The Story of Sterling Bunnell

Chuck and Chris welcome Tony Smith and Steve McCabe to discuss the founding of the Hand Society and Sterling Bunnell.  The two have been on an amazing journey of primary research to learn more about Sterling Bunnell.  They share insights with us in advance of their expected biography.  Join us for some exciting history of hand surgery.

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Transcript

Steve McCabe: 0:03

Welcome to the upper hand podcast where Chuck and Chris talk hand surgery.

Chris Dy: 0:07

We are two hand surgeons at Washington University in St. Louis here to talk about all things hand surgery related from technical to personal.

Steve McCabe: 0:15

Please subscribe wherever you get your podcasts.

Chris Dy: 0:18

And thank you in advance for leaving a review and leaving a rating wherever you get your podcasts.

Charles Goldfarb: 0:24

Oh hey Chris.

Chris Dy: 0:26

Hey, Chuck, how are you?

Steve McCabe: 0:27

Well, how can I be great, it's that time of year,

Chris Dy: 0:30

it is the most wonderful time of the year deductibles are met, or hopefully are booked. I have scrambled and, you know, found a bunch of hours that I really didn't think I wanted, but clearly actually wanted slash needed slash this is totally self inflicted.

Steve McCabe: 0:48

For sure, it's it is really a difficult time. And I know we both all look forward to the holidays. And but this end of the year rush, I have to say I think the rush started mid October. And you know, it's going to go through the end of the year. And actually, as we both have experienced, it's going to bleed into January.

Chris Dy: 1:07

Yeah. So I have had to have the hard conversations with patients, suggesting to them that their surgery will be in January or February, which sometimes gets met with Oh, and then the deductible thing, American health care, right. Like some of our international listeners probably are scratching their heads, saying what what does this matter, but you know, once you've met your out of pocket maximum, typically patients like to get things done because it's quote, free, which we all know it's never free. But it's amazing how much the you know, people assume that you're booking far out for surgery. So that helps us a little bit. But it is amazing how much you as the surgeon control the expectations as to when the surgery is going to get done. Because my medical assistant has told me, You need to tell them January, it can't be me. It's got to come from you.

Steve McCabe: 1:59

That's true. Yeah, I feel terrible. I mean, let's be honest, I like to, you know, I do have a wait, when we try to balance like, we have to save some room for acute cases. And even you know, in the middle of December, there has to be time for acute cases. But yeah, the expectations are really tough, especially when patients come in and expect a chronic issue be addressed the next week and less and last few i I shouldn't say I don't care. But less and less, do I lose sleep over that? I mean, it is what it is, and we're doing the best we can. Yeah,

Chris Dy: 2:33

I know the number of times now that patients have brought up how long it takes to get into see me, I felt that so much more in the last six months than I ever have. And I'm not saying that's it's because I'm so hard to get into. Because I'm so great. It's just a function of appointment slots and demand, I guess overall. And, you know, I look at them, like, I'm sorry, I'm seeing as many people as they can, I'm actually seeing more than I'm supposed to. But I promise you that we will do our best to get you in. And then usually when it comes to scheduling surgery, I play quote, dumb, that, you know, they're like, What are you booking out to? When can we do this? I'm like, I have learned not to answer that question, you know, my MA is in charge. And then I walked out of there better deal with it. So I've had to be a little more controlling in the recent in recent weeks. But I have one question from a practice management perspective for you. How much time do you leave in your block time for the acute cases, because I've struggled with this, because the way that our place works there, there is a expectation slash demand that you fill a certain percentage of your time in the block in order to keep your block. And so I'm wondering, you know, how much time do you keep for in the acute case? Because if you fill your block entirely, then you're scrambling to find time to get these acute cases done. But if you under fill your block, you know, acknowledging there's a likelihood of cases one of those cases no come in. Yep.

