 |
| Suzette Song, M.D. |
She described herself to me as a “pure-bred” Korean. But her Korean father was born in Japan while her mother, also Korean, was born in China. After medical school in Seoul, South Korea, her father came to the States for an internal medicine residency in Morgantown, West Virginia. He practiced general internal medicine and took qualifying exams in endocrinology, cardiology, and gerontology. He was still running into the ER in the middle of the night in his 60s. He did not encourage his precocious younger daughter in her quest to become a doctor.
But when she continued to say that this was her goal he tried to nudge her towards a specialty where she wouldn’t have to work quite as hard as he did, perhaps ophthalmology, or dermatology. She listened to her father, of course, but still thought she might be an internist, like him. However, she had to wait for that unforeseen experience that would present her with her own personal calling.
Dr. Song’s mother was a pianist and Dr. Song’s (slightly) older sister Mimi followed her lead and is a fine musician. As we talked through our protective masks despite being vaccinated against COVID-19, I saw Suzette’s expressive hands. I noticed her slender delicate fingers. I asked her if she played the piano, too. She told me, flat out, and without regret, that she has little musical talent. It was clear that her manual skills and her dexterity were to be employed elsewhere.
Suzette said that she and her sister “looked different” than the other kids in their elementary school outside of Pittsburgh and that they were often victims of hurtful racist remarks. “Where are you really from?” was the nasty response after she said she was born in West Virginia. The adults in the mostly white community were, of course, no better. The experience of being “the other” made her “tough” and “defensive.” And determined.
Some American history is important here: We proudly call ourselves a nation of immigrants but xenophobia and racism are deeply embedded in our story. In colonial times, in fact, Philadelphia’s own Benjamin Franklin felt that German immigration was a grave danger to the English way of life. And over time, with various waves of arriving immigrants, the "other” changes, but the newcomers are almost always viewed with deep suspicion, with fear. So, restrictions are devised.
The Immigration Act of 1917 halted immigration from most Asian countries and the Act of 1924 completely excluded those from Asia aside from the Philippines, then a US colony. People from other Asian countries were not permitted to enter the US legally again until 1952. The Act of 1965 ended national quotas set in 1920 and favored the immigration of professionals. As a result, Asian immigration to the US quadrupled in the next five years.
 |
| President Johnson signing the 1965 Immigration Act (from the AP) |
The flow continued, and Asian-Americans were the fastest-growing ethnic group from 2000 to 2019. And hate crimes, hate speech, violence, and discrimination against Asians, especially Asian women, are sadly common and rose sharply during the first year of the pandemic. Dr. Song told me that, yes, she has continued to experience this.
Getting back to our story, very competitive combined educational programs, including the one shared by Penn State and Jefferson Medical College (now Sidney Kimmel Medical College), have allowed young highly motivated students to obtain both a medical and a bachelor’s degree without the usual four years of college. Suzette (as usual, it seems) was in a hurry; she wanted to do that.
When she and her parents visited the campus and were given the standard tour at Penn State their guide had been in the program for two years. He was engaging, and his pep-talk was encouraging. He was so engaging, in fact, that Suzette soon “fell in love” with him (with future doctor Kevin Muzzio) and they later married.At Penn State, she excelled in the microscopic study of cells and, as a sophomore, she taught a graduate-level course lab in histology. When she needed the required research job at Jefferson she hoped to be in Philadelphia for the summer with Kevin. Happily, she was offered a position in the molecular biology laboratory and she rearranged her schedule.
 |
| Dr. Eric Hume (Penn Medicine) |
One day Dr. Hume took Suzette into the OR to let her observe him doing a case. He told her that in orthopaedics “you get to fix stuff that people understand.” And as she watched him work she was transfixed. Her reaction? “Ahhhh! This is awesome!” And, at that exact moment, at that instant, before even starting medical school per se, she “couldn’t imagine doing anything else.” And supportive Dr. Hume encouraged her.
As Suzette went through medical school and made friends with nearly everyone in the class of 220, including the 40 in the combined track with her, she kept her sights set on orthopaedics. She knew that ortho residencies were “super popular and very competitive to get into.” And she knew that there were very few women in the field. She often thought to herself: “Can I do this? Can I pull it off?”
The odds were against her. After the 1972 education amendment to the Civil Rights Act, including the Title IX gender discrimination section, the number of women graduating from medical school increased, tripling by 1980. But many surgical specialties remained underrepresented. In 1970 less than 1% of orthopaedic surgeons were women. By 2001 the figure rose to only about 4%. This was in comparison, say, to obstetrics and gynecology where, in the same span, the percentage of women increased from less than 5% to more than 70%.
 |
| US Orthopaedic Surgeons by gender and year (from AAOS) |
As she studied, she ran many of the orthopaedic experiments in the molecular biology lab. She got to know the orthopaedic residents at Jefferson and saw that “they were happy” despite their heavy workload. And she saw, she knew, that she could compete with them.
