The Upper Hand: Chuck & Chris Talk Hand Surgery

Chuck and Chris Welcome Pete Carter

September 25, 2022 Chuck and Chris Season 3 Episode 37
The Upper Hand: Chuck & Chris Talk Hand Surgery
Chuck and Chris Welcome Pete Carter
Show Notes Transcript

Season 3, Episode 37.  Chuck and Chris welcome Pete Carter to discuss and introduce the next episode.  In this episode, we introduce Pete and discuss some his personal story and how his interest in the founding of the ASSH developed.

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Charles Goldfarb:

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

Chris Dy:

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

Charles Goldfarb:

Please subscribe wherever you get your podcasts.

Chris Dy:

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

Charles Goldfarb:

Oh, hey, Chris.

Chris Dy:

Hey, Chuck, how are you?

Charles Goldfarb:

Fantastic. I feel like I haven't seen you forever.

Chris Dy:

It's been a long time. I've been on the road. And I'm sure you've been very, very busy as well.

Charles Goldfarb:

Yeah, I want to catch up about your travels. But we have an exciting announcement. And as timely.

Chris Dy:

We do. It's really exciting. You know, what's crazy is that next week, I guess by the time this drops, it'll be this week. It's the annual meeting for the acsh.

Charles Goldfarb:

It is and I was doing the math. It's not complicated math, but I was doing it. I haven't been to an ASSH meeting since 2019.

Chris Dy:

Oh, man. Well, you're, you're in luck. This will be a fun one. We've heard promos from Peter and from Glenn, about how great the program's going to be. And I think it's going to be fantastic. And you know, it's going to make the program even better.

Charles Goldfarb:

No, but please tell me.

Chris Dy:

We are going to record a live podcast on Saturday. So on Saturday, October 1 At the meeting, if you happen to be in Boston, come to room 202. It will be from 930 to 1015. Eastern time in at the meeting, and you can get to see a live recording of the upper hand.

Charles Goldfarb:

More than see you can participate and be involved. Ask us questions you can heckle us, although we may cut that out. We have a little swag to share. But not as much perhaps as we would like. But swags on backorder, too.

Chris Dy:

So you know we should do chuck in Boston at the live recording? Let's do our drawing for the textbooks. Let's do it in Boston.

Charles Goldfarb:

I love it. Oh, keep our feet to the fire. All right, absolutely.

Chris Dy:

So if anybody's interested in coming, please do otherwise, it's going to be Chuck and I use only Convention Center Room, just talking to ourselves. But I hope that many of you who are listening are going to be at the meeting. I think it's going to be a great time.

Charles Goldfarb:

Absolutely. So Chris, our audio may be a little compromised. I'm going to try to edit it and make it sound better. But our audio is compromised. Because once again, you're on the road. So catch us up quickly. What did you do last week? And where are you now?

Chris Dy:

So last week, I finished it finished my final trip for the Richard H Gelberman Traveling scholarship from the Hand Society. This was the 2000 to 2020 Award, which is crazy to think because I'm just now completing it. So this was the last trip of the four I'll be presenting the entire experience and a short six minute presentation at the hand society on Friday afternoon. But this was to Florannapolis Brazil to visit Dr. Jaime Bertelli.

Charles Goldfarb:

Do you remember the details on Friday afternoon as soon as in the main auditorium?

Chris Dy:

It's in the main auditorium. I believe it starts just around two o'clock.

Charles Goldfarb:

Okay, so please be there. I will I hope our listeners will make it. So what did you learn? Can you can you list some things? Or was it more of gesalt? And what did you learn?

Chris Dy:

Bertelli is one of the I think the leaders right now in peripheral nerve and really pioneering nerve transfers. But he certainly does the whole gamut of nerve grafting, exploration, tendon transfers, nerve transfers, does it all. So it was amazing to see him even just seeing him in office examining patients and how he thinks about indications seeing the type of referrals that he gets. And then being in the operating room with him was an absolute joy. And then eventually being invited to scrub in was super fun.

