Our twenty-four-day, thirteen-presentation tour through ten “Western” orthopaedic departments began on the way to Saskatoon, Saskatchewan, when those of us participating in the 2011 John J. Fahey, MD, Memorial North American Traveling Fellowship (NATF) caught glimpses of each other in airports while connecting to various flights. Finally, we made formal introductions in the Saskatoon International Airport after a seemingly exhaustive interview by the Canadian Border Control. We all greeted and got to know each other briefly in the airport while comparing our web searches of each other to our real impressions.
The first to arrive was Dr. Peter Rose. Originally from Houston, Texas, he had studied physics at the University of Houston before pursuing a degree at The Johns Hopkins University School of Medicine. After medical training, including a stint at the National Institutes of Health pursuing research, Dr. Rose did his residency training at the Mayo Clinic and was recruited to the faculty following two fellowships as a Mayo Foundation Scholar in spine and oncology. In order to participate in the NATF, he left a wife and baby daughter behind at home.
Sitting next to Dr. Rose on a Saskatoon Airport bench was Dr. Kelly Lefaivre, who hailed from Vancouver, British Columbia, where she was born and raised. She had completed an undergraduate degree at Queen’s University in Kingston, Ontario, followed by medical school and orthopaedic residency at the University of British Columbia. After obtaining a master’s degree in epidemiology from the Harvard School of Public Health and finishing a fellowship in orthopaedic trauma at the University of Texas Southwestern Medical Center, Dr. Lefaivre accepted an academic position in orthopaedic trauma at the University of British Columbia. She was the only fellow on this journey to visit her hometown and be able to reunite, albeit briefly, with her husband when we visited Vancouver.
Arriving fresh from a third-degree interview with border control was Dr. Jaimo Ahn from the University of Pennsylvania in Philadelphia. A graduate of Stanford University who had been originally trained as a biologist, Dr. Ahn completed a combined MD-PhD program in molecular genetics, a postdoctoral fellowship in molecular orthopaedics, and a residency at the University of Pennsylvania. He then pursued orthopaedic trauma training at the Hospital for Special Surgery in New York and a Memorial European AO Trauma fellowship in Bern, Switzerland, before taking a position as a surgeon and scientist at the University of Pennsylvania. Among many other distinctions, Dr. Ahn proved the lightest traveler: he never checked any baggage throughout our travels during the NATF.
Dr. Shane Nho hails from Chicago, Illinois. He had attended medical school at Rush Medical College in Chicago after completing an undergraduate degree in biology at Northwestern University. His residency training was at the Hospital for Special Surgery in New York, and he did a fellowship in sports medicine at Rush University Medical Center. He had been awarded the Herodicus Traveling Fellowship and worked with hip arthroscopists across the United States before returning to Rush University as a faculty member in sports medicine, specializing in disorders of the hip.
The last to disembark in Saskatoon was Dr. John Elfar from Rochester, New York. Originally from New Jersey, Dr. Elfar had graduated from The Johns Hopkins University with degrees in biomedical and electrical and computer engineering. He attended Harvard Medical School and pursued residency training at the University of Rochester before completing a hand and upper extremity fellowship at the University of Cincinnati. He is currently an assistant professor of hand and upper extremity surgery in the Department of Orthopaedic Surgery at the University of Rochester School of Medicine.
Over the duration of our time together in the NATF program, we learned many personal, philosophical, and, of course, academic things about each other. We have served as reviewers for the Orthopaedic Research and Education Foundation, the American Orthopaedic Association, and other subspecialty foundations. In addition, we have been reviewers for numerous subspecialty journals, including the Journal of the American Medical Association, The Journal of Bone and Joint Surgery, Clinical Orthopaedics and Related Research, and the Journal of the American Academy of Orthopaedic Surgeons. Table I provides more information about us and our experiences during the NATF.
With our group assembled and the greetings completed, we went to Saskatoon to begin the fellowship program. Dr. Thiessen and his family opened up their home for a wonderful meet and greet with the entire orthopaedic department. The next day, we each gave two twenty-five-minute presentations in a scientific session chaired by Drs. Yong-Hing and McKerrell before going to lunch in the faculty club at the University of Saskatchewan with the residents. In the evening, we had dinner with the faculty; glasses were raised and stories were told, including tales from Dr. Yong-Hing’s experience in the NATF program twenty years ago.
