|
Orthopedic Decisions Start Here.
[ Power Rankings ] [ Picture of Success ] [ Sales Tips & Quips ]
|
Other Articles In the Beginning, There Was the End: Manuscripts 101
Implant Retrieval Labs 101 Where Intuition Meets Intellect: Recruiting Surgeons
Match Day…the Next Five Years AAOS Awards Orthopedics This Week and Hofheinz the MORE Award – Again
The Evolving Reimbursement Landscape for Spine Procedures
How to Start a World-Class Orthopedic Department
|
|
The Picture of Success: Dr. Paul Manske
|
|
|
By Elizabeth Hofheinz, MEd, MPH
|
March 4, 2008
|
|
Born in Fort Wayne, Indiana, Paul Manske was the eldest of four children. “My dad was a parochial school principal and my mom worked as a dental assistant. They left my career decisions up to me.” With a flick of the wrist this future hand surgeon would sign up for his medical studies…and then witness the melee. “When I started medical school at Washington University in St. Louis in 1960 it was as rigorous as today’s program, but different in terms of pressure. At that time a lot of medical schools had a reputation for flunking out a certain percentage of students during the first year. The current philosophy is, ‘Gee, we have a lot of money invested in these people and they’re obviously bright so we’ll facilitate their becoming doctors.’ What has not changed is the rapid-fire manner in which an enormous amount of information is presented. You must digest everything quickly, meaning that unfortunately there is not a lot of time for reflection. What’s great is that it’s very focused on what you want to do. Much of what one learns in college is background, i.e., not necessarily what you would end up using. In medical school, however, everything you learn or think about is focused on what you will eventually do professionally.” But even that would require honing. States Dr. Manske, “From 1964 to 1966 I did a general surgery internship at the University of Seattle. Of the potentially available subspecialties I thought most seriously about cardiothoracic surgery. The Vietnam War was on and I had my eye on being drafted. There was a lottery that decided whether doctors would go in the service directly after internship, one year after the internship, or after all of one’s training. It happened that I fell into the ‘one year post-internship’ group, so I went into the Navy in 1966 and was assigned to the Marine Corps base at Camp Pendleton. The first six months I was stationed at one of the medical treatment stations there, followed by six months on an aircraft carrier, the USS Kearsarge. Part of that time the carrier was off the California coast, and the last three months it was in the Gulf of Tonkin. We were not really in harm’s way as the only danger to a carrier is if it is hit by a torpedo launched from a submarine. The Gulf of Tonkin is too shallow for subs and the North Vietnamese didn’t have submarines, so we didn’t have to worry about that. With 5,000 people and only four doctors, we had plenty to keep us busy, however.” Continues Dr. Manske, “My senior medical officer had done what I considered doing, namely a general surgery residency, specialized training in cardiothoracic surgery, and private practice. In talking with him I came to the conclusion that his professional life as a private practitioner didn’t seem very interesting. At that time there was an excess of general surgeons so he spent most of his surgical time assisting other surgeons. I was no longer enamored of this life and found that my attraction to cardiothoracic surgery was an intellectual, and not a practical, one. At a crossroads, I then had to decide on a career path.” Turning in his sea legs for dry land, Dr. Manske then transferred to the U.S. Navy hospital in Bethesda, Maryland. “It was February 1968, the time of the Tet Offensive and a lot of casualties. One thing the Vietnam War taught the U.S. military was how to establish an air evacuation system. Someone would get injured in the field, transferred by helicopter to an in-country hospital where he would be stabilized, and then flown back to the U.S. At Bethesda we had huge hospital wards of people with shot off arms and legs. The hospital needed people with surgical experience so I was put in charge of a 33-patient ward. I worked alongside the head of orthopedics and was also exposed to other orthopedic surgeons. I came to realize that in orthopedic surgery you have healthy people living normal lives, but something went wrong. I saw that there were a variety of options within the field, but the bottom line is that you get to restore people to health. Also, I became aware of the wide variety of procedures in orthopedic surgery—more so than in almost any other specialty. This is quite different from most other surgical specialties where they relegate themselves to a handful of procedures. Last, but in a way most important, was that the orthopedic surgeons I met were happy people who thoroughly enjoyed their jobs. There was not a grouch or prima donna in the bunch, and it made me think well of the field.” By this time, however, residencies were all filled up for 1968. Says Dr. Manske, “Given the awkward timing, I had to wait another year to begin my residency. It turned out fine in that I was able to give the military another six months, something they desperately needed as they were lacking in surgeons. I then traveled around Europe for six months, during which time I wrote to programs and set up interviews. At the time the concept of an orthopedic match process was just taking shape. The process was not yet in place and there were lots of individuals trying to find an opening for 1969. I had had such a positive medical school experience at Washington University that I set my sights on their residency program. Although the chair, Dr. Fred Reynolds, said they were all filled up, he indicated that he was considering adding another slot. In the end he did, meaning that I had the chance to be in an environment where I was already familiar with the people, school, and the community.” His primary mentor would end up being sort of a gruff marshmallow…a tough instructor who was nothing but empathetic with patients. “Dr. Reynolds took me under his wing,” says Dr. Manske. “A few years before I got there he was President of AAOS, so he was a nationally prominent surgeon who was very experienced. He was very respectful of the educational process we were going through and spent a significant amount of time teaching residents and structuring