Pediatric Orthopedic surgery

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Peds Ortho surgery was not what I expected. I think when I chose Phoenix for my 3rd & 4th year rotation site, I really didn’t appreciate the huge variety of pathology I would see, simply because it’s a huge city with tons of specialists. It has been phenomenal!!

My Ortho rotation was… Interesting. The stereotype for orthopedic surgeons (as shown in the cartoon above) is that they are jocks and basically carpenters who like to use power tools & brute force. My doctor didn’t fill any of the stereotypes at all!

Some rare things I saw: a baby born with a glycosylation defect (something we med students only read about for boards!). A real case of Ricketts. Cri du chat syndrome (again, a boards question). Klippel-Fiel anomaly. 62° scoliosis. A mitochondrial disorder resulting in scoliosis and dysmotility. Muscular dystrophy. Junctional kyphosis with a myelomeningocele. Killian syndrome, podocki-lupski syndrome, & Biount’s disease (all so rare we DIDN’T learn about them for boards).

We also saw the common “run of the mill” Ortho cases: supracondylar fractures. Mild to moderate scoliosis managed with bracing. Broken femurs. Fractures of ulna + radius. Club feet. Osteomyelitis. Osgood-schlatter disease. Slipped capital femoral epiphysis. Trigger finger. Marfan syndrome. Hand and digit fractures. Olecranon fractures.

We casted tons of kids and removed casts. We put pins and plates and screws into multiple broken elbows and arms and legs. My favorite surgery I got to see was the scoliosis rodding surgery, which had amazing results but looked really brutal/barbaric in the OR. He even let me put screws into the vertebrae and tighten the rods to align the spine!

The most interesting part of my rotation, besides the crazy and rare cases I saw, was how my doctor interacted with his patients. He didn’t seem like he enjoyed working with kids. So why he chose to specialize in pediatric orthopedics, I’m not exactly sure. For example, he would literally huff and puff if a child was playing on his rolling chair when we walked into a room. He would tell me how disrespectful a child was and how terrible the parenting was if the disposable paper on the exam table was torn by a toddler. He hated when the magazines were out of order in his exam rooms, and if the blinds had been moved at all, he threw a fit. He was a terrible mumbler, and when parents would ask him to repeat what he said, he would get really irritated and short with them. He would also try to give away children’s toys to his teenage patients who were clearly uninterested. One time he offered dessert that he brought to the clinic to a patient who had a G tube (i.e. Didn’t eat by mouth, but instead by a tube into his stomach). He was even a little offended when the patient’s mom said “thanks, but no thanks.” We had one patient’s mom who brought in her child’s MRI CD, and in her rush to get to the office on time, the CD had broken in half. She handed it to him & realized it was broken and was really embarrassed & apologetic… And he left the room and said to come back when they had something he could work with. He talked about how rude and disrespectful that mom was for the rest of the day! Over a simple mistake!! He had the benefit of being very “white male privilege,” so at times he would get really judgey about things that he probably shouldn’t have, like parents who didn’t have access to the most resources… And he would interpret that as them not caring about their children. It was so strange!!

At the end of my time with him, he had unexpectedly grown on me, and maybe that’s what his patients experienced too. I chalked his weird practice style up to just being a little odd/not exactly how I would do things. All of his patients seemed to really love him and his work. He was a great physician and his outcomes were some of the top in Phoenix for patient recovery & long-term healing. And he really loved the work he did. Like I said, most of his patients loved him and didn’t seem to mind. Maybe I was just hyper aware of his communication since I wrote my senior capstone on Doctor/patient communication in undergrad… Who knows!

Some weird encounters I had while on this rotation…
We did a special clinic one day a week for children with multiple defects- similar to my Peds plastic surgery rotation. There was a nurse practitioner who worked there as well. She told me she didn’t think I should see patients without my doctor with me since I was “just a student” & “wasn’t far enough in my training”. She knew I was a 4th year & graduating in May, so I’m not sure why she said that. I tried not to take it personally, but these hormones really betray me some days, haha! I also learned that when you break a femur, it actually will grow longer than the other femur when it heals! Most people are concerned it’ll be shorter, but it’s the opposite! Also, Pilates helps Peds Ortho cases more than other rehab modalities, which I found really interesting.

From the weird “zebra” cases I saw during this rotation, including tons of congenital anomalies, I got super nervous that something was wrong with my own baby. When all you see is rare defects, it’s difficult to remember they are in the minority & most babies are born healthy! My doctor also was really nice about me being pregnant- he even kicked me out of a surgery case because he didn’t want to chance exposing my little bumblebee to radiation! One morning he took me out to breakfast & told me all about his path to Ortho & how much he loves his work. Despite my initial impression, he was a very thoughtful physician. Overall, it was an interesting and educational experience, with a doctor who was more of an ‘acquired taste’ than an instant hit with me.

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