Courtesy Campbell Clinic
To be perfectly honest with you,” says Dr. S. Terry Canale, sipping coffee at the window table in the men’s bar of the University Club, “I’m no John Grisham, but I’m doing all right with it.”
With a well-deserved reputation, earned over four decades as a top orthopedic surgeon with Campbell Clinic, one might wonder why this esteemed physician is comparing himself to the best-selling author.
It’s because Canale retired (well, sort of — more about that later) on the last day of December 2015, and, with time on his hands now, he’s describing his newest venture. Deciding that nobody would read his memoirs even if he bothered to pen them, Canale has turned his writing skills to a novel. He’s midway through the first chapter, and he has a title for it: Murder by a Croquet Wicket.
“It started out as Murder by Croquet,” he explains, though he is reluctant to divulge the plot, “and then I thought, what about the wicket — the things you stick in the ground and have to shoot through them.”
It’s that attention to quirky detail that makes any conversation with Canale such an entertaining affair, for this is a fellow who once played touch football with Elvis, talks about midnight ambulance rides, ran in the Memphis and Boston marathons, firmly believes “lunch is for sissies,” served in the Army under the son of General Patton, and eventually landed in the emerging field of orthopaedics because — are you ready for this? — the other candidate for the position hanged himself.
It’s safe to say that the Canales are a Memphis institution. In the early 1900s, various members of the family made their fortunes in such wide-ranging business ventures as liquor distribution, wholesale groceries, and even funeral homes. In the 1960s, six brothers of John D. Canale became famous for their athletic skills. Writer John Branston described Frank, Justin, Whit, Conn, George, and Billy as “Memphis’ First Family of Jockdom,” and all these young men went on to impressive, though perhaps short-lived, careers in college and professional football.
“I was just a cousin to them,” says Terry Canale, “but it was really a lot more than that.” The “other” Canales owned a grand home at Belvedere and Harbert, and for a time “until I was 14 or so,” he lived with that family, and others joined the clan, until 620 South Belvedere, and a newly built house out back, eventually became home to more than 20 people.
“Back then, we played peewee football, and every single person on our team was a Canale,” he remembers. “Because my uncle ran the Spencer-Sturla Funeral Home on Union [later Canale Funeral Directors], we had jerseys with ‘Little Diggers’ stitched on the back.” Among the other kids they played with was a youngster named Elvis, “but that was before anyone knew who he was,” says Canale. “To us, he was just some nice kid driving a truck for an electric company.”
While his cousins opted for football scholarships with Southeastern Conference schools (mainly Ole Miss and UT), Terry Canale decided to attend the University of Virginia, and played lineman for the Cavaliers. Unfortunately for him, the team was in the midst of a 28-game losing slump.
“I had wanted to be a football coach,” he says, “but we had such a lousy team that I was a graduate assistant for only four days before I realized that wasn’t my calling.”
Dr. Canale, named Best Resident Teacher, speaks at the Campbell Clinic Resident Graduation, held at the Memphis Country Club Ballroom.
So he came home and began to take courses at then Memphis State University, after deciding on a career in medicine. His grades weren’t good, he admits, and his major didn’t help his chances of getting into med school. “I majored in geology because I was a football player,” he says, laughing. “The dean asked me what geology was, and I said it was the study of rocks, and he said, ‘You can forget about that.’”
So Canale took other coursework, repeated some of his basic science classes, and eventually got accepted to medical school at the University of Tennessee-Memphis, where he graduated in 1967. He earned a surgical residency at Philadelphia General, which was run by five different universities in the area. By this time, the war in Vietnam was raging. “Back then, you had something called the Berry Plan,” he says. “By the luck of the draw, if you were a doctor you either got sent to Vietnam as soon as you graduated, or you got a one-year deferment.”
Canale drew the “short straw,” as he says, earning a one-year residency at the Mayo Clinic after his stay at Philadelphia General. But he never made it to Mayo. Still in Philadelphia, a doctor there asked if he would consider a residency in orthopaedics. Apparently there was a “sudden opening.”
“I told him I wasn’t interested, hadn’t even thought about it, but he insisted that I talk with the head of the orthopaedic department at Jefferson Medical College, a brilliant surgeon named Anthony De Palma” (whose son became the famous film director, Brian De Palma). Canale was given two choices: take the residency in orthopaedics, or get shipped to Vietnam.
“And then De Palma told me something else,” says Canale. “‘You have 24 hours to think about it. But you can sub for the resident who two weeks ago hanged himself in the hallway.’ I thought to myself, “Holy ….”
So Canale served his orthopaedic residency in Philadelphia, and this was when he embarked on a lifelong health-improvement regimen. “I weighed 220 when I played football,” he says, “but in medical school all that athleticism went to pot because I was going to class all day and night, and I just turned into a slob. So I started running, and my weight dropped.”
