Beyond the OR: The Alexanders ​Balance Orthopaedics and Marriage

In the world of medicine, as dedication, skill, and a passion for healing intersect, remarkable stories often unfold. Within the demanding realm of orthopaedic surgery, where mending bones and restoring mobility are paramount, an extraordinary tale unfolds—a story of two orthopaedic surgeons who not only excel in their careers but also have built a profound connection beyond the OR.

“My story on deciding on orthopaedic surgery is blasé compared to the story of how I met and married Charlotte,” sports medicine and trauma specialist A. Herbert Alexander, MD, FAAOS, told AAOS Now when asked about how he met his wife, hand and wrist surgeon Charlotte E. Alexander, MD, FAAOS (referred to here as Herb and Charlotte).

“I met Herb when I was a surgical intern at Naval Medical Center, Oakland, California, rotating on ortho. He was a chief resident on orthopaedics,” Charlotte said. The pair did not get together until she became a resident, however. “We literally went out on our first real date in August, and he asked me to marry him. I was shocked but in love with him.” Two days later, Charlotte accepted the proposal. Three months later, they were married.

Since then, Drs. Alexander have been operating together for more than 40 years at their practice, Alexander Orthopaedics in Ketchum, Idaho. “Sometimes we disagree—and rarely keep quiet about it. We laughingly book these kinds of cases for ‘The Bickersons,’” Herb quipped.

Drs. Alexander answered AAOS Now’s questions on the benefits and challenges of being a husband-and-wife team in orthopaedics, how they manage stress, and advice to young couples pursuing careers in orthopaedics.

Charlotte: Long turnover times and support staff in the OR who are not prepared for the procedure.

Herb: Turnover time. I seem to spend more time between cases than I spend operating. This has been the case at every hospital I’ve worked at, except for a surgery center I worked at briefly. If the surgery center can figure it out, why can’t hospitals?

What advice would you give to young couples who are both pursuing careers in medicine or surgery?
Charlotte: Both partners in the relationship need to be supportive of the other in their careers and share the responsibility of raising a family, etc., equally—that includes planning ahead for childcare/nanny and, ideally, someone to do the house cleaning, meal prep, etc., and other chores that a full-time mom has to do, as well as taking care of children. This needs to occur prior to deciding to have children. Plan proactively for success not stress. Most critically, if possible, I would recommend to female residents that they wait until they have finished their training to have children. However, it does not seem that now there is any great time to start a family.

Herb: Wait to have children until you complete your training. In my opinion, having a nanny in the home to look after children is a much better solution than out-of-the-home childcare.

How do you manage the stress of working in a demanding field, and what do you do to unwind after a long day at work?
Charlotte: Take care of yourself first. Get as much sleep as possible, get plenty of exercise, preferably before you go to work if possible.

Herb: Exercise and hobbies and other nonwork interests are key. I make time for tennis, working out, aviation, hiking, skiing, computer technology, and time with Charlotte.

What do you believe are the most important qualities for a successful orthopaedic surgeon, and how do you work to cultivate these qualities in yourself and in your trainees?
Charlotte: Focus and drive, hardworking, eagerness to continue improving your skills and knowledge, humility, and being caring and willing to spend plenty of time with your patients.

Herb: The successful trainee is affable, available, responsible, honorable, ethical, knowledgeable, and technically competent. Except for knowledge and technical competence, these traits cannot be cultivated. The successful orthopaedic surgeon already has them. We can work on knowledge and technical competence, but the rest are innate or are heavily influenced by parenting, which occurred prior to my involvement.

What are the benefits and challenges of being a husband-and-wife team in the same field of medicine? How do you overcome any potential conflicts that may arise? 
Charlotte: It is wonderful to be able to work together, combining our skills in our own particular fields. Herb is a very skilled surgeon and my senior.

Fortunately, because I am a hand surgeon, our fields overlap. I don’t do shoulder or elbow except for neurovascular problems (i.e., plexus injuries, cubital tunnel, tendon transfers, etc.).

Herb: I must say that the benefit of having our husband-and-wife team is that I almost never have to worry about getting an assistant for a difficult case that warrants a second orthopaedic surgeon. Charlotte is there for me, and I’m there for her. And we know each other’s style and surgical technique. However, conflicts do arise. I’m dispassionate in the OR, and Charlotte is passionate. Sometimes, I have to tell her, “Cool your jets.”

A familial legacy
Drs. Alexanders have inspired not only each other in the OR but also their eldest daughter. Their daughter, Amy Ostrofe, MD, is completing a hand surgery fellowship at the University of California, Davis.

“The year 1986 was significant for me. It is the first year I started as an oral examiner for the American Board of Orthopaedic Surgery [ABOS]. It was also the year my first daughter, Amy Alexander, was born,” Herb shared. “Fast-forward 36 years to July 2022. Amy was 36 and had completed her orthopaedic surgery residency 2 years prior, and I still am an examiner 36 years later. Each year, the ABOS sends out a list of examinees to be sure there are no conflicts of interest. In my list of examinees was Amy Ostrofe, MD. So, of course, I had to recuse myself from examining her. But we had a great time, celebrating her achievement.”

On sharing more than 40 years of marriage, raising two daughters, and accumulating numerous accolades throughout both of their careers, Herb said, “There’s more to this story, but it would take a book.”

Cailin Conner is the associate editor of AAOS Now. She can be reached at cconner@aaos.org.