Charles Goldfarb:

And technically any pearls or was it more indications and patient interactions?

Chris Dy:

A little bit of both? I mean, you know, so I got to learn some of the surgeries that he has described and you know, JHS and many other journals directly from him. So a lot of technical pearls about how to identify nerves and branches, topographically little tricks that are not published. So super useful, and then just getting to watch him do the things that he described was super, super fun. So yes, technically, there were things learned a lot there. And indications wise, I came home full of ideas and actually applied some of those techniques. This week when I got home.

Charles Goldfarb:

Alright, so just just take us through our travels. So we flew to Brazil when you come back to St. Louis.

Chris Dy:

So I flew to Brazil on a Sunday I arrived on a Monday morning and I left Brazil on a Friday afternoon came back to St. Louis on Saturday, I cooked a boatload of food both day Saturday and Sunday, which was tons of fun. Worked on Monday, Tuesday, Wednesday, Thursday, and then traveled to Chicago on Thursday night.

Charles Goldfarb:

So are you in Chicago Chris? Are you in row This month,

Chris Dy:

I am not in Chicago, technically I am in Rosemont. And unfortunately will not be going into Chicago at all on this trip. But I'm at the the ORS clinician scientist development program.

Charles Goldfarb:

That is awesome. How many participants are there?

Chris Dy:

There's about 30 here. And the program is for residents, fellows and young faculty who are interested in a career in, in orthopedic research. And being clinician scientist. It's it's a great program. I did it myself when I was a resident in 2011, sponsored by the hand society. So thank you, ASSH. And this is my second year back on the faculty.

Charles Goldfarb:

Awesome. And then you're gonna come home tomorrow, which is Saturday. And then you leave for Boston for the SSH on Monday evening. Is that right?

Chris Dy:

Monday night, and you know, I did a better race thing. Well, this guy over take call, I did happen to squeeze in some call and some overnight call surgery what I was hoping for the three or four days, so it's been a bit of a whirlwind, but feeling good.

Charles Goldfarb:

And when or when's the Tiffany marriage rejuvenation time,

Chris Dy:

I'm not traveling at all in October. So that's fantastic. Perfect. I love every everybody's happy about that. So it's honestly the traveling is crazy. But I'm very fortunate to have the opportunity to have partners and a family that will support it. I've learned a ton and obviously very proud to represent our department in our division out

Charles Goldfarb:

here. Perfect. Well, congratulations. Really super exciting. So we're gonna pivot right now, to my interview with Pete Carter. Pete is a remarkable person. He's a fantastic storyteller. The rest of this episode is going to be Pete leading into the episode that will drop on Sunday after the ASSH, which is about the founding of the ASSH and Sterling Bunnell. But I think you'll enjoy meeting Pete with this episode. And looking forward to the post ASSH story of the embryogenesis as a hand surgeon would call it of the hand society.

Chris Dy:

I love it. I can't wait. So everybody enjoy the episode. Don't forget to hit our live podcast, make sure you're there in Boston, room 202. Saturday, October 1 9:30am. Eastern time. So join us there. We can talk about the peak Carter intro and see what everybody thinks. And we'll do a drawing for the book.

Charles Goldfarb:

Good evening, Pete. How are you tonight?

Pete Carter:

I'm great. Good to see you again, Chuck.

Charles Goldfarb:

Absolutely. Well, I am as I think you appreciate really excited about this, likely multiple episodes, because I am excited to share the story that you have to tell with our listeners and our viewers. So first of all, thank you.

Pete Carter:

You're most welcome. Thank you for the opportunity to tell the story again.

Charles Goldfarb:

All right. So I'd like to start just with some background. So tell because i While many of us, especially those in congenital hand surgery, know your story and are grateful and you've been a mentor to me, but I'd love to just tell your story very briefly before we jump into the meat of the matter. Where did you do your residency training.

