By William Vranos, MD

After “Why does my (insert body part) hurt?” the next most frequently asked question I get is “How did you end up in orthopaedics?” When I tell the story, I realize that a lot of people don’t know how medical training is structured and what medical students go through to arrive at the biggest decision of their career — which specialty to pursue. Hopefully the story of my “AHA! Moment” — the one that set my course for a specialty in orthopaedics — will be of interest to you.

I am second generation Greek. All my grandparents came to this country on boats over 100 years ago as teenagers. Thus, I had parents and two sets of grandparents hoping for a doctor in the family. It helps to understand the Greek mentality. In our culture being a doctor, above and beyond the level of education and prestige it affords, represents independence. As a doctor, you could “own your own business.” By my family’s way of thinking, my fall back plan, like that of my ancestors, would be to open a pizza place. That was not my vision of success, so I focused myself on schoolwork. In addition to my academic pursuits I enjoyed working in my uncle’s custom engineering shop doing welding, plumbing engraving and being the general shop guy.

Being a dutiful son and grandson, I got good grades and found myself in medical school. In some ways, I wasn’t sure why I was there, besides fulfilling the wishes of those who expected so much of me. Once there, however, I immediately knew I was in the right place. The science and study of medicine was fascinating.

William Vranos, MD
William Vranos, MD

I was, however, naïve as to the various specialties and the effort it would takes to be accepted into each. I had no idea what specialty I wanted, and figured I would find something along the way. Others were much more focused. From my first day in medical school I wondered who the intense people were in the front two rows of the lecture hall, asking questions, pulling their hair and twitching a lot during exams. They turned out to be the ones set on going into neurosurgery or ophthalmology, the two most difficult specialties to get into.

“Dave” represented an extreme example of single mindedness in pursuing a specialty. In the mid-1980’s, invasive cardiology was a brand new discipline, and very few centers offered or taught it. “Dave” volunteered to work in the cardiology lab as a first year medical student. He had no skills or credentials and basically emptied the trash cans and filled the lunch orders, but felt he was doing what he needed to get the recommendation that would be required when he applied for residency. Then, tragically, the cardiologist died in a small plane crash. “Dave,” without any sense of irony, threw his head in his hands and wailed “two years of my life wasted!!”

Others had very clear reasons for having their mind set early on a specialty. One friend of mine had been a respiratory therapist for years and came to medical school to become a pulmonologist. Another, due to a family tragedy, pursued pediatric cardiology. Many just wanted to go back to their hometowns and set up a primary care practice.

While I was amused by the intensity of those in the front row and respected those with noble intentions, I still had no idea what I wanted to do. The first two years of most medical schools involve extensive classroom and lab work and the last two years are devoted to clinical study. Since applications to residency programs go out in the fall of fourth year, that meant I had my third year to experience different specialties and decide what I wanted. I enjoyed my rotations in OB/GYN (delivering babies was fun), pediatrics (kids throw up a lot so pediatrics was out) and internal medicine (interesting but I found it occasionally boring), but none felt like a true “calling” to me. Then, on my first night on the trauma team, a gentleman came in with a Swiss army knife in his heart. While the surgeons cracked his chest and inserted central lines, one pointed to me and said “Start an IV in his leg.” I started that IV and the guy lived. That did it, I was going to be a surgeon.

To pay for medical school, I had applied for and received a USAF scholarship. The Air Force paid for my medical school and in return, I performed reserve duties in the summer and would owe full time active duty later. My reserve duty called for me to work as a medical student during my clinical years. In the summer after my third year, I headed to Eglin AFB in Florida to work on the general surgery service. While at the major medical centers of Emory University I took care of trauma patients, re-vascularized limbs and fixed aortas. At Eglin I removed lumps and bumps and an occasional gallbladder. This was before endoscopic procedures so I spent many hours holding a retractor – an experience that can wear on you after a while. Meanwhile, my wife was back in Atlanta, organizing my applications and supporting me as best she could. It was a stressful time. I wondered if my reservations about general surgery were legitimate, or just a natural reaction to the pressure of needing to make a monumental decision that would shape my life.

Then, the day came that clarified everything and changed my life forever. While at Eglin I noticed another group of surgeons who seemed to really enjoy their work. They wore fireman’s boots. The sounds that emanated from their OR room were different than I was used to. Was that a drill I heard? A saw? My surgery time at Emory had not included orthopaedics. I had no idea what they were up to.

On the fateful day, one of them asked my surgical attending for a medical student to help assist and I was chosen. I thought, “Great. Here I go again, holding a retractor for hours on end”. But that’s not what happened at all. We were replacing a hip. The anatomy was clear to see. Then they used a saw to remove the bad bone. They used reamers to shape the bone. One of them, noticing my obvious excitement, let me set the prosthesis into place. All those years in high school and college working in my uncle’s shop had trained me for that moment. I was overwhelmed with excitement.

I left the hospital that day thrilled but confused. Was it too late to change my mind? Would I anger my wife and advisors who had worked so hard for me to apply to general surgery programs? I pondered this as I waited under an awning, waiting for a typical Florida afternoon thunder storm to pass. As the storm ended, the clouds parted and a sunbeam hit me in the forehead. A bluebird landed on a tree branch next to me. Even a knucklehead like me knew a “sign” when I saw it.

Fortunately, my wife and advisors were supportive and happy for me. It was a lot of work but we got the new applications out just in time.

So that’s the long answer to a simple question. I consider myself extremely fortunate to be working in a field that I enjoy and is perhaps one of the most exciting and innovative specialties in medicine today, although I’m sure most physicians, in whatever field they practice, feel the same way. I think you’ll find, if you ask any doctor, that their story of how they arrived at their specialty is rooted deeply in their personal history and life experiences.

William Vranos, MD is a board-certified orthopaedic surgeon at BMH Orthopaedics & Sports Medicine, a department of Brattleboro Memorial Hospital. Dr. Vranos can be reached at 802-251-8611.