Spinal Patients Come Back to Give Thanks to Doctors : Medicine: Hospital gathering in Whittier reunites them with surgeons. The operations helped many victims straighten out their lives.
A little girl in a pink dress darted happily around a crowded room that held balloons, a buffet table, a skeleton and, in illuminated viewing boxes, X-rays of spines with steel rods.
Many people in the auditorium at Presbyterian Intercommunity Hospital at Whittier, including the little girl, Holly Bergk of La Mirada, had steel rods in their backs to correct various spinal deformities.
Holly was among about 100 surgery patients who had come with their families to a recent reunion at the hospital’s Southern California Complex Spine and Scoliosis Center.
The patients mingled with the center’s four orthopedic surgeons, who looked happy to see that most of them were standing and walking straighter than they once did.
Holly, with a 4-year-old’s shyness at being the center of attention, didn’t say much. She didn’t talk about the four operations she has had for scoliosis, a condition in which the spine curves abnormally. She mostly ate cake and smiled.
When she was 2, rods were put in her back in a 6 1/2-hour operation during which she almost died. Her temperature rose dangerously high, but ice and medication brought it down and allowed doctors to continue.
She must undergo surgery every six months to have the rods lengthened so her spine will grow straight. At 10, when her spine is almost fully grown, it will be fused (welded together) so that it will not curve again.
“She does not in the least feel sorry for herself,” said her mother, Janet Bergk. “She plays hospital. She’s done ‘surgery’ on all her stuffed animals.”
Although Holly wears a brace and is rigid from neck to hips, she can walk, run and ride a bicycle that has training wheels.
“After that first surgery, she was so pathetic,” her mother said. “She had eight different things coming out of her body--probes, monitors, tubes, catheters.
“I can’t imagine the pain she went through.”
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Undergoing a spine operation is like being hit “by an 18-wheeler,” said Dr. Gilbert Marrero. “It’s the biggest operation you can think of short of a transplant.”
And one of the riskiest. One slip into the spinal cord can mean paralysis. “When you’re hammering and chiseling at bone, you have to be careful. You don’t want to have to say, ‘Oops,’ ” Marrero said, knocking on wood in the spine center office the afternoon of the reunion.
Marrero, who has assisted on all of Holly’s operations, is the center’s founder and medical director.
A slender man with a dry wit, gold-rimmed glasses and a hairline that receded long ago, Marrero will be 70 soon. Yet he still stands at an operating table 10 to 14 hours at a time.
In cases where the spine disorders are severe, he said, “we have to do surgery from the front, then prepare the patient on another table and do it from the back.”
During the operations--which Marrero said cost about $15,000--rods are inserted along the spine to help correct the deformity, and bone from the pelvis or ribs is grafted onto the vertebrae. This turns the segmented spine into a solid column of bone that will not continue to be deformed. The narrow rods, which stay in permanently, hold the spine as straight as possible while the fused bone heals.
When it was suggested that, with his rods, screws, bolts, hooks, chisels, saws and hammers, he could be a carpenter, Marrero replied:
“Yeah. Carpenter, electrician . . . God knows what.”
“He’s very humble, modest, and kind of shy,” said Sandra P. Dunning, the center’s administrative director. “Sometimes he looks so professional and proper, but he can crack you up.”
Marrero, who in 1963 was one of the first surgeons in California to use rods in spinal operations, treated children with scoliosis for many years in his pediatric practice in Whittier. He has been on the staff at Presbyterian Intercommunity Hospital since 1963, and was chief of surgery in 1981.
In 1985, he approached officials about starting a spine center. With their approval, he opened the center later that year. It is one of several spine centers in the United States, Marrero said.
At first, Marrero was the center’s only surgeon. Now there are three more--Oheneba Boachie-Adjei, 42, a native of Ghana who came from the Minnesota Spine Center; Munish Gupta , 30, a native of India who came from a spine center in Louisville, Ky., and Talal Malhis, 45, a Jordanian who came from Childrens Hospital in Los Angeles.
“This is like the United Nations,” said Marrero, who was born in Chicago but grew up in the Canary Islands and Cuba, returning to this country in 1941.
The team completed 130 operations last year, most of them on patients with scoliosis or other spinal deformities and diseases. In recent years, more adults than children have been treated.
“Because surgeries are so extensive, a few years back we didn’t think adults, particularly those in their 60s and 70s, could tolerate them,” Marrero said. Now, he added, because of improvements in anesthesia procedures and intensive-care units, “You can operate on a 75-year-old like you can on an 18-year-old.”
Marrero specialized in spine surgery on children until 1987, when a 60-year-old neurosurgeon came to him with a spine that had collapsed from many operations on his lower back.
