You know what, one of the things that I have enjoyed of being part of this family at the AOFAS is just the access that I've had to so many of my teachers. And the access isn't just, hey, you know, how do I do this bunion better? Hey, how do I do that ankle replacement? It really is to get to know them as a person. And it's to find out, you know, what makes them tick. And so I feel lucky that I've had great role models. And I think part of having a role model is getting to understand who they are on a daily basis. I'm interested in, for instance, Mike Coughlin. At the end of the day, would you prefer red wine or Pabst Blue Ribbon? Over breakfast, do you drink your orange juice first or do you drink your coffee first? So I think I asked Keith if he could get maybe Roger and Mike together to talk about the real important questions and share who they are with us. Keith? Yeah, so I remember when my when my twins were in high school and they got this assignment that they had to interview their grandmothers and find out the family history. And since Mike, since Tom was my first fellow, it kind of makes me his dad. And since I trained with Roger, it makes him his grandfather and kind of makes Mike the uncle. So we're going to do a little bit of family history here. And it's it's kind of a unique experience. I think back to my first foot and ankle meeting in 1986 in Santa Fe, New Mexico, and they were thrilled to have 76 people there. We had six exhibitors in a little basement room in a hotel. And we look out here today and we see where we've grown and where we've come to. And a lot of that comes from the efforts of these two individuals up here. I think I got the opportunity to interview Roger because although Mike was his first fellow, I'm his favorite fellow. He loves all his children equally. But I want to start just getting a little bit of history and really asking Roger first, why did you select medicine? What made you decide to become a doctor? I have no good idea. For some reason I always wanted to be a doctor, even in junior high school. People ask me what I want to do. I said I want to be a doctor. And that's what I pursued. And why orthopedics? Why orthopedics? Well, when I got into medical school, I had no more idea what an orthopedic surgeon was than the man in the moon. And in anatomy class, they started showing us these movies on the function of joints that they'd actually made at UC. And it so intrigued me, I thought it was wonderful. So that got me going towards orthopedics. Then, while in medical school, I had a summer job with the Army and they flaked out on it. So I talked to Vern Inman, who was the chairman of the department, and he had a biomechanics lab at UC. This is San Francisco. And I said, can I work in your lab this summer? He said, sure. Nobody's ever asked me that. He said he'd be delighted. I said, so would I. So I spent the summer working in a biomechanics lab with two researchers who were working on the subtalar joint function. Vern Inman, although he was a Ph.D. in anatomy, he loved the foot. That was his favorite joint. So these guys were working on the motion of the subtalar joint. And I said, can I join with you? And they did. So I used to work with them and collect the data. And I found that very intriguing. So from then on, it was strictly orthopedics. I just wanted to go into orthopedics. And when I finished my, let's see, would have been medical school, I applied for orthopedics. And the donkey who was the chairman of the department then, Dr. Inman, had stepped down, said, no, the program's full. You can't get in, Roger. So I was sort of unhappy about that. So I went to see Vern Inman again. And I told him, I'd like to spend a year with you in the biomechanics lab. That's in lieu of a year of general surgery, which is masochistic. And he said, sure. He said, I'd be delighted to have you. So I said, well, Dr. Lucas, I can say his name now because he's dead. He said, I couldn't get in. He said, Roger, we'll take care of you. So the next thing I knew, I was in the orthopedic program. And that's where I was. I spent a year in biomechanics, learning as much as I could about the function of joints, but particularly the foot and ankle, because that's what Dr. Inman liked. So I just did that. And then when I started my residency, people said, oh, you know a lot about the foot. I didn't know anything. I knew how it worked mechanically, but I had no idea what a bunion was or anything else. And so that's how I sort of started doing more foot and ankle. So who are the other mentors that got you involved and who educated you in foot and ankle and directed your surgical career? Well, that's a good question because it wasn't anybody. Foot and ankle was zero. When I was at the VA hospital, the doctor who ran the program, I said, I kind of like foot and ankle. He said, well, my interest is in the