Terry Light, M.D.

Last year the Journal of Hand Surgery published a lecture given by a former President of the American Society for Surgery of the Hand (ASSH), Dr. Terry Light, the Dr. William M. Scholl Professor and Chair of Orthopaedic Surgery and Rehabilitation at Loyola University Health System. Dr. Light’s landmark speech urged today’s young orthopedists to move past the allure of the obvious and find real meaning in their work. It turned out to be one of the most popular and widely read articles ever published in that journal.

Dr. Light:

I grew up in suburban Chicago where I was surrounded by talk of medicine. My dad was an ophthalmologist and my maternal grandfather was a general practitioner. The automatic question in my family was, ‘So, what are you going to specialize in, Terry?’

Although the young Terry Light didn’t want to toe the family medical line, he did indeed have an interest in medicine. “While I learned a lot by working in my dad’s office for a few summers, the most valuable experience was traveling to Haiti to work at the ophthalmology clinic my dad helped to establish. This broadened my sense of world health issues beyond what I had ever seen or read in a book.”

Still not wanting to be defined by family expectations, Terry Light also looked elsewhere for inspiration. “I started college at Yale in 1965 and pursued biology. I then diverged a bit from the medical track and did a rather 1960’s thing…I took up urban and American studies. Along the way I continued with the premed requirements and ended up taking a deferment from Vietnam to attend medical school.”

Coming home, Terry Light began his medical career at the Chicago Medical School and, slowly, the siren song of orthopedics began to have its effect. “I had an uncommon amount of responsibility at Cook County Hospital because the staff was limited, a situation that suited me perfectly because I enjoyed getting involved rather than being a spectator. In my fourth year, while debating between ophthalmology and orthopedics, I did an orthopedic rotation at Yale-New Haven Medical Center, where two senior residents became my mentors. I went ahead did the ophthalmology rotation, but I was already sold on orthopedics because of the variety, the pace, and the esprit de corps.”

Back at Yale in 1973, Dr. Light met other iconoclastic spirits who helped him further evolve his orthopedic world view. “Dr. Thomas Krizek, a plastic surgeon and an unconventional thinker, gave me a sense that just because everyone believes something is true doesn’t mean it is so. The Chief of Yale Orthopedics was the inimitable Dr. Wayne Southwick, my idol and mentor, who had an infectious enthusiasm for orthopedics. Then there was Dr. John Ogden, who spurred my interest in the biology of limb deformity. With him, I began to explore congenital conditions by examining the morphology of skeletal injury and deformity.”

The deeper Dr. Light dove into orthopedics the more captivating the mysteries of the musculoskeletal system became and the idea of specializing seemed, ironically, even more remote. “I did a hand fellowship in Hartford, Connecticut, at Hartford Hospital and Newington Children’s Hospital. There I was trained by Dr. H. Kirk Watson, a talented surgeon who listened carefully to patient complaints and developed new surgical techniques. I never envisioned my practice as limited to hand because I enjoyed other things, including the cervical spine and hips. I was moved to see that our hand interventions could create substantial functional improvement for the patients, and in the process, help the families out emotionally.”

It was during this time that Dr. Light’s understanding of his own family history was enhanced.

When I was a child my mom’s cousin had a daughter born with a substantial hand abnormality. I recall the hushed conversations and the general sense of family dismay. Despite her physical impairment, my cousin was bright and attended Yale as an undergraduate when I was a resident there. Her mom would often pull me aside and say, ‘What can you do for her?’ This really gave me insight into the pain that families experience and the support they need.

While on Yale’s faculty, Dr. Light remained a generalist. “I was the Chief of Orthopedics at the West Haven, Connecticut VA Hospital, yet never entertained thoughts of an academic career. My father and grandfather had been in private practice in Chicago, and I didn’t think the salary in academia would be sufficient to support a family. My plan was to return to Chicago and explore private practice opportunities. Then I spoke with a rugby friend who told me that Loyola was looking for a hand surgeon…and that the Chair was doing some exciting things. I decided to give academia another look.”