After medical school, Suzette was readily accepted into the ortho residency at Jefferson. By her second post-graduate year, she and Kevin were (without her parents’ knowledge) living together. At one point they had the penthouse apartment at the Ben Franklin House across the street from the main hospital at Jefferson in downtown Philly.
She told me that “the windows would rattle'' as the noisy medevac helicopters slowed to a gentle touchdown on the hospital’s rooftop landing pad. Living there, she could get up before four and walk to the hospital to have her rounds done before the mandatory six o’clock (yes, six AM) conferences.
 |
| Famous ballroom of the restored Ben Franklin, setting of the courageous last scene of the 2012 movie "Siver Linings Playbook" (from Michael Bixler) |
During her five orthopaedic residency years, Dr. Song had two special foot and ankle mentors, Drs. Paul Hecht and Keith Wapner. After her training at Jefferson, including at the Rothman Orthopaedics Institute, she did a year-long foot and ankle fellowship at the highly-regarded Hospital for Special Surgery in Manhattan (currently the nation’s top-ranked orthopaedic hospital according to the “US News and World Report”). She took the bus between New York and Philadelphia weekly to be with Kevin.
 |
| Paul Hecht, M.D. |
She saw the foot and ankle as a “biomechanically-based” functional unit with easily visible outcomes after surgery. Outcomes that her patients would immediately see and appreciate. Suzette (having, she admitted, a big ego) also liked the idea of becoming an expert and of being recognized as such by her colleagues. Yes, a subspecialty fellowship in foot and ankle was ideal.
 |
| Meg Figdore, M.D. |
Dr. Song said that her practice was busy from the start. As the new expert in the region, she was frequently asked to see patients with complex foot and ankle problems that needed additional surgery after a procedure elsewhere didn’t solve their problems. She often saw 40-50 patients a day.
A third of her practice, she told me, had to do with so-called posterior tibial tendon dysfunction. This “really strong tendon” runs behind the inside of the ankle and, amongst other things, maintains the foot’s natural arch. If the tendon is weakened by wear and tear (often hastened by obesity) or disease (such as diabetes, vascular insufficiency, or inflammation) “the whole foot falls apart, resulting in all sorts of structural problems,” she said. The end result is now termed "adult acquired flatfoot."
 |
| Illustration of adult acquired flatfoot (from Todd Buck) |
When the ankle joint is damaged by severe arthritis causing chronic pain and instability the ankle may be fused with hardware (called arthrodesis) or replaced by an artificial joint. It turns out that the ankle has been a particularly difficult joint to mimic with a prosthetic due to its complex mechanics and motions, but recent advances have made this more suitable as an option.
 |
| Radiographs of ankle fusion and joint replacement (from seaviewortho.com) |
 |
| Reconstruction of Lucy (My, what big hands you have, grandma!) (from the National Science Foundation) |
The grasping ape foot, fit for climbing trees, had to become, little by little, more rigid and stable, but also elastic to allow efficient and safe walking on two feet. So, foot and ankle anatomy and function are quite complex: the human foot’s thirty-three bones, twenty-six joints, and over a hundred muscles, ligaments, and tendons need to work together to keep us from falling flat on our faces.
So, for 14 years Dr. Suzette Song, as part of the growing Orthopaedics and Spine Specialists group (then OSS Health) with their doctor-owned hospital, was “a pretty busy and productive surgeon.” She was the “only female (surgeon) in a big organization.” But she figured out the system, and worked within it to make her own practice run more smoothly, more efficiently (sometimes too efficiently, perhaps, as some of her patients, older women, felt that she talked too fast).
Suzette had two more children after Ryan (again, with Dr. Figdore’s help), and everything was good.
But she had no advance warning as something was to happen that would change her life forever.
It was the end of February 2014. It was a routine Saturday. She was a bit feverish and her stomach bothered her. No big deal. She waited for something to ache, like having the flu. That didn't happen over the weekend, and she was baffled. Early Monday morning, still sick, there was repeated vomiting and she felt dizzy.
So she called her secretary to cancel her hours for the day. Dr. Song felt poorly but really wanted to avoid the ER. She implored one of the nurses at OSS to come over to her house to give her IV fluids. Yes, she would feel better, for sure, when hydrated. But the experienced nurse saw that Dr. Song looked terrible: her blood pressure was unrecordable, she couldn’t think clearly, and at this point, her skin started to really hurt! A trip to the busy ER was unavoidable.
