Forget overwrought television medical dramas. Dr. Joel Politi broadcasts an intimate view of orthopedic surgery while wielding a razor-sharp bone saw on real patients.
Under the bright white lights of operating room No. 7 in Mount Carmel East hospital, Maddie Marsh holds a femoral head in her hands. The bone is pearly except for a few strands of pink tissue still clinging to its surface, having been freshly severed from the femur of a patient on the surgical bed nearby. It resembles a doorknob or the ivory handgrip of an old-fashioned cane.
Marsh rubs her fingers across the bone's surface. The rounded sides are solid and hard, but the top is softer, gritty, like it's falling apart. These are telltale signs of arthritis, which is being addressed today by a total hip replacement, swapping the worn femoral head for a synthetic implant made of either ceramic or cobalt-chrome, among other replacement parts.
A flat-screen TV on the wall behind the surgical team shows a zoomed-in shot of the patient's hip, cut deep like a crevasse. “This should be at 11 o'clock,” Dr. Joel Politi says, directing the camera operator to rotate the view to show a specific angle. The image on the TV spins. Politi, the orthopedic surgeon leading the team, points out the hip's socket joint, now more visible and clearly missing its ball counterpart, the femoral head. Satisfied, he burrows a long-armed drill into the crevasse.
The patient, shrouded by blue surgical drapes, is currently floating on a cloud of anesthesia somewhere above la-la land, blissfully unaware that an important piece of his leg was just in the hands of a moonlighting student from Tulane University. That's Marsh, a Bexley High School alum and incoming college sophomore. She's considering a career in medicine and has arranged to shadow Politi for two days during her summer break.
Marsh has never been in an operating room before this week, but it's not her first time viewing one of Politi's surgeries. Two years ago she got an intimate glimpse through Surgical Suite, a program that has invited more than 150,000 students into these sterile confines by way of interactive videoconferencing. Politi educates them on surgical procedures, health care careers and human anatomy as he answers their questions during a live surgery, scalpel and saw in hand. The cameras aren't rolling today, June 26, but watching Politi and his team operate still has the feel of an elaborate production.***
Surgical Suite's origins trace to the Liberty Science Center in Jersey City, directly across the Hudson River from Manhattan. For more than two decades, Liberty has offered a program that allows students to view a live surgery streamed into one of its theaters. When Liberty's director of education, Mare Hull, took a job with COSI in the late 1990s, she wanted to start something similar in Columbus, says Gail Wheatley, who was COSI's director of electronic education at the time.
Liberty had a large theater and was charging between $30 and $40 per kid, says Wheatley, who became the project manager. Those costs weren't a problem in that market, adjacent to Manhattan's Broadway pricing expectations, but she knew it wouldn't fly here. “So what we did that was innovative was we figured out a way to broadcast it out to schools around the country,” Wheatley says.
COSI's Surgical Suite program was launched in 2000, using full-motion videoconferencing equipment to film surgeries while charging schools for remote access to the broadcasts and often screening them simultaneously in one of COSI's theaters. The program initially offered high school students the chance to watch open heart surgeries performed by Dr. Jack Baker at Mount Carmel West hospital.
Surgical Suite's overarching goal has always been to provide access to careers in health care, says COSI CEO Frederic Bertley, and it's particularly valuable for underserved communities that otherwise might not be exposed to those types of jobs. “If your father's a neurosurgeon or your mother's an orthopedic surgeon, yeah you were maybe that lucky kid who got to go in and shadow your parent once or twice in their career,” he says. “Most of us don't have that opportunity.”
Politi was the exception. His father was a pediatric allergist, and he remembers touring the hospital as a kid and eating free doughnuts in the doctor's lounge. He went directly from high school into a six-year medical school, graduating in 1994. Several years later, while planning his move to Columbus as he finished a fellowship in Boston, he got on COSI's website to check out activities for his young daughters. He spotted Surgical Suite and wanted to be a part of it.
“I thought, ‘Well, we could do something that would be cooler,' and I was just coming to town,” he says. Though heart surgery is compelling—you can see the heart pumping blood through the bypass machines, Politi says—it's a complex, three-hour procedure that taxes students' attention spans. As soon as he arrived, Politi began lobbying Mount Carmel to add total knee replacements to Surgical Suite. His pitch: The surgery only lasts an hour and includes anatomy, physiology, pharmacology, biomechanics and chemistry.
He eventually received a grant from Johnson & Johnson to cover the $100,000 cost of cameras, equipment and setting up a connection between COSI and Mount Carmel East to stream the surgeries. In early 2004, he and his team became the new stars of the Surgical Suite program.
Heart surgeries were phased out not long afterward. Wheatley says medical advancements with stents and angioplasties meant that only the sickest patients underwent open heart surgery, which increased the odds that something would go terribly wrong during a broadcast. Meanwhile, knee surgeries have been broadcasting for 15 years, not only to COSI's Galaxy Theater but also to schools from Alaska to Maryland to Mexico. Bertley estimates that they film 160 to 180 surgeries a year, and Politi still handles the lion's share, though his partner at Gahanna's Orthopedic One, Brian Davison, performs some as well.