Pete Carter:

I was the resident at Parkland with Dr. Charles Gregory, one of the real great orthopedic educators. And I was very lucky to be able to get that residency. I'm not certain that I could even qualify for residency today. But it was a great experience for me. And then when I finished my residency or towards the end of it, I got interested in hand surgery from the course that I went to California that the hands society put off, and I had a chance to see some of the people I'd heard about. And I realized that hand surgeons were really neat guys, and they were approachable. And they had fun doing what they did. And some of these names like Joe Boyes and Julio Talesniek was just a pup them. But he was the one running the course. And there were some other terrific guys. Al Swanson was out there and wonderful guy that tried to remember his name. He was from Utah. And he invented Oh Schneider is it was named with Schneider. He was a plastic surgeon in Utah. Really interesting kind of crazy guy who invented the claim bandage, believe it or not, and never got any credit for it. j&j stole it, but He also invented the Schneider hemovac that and he did get some credit for that is that thing that we all suck blood out of total hip replacements. And he was a fascinating guy and one of his side gigs was he got interested in snake bite. And at that time, this has been this was in the 70s 40 years or more ago, there wasn't an available human anti venom. And he had a bunch of Mormon boys out there in Utah that like to play with snakes, and they'd been bitten a lot. And they had tremendous titers against the venom, and he would harvest their gamma globulin and surreptitiously, he could get this across the state line that treat people that had had snakebite but were allergic to horsehair, which is not that rare. So it was just, it was a fascinating thing. And I came home from that meeting and I said, Susie, you know, that business about going into a small town and being a general orthopedist. You didn't forget that. I'm going to be Hansard. So I told Dr. Gregory, and he was very excited about that. Dr. Gregory was not interested in hand surgery, when we would present a case. If it was a hand case. It was just next case to him. But it wasn't that he didn't think it was important. He just didn't. He didn't know much about it. And he didn't want never been talking about. And he was very encouraging. And I'd been in the army for a couple of years. And during Vietnam, I got drafted out of my internship. It's been a couple of years. Doing St. Paul, I was a flight army flight surgeon, but basically it was coughs colds and sore holes. You know, I didn't really do anything very spectacular from the standpoint of medical care. But at that time, there were a few programs in the country that the Chairman, if the person had been in the army before and gotten a lot of experience, he could give the person some credit, I'm wise. So I was able to start my hand fellowship, six months before my residency would have been finished. And that dovetailed in nicely with Dr. Littlers program because at that time, he took two fellows a year. Usually it was one orthopedist and then one plastic surgeon. And one of the fellows started in July, and one started in January. Both of them served a year. But that meant that there was always a Senior Fellow. So I got to start in January. And my senior fellow was a guy named rod ends from California. And Rod was the first plastic surgeon I've ever met that knows anything about Hansard. And then, of course, Dr. Littler changed my whole viewpoint on that, but he was pretty unusual plastic surgeon. At any rate, so I got the program and enhanced surgery up there. And I came back to Dallas in 1976.

Charles Goldfarb:

Can I interrupt and ask a quick question? What What if you had to summarize the most important one or two lessons you learned from Dr. Littler? What would

Pete Carter:

