Tyler Martin Schmidt, DO
Neurosurgical Resident at University of Rochester Medical Center
“I would like to see the day when somebody would be appointed surgeon somewhere who had no hands, for the operative part is the least of the work.”
– Harvey Cushing
Neurosurgery is holistic, human-centered, and extends beyond the operating room. Unfortunately, given the technical, high-stakes environment, the task-laden surgeon may struggle always to embrace this approach. Matthew J. McGirt, MD, of Carolina Neurosurgery and Spine Associates, renowned for his technical skills and his research contributions, embodies the principle of physician-patient connection. His experience with Dean Otto in September 2016 is a poignant reminder of the incredible impact the patient-physician relationship can have in the realm of health care. There is no question that this story is inspiring on so many levels.
Dean Otto set out on his bike on a crisp autumn day for a triathlon training session. Soon after, disaster struck when Otto was hit by a car and urgently transported to Carolinas Medical Center, suffering a traumatic fracture of the bony spinal column at the junction between the portion that supports the chest and the lower back. The bone shattered in an outwardly directed burst pattern pushing one piece into the spinal cord. The result was an immediate loss of function in the legs. Permanent paralysis from the waist down was the expected result. Dr. McGirt, a fellowship trained complex spine surgeon, was on-call and alerted about this urgent case by his astute neurosurgery resident. To increase Otto’s chances of recovery, Dr. McGirt rapidly shifted the bone fragment that had been pushed into the spinal cord through a technique known as manual reduction. Then he proceeded to perform an operation that would urgently decompress the underlying nerves and stabilize the bony spine, providing permanent protection for the spinal cord.
While Otto was in the ICU, McGirt was faced with the inconceivably difficult responsibility of explaining to the patient and family that, although the procedure was technically successful, Otto may still be paralyzed. This emotional conversation can be one of the most challenging parts of neurosurgery, regardless of experience, technical proficiency or clinical decision-making skills. He was met with a remarkable surprise when Otto triumphantly wiggled his toe and was further shocked when the patient challenged McGirt to run a half marathon with him just one year after he had recovered. Dean Otto’s impressive physical recovery was also emotionally charged when he sought out and offered forgiveness to the young driver who had caused the injury. The three men became training partners and friends, ultimately running the race together just one year after the crash.
Dr. McGirt references his experience with Dean Otto as a transformative moment in his career. At the time of Otto’s accident, he had been an attending physician for nine years, after completing residency training at Johns Hopkins and a fellowship in complex spine surgery. McGirt had always thought of the patient-physician relationship as sacred but needed something that would reconnect him with his patients on a more meaningful level. This individual case represented more than a successful complex spine reconstruction; rather it was a therapeutic opportunity for Dr. McGirt to step outside of the typical boundaries of neurosurgery and engage deeply with the human side of a frequently technical field.
This past fall, Dr. McGirt, and Dean Otto finished the Napa Half Marathon in an impressive one hour and fifty-nine minutes as profiled on NBC’s Today and The Ellen DeGeneres Show. Their race time represents dedication and training, but to these unlikely friends, it is symbolic of the power of recovery that can derive from the relationship between a dedicated surgeon and a motivated patient. This relationship was lifesaving for Dean Otto, but from a physician’s perspective it was life-affirming, a reinvigorating reminder of the impact surgeons can have on their patients’ lives far beyond the operating room. Neurosurgery is saturated with details: approach, technique and management of disease. Shifting our perspective from the surgical details to encompass the personal and social aspects of patients’ lives is a seemingly simple change. Arguably it will create a positive cyclical effect in which our patients benefit from the dedication of a passionate, engaged and interested neurosurgeon — one that remembers that the operative part is only part of the commitment we make to our patients.
Editor’s Note: The full segments which ran on NBC’s Today and The Ellen DeGeneres Show are embedded below. We encourage all of our readers to watch them. Also, please join the conversation online by using the hashtag #SpineMonth.
The Ellen DeGeneres Show: