Roger E. Joseph Prize Speech by Dean G. Lorich, M.D.

Tuesday, May 11, 2010

The Roger E. Joseph Prize was presented to Dean G. Lorich, M.D., Associate Director of Orthopaedic Trauma Service, Hospital for Special Surgery; Assistant Professor of Orthopaedic Surgery, Weill Cornell Medical College; Leader of the Hospital for Special Surgery mission of orthopedic trauma surgeons, nurses, and anesthesiologists to Haiti, at New York Investiture and Ordination Ceremonies on Sunday, May 2, 2010.  His speech is below:

 

Roger E. Joseph Prize Speech: Hebrew Union College-Jewish Institute of Religion Ordination and Investiture Ceremony, May 2, 2010

Dean G. Lorich, M.D.

I am honored and humbled to be on the same list as the previous Roger E Joseph luminaries, many of whom have spent their adult lives to improve the conditions of many- several at huge personal sacrifice.  I certainly do not view myself in this category.  I am just a fellow who was fortunate to go into the field of medicine, orthopaedic trauma surgery, where I have the privilege of treating people, and for the most part have the daily gratification of watching them return from the potentially devastating injuries to the productive lives they enjoyed pre-injury.

I grew up in a blue collar household in a Western Pennsylvania steel town to hardworking parents: however loving they were to their children, they also believed charity began at home. Both parents encouraged me toward a career as a surgeon, I believe, as they saw it as a profession, in that community and at that time, where the local surgeon was the most respected member who drove the nicest car.  In other words, charity and service were not necessarily natural in my upbringing.  Medical school and surgical training certainly do nothing to foster an interest in the greater good.  To the contrary, the extraordinary time demands and pressures only heighten young physicians’ feeling that “it is about me”.

However, once in practice, when the injured patient becomes your problem, when their lives and their future are intimately dependant on decisions made in a matter of hours, even minutes, does the awesome sense of responsibility for another person’s life weigh in.  And with their successes and recovery no sense of greater reward….and with their failures equally sharing their disappointment.  

Working in Manhattan at two of the premier hospitals in the world, New York Presbyterian Hospital and Hospital for Special Surgery, I have the ultimate experience as a surgeon. In this setting, as is typical in most United States hospitals, no physician is an island.  We are surrounded by staff that are superb in every realm of medicine and have mentors to advise us when we are overwhelmed by a problem. Healthcare and the health profession in the United States, we all are fortunate, is second to none.

When I was asked by the United States Military to participate as a visiting scholar in Landstuhl, Germany to treat our injured soldiers and help train our military surgeons in the latest orthopaedic trauma procedures I was honored.

For those who are not aware, Landstuhl Regional Medical Center at Ramstein Air Force Base in Germany is the first truly equipped medical facility most injured soldiers see after being stabilized in the field during Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom.  As the son of a father who served in the Pacific during WWII as one of the “Greatest Generation”, and my memories as a teenager too young for the Vietnam draft when my neighbored and family friends did not return, I felt compelled to do anything I could for our soldiers who were injured standing on the wall protecting my family.  My time in Landstuhl coincided with Falluja and the surge—casualties were quite high. My first day, my first case was assisting a military surgeon in amputating 3 limbs on a 21 year-old soldier who struck an Improvised Explosive Device.  Obvious by even the most battle hardened surgeon’s standards, emotions were charged in leaving a 21 year old a lifetime with 1 functioning limb.  Yet when we had completed the surgery and began to dress the soldier’s stumps the military surgeon proceeded to bathe the still intubated soldier, scrubbing his groin and buttocks which were still full of sand.  I asked the Military Colonel and Surgeon why he was doing this-  wasn’t there someone else who could scrub the soldier? And he replied “who?” the soldier was still asleep and we could clean him up and at least he could wake up clean and with some dignity.  Here I was supposedly the teacher yet was really the student learning what being a real doctor is about.  I will never forget going to the bedside of a special operations sergeant who had been injured by another IED.  This soldier with his training is the elite of the military.  After examining him and reviewing his x-rays he and I discussed his injuries and treatment options.  We could begin the process of trying to reconstruct his shattered limb, requiring many surgeries over the course of the next year, and at the end of the day the leg would never be normal but it would still be there or we could amputate the leg now and get him on with his life.  His answer and I will never forget it, “Doc, do whatever you have to to get me back to my unit fastest.” This experience working and treating the few who protect the many on an everyday basis was, and still is, an awesome reminder that freedom certainly is not free.

Shortly after the Haiti quake hit on a Tuesday, I was watching Anderson Cooper on CNN. The 1st reports coming from Port-au-Prince I thought surely must be media sensationalism. I thought how bad could it be… we had a magnitude bigger quake in San Francisco in ’89 and the death toll, while not insignificant in a densely populated area, was approximately 100.

What they were saying regarding Haiti must be an exaggeration. The next morning, Wednesday, I got a call from my partner at HSS, David Helfet, saying he was putting together a team of surgeons, anesthesiologists, and critical care nurses to go to Haiti and would I go? My first response was of course, in thinking it over, if it materialized, it would be the following week, if not weeks down the line. Thursday morning David called telling me it was a go, get packed….