Charles Goldfarb: 4:03

I think, you know, we are incredibly dependent on the skills of our nurses or Ma's and how much they get it. And so it's not formulaic, although it would be nice if it were. But like you, I do defer to Nermina, who's my nurse, who's amazing. And I give, I give her all the leeway in the world she wants. And I just tell the patients that they got to talk to the boss. But I think it's sort of a declining percentage of our time. You know, if we're two months out, you know, I think 50% of the time should be cases that have no time window. And then each week, that number deep, you know, increases so that there's less available time for acute cases. Obviously, the critical time is two weeks before I don't I don't have a formula that works. We also do try to understand who's willing to change their dates like are you Be willing to go early. Are you willing to go later put a little star by their name? But I don't have a magic formula? I wish I did.

Chris Dy: 5:06

Yeah, and I've definitely tried to be respectful of acute cases, especially as weather changes, ice forms, etc. So I have a little designation for a waiting list because I, and I make sure my medical assistant asked if they're willing to be on the waiting list of potential to potentially move up.

Steve McCabe: 5:22

So listen, we have a really special episode today.

Chris Dy: 5:25

We do, we're joined by a couple of guests that are going to tell us about the history of the acsh the American Society for Surgery of the Hand, so it's going to be a little bit of a holiday treat. So we should first acknowledge our sponsor Checkpoint surgical, who would like to wish all of our listeners a happy holiday season.

Steve McCabe: 5:42

To learn more about checkpoint's innovative solutions for peripheral nerve surgery, visit www.checkpointsurgical.com. Tony Smith and Steve McCade have a passion for hand surgery family tree, and a person who has become really impactful to them. And they're, as they grow to appreciate the history of the hand. Sadie is our founding member of Sterling Bunnell. And so they have really been on a deep dive and have some fascinating information to share with us. So I'm super excited to talk with them.

Chris Dy: 6:16

I think it's gonna be really fun. I mean, the number being the fellowship director and having reviewed every fellowship application that has come in to date, the number of times Sterling Bunnell has mentioned every year is incredible. And I am actually one of those people that mentioned Sterling Bunnell in my hand surgery personal statement. So I'm a history nerd for this kind of stuff. I love hearing about it. I'm actually looking at my copy of Sterling Bunnell's surgery of the handbook right now. And, you know, when I enhance surgeon in the area retired, and we were talking about transitioning his practice, he actually gave me another copy of this Sterling Bunnell book. So I think a lot of hand surgeons have a special interest in history just because our specialty was born out of, you know, a very unique set of circumstances.

Steve McCabe: 7:02

Absolutely. Absolutely. And let's thank our other sponsor, our founding sponsor, the upper hand is sponsored by practicelink.com, the most widely used physician job search and career advancement resource.

Chris Dy: 7:17

Becoming a physician is hard finding the right job doesn't have to be join practice link for free today at www.practicelink/theupperhand Practice Link the OG Upper Hand sponsor,

Steve McCabe: 7:29

For sure. All right, well, let's get to it. All right. Well, we are joined by two special guests today, Steve McCabe, who was a hand surgeon from Toronto, and Tony Smith, who is at Mayo Clinic, Arizona, and they have been invited to join the upper hand podcast, because they are impassioned about a project they have been working on now for several years. So I will ask them to share with us a little bit about why they have chosen to do extensive research, better themselves through creative writing classes as they write the biography of sterling. But now, Tony, you want to get us started? Sure.

Tony Smith: 8:16

I think that Hand Surgery is very unique that we can really tie the origins of hand surgery almost to one person and that's Sterling Bunnell, and years ago, I heard a talk that many of us in hand surgery were fortunate enough to hear or we read it. And that was the talk by Peter Carter on the embryogenesis of hand surgery. And when I heard that talk, I was just enthralled I, I didn't know much about Bunnell knew less about Kirk, and probably even less about the president. But it really stuck with me. And it sort of germinated over a couple of decades. And then lo and behold, just kind of out of nowhere, it became clear to me that this was something I was very interested in that I wanted to write biennials biography, and I knew I couldn't do it solo. So I recruited my good friend, Dr. Steve McCabe.

