Apparently, and this has been confirmed by my oldest sister whose memory is like a venus fly trap for all things childhood, my earliest career aspiration was to be a snake.

Now that I have a toddler of my own to observe, I am beginning to formulate a hypothesis that equates the stages of childhood with the various psychiatric disorders of adulthood. For example, only a three-year-old or someone with a severe form of schizophrenia – wherein the boundaries of reality merge into obscurity, setting its victim on a futile quest for the edges, as if to determine where the beach ends and the ocean begins – would give serious consideration to pursuing a profession in the slithering arts.

Lacking the vocabulary to express his psychotic delusions, my two-year-old son is currently manifesting all the classic signs of narcissistic personality disorder. In short, he lacks empathy, patience, or any instinct for self-criticism, and if he could conceptualize the universe, he would take great comfort in his certainty that he was its epicenter. But he’s a baby and, in him, I find these traits charming; somewhat less so in adults who share such qualities.

Gaining maturity, as well as a firmer grip on reality, and after pondering the more practical aspects of choosing a career, my goal shifted. Upon consideration of my attributes both physical and mental, and with special emphasis placed upon the greater community, my place within said community, and my personal hopes and dreams, and without the counsel of parent, teacher, or priest, and almost certainly without honest reflection on the significance of my diminutive stature or mediocre athleticism, yet with the boldness of General Custer, I resolved to become a professional football player.

God bless my beloved parents for the following: never indicating to me that my dream was… well a long shot at best, and all the while, gently nudging me into a more cerebral vocation. As parents of six, and starting a family at a traditionally young age for Catholics in the 1960s (i.e. one was a teenager, but back then they weren’t called “Teen Moms,” they were simply “Moms”), my Mom and Dad made a few errors. However, one message they endorsed then (and still do today) was: “As long as you treat others well and are happy, you can be whatever you want to be and we will be proud of you.” If there exists a more profound expression of a parent’s unconditional love, I am not aware of it.

“A businessman” (until I began to loath formal wear), “a writer” (until Dostoyevsky showed me what writing really looked like), and “a marine biologist” (until considering my motion sickness and general lack of interest in the subject matter) were all ephemeral yet reasonable sounding answers to the omnipresent query of childhood and adolescence, “What do you want to be when you grow up?” I did want desperately to grow up; I knew that. I was tired of being told when to go to bed and how much T.V. I could watch. Damnit if I wasn’t ready to make these decisions for myself; that’s what grown-ups do, right?

This fierce independence precluded many jobs; essentially any job with a boss was out of the question. (Alas, I was years away from matrimony, and therefore ignorant of the inevitable loss of self-determination to come.) I like interacting one-on-one with people but am a lousy salesman and have no interest in products, brands, or marketing. To quote John Cusack in perhaps his best role to date as Lloyd Dobler the 1989 film Say Anything, when asked by his date’s father to delineate his life’s ambition,

“I don’t want to sell anything, buy anything, or process anything as a career. I don’t want to sell anything bought or processed, or buy anything sold or processed, or process anything sold, bought, or processed, or repair anything sold, bought, or processed. You know, as a career, I don’t want to do that.”

This, by the way, is not the answer that a prospective medical student should give during an interview when answering the question, “Why do you want to be a doctor.” The correct answer to that question is, “Because I want to help people.” And apparently, as contrived and inane as this answer is, it seems to satisfy most interviewers. But really, who doesn’t want to help people? And which profession, exactly, is dedicated to the hindrance of others? Recently, my friend and neighbor who is a general contractor spent five hours digging a trench at the base of my house’s foundation to prevent further flooding in our laundry room. Helpful? Yes. Later that day, my wife spoke with an insurance agent about this problem. Helpful? Ye… Well, maybe that is a bad example but I think you get the point. A society only survives if the vast majority of the citizenry endeavors to help one another.

The motivations for becoming a physician can rarely be enumerated within a simple sound-bite. A few of my colleagues did go to medical school because that was what was expected of them; some grew up with physician parents, others were groomed from an early age. Most of us, however, enjoy the academic challenge that is sine qua non of both the achievement and practice of doctoring. Like most, I enjoy solving puzzles, fixing problems, and find great satisfaction in being a valued member of my local community. Also, I love making little kids smile and listening to old people tell stories; two common events in my work day.

My inspiration for orthopaedics was Dr. Hardy. As the end of my freshman year in college approached, my thoughts turned towards the approaching summer vacation filled with nights hanging out with old friends, trips into the mountains for camping and kayaking, and the necessary means to subsidize these endeavors: a summer job. Surveying the options, (cleaning horse corrals, washing cars in one hundred degree heat, and waiting tables), I realized that all of them sucked. My mother encouraged me to write Dr. Hardy a letter asking him for a summer job in his office. Bill Hardy, M.D. (“Doc” as he preferred, or at least people thought he preferred) was the orthopaedic surgeon that had taken care of my family’s intermittent musculoskeletal concerns for years. To give you some insight into mine and my mother’s fondness for this man, please consider my own case example.

We’ve all seen people who are pigeon toed. Almost all toddlers go through a stage of waddling around with their toes pointed inward and tripping over themselves. It’s cute and pathetic and they eventually grow out of it by the age of about three or four. Those who do not, grow up persistent “pigeon-toers” or, as orthopaedic doctors call them, “in-toers.” Worldwide, in the face of malaria, HIV/AIDS, genocide, and starvation, in-toeing is not a big problem. Around most of the globe, this malady likely goes unrecognized, untreated, and under-reported. However, in suburban America, where any perceived imperfection in a child born to well-educated, loving, and highly motivated parents (with a little spare time and money), in-toers crowd the interminably uncomfortable waiting rooms of orthopaedic surgeons. I do not wish to disparage the benevolent motivation of these concerned parents, nor do I wish to deter any future parents from seeking the counsel of a specialist for this problem. In fact, in-toeing can portend serious conditions such as cerebral palsy, hip dysplasia, and spinal cord abnormalities that require timely diagnosis and often surgical treatment.

