After 23 years of medical practice and more than 10,000 orthopaedic surgeries, Dr. James H. Lubowitz sat in the surgeon’s lounge at Holy Cross Hospital late Monday afternoon (Aug. 21) and picked up the phone to dictate the results of his final surgery in Taos.
It was a knee arthroscopy, in which a tiny camera and other instruments are used to operate on the complex joints and ligaments within the knee – the most common procedure he has performed throughout his career, he said, and to him, an “apropos” way to close out his decades in medical practice.
The surgery was one of seven he performed on his final day in the operating room before he dedicates himself as the full-time editor-in-chief of The Journal of Arthroscopy and Arthroscopy Techniques, a medical publication that circulates research in his field. He will also leave his post as director of Taos Orthopaedic Institute, Taos Orthopaedic Institute Research Foundation and the Taos Orthopaedic Institute Sports Medicine Fellowship Training Program.
In his stead, he leaves his two medical partners, Drs. Dan Guttmann and Jeb Reid, who will be joined by newly inducted partner, Dr. Sean Marvil, at the end of the month.
Lubowitz, 54, has tasked them with building upon a medical practice that he believes has done much to elevate the level of medical care in Taos County since he first began his practice in 1994.
Lubowitz was born in Philadelphia in 1962 and was raised in a family deeply rooted in medicine.
His grandfather was the first orthodontist in the city, and likely one of the first in the United States, Lubowitz said. His father worked as an ophthalmologist – a medical eye specialist. Lubowitz trained hard in both sports and school, finding his drive early, which was fueled by the high expectations and proud professional traditions of his family. “Growing up, my parents and grandparents said, ‘Well, you can be a doctor or a lawyer,’ “ Lubowitz recalled.
It was a question only until he injured his ankle during a high school soccer match and visited the team doctor for the Philadelphia 76ers basketball team. He watched the doctor work as he placed his ankle in a cast, and that was it, he said. “Taking care of athletes and sports injuries seemed exciting and glamorous and synchronous with who I was and what my interests were.”
Lubowitz went on to Harvard with his goal in mind, then to medical school at Pennsylvania State University, to UCLA for five years of orthopaedic training, and finally, back to Pennsylvania and the Rothman Institute for an additional, optional year of training as a fellow, where he developed a specialization in knee orthopaedics.
The Taos decision
An avid skier, Lubowitz wanted to establish his practice in a mountain area, where he knew that frequent knee injuries would provide patients and where fellowship programs had found success.
Some of the options, such as Jackson Hole, Wyo., were too cold, he said. Lake Tahoe, Calif. received plenty of sunshine and had tough terrain, but glitzy casinos seemed to be all that were left when the lifts stopped turning.
But Taos, he heard, emphasized art and spirituality, and had a reputation for being more authentic than some other mountain towns lost to corporate buyouts and whose populations were already over-served with orthopaedic practitioners.
Lubowitz, then 31, arrived in 1994 for his interview at Holy Cross Hospital. When he was hired shortly after, he began formulating a model of practice that involved two operating rooms that would serve patients on what he described as a “staggered” system, “not concomitantly, which wouldn’t be safe for patients – but to go back and forth from room to room, to recruit other orthopaedic surgeons,” he said.
His goal was to raise the level of care, efficiency, safety and quality in Taos to that of a big city – or beyond.
The idea was met with some skepticism, Lubowitz recalled.
After all, Taos County had less than 30,000 residents at the time. But Lubowitz moved forward with his plan nonetheless, including a fellowship he envisioned as one of the best in the nation. He said he half expected the skeptics to be vindicated in time, but within two years, business was booming and he had little time to hit the slopes.
Lubowitz worked seven days a week for the first five years, performing sometimes 800 surgeries each year with a staff he was still trying to train to follow his exacting procedures and preferences. “I didn’t have the team together then,” Lubowitz said, “so I was completely busy electively from 7 a.m. till 5 or 7 p.m. Then the skiers would start rolling off the hill, I’d grab a quick dinner. We’d operate till midnight or 1 a.m. and then start up with the elective stuff again the next morning.”
In 1999, he began his fellowship training program by placing an ad in the back of a medical journal called Bone and Joint Surgery and soon received his first two fellows.