Steve McCabe: 9:13

Hey, what would you like to add? Thank you, Tony. I had a serious health problem a few years ago, and I was languishing a bit looking for a purpose. And Tony gave me a call and he said, you know, why don't we write a biography of Sterling Bunnell, it's never been done before. And at first, I didn't know what to make of that. But as we got involved in this project, it turned out that he's a fascinating guy. He lived through a very consequential period of history. And and he just had so many diverse interests, that it became a project that's taken on a full life. I love that and our listeners, those of you who are truly loyal will remember that we had Peter Carter on the podcast, sharing At least one of the stories he loves to tell. And you know, for those of you haven't heard Peter Carter talk about, there was a there was one about Christmas and then this was about the duck hunter, the politician and the general I believe is what it was called. Those are really highly recommended talks. You will love them guaranteed. So, let's start to talk about but now, what made Sterling Bunnell uniquely qualified to start a new surgical specialty?

Tony Smith: 10:33

So I think that through our research, one of the things that we came to realize that Bunnell was doing cancer surgery, years, if not decades, before people thought that he was doing it. So we actually, one of our real finds are communications, written communications written letters between Bunnell and either his son or to his wife. And when Bunnell was sending off his 1944 textbook, in 1943, he was sending it off to Lippincott. He wrote in a letter to his wife, he says, the book, it started back in 1908. So 1908, he graduated from medical school, he did an internship and two years of a surgical residency. So in 1911, he goes back to San Francisco. He's on the faculty of UCSF. He's in practice with his with his mentor, Wallace, Terry, and he starts doing hand surgery. And so, you know, he actually had many things that appeared very, very early. So in 1915, he discussed his first hand surgery case in public forum. That was a risk dislocation in 1917. At the San Francisco Medical Society, he put together he a series of flexor tendon repairs that he had done. In 1918, he published his first paper related on hand surgery, and something that many people don't realize. In 1923, he presented to the AMA annual meeting in San Francisco, and it was on hand reconstruction surgery. And this was the AMA, at that time before there were subspecialty societies, it was the largest group of physicians in the country. And he presented right after William star Judd from the Mayo Clinic. So I think that we feel that 1923 should be the start of hand surgery with the nails addressed to the AMA. Rather than most people say, hand surgery started in World War Two.

Unknown: 12:53

Very good. Yeah, very interesting. You know, Bunnell is early life it was like all the holes in the cheese aligned. And he had so many diverse interests, it just seemed to connect and set him up to be in a position to do hand surgery. And we've read through many of those his interest in art, his athletic abilities, his interests through medical schools, adventures, his bird carving experiences, all of these activities merged together to set him up, to be interested into again, surgery.

Steve McCabe: 13:27

I love that I love that. Tell. Tell us a little bit about a few of those role models for Bunnell, whether it's the whether it's whatever field do you think would be interesting to the listeners?

Tony Smith: 13:39

So I think that his father was an interesting guy, his father, James had actually come west. He was a Wells Fargo employee. And he came west because of the gold rush. And so one of the terms that we've labeled Brunel in one chapter, Sterling Bunnell, son of the Gold Rush, because his birthplace was determined by the gold rush. And they originally lived in the city, and then they moved to Berkeley. And we in Berkeley, they started together. James and his son Sterling started hiking in the strawberry hills. And so his dad was an early role model got him interested in the outdoors. His brother in law, Charles Keeler was actually an ornithologist and Bunnell got introduced into ornithology very young, we have held in our hands, birds that he stuffed at age 14, and they're still in fine shape, and you can see them at the academy and natural sciences in Philadelphia. And we really wondered if that, you know, that's basically hobby application, whatever you want to say, bird taxidermy, how did that influence his ability as a surgeon, and we think it had a big influence. Number one, it taught him comparative and Atomy because you don't you don't really capture and stuff birds of the same species. It's birds of different species. So you learn comparative anatomy. And then we were fortunate enough that we actually visited the Academy of Natural Sciences, where we made a friend with a PhD ornithologist Dr. Nate Rice, and we watched him skin and stuff or bird, and it's a technical exercise. So our feeling is that the ornithology because Brunel started at 14, and his collection, which he sold was 664 birds. It was like doing 664 cases, technical cases, demanding cases. And he was starting these as a teenager. I think. I'm going to I'm going to defer to Steve and let Steve carry on.

