Army’s retired top orthopaedics consultant is passionate about patient care at UF
It is a typical day at work when Hudson Berrey, MD, walks into the operating room to remove a patient’s leg.
The young man’s family has already been warned the cut will most likely be above his knee. But Berrey knows a below-the-knee amputation will give the patient a much better life, so he’s going to see what he can do. Inside the leg, there are layers of gray, dead muscle. Still, Berrey sees hope.
There is just enough healthy tissue left for him to work with. Carefully, he salvages it and removes what’s beyond repair. Then he pulls muscle and skin into place, shaping a limb that will be optimal for a prosthesis once the patient heals.
“He would have lost the leg above the knee 99 times out of 100,” Berrey will later say, “but I’ve done this a few times before.”
That’s as close as Berrey will come to bragging, but in the world of orthopaedics, he is a rock star.
The University of Florida College of Medicine – Jacksonville professor has handled as many as 100 amputations per year in more than 35 years as an orthopaedic surgeon. He’s treated bone cancer patients ranging in age from 9 months to 104 years. He was even one of the first physicians to use a novel expandable implant from France that was designed to keep up with a child’s growth.
One recipient, a young girl, avoided a whole-leg amputation when Berrey replaced her cancerous thigh bone with a custom-designed metal rod. Every few months, he used heat to activate a spring in the rod, expanding the implant little-by-little so the leg would grow at the same rate as her healthy leg. The girl was able to carry on and participate in sports — including her love, dancing — thanks to the rod. Now a college student, she is full grown and planning to become a pediatric oncologist.
No greater honor
Long before he came to UF, Berrey was a colonel in the U.S. Army. He spent his final years of active duty as the orthopaedic consultant to the Army surgeon general. He also served overseas during wartime and served as chief of orthopaedics at Walter Reed National Military Medical Center, which is the Army’s premier teaching hospital. He headed Walter Reed’s Amputee Clinic for eight years.
Treating wounded American military personnel is still his greatest passion.
“There is no greater honor for a surgeon than to care for the warriors of his country,” he said.
The military was a natural fit for Berrey, the son of an Army doctor. But the aspiring civil engineer didn’t decide to pursue a career in orthopaedics until he joined the swim team at the U.S. Military Academy at West Point. The team physician quickly became his mentor, and Berrey — who was on his way to becoming an artillery officer at the time — changed paths.
His career choice led to a lot of moving: he studied medicine at the University of Texas Medical Branch in Galveston, Texas; completed his residency at the Tripler Army Medical Center in Honolulu; filled his first post in Panama; and completed a fellowship at Massachusetts General Hospital in Boston.
But the moving didn’t bother his wife Rolly, the daughter of an infantry colonel. In fact, the couple met in Panama when both of their fathers were stationed there. Berrey never looked back after Rolly, who he had just met, called him from the phone on a C5-A Galaxy flight deck on the way home for the summer.
Teaching the right way to amputate
Even during America’s peacetime, Berrey was drawn to help the war wounded. When he was stationed in Panama, he traveled to Hondoras to assist in an early Army effort. Later, while he was at Walter Reed, he was an advisor to the El Salvadoran Army during their civil war. Hospitals there were bombarded with people losing limbs to landmine explosions, and everyone was getting excessive amputations. Berrey taught surgeons how to save more length and amputate lower on the leg.
Amputation is actually a “very precise and delicate” surgery, Berrey explained.
“The way a patient is able to move about and ambulate is very dependent on the care of the surgeon. You can do them quickly, but that doesn’t mean you have to do them quickly. Quick is not usually better.”
In fact, many of Berrey’s patients come to him for a second surgery after having an amputation elsewhere that didn’t turn out well. Berrey said amputees are often told they will just have to live with pain, but that isn’t true. A carefully crafted amputation should not be painful and should fit comfortably into a prosthetic.
Although patients often look at it as a last resort, Berrey said amputation can greatly improve quality of life.
“Amputation is not a surgery of failure. It’s a surgery of rehabilitation,” he said. “People end up prisoners to their legs. They become attached to them and don’t realize their lives could be so much better.”
He said having a full amputee team, which includes a dedicated prosthetist, is the real key to a good outcome.
More than just physical support
While he was in El Salvador, Berrey also helped raise patients’ morale by organizing an amputee soccer league. The rules? Players on the field had to have lower extremity amputations, and the goalies had to have upper extremity amputations. The league renewed many of the patients’ spirits as they adjusted to their changed bodies. That part of care would always be important to Berrey: he believes in giving patients moral and spiritual support just as much as he gives them physical support. When asked, he’s even been known to bow his head and pray with them.
After Panama, Berrey went to Boston for a fellowship in a specialty few orthopaedic surgeons choose: musculoskeletal oncology, dealing with tumors in the bones, muscles and soft tissues of a person’s extremities.
“It’s not something many orthopaedists desire to do, because I deal with a lot of people who are really sick, both physically and emotionally,” Berrey explained. But his passion for building strong doctor-patient bonds made him a natural fit for the specialty.
In most areas of orthopaedics, patients receive treatment and then move on, Berrey explained.
“There’s not often a long term (relationship). You don’t get to know people that well. But when you’re helping them fight cancer, you get to know them intimately.”
That year in Boston was extremely challenging, but Berrey would use what he learned for the rest of his career as he treated patients, including one man he’ll never forget: a fixed-wing Army pilot who didn’t want the bone cancer in his leg to stop him from returning to duty and flying. Berrey operated on the man and removed the cancer, filling the hole that remained with bone cement. He then reinforced the leg with a metal plate that would prevent it from breaking. The pilot was able to return to duty and even paid a “reverse house call” to Berrey in Iraq. He flew to Berrey’s base to have the doctor check the leg while both of them served overseas.