We were then whisked away by cab to the airport for a quick flight to Calgary, our second stop on the tour. Our host, Carmen Brauer, was absolutely wonderful, as would later be evident by our secret ballots for “best host” of the tour. She took us to many sights, including the Olympic Oval in Calgary, which was designed as a training center for speed skating and has the fastest sheet of ice in the world. As it turned out, the ice was a little too fast for Drs. Elfar and Lefaivre, who abstained from full laps around the oval in favor of a shorter token skate with the assistance of ice walkers. Dr. Rose, on the other hand, did not let limited experience stop him from winning the bronze medal for the NATF speed skating competition, finishing just behind Drs. Ahn (silver medalist) and Nho (gold medalist). Together, we later attempted to hijack a bobsled but failed because of a crew of viciously competitive lugers. Unfortunately, our trip to Banff was canceled, but we did have a lovely dinner with the faculty after a trip to the mall to pick up some necessities, including replacements for lost electronic chargers and much-needed razors.
Our talks at the Alberta Children’s Hospital were telecast across the city into multiple locations. Next, we toured the extensive and impressive laboratories at the University of Calgary, culminating in a tour of the advanced motion and gait laboratory and the robotic testing unit. Finally, we said a sad goodbye to Calgary and were whisked out of Canada, but not before Drs. Nho and Elfar learned how to check their bags with airport customs before boarding the plane.
On arrival in Portland, Oregon, we were picked up from the airport by some of the residents and taken to the Hotel Monaco. Dr. Ahn had had a previous experience with this pet-friendly hotel, and he surprised us by having a live fish delivered to each of our rooms. All of the fish survived, and in the evening, we went to Dr. Gellman’s beautiful house for dinner with the residents.
The next day, we went hiking in the Columbia River Gorge area to see the Multnomah Falls and the Horsetail Falls. It was a fun hike with spectacular views. That night, Drs. Yoo, Hart, Friess, and Doung showed tremendous hospitality at dinner at a Portland landmark: Jake’s Grill and Seafood Restaurant.
On a secret quest to tour the city on the next day, we found the famous tourist trap of Voodoo Doughnut, and Drs. Nho, Rose, and Elfar still had room for dinner from street vendors in Portland’s historic downtown area before bidding farewell to Oregon Health and Science University.
Our next stop in Vancouver, British Columbia, was two flights away. This is Dr. Lefaivre’s hometown, and our host, Dr. Brian Kwon, was ready for action. The group split up, and we participated in various activities, including ziplining, shopping, and relaxing for the afternoon. We had dinner in a park restaurant with a fabulous view of the entire city.
The following day, there was a scientific session with presentations from all of the NATF fellows, followed by specific sessions designed for each fellow to interact with members of his or her respective field. Dr. Lefaivre actually performed surgery during an open spot in the schedule.
At this point, our great luck with travel arrangements ended, and a delay of many hours and a change in flights out of Vancouver disrupted travel to our next destination. Dr. Rose, with an ability to solve such problems, got us all into the Delta lounge at the airport in Seattle during our layover, while Dr. Lefaivre stayed in her hometown to wait for the next flight. The group reunited in Salt Lake City, Utah, in the afternoon.
The scenic views and fresh mountain air were the backdrop for a wonderful dinner at the home of Dr. Charles Saltzman, chairman of the Department of Orthopaedic Surgery at the University of Utah. The dinner was prepared by renowned chef Valter Nassi from the local Cucina Toscada restaurant, and our role was that of eating the incredible meal while taking in the views of the valley below.
The following day, we had a stimulating academic experience and a wonderful exchange of ideas. Dr. Darrel Brodke gave us a tour of the beautiful new University Orthopaedic Center at the University of Utah. Drs. Alan Stotts and Charles Saltzman took us on a brisk hike (3.5 mi, 1900-ft elevation gain to almost 10,000 ft) to Desolation Lake. When we encountered a moose in the middle of a trail, we retreated calmly to avoid sure disaster. That night, we enjoyed dinner at a local Mexican restaurant with Drs. Steve Aoki, Florian Nickisch, Kevin Jones, and Joshua Klatt, and we finished our time in Salt Lake City with a resident outing.
