Enduring Lessons

Three generations of Hoya orthopedic surgeons reflect on their common practice

Three orthopedic surgeons practicing in Modesto, California represent what it means to attend medical school at an institution like Georgetown, where history can more easily be counted in generations than years. Doctors Donn Fassero (M'74), Todd Smith (M'91), and Richard Han (M'09) all graduated from the Georgetown School of Medicine in successive generations. The three Hoya doctors happen to be working together under one roof, in an orthopedic practice of six surgeons at Sutter Health, a network of physicians and hospitals in Northern California.

Studying medicine in an era of change

Donn A. FasseroDonn A. Fassero (M'74)

A Seattle native, Donn Fassero did his undergraduate work at the University of Washington at the height of the Vietnam War. At the time, ROTC was mandatory for healthy male students at state schools. He became an officer after graduation. Fassero had an interest in science—his undergraduate degree is in pharmacy—but he didn't think about becoming a doctor until he was stationed at the Brooke Army Medical Center in San Antonio, Texas, where he worked in the burn center. The new therapies being developed there for burned soldiers fascinated him, and his commanding officer encouraged him to consider a career in medicine.

After three years on active duty, he decided to apply. He was in Kodiak, Alaska, working in a pharmacy there, when he got a call inviting him to a personal interview at Georgetown. He got himself on a plane and headed to Washington. He remembers hoping the interviewer was impressed that he had come so far just for the chance to attend the school. Georgetown had a reputation for seeking diversity in its student body. As a veteran and a little older than the typical applicant, Fassero thought he might have an advantage. He was admitted and started school in 1970.

Fassero recalls Washington in the early 1970s as a very exciting place to be. The Watergate scandal as well as anti-war and civil rights movements were all playing out in Georgetown's backyard. He worked at a pharmacy on P Street and filled prescriptions for members of Congress and Supreme Court justices. Capitol Hill and Pentagon staffers were among his neighbors. He frequented as many of the events on campus as he could and heard speakers from all walks of public life. "Some of the students were just exhausted from college and getting into med school, but I wanted to take advantage of all the opportunities."

During his second year, the D.C. government eliminated a subsidy that it had been offering to medical schools in the city. Fassero's tuition doubled overnight to more than $20,000. He was able to continue on his own savings from his years in the work force, his part-time earnings at the pharmacy, and a small stipend from his GI benefits.

In his fourth year, Fassero had an opportunity to intern in Johannesburg, South Africa. He worked in what was called the "non-European hospital" that served non-whites including Indians and Zulus, offering him the opportunity to see the impact of apartheid firsthand. "The 'whites only' atmosphere was appalling, but it was a beautiful country," he recalls. "At the time it was peaceful, but you could see something was going to change soon."

He rotated through programs in the Veteran's Administration, D.C. General Hospital, and the P Street Clinic, working there in psychiatry with a child who was a paranoid schizophrenic. "After six weeks I went to the professor and said, 'I worked as hard as I could, but this poor soul is no better— in fact I think he is getting worse!' It was so frustrating. I was resigned to failing the course, but the professor said, 'Son, you have to have patience, and by the way, maybe you should consider surgery.'"

His lack of an affinity for psychiatry notwithstanding, Fassero found that he did love surgery. George Hyatt taught orthopedic surgery, and was an early mentor, instrumental in honing Fassero's interest in what has long been a very competitive field. Fassero notes that today many students learn orthopedics differently, with more subspecialties. "We were trained more as generalists—fellowships were not typically available. We did everything—club foot deformities in children, all kinds of fractures, trauma, and knee replacements. Now you have a more restricted practice—shoulder, neck, or spine surgery or joint reconstruction."

After Georgetown he was accepted to the Mayo Clinic for his orthopedic training and completed both his internship and residency there, before going into practice in Modesto in 1979. "I think Georgetown has a lot of appeal for a lot of reasons. Two weeks after I started, I got a call from Yale where I had been waitlisted. They said there was an opening if I wanted to come. I said 'I don't think so.' I just liked everything about Georgetown and I'd only been there two weeks. It was a great opportunity and a great education."

Living Georgetown values

Todd C. SmoithTodd C. Smith (M'91)

Todd Smith grew up an only child after his father passed away when he was small. His mother was a physical therapist, so from an early age he learned about rehabilitation. It was around junior high when he thought, "It might be cool to be a doctor." Even so, he graduated from UC Berkeley, worked for a few years while getting an MBA, and married his childhood sweetheart before deciding that medical school was something he really wanted to pursue. He applied and was accepted to Georgetown, coming to Washington with his wife in the late 80s. Like Fassero, he had saved enough for his early tuition bills from his years in the work force. After that he managed on loans and his wife's earnings, but incurred a fair amount of debt. "It was modest by today's standards, but basically the equivalent of a mortgage payment—without the house to go with it."

