A Surgeon's Saga
7/9/2003By Richard Broderick
The patient in O.R. 6 today is a 41-year-old woman undergoing surgery to create a new valve connecting her stomach to her esophagus.
The operation will alleviate her gastroesophageal reflux disease, a kind of never-ending heartburn in which stomach acid washes up into the esophagus, irritating the tissue lining of that organ. If untreated, the condition causes more than discomfort. Many patients suffering from reflux go on to develop cancer of the esophagus.
The procedure, fairly complex under the best of circumstances, has been made even trickier by the failure of a previous surgery performed elsewhere. In the words of Dr. Michael Maddaus (B.S. '78, M.D. '82), the thoracic surgeon performing the operation today at Fairview University Medical Center, the old surgery was "botched."
But the patient is lucky. Maddaus is co-director—and a major instigator—of the University's new Center for Minimally Invasive Surgery, which opened this April. One of a handful of surgeons in the United States able to perform laparoscopic resections of the esophagus, he holds the endowed Garamella Lynch Jensen Chair in Thoracic and Cardiovascular Surgery and was recently inducted into the American Association of Thoracic Surgeons. Both are singular honors for a man so young (Maddaus turns 49 this fall) and are testimony to his renown in minimally invasive techniques.
Those techniques will speed the recovery for today's patient and ease her post-operative pain. Instead of a long incision requiring weeks to heal—the normal route to the esophagus taken during traditional "open" surgery—Maddaus is operating through several small portals in the woman's abdomen through which are inserted wandlike instruments tipped with clamps, scalpels, and other instruments, including a tiny, high-resolution video camera.
As Maddaus and the other surgeons assisting him manipulate the instruments, they view the interior of the woman's thoracic cavity on four flat video screens attached to overhead booms and arranged at various angles around the head of the operating table. The screens are part of the equipment in the hospital's new "endosuites"—operating rooms dedicated to minimally invasive surgeries and equipped with the latest high-tech equipment. In addition to the video monitors, the ceiling-mounted towers in the endosuites feature voice-activated telephones (for real-time consultations with surgeons elsewhere), lights, monitors showing the patient's vital signs, and more.
Two of the endosuites have already been installed, two more are planned. They constitute the key clinical feature of the University's minimally invasive surgery center, which also includes an education center and research laboratories. In years to come, the center will train every surgical resident at the University in minimally invasive techniques, and will also serve surgical fellows specializing in minimally invasive surgery and surgeons who've completed their training but wish to come back and brush up on minimally invasive procedures. In one fell swoop, the center places the University in the forefront of this burgeoning field of medicine.
Fit, relaxed, focused, Maddaus looks the very picture of worldly accomplishment, a man who has gone from success to success without breaking stride. Married to a high-risk obstetrician, the father of six children (the two oldest of whom are University students), he seems like the kind of guy who rode the fast-track to the top.
That is, until you notice the sprawling tattoo plastered over the top of his muscular forearm—a relic of his time in the Navy—and hear him joke with colleagues about being a high school dropout and juvenile delinquent. Strange but true, he was both—a kid who seemed more likely to grow up to spend his life languishing in a jail cell than in command of a high-tech operating room.
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"He was this little lost soul," says Robin Schiebel, who met Maddaus when they were both 13 and became his on-again, off-again girlfriend through their teen years.
Like many of the teenage girls who hung out with Maddaus and his male friends in and around south Minneapolis, Schiebel grew up in a conventional, middle-class Kenwood home. Maddaus, however, did not. "I don't remember him going to school, just hanging around outside when we'd get out at the end of the day," Schiebel recalls. "There were no boundaries in his life."
Indeed, during his earliest years, Maddaus lived with his mother and grandmother, a divorced Norwegian immigrant. An alcoholic, his mother became pregnant with Maddaus during an affair with a married man who worked with her at the restaurant where she waited tables. Until he was in his twenties, Maddaus was under the impression that his biological father was dead; when he found out the truth, he sought the man out. "I just wanted to see what he was like," he says. "He offered me money, but I think it was to avoid trouble, not because he cared about me." It was the only meeting that ever took place between the two.
