Dr. Christopher Born

Sometimes when the phone rings, it’s a call from home. Other times, it’s Homeland Security. Dr. Christopher Born, Chief of Orthopedic Trauma at Brown University, is known for his expertise in handling mass casualty situations.

The Winding Road to Orthopedics

Raised in New York City by a stay-at-home mother and an ophthalmologist father, a young Christopher Born held fast to his parents’ educational expectations. “My dad was the son of immigrants and he and his sister both attended college, the first in their family to have done so. Having grown up in the depression, my dad understood the value of hard work and of living within one’s means. This made a substantial impression on me…and if you talk to my kids they will tell you there is a tremendous similarity between me and my dad in that respect.”

Yet for awhile, he was a bit more focused on merriment. Dr. Born: “When I walked through the doors of the University of North Carolina at Chapel Hill in 1966, I wasn’t gracing them with an A student. I was having too good a time to focus on academics—that would come later. In the meantime I had to finish college during summer school, only to be followed by the unnerving prospect of going to Vietnam. As fate would have it, my draft lottery number was 326, meaning that I was not going to be drafted.”

So what would he do? At that point there were several options, including geopolitics and sheep. Dr. Born says, “I was a political science major, but I didn’t know what to do with it. I ended up taking a year off to travel around the around world by myself, hitchhiking along the way. Part of that time was spent at a sheep station in Australia where I helped care for cattle and sheep on a 16, 000 acre farm. In time, however, I knew I would have to come home and face the career music.”

The last few weeks on the farm I had long conversations with myself about the future. I tried to focus myself by thinking of everything that had ever interested or excited me (that I could turn into a work life). I could only come up with two things: art history and biology. The latter won out, and based solely on one course I had taken in high school, I decided to become a physician. I gave in to my interest in various life forms and embryology, despite the fact that I felt I had more of a talent for literature and the arts.

After learning much about single celled organisms, Christopher Born moved on to larger life forms. “In 1972 I began premed studies at Columbia University. I attended school at night and worked in a lab at Sloane Kettering during the day. After a year I decided that I wanted to do something that involved patients, and went to the New York Hospital and asked if there were any jobs available for someone at my level (an orderly, etc.). The administrator initially said, ‘no, ’ but then changed her mind—and my life. ‘There is one job as an orthopedic cast technician in the fracture clinic, ’ she said, ‘but you have no experience.’ I promptly replied, ‘What is orthopedics?’

“She had some faith in me, however, most likely because the only other applicant for the position was a high school graduate, while I was a premed student. I stocked supplies, helped put people in traction, etc. I really enjoyed the materials and learning about the various injuries. It was evident that there was an artistic component to this work. I could also see that it was necessary to have the ability to assess things in three dimensions.”

His next career move almost had him asking, “Se habla ALIF?” Dr. Born explains, “Because of my less than stellar college grades, I didn’t get any interviews when I applied to medical schools. I went to Mexico to study Spanish, with my plan being to enter medical school there. While in Mexico I learned that I had gotten an interview, and was subsequently admitted to the Georgetown University School of Medicine. I enjoyed the program, and was heavily focused on getting a surgical residency. In addition to orthopedics, I was considering urology and ENT. My generous father said that he would continue practicing until I made my decision…and that he would give me his practice if I wanted it. In the end, however, I was drawn into orthopedics by the allure of fracture work.”

Building an Education and a Career

Entering the orthopedic residency program at the University of Pennsylvania in 1979, Dr. Born soon got to engage in his new passion. “The Chair, Dr. Carl Brighton, had developed an outstanding orthopedic laboratory at a time when such places were uncommon. I worked alongside him in the lab looking at the stresses within bone and what kind of reaction the bone and tissue has—and how that was related to healing.”