When his tenure in Philadelphia was over, he joined the U.S. Army Medical Corps as a captain (leaving the service as a major) and was transferred to Ft. Hood, Texas. “Our commanding general there was George Patton’s son,” he says. “I never got to meet him, but people said he was just like his old man, riding around on a horse, carrying pearl-handled pistols.”
His military tour of duty finally over, Canale began to search for employment. He considered an offer from Campbell Clinic, in the 1970s a growing practice with some 14 surgeons tucked away in a small brick building at 869 Madison. “I told my wife, I’ll see what they offer, and I’m not going to work for a penny under $20,000. Well, they offered me $40,000, which I thought was fantastic, and that was that.”
He joined the Campbell staff in 1974, and that’s when he began what might be called phase two of a self-improvement plan: better eating habits.
“When we were on Madison, we had the worst kitchen. They served roast beef and mashed potatoes and gravy, and if you stepped away to take a phone call, when you came back, it was all congealed,” he says. Then there were the “fat pills.” The cafeteria served big chunks of cornbread, “and they would just lob these into the deep fryer, and they floated up when they were cooked. The grease would just be dripping off.”
So Canale began to avoid these lunches, and he discovered another advantage. “I went to the office and finished up early, and if I didn’t eat, I could go over to surgery and get the best nurses and best equipment, get started early, get finished early, and have the best of both worlds. So I just quit eating lunch.” Even today, he insists, “Lunch is for sissies.”
When he started at Campbell Clinic, Canale explains that orthopaedics was not considered a large specialty, and many hospitals didn’t even have orthopaedic specialists. “General surgeons did hips, knees, amputations, and everything else,” he says. Orthopaedists mainly focused on back problems. “So it’s changed a lot. General surgeons won’t even do amputations now; it’s beneath them. Or course, orthopaedic surgeons really don’t like to do them either.”
Why not? “It’s unrewarding,” he says. “Let’s say a cardiologist has tried to restore circulation to a bad leg, but it failed. So you’ve got a dead leg and the best you’re going to get out of it is a person legless, who’s going to need a stump or a prosthetic.”
Eventually, with a major role played by Campbell Clinic, the world of orthopaedics grew to include other joints, especially hips and knees. “And that all began with [Campbell Clinic founder] Willis Campbell,” says Canale. “He started it all with Richards Medical here, who made specialized appliances for him, like the prosthesis the guy with the dead leg could walk on. And one thing led to another. That’s the reason all the medical companies — Smith and Nephew, Richards, Wright, Sofamor Danek — are here, because of Campbell.”
Canale was initially interested in pediatric orthopaedics, after receiving a Berg-Sloat fellowship while serving at Ft. Hood. “They paid me money to travel to different hospitals, and I picked pediatrics,” explaining that orthopaedic problems in children, then as now, are labeled either “hot” or “cold.” Cold orthopaedics involve congenital problems: a hip dislocated at birth, or a child born with six fingers. “Hot” usually means fractures, which are still huge problems with active children.
But he didn’t focus on pediatrics very long. “When I got back here, having played football, I began taking care of the Memphis State football team, and more or less the Ole Miss team as well, so I took care of students at those schools for almost 25 years.” Because of his interest in tennis, he became the “go-to guy” for players competing at The Racquet Club as well.
In 40 years, Canale has witnessed dramatic changes in orthopaedic surgery and medicine. “Back in the 1970s, if you operated on a knee or hip, the incidence of infection was around 10 percent,” he says. “That compares to less than one percent today. And whenever you got an ortho infection, the joint was usually destroyed. You couldn’t do anything with it. But all that’s changed now, because of better antibiotics and better procedures.”
He can tell horror stories of the “old days,” which really weren’t that long ago. Canale particularly remembers a case involving a young man, who developed an infection following a prodedure, and ultimately required 17 operations just to get rid of the infection.
The other major advancement was the development of total joint replacement. Years ago, the standard treatment for a bad hip, for example, was to replace just the ball at the top of the femur. “We had what you called cup arthroplasty,” he says, “and that was basically opening up your hip, taking all the arthritis out of it, cementing a steel cup onto it, and hoping it didn’t get infected. That was considered state-of-the-art when I was starting out.”
The other common procedure was joint fusion, as crude as it sounds. “If you had really bad arthritis or an infection, we’d take one end of the bone and stick it to the end of the other bone, and it would grow together as one bone. You had no bending at all, just a totally stiff joint, but that was all we had. “
So the big advancement has been the total joint, where the entire knee, hip, shoulder, or elbow is replaced with a high-tech joint.
