The Carpenter Surgeon, Literally

Dr. Paul Anderson, professor of Orthopaedics at the University of Wisconsin, his wife Veronica and their black lab, Murphy, live in a spacious home in Verona, a community of winding roads and rural vistas outside Madison. Though their home has two attached garages, both of their cars are squeezed into one garage. The second garage is taken over by Anderson’s wood work shop and his orthopedic residents from the University of Wisconsin Medical School. In a program unique to Anderson, his students can be found, any day, in his garage crafting boxes to hold their loupes, the magnifiers they wear fitted onto their glasses when they do surgery.

These are not ordinary boxes. The residents craft the boxes, made of rare woods, with intricate and decorative joining of a contrasting color wood. Not a nail or a screw will be found in any of them. The box Anderson held in his hand was of white oak with walnut dove tails in the mitered joints.

What is going on here? Aren’t orthopedic surgery residents too busy learning their craft to spend time building boxes in a garage? Anderson’s response is that, by working with wood under his exacting tutelage, they are learning their craft. He referred to a study that found that one of the three predictors of surgical residents becoming highly skilled orthopaedic surgeons was if they had once done wood working.

He shook his head.

We have people come in who have never used a tool in their life. And we expect them to be able to put a complex fracture back together when they have never screwed two boards together. I bring residents here and teach them woodworking as it is good for their skill as surgeons. If they need to learn how to drill holes that are perpendicular to bone, they can practice on wood. They can learn how to join things. The principals for joining bones are the same as in wood working.

Don’t call him a carpenter. “Cabinet-making requires surgical precision—you need to be within a hundredth of an inch, ” he said. Anderson’s first career choice was architecture. He took shop in junior high school and was good at mechanical drawing. Medicine also appealed to him but being aware that “at the time only 15% of people who applied were getting into medical school, ” he settled on a fall-back position as an engineer. He had earned an M.A. degree in chemical engineering from the University of Michigan when medical school finally beckoned.

He graduated from Wayne State Medical School and during his third year rotation settled on orthopedic surgery. “It seemed like the ortho patients were doing better than other surgery patients, ” he said.

“They survived their surgeries and they got better pretty quickly. Maybe it was that early self-gratification [that appealed to me] but that is why I chose orthopaedics. “

In 1992, while living in Seattle and working at the University of Washington Harborview trauma center, he signed up for classes in cabinet-making offered by the local community college. The class site was a high school industrial-level wood shop.

“The shop teacher taught us how to use the equipment. We had belt sanders, joiners, large table saws, drill presses, mortising machines—everything. I spent three hours a week using this very elegant equipment learning how to do things safely. Out of the 15 people in the class, four were surgeons. I did that for ten years.”

Anderson maintains that there is “a big synergy between carpentry and the human body. A lot of the approaches and processes are the same.” He led the writer over to a shelving unit against a wall that was holding art objects. “This is something I just finished over Christmas and installed and finished last week. The wood is called primavera. It is from Latin America and is pale looking with a golden pattern.”

He pointed to an upper corner of the construction. “This piece is cantilevered, although it is up against the wall so there is no bending on it. The question is how do you make this so it will stick together and not fail? This is much like a femur and if you have a femoral neck subtrochanteric fracture, how do you fix that? The modes of failure will be the same.”

Anderson pointed out that there are at least seven joints common to woodworking that are also described in textbooks of orthopedic surgery. “The first thing to learn about wood working is the art of joining boards together, ” he said. “The actual joining is much like orthopaedics. In orthopaedics we have a fracture. How are we going to fix that fracture? There are biomechanical principals you must use when you are fixing bones. The same principals apply in fixing joints together in wood. One of the problems is that wood is not dead. It changes size according to the humidity."

If you have tethered wood the wrong way, the joint will fail. Accounting for wood movement is much like what we do for dynamic compression in the body where we allow things to compress on their own. We just control it.” In his wood-working, Anderson never uses metal fasteners.

Anderson grabbed a piece of paper and began sketching joints.

Here is a set-cut osteotomy. We use this alot in the shortening of the radius or for bunion surgery. We would cut it like this, ” he said, rapidly sketching, “and put the screws in here. For bones we always use screws. In bone it is called a set-cut. In wood we call it a half lap, a very common joint. It is exactly the same.

Anderson sketched mortise and tenon joints. “One way of fixing a femur fracture when a hip is broken is to take the spike of the femur and put it in the center of the femoral canal and then we would put our hip screw in. Very similar to wood.”

“Another way of lengthening bone is by using a scarf joint where you cut a long oblique cut on two surfaces and you slide them to get a small amount of additional length. Then you put screws in to fix them. This same joint is used in woodworking where it is also called a scarf joint. In working with wood you can sand off the edges. That is the beauty of wood work. Sandpaper does a lot.” He added, “I have also seen orthopaedic surgeons, when the joint does not look quite right, take a burr and machine the bone.”

One of the most esthetically pleasing and strongest of the joints is the dovetail—a familiar joint found on all well-made drawers. This is the joint Anderson teaches his students to use on their loupe boxes—knowing that they may someday come across it on a spinal interbody fusion.

Anderson estimates that he spends from six to eight hours a week in his woodshop. Is it a stress reducer? Maybe, he admits. He says that he has many tools in his workshop that are better than the ones he has in the operating room. He finds the technology of the wood working saw blades to be far more refined than that in the saw blades that he uses in the operating room.

“The problem with saw blades is they generate heat from friction and heat kills bone cells. It narcotizes the bone edge. So we have to dissipate heat. We also like a straight, smooth cut. The problem we have in the operating room with a lot of saw blades is that they do not clear the bone of bone dust or bone chips. What are needed are gullets, which are valleys between the teeth for the bone dust to hide out in. The teeth should not be lined up straight. Instead they are offset left and right. This creates a little bit wider kerf but that allows for clearance of those things and significantly less heat generation.”

Anderson finds the chisels he uses in wood working to be similar to the ones, called osteotomes, which he uses in the operating room. But the protocols are different between wood workers and surgeons, he says. Wood workers, themselves, keep their chisels sharp and finely tuned. Surgeons do not maintain the equipment in the operating room. As a result Anderson finds that “in the operating room the chisels get dull all of the time. My chisels here [in the workshop] are generally in better shape than the ones I use in the body.”

Anderson is an artist of a cabinet-maker who takes on big projects. Anderson and his wife are fond of classic Stickley, mission-style furniture and the staircase, which Anderson helped design, in their house reflects this preference. He built a side-board and mirror for his dining room that carries out the design of the dining room table. The king-size bed for their bedroom as well as cabinetry, over eight feet long and six feet high, which fills the entire opposite wall, is also his work. The grandfather clock that he built is a masterpiece. His wife’s favorite wood is cherry while Anderson prefers sawn white oak, mahogany and black walnut. He made his office furniture out of mahogany.

Besides teaching, administration and performing spine surgery, Anderson is involved in basic research on artificial discs and regenerative medicine. He believes that, within a generation, physicians will be using stem cells for muscular skeletal repair. He is working closely with colleague Dr. Wan Ju Li, Ph.D., who calls himself the “stem cell doctor.”

Anderson has published more than 150 articles on orthopedics and takes many more orthopedic journals than he does wood working magazines. However, when the periodicals arrive at his home or office, it is the woodworking journals that he reads first. Someday, he says, he hopes to publish an article in one of them.