negative range, and I have trouble getting it up to zero. So that showed you how much I got out of that. For a hammer toe, it was a proximal phalangectomy. For a bunion, it was a Keller. And that was all there was. So there was nobody there to teach you. You just had to pick it up, reading and seeing bad results that they had, and wondering how you could improve upon that. And Mike, what got you interested in medicine? Well, so I came from a little different standpoint. I grew up in Idaho, and my father was the second board-certified orthopedist in the state. He'd come there after the war, but he'd grown up there. And so he was really my role model, and I actually thought if I could be half of what he was, I'd be successful in life. And so I think he's long gone at this point, but he was my role model to go into medicine. And how about orthopedics? How did that happen? I had really two kind people who were both chairmen of departments. Rod Beals, who's Tim Beals' father at Portland, at the University of Oregon, and then Sherm Coleman at Salt Lake City for the Coleman block test. I mean, two real giant people who took time during my medical school to give me individual teaching and really sold me on orthopedics. And how about foot and ankle? Well, so then I came to UCSF, and he's the last man standing, so to speak, figuratively, in other words. But Roger was a role model and a very busy foot and ankle surgeon. I was in the East Bay much of the time, and I got to know him, and that was why I went into foot and ankle surgery. Roger, back in the day when things started moving and you started building your career, I mean, what did you envision as your career in foot and ankle, and what did you think would happen? I didn't know a thing. I really didn't. It's funny, as you look back now that I'm—let's see, how old am I? Sixty? Sixty-two. And you look back at your career, you say, how did you do these things? You know, how did things fall into place? Well, they don't. You just kind of keep wandering along a path, and things just sort of keep happening. Nothing's planned as far as I can—as far as I'm concerned. Fortunately, everything tended to work out, and I wasn't afraid of working hard, and I just kept doing it. How did the AOFES get started? Well, I'm not that old. But anyway, it was mainly started by a group of orthopedic surgeons in the East Coast. There was nobody on the West Coast except maybe Bill Wagner from L.A. who was doing anything pertaining to the foot. Most of it came from the East Coast. At least that's what they thought. And so they got together, and they decided they wanted to have a society. And there were about—I think about 15 or 20 of them started the society, and that's how it got going. And when did you get involved? Because you were secretary for 20 years? Nine years. Horrible. Anyway, project back a little bit. This now was in, what, the late 70s or early 70s? There were no computers. There was no nothing. Everything had to be done by hand. And so I got into the foot society because I heard about it, and I went to a meeting, and they were looking for people to join. So I joined. And the older gentlemen who were there wouldn't let me do anything. They said, no, you're from the West Coast, and we don't put up with West Coast people. They're all crazy. So I got to know some of them, and they realized I was crazy, but I would work. And nobody wanted the job as secretary. They all—you say, who wants to be secretary? Everybody took two steps backwards, and I was still standing there. So I got to be secretary, and that's how it went. And so nobody else wanted the job, so I just kept being secretary and secretary. So after nine years, my family and I got sick and tired of it, and I told them, I have to move on. I can't keep doing this. So that's when my secretarial job ended, and I became vice president. So who were some of the presidents that were there when you were secretary? Jim Bateman from Canada, from Toronto. A wonderful man. Sort of funny. He's Canadian. Great guy. And he was hard of hearing, and we would go to meetings out of the country or elsewhere, and somebody would ask him a question. He said, eh? So I'd go over and whisper in his ear what the question was, and I realized that was just his way of expressing himself, eh, as Canadian. So I kind of made an idiot of myself. But anyway, Bob Samuelson was there. He was from the West Coast. He was a very good foot and ankle surgeon. And then, oh, what's the name of the guy from Stanford? My brain is going, too. I can't think of his name anyway. He was a very nice person, too. But there weren't very many from the West Coast. And when did the whole idea of having a summer meeting come about? Do you remember what the first meeting was? Well, the first meeting, we were talking about it at the board several times, and nobody could decide on it. Nobody