This article first appeared in the St. Louis Beacon, March 28, 2011 - Anna Knochel knew she was lucky to be alive.
She had been mauled by a bear while on a camping trip with her 4-H group near Tucson, Ariz. At 16, Anna had the rest of her life ahead of her. But what kind of life?
In many respects, that was in the hands of Dr. Susan Mackinnon, who would perform a surgical procedure she had pioneered in 1989 and that she had done only a half dozen times since. She was going to try to reattach the nerves in Anna's right leg - the one the bear had shredded during the assault - with portions of two nerves from human cadavers.
During the 11-hour operation at Barnes-Jewish Hospital, Dr. Mackinnon, a nerve repair specialist and Washington University chief of plastic and reconstructive surgery at BJH, changed course and elected to use nerves from Anna's healthy left leg to replace the sciatic nerve which runs down the back of the leg.
The successful operation restored some function to the severely damaged leg, enabling Anna to walk again.
Mackinnon, who also holds the Sydney M. Shoenberg Jr. and Robert H. Shoenberg Endowed Chair in Plastic and Reconstructive Surgery at Washington University, is widely recognized as an international authority on nerve regeneration, nerve transfer and nerve transplant. Her work at the Tal Nerve Peripheral Nerve Research Lab at Barnes-Jewish has focused on where to get nerve replacements, including from cadavers.
"When nerves are damaged, rarely are the nerve endings able to be sewn back together," Mackinnon said. "You have to splice in a healthy piece of nerve and there are nerves you can use as a bridge to put between the injured nerves."
Dr. Mackinnon's nerve research and surgery turns heads; it also helps fingers and toes wiggle and elbows and knees bend - and so much more.
A Specialty Without a Home
Mackinnon proudly shares that everything she does in the lab immediately translates into the clinical, because the questions she researches originate with patients. It's called transitional research. And it has changed the landscape for nerve surgery.
Before Mackinnon's work, "people were basically destined to be incapacitated for life, mentally and physically," said her colleague, Dr. Gregory Sicard, a professor of surgery and executive vice chair of the Department of Surgery at Washington University's School of Medicine.
"Nerve injuries can be extremely incapacitating, including in the young population, and very few people had treatment options for severe injuries."
The focus on nerves that Mackinnon has brought to medicine remains a rarity.
Nerves, the tiny cords that carry the signal to command movement, are a specialty in search of a home. They are treated by orthopedic, neurological, plastic and reconstructive surgeons.
"There is no specific specialty," Mackinnon laments. "It's an orphan specialty, particularly peripheral nerves."
Estimates put nerve injuries at more than 400,000 each year, most often the result of simple mishaps: car accidents, run-ins with power tools and appliances, sports, even another surgery.
"What I've dedicated my career to is advancing peripheral nerve surgery," Mackinnon told St. Louis Magazine in 2007. "... if you have a nerve injury, you would maybe think, 'Oh, I should go to a neurosurgeon.' But they actually are more expert in brain and spinal cord, and they don't do much of the periphery with the nerves left. Orthopedics do nerves, so do plastic surgeons, thoracic surgeons, general surgeons. So bringing it into a specialty -- for heaven's sakes, why isn't it a specialty?
"I think the general management of nerve injuries in the United States is an embarrassment."
In Rare Company
Sicard recognizes Mackinnon's pioneering role not just in the field of nerve reconstruction, but on behalf of women. "She is a woman in a very competitive field, a trailblazer, providing seminal and important contributions," Sicard said. She demonstrates that you can face all the challenges and still be successful in basic research, clinical research, training in education and have an outstanding clinical practice."
"She also recognized the importance of fomenting women in surgery, which has always been known as a man's field," Sicard added.
A 1998 examination of the Women Physicians' Health Study found that, compared with other female physicians, female surgeons tended to be younger, white, born in the United States unmarried, and childless.
Mackinnon does not fit neatly into the profile.
'Move the Bricks'
Susan Elizabeth Mackinnon, 61, the oldest of two sisters, was born, raised and attended college in Canada. She married a fellow med school student, Dr. George Alexander (Alec) Patterson, in 1972, and was nine months pregnant with the first of their four children when she graduated from medical school in 1975.
She had not set out to be a trailblazer; she had planned to be a history teacher and help people understand the past, the better not to repeat it. But a favorite history teacher dissuaded her from historical pursuits.