“He said, ‘Gilbert, say this stuff you’re doing with kids with screws in the bone, do you think you could do that to me?’ ”
Marrero consulted with the only doctor he could find who was doing surgery with rods on adults, then operated on the neurosurgeon.
“It took us 18 hours,” he said. “We thought sure as heck we were going to kill him.” But the neurosurgeon left the hospital five days later and now has been able to resume his practice, Marrero said.
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A blues tape playing in the operating room is heard above the beeping heart monitor. Boachie-Adjei’s choice. Marrero likes Latin music. It depends on who gets there first.
In their blue head-to-toe garb, their gloves a brilliant white under the powerful lights, they are attempting to reconstruct the badly deformed spine of a 61-year-old man so that he will no longer be humpbacked.
Marrero, the assistant on this case, has his head enclosed in a bubble-like helmet and looks like a spaceman. Boachie-Adjei, the lead surgeon, wears only a mask below his cap.
On a table beneath the X-ray box, toward which the surgeons periodically gaze, the Atlas of Spinal Diseases is open to a chapter on ankylosing spondylitis, the patient’s ailment.
“I took most of the pictures in there,” says Boachie-Adjei, who co-authored the book.
Using hammers, knives and chisels, the surgeons break off chunks of bone. Bloody gauze pads are tossed to the floor.
The patient, completely draped except for the exposed chasm in his back, sleeps. His head is unseen beneath a maze of clamps, hoses and gurgling tubes. The anesthesiologist checks the dials and screens that verify that the man is responding properly.
Boachie-Adjei uses a coagulator--”a very sophisticated flame-thrower,” Marrero says--to stop some of the bleeding.
“We could have gone into welding,” Boachie-Adjei says with a chuckle.
A small monitor is placed into the spinal canal and attached to a recording device that tells how the spinal cord is functioning.
It is 1 p.m., four hours after the operation began. It won’t be over for another five. The steel rod has yet to be inserted.
“It’s hectic; it’s incredible,” Boachie-Adjei says.
Three days later, the patient was doing well, Boachie-Adjei said.
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The surgeons, looking mysterious, almost unrecognizable, in the operating room, wore suits and ties to the patient reunion.
The former patients were also dressed up. Boachie-Adjei got a laugh when he said to the audience, “We usually see you under the sheets, moaning.”
During a brief program, some of the former scoliosis victims got up to speak.
Janet Bergk told about Holly, and when she said her daughter would need 13 more operations, the audience gasped.
Joani Taylor, 27, a teacher from La Habra who has a rod in her back, said: “I had it done two years ago. I had to have it or end up looking like a pretzel. In eight months I could go back to aerobics.”
Elizabeth (Bill) Tunison, of Whittier, said: “I couldn’t stand up or walk without excruciating pain. Now, five years later, I’m standing straight and tall.”
After the program, Lucie McMurtie, 38, of Bellflower said she wasn’t one of the success stories. Her severe scoliosis, which developed from childhood polio, has weakened her lungs and heart.
She had a spine fusion and rods inserted a year ago, and nearly died.
“She flat-lined three times,” Marrero said.
“My rods go up almost to the back of my head,” McMurtie said. “I can’t stand or sit up for a long time. I can’t work anymore. I was more crooked than I am now, but I’m not aligned yet. If we could just go in there and cut the rods, but because of my lung problems we can’t. So I have to live with this pain.
“I expected to come out perfectly straight and normal, and it didn’t happen. It wasn’t their fault. I just couldn’t handle the surgery.”
She smiled. “But I am alive, which is great.”
Marrero was still being thanked by the people he has straightened out.
“I’m just a technician, believe me,” he said to one. “I just do surgery, and when the surgery is over, I take off my gloves and go home.”
Janet Bergk knew better.
After her daughter’s harrowing first operation, Marrero had refused to leave Holly’s side.
“He said he’d stay overnight with her if I couldn’t,” she said. “For him, it’s not a job, it’s a passion. He told me he’d be in on Holly’s surgeries until the day he dies.”
Glossary of Spinal Terms
Scoliosis: A condition in which the spine curves abnormally. As the spine turns, it pulls the ribs along with it so that one side of the chest becomes higher than the other or sticks out farther. There is no known cause.
Kyphosis: Increase in the forward curvature of the spine, known as “round back.”
Lordosis: Increase in the backward curvature of the spine, known as “swayback.”
Fusion: The most common treatment for scoliosis is a spine fusion using a bone graft. The vertebrae that form the abnormal curve are fused together with strips of bone grafted from the ribs or pelvis. As the bone heals, the spine becomes solid and will not curve again. But the rest of the spine will still be flexible.
Rods: Metal rods hold the spine as straight as possible while the fused bone is healing. Rods are placed along the spine and attached by hooks or wires.
Source: Scoliosis Research Society