After he finished his fellowship in Boston, Berrey went to Walter Reed. For a while, he was the only orthopaedic tumor surgeon operating in the entire Department of Defense, and that kept him very busy. But he still found time to make changes for the better for his students. He started a residency program with a feature the Army had never offered before: a full year for research. In fact, only a few of the best orthopaedic programs in the entire U.S. offered equal research opportunities.
“It’s 25 years later, and that program continues to bear fruit. One of my residents went to San Antonio and started the same thing there,” Berrey said.
Mass casualties in Saudi Arabia
Almost half of the Walter Reed orthopaedics staff and many of the surgical staff — including Berrey — deployed to Saudi Arabia during the Gulf War starting in 1990. Berrey was the deputy commander for clinical services in the 400-bed 85th Evacuation Hospital, where half the beds were outside in un-air-conditioned tents. At times it was a scary place, with jets blasting overhead and Scud missiles exploding nearby. Berrey remembers shaving at an outdoor wash rack one day when a Scud missile was intercepted and exploded directly above him.
Then one night in late February 1991, an Iraqi Scud missile dropped right through the ceiling of a warehouse that was home to an Army reserve unit from Pennsylvania. Among the many injured, 80 were rushed to the 85th with injuries ranging from life-threatening wounds to a few small cuts. The emergency response plan Berrey and his team had written for the hospital was about to be put to the test.
“We had six operating rooms going all night,” Berrey recalls.
While the ORs took patient after patient into surgery, anesthesiologists rushed to resuscitate others, clear airways and check vital signs. Two men were too close to death to even operate on. A nurse and a chaplain stayed with them as they breathed their last breaths. Another man died in surgery, and one more died after surgery. Everyone else — more than 70 patients — survived.
“I remember I was walking out of the OR, dead tired, just after the sun came up. But I looked around, and I thought our emergency response plan had worked well. We had everybody working, and everyone felt good about what they did,” Berrey said.
When it was finally time to return to the U.S., Berry said reuniting with his family was the “coolest moment” of his life. His then 8-year-old daughter spotted him across the airport and ran to jump into his arms. Right behind her came Rolly and his younger daughter, then just a baby. Both daughters, now adults, became civil engineers.
Berrey retired from the Army in 1993 and took a job at the University of Texas Southwestern Medical Center in Dallas. Then he received a call from Gainesville, and was soon working as the chair of orthopaedic surgery at what is now UF Health Shands Hospital. Six years later, in 2002, he came to the UF College of Medicine – Jacksonville.
During more than a decade in Jacksonville, Berrey and the rest of the orthopaedics team have continued to improve the program. Berrey led the charge to expand the program to an additional location, UF Health Emerson Medical Plaza, and also bolstered the residency program, expanding the program from two to four residents per year. He supported the start of the podiatry residency program and brought on more faculty. He also hired three full-time trauma surgeons and obtained dedicated orthopaedic trauma rooms.
Serving others
During his career, Berrey has always had a heart for helping others. He served aboard the USS Mercy on its maiden voyage, treating patients in the Philippines on goodwill missions. He traveled to Vietnam to teach surgery to doctors in the post-war country. And he’s organized full teams of physicians to travel to Haiti and offer surgeries free-of-charge, including several trips after the earthquake tragedy. In fact, residents in the orthopaedics program can join faculty for week-long trips to Haiti, Peru or Grenada to care for patients and participate in research related to their care.
Berrey also took part in a national orthopaedics disaster response course that was developed by the military orthopaedic community and is now co-sponsored by several national orthopaedics associations. He said physicians who “just show up” to a disaster area often end up under-utilized. The course helps prepare surgeons in advance for the mindset they need working in a disaster setting, the skill set required, the types of supplies they need to bring and the types of injuries they may deal with. Course participants also learn how to get in contact with the appropriate organizations and they are added to a database so they will be easier to contact and recruit when the disaster strikes.
The Army calls again
When the U.S. returned to war in Iraq and Afghanistan, Berrey heard the military was short on orthopaedic surgeons. He offered to help, and it was no surprise that he returned to active duty one last time. He deployed to Iraq in 2008. But what was supposed to last four months turned into a 14-month tour when Berrey developed a shoulder and cardiac problem related to his pre-deployment inoculations. This time, the physician would experience military care from a patient’s perspective.
Berrey was flown to San Antonio, Texas, for a shoulder operation. He was amazed with the Critical Care Aeromedical Team (CCAT), or “flying ICU,” that could refuel in the air. Ironically, when he arrived in Texas, he found that the orthopaedic surgeons managing the orthopaedic department were his former students.
During his recovery, Berrey couldn’t resist getting involved with the team that was caring for him. He assisted them as they treated wounded soldiers. One soldier, a young woman who lost both legs, told the team she dreamed of being able to wear high heels again. The team crafted artificial legs with high heels for her. Berrey said she stumbled around like a “newborn foal” as she learned to walk in them, but she had a priceless smile on her face.
Outside of work, Berrey is deeply involved with his church, St. John’s Episcopal. He serves on the vestry and sings bass in its high-profile cathedral choir. The choir performed in Ely Cathedral in Cambridgeshire, England, three years ago, and this year they will return to perform in Westminster Abbey and Canterbury Cathedral. Berrey also loves to sail, swim and scuba dive.
Now in his early 60s, Berrey still gets a twinkle in his eye when he talks about his profession and the many patients he has taken care of.
“I’d do it all over again in a heartbeat,” he said. “I take care of wonderful people, and that’s the joy of it.”