“Another mentor, ” continues Dr. Born, “was Dr. Bruce Heppenstall, head of the fracture service, who taught me the importance of being bold, but thoughtful. ‘Have a plan and carry it out as quickly as is safely possible, ’ was his motto. Dr. Richard Rothman also factored heavily into my education, and stressed the value of sticking to your guns when looking at surgical indications. And he was adamant about putting the patient first. He would give an example along the lines of, ‘Let’s say there is a situation where you want to be a hero. But once you analyze things you can see that proceeding along xyz course of action could elevate the chance of causing harm.’”

He homed in on trauma, but Dr. Born didn’t have the widespread options that budding traumatologists have today. “Because of the paucity of trauma fellowships in the US, I made plans to go to Switzerland for a six month AO fellowship. One of my colleagues at Penn, Dr. Bill DeLong, had decided to take a job at Cooper Hospital University Medical Center in Camden, New Jersey, a level one trauma center. After a conversation with Bill, I decided to join him at Cooper, with the understanding that I would do the AO fellowship first. Bill convinced me to go ahead and start at Cooper and said, ‘We’ll figure this out later.’ Whenever I see him these days, I tell him he still owes me six months in Switzerland.”

As for Dr. Born, he gave 12 years to Cooper. “From 1984 until 1996 I was the Assistant Division Head of Orthopedic Surgery at Cooper and was an Associate Professor of Orthopedic Surgery at the University of Medicine and Dentistry/Robert Wood Johnson Medical School. It was amazing to work seemingly 24/7 at a level one trauma center, something that was akin to being in a MASH unit. There were only two traumatologists at first, and then we slowly increased to six and brought on residents and fellows. It was a widely respected program, and people talked often of doing a ‘Cooper rotation.’”

In 1996 “team DeLong-Born” moved to rejoin the faculty at the University of Pennsylvania. Dr. Born, an Associate Professor of Orthopaedic Surgery who served as the Co-Director of Orthopedic Trauma at Penn, says, “Bill and I were recruited to Penn by Dr. William Schwab, who at one point had been at Cooper with us. Although it was a great learning experience overall, we did have some challenges with regard to getting trauma patients into the OR in a timely fashion. Penn’s healthcare system is so vast that there are enormous demands for space…and ours was just one area that needed servicing.”

Enthused by the prospect of building a trauma program, Dr. Born—and Dr. DeLong, of course—left for Temple University. “In 2002 Bill and I went to Temple to help build their trauma program. Despite being a level one trauma center, they didn’t have orthopedic trauma expertise at the time. It was great to be able to help the Chair, Dr. Joe Thoder, with his academic mission. After two years there I was presented with an opportunity at Brown University, one which was very attractive, in part because my wife and I had a house in the area. My wife had a very successful business in Philadelphia, so she wasn’t able to join me full time. We basically settled into a pattern of commuting back and forth between Rhode Island and Philadelphia.”

Researching New Technology

On the research front, Dr. Born and his colleagues at Brown have been busy with antibiotics. “My team and I have been studying whether using beads impregnated with antibiotics in wounds that have VAC (vacuum assisted closure) dressings can augment bone healing. The fundamental question at this point is, ‘If you put these beads in a wound with a VAC dressing, does the antibiotic still have a high concentration even though there is essentially a vacuum sucking antibiotics out of the wound?’ We are wondering if there is a way to modify the time and duration of the VAC cycle to increase local antibiotic tissue concentration. We also have to identify what proper pharmacologic dosage is needed for the VAC dressing combined with antibiotics. It will likely end up being an intermittent schedule, a la VAC on for 20 minutes—VAC off for two or three minutes.”

This and other work will ultimately benefit men and women in uniform. Dr. Born: “We have been working with the Veterans Administration and the Center for Restorative and Regenerative Medicine here at Brown to research aspects of managing injuries that are sustained by soldiers. This multidisciplinary group has taken on a lot of initiatives, including neurophysiologic studies.”

For example, other researchers in the Center have developed a system to place an implant into the motor cortex of the brain that can pick up brain waves. The waves are then interpreted in terms of purpose and can be connected to a computer which can manipulate a robot. This means, for example, that the patient can just think about moving a mouse on a screen and it moves up and down. Simply amazing.