Shortly after she arrived at the hospital her husband, who had been working there, made his way down to the ER to see her. Suzette’s blood pressure was dangerously low and she was in a lot of pain. Morphine would drop her pressure further, so she told them (yes, she told the staff) where they could find some (expensive) IV Tylenol (it wasn’t used). They thought at first that she was septic. She had stat lab work and her liver enzymes were through the roof. She was sent for a CT scan of the abdomen.
 |
| CT image of an acutely-failing liver full of nodules (looking from below) (from Eurorad) |
Yet Suzette, the skilled surgeon faced with a crisis, thought methodically. She figured out in her mind who might be on-call and who would be the best doctors for her, and she made her choices known. When critical care specialist Dr. Richard Murray arrived at her bedside, she realized that she was really sick.
Kevin had never seen such high liver enzymes and he knew that his wife had life-threatening hepatic damage. A decision was made quickly: she needed to be transferred immediately to a center where she might, just might, be lucky enough to get a liver transplant before all hope was lost. Time was of the essence. When Kevin told his wife that she would be sent to Hershey by a medevac helicopter her response was: “What’s Hershey?” Her brain was failing.
 |
Dedicated MEDEVAC helicopters to transport the wounded were first used by the US during the Korean War, a "forgotten" war. From 1950 to 1953 three million lives were lost, mostly civilian. Virtually all of Korea's major cities were destroyed. (photo from "Olive-drab") |
 |
| "The Damned Cast into Hell" painting by Luca Signorelli (photo by Steven Zucker from smarthistory.org) |
By Wednesday Kevin had to start planning her funeral. He contacted family and friends so that they could say goodbye to his wife. As she vaguely recognized the faces of those who made the trip to Hershey, people from widely different eras of her life, she was sure that she slipped into the hereafter. Why else, she thought, would all these people be at the same place at the same time?
She had been placed on the top of the transplant list, and by Thursday night they had found a donor liver. But it wasn’t certain that the organ would be suitable or that Dr. Song would even survive until surgery the next morning. It was a very difficult night for her family and friends, as they waited and waited. And after Suzette underwent the delicate, meticulous, and long surgery (pioneered by the famed Dr. Thomas Starzl at the University of Pittsburgh in the 1980s), she didn’t wake up for a week. Would she be okay?
 |
The damaged liver is removed and the new liver is put in place and is carefully attached to arteries and veins. The surgery may last more than 12 hours. (from transplantliverindia.com) |
Dr. Song had to be hospitalized several times the year following the transplant and resuming her demanding surgical practice wasn’t possible. Even now, in 2021, seven years later, she still fatigues easily, has some weakness and loss of dexterity in her hands, and has tingling in her hands and feet when she’s tired or hot or cold. She had to find another way to continue her career. So, “plan B.”
As we have seen, Suzette had long had an interest in the “process” of her medical practice and tried to find ways to do things better. With the help of her (all male) partners at OSS, she was able to take this interest to a “system” level. But she said she had to learn new skills, skills that were somewhat foreign to surgeons, administrative skills. Skills such as listening, collaborating, and knowing how to “get people on board.”
She has the title of Vice President of Medical Affairs but spends most of her energy “on big projects” and “workflow stuff.” She tries to learn from previous mistakes. Though Suzette “absolutely misses” being in the OR her work now is rewarding as she can “help a lot of people” rather than just one patient at a time. For example, if she helps to lead process improvement on even one step of a total knee replacement at OSS she can have an effect on the lives of a thousand patients a year, she said.
 |
The OSS Orthopaedic Hospital in York, one of ten various OSS facilities in the region (photo from OSS) |
(Though Dr. Song has received two doses of one of the mRNA vaccines against the SARS-CoV-2 virus her anti-rejection medicines blunt her immune response and she likely remains susceptible to the virus. So she continues to wear a mask, and a personal air purifier and ionizer dangles from a delicate cord around her neck for added protection and peace of mind.)
And in her newer role, her second career, and over time, and from her own experiences, she has learned to view things from the standpoint of the patient. When she took her mother to see her mother’s oncologist, Dr. Amir Tabatabai, he gently asked Mrs. Song if she would allow him to examine her. Suzette was moved by this simple act of asking permission. She sensed that this is a way medicine could be practiced: focusing on the patient, unrushed, unhurried, slower. And she saw that medical care could be standardized without being dehumanized, she told me.
 |
| Kevin |
By now, it was late in the afternoon, and after a few hours of telling me her story, it was time for Suzette to return home to Kevin. It was Sunday, and he would be making Korean grilled steak.
 |
| "Grey Coat and Pink Hangers" (photo by AC) |