Unknown: 15:48

So we had an interesting experience at Drexel University. Two people showed us how they stuffed birds. And we had a tour of some of biennials birds. And at the end of the stuffing procedure, you have to suture the skin closed over the stuffing, and there was a long thread hanging from the head of the bird. And the PhD ornithologist, said the last person to touch this thread was Sterling Bunnell. So I thought if only I had my suit scissors there. It could have been the only person who ever cut sutures for Sterling Bunnell. That's still on the planet. It would have been a wonderful story to tell. But unfortunately I did. But his bird stuffing continued he, he was chosen to go on a South Seas adventure expedition with a famous bird collector Rollo Beck. He was born about 50 years after Charles Darwin and collecting species was a viable biologic activity. They're trying to categorize species. So he was chosen from his undergraduate studies to go on this three month sociis adventure. They went to some islands off the coast of Mexico. And they spent three months there collected about 1000, bird specimens, the details of how they did it probably wouldn't stand up to the political correctness today. But they were very successful. And we have his daily journal, which is just fascinating. And it's a daily entry about what he was doing. So So bird collection, and his interest in biology just runs through his whole life.

Steve McCabe: 17:27

Of that. What about surgical mentors? Do you know anything about who guided his early path?

Tony Smith: 17:35

So he went to medical school at the University of California, San Francisco. And his surgery chief was Wallace Terry. And so Wallace Terry was a very interesting guy because Wallace Terry was interested in thyroid, and he had actually gone and studied with Coker. And so I think that it would be fair to say that that travels, those travels meant a lot to Wallace Terry. So after Bendel's internship at St. Luke's in San Francisco, he traveled around the country. And he sent some letters home, so we can have some good documentation that he was at Hopkins, that he was at the MGH he actually spent time with a famous surgeon there, Robinson, but the person that was his that was his mentor, other than Wallace, Terry was George Kreil. So he went to Cleveland, he spent a month with cryo, he did some thoracic research. And he got two publications out of it. But I think that the the thing that Kreil taught him was the technique that Kreil had done. And originally in in 1900. Bunnell was with Kreil, about 1910. And that was the technique of direct blood transfusion. And so this involves laying two patients supine with their arms adjacent to each other. And basically what you did in the donor, you dissected out the radial artery and the recipient, you dissected out their cephalic vein, and you connected him. And so these were patients that were in extremists, and been ill mastered that technique. And then when he came back to San Francisco, after the World War Two, so a full 10 years after he was with Kreil is when he started flying to the small towns, we've you know, all of us have heard about the nail being labeled the flying surgeon. And this technique of direct blood transfusion allowed him to fly to little towns and do life saving surgery.

Unknown: 19:44

Very interesting. So George Kreil is a fascinating character under himself. He was very interested in clinical research. He was also known as the first neurosurgeon in Ohio Do both he and Cushing were both born in Cleveland, and they remain good friends through life. So this game Bunnell an opportunity to participate in the neurosurgery community that was developing on the East Coast. And I think that became very important for his entry into the Army Medical School. He knew the inside group of people. And so he was chosen there. One small aside for George Kreil. He learned his techniques for vascular repair from Alexis Carell, we have his biography and he went down to New York to learn how to do vascular repair. So it's a small group of very interesting people at that time. But Bunnell biennales connection to Kreil, I think, smooth his way into the Army Medical School.