"He would bring a pile of textbooks to class and say 'Most of what's in these books is incorrect'," Mackinnon recalled. "He taught students to be skeptical. He didn't think that I could change people's perception of history, so I went to something practical: helping people who are sick."
It was her second lesson in skepticism. The first came very early. Her father, a civil engineer, moved the family often to the location of his projects. By the time she was in third grade, she had lived in three provinces - and learned three different ways to write the letter "r." Each teacher had insisted that their way was the only correct way.
"I learned there is more than one way to do things," Mackinnon said. "It influenced me and gave me the freedom to be a little skeptical."
The experiences shaped Mackinnon's philosophy of life: "Move the bricks out of my way; don't put bricks in front of me."
Great Expectations
"Our parents had high expectations for us," Mackinnon said.
And they set an example. Her father was in charge of building the Pearson Airport and the art museum in Toronto; her mother, graduated from college and later worked outside her home, during a time when most women did neither.
She and her sister, Jennifer, now a Supreme Court judge for family court law in Ottawa, lived up to their parents' expectations.
In the Canadian system, she went directly from high school to two years of pre-med and earned her medical degree from Queen's University in Kingston, Ontario, in 1975. She subsequently did a surgical residency at Queen's University and a residency in plastic surgery at the University of Toronto. She completed a neurosurgery research fellowship at the University of Toronto in 1981 and a fellowship in hand surgery at Raymond Curtis Hand Center at Union Memorial Hospital in Baltimore in 1982.
Mackinnon received the Medal Award in Surgery from the Royal College of Physicians and Surgeons of Canada in 1988, the year she performed the first donor transplant. In 2007, she was elected to the Institute of Medicine of the National Academy of Sciences, one of the highest honors medical scientists in the U.S. can receive.
"Work is a privilege," Dr. Mackinnon says. "If you can have a job that can give you meaning, that's such a privilege. Mother wanted that for her daughters."
A Marriage in Tandem
Mackinnon met her husband at Queen's University where Patterson was a year ahead. "Alec and I were very similar," Mackinnon said. "We did not have a lot of money but we had education and high expectations. Early on, knew we wanted to make a contribution in a certain area, so we focused."
Since meeting, their paths have never diverged. Both lead their surgical divisions at Washington University's School of Medicine. Dr. Patterson is chief of the Division of Cardiothoracic Surgery and Section of General Thoracic Surgery at Washington University. He is known worldwide for his groundbreaking lung transplant work. Within three years of coming to Washington University, Mackinnon had National Institutes of Health funding for her nerve transplantation research; within five years, she was head of her department.
"When the chief of plastic surgery retired, there was no question in anybody's mind that we had the very best candidate right here: Susan," said Sicard. She and Alec "have always been key components of the leadership that has guided the department of surgery."
The couple, who can almost see their offices from their home in Clayton, came to St. Louis in 1991. Mackinnon said they hadn't planned to stay long.
"We thought we'd stay four or five years, then go back to Toronto," Mackinnon said. "But the kids didn't want to leave St. Louis."
The "kids," all of whom were born in June except one because, the highly organized Dr. Mackinnon explained, "it fit in best with the academic year," are: first-born Lachlan, 35, an award-winning chef and co-owner of Frasca restaurant in Boulder, Colo.; Jennifer "Megan," 33, a Chapel Hill, N.C., orthopedic surgeon; Brendan, 30, an orthopedic intern at the University of North Carolina; and the youngest, Caitlan, 28, a health administration fellow at Barnes-Jewish Hospital.
Sharing The 'Recipe'
Last November, a Washington University article noted that a California woman with an egg-sized tumor near her spine, sought out Mackinnon's expertise twice, when she found no other options nationally. Mackinnon removed the tumor and performed a nerve transfer in her arm.
"Dr. Mackinnon saved my life twice," the woman said. "She saved my life when no one else would touch me."
Mackinnon wants the kind of procedures she used on the California woman (who did not want her name used), and all of her other work, to be readily available to other surgeons. She has written and published hundreds of articles and book chapters, but she is eager to share her work in a new technical venue.
For three years, she and a partner, Dr. Ida Fox, a fellow plastic surgeon, have been working on a military-funded website that will share surgical procedures in step-by-step detail. The site for her "surgical recipes" is expected to be completed soon.
"The site will go a long way toward translating information to a greater number of surgeons," Mackinnon said. "We are the chefs and we are giving them the recipe."
Gloria Ross is the head of Okara Communications.