Oh, gosh. Did he teach you how to draw?Well, it they be? was a little bit intimidating. Trying to draw anything with him in the room. He was he had been an artist since he was a child. His mother had encouraged him to take art lessons. And he got into medical school. Because he illustrated when he was at Duke he illustrated a neurosurgery textbook or neuroanatomy textbook for one of the guys the anatomy department. And so he was unbelievable. He used to give conferences. This is the days before PowerPoint. And we would all have our slides in carousels. And he would show up at the conference, he have 135 millimeter slide in his pocket. And that would just be the clinical case that he would show you. And then he always wanted the the board that was a regular Blackboard then would be clean. And we had to have a new box of colored chalk because he didn't like to draw with an old chip. He wanted a full piece. And this guy could draw the hand so fast. He dropped from one side and then he would turn it around and turn it up 45 degrees looking down. I mean the man knew the three dimensional anatomy of the hand And I don't know anyone, before sans that really understood it like he did. And then he had the gift to be able to illustrate it. So, but the guy that really got me drawing was Dr. Gregory. It was very important in my residency, we we had to present the case that we'd done in front of Dr. Gregory once a week, and he always wanted you to illustrate to draw the anatomy, draw what you've done. And the old saying was, you knew you were finished with the residency? When Dr. Gregory asked you a question, and the first thing you did was start looking for chalk. But so drawing has always been critical to me. And I tried to get my residents to think about that and draw it because anatomy and anatomy in three dimensions is something that, that medical students don't learn. I mean, their whole life. In medical school as a two dimensional life. They learned their anatomy from a page. And by large, I mean all of us hate cadavers, they stink? They don't look, right. I mean, those of us that are surgeons have had the opportunity to see what anatomy and its perfect state looks like. But I insist that my residents learn to do that. And I've found it a powerful tool in teaching patients. I used to make a little sketch of the hand while I was talking to the patient. And I would write the chief complaint and the date of injury and my impression and the recommendations and the pros and cons and risk. And then my nurse who was my wife, no one knew that except us and the people that work there. But she would make a xerox copy of that and give it to the patient. Because patients always have the experience when they get home is, what did he say? Oh, patient is damn fine. No, no, I can't remember. But now they got this. Well, this is it right here. He said this and this and this. So there are a lot of wonderful things, patients want to help you get them well. And drawing thanks, all of us are visual learners to some degree. And I think if you can get the patient educated, I mean, they're not think they can understand the basics. They may not. They're not sophisticated thinkers, but they, they they're much better and much more on your side. And I can't tell you how many times I've been talking to a patient solo skateboard fractures. And I was going to next question, you know, if you know anything about because none of them really believe that a fracture. First of all, you know, nobody knew about skateboard fracture until wreck. And so to draw it out, it's amazing how once you draw the anatomy, you can feel it happening in the room. You know, a lot of these guys had seen two or three other doctors before they saw me. And all of a sudden, the people have this attitude of God, this makes sense. This guy knows what he's talking about. And trust comes from that too, of course, for sure.

Charles Goldfarb:

So your career and I don't want to oversimplify maybe, you know, you focused on adults and you built a reputation. And as I understand it, you are a leader in the country with using the Herbert screw when it first was developed, I helped popularize that technique, which has evolved since then further. And then the second part of your career, maybe was Texas Scottish Rite and your partnership with Mary Beth. Is that a fair overly simplified? Summary?

Pete Carter:

Yes, there was a blend in between because I, I'm not a golfer. I never could understand golf. And so my day off, I used to go to Scottish Rite and and work one day a week for free. And it was fun, and I enjoyed it. And in fact, that's, that's another interesting story. One of my children had two sons, the youngest boy went to Emory to college. And soon as he and I had a deal where we would always ride in the car with our sons to college, one of us would So we fly back home and the other person would use the other half of the ticket to go the other direction. And it was a great time because you had time to visit and talk and, and talk where the conversation could be no conversation for long periods. Very powerful. And he right, that was bitching about HMOs and stuff. And this is my son, who is a lawyer now. And he said, in fact, he went to Wash U is where he got his law degree. And he said, Well, did you said in there anything about your job that you like anymore? I said, Well, I love take care of those kids. And he said, Well, why don't you just do that? I didn't have an answer.

Charles Goldfarb:

That's amazing.

Pete Carter:

