He has treated refugees with tuberculosis and received patients by oxcart. Dr. Taylor Smith, winner of the 2011 Humanitarian Award from the American Academy of Orthopaedic Surgeons (AAOS), has devoted much of his life to serving those in greatest need…even though, says Dr. Smith, it can break your heart.
The founder of the orthopedic division of Operation Rainbow, Dr. Smith says, “There is so much need that I just can’t feel fulfilled if all I do is treat patients with ‘regular’ aches and pains.”
If a patient is complaining of shoulder pain after a round of tennis, I may find that my mind wanders to the young boy I treated recently in Haiti who had to have his leg cut off.”
Photo courtesy of Dr. SmithThe son of an orthopedic surgeon, and the grandson of a general practitioner, Dr. Smith has long been witness to the daily challenges of living of those who suffer. He says, “My dad was the chief of surgery at Shriners’ Hospital in Houston, while my grandfather treated patients in insane asylums and worked on Indian reservations. I was greatly influenced by them both…and I never thought of becoming anything other than an orthopedic surgeon.”
Now Clinical Professor of Orthopaedic Surgery at the University of California in San Francisco, Dr. Smith had the early advantage of being prepared for the lifestyle of an orthopedist. “My dad, the team physician for the Rice University football team, took me along to games, where I had a great chance to learn about the injuries and how they were handled. I grew accustomed to the family ‘rhythm’ of my dad’s long hours, calls in the middle of the night, and time away of family. My mom was a teacher…I fought her on certain things all the way through high school. In the end, however, I didn’t want to disappoint my parents—so I settled down and got to studying.”
Book learning has its place…but, as Taylor Smith soon discovered, life has other lessons. “While doing my internship at Hermann Hospital in Houston, I was drafted. It was a sensitive time, namely, the Cuban missile crisis. The advice I got was, ‘If you don’t sign up for the Air Force or the Navy then you’re going to receive a letter welcoming you into the Army.’ I opted for the Air Force, went through their flight surgeon program, and went to the Philippines with only one year of orthopedic training. I was soon reclassified (left the flight surgeon program) and joined the orthopedic department.”
There were planeloads of patients at Clark Air Base in the Philippines, says Dr. Smith, but not a lot of surgeon egos. “We got all of the air evacuations from Vietnam, and would receive an average of eight planeloads of injured a night. I spent over two years training with a superb orthopedist named Dr. Ralph Peterson, who not only taught me how to operate expeditiously, but how to avoid any hint of the prima donna. You just could not demand or expect things that weren’t available. This time was valuable in many ways, and when I did complete my residency I had more experience than most of my peers. That meant that at an early stage in my career I enjoyed more responsibility.”
While Dr. Smith was in the Philippines he took time out to travel to Hong Kong and study with a spine master. Politically, it was the time of the Cultural Revolution in China—clinically, it was a revolutionary time for those who walked for the first time. “I briefly rounded with Dr. Arthur Hodgson, a guru who was famous for using an anterior approach for tuberculosis and scoliosis. When I asked if I could return to study with him, he invited me to be one of his first fellows. We treated a flood of refugees coming in from China, many of whom had a partial or total paralysis. When we did an anterior approach to the spine, lo and behold these patients were walking. No one had ever seen this before Dr. Hodgson put it on the map.”
Dr. Smith’s life course was forever altered by what he experienced in Asia those early years. “This was a turning point for me…from then on my eyes were open as to the value of international work. I was inspired to see how well the local medical personnel could do with the little they had—and they were treating serious conditions such as polio and chronic infections.”
After his fellowship in Hong Kong, Dr. Smith found a place for himself in academia…then he had to share a place in the sun with his dad. “I accepted a position as the chief of orthopedics at County Hospital in Oakland, California. It was a different kind of drama/trauma that I encountered there, as this was the era of the Black Panthers and the Symbionese Liberation Army. I was later asked to come to the University of Texas in Houston—the program started by my father—to head up the orthopedics department. It was very humbling to work alongside my dad; his were big shoes to fill. I was the first full time professor of orthopedics there, so I established the department and then after seven years returned to California to join a private practice.”
Although his Houston years involved budgets and staff meetings, Dr. Smith did make time for aiding others abroad. “I was sent to Taiwan by the U.S. State Department to do spine surgery; while there I met several Australian doctors who had done orthopedic work in Fiji and they asked me to join them on their next trip. The difference between the two locales was striking. Whereas Taiwan was well advanced in orthopedic care, musculoskeletal care in Fiji was adrift because of politics. The government (largely comprised of native Fijians) had passed a law saying that native Indians could not work in the government. Given that all of the doctors were Indians, this left the patients at a real loss.”
“Because of my experience treating polio patients, my colleague in Houston asked me to accompany him to work in China on an Operation Rainbow project. We made four trips, but could see that it was really too far and too expensive to continue. We decided to focus on Central and South America after that; in 2010 Operation Rainbow took 13 trips to Haiti and Latin America.”
Dr. Smith, staff, and patient in EquadorDr. Smith says that his secret of success is pretty simple…he loves his work. And he has found it especially rewarding to contribute to Haiti’s efforts to care for its orthopedic patients. “Two weeks after the earthquake I was in Haiti leading a team put together by Sutter Health, a large California medical plan. We went to a small hospital north of Port au Prince in the town of St. Marc. Along with the team from Mass General, we worked as a well oiled machine and performed a lot of surgeries. Over the next few months we were also able to get a substantial amount of equipment transferred down there.”
Never a prima donna, Dr. Smith states, “We don’t count on having regular electricity or water, and in fact have gotten used to operating without it. I concentrate on keeping the team small, usually including three orthopedists, a senior resident, a pediatric orthopedic surgeon, two anesthetists, an anesthesia tech and four nurses. Because the island lost a third of its orthopedic surgeons there is much that must be done in the way of rebuilding their infrastructure. To that end we do some teaching when we are there; it is usually one on one, with our anesthesia people working directly with their anesthesia people, etc. My dream is that we could make St. Marc’s a center of excellence and other hospitals in Haiti could emulate this work.”
The exuberant Dr. Smith is also practical. He says,
Working abroad is a wonderful way to expand your—and your family’s—horizons. Many people feel trapped in a routine where they are taking call, paying the mortgage, etc.
“We get a lot of inquiries from orthopedists who want to work abroad. More often than not, it doesn’t work out. So our strategy is to find good people and keep asking them to return.”
Reflecting on the intersection of his work and personal lives, Dr. Smith notes, “It was a great sacrifice not being able to spend a lot of time with my family. The upside is that we got to travel together to fascinating places—we spent three months in Taiwan, and a total of two months in Fiji. Instead of being involved with Little League they came to the OR when I was traveling and learned quite a lot from watching the procedures. Other than my practice, my children are my biggest accomplishment. It has been wonderful to have my son go into orthopedics, and have my daughter become a nurse. I have three other children who are still in school.”
Dr. Taylor Smith has the last word: “I am amazed that people compliment me on my work. Frankly, I’m embarrassed…I just direct traffic.”