The key, Politi says, is being confident enough to know the surgery will go well and being efficient enough that the audience interaction doesn't interrupt the procedure. He has performed thousands upon thousands of joint replacements, with 700 to 800 more each year, so he literally knows the procedure inside and out. The broadcasts can be a scheduling burden, but he enjoys the work. “You have to want to do it,” he says. “You have to know that you're making a difference and want to educate.”***
Viewing a typical broadcast that COSI recorded, the screen is filled almost entirely by a top-down view of the innards of a patient's knee. Politi uses his electric bone saw to shave a millimeter off the top of the femur, creating a platform for one of the implants. The saw goes through bone like a sharp knife through a wheel of hard white cheese.
“You guys got questions?” Politi asks his remote viewing audience.
Of course they do. The high schoolers chime in during the next 50 minutes. Sanita from Missouri asks about how to avoid oversizing or undersizing the implants. Jordan from Honolulu asks whether pre-op, surgery or post-op is the most difficult for patients. A student from North Dakota asks why Politi went into orthopedics rather than neurosurgery or cardiothoracic surgery.
“Orthopedics to me is a very concrete thing, meaning that there's problems that you identify and fix. It's tangible,” he answers. “People get better from [it], and you get to use power tools, so who wouldn't like that?”
Those who have worked with the program say this easygoing, interactive format is the greatest advantage of Surgical Suite. Various documentary cable TV shows focus on surgery, and anyone with an internet connection can watch a recording of basically any surgery imaginable on YouTube. But Politi's ability to provide expertise and respond to questions in real time is still rare.
“How often do you really get to look down in the human body while you're talking to somebody that cut it open?” Wheatley asks.
COSI prepares students for that experience by sending out teachers' kits, which include access to animated virtual surgery games developed by Edheads, Wheatley's online education company, which she now runs full time. The animated versions help them understand the process beforehand without any gore, so they're ready with questions. Marianne Riofrio, who teaches anatomy at West High School in Columbus, has used Surgical Suite's remote broadcasts about 10 times, and she says it's always surprising to see Politi and his team use the power tools. “Watching them saw this guy's bones, you know, the patient's bones, is usually a little startling for everybody.”
Scott Logsdon has taken his AP biology classes from Bexley High School to COSI for the past four years. The patient's knee is magnified immensely on the giant screen. “You're right in there,” he says. “The cameras are all over the operating room.” At the end of each surgery, Politi introduces everyone—nurses, surgical techs, anesthesiologists, medical device reps and physician assistants—and they all have a chance to describe their roles, their degrees and the training they received. “It's just a well-oiled machine,” Logsdon says, “and he gives kudos to every single person on that team.”
Not only is Politi knowledgeable, Logsdon says, but he's personable and doesn't talk down to the kids. He has a sense of humor and thinks quickly on the fly, turning offbeat questions into useful responses, Wheatley adds.
In the recorded broadcast, which COSI keeps on hand in case a live session has to be canceled at the last minute, a student from Virginia Beach asks which surgery would be required for a floating patella, the kneecap. All patellas float, Politi says, but rather than simply correcting the student, he uses it as an opportunity to teach more about the patella and what they would do if the implant detaches.
As he expounds, he and his team rebuild the patient's knee. He tracks the path of a new plastic kneecap. “That's a happy knee,” he says, channeling painter Bob Ross while he moves the patient's leg up and down like a life-size marionette. The camera shows close-ups of the cut end of the tibia. It looks like a sea sponge or coral, Politi says, and they use its porous consistency to their benefit, grouting into it with bone cement like brick and mortar.
A question comes in from Arizona: How long does it take surgeons until they're not bothered by their grisly work?
“We practice cutting on each other every day until you're not grossed out by it,” Politi quips. Then he answers for real: Some people can't stomach the operating room, and others are never really fazed. He's the latter. “I thought it was cool the day I walked in.”***
Just after 6 a.m. on June 26, Politi stands in Mount Carmel East's new lobby, part of the hospital's ongoing $310 million modernization. In person, he's got an air of clinical detachment common in his profession, but it's mixed with a laidback demeanor and a sarcastic sense of humor that probably helps him connect with teenagers. He's as likely to make a quick joke as he is to rattle off the jargon-filled steps of a hip replacement (he also can do that in a dizzying amount of detail). Even at this early hour, he's energetic and ready for a full day of surgeries, starting with a patient's total knee replacement.
On the twisting walk from the security desk to the operating rooms, clinical manager Thomas Grodhaus offers a piece of half-serious advice: If you feel faint and start to fall, just don't hit anything blue. That's all sterile. The circulating nurse, Linda Johnson, takes it a step further. If you feel queasy or lightheaded, sit down or get out. Toughing it out doesn't work. Orthopedic surgery isn't for the faint of heart, or head or stomach.