Nevertheless, in most cases – as in mine – in-toeing bothers mothers more than it bothers kids, and represents a benign, normal variation in lower extremity anatomy. I am fortunate to practice orthopaedics in the era where normal in-toeing is well recognized as just that: normal. I was however, unfortunate to be a little kid in the era where in-toeing was aggressively and unnecessarily treated with ineffective, albeit well-meaning, meddling. So I was placed in Denis-Browne bar shoes, leg braces, and other contraptions that have no role in the treatment of in-toeing, benign or otherwise. I don’t really remember the braces as I was too young, but I do remember the next phase of my treatment: wearing my shoes on the wrong feet. For years, I was instructed by my mother – who was instructed by pediatricians and orthopaedists – to wear my right shoe on my left foot and my left shoe on my right foot.

Allow me to explain how absurd this notion is. First of all, if the goal is to prevent a kid from being labeled as “different” or “weird,” consider how a group of ten-year-old boys on the playground will deal with one of their peers who is wearing a brand-new pair of Air Jordans on the wrong feet. I don’t care how cool those high-tops are, their appeal is completely lost once they are placed on backwards. Now, I am certainly not suggesting that parents and doctors acquiesce to fashion trends when prescribing and enforcing treatment. There are cases in which uncomfortable and aesthetically displeasing orthoses are beneficial and should be worn despite potential social awkwardness. The wearing of a thoracolumbar brace, for example, has been proven to successfully prevent the worsening of certain cases of adolescent scoliosis, thus preventing corrective surgery. But let me assure you, even if a kid’s pigeon toes are the manifestation of a serious illness, wearing shoes on the wrong feet ain’t gonna help.

So imagine my joy when I first met Dr. Hardy. We had just moved to California from the Midwest. I had shaggy hair (Nirvana was a decade away from making it’s “Smells Like Teen Spirit” video and grunge was not yet in vogue), and I spoke with a strange accent that was a mix of southern drawl and Chicago twang. I was so odd in fact, that during my first week at the new school, a boy named Eric decided he didn’t like the looks of me and asked me to meet him at the drug store after school. Though I was honored by the invitation, what I didn’t realize was that this gesture was a euphemism for asking me to fight. Gleefully ignorant of my fate, I rode my bike to the wrong store. I guess I looked so tragically lost that Eric crossed the street and, instead of beating me up, bought me an ice cream cone. We were best friends for years after that.

Sitting in Dr. Hardy’s office, the umpteenth in a succession of orthopaedic surgeons’ offices, I imagined what horrible instruction awaited me. Would this guy suggest that wearing a dress would somehow help? My Mom, God love her, so trusted doctors that if he had, you can bet Eric would have had a whole new reason for kicking my ass the next day. But alas, I will never forget what Dr. Hardy said. “Tommy, do your feet bother you?” he inquired. Gazing up at him through my overgrown bangs I responded,

“No.”

“Do you like wearing your shoes that way?” he asked me directly.

“No,” I responded, too shy for the obvious response: What do you think, smart guy?  And then it happened. One of the greatest moments of my young life; on par with standing on the field at an Oakland A’s baseball game when my Dad threw out the ceremonial first pitch, and getting a new ten-speed bike for my eleventh birthday. Dr .Hardy said,

“Tommy, go ahead and put your shoes on the correct feet.”

It was at that moment that I knew I was in the presence of genius; if not genius, at least mercy. That momentous office visit marked the end of a decade of useless treatment of a benign condition, and the beginning of my career in medicine. It also gave me an excellent tool for evaluating in-toers in my own office. I ask the patient’s Mom to watch me walk, and if the kid’s pigeon-toe-ed-ness isn’t worse than mine, I tell her there’s nothing for her to worry about.

Eight years later, Doc would respond to my letter with a job offer. That summer after my freshman year, I was introduced to the practice of medicine, the toils of running a small business, the blood, sweat, and tears of orthopaedic surgery, and the rigors, regrets, and satisfactions of a life dedicated to helping people feel better. Some days I think I am living up to Dr. Hardy’s example. There are days when I see the joy in the face of a young boy when I tell him he doesn’t need a cast and he can go back to playing football. There are moments when I see the relief in a mother’s eyes when I reassure her that her kid is normal and perfect in every way. There are moments that I laugh, imagining the smart-ass response a kid wants to give me when I ask a stupid question like, “Are you excited that summer is almost over?” And there are moments when someone pukes on me.

Hand surgery occurred to me while working at the Shriners Hospital for Children in Sacramento as an orthopaedic surgery resident at U.C. Davis. Michelle James, M.D., one of the most intelligent physicians, talented surgeons, and stellar human beings I have had the pleasure of knowing, was most inspirational. With a few hours of work, she could change a kid’s world; giving him or her a functional upper extremity so the child can do what children throughout the world want to do most: play. In addition, witnessing these youngsters overcome such severe deficiencies with grace, joy, and an absence of remorse reminds me to try to do the same myself, and to model these coping skills for my own kids.

I’m glad I did not become a snake. I would have missed eating pizza, kayaking the rivers of the world, and watching Cheers re-runs. Dostoyevsky aside, I suppose I never gave up on becoming a writer; we’ll see where this goes. Eventually, I grew to a size sufficient to make the De La Salle Freshman Football Team, but I was well into college by then. Still, I think I could have helped the Detroit Lions; hell, they couldn’t have been any worse with me throwing the interceptions. As it turns out, whether by default, inspiration, academic momentum, or fate, I think I made the right choice. I sure hope my patients agree.