wanted to take responsibility for it. So finally, I think somebody on the East Coast, I don't know if it was Goldner or who it was, was it John Gould? He said, well, I'll take care of this. I'll get one going. And he put it together at the Greenbrier. Thanks, Mike. And that's when they had the first meeting. I don't know how many people came. I know I didn't go. It was sort of scheduled the last second. There were several people from Boston, Arthur Trott and John Gould's father, Nate Gould, and Joplin, he was from New York, and Mel Joss, who was from New York. They were all kind of working towards it. So, Mike, how did you meet Roger? So I was a junior resident at UC San Francisco and rotated to the East Bay, and Roger would come to several of the hospitals, and that's where I ran into him. He was a very busy foot and ankle surgeon, and so we interfaced a lot. And what about him impressed you? Well, what impressed me, well, so he was a hard, hard worker, and he was very organized. And some of those traits I've tried to carry on. He'd come in, he'd tell the scrub nurse what he was going to need and what he was going to do, and he'd set the stage for this. He never seemed like he was in a hurry, but his cases got done in half the time, because he was so well organized. And how did the fellowship start? So, towards the end of my residency, I went, and there was only one fellowship in America, think of that now with 56 or so. There was one in Cincinnati with Gin Estrus, and I said, can I just come out and hang out with you for six months? And that's how it really started, and this went on now. I forget if there's 76 fellows that you've had or something of that nature, but it started with me in 1978. So when you looked at Roger, what qualities about him did you most want to emulate? Well, so he had never done this before, and I hadn't been a fellow either, so we had to train each other. I held retractors for six months because he didn't know what to do with me, but that was fine with me. I just wanted to see his moves and learn that. He was probably the finest surgeon I'd seen through the whole UC program, and so I wanted to emulate that. His organizational skills, his hard work, but mostly his intellectual honesty. I mean, he'd say, do you think we can say that? And what was fun was bouncing ideas off of him. He never felt challenged by that. And what made you decide to let Michael stay? I didn't. He did. He phoned me up and said he wanted to be my fellow, and I told him I don't have a fellowship program. He said, well, you do now, and that's how it started. So he was my first fellow, and they just sort of kept snowballing after that. I had 76 fellows for six months at a time, and they were delightful to work with, and it was fun. Most of them were very talented people. You can see the results on my right and left. But anyway, fellowship teaching was very good. I gave it up last year because my volume had dropped off too much, and I couldn't train them fast enough. But anybody who has a big volume foot practice, I would advise you to consider starting a fellowship program. So there's an echoing message there with I don't have a fellowship, but you do now, because 20-some-odd years ago here in Boston when the AOFS meeting was here, Roger Mann walked up to me and said, I want to introduce you to your first fellow. And I said, but I don't have a fellowship. And he goes, you do now, and he introduced me to Tom Lee. So I guess there's a tradition here as well. So Roger, when you look back at your years on the board at AOFS and your time as president, what change or what effect do you think you brought to the AOFS that meant the most to you? Well, I think I helped make it a very open organization. The nice thing about foot and ankle society is everybody's basically equal. Everybody who wants to can run for office, get on the board, and things like that. Some of our other stuffier friends in hand and hip and things like that, they keep you guys down, whereas we always wanted to be friendly towards everybody and welcomed everybody. It took a long time to gather people together, because first of all, nobody knew anything or liked anything about the foot. We had to convince them what a great field it was. And we did that over time. Can you talk a little bit about Henry DeVries and his influence in your life? Well, Henry DeVries was a podiatrist who practiced in Chicago. And I don't know how exactly this happened, but when I was still in the Army, a group in Oakland, which I eventually joined, had invited DeVries to come out and do footwork for them. So he had sort of an established foot practice in Oakland, and I joined that group. And what I would do is on my spare time, when I first got started, I'd stop down in his office and watch him do things and learn things. And that's how I started to learn about the foot and ankle. He was