr. Watson, also meant flying by the seat of his pants. “There was no formal instruction available on how to perform this technique…and not much written on it either. In 1987 Professor Ilizarov came to the U.S. for the first time and delivered a lecture in New York. In attendance was a ‘Whos Who’ of orthopedics, with the majority of participants being department chairs. And then there was me, who only received an invitation because of my interest level. Most lectures were in Russian and unfortunately they had a bad interpreter. It was a three day symposium…by the final day there was hardly anyone left in the audience.”

Most would only venture to Siberia as the result of a banging gavel. Dr. Watson, however, was eager to go. “As a company in the U.S. started providing materials to do these cases, a small, but increasing number of orthopedists stepped up and got interested. A self taught bunch, we would send Xrays around to consult with one another. The crowning moment was when we stepped on the plane that would take us to learn from Ilizarov in Siberia. For over two weeks we worked in his 1500 bed hospital using only external fixators. He also had an enormous animal research facility with 400-500 Ph.D.’s—all of this in the middle of nowhere. Today, the Ilizarov technique is still used for some difficult problems. The technology has been refined and Americanized to include fancy technical aspects, but the basic idea of distracting bone and lengthening limbs remains the same.”

Looking for Trauma

Returning briefly to the Cleveland Clinic, Dr. Watson soon realized that he needed more trauma. “In 1991 I left for the Henry Ford Hospital in Detroit, where I knew I would find a substantial amount of trauma. Here I worked with Dr. Roy Moed and we built a large trauma service and began a legacy of publications. After 14 years and the addition of talented staff, the institution changed and Dr. Moed was recruited as Chair to St. Louis University. I followed suit.”

Commenting on how his specialty has fluctuated throughout the years, Dr. Watson notes,

Traumatology is different now than when I first started. It used to be that an institution would hire one person and work him or her into the ground. In an academic facility you are expected to publish and obtain grants, but if you are the only trauma surgeon you’re in the OR all the time…not in the lab or sitting behind a desk. So you come up for review and the Chair says, ‘But you didn’t publish.’ And you exclaim, ‘But I did 2000 cases!’ This is usually an unacceptable answer, however. Such a situation sends most burned out traumatologists fleeing the hospital and into private practice.

His mentor, however, saw possibilities amidst the morass. “When I joined Dr. Moed in 1991 he had an idea that we start an orthopedic trauma service with a core number of individuals who could share the load, take care of a high volume of patients, and yet have time for the academic pursuits of research and publishing. He convinced Henry Ford Hospital to establish this type of orthopedic traumatology service….separate from the rest of the orthopedic department. This would mean that the remaining faculty in the orthopedic department could do more elective surgeries and not be burdened with the trauma cases. When there is only one trauma person, the elective surgeons by default have to do trauma cases as well and are not able to build a viable elective practice. This new model also meant that you could have a life—only if it was just a little control over your schedule.”

Research and Politics

Part of his life away from the OR involves investigating orthobiologics and bone graft substitutes. Dr. Watson: “Engaging in this work is letting me know how much we need to learn about autoengineering. We thought that if you take simple bone marrow, process it, and inject it into a nonunion then the bone would heal, but it didn’t work. We have to do more than just aspirate the marrow and inject it into the fracture site. This might involve expanding the cells in tissue cultures or processing them in a different manner.”

Another way of contributing to the field is by holding up a mirror to oneself and others. “I serve on the hospital’s Trauma Peer-Review Committee, where we sit down monthly to review the trauma cases on the orthopedic and trauma general surgery services. We analyze complications and less than favorable outcomes on approximately two or three cases a month. It’s definitely challenging to be critical of oneself and one’s peers. You’re also doing a bit of tiptoeing around very strong surgeon personalities…..because we are all working towards process improvement and a better functional outcome for the patient. In this process we sometimes have to ‘educate’ our colleagues that there may be a better way to accomplish those goals.”

He thought trauma was a jungle…then he got into politics. Dr. Watson: “I have just completed my term as President of the Orthopaedic Trauma Association. This apolitical orthopedist got his wake up call, and I realized that I had to learn to think in a much different manner. The volume of work was also a challenge. I learned that while I’m a typical traumatologist in that I procrastinate, I had to rectify that tendency. (We tend to put things off because we’re used to just dealing with whatever emergencies roll in the door.) I recently advised the incoming President, Dr. Dave Templeman, to invest in a Blackberry. ‘Look, ’ I said, ‘the last thing you want is to get home at 8pm and find 20 emails that must be answered before you go to sleep.”

To unplug from the e-world, Dr. Watson and his family head to the open skies of Tensleep Wyoming. “I have a little ranchette out there of about 90 acres at the base of the Bighorn mountains. We go fly fishing, visit my mom, drive in the wide open spaces (in my 4 wheel drive truck)…and leave the Blackberry behind.”

Much of my success, ” states Dr. Watson, “can be attributed to my pragmatic, accomplished wife. She is a nurse and was often in charge of a surgical trauma ICU for many years when we were in Cleveland. So she understands what it is that I do for all those hours, and often gives me great patient advice! I have been very fortunate that she can function independently with regard to her interests outside of my work (and not rely on me to be the sole source of entertainment).

Dr. Tracy Watson—lengthening limbs and strengthening lives.