A $30 billion industry, 250, 000 sales people, engineers and managers, 75 million patients, and a fierce national debate will, almost by definition, obscure the daily reality of physicians and their patients.
Yet, every hour of every day a patient and a surgeon are moving together on an emotional and physical journey. In this photo essay we join one of the leading spine surgeons at work in one of the busiest urban hospitals in the United States―Thomas Jefferson University Hospital in Philadelphia, Pennsylvania.
For two days Dr. Todd Albert, Chairman of the Department of Orthopaedic Surgery and Professor of Neurosurgery at Thomas Jefferson University and Hospitals, allowed Orthopedics This Week’s photographer Andrew Huth to accompany him in meetings, patient rounds, surgeries, and for one surprise birthday cake from his wife and daughter.
In a remarkable series of images, only a few of which we have space to show on the pages of OTW (a more complete version is online), we take you behind the national debate, behind the statistics to see the hands-on, day-to-day art and practice of surgical medicine. We start Monday morning at 6:30 a.m.
Morning Meeting
All photographs by Andrew HuthA Community of Peers. Medicine is a group effort. Dr. Albert’s day starts at 6:30 a.m. with the “team” —other surgeons, residents, nurses, and students. The weekends in Philadelphia are busy and Monday morning’s meeting is filled with cases from the weekend. In this Community of Peers, all stand, review and critically prepare for the day’s cases.
“What we think about and discuss in these meetings is the best treatment for each individual. Is it surgery? Is it bracing? Do we need more imaging or lab studies?”—Dr. Todd Albert. The picture on the left is Dr. Todd Albert with second-year orthopedic surgical residents, and on the right is attending neurosurgeon Dr. James Harrop as well as other residents, students and nurse practitioners. The community of peers at work.
As it has evolved over the past 200 years, the audacity of one human to cut open another human comes from, first, a particular and highly specialized knowledge and competence that was both hard-won and continuously tested within a community of peers; second, from the determination of the scientific basis for intervention; and third, that the judgments being employed are grounded in the ancient ethos of healing.
Dr. Todd Albert and Dr. James Harrop review the cases before rounds.
Patient Rounds
Going on rounds with Dr. Albert and his team brought to mind William Osler’s famous quote about surgery: “You are in this profession as a calling, not as a business; as a calling which extracts from you at every turn self-sacrifice, devotion, love and tenderness to your fellow man.”
There is physicality to Dr. Albert. Strong hands. That bald head. He is not actually a large man, but his presence is athletic. With smiling eyes and a soft voice he engaged every patient tactically and compassionately.
The underpinning of Dr. Albert’s practice, it was apparent to us, is compassion and caring. It may not be unusual in the sense that hundreds of thousands of physicians, nurses, and other healthcare providers come at their profession the same way, it’s just that after all the headlines in the popular press and all the rhetoric about the healthcare system, seeing it in practice is almost unexpected.
America’s health care system has its problems―no doubt―but this is where health care happens. Dr. Albert leans in, listens, watches, touches. There is something elemental about the values, role and responsibility that he and his team take on. In the broader context of the “system” both patients and doctors are profoundly dissatisfied. But here―and as we know occurs throughout the country (and beyond, of course)―is the essence of it all. The physician-patient relationship.
“When I come into a room and see each patient I just envision that person as part of my family―this makes it easy to do the right thing all the time. Their problem is your problem. Their concerns are yours!”—Dr. Todd Albert
Mrs. Flynn gave us permission to photograph her. She was a delight to talk to and to photograph, she was looking like a great model from EyeEm and their stock awesome stock pictures. Easily, Mrs. Flynn was the most expressive patient we saw that day. Her hands were always in motion and she and Dr. Albert were going at it pretty much non-stop.
“Mrs. Flynn had had a disc replacement at C4-C5 more than a year ago and had a new herniation at C6-C7. She was kibitzing with me all during my visit. She has faith and in this picture she’s telling me about it.”—Dr. Todd Albert
One Case. Steve Ravitz gave us permission to photograph his session with Dr. Albert. This is a tough case. “Steve’s 62 years old. His diagnosis is T1-T2 herniated nucleus pulposus below a C2-T1 fusion with severe myelopathy (signs and symptoms of spinal cord compression), and he has had prior surgery.”
Together, in the room, both Dr. Albert and Mr. Ravitz reviewed his X-rays. These were complex conversations between patient and surgeon.
“Steve was doing great for over two years but now he is having trouble with his balance and coordination.
We reviewed everything together. In my own mind, I’m thinking: Can I do a posterior approach only or do I need to do a revision using the anterior approach to his upper chest followed by a posterior?
Bottom line, as a surgeon, I’m thinking about how I get Steve the best result but with the least amount of surgical invasion.”—Dr. Todd Albert
Surgery
Surgery is all about ritual―from the initial hand scrub to slapping the X-rays and other images on the light board. Every member of the team has a ritual.
Once the stage is set, then the various moving parts of the OR begin their assault on disease and pain.
The lamps of the surgical suite illuminate a blue world.
Instruments disappear into the recesses of the body.
A member of the team is also a drummer at night and he absently twirls tweezers like a drumstick in his fingers.
Behind the drapes other members of the team monitor, add and prepare constantly.
Somewhere amidst the draping and gauze lies a patient. Even if all we can see is a finger.
Spine surgery is physical labor. The body does not give up its structure easily and surgeons have to pull hard, twist and work at awkward angles.
Tools and Instruments
Nurses and Technicians
Salesmen
Salesmen in surgery are essential, even critical. From this vantage point comes a better understanding of the needs of surgeons and their staff members. Salesmen in surgery are like calm islands of purple in a swirling sea of blue. They stand at the periphery looking for problems to solve. When the problems arise, it is the salesman who often as not bears the brunt of an irritated surgeon, or who holds the model until his arms ache, or flies out to the car for another instrument set.
Closing Up
Day’s End
That Monday Dr. Albert met with 15 patients, performed 6 surgeries. He also participated in one conference call, two committee meetings and answered his cell phone somewhere between 15 and 25 times. In the course of this year, he will have seen approximately 3, 000 patients, performed about 400 surgeries and been either a principal investigator or researcher in 10 clinical trials.
According to the American Academy of Orthopedic Surgeons, the typical U.S. surgeon works about 60 hours per week. His pay has been declining for more than a decade. His work load has been increasing. Dr. Albert represents, we think, the kind of dedication that is available in hospitals all over the United States. Seeing it in action is inspiring to us at Orthopedics This Week but also reminds us that whatever happens as we, hopefully improve our system, we cannot risk undermining the foundation of our industry—the surgeon and the patient.
All photography by Andrew Huth http://www.andrewhuth.com