His close friend from high school, Guttmann, was a few years younger and had been following a similar path, with the one exception that he planned to focus on upper extremity orthopaedics, a happy complement to Lubowitz’s focus on those lower. Guttmann joined Lubowitz in the early 2000s, and Reid was brought on soon after.
Working together, their program expanded to host three fellows per year, and the team that Lubowitz had built at a then-relocated Holy Cross Hospital was in the nascent stages of the “crack team” it is today.
With three partners and ample staff and a thorough understanding of the lack of access to medical treatment in the rural areas outlying Taos, they began loading up a Chevy Suburban with all that they would need for a mobile orthopaedic medical unit, and began visiting Ratón, Las Vegas and Los Alamos, as well as Santa Fe.
They still make the trips today.
Lubowitz was recruited to work on the medical team for the U.S. Ski and Snowboard teams, and worked with top athletes like Lindsey Vonn and Julia Mancuso.
And in 2013, Lubowitz’s orthopaedic department received the recognition he was aiming for when he set out to build his practice in 1994, when Holy Cross Hospital was recognized as one of the top 25 hospitals in the United States for anterior cruciate ligament (ACL) surgeries.
Into the O.R.
Just after midnight Monday morning, Lubowitz awoke and was staring at his ceiling as he thought about the surgeries he would perform on his final day in the operating room – not because they would be his last in Taos, he said, but because he would frequently wake up throughout his career to picture each step in each procedure on the night before surgery.
“I’m a big believer, both in sports and in surgery, in visualization,” he said. “I go over each step of each surgery in each case.”
He spent most of this reflective time visualizing his most difficult case, an ACL reconstruction in the knee of a motocross rider, who, as Lubowitz expected, “was going to test it to the max.”
He imagined himself in his scrubs and doctor’s shoes, the highly-trained assistant at his side and the scrub tech that would hand him instruments as he worked, the new fellows that might – or might not – know his preferences. Beside him, he imagined the four or five scrupulously sterilized trays that each held 100 different instruments – “a 6 millimeter drill, a 6 1/2 , a 7 and a 7 1/2 and there’s dilators, and taps, and screws …” he said. “It’s very high tech, as you can imagine.” He pictured the keyhole-sized incision he would make, through which a high-definition camera would be inserted as a pump released saline into the knee to clear his view and allow him space to work.
He went back to sleep.
He awoke again to the sound of his alarm at 5:30 a.m. His wife rushed to make him breakfast – chilaquiles and black coffee – and snacks to eat between surgeries. Then he was out the door.
After a brief meeting with his fellows, surgeries started at 7 a.m. and then everything else – calls or texts on his phone, emails he hadn’t attended to, The Wall Street Journal edition he hadn’t had time to read that morning before work – it all fell away and he was focused on taking care of his patients. “One of the secrets of my success is the ability to focus,” he said. “to be able to go from multitasking to supreme focus, where you could set off a firecracker in the back of the operating room, and I would notice it, but I wouldn’t turn around or stop what I was doing.”
Nurses and fellows, and one of Lubowitz most essential people, Christina Hull, Director of Surgical Services, who was hired earlier this year, of course knew it was his last day, and would see him hustling back and forth between operating rooms to check schedule boards, responding graciously to compliments and verbal pats on the back. But his focus didn’t waver. “I still had a job to do,” he said.
At 11 a.m., staff that wasn’t busy would go outside to view the eclipse. Lubowitz, too, stole away to sneak a glimpse, but returned to finish out his day.
After making the call in the doctor’s lounge, he visited with his patients, some of whom were waking up from anesthesia and then met with his team, all of whom he credits – from the volunteer that worked at the counter that day, to Hull, to the cleaning staff – with the operation that he is leaving behind.
“It’s about the team,” Lubowitz said. “I think we’ve improved the health care, not just the orthopaedics, but in this county. In the entire department of surgery and anesthesia, we now have super-experienced nurses and techs and anesthesia providers, which allow the general surgeons and the podiatrists and the gynecologists and the neurologists to walk into a state of the art, nationally recognized for quality and safety and cost OR and work with that same team.”
Lubowitz emphasizes that he is not retiring from something, but rather “to something,” which will include his editing, but also more time spent doing what both he and many of his patients love: running and biking, surfing, and 23 years after he moved to Taos with the expectation that he would have time to ski, finally hitting the slopes.