It isn't often you find a classy person like Dr. C. Andrew Laird hanging around joints like that.
But then it isn't everybody who is an orthopedic surgeon. And you certainly don't find many of those who, having stitched his last patient of the day, climb into the pilot's seat of a jet helicopter.
This ability comes in handy because throughout Arizona there is a waiting list of citizens with ailing joints, waiting for help. Quite often the response comes from a specialist who worked his way through medical school by flying crop dusters.
"She'll be walking tomorrow," Laird predicted, quietly cutting into the left leg of an 81-year-old woman lying anesthetized on an operating table at St. Luke's Medical Center here.
A good thing she wasn't awake, because she would have thought she was on the moon. Surrounding her in a laminar flow room--where the constant flow of filtered air replaced itself completely 300 times an hour--were five experts.
The surgeon, assistant surgeon, positioning nurse and instrument nurse all were dressed in blue paper gowns, hoods with plastic bubble masks covering their heads, exhaust hoses from the space costumes expelling their stale breath. At the patient's head, away from the incision, the anesthesiologist wore a more familiar sterile outfit.
"This woman couldn't walk a quarter of a block anymore," Laird commented to a specially clad visitor in the room. "Her arthritis was so bad that her knee hurt when she turned in bed at night."
Sometimes the repairing involves shoulders, elbows, hips--but often the patients have had it with aching knee joints. And getting a replacement seems to be about as easy as having a crown put on a tooth.
To save as much as possible of what is already there, this orthopedist has become something of a trailblazer in reviving what is known as single-compartment knee replacement (more on that later). But in this case a total knee joint replacement was the only solution.
"The X-rays tell me a lot in advance, but until I go in, I don't know whether we'll be doing unicompartmental or total replacement," the surgeon explained.
In simplified terms, the knee joint is the largest weight-bearing one of the human body. The lower end of the thigh bone (femur) has a rounded surface that moves in a shallow groove on the upper end of the shin bone (tibia).
"These two bones are covered by a cartilage cushion three-eighths of an inch thick, which is five times smoother than if you rubbed two ice cubes together," Laird said.
When the cushion is destroyed by inflammation or wear, pain from arthritis results.
"Actuarially, this person is looking at eight or nine more years of life," the doctor said of the patient in front of him. "Why should she have to sit on a rocker and watch the world go by?"
Many of those who come to him are elderly. Indeed, one was a 94-year-old Episcopalian clergyman, who underwent the unicompartmental surgery and now walks several miles a day.
Some have links to the famous. Jo Esterly, mother of actress Raquel Welch, had a total knee joint replacement done by Laird.
As for his newest patient, about 90 minutes had passed and the new parts were cemented in place. "When she leaves the hospital, she will be walking without pain," Laird said while heading for a break in his office.
Still ahead in the day was one more of these operations (often he does three a day). And then he would put another talent to use in visiting some of his recovering patients at a different hospital.
"That was the typical knee joint replacement, and the kind I have to do 80% of the time," the doctor said, munching on a doughnut. He had been up since 4:30 a.m., and it would be 10 p.m. before he would get to sleep.
Laird went on to recall how his training had included time with the late Sir John Charnley of England, who pioneered total hip replacement in the early 1960s, which in turn led to knee replacement in the early 1970s.
That has become the most popular procedure involving an ailing knee. And like nearly everyone else, Laird uses it most of the time. But for a dozen years, he has been championing a lesser-used and more conservative approach.
"I would rather have a crown put on an existing tooth than have a false tooth," he said. "In our unicompartmental surgery, we replace just one of the two sides of the joint. We leave as much as possible of what is God-given."
The procedure is akin to half-soling a shoe. Last year, before the annual meeting of the American Academy of Orthopaedic Surgeons in Atlanta, Laird presented a nine-year follow-up study of 184 knees on which he had performed the operation.
The study found that "92% of the patients (there were 139 of them) rated their knees as greatly improved, 5% as moderately improved . . . 85% were completely pain-free." A team of nurses, physical therapists and radiologists, after concluding research, rated pain relief good to excellent in 90% of the patients.
"I didn't develop the procedure, but I have always believed in it," the doctor said. "I think support for it is developing."
As in the total type, the retreads consist of steel on the top, plastic opposing it on the bottom. Over the years the combination has evolved from trials with cellophane, ceramics, metal to metal.
The explanation concluded, the time had come. The doughnut was finished, as was the brief course in medicine. Awaiting the surgeon on the floor below, already under anesthesia, was the 69-year-old wife of another doctor.
"She loves to play golf," Laird said, walking to the elevator. "But her knees gave her so much pain that she had to give it up."
Except for the head visible only to the anesthesiologist, only the right knee of the sleeping patient was bared through the draping over the table in the operating room. The limb had been painted with an orange disinfectant solution, leaving a transparent covering that would isolate the incision from the rest of the leg.
Once again the surgical team in the laminar flow room was in space costumes, their hoses looking like tails. Illuminated on the wall were three X-rays of the patient's knee. Once a tourniquet had been tightened on her thigh, a wall clock was started, since tourniquets usually shouldn't be inflated more than 90 minutes.
