When the 17-year-old John Cardea emerged from a coal mine deep in the vast system of mountains in eastern North America known as the Appalachian Chain, he wiped his brow and said, “Mom, get me some more books.”
The third generation son of miners of one of the oldest geologic structures on earth had just set himself a new goal. He was going to become a doctor.
John Cardea, now Chair Emeritus of the Department of Orthopaedic Surgery at Virginia Commonwealth University (VCU) looks back and recalls: “I was born in West Virginia, in the heart of Appalachia. My grandfather arrived at Ellis Island from Italy and he got a job in the coal mines…my dad followed him into that life. My mom had other ideas for me, however. She was a nurse who influenced me profoundly, especially when it came to obtaining an education.”
Not only did young John Cardea become a doctor, he also became a leader in the training, education and nurturing of thousands of future surgeons. A founding member of the American Association of Hip and Knee Surgeons (AAHKS) and former president of the Orthopaedic Trauma Association (OTA), Dr. Cardea has pursued his passion for teaching and leadership with unusual gusto. And don’t let him find anyone acting unethically. (Hint: they can’t hide.)
Communication has always been of the utmost of importance to Dr. Cardea. He says, “If you come from Harvard, but you feel uncomfortable talking to your patient who is a farmer, what good are you?” One reason that Dr. Cardea has been a successful leader is his lifelong ability to talk to anyone…and listen. That doesn’t mean he didn’t hit some bumps along the way, however. “Growing up in Appalachia gave me an incredible ability to talk to people and to ‘read’ people. That being said, it took me awhile to get comfortable in the environment of higher education. I had endured years of snickering about my plans to become a doctor (most of my peers either took to the mines or joined the Marines). My family members, fortunately, were very supportive.”
Occasionally, a hint of self-doubt would creep into Dr. Cardea’s thinking. “While I had had dedicated and involved teachers in my youth, and I had received a broad education, my vocabulary skills and the way that I used words was limited because I was raised in Appalachia. I excelled at math and science, but sometimes felt self conscious in college. In those times my tendency was to withdraw. Whenever I wavered or felt any doubt, however, I held tighter to the goal of being a doctor and that commitment helped me to study even harder. For inspiration, I would ride my bike over to the West Virginia University Medical Center and give it a long, hard stare.”
For that boy on the bike, the goal to be admitted into medical school must have seemed impossibly remote. John Cardea, however, would not only achieve that goal but eventually rise to the pinnacle of his profession and craft one of the leading international surgeon societies dedicated to furthering medical research.
I finished my residency at VCU in June 1973 and one month later the powers that be appointed me to become a member of the faculty—the only full time faculty member. Why? Because the chair and all of the attendings had left!
“As the medical college struggled, I struggled along with it, learning about administration and trying to do my best without having any mentors. I did get a lot of guidance from the American Academy of Orthopaedic Surgeons (AAOS), as well as some leading surgeons who I met over time.”
Dr. Cardea did find his way, and built a home for orthopedics at VCU. “I was the Chief of Orthopedics in the division of surgery, and also the Chair of the residency training program. It was especially difficult to interact with people who gave feedback that had no consequence for them. They would come in my office, give their opinions and leave—but I had to live with the entire situation. For example, some people said, ‘You should go to the Accreditation Counsel for Graduate Medical Education (ACGME) and demand that orthopedics be given the status of department.’ Mentors from other departments advised me to wait, which I did. When in 2000 we got a new chair in the department of surgery, someone who never listened to his subordinates, we moved forward. It took us four years to become a department.”
Dr. Cardea’s capacity for research, education and leadership would eventually extend far beyond the universities and research institutions in the Virginias. “In the mid to late 1980s hip and knee was exploding. There were two hip and knee organizations, but they were limited in activities and size by their charter (and were primarily engaged in research). I worked with my colleagues to form a new group that would bring together everyone in orthopedics with an interest in hip and knee; the AAHKS is now the largest such organization in the world.”
Dr. Cardea also brought his leadership skills to the Orthopaedic Trauma Association in 1988 when he was elected president. “I was part of the organization as it grew from its original version as the ‘Orthopaedic Trauma Hospital Organization’ to become the OTA in the early 1980s. As founding members, we wanted to ensure that there would not be a small group of people controlling the organization. We had seen several examples of entities that were run by cliques and just rotated people through the leadership positions. The OTA grew steadily over the years; I always felt part of this great organization and was very proud to be elected president.”
As an oral examiner for the American Board of Surgery (ABOS), Dr. Cardea has—for 30 years—had a hand in formulating the process to test physicians. “It’s been fulfilling to contribute to this interesting process. As you might expect, it has changed over time. While the applicants used to be responsible for the body of knowledge in orthopedics, with the rise in sub-specialties the board had to change its examining patterns. Until 1992 doctors would go to different stations labeled, ‘pediatrics’ ‘trauma’ etc., and take a test. If at the end of the day a doctor made a passing grade then he was an orthopedic surgeon. But because of specialization and subspecialization we now ask surgeons to collect their operative cases from a certain period and send them to the board, which then chooses 12 of the cases to test prospective new surgeons on. We have worked hard to make the process nondiscriminatory and scientific, but there are still those who fail. I always tell people, ‘You can’t just know the case. You must know the body of knowledge involved.”
When he was 17 years old, the young John Cardea emerged from the bowels of those ancient Appalachian Mountains and set out to scale an even taller peak. Dr. Cardea: “I am very goal oriented and will look for any legitimate way around, over, or under a brick wall. That is how I went about building the department of orthopedics at VCU.”
Building a department and forging responsible orthopedists have been Dr. Cardea’s two grandest accomplishments. Though he is a master at selecting successful orthopedists, Dr. Cardea is somewhat disheartened to see the generational shift in educational expectations. “I adore education because I love seeing someone come in with an incredible desire to learn—but no idea how, when or why to operate—and see them turn the corner over time. But my bottom line has always been that if I didn’t think they should be operating on me, then I won’t let them out of my program.”
“Now it is the MTV/USA Today generation where there tends to be more thinking along the lines of, ‘What can you do for me?’ Many students say, ‘You didn’t give me that information so how can you ask me about it?’ If you say, ‘It was in the book, ’ that doesn’t hold water with them.”
What is Dr. Cardea’s advice for a new generation of surgeons ‘coming up?’ “Dedicate yourself to doing your best. You can’t stumble through medicine because you’re dealing with people’s lives.”
If you catch yourself looking at the clock/calendar and saying, ‘I need my Mercedes payment on the fifteenth so I’m going to do this surgery’ then yes, catch yourself before you act. Irresponsible thoughts run through everyone’s mind sometimes…the trick is to be guided by your highest principles and not give in to temptation.
And if you do give in, Dr. Cardea will find you. “I’m proud to say that in 27 years we only had two residents who didn’t complete our program. One situation involved a young surgeon who lied on rounds, falsified notes, and basically allowed a patient’s wound to get infected. Not only did I toss the guy out of the program, I followed him until I ‘drummed’ him out of medicine. I didn’t want this person to become someone else’s problem.”
When dealing with this and other stressors, Dr. Cardea has a solid, loving shoulder to lean on. “My wife has been a real trooper through the years; between working as the chair, taking call, and handling university duties, I often came home at 10pm. She has created her own life and is someone I greatly respect. Each of our four children took a look at my life and said, ‘no thanks’ to medicine…they said I worked way too hard. As for my free time, my wife and I golf together, and I am starting to do a lot of traveling.”
Dr. John Cardea…having journeyed from the coal mines to his personal summit he showed the way for others and in the process created a legacy of education, research and integrity.