Steve McCabe: 20:52

Tell us a little bit more about that. So before World War One, but now was selected to attend the US Army neurosurgery school in Philadelphia before going overseas? Yes, help us tell me because

Unknown: 21:05

of the experience of the British and French, they knew there would be a lot of severe head injuries occurring in World War One just because of the nature of the battle. And so the army decided they need to have at least 250 neurosurgeons trained to go to France. So they put out a call, they had 1000 applications, and Bunnell was one of the chosen ones. He went to, to the school in Philadelphia, he was in the second class, and they taught about anatomy, surgical technique, central nervous system surgery, peripheral nervous system surgery, and he was then shipped over to Secaucus, oh, excuse me, it was a 10 week course seven days a week for 10 weeks. And it's led to the literature calling them a 70 day brain surgeon. So he was a 70 day in brain surgeon. He was shipped temporarily to Secaucus at an infectious disease hospital while the crew and St. in San Francisco was mustered. And then he was shipped over with the team to go to field hospital number 47. Where he became the chief of surgery, the highest level of the trainees were given very responsible jobs, and they were prioritized into four levels and but now was in the top level. So he became the Chief of Surgery of a field hospital in France. And he actually went is a neurosurgeon. The goal was to have a neurosurgeon in each hospital, but they were overwhelmed with trauma. So that idea wasn't really didn't pan out. He just became basically a trauma surgeon, but it's pretty clear he did a lot of hand surgery, a lot of orthopedics, a lot of trauma surgery.

Steve McCabe: 22:54

Fantastic, fantastic. All right, Tony, let's pivot back to you. And fast forward a few years and the early 1930s Sterling Bunnell met Dr. Norman Kirk in San Francisco. And Dr. Kirk became an important figure and Bunnell is life. Tell us more.

Tony Smith: 23:13

So Norman Kirk was a career army general surgeon. And in World War One, he became an expert on lower extremity amputations. And so through this experience, he published a book that became a really a gold standard on the treatment of lower extremity amputations. And he became the first board certified orthopedic surgeon in the army. And so in the 30s, Kirk, who again was a career army officer made a transition from his duty station in the Philippines to become the chief of the surgery service at Letterman Army Hospital in Philadelphia in San Francisco. And that's where he met Bunnell because that's obviously we're Bunnell practiced. And Kirk in Bunnell shared common interest. They were both interested in hunting and fishing, so they really got to be friends. And then, lo and behold, literally 10 years later, so in 1943, Norman Kirk was named US army surgeon general. And that put him in a very influential position. And per Peter Carter's paper. What what really happened in the fall of 1944, Kirk was doing a routine visit to Valley Forge Army Hospital in Phoenixville, Pennsylvania, which was the largest one of the larger army hospitals in the United States. And he was appalled by the number of soldiers with crippled hands. And so he reached out to Brunel and said, I need for you to start a crippled hand service. And that course was a call that Brunel heated. He closed his practice. He said I basically served as the consultant set up nine army hand centers across the United States, one for each of the nine service regions for the US Army. Those centers were populated by young army surgeons who became the basically the founders of the American Society for Surgery of the Hand. So biennials a relationship with Kirk allowed Brunel to do things that were important to all of us.

Steve McCabe: 25:29

The hands Society was founded in 1946, I believe, correct. And the famous picture is of Brunel, and is it of those nine other surgeons,

Tony Smith: 25:40

the important thing is, those are actually the alumni. So those are the people who worked at the hospital. So I think that the one thing is, it's not exactly every one and I'm gonna let Steve elaborate on it. That's from the Blackstone hotel. The picture is really more almost like an alumni meeting. But but yet people say that that's from the first meeting of the A SSH. Yeah, it it really is mostly just the people who had been in the Army hospitals, but I'm gonna let Steve elaborate. Go ahead, Steve.

Unknown: 26:19

There. Yeah, it's a it's an interesting thing. It's called the first dinner for the hand society. There's one and Society Meeting bulletin that labels it as a reunion meeting of Bunnell's trainees, all of the people in the picture are from the nine army centers except one person. And he was at a hospital that Bunnell visited, Bunnell visited 47 other hospitals and taught not just the nine hospitals, so he spent the whole time traveling around teaching. The surgeons at Baker were the ones who started all of the chiefs at the nine hospitals except George Phelan are in that picture. And George Phelan and center is represented by one of his students. So there was a representative of all nine senators, plus one extra person and I just can't see his name here. I have it written down Donald Slocum. Donald Slocum was not one of the chiefs. But Bunnell visited his hospital several times. And so he was one of the group. So it's really a reunion picture of Bunnell and his trainees.