Another clock showed the time of day as 11:30 a.m.
A Quick Decision
As soon as Laird had made his first cut, he made a quick evaluation and announced: "This will be a total."
To sculpt the bone to accommodate the prostheses, he used tools--both a battery-powered and an air-powered saw, a mallet, chisel, rasp, scalpel, forceps.
As he customized the knee, he employed a drill to form holes for the pegs in the various sizes and styles of duplicate metals and plastics he was trying.
"We'll take a large right femoral and a 12.5 flat tibial," the doctor finally ordered.
A circulator, as such helpers are called, went to a cabinet in the room to fill the request, as if selecting a pair of shoes from a shelf.
As she was removing the two pieces from sterile packages, the instrument nurse near her was mixing powder and liquid to make a putty-like surgical cement, which eventually warms to the touch.
Laird, while waiting, squirted the exposed bone with something looking like a turkey baster, containing a triple-antibiotic solution. Occasionally, he used a device similar to what a person would use on one's gums, a high-pressure flush.
The cement took just a few minutes to mix, but another 25 minutes passed as it set while bonding the metal and plastic into place.
Slightly more than an hour had elapsed. Laird and his assistant, Dr. Richard Davis, sewed up the patient. Instead of a third operation this day, the 48-year-old chief surgeon had scheduled more time on rounds to visit the recuperating. He had even allowed himself 20 minutes for lunch in his office.
"My first year at Oklahoma, I played linebacker and end on the freshman squad for Bud Wilkinson," recalled the 6-foot-3 specialist, munching on a roast beef on rye. Unmasked, he is a Raymond Burr look-alike.
"I did my premed at Colgate and attended medical school at Ohio State." While there he became the friend of a young student who had already progressed into a fair golfer, and today he and Jack Nicklaus still keep in touch.
Laird next trained four years at the UCLA Medical Center to become a general surgeon. But after a year serving with the 1st Marine Division in Vietnam, during which he found himself dealing a lot with extremities wounded by land mines, he developed an interest in orthopedics.
He got a residency in that field at the University of Miami, trained in England, and has practiced in Arizona for 12 1/2 years.
Works at 10 Hospitals
He said he is on the staff of 10 hospitals in the state, all of which he has access to by air. Many of his patients, being elderly, like the idea of remaining near their homes.
For many, such operations wouldn't be available, had it not been for this doctor's service in Vietnam. "While I was there I saw the efficacy of 'copters," he said.
He attended the Hughes helicopter school in Culver City, and purchased a 500-D jet version.
How rare is it for a physician to pilot his own 'copter as part of his medical practice? "I would be surprised if there are more than two or three others in the nation," said Howard Collett, editor and publisher of Hospital Aviation Magazine.
"In the rural states, there are a number of doctors who fly fixed-wing aircraft," he said by phone from Orem, Utah. "In Australia, the Royal Flying Doctor Service permits doctors to serve patients in the Outback."
Served by Air
The Flying Samaritans, of course, is an organization with chapters throughout Southern California. Its 1,500 members, many of them physicians, fly about 30 private planes each month to at least 15 locations in Mexico, where free medical clinics are held.
As for Laird, on this day he would be visiting Sun City, about 25 miles north of here. "Arizona, for all its benefits, isn't the greatest state for freeways," Laird said. "If I had to drive, I would be wasting 45 valuable minutes."
Before departing St. Luke's, he checked on a few patients. In the hallway, he came across 81-year-old Ann Zastrow, recovering from a hip replacement. "Want to fight?" she asked, shadow-boxing peppily.
Still wearing his white doctor's coat, Laird strode across the hospital lot to his parked helicopter. From medical charts to navigational charts in one easy step.
The blades were whirring, kicking up dust, as the surgeon went through a preflight checklist.
He took time to mention that sometimes, on these trips, he takes along his wife, Connie, and four children, all under age 9. They help cheer the patients.
Now it was all concentration on the task at hand as he grabbed the controls. The craft lifted skyward over the metropolis. Only nine minutes later it was settling down outside Walter O. Boswell Memorial Hospital in Sun City.
Among the patients he chatted with was Robert Perz, 64, a contractor.
Perz had gotten a double dip. He had a total joint replacement of the right knee, and, a week later, a unicompartmental of the left, both performed by Laird.
"Before this, for the last two or three years, every step I took was painful," Perz told another visitor. "If I played golf, the next day I paid for it. You don't know what it's like until you get a new chance to walk."
Of necessity, none of the doctor-patient dialogues was lengthy, but all were obviously appreciated by those in the rooms.
Then the doctor was in the copter again for a quick flight back to Phoenix. Laird is chairman of St. Luke's department of orthopedic surgery, a post that consumes time.
Sometimes, not often enough, there is a sufficient interval to take his family to something like a professional basketball game.
Even then, from time to time, an occasional former patient in the crowd will come over to see him. The fact that the person is walking toward him doesn't mean much to everybody in the stands. But to two people, it does.