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Editorial


Front Page - Friday, January 5, 2018

Restorations a passion for Apyan


Hips, knees or Model Ts, surgeon fascinated with ‘how things work’



One step inside Dr. Paul Apyan’s waiting room, and it’s clear this is no ordinary doctor’s office.

On one wall hangs a convex Model A Ford windshield converted into a black-framed mirror. A working replica of an antique popcorn machine greets patients with a comforting, buttery smell that permeates the entire fourth floor of the medical building. A red-and-yellow 1930s Gilbarco gas pump topped with a lion image towers near the check-in desk.

“I bought it partially restored but it wasn’t a good restoration,” Apyan, 64, says of the gas pump. “I knew I could complete the restoration and, now that I’m in my own office, I want people to understand who Paul Apyan really is. That gas pump is a part of me. It’s part of who I am.”

Apyan, a talkative physician who almost didn’t make it into medical school, is one of the area’s best-known orthopedic surgeons, with nearly 6,000 hip and knee replacements under his belt and 30 years of experience training surgical residents from Switzerland to Hong Kong.

In the spring of 2017, he left a large practice group to open an office next to Parkridge Medical Center.

The son of an Armenian immigrant – his father’s parents fled the Turkish genocide that began in 1915 – Apyan grew up in Kenosha, Wisconsin, in an apartment above the family’s rug cleaning store. “We cleaned carpets for a living. We repaired Oriental rugs,” Apyan recalls, pointing to a photo of his dad.

“My parents felt the greatest thing you could do for your children was to give them an education. So, with me and my three siblings, my parents paid for all of our education, including my going through medical school. And then we each got a car when we graduated. My parents gave us a tremendous advantage.”

Apyan set out to study architecture at Miami University in Oxford, Ohio. But during his senior year of high school, he suffered an eye injury and underwent two surgeries for a detached retina.

“And I thought, ‘This is pretty cool, the notion of helping people when they really need help,’” he recalls.

He switched his major to chemistry but couldn’t get into medical school because his grades were too low. Finally, after working for a year in his dad’s business, Apyan was accepted into the University of Wisconsin School of Medicine – on his third try.

“I have a folder at home that has 51 medical school rejection letters and one acceptance letter,” he says. “I have a persistence-based mentality.”

After completing residencies in general and orthopedic surgery at the University of Tennessee at Chattanooga, an orthopedic trauma fellowship in Munich, Germany and an arthroplasty fellowship in hip and knee replacement surgery in Ontario, Apyan returned to Chattanooga and began practicing in 1987.

Affiliated with both Erlanger Medical Center and Parkridge for more than 30 years, he also served as an associate professor in the Department of Orthopedic Surgery at the UT College of Medicine. He no longer practices at Erlanger.

In the early days, he did mostly trauma work.

“Then as you get older, you get tired of taking all those calls in the middle of the night [from] all the motorcycle wrecks and the car wrecks,” he points out. “That’s why I did a second fellowship, so I could back away from the trauma as the younger doctors came in. Then I gravitated toward doing more of the elective joint replacement surgeries, and that’s where I am now.”

Quirky and direct – “I’m kind of an odd individual, and a little goofy,” he admits.

Apyan loves to joke around with his patients and encourages them to call him Paul. This morning at the hospital, he explains, he checked in on a woman on whom he performed a total knee replacement yesterday. When he asked her how far she’d walked today, the therapist in the room interjected, “10 or 15 feet.”

Grimacing, Apyan teased the patient, “Had I known you weren’t going to walk much, I’d have put a used knee in you to save money. I mean, we’ve got to control our Medicare costs here.”

She looked surprised, but Apyan quickly set her at ease. “Of course, I’m kidding,” he assured her. “If you’d said you walked 500 feet, I would have said, ‘Only 500?’”

Apyan also prides himself on personal service.

“Our office answers the phone every time you call,” he says. “There is no automated phone tree. I’ve also told the girls, ‘If it rings more than three times, we’ve lost a customer.’ And every time you come to see me, I’m who you see. There’s no nurse practitioner. There’s no PA (physician assistant).

“If you want to see Dr. Apyan, you make an appointment and that’s exactly who you’re going to see.”

His new office features a number of nostalgic touches designed to make patients, many of whom are Baby Boomers like Apyan, feel welcome. In one room is a blue porcelain 1920s Watling drugstore scale for monitoring weight. A 1925 Chattanooga Medicine Co. advertisement hangs in the hallway. The doctor plans to decorate his patient rooms with car themes centering around Model A and T Fords from the early 1900s, a 1965 Corvette, and a “Back to the Future” DeLorean, all of which he owns.

“As an orthopedic surgeon, I’m somewhat mechanically inclined,” he adds with a grin. “I’m fascinated with how things work. I’ve taken things apart just to see what the heck was there. I’m a curious guy. Why does your seatbelt catch you when you slam on the brakes? Someone had to think that through. Pretty cool.”

