Dr. Sigvard Hansen challenged assumptions and helped turn around trauma care

SIXTY-PLUS YEARS ago, alone on a broken-down tractor somewhere in the middle of 300 acres of farmland in the Spokane Valley, 10-year-old Sigvard T. Hansen, Jr., figured out what was wrong, and fixed it.

Repeated rendezvous with such balky farm machinery taught Hansen valuable lessons, ones that some day would help him plow a wide swath right through the middle of medical orthodoxy.

True, the looming pixie dust of determinism that had begun to sprinkle the husky youngster didn't signal anything particular about feet — the body part that today is indelibly linked to his name around the world.

But there was plenty about self-reliance, about analyzing the problem, keeping your eye on the goal and, ultimately, making things work.

The grandson of Danish immigrants who settled in the tiny town of Wilbur in Lincoln County, young Hansen, known as Ted, was expected to work very, very hard and always to be honest and fair.

As he sat on the broken tractor, he knew better than to seek out his dad, a demanding high-school principal, athletic coach and teacher who, with his brainy wife, was growing beans and wheat and raising pigs, chickens and cows — plus three children. Hansen, the oldest, knew what his busy dad would say because he'd heard it plenty: "Just fix it."

A strong, smart young man who entered Whitman College in 1953 to study mechanical engineering, Hansen veered when he ran into theoretical mathematics. He couldn't see it or touch it, so it didn't make sense to him.

Comparative anatomy, though, was real. In medical school at the University of Washington he quickly turned to a specialty tailor-made for his skills: orthopedic surgery.

If times had been different, if he had been different, he might have become just another surgeon. But whoever wrote that script wasn't counting on a couple of Hansen's most enduring, celebrated and sometimes cursed qualities: fearless independence, incredible "3-D" perception, and the drive to muscle past opposition when he's sure he's right.

Ultimately, such qualities would lead to his recognition as "the father of traumatology" for his role in building Harborview Medical Center's vaunted emergency-care system, and to worldwide prominence as a foot and ankle surgeon.

LIKE MUCH OF the world around it, Harborview in the 1960s was in transition. Treatment of broken, diseased and deformed bones, previously a subset of surgery, was gaining strength as its own discipline. Word of new, drastically different European techniques for fixing broken bones was raising eyebrows.

And at Harborview, plans were under way for a system — formalized as Medic One in 1970 — that would for the first time deliver large numbers of major accident victims to the hospital alive.

Into this swirl came Hansen. The former college-fraternity president and football-team captain had spent three years as the lone medical officer at a Navy ammunition depot in Hawaii, where he'd revamped routines and solved long-standing patient issues.

Even while still in training, the young doctor was singled out early on to insert the hardware to fix fractured hips, relying on what others called his "golden fingers" and "uncanny gift" of three-dimensional perception. He was so competent, superiors often didn't bother to supervise. Hansen quickly rose through the ranks and became a teacher himself.

In the late '60s, as students were experimenting with drugs and radical politics, Hansen also was testing new ground. Dumping medical dogma, he adopted the controversial new European techniques for repairing severe fractures of trauma patients.

Standard practice had long been to put patients with thighbone fractures into casts and long-term traction, where they healed slowly, growing weaker and often developing pneumonia or blood clots. Sure there was a better way, Hansen soon began fixing their fractures within hours, nailing metal rods into their broken bones.

As a result, patients quickly began walking, giving them a fighting chance to recover from their other injuries.

Dr. Robert Winquist, later hired by Hansen as a young resident, recalls being awed.

"He wasn't doing anything that was in the books. I asked him early on, 'Where do you get your information?'

"He said, 'I don't ask anybody east of Ninth Avenue' " — the hospital's street — essentially eliminating the entire U.S.

Intent on refining the techniques, Hansen broke rules and sometimes used unorthodox methods, such as using old drain pipes to bend metal rods to better fit inside a patient's leg bone.

"He tried my patience," admits Dr. D. Kay Clawson, then chairman of the orthopedics department at the UW, which manages Harborview. But Clawson, who was instrumental in bringing the techniques to Harborview, also recognized Hansen's talent, and protected him.

At conferences, Hansen and Winquist, who helped refine the techniques and document results, began revealing their methods to other surgeons.

"They would shout 'That's malpractice!' " Winquist recalls. "Pretty much everything we did was considered malpractice."

Hansen ignored them.

He was "brave enough and good enough" to make it work, Winquist says.

As orthopedic trauma became more specialized, Hansen increasingly focused on feet and ankles, medically underserved body parts where trauma, genetics or disease can render a person nearly helpless. His skills served him well in those complex structures, whose many angles and planes often stymie other surgeons.

There, too, he met opposition from the establishment. And there, too, he changed history.

In the end, Hansen became an icon, says Dr. Andrew Sands, a New York surgeon and protégé in the mid-1990s. "He single-handedly changed the way foot and ankle surgery is done in the United States."

Across the country, the doctors who have trained with him list membership in the Spinoza Society, a group begun years ago by Hansen and Sands, vowing to challenge dogma, each other and themselves. Its motto, Hansen says: "Don't believe what the big guys tell you."

SINCE HIS college years, Hansen has thought a lot about feet, particularly about the atavistic traits that cause foot problems. Feet, he says, are our most uniquely human body part, fascinating from a mechanical as well as medical perspective. Ultimately, he likes taking a "crooked, terrible foot" and making it work.

Mike Kilpatrick has a couple of those.

In an exam room, Hansen greets Kilpatrick, a retired school administrator with diabetes and genetic foot issues. He can't walk. Both feet have collapsed, have stubborn ulcers and are painful. The toes on his left foot have been amputated.