The other change has been the materials used. “We’ve gotten away from metal-on-metal, which turned out to be a disaster,” he says. “The stainless steel reacted with the body, so patients were getting these big cysts around the joint called pseudocysts.” New materials, such as teflon and high-strength plastics and polymers, have almost eliminated that problem.
The new materials, combined with advances in technology, mean the new joints last much longer than they used to. “When I was coming along, the idea was to save the total hip operation for the old lady, because she might outlive the joint if we operated on her if she was too young.” Back then, a hip joint was expected to last about 10 years, and replacing it was difficult. “Now that they are lasting 20 and 25 years,” he says, “the attitude is, ‘Hey, doctor, operate on me when I’m young so I can have a better quality of life and be useful. Don’t wait until I’m too old, so old I can’t walk.’”
New surgical techniques have also brought about changes. “Shoulders are fantastic now,” he says. “We used to do a fairly poor total shoulder operation. They came loose and caused problems.”
But Dr. Quin Throckmorton at Campbell Clinic developed a solution called the reverse shoulder. Just as the name suggests, the ball and socket of the shoulder joint are swapped, which allows more strength and freedom of movement. “You’ve now got more muscle pulling across the top of the shoulder,” says Canale. “So that’s a big thing, and we’re doing a lot of those.”
An equally impressive discovery was the development of minimally invasive surgery. “Back in the 1970s, we kept people in the hospital for one or two weeks, just for stupid things. Now we can send them home the same day.” Campbell Clinic has even begun running TV ads for same-day hip replacement surgery, something that would have been considered impossible, or at least extremely risky, years ago. “We do the surgery that morning, work with a pain specialist to control the pain, and they go home that evening,” he says. “They have to sleep in a special bed, and will work with a physical therapist, but they don’t have to stay in the hospital. Hell, even I hate to stay in the hospital!”
He speaks from experience, with two total hip replacements in recent years. How does it feel for an orthopaedist to undergo his own orthopaedic surgery? “I got the two best guys at Campbell to do them, James Guyton and James Harkess, and I trained both of them,” he says. “And I told them, I want to stay awake and watch, to make sure you clowns do it right.”
So the surgeons set up a mirror allowing Canale to monitor the procedure, while he had a spinal block. Or so he thought. “I just remember one of them saying, ‘Goodnight, Dr. Canale,’ and poof, I was gone. Later, I said, ‘You lied to me!’ and they laughed. You don’t keep anybody awake for something like that.” Not even Dr. Terry Canale.
Courtesy Campbell Clinic
Campbell Clinic helped Dr. Canale celebrate his 40 years of orthopaedic service with a distinctive pair of eyeglasses.
During his 40 years as a surgeon, Canale has operated on “more people than I can remember.” He recalls surgeries on tennis star Bobby Riggs, but the rest are a blur. He remembers some amusing moments in the operating room. One time, a patient asked, “Dr. Canale, do you also own that funeral parlor?” and he reassured him, “No, that would be a conflict of interest.”
Over these four decades, he has shared his knowledge and experience in countless ways. He has been chief-of-staff at Campbell Clinic, chairman of the UT-Campbell Clinic Department of Orthopaedic Surgery, and president of the American Academy of Orthopaedic Surgeons. He has served as editor of Campbell’s Operative Orthopaedics, the 5,000-page textbook that is considered the bible of the orthopaedic field.
Even in the age of the Internet, the Operative is a best-seller. “We literally wrote the book on orthopaedics, and it’s now been translated into eight languages,” Canale says. He has authored, at last count, 58 book chapters and 59 medical journal articles. Until 2015, he was the editor of AAOS Now, the journal of the American Academy of Orthopaedic Surgeons. He is also involved with the clinic’s own quarterly, Campbell’s Research Journal.
Though he is supposedly retired, that merely means he will stop seeing patients. Canale will continue working in Campbell’s research and education departments, interview potential residents, and work on the forthcoming edition of the Operative, which comes out later this year.
In the last editorial he wrote for AAOS Now, Canale bid farewell to his readers in this way: “Who needs a 74-year-old orthopaedist? I’m at the age that I’m being operated on more often than I’m operating. When I was younger, patients would say to me, ‘You’re going to operate on me, right, and not the resident?’ Now they say, ‘Are you going to do the operation? Can the resident help?’”
At the same time, he wrote, “I’m not leaving the orthopaedic office and going home to hibernate.” In addition to painting that he took up years ago — his colorful acrylics have been displayed at galleries around Memphis — he’ll swim and play tennis at the University Club, travel to the Gulf Coast with his wife, Sissie, and spend time with daughter Haines and son Robb and his five grandchildren. And, though by his own admission he is no John Grisham, perhaps someday soon he will be signing copies of his best-seller, Murder by a Croquet Wicket.