Also important for those in the military, as well as civilians, are advances in prosthetics. “Most prosthetics are passive, such that if you have a below the knee amputation and you walk on it, the feedback you get in terms of where you place your foot in space is limited. The gait cycle takes a lot of energy, not to mention lugging this prosthetic along. Another researcher affiliated with the Center, Dr. John Herr of MIT, has developed a below the knee prosthesis that is active, meaning that it responds to gait and speed. It is in the trial phase now, but thus far people are saying that they have more of a feeling of a normal gait…and that it takes less energy.”

With all of the planning, technology, surgical time, and post-op work that goes into implanting a device, wouldn’t it be nice, says Dr. Born, if it could actually remain in the patient for a long period of time (and not cause infection)? “Our orthopedic trauma division has submitted a number of grant proposals to the Department of Defense and private foundations to examine the interface between metal and bone, and metal and skin, in order to refine the technology for coating implants. This work should enable us to make antibacterial and antimicrobial coatings and to make coatings that promote bone attachment to the implant. In joint reconstruction they have surfaces with microbeads that are embedded in the cracks and crevices; the body is thus fooled and bone can interdigitate and create a bond. We are looking to do the same thing with a different technology.”

Responding to Disaster

One area where he might not have the latest technology at hand, but where there are other vital challenges, is disaster response. Dr. Born, Chair of the Mass Casualty Response Committee for the Orthopaedic Trauma Association (OTA), explains, “A few years ago it dawned on me that I was unaware of a formal or even an informal system whereby orthopedic surgeons might respond to international disasters. I began trying to increase the awareness and training in this area, with a focus on the fact that responding to disasters has its own unique issues, including, for example, the safety of responders, what kind of disaster has occurred, etc.”

“I have come to learn the importance of a seamless command structure, with people who understand how the package is supposed to be put together. So when a disaster happens, there is no question what needs to be done. The first two or three years that we ran this program at the OTA, we had 20-25 attendees. There are an increasing number of competing programs, and this year only five people signed up—so we canceled. We are in the process of rethinking how we structure/approach this next year. There are other educational venues, of course, including the AMA and ACS.”

But when Dr. Born gets the call, he knows enough to be ready. “In 2004, I received a phone call at 11:00 one night asking if I would go to Iran. There had been a massive earthquake in the city of Bam, and immediate assistance was needed. I got my cache of equipment that is always at the ready, and linked up with the International Medical Surgical Response Team (IMSuRT), part of FEMA that is based out of Boston. We mustered at Massachusetts General Hospital and flew to Frankfurt, then on to Iran. It was incredible that the city of Bam, which the day before had had 100, 000 occupants, had lost 25 to 30, 000 people in the earthquake.”

Because of diplomatic issues, the U.S. government couldn’t officially send help. However, the Iranian government, working through intermediaries, approached the U.S., and 60 of us private citizens went for two weeks. I found the Iranians to be very welcoming, and was surprised to see how well organized the U.S. team was. All of the equipment worked, and each person knew his or her role. We brought everything we needed and were a self contained unit. After awhile, however, you begin to run out of supplies and get fatigued. Two weeks was our limit.

To any colleagues who might be interested in keeping a “go” bag and mustering in the middle of the night, Dr. Born advises, “The most important thing to keep in mind is that you must be prepared to fly by the seat of your pants. You don’t have the equipment you’re accustomed to having so you have to ‘make do.’”

Whether it’s Iran or Philadelphia, his “go” bag is packed. “My wife and I do a lot of traveling back and forth on weekends. She started a master’s program in organizational dynamics at Wharton 15 years ago, but had to put it on hold because her business took off. She is now finishing up that program. Our youngest child just graduated from Brown this year and is living in Providence with me, working at the Rhode Island School of Design (RISD) Museum.

Dr. Christopher Born…for when disaster strikes.