Steve McCabe: 27:31

So, it's super interesting. And I do want to circle back on a couple other details. But what happens next, I mean, some of this will be familiar to some of our listeners, and personnels influence in the development of the field of hand surgery and the hands society. I don't really know what happens after 1946. And after this famous picture, what details can you shed on that, if any?

Tony Smith: 27:55

So I think the important thing that that we can say is number one, the hand society survived. It went on there now was the first president. And it was a meeting that was tied to the academy meeting. They initially had their papers published in jbjs. They didn't have a journal, they had society didn't have a journal until years later. And the specialty grew very slowly. It wasn't, you know, but four years later in 1950, that we had another war. And so the Korean War, littler, who is really, one of Bunnell is real protegees. In World War Two, littler became the surgical consultant in hand surgery for the Korean War. My now littler, was in practice in New New York City. And he would come down to Valley Forge, which actually had been a place that was very important in World War Two. And he served as a surgical consultant there and work with some sort of next, not really, next generation is sort of half generation surgeons who were there. Two very famous plastic surgeons, Earl Peacock, who was the chief at the University of North Carolina, and actually a famous plastic surgeon who became a very well known hand surgeon, Dr. Robert Chase. And so Chase was at Valley Forge. And so what was happening was, the specialty was largely growing, it was growing faster than you would think. You know, if you will look back and communications from the nail, number one, his book sold 1000s of copies. So they originally printed 7000 For the first the first printing and that sold out. So there were 1000s of people that were interested in hand surgery and buying his book Look, the number of attendees who came to the acsh grew dramatically. And then the other thing that Bunnell did even in the 40s, he actually helped found a hand surgery societies. In other countries. He was very he had had a huge meeting. We have a wonderful itinerary, where he went to Britain, you know, and, and, and really was there for a long time, many days, actually wonderful thing where he went fishing with Sir Harold Gillies. So so so Hansard, he was growing in other countries, but well before Bunnell also a death in 1957.

Steve McCabe: 30:41

Perfect. Thank you, Steve. Yeah, so

Unknown: 30:43

I think the things that come to mind that initiated and grew from that, number one is the book, which was the official book for the army. And Bunnell row to his wife, the book is flying off the shelf. And the second thing that I think we need to bring up is the development of the Chicago school. So Koch was the second president of the Han society. It's interesting that the Chicago surgeons are not pictured in that picture, even though the meeting was in Chicago, and they are inaugural members of the and society. But the development of the Chicago school with Coch, Mason and Allen, I think also is something that was very important at that time.

Steve McCabe: 31:30

Thank you. Thank you. super interesting. So tell us a little bit more about this, the first edition, I don't know how many editions that were in his lifetime of his book on hand surgery.

Unknown: 31:42

So he had three editions that he added, and then boys, two further editions. And it's basically a single author book, except for the chapter on tumors, one of his partners, wrote the chapter on tumors. I think the fascinating thing is, the first chapter is devoted to comparative anatomy of the upper limb. And it's just a fascinating read. And it reflects back onto his interest in biology through his whole life. The second chapter is about the normal hand. And it's a comprehensive understanding of the normal hand, that every hand surgeon and every hand fellow should read and memorize. It's extremely current. And it's, it's accurate, up to date and very thorough. And I would recommend that everyone enhance surgery training should read that chapter chapter two have been house book. I'll just talk about the third chapter briefly. It's an ode to workers compensation. Workers Compensation was being developed at that time. And California had a fairly advanced system. But now, in his introduction, calls it the age of mechanization. And he talks about war injuries, and industrial injuries. And that third chapter is an ode to documentation and accurate measurement. So I'll leave my comments at that first three chapters. Don't

Steve McCabe: 33:09

you want to add anything else regarding the textbook?