Before going to the airport, we had our first opportunity to do a much-needed load of laundry. Finally, well rested and armed with clean clothes, we flew to San Francisco. After a very bumpy flight into the Bay Area, words were few in the car with our faculty greeter, Dr. Colleen Sabatini. We decided to forego lunch and recuperate in preparation for our presentations that had been scheduled for the next day. Drs. Nho, Rose, and Elfar chose to tour the city by foot, including lunch in Chinatown and a walk to Fisherman’s Wharf, where Dr. Elfar was accosted by the Wharf Bushman (a man who hides behind tree branches and scares people). Dr. Nho diffused the situation, and Drs. Rose and Nho escorted the mildly traumatized Dr. Elfar on a lifelong-dream ride on a San Francisco cable car, which was accompanied by many verses of the Rice-A-Roni television commercial theme song.
Monday began with conferences hosted by Drs. Thomas Vail and Ted Miclau at the University of California San Francisco (UCSF) Parnassus Campus (Fig. 1). Next, we went to tour San Francisco General Hospital (SFGH) with Dr. Miclau. We were all very impressed with the Orthopaedic Institute and the Orthopaedic Trauma Institute. We also visited the new UCSF Orthopaedic Clinic with Dr. Ben Ma, who gave us a tour and hosted case presentations in the evening before dinner. On a small 7and somewhat secret excursion, Dr. Mohana Amirtharajah provided us a tour of San Francisco. Then, in the evening, Drs. Vail, Berven, O’Donnell, Amirtharajah, and Miclau all joined us for Thai food. The next day, we had a stimulating conference at SFGH and enjoyed Mexican food in the Mission with Drs. Meinberg, Matityahu, Coughlin, and Miclau.
After the bumpy ride we had experienced into the Bay Area, we all hoped for a calm flight to our final destination on the tour. Alas, it was not to be. However, we all arrived safely, but a bit shaken, in Los Angeles. We looked forward to finally meeting the chairman of the NATF Committee, Dr. Jeff Wang. Indeed, he and the spine surgery fellow were waiting for us very late in the evening to provide us with transportation to the hotel. We were all very grateful for such a great host.
The University of California, Los Angeles (UCLA) academic session was stimulating, and it ended with an award ceremony for the NATF participants. We toured the Ronald Reagan UCLA Medical Center, and we took photographs next to the picture of the former president and first lady (Fig. 2). Dr. Wang and his brother hosted us for lunch at the Jonathan Beach Club in Santa Monica. Next, we were off to a behind-the-scenes tour of the J. Paul Getty Museum. It was incredible to see the research and restoration of artwork from the Middle Ages. The tour was so behind the scenes that some of us worried about bumping into priceless pieces of art. With all of the “oohs and aahs,” it was clear that this museum was the highlight of the trip. We had dinner at the Napa Valley Grill, and Dr. Jeff Eckardt named us the “5-11,” which stood for the “five 2011 NATF fellows.” We were accompanied by four former NATF fellows: Dr. Oppenheim, ’79; Dr. Eckardt, ’82; Dr. Delamarter, ’88; and Dr. Wang ’99. Dr. Pedowitz, ’94, was not able to join us. Dr. Eckardt gave us a tour of the new UCLA Santa Monica campus, which will combine the UCLA Department of Orthopaedic Surgery and the Orthopaedic Hospital. The fellows spent the afternoon at the Orthopaedic Hospital Research Center and the Orthopaedic Hospital in downtown Los Angeles. We had a wonderful exchange about innovative research and scientific advancements. The day was topped off by dinner at the California Club with Dr. Luck, a legend in the field of orthopaedic surgery and a very gracious host.
The next morning, we were taken in a large sport-utility vehicle to Orange County to visit the University of California, Irvine (UCI). We had an excellent scientific session hosted by Dr. Bang Hoang and Dr. Thay Lee. UCI Chairman Dr. Ranjan Gupta took the NATF fellows on a tour of the UCI campus, which is very much in a state of rapid expansion. Drs. Gupta and Hoang invited us for dinner at the Shady Canyon Golf Club. It was a wonderful evening in a fantastic venue. The following day, Dr. Rosen invited us on his sailboat and took us for a sail off Manhattan Beach. Dr. Elfar was caught taking numerous naps during the boat trip. We ended the evening at a restaurant by the marina with Drs. Hoang, Rosen, and Rafijah.