At 73, Hansen is a strong man with steady, muscled hands that feel reassuringly warm and sensitive. He picks up Kilpatrick's left foot, gently feeling for pulses and muscle tightness.

They chat about Kilpatrick's years teaching in Africa and Indonesia, swapping stories of adventure. Hansen laughs easily, asks lots of questions and listens closely. He wants patients to know him, and he wants to know them, for what may be a long journey together.

Other doctors told Kilpatrick that more amputations were his only option. Hansen disagrees.

"So there is something that can be done?" his wife, Sally, asks cautiously.

"Oh yes," Hansen assures them. "I do it all the time."

More stories ensue, and eventually, Hansen details procedures involving cutting Kilpatrick's calf muscles and inserting metal pins — "what we call rebar" — into his feet.

"I was trained that none of this could be done," Hansen tells them. "I decided everything I had been taught was probably baloney."

Kilpatrick nods. "Things change . . . .You've always got to be open."

Before he met Kilpatrick, Hansen reviewed his X-rays with his "fellows," the doctors who train with him. He insists they discover not just what a patient has, but why.

"You need to figure out the cause of the problem," he says, "or else the treatment will never work."

Hansen genuinely likes his patients, likes not knowing whether they can pay, likes teaching. It's what has kept him at Harborview.

Time after time, he's jumped off the career track to return to patients and teaching. His intolerance of bureaucracy is legendary, despite chairing the UW orthopedics department from 1980 to 1985. Asked then if he would consider being a dean, he shot off a note: "I consider my five years as chairman to be a prelude to Hell. I would consider being a dean actually arriving there."

He refuses to use e-mail, dictates notes and derides "playing with computers" instead of caring for patients. Hospital officials tolerate his heresy because he brings in money, he says. He makes a good living because what he does isn't easy, he adds, and "everybody can't do it."

Hansen is not arrogant, says New York video producer Christopher Hansen, his older son by his first marriage. "He's not about 'me,' about himself. He wants to make people better. It's never been about him."

ROSALIE GIZINSKI, 72, is out cold in Operating Room No. 9 in Harborview's basement. She's waited almost two years for this surgery by Hansen, director of the Sigvard T. Hansen Jr. Foot and Ankle Institute.

Until two years ago, she and her husband, Gene, walked around Green Lake every morning. Previous surgeries failed to help much, and now, pain has curtailed her life. Her podiatrist told her to see only Hansen.

Hansen's patients come from afar, often with complex problems, and wait months to see him.

Some have been turned away by other surgeons, including those who avoid difficult cases. "My answer to that is: Who the hell takes care of the people who aren't ideal but have serious problems?" Hansen says.

Hansen believes in surgery. He chose it over less drastic options when he had heart problems at 64, and again with prostate cancer. "I think it's the best way to go."

Outside the operating room, Hansen stands at a sink, scrubbing. Hands in the air, he backs into the room and slips them into latex gloves.

As he and his trusted team prepare to remove Gizinski's ankle bones to make room for a metal-and-plastic implant, they move in quiet unison. His nurses each have been with him for more than a decade, his usual scrub tech for 25.

"He's very easy to work with," says Anne Foster, his circulating nurse. "He's so steadfast — no big drama."

Darrell Flamand, the implant manufacturer's representative, watches Hansen, as he often does. "He's amazing. He'll do these extreme cases that would take another surgeon all day to do, and he'll be done in two hours."

Other surgeons use a "jig" or guide. Not Hansen.

"The jig is his brain," says Winquist.

As the time ticks by on the big operating-room clock, Hansen and Dr. Erik Novak, a fellow, work over Gizinski, intent and focused. Hansen lets Novak do some, occasionally guiding him. "See that?" he asks, checking placement on X-rays displayed nearby.

Two hours later, they're done. With a fellow, Hansen may tackle four cases a day. While he's operating, he won't feel aches or fatigue.

When the 12-hour day is over, he suddenly notices that his knees ache, and he finally sags.

HANSEN SAYS he plans to retire from surgery by age 75. He's got patients lined up until then and nothing to prove.

Looking back, he speaks almost fondly at the once-bitter opposition he inspired. Gone are the cries of "malpractice!"

"The things that we did that were so controversial are all standard now," he says a little wistfully.

A few foot-and-ankle surgeons still oppose him "because they have different philosophies," Hansen says. "Of course, I don't make any bones about the fact that I think they're full of . . . ."

It's not that he hadn't made mistakes. He has, and talks about them with candor and regret. He once invited the mother of a patient to sue him, but she declined. Since 1976, only two patients have filed claims.

His biggest challenge, he says, is convincing patients that he might fail. "I have to tell them that this is a bad problem, and I may have trouble with it."

At conferences, talk often turns to the question: "Who'll be the next Ted Hansen?"

He wonders that, too. He's not sure anybody today could buck medical orthodoxy the way he and his colleagues did, he says, because today's "evidence-based medicine" requires prior "evidence."

"It's absolutely crazy," he says. "People who would be innovative are sort of shut down these days."

But that dilemma may have to be solved by others.

A January safari-and-winery-visiting trip to Africa with his wife, Dalia, was significant: It was his first "real" vacation — no slides or manuscripts.

For the past decade or so, his man-against-mountain struggle has moved closer to home: He's been trying to keep the house above Perkins Lane above Perkins Lane. Over 12 years, he's built a series of walls, moving heavy rocks.

Now, he mostly works on a basement wine-cellar excavation and rockwork project.

His aching knees need surgery, but he doesn't have time, he says. "I'll do that when I retire."

Carol M. Ostrom is a Pacific Northwest magazine staff writer. She can be reached at costrom@seattletimes.com. Benjamin Benschneider is a magazine staff photographer.