Dr. Light continued with general orthopedics at Loyola and took trauma call for both the orthopedic and hand services. “After five years I narrowed my focus to the hand, in part because I realized that in ‘the big city’ it would be easier to build a practice if I specialized. But I will never forget some of the most dramatic cases in those first five years. One man had been working on an underground project and got his hand caught in a machine. He was pulled into the machine, broke his neck and had his arm ripped off. The arm was not salvageable, but we were able to do spine surgery, as well as create flaps to cover his upper arm so that he could wear a prosthesis. He was an amazingly resilient individual who later threw a barbeque for all of the doctors and nurses who had taken care of him.”

In the years to come Dr. Light would be surrounded by, and think often of, the emotional side of medicine.

While working with children can be fun, many of my colleagues are afraid of the parents, thinking, ‘Why do they ask so many questions?’ and ‘Why are they so difficult?’ I have come to understand that the parents are going through a grieving process. The child they have long awaited is born with two thumbs or webbed fingers…this is not the perfect child they expected and they are worried about his or her future. The reality is also that if the treating physician is pregnant or the doctor’s wife is pregnant, then he or she has to spend their days seeing kids with abnormalities. There ensues somewhat of a bargaining process, i.e., ‘OK, this I could deal with…that, I could not.’

So what kinds of problems come through Dr. Light’s door? “If, for example, a child presents with eight fingers we use the anatomy to recontour the hand to create a hand which appears reasonably normal. A common scenario is to have a child born without a thumb. In that situation we shift the index finger to the thumb position. The absence of the one finger is not nearly as noticeable as a missing thumb. As for prostheses, they are usually not successful for kids with congenital problems because prostheses have no sensation…and patterns of use depend heavily on sensation.”

“The most common conditions we see are webbing of fingers and polydactyly (extra digits). I work at Chicago Shriners Hospital one day a week where we often see children from abroad who have been adopted by American families. These are situations where if the child was six months old we might deal with it in a straightforward manner, but because these children are older (six or seven, for example), then you must use more complex methods such as distraction techniques.”

Then, there is Dr. Light’s famous lecture and subsequent article.

Last year the Journal of Hand Surgery published a lecture I gave to the ASSH residents and fellows meeting. I had seen an ad for a job that focused heavily on the salary, benefits, and how many days of call were required. I felt inspired to tell these young trainees that if they let that be their guide then their careers would not be as rewarding as they might be. In 40 years I have never given a paper that received so many accolades. I got emotional emails from around the world, and many people have stopped me at national meetings to discuss the content of the paper. It gives me hope.

And his concerns? “Orthopedics is at risk of fragmentation such that in the next generation we may see hand and spine split apart from orthopedics completely. If this happens, then individuals in those areas will have to apply for separate board certifications. The real issue here is that we would lose the cross fertilization of knowledge that comes from having orthopedics as a base.”

Dr. Light may not have control over this or other major issues in the field, but he can control how much variety and enjoyment he takes from life…and how much he gives. “My wife Holly is our foundation. She was a physical therapist at Yale New Haven Hospital when we met. One of our daughters has just started her senior year of college and the other has just started her second masters program. My younger daughter and I are planning a trip to Vietnam and Cambodia as a follow up to my previous trip last year when I worked in a hospital in Ho Chi Minh City.”

“I also devote time to the Frank Lloyd Wright Home and Studio Foundation, and am a former chair of the Board. We are fortunate to live in an historic district that is filled with Wright designed homes. My other passion is collecting Marblehead pottery, made by hand in the early 20th century. I was interested to learn that this pottery was started by a doctor who thought of pottery as therapy for patients with nervous disorders.”

Dr. Terry Light: connecting with himself, others, and the larger meaning and purpose of orthopedics.