His interest in restoring cars was sparked when, at the age of 22, he bought a 1926 Model T after watching the classic comedy film, “The Great Race,’’ starring Tony Curtis.

“It was beat to death, rust and black,” he remembers. “No upholstery, no interior, top missing. And my dad said, ‘Someone put a piece of junk in our driveway.’” It later sat in the family’s warehouse for almost 35 years; Apyan finally fixed it up a decade ago.

Today, he owns eight collector vehicles. The oldest is an Oldsmobile from 1902, the first year they were manufactured. All have been restored or are awaiting parts. When Apyan outgrew his first 1,000-square-foot garage, he built another, then another. Then he started restoring old gumball machines, gas pumps and other devices. “Every antique device I have,” he notes, “works as originally intended.”

An avid traveler and compulsive list-maker who thrives on being productive, Apyan has spent many years studying his patients – not just their medical conditions, but their personalities. He has learned to speak differently to people of various cultures, he says, because “you have to recognize who you’re playing ball with.”

Gone are the days of the authoritarian doctor in the white coat who barks orders and steers patients toward an employee who stiffly schedules his surgeries. Now, he explains, the physician must know how to communicate with the patient, something that may come more easily to Apyan because he, too, has had a hip replacement.

“Data shows that the patient will determine in 20 seconds, once the doctor enters the room, if that doctor’s going to be their doctor or not,” he acknowledges. “Doesn’t matter if they’re male, female, white, black. So, my job is to put them at ease immediately. … I’ve got to disarm the patient, if you will, and make them feel comfortable so they’ll tell me the truth and they’ll hear me.

“Now once I give you the information about what your problem is, I’ve got to make sure you don’t make a bad decision.”

Still, Apyan says he believes in giving them options: steroid injections, medication or surgery. “I’m actually like a waiter in a restaurant,” he points out. “Today we have a wonderful six-ounce filet. We have a free-range chicken breast. And we also have salmon. Which one of those is the right answer? I have no idea. If the fourth option was a glass of hemlock—that we’re not going to do.”

Despite his congeniality, Apyan doesn’t mince words with his patients.

“I’ve been accused of being very direct, which I am,” he says. “[I might say], ‘Come on, you’re 306 pounds. What the hell did you expect to happen to your hips when you’re 57 years old?’ I’ll do that to people because they need to understand that they’re part of the problem and they’re part of the solution. All I’m going to do is operate on your hip. After that, it’s up to you.

“You’ve got to do the exercises. You’ve got to take the pain medicine that’s prescribed, and only as prescribed. And if you do, you’ll be really happy with me.”

In his practice, Apyan is seeing more and more baby boomers, many of whom are obese or need additional procedures. He also treats younger patients who wouldn’t have been considered good candidates in years past, partly because the technology has improved.

“Twenty-five, 35, 50 years of being overweight, plus being older, speeds up the deterioration of the weight-bearing hip and knee replacements,” he says.

“If you carried 500 pounds of cement in the trunk of your car, the rear tires will wear out sooner. That isn’t hard to explain. That doesn’t mean I don’t like the car that’s full of concrete. It just means it is what it is.”

Five years ago, Apyan went back to school and earned his MBA. Rather than do it online, he opted to attend weekend classes while maintaining a bustling practice.

“I’m fascinated by business,” he says. “Having grown up in the carpet cleaning business above our store, how you make money honestly and ethically is very interesting to me. The business of health care today is mass confusion.”

In his last semester, a professor approached him and asked, “Could you help my sister-in-law?”

The teacher pulled an x-ray out of a folder “that looked like it had been stomped on by 100 elephants,” Apyan explains.

The 56-year-old woman, it turned out, had been born with a dislocation of the hips, had endured a botched operation as a child that worsened her condition and hadn’t walked without great difficulty in 50 years.

She was only able to leave her sixth-floor apartment in Albania twice a year, when relatives carried her down the stairs to visit her mother. She had no health insurance.

In 2016, Apyan performed the operation at Erlanger, which agreed to a reduced rate. He convinced the hip replacement company to donate the implants, and he did the surgery for free. Four months later, the woman returned to Albania. She now walks with a cane, can get in and out of a car by herself, and walks to the neighborhood market.

“This is why you go to medical school – helping those people who don’t know they actually are going to benefit from what you can do,” Apyan says.

In December, he will replace a second hip in a patient who is now 100 years old and “mentally clear as a bell.”

He did the first one five years ago, when she was just 95. “She’ll be 101 in April, and she and I have a birthday a week apart,” Apyan says. “So, we’re going to have a birthday cake for that.”

His favorite part of being a surgeon is operating, which, he says is “actually a lot of fun.” A close second is interacting with the patient and preparing her mentally for what lies ahead.

“I can put a hip in a damn elephant if I have to,” he explains. “I don’t mean that from an arrogant posture. If you’ve been in the same community for 30 years, and you don’t have a zillion lawsuits hanging over your head, you’ve been good to people, and people are willing to come back and see you 29 and a half years later, maybe, just maybe, I did something good.”