Remember

We remember.

Never forget.

Dr. Ignacio Ponseti (1914-2009)

The University of Iowa community lost a colleage and friend when Dr. Ponseti died of a sudden illness on Sunday; he was 95. Dr. Ponseti developed a groundbreaking treatment for clubfoot using only casting and braces, not surgery, to train the foot into normal alignment. He persevered in his work even when the orthopaedic community disregarded his findings; through peer-reviewed research the Ponseti method has been shown to have a success rate of nearly 98 percent without the risks of a surgical procedure (the method is also inexpensive and popular in poorer areas of the world). Dr. Ponseti's method was championed by parents, eventually culminating in founding of The Ponseti International Association in 2006 at the University of Iowa.

From the UI HealthCare news release:

Ignacio Ponseti, MD, whose pioneering, non-surgical, low-cost clubfoot treatment has benefited hundreds of thousands of children worldwide, died today at University of Iowa Hospitals and Clinics in Iowa City, Iowa, at age 95 following a sudden illness. Ponseti's gentle methods and soft-spoken compassion were a hallmark of a six-decade commitment to helping children, and belied a sometimes tumultuous, even dangerous, early career in medicine.

Ponseti was born in 1914 on the Spanish island of Minorca. As a teenager, he worked summers in his watchmaker father's repair shop. Hours spent learning to make and replace tiny, delicate watch parts were lessons in patience and precision that would serve him well in the years that followed.

Ponseti entered medical school in Barcelona in 1930 and completed his degree in 1936, just before the start of the three-year Spanish Civil War. Volunteering to serve as a medical officer with the Loyalist army, he spent the war in the Orthopedic and Fracture Service treating battle wounds. By 1939, General Francisco Franco's fascist army had gained control, and Ponseti, fearing imprisonment or worse, chose to leave Spain.

His escape was not a solo effort, however. Ponseti also arranged a risky evacuation for the nearly 40 wounded men in his care. He worked for three days and nights to set their fractures, and then, with the help of local smugglers, he transported the wounded by mule over the Pyrenees mountains to safety in France.

Finding himself with no home or citizenship, Ponseti left France for Mexico, where he served as the community doctor for Juchitepec, a small town south of Mexico City. There, he successfully treated typhoid patients with hydration and bean puree.

While in Mexico for two years, Ponseti met Dr. Juan Farril, a professor of orthopedics at the University of Mexico who had trained in the United States. With Farril's assistance, Ponseti arranged to study with Dr. Arthur Steindler, then chairman of orthopedics at the University of Iowa. In 1941, Ponseti moved to Iowa City.

Ponseti's limited English and lack of a medical school diploma (due to the outbreak of the Spanish Civil War) almost stymied his entry into Iowa's residency program. Fortunately, he was able to explain the situation - in French - to Carl Seashore, then dean of the UI Graduate College, who helped resolve the problem.

After completing his residency in 1944, Ponseti joined the orthopedics faculty at UI Hospitals and Clinics, where he remained for the next four decades treating patients, teaching and conducting research. He retired as professor emeritus in 1984, but returned to the University in 1986 to a consultative practice in orthopedics until he fell ill last Tuesday (October 13, 2009).

Ponseti's work on clubfoot started very early in his UI career in the 1940s. It was obvious that without treatment, children with clubfoot faced a lifetime of debilitation, and even possible amputation. But the surgical treatments used at the time had significant limitations. With nearly 200,000 children born each year with the condition, the need to find a more effective treatment was imperative.

During his first year as a graduate fellow, Ponseti reviewed the outcomes of Dr. Steindler's clubfoot surgical treatment used between 1921 and 1941. Analysis showed that surgical treatment often resulted in stiff, fixed ankles. Moreover, although the treated children could walk, they almost always had a limp.

Ponseti's extensive examination of the anatomy and biology of infant feet, led him to believe that physical manipulation and casting might be a more successful approach. In 1950, Dr. Carroll Larson, head of orthopedics at the University of Iowa, put Ponseti in charge of the clubfoot clinic, where he developed the eponymous method that would slowly but surely revolutionize clubfoot treatment.

Known as the Ponseti method, it involves the careful manipulation of muscles, joints and ligaments held in a series of casts and braces to reposition the foot back to normal. It has become the "gold standard" for clubfoot treatment, after decades of positive follow-up results and numerous international peer-reviewed studies showing success rates as high as 98 percent.