A short one-hour drive south from Orange County was our last stop on the trip, and already, the nostalgia was beginning to surge. Throughout the drive, we had to remind our limousine driver to slow down because we feared becoming a road statistic.
There were many different places to visit in San Diego. We met with Dr. Wenger at the Rady Children’s Hospital to review pediatric cases. Dr. Newton gave us a tour of the hospital and research facility. Next, we met with the research faculty at the University of California, San Diego (UCSD) and had a stimulating exchange of lectures. We met with Drs. Garfin, Abrams, Pring, and Schwartz for dinner at Candelas Restaurant, where we indulged in a special meal. The following day was reserved for subspecialty conferences and case discussions.
Next, Dr. Provencher (NATF fellow, 2005) was our host at the Navy Medical Center. He took us on a tour of the helicopter training facility, and each of us had a chance to use the virtual helicopter simulator. Dr. Rose earned a secret nickname when he was able to fly the helicopter upside down for a short while (nickname redacted). We were able to fly the virtual helicopter around the San Diego Bay and attempt to land the aircraft on a carrier; some of us were successful. Next, we toured the USS Bonhomme Richard with Dr. Manny Alsina, the director of medical services on the ship, which houses six operating rooms and has the capacity to act as a 600-bed hospital for wounded sailors and marines. We were invited to have dinner at Captain Covey’s (NATF fellow, ’90) house. The following day we had a conference with the UCSD, Navy, and other groups in the metropolitan area. The NATF fellows were welcomed warmly and provided their last lectures of the fellowship. The afternoon was spent with Navy faculty and at lecture rounds with the residents. San Diego was an excellent location for the conclusion of the tour.
While we were traveling, our lives back at home and work did not stand still. Looking back, we realize how much we had missed in both domains. We were able to remain in contact with our families on average for twenty-two of the twenty-four days that we were away. Fortunately, only a total of four family “events” were missed. Our contact with our offices was less frequent (average, sixteen of twenty-four days) and more varied (range, five to twenty-four days). In both realms, we were all extremely appreciative of the unwavering support. Table II provides more details about our travels.
We learned firsthand how traveling fellowships do not represent real life. We lived out of suitcases (two to four bags), moved from hotel to hotel every few days, talked about academics constantly, had few opportunities to sleep in, drank and overate almost daily (average, seventeen and twenty-one days, respectively), but did not exercise to match (average, thirteen days). Two fellows confirmed they had maintained their starting weight, while the other three did not comment.
Our most memorable moments included a cable car ride, ziplining through the clouds, crashing into a glass wall at a dinner, the tour of the J. Paul Getty Museum, flying a simulator helicopter, partaking in very lively host dinners, and responding to provocative questions at the podium. As we explored different institutions, we learned that “we all confront the same problems, even if different places approach them differently” and “even powerful people and places are subject to basic pitfalls.” Overall, as much as we took away from our hosts, we also realized that we were “happy to be in our own places.” Just as importantly, let us persuade you not to “try to walk 5 km in heels, as you will pay the price later.”
For those considering an NATF tour in the future, consider this pearl of wisdom: “Be careful what you wish for, you just might get it.” Comments from the NATF fellows included: “It’s a great time, but I would mail ahead deposits of clean laundry to be waiting for me,” and “I worked out every day and was glad to have done so. I ended the tour exactly the same weight I started.” Other comments included: “I would have found some way to have my family visit me, even if it meant bending the rules a little,” and “Let yourself recover before you fully evaluate the value of the experience, which in retrospect is significant.” Lastly, one fellow remarked, “Find time, even if just a few minutes a day, for yourself,” and perhaps, most importantly, “Have fun.”
At first, all of us wondered why we had been chosen for this prestigious honor. Over the course of our days together, we developed friendships that we believe will last our entire lives; all five of us agree that these relationships are one of the most important advantages of the fellowship. We had many wonderful experiences, despite missing our families and our loved ones. As our travels on the West Coast fade into the sunset, we acknowledge that the NATF provided us with the time of our lives, and we wish that all of our colleagues could participate in this fantastic program. Although unwilling to reveal our true identities, we leave you with our NATF call signs: Flipper, Stiletto, House, Metro, and Shillelagh.