He was drawn to orthopedic surgery from the beginning. "They were the guys with plaster on their scrubs and scissors in their pockets. They looked like they were having fun—and it IS fun putting people back together again." Smith also believes that orthopedic patients may be disproportionately grateful to their physicians. "By the time they get to see you, they have usually put up with not only pain, but lack of function in their lives. When you can fix those two things, it's significant."

What Smith remembers most about medical school is, although it was rigorous academically, "Georgetown was a family—everyone was there to try to help you succeed. They taught you up front that this is not about being better than the guy next to you. This is about working together to make the patient better."

Smith also acknowledges the growing fragmentation in the field. "In Donn's era, people were generalists who became subspecialists and now people aim at subspecialty initially. Many sports doctors only want to do sports when their practices need them to do some general as well."

Though they attended Georgetown School of Medicine 20 years apart, Smith and Fassero had many of the same teachers that are now legendary. "Proctor Harvey taught us to listen to the patient. He was such a wonderful clinician. He would get so much from talking to the patient before he ever put on a stethoscope. John Dillon was general surgery chair—with him you had to be prepared to sweat the small stuff. He broke down your assumptions. It's not about knowing; it's about understanding."

Smith credits the medical school for teaching him to always focus on the patient first. "It permeated everything— the tests you order should confirm what you thought after examining the patient. Not the other way around. I recognize that quality in both Donn and Rich," he says.

Smith also recalls an emphasis on teamwork and leadership—you had to be good at both. "Being around Georgetown and in D.C., you were around leadership all the time—the concept of physicians as leaders and learning how to step up to that role. You had to be a respected member of the team to lead it. Leadership is about removing the barriers for the people you are trying to lead. To this day, I think about that when I am training new partners or physician's assistants. It was the underpinning of how they trained us at Georgetown."

The value of listening

Richard J. HanRichard J.Han (M'09)

A native Californian, Han is the son of Korean immigrants who owned a deli and coffee shop in the Bay Area. He was motivated to work hard by his parents, who got up at 3 or 4 a.m. to open their shop. He has wanted to be a doctor for as long as he can remember. He earned his undergraduate degree from UC Berkeley, and like both Fassero and Smith, spent time working before applying to medical school. He entered a one-year graduate program at Georgetown and while there, fell in love with the university and the city and applied to the medical school. He graduated in 2009, going on to an internship and residency at Temple University and a fellowship at University of California San Francisco Medical Center. He joined Sutter Health last year.

He did not receive financial aid, and acknowledges that the debt is daunting, but he does not regret it. "A Georgetown education is a worthwhile investment," says Han. "It's a brand that is well-recognized. But the debt can make it hard to go into lesser paying fields." Early on, his interest shifted from cardiology to orthopedics. "You can fix problems immediately, as opposed to managing problems over the course of a lifetime," he says.

Georgetown offers a strong support system, says Han. "It was a great community. No matter how competitive a field you wanted to go in, they would help you. After a test we would have a party on the lawn. It was a very 'work hard/play hard' atmosphere." Han fondly recalls Jack Delahay, the legendary professor of orthopedic surgery, as "easily the greatest teacher I ever had in my life—a character of characters. He was good at putting the pressure on and finding the humor in it, while making you want to step up and learn more."

Han speaks fondly of the relationships he made while at Georgetown, forging some of his closest friendships there. "We would spend hours studying together at school and then spend many hours enjoying the nightlife D.C. had to offer. And I met my wife Aimee there when she was a graduate student —a real Georgetown romance story."

Han believes that Georgetown's Jesuit principle of cura personalis guided his education and now his practice. "I met with a patient the other day who had been referred by her primary physician for her shoulder. She said, 'You're the only doctor who listened to me.' There wasn't much more I could do for her at that point but listen, but I learned the value of that at Georgetown. You have to listen to the patient. It's not just a limb or an isolated problem—there's a bigger picture."

As the new kid on the block, Han is impressed with his colleagues, both for their experience and their leadership. "Leadership is something we were challenged to take on at Georgetown. Donn is past president of the California Orthopedics Association and Todd is chair of the Sutter Health board, so I see the challenges coming," he says. In the meantime, the proximity of his partners means Han can always call upon them. "When I have a tough case, Donn or Todd is always down the hall from me. That's what medicine is —a constant learning experience."

By Patti North
Patti is the director of alumni communications in Georgetown's Office of Advancement and an occasional contributor to Georgetown Medicine. She can be reached at pn66@georgetown.edu.