We will be performing site maintenance on AAOS.org on February 8th from 7:00 PM – 9:00 PM CST which may cause sitewide downtime. We apologize for the inconvenience.

While on a riser, Terri Cappello, MD, stands next to a resident at the Loyola University Chicago Stritch School of Medicine.
Courtesy of Terri Cappello, MD

AAOS Now

Published 1/1/2018
|
Terri Cappello, MD

'May I Have a Step Please?'

Life as a petite woman in an orthopaedic operating room
Sometimes, it pays to be naïve. My naiveté served me quite well during college, medical school, and residency.

It never occurred to me that a woman would not study engineering on her path to becoming an orthopaedic surgeon. My father literally told me I could do anything a boy could do.

My first lesson in adaptation came when I was on orthopaedic rotation as a 4th-year visiting medical student. One of the attending physicians pulled me aside and gave me advice for my future residency interviews. He told me what to say when I was questioned about how a woman my size (5’ 2”, relatively thin frame) could perform the surgical duties of an orthopaedic surgeon. He told me to look the interviewer in the eye and say, “That’s what power tools are for.”

Thankful for the advice yet still naïve enough to think I would not need it, I powered on and didn’t look back. The unwavering and supportive guidance of my father and my future chairman enabled me to never doubt my presence in the operating room (OR) and to naturally find ways to adapt.

So as a petite woman, that’s what I did—I adapted. During my residency, I operated while standing on one or sometimes two steps. I learned how to stand on the base of the operating table if needed. I searched out and, at times, coveted the shortest lead apron available. I learned to keep back pain at bay by being diligent about my core strengthening routine. In my experience, orthopaedic residents are experts at problem solving, and this was just another problematic situation to resolve.

I learned proper technique and body mechanics to maximize my performance. As a junior resident, I was called by the emergency department (ED) attending physician to treat a gentleman with a dislocated total hip. He thought the patient would need to be taken to the OR for closed reduction, and that I should call my attending physician. He told me that a physical medicine and rehabilitation (PM&R) resident had already tried twice to reduce the dislocation, so clearly it could not be accomplished in the ED.

I understood his concern when I saw the tall, muscular PM&R resident standing at the patient’s bedside. I discussed my plan for another attempt with the patient, explaining that I was the orthopaedic surgeon and therefore more skilled in this procedure. He agreed, as did the ED physician, who reluctantly ordered the sedation.

I climbed up on the gurney, straddled the patient, gripped his calf under my arm and my leg and instructed the burley PM&R resident to stabilize the patient’s pelvis. Carefully, using the maneuvers I had been taught, I successfully reduced the patient’s dislocated total hip. It demonstrated that the acquisition of knowledge is more powerful than physical strength alone.

But certainly, power tools have helped. I am old enough to recall placing distal femoral traction pins with a hand drill, and that procedure is undoubtedly easier when using power drills. With the increased presence of power tools in the OR during the past 20–plus years, brute strength—or at least unharnessed brute strength—could be seen as a detriment. Familiarity with the required surgical procedure, performance of proper technique, and finesse serve any orthopaedic surgeon better than pure strength.

As a senior resident, I walked into the OR for a revision total hip replacement and was greeted by the attending physician with a loud sigh of relief. He knew I could do the case—and he also knew I wasn’t going to fracture the femur while reimplanting the femoral component.

Strength, endurance, and agility are certainly needed to function well as an orthopaedic surgeon. A certain level of physical fitness is required, especially to endure the rigors of residency. Since entering the field decades ago, I have been committed to regular workouts to maintain my overall fitness and strength. Is that more pertinent to someone who, like me, may have less natural physical strength due to their size? Possibly, but it’s also beneficial for overall health and longevity.

The unceasing acquisition of orthopaedic knowledge continues to empower me in my career. Knowledge is all the power that I, or any orthopaedic surgeon, needs to be successful. Our ability to adapt, learn, and then succeed is maximized when we know our purpose is right. I did not mind adapting the OR to my physical limitations because I knew I belonged there. That level of acceptance enables all residents to gain the knowledge that will empower them to conquer the challenges of residency—one step at a time.

Terri Cappello, MD, is a pediatric orthopaedic surgeon and an associate professor in the department of orthopaedic surgery at Loyola University Chicago Stritch School of Medicine.