Some photographs you stage. This one the universe staged for us — twice, in the same corner of the same exam room, 27 years apart.
On 27 February 1999, I propped my two-year-old, Alexandria, up on the clinic chair at the Texas Diabetes Institute in San Antonio. Larry Lavery and I were in the early, caffeinated years of trying to understand the diabetic foot. There is a clock on the wall and a date stamp burned into the corner of the film. I was thirty-something, with hair.
This week — same room, same chair, same clock — that toddler is back in the chair. In scrubs. Having just graduated chief resident.
The giants who raised her
Here is the part that undoes me a little. I did not hand Alexandria this profession. My academic family raised her into it.
Lee C. Rogers was our fellow in Chicago nearly twenty years ago, back at the Center for Lower Extremity Ambulatory Research (CLEAR) at Scholl. Today he is Chief of the Division of Podiatry at UT Health San Antonio — Alexandria’s boss. The endowed chair he now holds once belonged to Prof. Lawrence Harkless, one of my great mentors, in the very division where Larry and I started in the mid-1990s. “Full circle” does not begin to cover it.
Larry Lavery — my research partner since 1995, the man Andrew Boulton once dubbed the other half of the “Lennon and McCartney of the diabetic foot” — was one of her attendings. (Lee recruited him to San Antonio. He recruited Bob, too.)
Bob Frykberg — whose textbooks and mentoring taught half of us this field, from The High-Risk Foot in Diabetes Mellitus onward — was her residency program director.
So she was handed, giant to giant — from one of my fellows, to my closest research partner, to one of the founding figures of the modern diabetic foot — and walked out of that same clinic as their chief resident.
Three generations
My father was a foot doctor. I followed in his footsteps — literally the most humble part of the body, which I have always thought was rather the point. Alexandria is now the third generation of podiatric surgeons in our family. And the place that started it for Larry and me is the place that finished this part of her training. The chair, apparently, was just keeping her seat warm.
People ask why I keep going on about the team approach — toe and flow, the multidisciplinary clinic, weird ideas and weird people in one room. This is why. The team is not only how you save a limb. Over a long enough horizon, it becomes a family. Sometimes literally.
A toast, for posterity
Twenty-seven years ago, in an exam room at the Texas Diabetes Institute, I propped a giggling two-year-old up on a clinic chair while Larry Lavery and I were busy trying to figure out the diabetic foot. Tonight, that toddler graduates chief resident — in the same building, the same division, trained by the same giants.
Lee Rogers was my fellow in Chicago nearly twenty years ago; now he’s her chief. Larry — my partner of thirty years, the man Prof. Boulton once called the other half of the “Lennon and McCartney of the diabetic foot” — was her attending. And Bob Frykberg, whose textbooks half of us learned this field from, was her program director.
So I didn’t just hand my daughter a profession. My academic family raised her into it — one giant passing her to the next, until she walked out of that same clinic as their chief resident.
Lee, Larry, Bob — thank you for finishing what Tania and I started. Alexandria — that chair has been waiting for you for twenty-seven years. Congratulations, Dr. Armstrong. To our progeny, personal and professional.
Congratulations, Dr. Armstrong. Go make a difference and pay it forward. The chair’s yours now!
With gratitude to Lee C. Rogers, Lawrence A. Lavery, and Robert G. Frykberg Prof Lawrence B. Harkless— and to the Texas Diabetes Institute and UT Health San Antonio.
#LimbPreservation #ActAgainstAmputation #DiabeticFoot #ToeAndFlow #Podiatry #ChiefResident #UTHealthSanAntonio #TexasDiabetesInstitute #Mentorship #ThreeGenerations
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