a very good surgeon. He was very dogmatic. He had certain rules to do things. Why do you do it? Because this and this exists. And I learned a lot from him. After you move past the forefoot, he didn't do much. But everything else around the forefoot, he was very good. Mike, when you got involved in AOFAS, Mike was actually the youngest president of the AOFAS. When you look back at your time as president, what are you most proud of? Well, I think a couple of things. It's hard to believe, but when I became vice president, I was 38 years old. So you sort of reflect on what a change this was from the older gentlemen, not including Roger, who were president, and John Gould, who was young. But it was a huge youth movement that sort of came in, and that's what I think was a major move. You think of the people that I invited to go along for the journey, like Tom Clanton, Glenn Pfeffer, Greer Richardson, Jim Brodsky, Mark Meyerson. They all became later presidents. And it wasn't just me. It was this youth movement, all those young people with high energy that transformed this into what we see today. Secondly, what was very special to me was I wanted to give women a place in this society. And the first thing I did was rewrite our bylaws from saying he and him to we and us. And secondly, I started the women's footwear panel to give women a voice in the media to talk about women's issues. And lastly, I chose Francesca Thompson as the first woman subspecialty program chair. She was in line and became president-elect, but unfortunately succumbed to multiple myeloma. But she would have been the first woman subspecialty president in all of the AOS had she not passed away. We had to wait for Judy B. 10 years later to fulfill that role. So I think the youth movement, including women and an equal status in this partnership, were the things that I cared about most. And how did IFAS come about? So IFFAS is our international arm that we partner with all of our friends from around the world. And they've been a major part of the AOFAS for a long time. And so many of our sort of past presidents said, let's try to organize this in a way that we can educate the world, but they can educate us. And so every three years, we have this triennial meeting that moves from Asia to America to South America to Europe. The major thing was not to waste a lot of money and to do this expeditiously. And so one last question before Sheldon cuts us off. Roger, you're 82, although you act more like you're 62. I can attest to that. When you look back, what makes you most happy and what are you most proud of? Well, I'm happy about what we see here. Look at the audience we have out here now. When you stop and figure that our first meeting that we had was just this one little group right over here, standing in the sands in Santa Fe with Mel Joss at 104 degree temperature wearing a coat and tie. No, I think the way the organization has grown makes me really very proud and very happy that I was able to contribute to that. And then also being able to train 70 some odd fellows in Futton Eichel, I thought was a wonderful undertaking. They like it, I liked it. And I basically had the opportunity to transform foot and ankle surgery. When I got into it, the field was chaotic and I took it upon myself to try to organize it. And then in my practice, I had a busy enough practice, I could see things, I could try things and if they worked and I liked the results, I then published papers. And I published a paper on every major procedure that we do around the foot and ankle. And by doing that, I was able then to establish a background which gave me material to put in my textbook, which eventually was passed down to Mike and on to, who's doing it now? Charlie Aniston. Bobby? Charlie Saltzman and Bobby Aniston. Yeah, that's right. Charlie Saltzman does it now. So anyway, I was just able to organize all this material, put it together so we have basic standards to use as we do different procedures instead of the chaos that I walked into. Mike, what makes you most happy when you look back at your years in this career? I think just the educational experience. As Roger said, it was so primitive in those days, there were very few things that we do. And I see the exciting changes that not only happened, but have come about. And I think if you look at an old orthopedic textbook, there's four pages of foot and ankle surgery. And now we have volumes that speak to the educational opportunities and the opportunities to help our patients. I think we've come a long, long ways. But just the fact that you're here means the journey continues for us too. Excellent. We should give a round of applause, everybody. Roger Mann, Michael Coughlin, Keith Wapner.

Dr. Roger Mann

Dr. Michael Coughlin

American Orthopedic Foot and Ankle Society

influences and mentors

growth of AOFAS

foot and ankle surgery