The piece below is outstanding. It is long but it is worth reading to see what is inside a human being. When I considered posting this piece I was yet to receive word that Dr. Horton would be retiring. I was shocked and distressed! Why would a man retire so suddenly and at 58 years old. This week I received a letter from him (& to all his patients) saying he was having to retire due to arthritis in his hands! I immediately thought of the people who would not have the privilege I had of being given "life" back. I thought of him and what it would be like to no longer do what you loved doing and were so gifted in doing. Many thoughts have come to my mind and many prayers for this man.
Take the time to read this -- it is well worth your time.
Cheryl -- 11 months post op and standing tall and feeling stronger every day.
SOLI DEO GLORIA
Dr. William Horton
Before he performed surgery, Dr. William Horton, Professor of Orthopaedic Surgery at the Emory Spine Center, transported people to surgery.
Growing up in Atlanta, Georgia, a young Bill Horton was looking for a unique summer experience. “I knew several physicians growing up, and in my senior year of high school I took a summer job as an orderly at a local hospital. After cleaning the ORs I would observe the surgeons as they worked. I was fascinated by the anatomy and what could be done for people. My time as an orderly also gave me a window into the anxiety that patients experience. When I transported them to surgery from their rooms I paid attention to the nurses and doctors who took time to comfort them and help diffuse some of their fear.”
Ethics, Morality, and Medicine
Philosophy and/or ethics are often not uppermost in someone’s mind when filling out a college application. But they were for Bill Horton. “I left high school excited about medicine, but I didn’t want to do the traditional major in chemistry or biology. The University of Virginia had a unique program that allowed undergrads to design their own major program, and at the end, tie everything together with a thesis. I was fascinated by the ethical dynamics of caring for people, so I designed a course of study that combined biology, psychology, philosophy, and religion, and wrote my thesis on euthanasia and infanticide.”
The term “bedside manner” has been tossed about for years. But Dr. Horton, with his tendency to reflect and dig deeper, would take a path few have experienced. “It was the mid-1970s, the period when Raymond Moody was featured in Time magazine for his work on near death experiences. His findings opened new territory, and made me think deeply about what is involved in the morality of caring for one another. In particular, I came to see that medicine is highly ethically charged. Doctors are often making decisions for those who can’t decide for themselves…the newborn, the unborn, the infirmed.”
Surgeons typically like black and white…concreteness. Dr. Horton, however, was willing to stay in the gray. “It was also during this thesis time that I began to think about the paradoxes inherent in medicine. No one has a crystal ball; we’re often dealing with mystery and the unknown despite all the data and objectivity because science is not fully developed in certain areas.”
e have to help patients deal with the paradoxes inherent in their experience and the emotions it brings,” states Dr. Horton. “They are frightened and frustrated that their bodies are failing and often ask, ‘What does it mean that the doctor can’t fix me?’ Partnering with them to work through these issues is an important way of honoring the mystery of how our physical body and spirit interlace and influence one another. As a doctor it is essential to understand that we’re working on the body, and, by default, on the soul and mind. In the end they are one in the same.
Opening Doors to a Fulfilling Career
Some people have their career plans firmly in hand. Others “wait and see.” Dr. Horton: “Instead of being calculating about my career, I saw that doors just began to open and I stepped through one, and then another, and another. Instead of a fixed career highway it was more like stepping stones.”
The doors then opened to the Medical College of Georgia. “During medical school I was very influenced by Dr. Gene Colborn, an anatomy professor whose teaching deepened my thinking of anatomy and its dazzling complexity to the point that knowing the human body was like marveling at the Sistine Chapel—except this was far beyond the normal human creative powers. When I later worked with a rheumatologist named Dr. Joe Bailey, I told him of my interest in orthopedics. He quickly referred me to Dr. Jim Harkess at the University of Louisville, a true renaissance man who had an incredible grasp of the art of orthopedics.”
