Photographs by Luigi Ciuffetelli www.luigic.com
Pushing the Limits
Dr. Joseph J. Bennett
Joseph J. Bennett has made himself right at home in Delaware.
Bennett, a surgical oncologist (a doctor who uses surgery to treat malignant cancers), joined the staff at Christiana Care’s Helen F. Graham Cancer Center two years ago. He had just completed a two-year clinical fellowship in surgical oncology at the Memorial Sloan-Kettering Cancer Center in New York—one of the best cancer hospitals in the country—and he was eager to help expand Christiana’s new cancer center.
Christiana is one of 16 cancer centers chosen to take part in a three-year National Cancer Institute pilot program to expand cancer research and deliver the most advanced care to more people and in the communities where they live.
Bennett went to Christiana specifically to build the hepatobiliary department, which manages complex liver and pancreas surgeries, and to create a center for melanoma, sarcoma (a rare soft tissue cancer) and gastric cancers.
“I think I probably treat a lot of diseases that other people don’t want to treat,” Bennett says. “I think I filled a void. I think people are happy having me here treating some of the diseases that are, for some people, less desirable to treat because of the complicated nature of the surgery and the disease.”
Sarcomas, for example, were rarely treated at Christiana before Bennett’s arrival, though about 5,000 cases are diagnosed in the United States annually. Now the cancer center sees 60 to 100 people a year who potentially suffer from the disease. Sarcomas are difficult to detect because they are often confused with benign tumors or bruises, especially in younger patients.
Christiana has increased treatment of the liver and pancreas as well. Before Bennett arrived, the center had performed 38 complex pancreas surgeries over 10 years. The center has equaled that figure in the past 18 months.
“I think people used to get sent up to [The University of Pennsylvania] or to Johns Hopkins or to Sloan-Kettering,” Bennett says. “I guess we’ve brought Sloan-Kettering here.”
Though there are 25,000 people per year who suffer pancreatic cancer, only 20 percent of people can get a potentially curative operation. For many of the diseases Bennett treats, surgery is the only possibility for a cure.
Christiana has also increased the number of liver cancer surgeries it has done for people who are not transplant candidates. The combination of surgery and chemotherapy for colorectal liver metastases has dramatically improved the chances of survival.
“The combination of working with the medical oncologists who can provide all the top, frontline chemotherapy, in addition to doing surgery, has allowed us to operate on people who we used to never be able to operate on,” Bennett says. “So we can really push the limits to provide amazing cancer care.”
Bennett has been busy establishing databases for all of the cancers he treats so the cancer center can evaluate its outcomes. Christiana now ranks as a high-volume center for gastric surgery (a rare operation for stomach cancer) for a center of its size, performing more than 15 gastric cancer operations per year. Bennett will examine outcomes based on tumor type and types of surgery, chemotherapy, and radiation to gauge the center’s successes and failures.
Bennett is also busy at the Center for Translational Cancer Research, a cooperative effort between the University of Delaware and Christiana Care, among others. He is working with Dr. Joel Schneider, a chemical engineer who has developed an anti-bacterial hydro gel that could be used to treat solid organ injury after surgery. The two have explored using the gel to seal livers after surgery to prevent bile leaks and bleeding. They also plan to test it for preventing wound infections and aiding healing. The gel could one day be used to deliver other products that would increase liver growth and allow liver cancer patients to receive surgery.
“The properties of the product can be changed to meet the needs of the situation in the sense that it can be liquid at room temperature,” Bennett says, “but when it warms up to the body temperature it will solidify. It’s an amazing product.”
general orthopedic surgery
Putting Humpty Dumpty Together Again
Dr. Eric T. Johnson
Eric Johnson was eating lunch with his 10-year-old son when they heard the whine of a motorcycle zooming dangerously fast down the highway.
“There goes one of dad’s patients,” said the young man, never looking up from his soup.
Johnson is chief of orthopedic trauma at Christiana Care. Until recently, he was the only fellowship-trained orthopedic trauma surgeon in Delaware. That meant that when people were severely injured in an automobile or motorcycle crash, a fall or an industrial accident, Johnson was called to the hospital to treat them.
Christiana Hospital is a Level I trauma center, meaning it provides the highest level of care to trauma patients. And because of Christiana’s proximity to I-95, and the fact it’s the only Level I trauma center between Philadelphia and Baltimore, it’s a very busy place. In fact, last year another orthopedic trauma specialist was hired to help ease Johnson’s workload.
The trauma call at Christiana is divided among nine surgeons, including Johnson. The surgeon on call handles most cases, but Johnson or his new partner is summoned to help manage severe injuries from blunt trauma (physical injury of a body part due to impact), as well as specific injuries, such as a fractured pelvis or hip.
After medical school at The Pennsylvania State University College of Medicine, Johnson spent a year of fellowship in orthopedic trauma surgery at Cooper Hospital University of Medicine and Dentistry of (Camden) New Jersey. Along with his trauma work, he has a general orthopedist practice at First State Orthopedics, where he performs routine joint replacements, among other procedures.
Johnson says only about 20 fellowship-trained orthopedic traumatologists enter the field each year in the United States. Most head to metropolitan areas.
“It’s a field that is not as well known as sports medicine,” he says. “Nor is it glamorous in some ways. Because of the hours and the type of work, it lends itself to being a little less popular in terms of what people want to do for a career.”
But the focus fits Johnson like a surgical glove. He has always enjoyed taking things apart and putting them back together. During his 11 years at Christiana he has treated dozens of auto accident victims. Less routine cases have included performing an amputation at a stone grinding plant after a worker’s leg became stuck in a grinder, operating on a female tugboat captain who was sandwiched between two boats, and treating injured jockeys at Delaware Park.
Time spent in the operating room varies, depending on the complexity of the injuries. It takes six to eight hours to operate on a patient suffering from multiple limb injuries. Complex pelvic cases last four to five hours.
“Your pelvis and hip socket, there’s a lot of stuff around there,” he says. “It’s a deep area with a lot of soft tissue. It’s difficult to get down there, and, once you do, it’s oftentimes a mess.”
Newer techniques include taking X-rays or CT scans in the operating room to use as roadmaps during surgery. The procedure is easier on the patient because it allows for a smaller incision, which means less pain and faster healing.
Other recent advances have helped improve management of fractured and broken bones. Johnson was one of the first surgeons in Delaware to use bone morphogenetic proteins, a biological product that’s used in spine surgery, fracture care and trauma surgery to promote bone growth and fast healing. The metals and ceramics used in hip replacement surgery have also improved over the past couple years, Johnson says.
While Johnson describes his trauma work as “fun,” he also enjoys the challenges of his orthopedic practice. He recalls a day about four years ago when the matriarch of a large family, hunched over two canes, shuffled sideways into his office. Johnson performed a simple knee replacement surgery, and with the help of other doctors who guided the woman through other problems, she was able to walk again, cook for her family and care for her sick husband.
The woman recently dropped by Johnson’s office.
“She said, ‘I couldn’t walk. You gave me my life and my family back,’” Johnson recalls with a smile. “That’s what it’s all about.”
colon and rectal surgery
It Can be Lonely at the Top