We would fly into Port-au-Prince leaving Friday morning. At that point, reality struck- no matter what any of us expected with 9/11, or in my case, Landstuhl, no one was, or would be, prepared for Haiti. I immediately called my wife, Deborah, half-hoping she would put the kibosh on the idea and not let me go. Deborah, whose career and life are spent working with children with autism, not surprisingly said you’re going, she would get me packed, and could she go with us?

The greatest fear as a physician in going into a situation like Haiti is not the personal risk or inconvenience… it’s whether you can help. I am a surgeon operating in the most sophisticated ORs in the world, surrounded by a first rate support staff. The situation in Haiti couldn’t have been more different. Would we be of any help, or would we be getting in the way, even impeding the true professionals and military on the ground?

When we arrived in Port-au-Prince the devastation was incomprehensible- hundreds, if not thousands, of dead bodies strewn in the street…the entire population living and sleeping in the streets for fear of more buildings collapsing…the stench of death and rotting bodies was overwhelming. My fears regarding our effectiveness as a surgical team were heightened when we arrived at the General Hospital in Port au Prince where we had intended to work. The surgical ward had completely collapsed with the quake and a ragtag group of foreign volunteers was attempting to treat the thousands of casualties with a few lights powered by a small generator…no running water… performing amputations with a few hacksaws.

I also realized that there was no official group to get in the way of the initial responders; they were not part of anything official- they were physicians like us who found their way into the country only supplied with good intentions.

 For us to be the most effective with our surgical expertise and equipment, this was a huge disappointment. While I believe there is a tremendous value in comforting the injured on the ground and pulling bodies from the rubble, we needed a facility to work that we could do the most good in saving the most lives and limbs possible.

Fortunately, some locals understood this and found a hospital with 2 and ultimately 4 functioning operating rooms that had electricity and running water. What we found there was more than 1,000 injured Haitians plus their families lying on the hospital floors and in the streets outside the hospital… 1/3 of them were children. Any doubt regarding why we were there was completely lost. Looking into a 3-year-old’s eyes with a broken femur lying on a board on the floor alone, her family all dead, I realized there but for the grace of God could be my 3-year-old daughter. We could and would help ‘til we couldn’t do it any longer. Over the next several days we operated continuously as a team doing as many procedures and treating as many children and then adults as we possibly could. However, the casualties kept coming. At some point everyone just was overwhelmed with exhaustion.

We essentially were, and felt, alone. Isolated from any outside supply or reinforcement of medical personnel, our surgical supplies, food and water dwindled: we were physically and mentally beyond exhaustion. The situation ultimately became untenable as casualties kept coming in greater numbers and the crowd, comprised of family members, became more desperate for care of their loved ones. We were forced to leave because the circumstances- food, supplies, water, and finally even our safety was compromised. Our entire team felt we had failed… how could we leave? We had started something we couldn’t finish. We were leaving so many poor people behind untreated or needing further treatment for their devastating injuries. The job was undone …. yet there was no end point.

Ultimately, we were led out of the hospital by armed guard and made our way to the airport, hitching a ride on a cargo plane to Canada and then back to NY.

The days after our return were spent speaking to whomever regarding the plight of Haiti- we were desperate to get their help as thousands ultimately would die or lose limbs needlessly if organized care was not stepped up.

We exhausted our political and medical connections trying to get the message out and solicited our medical academies, emphasizing that the situation could not wait to get organized- things needed to happen now. Much good has happened in Haiti, although Haiti still remains a job undone. The country has been devastated and left with no government or medical infrastructure to help themselves; ultimately, with a massive amount of outside aid, it will be a land of cripples and orphans unable to care for themselves.

Over the ensuing months subsequent to our return, I was shocked to hear the significant criticism verbalized and on various websites directed at our group and other early volunteer responders. We were called “cowboys” rushing into a disaster with no professional experience. Sitautions like these should be managed by the military and official government and non-government organizations. How could “individuals” possibly expect to help, going it alone?

To this I would just say, without groups like ours out there, organized only with medical expertise and good intentions… if not for folks like us, then who? The USS Comfort arrived exactly 1 week after the quake. At that point there were 100,000 dead.

Over the last several months many have asked why we went… none of us had a personal connection to Haiti… you had no idea what you were walking into… you were incredibly naïve. I would respond, the questions should not be “why?” but “why not?”              Everyone capable of doing something or anything should. In our case, we had the expertise to provide expert trauma care. In my mind this is no greater than a banker who has a private jet and organized food and water to be shipped, or the therapists from our hospital who are going now in country to teach the amputees how to walk again.

In other words… each one of us is going to be confronted at some time in our lives with the opportunity to help some poor unfortunate souls in some way. It is all too easy to take a left turn and leave that responsibility to someone else as being too difficult or overwhelming or inconvenient. I always tell the orthopaedic residents I train if the medical decisions they are making are based on your own convenience, it ultimately tends to be the wrong decision for the patient.

Everyone is here today because they believe in society’s greater good. Our reasons for participating in humanitarian causes are individually different. For many, including myself, we feel better about ourselves by helping others. I am grateful for the opportunity God has given me with my training and surgical abilities to directly help people. What my colleagues and I did is not heroic at all, only a natural consequence of what we could and should do. However, I would hope all agree as we look at our children that they see these small acts of kindness and are inspired to the human cause that they may be the next generation of Rosa Parks or Victor Kuglers.


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