The long
way around.

I started my career in a spine and orthopedic practice in Southern California, and for five years the job was mostly surgical. First-assisting on cervical, thoracic, and lumbar cases — fusions, decompressions, spinal cord stimulator implants — then managing the same patients through their post-op course. High volume, high acuity, and an education you can't get any other way.

What I learned there was mechanical, and it was invaluable. How a disc actually behaves. What a good decompression looks like from eighteen inches away. Which post-op complaints are expected at week three and which ones mean something is wrong. That knowledge doesn't fade, and I still use it every week.

But I also learned something the operating room can't teach you, which is what happens after. The surgery would go beautifully — clean margins, good hardware, textbook films — and then I'd see the patient at three months and their life hadn't changed much. The structure was fixed. The person wasn't better.

That gap is what eventually moved me. I spent the next several years in outpatient orthopedics in Tennessee — fracture care, sports injuries, a very high injection volume, workers' compensation — and it was good work. Conservative care, done carefully, keeps a lot of people out of an operating room they didn't need. Building an orthopedic line of care from nothing at three clinics taught me as much about systems as about medicine.

Still, I kept circling the same question. Not can we fix this structure, but can this person get their life back. Those turn out to be different specialties.

Now I practice physical medicine and rehabilitation with Medrina, working inside skilled nursing facilities across Middle Tennessee. My patients are recovering from strokes, hip and knee replacements, spine surgery, long hospitalizations, the kind of complex medical events that take away function all at once. The work is functional assessment, rehabilitation planning, pain and medication management, and a great deal of coordination with the physical and occupational therapists who see these patients far more hours than I do.

It is slower work than surgery and less dramatic, and it is the most satisfying medicine I've practiced. The wins are smaller and they matter more — the transfer that finally becomes independent, the patient who gets to go home instead of staying. My orthopedic and spine background shows up constantly here, because a meaningful share of post-acute patients are recovering from exactly the procedures I used to assist on. I know what was done to them and what the recovery should look like.

Home first — my wife and my son, by a wide margin the best thing I've been part of. Everything else arranges itself around that.

The rest goes to things that keep me useful. I train most days, which is partly vanity and partly professional empathy: it is easier to ask a seventy-eight-year-old to do something uncomfortable when you've asked it of yourself that morning. I ran cross country and track in college, and while the mileage is long gone, the disposition isn't — I still think in terms of slow accumulation rather than breakthroughs, which turns out to be the correct model for rehabilitation and roughly nothing else in medicine.

Beyond that: a long trail when I can get one, mountain country by preference. A kitchen, used slowly, with people I like at the table. And a stack of books that never gets shorter — history, medicine, philosophy, the occasional novel — usually several going at once, which my wife finds less charming than I do.