However, for the first 40 years after developing the technique, only Ponseti and a handful of orthopedic surgeons used the method, treating more than 2,000 children. Frustrated by the under-use of his technique, Ponseti and colleagues who had used the technique began making a concerted effort in the 1990s to communicate the method and its successful results to as wide an audience as possible.

Ponseti's book, “Congenital Clubfoot: Fundamentals of Treatment,” published by Oxford University Press in 1996, describes his experience with the method and includes patient studies confirming the success of the approach. A string of peer-reviewed articles, including multi-decade follow-up studies, also helped raise awareness and professional acceptance of the method.

By early 2000, the Web became an effective grass-roots medium, especially among the parents of successfully treated children who advocated the Ponseti method to other families searching for the best treatment for clubfoot. Over the past decade, these educational and advocacy efforts have resulted in the Ponseti method being considered the mainstream treatment for clubfoot in North America today. The technique is increasingly used to help children with clubfoot from underdeveloped regions of the world. In August 2006, the American Academy of Pediatrics endorsed the Ponseti Method.

Even though he was in his eighties and nineties, Dr. Ponseti continued to train physicians in his method, many of whom came from around the world to learn the technique. You could see the gaggle following Dr. Ponseti down the hallway. Dr. Ponseti's 1996 textbook, Congenital Clubfoot: Fundamentals for Treatment, has recently been reprinted. In 2006, Helena Percas-Ponseti, herself a professor emeritas of Spanish literature, wrote Homage to Iowa: The Inside Story of Ignacio V. Ponseti, a biography of her husband. I have a copy of this book, signed by both Dr. Ponsetis, on my bookshelves at home.

Rest well, Dr. Ponseti, you gave hope and happy life to so many.

Time Paradox

It seems like yesterday and at the same time light-years ago that I stood motionless next to a child's hospital bed on what had seemed like an ordinary Tuesday morning - freshly drawn tubes of blood in one hand, ID labels in the other, and a very upset child behind me - staring at CNN video of the World Trade Center Towers as the first tower fell. The nurse next to me started sobbing. I did, too. Even thinking about that moment brings a lump to my throat and I have to work hard to swallow it down.

Later that week on Friday the noon whistle blew at the University of Iowa power plant. Basil Thompson asked our accompanist to cease playing and my character dancing class joined the entire University in marking a minute of silence for all those who lost their lives the Tuesday previous. Basil is gone now, too, from a heart attack suffered while giving a ballet class in 2005 and his memory also seems like yesterday, but also so many ages ago.

After 9/11 I turned to the poetry of Emily Dickinson, an odd choice I know but she has a little poem about hope:

Hope is the thing with feathers
That perches in the soul,
And sings the tune--without the words,
And never stops at all,

And sweetest in the gale is heard;
And sore must be the storm
That could abash the little bird
That kept so many warm.

I've heard it in the chillest land,
And on the strangest sea;
Yet, never, in extremity,
It asked a crumb of me.

Always remember.

Deep thought for the day

If you are up shit creek, is it necessary to kill your entire family?

Granted, the autopsy will tell whether or not the father is the charred body in the family's van but if that's not the father and if the evidence doesn't point toward him as the murderer of his wife and four children I will be very, VERY surprised.

I don't particularly care if your life has totally gone to pot, that you've been indicted for embezzling half a million dollars from the bank (of which you are the vice-president), that you're probably going to jail because you admitted to the police that part of that money went toward a serious coke habit. I really don't. If you want to skip out on the charges and kill yourself, be my guest. Just don't take anyone else with you.

Here's a little prayer hoping that the children's deaths were quick and that they didn't realize what was going on.

Current book-in-progress: Beloved (for LbW BNBC April), Then We Came to the End (gotta support the Iowa alum), Birdsong (for our in-store group), Villette (also for BNBC April, just not my group), and whatever else I find
Current knitted item: My first commission - a tan neck warmer for a co-worker's partner
Current movie obsession: I just finished Once - a great little movie, very moving and sweet, I might like the music better (the soundtrack is on order)
Current iTunes loop: It's a tie - Sarah Barreilles's Little Voice and the original cast recording of Rent

There are no words

Ordinarily I reserve the right to be a curmudgeon on Valentine's Day. This trumps any holiday.

