Del
Mar resident Dr. Scott Miller is fortunate in that he
experiences many rewarding moments in his career as a
cosmetic and reconstructive plastic surgeon, but none
more so than in the work he does through his involvement
with the Interface International Surgery Program. His
work with the program takes him to various areas of Mexico
where, as part of a medical team, he operates on children
with disfiguring birth defects or accident related disfigurements.
Miller said he became involved in
the program because he liked the vision of its founder,
Dr. Jack Fisher, who established the program at UCSD
in the late '70s.
"I have looked at a number of these types of
programs and where I feel they always get themselves
in trouble or fall short is they try to be too grandiose-I
liked the fact that Jack has always kept this program
small," Miller said. "We go to small colonies
in Mexico that are underserved but we don't go and
say, 'Here we are to save the day, now move over';
instead, we come together with them and say we are
there to offer our assistance. Some of these locations
have excellent plastic surgeons, what they often don't
have is the facilities and supplies and ancillary personnel
needed. We offer them the wherewithal to do their work-sometimes
we will learn as much from them as they do from us."
Miller said the group travels down
to Mexico about six times a year and he goes on about
three of those trips. They bring with them equipment
such as portable suction kits and anesthesia machines
so they can turn ordinary rooms into operating rooms.
Miller said they also bring with them a team of personnel
specializing in different areas because many of the congenital
defects they deal with need more than just one type of
treatment, for example, in addition to plastic surgery
the patient may need dental work or speech therapy.
"Our triage consists of multiple stations with
mini-clinics so if I see a patient whose palate is
not closing properly I may send him over to the speech
pathology station to be assessed there, or if I see
a patient who has bicuspid teeth coming in and he needs
some bone in there then I send him to see the oral
surgeon about a possible bone graft so his tooth can
grow through a solid foundation," Miller said.
Miller's group generally goes to a
specific spot in Mexico for three to five days at a time
and set up a clinic with about five rooms. On the first
day they see patients, make a determination for treatment
for each patient and then create a schedule for the next
few days that will allow the medical team to perform
all the treatments necessary (and possible).
"We tell people when to come back, what to do
in preparation for surgery, and have a pediatrician
check them first to make sure they have not had a recent
illness because that would prevent us from performing
surgery," Miller said.
He added that the three most common
defects they treat are cleft lip - either on one side
or both, cleft palate and cleft lip nasal deformity.
While Miller and his colleagues mostly
work on children they also treat some adults.
"It is very rewarding because you go in there
and see things that don't look right on people and
you leave there and they look and feel much better," he
said. "Now granted they are going to continue
to have a certain amount of deformity and will need
to have fine adjustments in the future, but you did
the big thing and that is important."
One of his most rewarding cases occurred
recently and it involved a boy who fell from a third
story window. Miller and his colleagues were treating
children at a Red Cross center when they received an
emergency call for help from a local hospital. The little
boy who had fallen from the window had several severe
facial fractures.
They didn't have a plastic surgeon
at the hospital, just an ear, nose, and throat doctor
who needed assistance. So Miller and operating room technician
Norman Kier went over to the hospital and worked as a
team with the doctor to help the boy.
|
"It is amazing how much they can accomplish
at those local hospitals without half of the equipment
we have," he said. "Some of the stuff we
use almost seems superfluous. All of our stuff is disposable
and all of their stuff is reusable, for obvious reasons.
When we got there we determined the boy had a fracture
of his mid-facial bone and a fracture of his palate,
requiring mini-screws and a micro-facial kit which
of course they didn't have a the hospital. So my colleague
and i discussed it with the doctor and we ended up
using a hand held drill - the kind your 7-year old
would have in his little tool kit. It was sterilized,
of course, and we drilled two holes and using wire
that wasn't really the right kind of wire, we wired
the bones together so this child would have a stable
palate that wouldn't float around when he ate, and
wouldn't develop growth deformities. It was an incredible
experience."
Miller said the experience was made
even better by the appreciation the boy's parents showed.