the program. Patient care was the one thing he considered to be more important than teaching residents, so he spent a lot of time making sure they got consistently good care. No matter whether he was treating a CEO or an indigent patient, Dr. Reynolds displayed an unmatched professionalism and empathy. He was never demeaning and took as much time as someone needed.” “Also important to my career development,” says Dr. Manske, “was Dr. Relton McCarroll, a surgeon with a huge practice at Barnes-Jewish Hospital. From early morning to late at night he would devote all his energy to educating residents and taking care of patients. And he did it with such humility. I recall one time when I was on call Sunday and I got backed up as the day turned to night. I finally reached one of his patients, someone with whom there had been a complication. By that time, Dr. McCarroll had come in, done the job, and gone home.” Considering his subspecialty options, Dr. Manske reflected on his original impression of orthopedics. “When I was first exposed to orthopedics, I initially thought it was a rather crude specialty that lacked sophistication. While my impression has changed over time, that was my mindset at the time. However, I did think that working with the small bones of the hand would be nuanced, sophisticated, and the ultimate in technical challenges. At the time, there were only five or six hand fellowships in the country. When I was a first-year resident, my chief resident had done a six-month hand surgery fellowship before his last year of residency. Taking a cue from him, in the middle of residency I arranged to go to Louisville, Kentucky, for a hand surgery fellowship. This time at Jewish Hospital & the University of Louisville brought me into contact with the multitalented Dr. Harold Kleinert, who ended up having the most influence on my surgical technique.” Continues Dr. Manske, “I then began working with an orthopedic surgeon I had met in residency. There wasn’t enough work, so after six months I took a position at the Washington University School of Medicine. While for the most part it was a good experience, as time went on I could see that the orthopedic program was going through some turbulence. Dr. Reynolds had left and there had been a number of different chairs in a relatively short period of time. By 1979 it became apparent to me that it was unstable. I left and began working at a private practice in St. Louis that had a lot of specialists. I retained my Washington University affiliations, and I had an NIH grant with a mandatory day off so that I could do research. This basic science grant was to investigate flexor tendon healing and to find out what makes these tendons different from tendons in other parts of the body. Until the 1960s we thought that if these tendons were cut, you shouldn’t operate because the healing process was poor. It was considered to be a ‘no man’s land’ in that no man was qualified to do it. One of the problems was that no one understood much about the biology of how these tendons received nutrition and healed. Our primary finding was that these tendons receive their nourishment by the diffusion of nutrients rather than by nutrients coming in via the blood vessels, as happens in most parts of the body. At the time the thinking was that the tendons in the fingers and palm couldn’t heal on their own and needed scar tissue from the periphery. Then that scar would make adhesions and cause the tendons to be welded down which restricted movement and gliding of the tendon. We established the fact that these tendons could heal and form cells, so that efforts could be directed to a minimum of adhesions from the periphery.” There would come a time when he would put his own steadying hand on the Washington University School of Medicine. Says Dr. Manske, “I was Chair of the Orthopedic Department from 1983 to 1995, during which time the full-time faculty increased from 6 to 16 orthopedic surgeons and the residency was expanded to 25 residents; orthopedic subspecialty rotations were instituted and fellowships in hand, spine, and pediatric orthopedics were begun. In 1996 I got to exercise another skill set when I became Editor-in-Chief of The Journal of Hand Surgery. This has been an experience that has given me the chance to reflect and be a teacher. I truly enjoy the process of helping physician-researchers learn how to improve their manuscripts. And I am fortunate to have an enthusiastic cadre of associate editors who are willing to work very hard.” Some of Dr. Manske’s most rewarding moments are spent making big changes to little hands and lives. “I have written a lot on the surgical treatment of children with congenital hand deformities. One of the most interesting surgeries I perform is called pollicization and involves a young patient born without a thumb. The procedure involves taking the index finger and rolling it into the thumb position. You’re essentially making an index finger into a thumb. Besides being useful, it’s helpful in that it takes on the appearance of a thumb so that it’s not as noticeable that the child is missing a digit. Other important operations are the releasing of webbed fingers or closing the cleft in patients with a cleft hand. In the latter operation you take the skin from the cleft and put it between the thumb and index finger and thus allow for fine motor functioning. Some of these children have no thumb or bones in the forearm so the hand is angled over, a condition known as radial club hand. In these cases you set the hand and wrist on the end of the remaining bone so that the hand looks straight.” When it’s time for a break from his responsibilities, the former Navy man goes back to the sea. Dr. Manske: “To get away, my wife, three children, and I head for the relaxing shores of Nantucket. Having a home on this beautiful island is so peaceful. We enjoy the walks, the lighthouses, and just being away from it all. It’s really a blessing.” Dr. Paul Manske…using his fine motor skills to help others have theirs.
|
|
 Top |
|
He spent time in the Gulf of Tonkin during the Vietnam War and knows the hand like the back of his, well, hand. Dr. Paul Manske, Professor of Orthopaedic Surgery at Washington University School of Medicine in St. Louis, is the kind of surgeon you want in the OR: seasoned, cool under pressure, and thorough.
Home | About | Contact | Advertising | Conferences | Job Board | Subscription | Past Issues | Book Store | Privacy © RRY Publications |
