Dr. Elan B. Singer, MD
Last week we were exposed to blood and guts at the hands of Dr. Elan Singer, a specialist in reconstructive surgery.
The title of his talk was “Plastic Surgery: what you don’t see on TV” which he illustrated with a slideshow. He began with pictures of the over-treated faces of ladies whose attempts to improve their appearance had gone horribly wrong. By contrast, the other form of plastic surgery directed at victims of burns or other accidents, including war injuries, was the one he focused on. Here the aim was to improve both the function and the appearance of those parts of the body that had been damaged.
Dr. Singer volunteered his time and expertise on a pro bono basis in a number of ways. The first that he told us about was a visit in 2005 to Nigeria where he and a small medical group were the guests of the Governor of the State of Edo. The governor proudly showed them his estate that included a golf course complete with a wandering, ornamental ostrich. This contrasted sharply with the local hospital where facilities were minimal. A photograph showed the doctor scrubbing his hands under a faucet before operating but in reality no water ran from the faucet; it was provided by a nurse pouring it from a jug. Most of the cases were burn victims from an accident that occurred 4 years earlier. The State heating and cooking oil monopoly had contaminated the oil with gasoline that had exploded when lit for cooking. Photographs showed survivors with their skin, for example, welded from chin to chest so that their heads were immobile and mouths hideously distorted. The doctors were able to restore mobility and make significant aesthetic improvements. There was always the danger of infection and one of Dr. Elan’s concerns was follow up care after they left. He noted that there were only 40 plastic surgeons in the whole of Nigeria, a country if 158 million, whereas there were 40 in the one block in Manhattan where he lived.
The next set of slides recorded his visit to Haiti in January of 2010 just 3 weeks after the devastating earthquake. Out of the capital Port-au-Prince population of 1 million, 250,000 were estimated to have died in the first 5 minutes as most of the buildings collapsed. The majority of cases he treated involved open wounds and fractures that needed amputations if they had not been treated immediately. Again, the risk of infection was very high. There was no electric power and they had to operate using flashlights. Dr. Singer described some of the skin grafting procedures in detail. Lack of infrastructure meant that there was nowhere to send the patients after surgery because the houses were almost all destroyed. The 82nd Airborne and many NGO’s such as the Red Cross and Doctors without Borders had combined to provide tents and food to try to provide essential needs. Clearly this had been a harrowing experience the suffering from which was still ongoing because of poverty and corruption at the official level.
The third part of Dr. Singer’s talk was dedicated to the Walter Reed National Medical Center where he worked one week-end a month. He explained that, after 2001, the tempo of wounded warriors shot up and the ratio of those wounded to those killed in action was 10:1. This was an improvement but also reflected the fact that many were living with devastating injuries. He described how the first hour after a serviceman was wounded was referred to as the “golden hour” during which, if treatment could be given, the chances of survival were high. He described the 5 echelons of treatment beginning with the corps man on the spot, passing through secondary and tertiary care, then the treatment center in Germany and finally Walter Reed. He then described some of the advanced forms of skin grafting and prosthetics that came from “harvesting” skin, muscle or even bone from healthy parts of the body.
In Q and A, he was asked about synthetic skin grafts. These were good but there was no substitute for natural skin as the outer surface.
How long did re-hab typically take? For a wounded serviceman, it could take 4 ½ days to reach Walter Reed, then 7-10 days for the wounds to be properly cleansed and swelling to subside, then the big operation followed by 3-4 months of re-hab that was continued at the serviceman’s home – probably 1 year in total.
If a fibula was substituted for a humerus, could it bear the weight? The body was remarkably good at adapting to different needs and yes it could.
How about the mental problems and suicide rates after release from hospital? This indeed was a major problem for the wounded and PTSD was increasingly recognized as a condition that had to be addressed on an ongoing basis.
This was a rare look at a branch of medicine that is all important as we work our way through two long and devastating wars, presented by a doctor who was both a specialist and a remarkable philanthropist. On the Peter Knight scale of 1-10, this was an informative, if a little overwhelming, 8.