"As we left the boys parents came up to us and
thanked us and asked us how they were going to pay
us. That is interesting because in America when you
come out of 13 hours of trauma surgery the first thing
you usually hear is, 'Is this covered by insurance,
why did it take so long?' - no thank you or how are
we going to pay you. Of course, we told the boy's parents
that no payment was necessary, it was just so nice
that they thought to even ask."
Miller said on their last night in
town he and his colleagues were out for dinner and the
boy's parents came over to the table and brought them
four bottles of tequila - valuable items in that region
- to say "thank you."
"That was very heart warming and made us all
feel very good," Miller said. "The thing
about these trips is that they are not really philanthropic
or charitable because you get as much as you give.
They make you feel so good that you feel like you are
the one doing the taking."
That feeling is one of the reasons
Miller decided to go into medicine. Raised in Las Vegas,
Miller is the son of a radiologist although he said that
fact didn't really influence him to go into medicine.
"I really made a decision to go into medicine
based on what my day would be like," he said. "I
spent time with friends of my father's, in their operating
rooms, in their offices, and I decided it would be
a really thrilling way to spend your day - working
on people, helping people, talking to people - I liked
all parts of it."
Miller says that when he talks to pre-med
students he recommends that they don't make a decision
to go into medicine based on whether they like biology,
instead he recommends that they spend time in different
offices and see what their life would be like if they
were a physician.
In choosing his specialty, Miller considered
several factors. First, he determined he wanted to be
a surgeon because, as a lifelong sports and art enthusiast,
he felt that performing surgery was much like creating
art or participating in a sports event. |
"I read these great articles
by an author from the University of Chicago who was right
on when he said art, surgery and sports all have one thing
in common and that is a sort of state where you lose track
of time because you are so engrossed in an activity. I
just love that experience where time stands still."
Miller is quick to dispel the myth
that surgeons don't like interacting with patients.
"I love seeing patients; this misconception
that surgeons operate but they don't like patient care
is not true at all. There is no closer bond than between
the surgeon and someone who allows them and trusts
them to operate on them and make them better. That
is an incredibly tight bond and I enjoy my relationships
with my patients."
However, he also realized that, to
suit his personality, he needed the type of specialty
where he could "fix the problem."
"I do have a short attention span from that
standpoint," he said. "My father-in-law is
an oncologist and it is a wonderful calling, it is
unbelievable what he does. when we go out to dinner
with him in Las Vegas people come up to him and hug
him and kiss him and sat, 'Thank God for you, you gave
my wife Edna eight years she never would have had.'
But I realized I could never do that. I need to see
a problem, go into the operating room, fix a problem,
feel good about it and go home. My personality is such
that I need that quicker feedback."
Plastic surgery seemed a perfect match
for Miller because it allowed him the satisfaction of
the operating room, the fulfillment of working with and
helping people, the thrill of immediate results, and
a certain amount of creativity.
"Of all the surgical specialties it was the
most creative to me and having that love of art in
my background it meant a lot to me that each operation
would be unique," he said. "I actually spent
time with a surgeon who was a classmate of my father's
and he saw a child with a deforming scar and he basically
sat there with a pen drawing on the child's face, developing
a pattern that was going to be able to fix the deformity
and give the child a better life. No to make light
of other specialties because they are so important,
but the fact that plastic surgery is so creative really
appealed to me."
Miller went to college and medical
school and did his general surgery training at UC Irvine;
he did his plastic surgery residency ay UCSD. In culmination
he studied with one of the top experts in the field -
Dr. Bruce Connell - and now Miller has been in private
practice at the Scripps Medical Office Building in the
La Jolla area for about 5 1/2 years. A member of the
American Society of Plastic Surgeons, he is also an attending
surgeon at Scripps Memorial Hospital in La Jolla, a voluntary
clinical instructor of plastic surgery at UCSD, and the
author of numerous articles and a chapter on facelift
advances in a plastic surgery textbook. He and his wife,
Lisa, have two boys, and one girl and have lived in Del
Mar for about five years.
Looking to the future, he hopes to
spread the word and get more people involved in the Interface
International Surgery Program. In the meantime, Miller
will continue to go down to Mexico as often as he can.
"I have found my calling and I feel blessed
to do what I do," he said. |
