Professor emeritus honored with humanitarian award

Richard Gross may hold the title “professor emeritus” in the Department of Neurosurgery, but he’s far from being retired from work. At a time of life when his only exertion could well be a round of golf, this pediatric orthopedist continues to study and research, striving to develop a better way to treat kyphosis, a condition generally known to the public as hunchback. 

“I want to get that done before they’re patting my face with a shovel,” he says dryly from his office in the Bioengineering Building on the campus of the Medical University of South Carolina.

Gross has gotten a lot done in his career, having operated all over the world in all sorts of conditions. Most people would think that his medical work with children is “giving back” in and of itself, said Steven Frick, chief of pediatric orthopedic surgery at Stanford Children’s Health, who studied under Gross as a medical student at MUSC and now counts Gross as a friend.

But Gross is a citizen in the fullest sense of the word, Frick explained. “He’s a citizen in the sense of being involved and aware and trying to help.” Gross was a longtime goalkeeper coach for the Wando High School soccer team, with three of “his guys” listed among the top 10 for career shutouts by high school goalkeepers in the nation. He moderated debates on public radio; served as a mentor through the Leadership Fellows Program at the American Academy of Orthopaedic Surgeons; was an American Medical Association delegate for five years; and steered Pattison’s Academy for Comprehensive Education, a Charleston public charter school for children with multiple severe disabilities, through a financially treacherous time to stability.

“That was something I learned from him – you could be really committed, really devoted and really knowledgeable about your area of medicine but also not do that to the exclusion of being involved in your community and the world,” Frick said.

For his lifetime of work, the Pediatric Orthopaedic Society of North America recently awarded Gross its Humanitarian Award. Frick was serving as president of the society and got to present the award to his mentor and friend.

 

It probably wasn’t a moment that Gross ever envisioned when he graduated from medical school in 1965. At the time, pediatric orthopedics barely existed as a specialty. Gross had received his commission after completing the ROTC program, so after medical school he entered the Army for further training. He requested cardiology for his first rotation but ended up in orthopedics.

“I expected to go to Vietnam. I was shocked that I didn’t go right away because that’s what every resident did, but the war was starting to wind down,” he said. Most of his patients were casualties from the Vietnam War – soldiers injured by gunshots, grenades, mortars or mines. They were the ones who couldn’t be quickly fixed in Japan or the Philippines and returned to battle.

In his last year of residency, he worked at the Carrie Tingley Hospital for Crippled Children in Truth or Consequences, New Mexico, where he decided he preferred working with children to war casualties.

"I felt you have to do something to justify the air you breathe, the food you eat, what you consume in your time on the planet."

Dr. Richard Gross

Once he got out of the Army in 1973, his career would take him to Oklahoma, where he was the first pediatric orthopedist in the state, to Florida and then to MUSC in 1986.

That’s also about the time he began to make trips overseas to operate in developing nations. Over the years, he’s traveled multiple times to Pakistan, Palestine, Romania, Vietnam and Tanzania.

 

“I felt you have to do something to justify the air you breathe, the food you eat, what you consume in your time on the planet,” he said. “I was also curious about what was going on elsewhere in the world.”

Gross usually traveled alone or in small groups.

“There’s no way to learn more than going by yourself,” he said. He did do one of those big medical mission trips backed by a nonprofit in the U.S., but it wasn’t for him. The group essentially moves in and takes over, he said, and there’s no way to immerse yourself in local culture. Traveling alone in Peshawar, Pakistan, or in Vietnam, he was invited to dinner in locals’ homes. In Vietnam in the 1990s – years after he expected to go there as an Army doctor – he was amazed at how the locals seemed to have gotten past the war.

And though he doesn’t use buzzwords like “collaboration” or “interprofessional,” his respect and fondness for his colleagues abroad is clear.

“The Vietnamese doctors are very good. They size you up and decide what they think you can do. It works both ways,” he says with a twinkle in his eye.

His first trip, to the Afghanistan-Pakistan border, gave him a taste of bootstrap medicine. A former colleague from Florida, pediatric surgeon Farhat Moazam, had just become chief of surgery at a new medical school in Karachi and asked him to operate on a special case. In a brand-new hospital that hadn’t yet done any orthopedic surgeries, they found themselves mid-surgery with the wrong size screws.

“And these are the only screws we have,” Moazam wrote in a diary entry that she later shared. “We are both stunned. After a moment of silence, I ask the OR supervisor to call somebody in Purchasing Department about additional screws. He rushes out. We wait. Can you wait for 20 minutes, he says upon return. We have found the supplier’s son who will open his shop on Bunder Road and try and get us the screws. Dick and I look at each other. We have no choice as it is late Saturday and all shops are now closed. Go right away, I say.”

 

After an hour’s wait, they were able to get the screws they needed. The surgery was a success, though their patient, a farmer’s son from a rural area, became thoroughly citified and never returned to his village.

On the Pakistan-Afghanistan border in the 1980s, Gross worked in both secular and Islamic hospitals and observed how U.S. aid influenced the relations between the political parties on the ground. He went on a harrowing trip through the tribal areas into Afghanistan, where armed border guards harangued his escort while he stood by, hoping for the best. He saw firsthand the effects of U.S. Rep. Charlie Wilson’s efforts and was disgusted by how the U.S. withdrew its support when the Soviets retreated.