The interior of operating room No. 6 is radiant white with a protective field of sterile blue—surgical gowns, towels, drapes—around the patient, who's prepped for surgery. Politi makes several incisions with the scalpel, peeling back the skin and layers of tissue. The high-pitched whine of the bone saw and the drill follow in short order. A few minutes later, physician assistant Jenna Klopfenstein, wearing hazmat-style headgear reminiscent of the movie “Arrival,” wields the mallet. Orthopedics is far from delicate, more often resembling a mechanical fix to an inanimate object, and it is jarring to see human limbs banged back into shape like a bent car axle.
Yet the scene isn't necessarily the gruesome deconstruction conjured by all the caveats of queasiness. The procedure is largely bloodless, thanks to a tourniquet around the patient's thigh, but the surgical team also operates with a certain levity about their work. Politi mentions that they often listen to music, and a nurse named Rosie White turns up the satellite radio. Surgery now has a soundtrack. Politi works the saw while Klopfenstein uses a suction device to whisk away small amounts of blood, fluid and detritus. It's saw and suction, saw and suction, intermingling with Dobie Gray's voice: “Give me the beat boys, and free my soul, I want to get lost in your rock and roll, and drift away.”
The operating rooms are new, and the Surgical Suite team will be able to broadcast in high-def once the school year begins. There's no filming today, but Politi is still educating. As he removes pieces of bone and miscellaneous tissue, he passes them to surgical tech Diane Tarr. She hands the body parts over to Maddie Marsh for closer inspection. Here's a piece of tibia, and here's the meniscus. Politi's running commentary describes each piece of human anatomy he passes along.
He hands Marsh a small glob of acrylic-based bone cement, which makes the operating room smell like a nail salon. He explains that the cement undergoes an exothermic chemical reaction as it's mixed, making it warmer to the touch. Over his shoulder, Klopfenstein pours a saline solution onto the cement on the patient's rebuilt knee, accelerating the reaction.
As the surgery winds down, Klopfenstein stitches the patient's leg while others begin sanitizing and putting away the equipment. Politi leaves to prepare for the next surgery. “He's pretty badass,” Marsh says, awed by the speed with which he works. The surgical team's movements appear to be choreographed down to the last detail. Logsdon says he rarely hears Politi ask for a specific instrument. “It's almost like an octopus, like here comes another arm, and here's the instrument he needs at exactly the time he needs it.”
By the time Klopfenstein places the last piece of dressing on the patient's leg, the room is almost entirely stowed away and empty of personnel. The surgery took 52 minutes start to finish.***
Two minutes later, in operating room No. 7, Politi makes the initial incision on the second patient. “All right, so hip replacement—little different,” he says. He dislocates the hip, popping the femoral head out of the socket with a quick, decisive yank. This procedure is gorier, indicated by an ever-growing accumulation of bloody towels and chunks of tissue on the surgical tables. But upbeat music is still playing—New Radicals' “You Get What You Give”—and the lesson continues.
Hip replacements aren't part of Surgical Suite, but regardless of the procedure, Politi is used to an audience. They have a steady stream of observers in the operating room, including doctors in residency, medical students and physician assistants in training. Each May, the surgical team hosts six to eight students from Columbus School for Girls who spend between one and four weeks shadowing them. People often ask how Politi can perform an operation while responding to (and entertaining) students, but teaching during surgery is second nature for him.
Marsh took the inside track to get here. Politi's second-oldest daughter, Leah, was in her class at Bexley High School and also attends Tulane. In 15 years, the only compensation Politi has requested for the Surgical Suite program is that his four daughters' high school biology classes get to attend screenings at COSI free of charge. Marsh's class was one of those, so when she wanted an even closer view, she knew where to turn.
Several former students have followed the same route, shadowing Politi after a Surgical Suite session. Some have gone on to medical careers, though one of the frustrations for Politi and Co. is they never meet most of the students who watch, so they're left wondering. “There's countless stories of people who have watched this that we know we've influenced, but we don't get the tangible evidence,” he says.
Marsh has been leaning toward a career in medicine since before she ever watched Surgical Suite, possibly as a doctor or a physician assistant, though she's unsure what her specialty would be. A surgical career was never her plan, but she decided to shadow Politi anyway. The broadcast had been a little gross, she says, and she was nervous that she would pass out or vomit seeing it in person. Instead, she says she really enjoyed being up close to the excitement.
The second surgery of the morning goes even more quickly than the first. Politi hammers the prosthetic implant into place, and a few minutes later he gives Klopfenstein a fist bump, the ceremonial end of the proceedings. His part of the operation took just 33 minutes. He walks out toward the nurse's desk. Some members of the surgical staff stay behind to finish closing up the patient and clearing the room.
Marsh lingers in surgery to see Klopfenstein complete the closure. The longer she watches each operation, the more she finds herself creeping toward the surgical bed for a closer view, a better angle, another student inching toward that sterile field of blue.