Deciding on a direction
Securing a fellowship that provides the right “fit” involves a good amount of research and planning, and also some chance. There were many initial questions: what the specific skill sets I could learn were, how I could add value, where and when to go, and of course, how my young family would fit in.
I finally decided to focus on hip arthroscopic surgery. It is a nascent field in Singapore and only just establishing itself worldwide, but the need for it is definitely growing. Thus, a centre providing adequate hands-on experience and ease of communication was important as the “hand-screen” coordination can only be achieved with practice. A story goes that when an eminent surgeon was asked how he managed complex procedures so well, he dead-panned, “With great skill”. It was a light-hearted remark, but holds a ring of truth – in any skills-based procedure, there is no replacement for actual hands-on practice.
These criteria narrowed my options to a handful of experts residing in Canada, Australia and New Zealand. A series of fortunate events led to an introduction to Dr Matthew Brick (Mat), my mentor in New Zealand. After several email exchanges with Mat, conversations with his previous fellows and a quick visit, I was confident that this was the fellowship for me. It also helped to have common ground; Mat is of the opinion that hip arthroscopy has to be learnt hands-on and he is a fellow athlete – a previous World Duathlon Champion, no less.
After numerous applications, enquiries, chats with prior fellows and some luck, I got a fellowship place with Mat for 2020.
Charting new family territory
Going on fellowship with the family (one wife and two little ones) led to the discovery that the laws of multiplication, instead of addition, apply to complexities. Though my visa came through fairly quickly, those for my family did not. We were otherwise prepared – flights booked, children withdrawn from school, wife stopped working and goodbyes were said. As the day of departure drew near, we reluctantly acknowledged that I would have to depart on my own as, despite our best efforts, my family still had no visas. It was a fairly inauspicious beginning as I regarded the Frozen 2 exhibition in Changi Airport, while the family waved goodbye. Into the unknown, indeed.
After almost a month of uncertainty, we received good news just before the Lunar New Year and we were finally reunited in New Zealand. The beautiful Auckland coastline and the warm, breezy weather provided the perfect antidote to the tumultuous start.
Soon after, the rumblings about COVID-19 began to gather steam. From a single imported case in New Zealand in late February to Lombardy’s lockdown a month later, it became increasingly apparent that we had a decision to make. Should we stay in New Zealand (cases were low, but we were unfamiliar with the healthcare system), or return home (risking possible contagion on a flight)? And if we returned, could I continue my training? After much deliberation, we decided to stay on.
Through the ensuing New Zealand lockdown, we discovered the joys and challenges of being “stuck” together at home. Thankfully, the laws of multiplication also applied to joys – we have grown closer as a family and the year has yielded many precious memories.
Into the hip unknowns
While the concept of hip preservation has been around for some time, the practice of hip arthroscopy in Singapore is not yet common. My fellowship centred on addressing hip pain through preservation surgery, with the goal of avoiding a total hip replacement (THR).
Femoroacetabular impingement is a common cause of non-arthritic hip pain among the patients at Mat’s practice. This condition occurs when an abnormal bone shape causes jamming or impingement, leading to pain or stiffness. Left unaddressed, the acetabular cartilage can get sheared off, giving rise to osteoarthritis and eventually the need for THR. For young adults, THR spells a future of revision surgeries as THR implants have limited lifespans. Hip arthroscopy, while not a magic bullet, is able to help in many cases.
Rare conditions appear fairly regularly at Mat’s practice as well. Patients with hip micro-instability, dysplasia, piriformis syndrome, psoas impingement (sometimes after a THR), iliotibial band tendinitis, proximal hamstring and gluteus medius tendon tears come from all over New Zealand. As a result, I got to learn techniques and procedures that I had previously only read about.
Because of Mat’s specialisation, I became familiar with surgeries I had previously considered risky. In one case, a proximal hamstring tear. When she consulted her local orthopaedic surgeon for repair options, she was advised to stop running instead as it was considered too dangerous to operate on. Wanting to maintain her activity, she sought out Mat’s practice. His experience gave her confidence in deciding on surgery, which was a successful one, and after a smooth recovery, she is now happily back to running.
Being a part of patient journeys is what attracted me to orthopaedic surgery in the first place. There are few things that give more satisfaction than seeing patients being able to continue pursuing their passions. To that purpose, I hope to establish a hip preservation service for our local context.
Mat has the coveted skill set of being an exceptional surgeon and mentor. Through experience (3,000 cases and counting), reflection and refinement, he has a structured way of teaching the fine art of hip arthroscopy. Observing the first few cases felt like watching a perfectly synchronised orchestra; the flowing, meticulous and precise movements brought tears of joy to my eyes.
In the face of such perfection, the first few weeks of my fellowship were stressful. As the novice, I tried to remain in tune with the rest when it came to my turn to play “solo”. Though I (inevitably) struggled in the beginning, Mat’s expert teaching and leadership helped me grow into a full member of the team. His sincere encouragement helped immensely on days when self-doubt crept in. Honing surgical skills was the focus of my fellowship but I was also getting an education on what it meant to be a mentor!
In the “rooms” (Kiwi-speak for clinics), Mat also has plenty to teach. Genuinely interested in people, he establishes rapport easily. His honesty and commitment to helping patients understand their conditions and treatment options let them know that we are on their side. The majority of his patients are friends or family of his previous patients, a testament to their trust in him. His sporting background helps him relate authentically to athletes struggling in their journeys. His corridor is filled with mementos of appreciation from numerous world-class athletes who have successfully returned to their sport.
Outside of work, I took part in my first Half Ironman with Mat. Needless to say, even though I was happy with my time of 5 hr 23 mins, he showed me “who’s boss” by finishing the same course half an hour ahead of me.
Looking back on the year
The year has been humbling, stretching and energising. I encountered many “firsts” both professionally and personally. With the help of others, I found a fellowship that was the perfect fit for me. Though it was difficult to be the rookie again, consistent practice has helped hone a new set of skills, both in and out of the operating theatre. Our family’s adventure has been akin to sandboarding – uphill trudges followed by exhilarating slides that got better as we learnt and adapted. And even if parts of it were uncomfortable, we’d do it again in a heartbeat.