The fourth school shooting this week and the most lethal. Why?

Is the "school shooter" phenomenon spreading virally i.e. one incident sets off the next and the next (think Malcolm Gladwell's The Tipping Point)?

If this bozo (who by now has been identified as a former student of NIU, now at Illinois Champaign-Urbana) felt the need to exterminate himself, why kill people he didn't know? Why? None of them did a damn thing to him. What irritates me most is that shooters like these take the coward's way out, taking no responsibility for their actions.

Incidents like these weigh heavily on me because I would like to return to school and eventually end up as a professor. Will I need to always be on my guard in case a student, disgruntled by the lack of an "A," comes to my office with a weapon? Will I need to carry one myself? Will I have to lock my classroom doors once I begin teaching a class? Will we all need to swipe our ID badges to gain access to buildings and classrooms? Will I need to be schooled in psychological profiling to identify students in need? It is mind boggling. I am not an advocate of having more weapons because that really won't solve the problem. In nearly every school shooting as of late, the attacks were a surprise, none of them were previously suspected by school officials, security officers, or the shooters' friends. Even if a member of the class had a gun, a high powered weapon can spew dozens of bullets in just a few seconds, enough to kill or severely injure many people before that class member could procure his/her weapon.

There is no easy answer.

May the family members of the victims find peace and solace in one another. God bless.

Today, we are all Hokies

After reading the growing media coverage of the mass shooting at Virginia Tech, I waited nervously all day. Alpha Chi Sigma, the chemistry fraternity - of which I'm a District Counselor, has a large chapter at VT. Gamma Iota chapter hosted our 2004 Biennial Conclave and we had a marvelous time on VT's beautiful, peaceful campus. Thankfully, we heard from the chapter's president and none of our brothers are among the deceased or injured (and my friends Katharine and Beth, whose cousin attends VT, also heard he was unharmed). My heart breaks for all the families, friends, emergency workers, alumni, and administrators of VT. I pray to whichever God is listening right now that the entire VT community find peace and solace in one another as they heal. So many lives lost - none for any better reason than they happened to be in the wrong place at the wrong time.

And now, some callous idiot has posted on the Barnes and Noble Book Clubs board that we should all buy a certain novel about gun-toting nuns in Wal-mart because the VT tragedy illustrates perfectly why the US should have gun laws. The post is as follows:

Yesterday's mortifying events in Blacksburgh Virginia underscore the importance of finding a way to stop the production and distribution of handguns. Only a few days ago I posted a message recommending xxxx's newly released novel "XXXX" and calling for EVERYONE interested in the subject of violence committed with pistols to read.Did you see? and if you did, did you care?If you did, and you didnt, you are part of the problem.xxxx'snovel is not available from Walmart online. Why? because in the story Nuns terrorize a WalMart gun department and destroy all the handguns present.WalMart refuses to publish it. How is this free speech in action? WalMart will say "We decide what free speech is".Fortunately, none of the other vendors agree. XXXX is not a political tract. It's a delightful novel filled with wonderful characters and at the base of it all is the question: why, when people can have all the rifles they want cause the constitution grants permission, do we need to allow handguns too?Look, don't listen to me. I'm only a schmuck who stumbled on a book far above his head and got kicked in the mind by it. I think the ISBN of XXXX is ISBN-10: ##########. I'm tellin' ya. This is a great read.

Did you notice a few things are missing? I took out the author, title, and ISBN - I don't want anyone, not a single person to buy this book. I even submitted a complaint to the BNBC admins; I'm a pretty tolerant person but this pretty much stretches my limits. The poster is part of a circle of authors with TERRIBLE self-published novels and they all push each others' novels. Promotion is one thing; the unfeeling use of a heinous act of violence with no regard for victims and survivors to sell a completely unrelated novel (which is crap, by the way) is completely ... I don't know. I don't even have a word for it - I need one which encompasses this jerk's callousness, self-aggrandizement, and my sentiment that he be electrocuted by his computer next time he's near it.

I shed many tears yesterday for thousands of people I will never meet and I shed more now in memory of the victims and their families. Nikki Giovanni spoke at the convocation and I close this post with her words:

We are sad today, and we will be sad for quite a while. We are not moving on. We are embracing our mourning. We are Virginia Tech ...
-- Nikki Giovanni, University Distinguished Professor, poet, activist