Embarking on an orthopedic residency at the University of Louisville, Dr. Horton learned the importance of integrating X, Y, Z coordinates…i.e., 3D. “I was drawn to the spine because of the brain-body connection. But I also learned a great deal from the hand surgeons at Louisville, including Dr. Graham Lister, one of the best teachers I have ever encountered. Trained in plastic surgery, Dr. Lister had an amazing way of examining the external hand and then showing you how to visualize everything that is under the skin, and then to transfer that insight along with the diagnostic images to mental 3D and imagine exactly what you’re going to find once you’re in the OR. It was incredible to create this bridge between the exam room, the office, and the OR.”
Now an active advocate for such knowledge, Dr. Horton notes, “While some have a natural gift for such ‘vision,’ others must work to develop it. If you can’t transition between 2D and 3D it is difficult to achieve maximum safety and effectiveness in the OR. There are times during surgery when you simply can’t yet see what you ultimately need to—you must visualize and imagine beyond where you are. Fortunately, these concepts are increasingly emphasized in surgical training.”
Specializing in Spine
Even as a resident, Dr. Horton carried a sense of humility that would open his eyes and open new doors. “I became fascinated by the spine because I saw it as one of the great diagnostic and treatment challenges that remained to be solved. It became clear that diagnosis was still in the infant stages and that there was so much that needed to be developed. I was also aware that the talents of other healthcare professionals were not always well integrated. If a patient says, ‘I saw a chiropractor and he relieved my pain,’ then we should respect that and realize that all sorts of healing has its place.”
By the third year of residency, Dr. Horton had found a subspecialty that brought great emotional rewards. “I was so fortunate to work with Dr. Ken Leatherman, the head of spine at Louisville who did complex spinal deformity surgery. It was thrilling not only to do these elegant operations, but also to see the look on the patients’ faces that said, ‘I’ve got my life back!’”
he deformity touches so many areas of their lives…they have physical pain, functional issues, and often a low self image. I saw how spinal deformity work could deeply enhance life and the sense of self, helping people feel that they were as good as the next person. Treatment uncorks a sense of confidence that’s incredibly powerful in both adults and children.
Beginning his fellowship in 1986, Dr. Horton learned avant garde spinal techniques from the master. “I spent my fellowship year at the Kenton D. Leatherman Spine Center at the University of Louisville, a facility that was really cutting edge. Dr. Leatherman was the first in the U.S. to use the revolutionary Cotrel instrumentation system from France. He also did the first anterior vertebrectomy for congenital deformity in the U.S., which was dangerous pioneering work. Because there was a good working relationship between orthopedics and neurosurgery I also had a chance to learn neurosurgical techniques in spine. There was so much complex surgery going on that I became extremely comfortable with virtually any problem or unusual anatomy that presented itself.”
During this time the already empathic Dr. Horton got to see a bedside master. “Dr. Leatherman was the kind of person who would say to me, ‘Come sit beside me in Mrs. Gordon’s room and watch how we talk about her problem.’ He was able to walk with patients through their illness—and he was present to patients in a way that let them know that he was truly with them on their journey. He taught us to carefully weigh all risks and benefits and make patient decisions very personal ones. ”
Worldly Knowledge
To gain an even deeper understanding of the technical aspects of a patient’s surgical journey, Dr. Horton would take his own journey. “After finishing in Louisville I embarked on a European traveling fellowship, having my eyes opened to the many different ways of approaching the same surgery. In England I learned from Drs. Robert Dixon and Greg Houghton the British trait of being incredibly thoughtful about differential diagnoses. In France I found that they approach surgery like an art form—finely nuanced. Drs. Yves Cotrel and Daniel Chopin would make subtle but important adjustments during the surgery because they used a geometric 3D process. It was a more creative surgical approach than I had ever seen.”