Tony Smith: 33:12

No, I think other than then then one thing, I think that when we look at Brunel, and you start thinking about what were his enduring contributions, one of his enduring contributions was the concept of the hand surgeon as the regional surgeon. And I think if you look in the preface, VNL talks about how a hand surgeon has to combine the skills of an orthopedic surgeon of a neurosurgeon, and as a plastic surgeon, and he writes that book, and they send it to the publisher in 1943. So he writes that before World War he's ever involved in World War Two, if you then look at what they did in World War Two, and there's a fascinating book that many hand surgeons don't know about, that's a US Army publication called hand surgery in World War Two. It basically is documentation from the nine centers of the stuff that they did, and they did. As you can imagine, war injuries are combined injuries. So you've got a soft tissue injury, a bone injury and nerve injury. And Bunnell through his recognition of hand surgery as a regional specialty, really predicted what would be required for the hand surgeons in World War Two.

Steve McCabe: 34:42

Let's go back for I want to hit on a couple of topics. You both mentioned that flying was a big part of his life and that he was the flying surgeon I know there was a plane crash that is of some repute. So any any insights you can share about Oh, Steve, let's start with you with vanilla is piloting.

Unknown: 35:06

Yeah. So he learned how to fly after the war. I'm gonna pass it to Tony because his most serious crash was in willona. And Tony has visited the site and it's study that very carefully. So I'll pass to Tony to discuss his flying history.

Tony Smith: 35:23

Yeah, so Bunnell, after World War One took up flying, I mentioned that he became known as the flying surgeon where he flew to out the outlying communities. And I think it was interesting when you think about in this day and age, you know, we all know that the centers, like I'd say, at Washington University, the patients are brought in from outlying areas to the center, and what Bunnell did he reversed it, he went from the center to the outlying area, and I think that was that was interesting, because he had the means to get out there rapidly. But you know, Bunnell was very productive. He started being a flying surgeon at night 23. It ended in 1926. In July, he had was in San Francisco, he they were looking for someone to take Leroy Jeffers, who was an unknown author or an adventurer, to the Sierra Nevadas. And no one went no pilot in San Francisco would take him by now offered to do it. He did it and close to willona, California, their their destination was the hotel Wawona. Bunnell turn to the right, he lost power immediately. The plane dropped 100 feet straight down and Jeffers was killed. When when Brunel was asked what happened. He said I bank to the right. And that's all I can remember. He sustained some minor injuries. His major injury was a fracture dislocation of the hip. One of the local surgeons actually did a closed reduction the next day. Um, he did, he did have some facial lacerations. And he did lose consciousness for a short period of time. But then he was transported back to San Francisco. He was treated in balance traction. He ultimately returned to work but developed a non union. And then he was treated at the postgraduate Hospital in New York City. And he was underwent a tibial bone graft by Dr. Fred Albie, who is who incidentally was assisted by Dr. Leo Mayer, who is a very, very close friend of Brunel. And so I think one of the things that people talk about a famous hand surgeon I mean, a famous orthopedic surgeon at the MGH was Smith Peterson. There is this best Peterson nail, and people say that he was treated with a Smith Peterson nail, he was not treated with a Smith Peterson nail, but he developed a sighting device so that you could place the Smith Peterson nail or tibial bone graft more accurately.

Steve McCabe: 38:17

Love that. So as we come to a close, I'm curious as to your takeaways, whether from each of you, whether they be about Bunnell and his influence on all of our lives, or whether it be about this process of deep investigation of a figure who you guys are incredibly passionate about. Steve, you want to? Yeah, yes,

Unknown: 38:39

thank you. So it's been a great adventure for us. We've traveled around to various locations, the archives, I recommend to everyone the archives in San Francisco, we visited the San Francisco Academy of Natural Sciences, where we found some notes and a notebook, the Drexel Museum in Philadelphia. Tony's visited willona. So it's been a process of incredible discovery. And and for people who enjoy research, that moment, when you find out something that's new, is so exciting. So we felt that all the time, we've developed some interesting habits. We go to the same two restaurants in San Francisco every time we go to visit. And Tony always drives which drives me crazy. But anyway, that's fine. And we visited banality final resting place in a small town outside of San Francisco called coma. So just the whole process has been really an exciting voyage of discovery for us.