Gross learned from his overseas colleagues, too, even as he worried about their fates.

“In 1993, I wrote a paper for the Journal of Pediatric Orthopaedics, describing a surgical technique I had learned from an Afghan surgeon, placing his name first as an author,” Gross wrote in Small Wars Journal. “I do not think he has ever seen the paper, and I don’t know if he is still alive. I have feared the worst for most of those with whom I worked.”

Even as he’s observed history on the ground, he’s also watched the evolution of medicine here in the U.S. It’s a progression he doesn’t entirely approve of. When he began practicing medicine, the American Medical Association had long declared advertising unethical. Then, in 1975, the Federal Trade Commission filed antitrust cases against the AMA and other health associations, ultimately leading to the medical advertising marketplace today. But Gross looks at today’s ads and sees money that could be spent on equipment or more nurses.

He’s also discouraged with the way many hospitals determine doctors’ pay, saying it doesn’t offer them the flexibility he had to work fewer hours so he could volunteer as a soccer coach.

“I made a smaller income, but that was my choice. You don’t have that choice now with the way it is,” he said.

At the same time, he concedes that the old way of doing things wasn’t ideal, either, noting that his alma mater, Duke University School of Medicine, had a reputation for “no marriage surviving their surgical training program.”

“Not everything was perfect. There were a lot of failed marriages. There were a lot of doctors who were very one-dimensional people. But I think the pendulum may have swung a little bit too far the other way,” he said. 

Gross was trained during a time that saw the relationship between doctor and patient as a covenant. And because he worked on pediatric cases that often required ongoing care, he said he got to know many of his patients’ families quite well.

It was a patient who got him involved in Pattison’s Academy. He’s served six years on the board, including three as president, during the tumultuous time period when it looked like the school would go under for lack of funding. The board managed to get the Charleston County School District to give the school a one-year reprieve, but the board had to promise it wouldn’t ask for additional funds.

“I don’t know how we thought that was going to work, looking back,” Gross said. “Three weeks before school, we had no teachers, no nurse. We had to take out a loan, which we personally guaranteed, to get started.”

But then, he said, things began to turn around. “I mean, it was some kind of karma. People just dropped out of the sky almost. We had enough people hired in three weeks to open the school. One of the provisions was that we had to get through that school year without asking the school district for money, and we did that. Looking back, it’s pretty remarkable that we got there.”

Now, with the school in a stable situation, he’s comfortable stepping down.

 

Frick, his former student, also got to know Gross from the patient perspective. Frick was already interested in pursuing pediatric orthopedics when, in his fourth year of medical school, his son was born with a clubfoot. That’s when he got to see Gross from the perspective of a patient’s family member and found him kind, considerate, caring and willing to spend time explaining everything. Often, Frick said, when a patient or family member is a doctor, the treating doctor will slip into medical jargon. But that wasn’t the case with Gross, he said.

“My wife always appreciated that he explained things in a way that was for a parent, not for someone who’s in medicine,” Frick said.

Frick went on to a residency in Charlotte, but he and Gross continued to correspond and meet up when they could. He said Gross’s work is ignited by his curiosity about the world.

“He is very committed to his professional work and really driven by it. It’s a calling for him,” Frick said. “He’s very professional about the work he does. He is a contrarian, and I think he enjoys being a contrarian. He likes the contest of ideas and thinking about things and trying to figure out if this idea is a better idea than the last idea, and makes more sense, and perhaps there’s a better way for us to address a certain problem.”

"He is a contrarian, and I think he enjoys being a contrarian. He likes the contest of ideas." 

Dr. Steven Frick

The idea that there must be a better way to address a problem is behind his latest project. For the past 10 years, Gross has been working on a spinal implant treatment for hunchback and other spinal deformities. The implants are attached to four ribs and slowly pull the bones back to bring the patient to a more upright position. It’s an alternative to the risky and more complex vertebral column resection procedure. Gross said the project started when he began looking for something to do for a 12-year-old patient whose back “had gone to hell in a handbasket.”

“I wrote people I knew around the country, and there wasn’t any good solution,” he said.

Gross obtained funding from the Scoliosis Research Society to further his research. At the age of 72, he participated in a grant writing workshop to improve his chances of obtaining funding, which Hai Yao, Ph.D., professor and the Ernest R. Norville Endowed Chair in the Clemson University-MUSC joint bioengineering program, characterized as a “show of commitment to scholarship and service” that he says he uses as an example to motivate his Ph.D. and M.D./Ph.D. students.

Gross joined the Clemson bioengineering program as a research professor without pay just to continue this work, Yao said. The two have been collaborating for a decade and have had a manuscript published in the Journal Spine Deformity.

“I have always been amazed at the passion that Dr. Gross holds for improving health care in pediatric patients,” Yao wrote in a letter to the Duke Medical Alumni Association.

For Frick, one of the more rewarding parts of serving as president of POSNA was getting to call people to let them know the awards committee had selected them to receive awards. “I got to call Dick and tell him that. And he’s so funny. He said, ‘Things like this just don’t happen to me.’ And I said, ‘Well, it just did, so enjoy it.’”

“For me, it was truly coming full circle that someone who got me interested in pediatric orthopedics, I could help honor at the end of his career,” Frick said.