So I had Mary Beth was working at Scottish Rite about two or three days a week and, and I was going over there once a week. And she and I always been very close. And I said, Mary Beth. You know, I think the two of us on a quit our regular jobs and do children's hand surgery full time. It was outrageous. Nobody ever. No one's doing that. And so she she thought was great. And so we went to Tony hearing who's the chief of the hospital then. And we're able to convince him to take a chance on us. It was a wonderful thing. It so having my soil was high, then the hospital was pretty flush. But they they hired to full time answered. It was nuts. And how long did you do that? How many years 10 years I had I'd saved my money when I was in private practice had a good financial advisor and a wife that shopped at Target. I had saved enough money where I didn't have to work anymore. But I wanted to work. I wanted to work because I wanted to not because I had to. And so I took a job there typically a cutting bay but I'm really important to me then. And then the first thing we did was we decided well we need to have a a training program in children's Hansard because as you know the volume in Scottish Rite is nuts. I mean, most people that I tell how many cases in some way they think rely on you know like is Texas, another Texas longtail so I got some of my friends launched a little travel club Paul Manske and Dick Gelberman were both in this club. But these guys had had fellowships, one of the bear the glaring deficits, have many hand fellowships. They have great adult hands, but virtually no children's hands. And so I got the guys at Mayo Clinic and David Greene's program San Antonio, ones in New York. And we got the reticence to start rotating with us for a month. And we didn't know how long it needed to be. That's okay, because nobody else did either. So, and then we said, well, maybe we ought to have something that somebody who wants to really do this step, to be able to have a more advanced one, how long, you have no idea. But we started with three months, kind of evolved in the six months. Now people come and spend six months with us if they're interested in making children's hand a major part of their life. And now 20 years later, there are lots of guys like us that do a lot of children's hand surgery, if not exclusively children's that surgery. And it's been a neglected area. I mean pediatric orthopedists. It's just next case, when you want to talk about I am case most, which is good, because it means we get to good, but that's sort of the history of my career. And then when I was 65, I promised myself that I would quit operating.

Charles Goldfarb:

This episode is an introduction to our next tell us about your interest in the history of the hand society, which led to this remarkable next lecture.

Pete Carter:

I love surgery. I love teaching it. And now that I don't do it. I still do some teaching, but I have only the courage of the noncombatant. I lose credibility when I don't actually do it. So. But it was it was a great chapter in my life, like a lot of things, you find new avenues for adventure. And that's when this history thing sort of started. Yeah, with deep eye towards the end of my adult practice. I read a book by Doris Kearns Goodwin called No Ordinary Time. It won the Pulitzer Prize. And it was about the White House during World War Two. And I was just blown away by that. And then I knew that Dr. Littler had told some stories about when he was in World War Two. And sort of started looking around things and reading a little bit. And then I was lucky enough to be in the AOA. I was at an AOA meeting one time and Andy Weiland who was in the travel club with Dick and Paul, and I and a bunch of other really great guys. Andy went to school with Doris Kearns It was then they went to college together, I can't remember which one it was. But at any rate, he entered she she was a speaker at AOA leading that year. And at a cocktail party, he introduced me to her. And I told her about what I done on this, and I was having trouble finding some things and she said, Well, you need to get into the FDR library. And I said, Well, yeah, yeah, there's no chance that you want to bet. She made one phone call and I was in it. But so I went to Hyde Park, New York and went through the library and spent some time in Bonanzas old office got to know one of his last partners, wonderful guy named Dr. Brown. And Browning just took me under his wing and told me a lot of great stories about the nail and took me to a lot of these places that I subsequently found out about got me hooked up with Bunnell's son, who was a psychiatrist in the East Bay. And it just kind of went on from that. So and it was it took me years to do this, I was I would take trips and go to a place to kind of see where it had happened. And a lot of these hospitals that were involved in this during World War Two, no longer do this. They're not even there. In fact, there's only one of the 10 that's still a functioning hospital. So it's, it just sort of grew. And it took on a life of its own. And then when Mary Beth became president, the hand society, she was interested in this. And she asked me to give this talk at the meeting. And then someone asked me to give the president and fellows talk, because they'd heard about it. And that's where this where I got involved with the Dick Smith lecture.

Charles Goldfarb:

So I love that that is a perfect segway to our next episode, which is a story of a politician, a general and a duck hunter. That is the origins of the American Society for Surgery of the Hand, as told by Peter Carter. Hey, Chris, that was fun. Let's do it again real soon.

Chris Dy:

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

Charles Goldfarb:

Mine is@congenitalhand. What about you?

Chris Dy:

Mine is @ChrisDyMD spelled d-y. And if you'd like to email us, you can reach us at handpodcast@gmail.com.

Charles Goldfarb:

And remember, please subscribe wherever you get your podcast

Chris Dy:

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

Charles Goldfarb:

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