Steve McCabe: 39:46

Love that Tony. Show. So I

Tony Smith: 39:50

think the one thing that we didn't mention is that Brunel started as an artist, and we've got some wonderful, wonderful quotes You know, that is a young young person, his uncle saw his drawings. And he went to Berkeley. And he was starting his junior year at Berkeley, and there's no communication from a family friend back to Bill's mom. And she says, I'm glad that Sterling has decided not to be an artist. Because it is just, you know, basically I'm paraphrasing that it's, you know, a good hobby better, but a bad job. And so I think when you look at Brunel, he was an artist. He was an ornithologist, and by default, became a comparative anatomist. He was an adventurer, he spent 77 days in Yosemite, where he interacted with a family friend, John Muir, an MD naturalist, CH. Mariam influenced him. He then went on the 100 days to the South Seas, and then had came a finished college medical school became a neurosurgeon, a combat surgeon, and on. So I think that to me, the interesting thing was, how they all fit together. And so, you know, we've even thought that, you know, could you actually have almost an instructional course, on the education of sterling Bunnell, the things that he did, that prepared him in his life, to be the founder of the discipline of hand surgery that we all enjoy.

Steve McCabe: 41:37

You know, I love that. And an ISA simply kind of captured all of those different elements. There's so much in our current day that encourages kids to take the straightest path possible to a career. And I think we all would agree that those those curves and detours and different experiences all can contribute. So it's the journey, not the destination, which makes us who we are. Last question, when can we expect the final product that finished the book?

Unknown: 42:08

Number one, I wish I could predict the future. But we we have a fairly firm deadline, that we would like to offer our book to the attendees at the if SSH meeting in Washington, DC. That's our goal. And we're doing everything we can so that we can offer something to the attendees, because I think that, you know, if we reflect back on Bunnell, what was Bunnell. Sure, Bunnell was the founder of hand surgery. But I think that at that meeting, we will have people from up to 60 other countries. He was the founder of hand surgery in America. And that meeting in America, it's an American meeting. And I think Bunnell, you know, really is he's the hand surgeon for for for Americans. And he was an American Hansard. And so should we obviously, would like to have something to offer to the visitors to America.

Steve McCabe: 43:09

All right, all those listeners. So by 2025, you can get your hands on this book, which is a lot of years of effort and and deep dives and should be fascinating. So I want to thank Steve McCabe and Tony Smith, not only for this podcast, or really only a little bit for this podcast, but for the effort to learn more about someone so influential to all of us. So thank you both very much. Thank

Unknown: 43:37

you, Charles. Thank you for inviting us.

Tony Smith: 43:40

Yeah, Chuck, really, really good to see and it's really an honor to be on your podcast, you're making a great contribution to hand surgery with the upper hand. Hey,

Steve McCabe: 43:49

Chris, that was fun. Let's do it again real soon. Sounds

Chris Dy: 43:52

good. Well, be sure to check us out on Twitter at hand podcast. Hey, Chuck, what's your Twitter handle?

Steve McCabe: 43:57

Mine is at congenital hand. What about you?

Chris Dy: 44:00

Mine is at Chris de MD spelled dy. And if you'd like to email us, you can reach us at hand podcast@gmail.com.

Steve McCabe: 44:08

And remember, please subscribe wherever you get your podcast

Chris Dy: 44:11

and be sure to leave a review that helps us get the word out.

Steve McCabe: 44:14

Special thanks to Peter Martin for the amazing music. And remember, keep the upper hand. Come back next time