And what was the surgical zeitgeist in Germany? “Germany was the anti-France, with a style that is very precise, completely black and white. I learned from Professor Klaus Zielke, a master of preoperative planning. You did steps 1 through 6 and you didn’t deviate. What is helpful about the German approach is that it is predictable. The downside of their process was that once the preop plan was done you weren’t allowed to question it…the professor is top dog and that’s that.”
Research and Academia
Returning to the U.S., Dr. Horton surveyed his career options. “I was initially turned off by academics because I had witnessed how politics and egos sometimes resulted in unhealthy and unfair treatment for many faculty members. I had been approached by Dr. Pierce Allgood, who I respected enormously. He drew me into joining his large private practice in Atlanta. It was a busy, challenging spine practice…without the bloodshed of academics. That experience was fantastic.”
The intellectual stimulation of a scholastic environment, however, remained alluring. Dr. Horton: “In 1989 I got a call from Dr. Tom Whitesides at Emory who told me that he and Dr. Lamar Fleming wanted to build an international spine center. I had long admired Tom’s creative thinking and technical innovations, as well as his rich character. The more he talked the more I became interested. It was an opportunity to enhance a fulfilling clinical practice with teaching and research. So I accepted their offer, to a great extent because they were focused on building something special while getting past the strife of academia.”
Free to treat patients and conduct research in a collegial environment, Dr. Horton set off to explore biomechanics. “I could see that current methods of treating kyphosis, a condition which has the highest risk of paralysis, had shortcomings. I developed a technique for reducing severe kyphosis that was a different clinical approach; instead of working from the ends of the deformity I reversed the paradigm and started from the apex using gradual reductions…one vertebra at a time.”
hat study involved complex kyphosis cases with some of the best correction rates ever reported,” says Dr. Horton. “But more importantly, there were virtually no complications related to the correction, which was usually fraught with neurologic complications and problems at the ends of the system. This new technique nearly eliminated that kind of problem, and has had a significant effect on how surgeons reduce all types of kyphoses.
“I then became curious about the biomechanics of the sternum,” continues Dr. Horton. “We all get blinders on from time to time…and spine surgeons are guilty of looking at the spine but forgetting about the torso. Our work was honored with the Russell Hibbs Award for Basic Science, given by the Scoliosis Research Society. The research elucidated the value of doing osteotomies to correct the spine, and highlighted the importance of the sternum in spine biomechanics. A sternal osteotomy is rarely indicated, but this work shed light down a dark hole in spinal biomechanics, and is relevant in trauma and tumor reconstruction as well as deformity.”
Yet another area that drew his interest and knowledge is international orthopedic education. Dr. Horton: “A year and a half ago we started the Emory Spine Center for Outreach and Medical Education. Having worked with Orthopedics Overseas in underdeveloped areas I was sensitive to the power of international relationships and how important it is to learn from one another. The program is focused on delivering mentored education for doctors in developing countries, with China hosting the pilot program. Doctors in the developing world are often extremely bright and desperately looking for seasoned teaching and advice, and they can’t often find it. We want to change that.”
Life at Home
He really shouldn’t have any time left to himself. But alas, he constantly tries to live a balanced and active personal life. “For 31 years I have been married to my wife Leah, who is an incredible woman and a pastor with Trinity Presbyterian Church in Atlanta, a place we love very much. We have three daughters. One is a senior in college who has a penchant for English and French, another is going to medical school, and the third is studying for a Masters in Public Health. They are three wonderfully adventurous women who have all lived near a pig sty in the West Indies, gone sailing in the Pacific, and enjoyed the messiness of trout fishing in North Georgia.”
“I enjoy the outdoors,” adds Dr. Horton, “and I am fortunate to have a group of buddies who bike together and coax each other into doing things we probably shouldn’t—like Olympic triathalons. Music is a passion of mine (a lot more passion than talent) and I goofed around in a bluegrass band in medical school. I enjoy reading nonfiction and writings about spirituality. I enjoy grilling food, and am a major enthusiast of The Green Egg for steaks or anything.”
Dr. Bill Horton…orthopedist, philosopher, renaissance man.
