Dr. Cynthia Verchere is a pediatric plastic surgeon and clinical researcher at BC Children's Hospital.
I recently came across an old box containing my applications to medical school and was reminded of how I became interested in plastic surgery. I had been a fairly high level athlete so all my applications specifically say I wanted to go into sports medicine and orthopedic surgery. But during medical school it became clear that there was something really special about pediatric plastic surgery and once I was exposed to it, I never really looked at anything else.
During my medical school rotations in plastic surgery, I would often glance up at the clock thinking it was 10:00 in the morning and it was actually 3:00 in the afternoon! I found the surgeries and patient care to be challenging and interesting and creative. Now, more than 30 years later, I've recently retired as director of the Burn Program we started in 1996, and I've been head of the Division of Plastic Surgery at BC Children's Hospital since 2007.
I'm honoured to be asked to share a bit of my journey with you, along with some thoughts for women considering careers in medicine.
I didn't and couldn't prioritize research when I first started as a plastic surgeon; I focused on building my clinical practice and my family. It wasn't until almost 10 years into my practice that I could really put time and energy into research, and it was directed mostly toward care of the burns, brachial plexus injuries, and cleft lip and palates that were in my practice.
As a clinician working with pediatric patients, my research is usually piqued by curiosity about things I work with day to day. For example, I might do a certain intervention or surgical technique and start to observe unexpected or unexplained patterns in the outcomes. I'll then wonder why this pattern is occurring and whether or not it is a real thing or just happening by chance. Other times a student or resident will ask why something happens or is done a certain way and my response may be, "well, we actually don't know that yet." A real curiosity and intention to seek the best evidence is what informs the research I choose to do. As a clinician researcher, a lot of the work is done off the side of my desk with the support of trainees and our BCCH division research coordinators, but I can’t always look at everything I’d want to.
One of the early papers we published was about a new long-acting silver burn dressing called Acticoat. It was invented in Canada and we were one of the earliest places to routinely use it in North America. Although we were a small burn centre, we were able to collect and observe outcomes showing that this type of burn dressing was much better in many ways than the standard at the time. Because this dressing only had to be changed twice a week instead of every day, we could develop an outpatient program where we were able to reduce the average time patients stay in hospital from 13.85 days to 0.85 days.
And sometimes I hear people refer to that paper and I recognize that our centre's experiences might have provided evidence for other centres to make changes in how they manage burns to improve healing for their own patients. Dressings like Acticoat have since become the mainstay of care of burns worldwide.
More recent interesting work we've enjoyed has been in the area of brachial plexus birth injury. (continued below)
The nerves from the neck to the arm make up the brachial plexus, and injuries to those nerves occur in about one in 1,000 births. These occur mostly during difficult vaginal deliveries when the shoulder pulls away from the head and stretches the nerves that go to the arm. Many of these nerve injuries naturally recover reasonably well on their own, but the more severe cases can lead to varying degrees of permanent paralysis and imbalance of the shoulder girdle.
We decided to focus on the biomechanics and positioning of the shoulder in growing babies as they go through muscle imbalances common during recovery. We developed a program using the Sup-ER splint, a device that puts the shoulder in a much better position for healing and we found that we needed to operate less on the actual brachial plexus. Patients were recovering movements that most hadn’t before. This focus on the shoulder is not traditionally what plastic surgeons look at, but our team observed significant improvements with our program and we decided to look objectively at our results and publish them. This field is still a subject of active long-term research in our clinic.
Most of the time with research, you hope one or two people somewhere will read or cite your paper, but in this work I have had the experience of being at an international meeting and hearing someone talk excitedly about what they called the "Vancouver splint," not even knowing I was there! It made me smile and I thought it must be similar to when you're a musician and hear your song on the radio for the first time.
That said, going about the intense process of designing studies, collecting and interpreting data, and publishing your work can be very challenging. And putting yourself out there can be scary and vulnerable — everyone can see the flaws of the paper, you have to go through the process of peer review, and sometimes you think it's all really dumb and pointless and you don't want to do it anymore.
But if and when your work is published after peer-review, people from around the world may read it and actually use it in ways that directly improve the outcomes of their own pediatric patients. That's such a great feeling — to have reached beyond what I can do with an individual patient here.
There's something really amazing technically about my favourite surgeries: repairing a cleft lip, or repositioning and shortening an index finger to make it into a thumb, tissue expanding normal skin to replace scar or abnormal skin, or making an ear out of rib cartilage. It's just so cool and so interesting on its own. Every time you do it you think about how you can improve, so that this child or little baby or the next one to have surgery will not have to even think about it much during their life. They can just go and do what kids and babies are supposed to be doing, and be exactly who they are meant to be.
There is an immediate gratification with those types of procedures, but one of my favourite parts of pediatric work is being able to have interactions with families over the long-term. In the majority of regular surgical interactions, patients would come to the hospital, see a doctor in consultation, have the surgery, be seen once or twice after that, and then they leave and we never see them again. But in a significant proportion of pediatric plastic surgery diagnoses, we follow patients over their entire growth, and/or plan multiple staged procedures. You start to feel like you've really gone through something with the whole family, truly got to know each other well, and have navigated together through a really challenging time. That truly adds something special, and I feel privileged to be part of this journey with families and patients.
Don't be afraid to say a polite "no" if it means your balance is maintained. When you first start your job, it's very easy to get caught up in joining various committees and groups and responsibilities. Of course partake of everything that is your passion, but it’s prudent to be careful with apportioning your time, building your practice, and figuring out what your schedule will be like. You may be thinking of building or raising a family, and that often coincides with your early career. Keep some room for that, then once everything is more in place, and you’ve figured out your particular pattern of juggling, you'll have time to join various initiatives, including research or committees or outreach projects.
Once you have your platform set, it's a lot easier to keep all the balls in the air and less challenging to add more balls to the mix. Be mindful of and careful with what you prioritize and when you prioritize it. I’ve come to think that maybe we CAN’T have it all, all at once. But with thoughtfulness and prioritization, you probably CAN have it all if spread over the course of your career.
Behind anyone who has a successful career, or a career that means something to them, are good partners. In clinical practice, it's vitally important to have a really good secretary, really good childcare, and a really good life partner, all of whom share your basic values and priorities. I’d add for research, having a person or team helping you get through the time consuming and technical parts of taking a study from idea to publication makes a huge difference to successful research.
I have loved my career. I’ve never been bored, I love working with kids, and I feel privileged to have a job where the basic unit of work is so positive. I appreciate being a part of a child’s or family’s life during what are likely stressful times, and to have remained connected to many of them. As a surgeon, I hope I have done some good for individual patients. But the small amount of clinical research I’ve done has been much more fulfilling than I had anticipated, and I see now how it can extend one’s reach to more than individual patients.
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