What stability Maddaus ever enjoyed seems to have been provided by his grandmother. When she died of cervical cancer, home life slid into chaos. "I have only spotty memories of anything before I was about 12," he admits—not an uncommon phenomenon among people raised in chaotic conditions. "Home" was a succession of rental houses and apartments around south Minneapolis. "He and his mom were always moving around," Schiebel recalls. "I can remember them being in four or five places, all in the same area."
After marrying and divorcing a couple of men, his mother ended up marrying a guy who'd just retired as an enlisted man in the Navy. At that point, home life went from bad to unbearable.
"When [my stepfather] came into the house, my mother's alcoholism became very apparent," says Maddaus. "One Sunday morning I woke up and she was drunk and stumbling around and wanting to dance with me and all that kind of pathological stuff. Meanwhile, he was occasionally physically abusive to me. She was always drunk and in bed and going to the hospital. So I ended up living out on the streets. They couldn't control me. My friends were my family. They were people from similar backgrounds."
Among that family was the man who would become Robin Schiebel's husband, David Schiebel, who is today, ironically enough, an investigator with the State Police. Together, with a couple of other buddies, Maddaus and David Schiebel were the nucleus of a floating band of Lost Boys.
"We never hurt anybody, though we did some bizarre things," David Schiebel recalls. The bizarre things included a steady round of petty and not-so-petty thefts: Sometimes, the gang would break into garages and steal lawnmowers to convert the motors into minibikes or go-carts. But the big thrill was joyriding—boosting cars on the street or (a favorite) sneaking onto a General Motors car lot on Lake Street during the day, taking keys left in the ignition of Corvettes and other muscle cars, then returning at night to drive the vehicles off the property.
Mostly, though, time was spent in parks or down by the railroad tracks north of Lake Calhoun where Maddaus, Schiebel, and other assorted friends would, in Schiebel's words, "party hardy." Partying involved prodigious amounts of drinking and more-than-occasional indulgence of recreational drugs—mostly marijuana, hashish, and LSD. Maddaus and company also got high on over-the-counter medications, like cough syrup and nasal inhalers, and once even went out and collected mushrooms from a cow pasture because someone had told them that mushrooms that grew under cowpats had psychedelic properties. Hanging around the entrance to Hum's Liquor at 22nd and Lyndale, the underage gang would cajole customers entering the store to buy booze, especially cheap, sweetened wine like Bali-Hi, Ripple, and Boone's Farm.
"Mike was a big wine drinker," says Robin Schiebel. "He'd get so drunk, he'd throw up and then pass out."
Other times, Maddaus and friends would go to heavy metal concerts—Black Sabbath was a favorite—and drop acid. Then there was the incident with the pills he and David Schiebel came upon at a house where one of their female friends was babysitting.
"In the house there was a huge model of a sailboat," Schiebel recalls. "I got up and looked inside and found a baggie filled with blue pills." Even though the duo had no idea what was inside the baggie, they swallowed some on the spot just to find out, and then pocketed another 50 or 60 when they left. The pills turned out to be particularly potent form of LSD. "That kept us happy all summer," Schiebel says.
Today, Maddaus is trim and muscular—the result of regular workouts—but in those days, the impression he made was decidedly less imposing. A favorite outfit was a pair of brown flare pants, a brown see-through shirt, and a medallion. As a teen, he was on the runty side and rather ungainly. One time that ungainliness almost cost him his life.
Among his friends, Maddaus was "famous" for not being able to fight—if it came to a physical confrontation, David Schiebel would usually step in and take care of things. But once, for reasons neither man can remember, Schiebel and other members of Maddaus' crowd goaded him into a fistfight with an older and much more physically commanding kid who, just to make matters more interesting, had several brothers in the Hell's Angels.
"He almost killed Mike," Schiebel says. "He had him down on the ground and was stomping on his head." In the aftermath, Maddaus' face was so swollen that his right eye was shut, and for several days he carried around a cup into which he'd spit blood from the huge clot in his cheek. To add insult to injury, Schiebel convinced Maddaus to fight the older boy again a few weeks later. To ensure that his buddy came out of that second scrape in one piece, Schiebel helpfully toted along a sawed-off shotgun just to even the odds.
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Not surprisingly, the partying and joyriding, drunkenness and fighting attracted the close attention of the law. By his own account, Maddaus was arrested 24 times as a juvenile, mostly for car theft, but for burglary and other offenses as well, and spent time in a number of detention centers, including multiple trips to Glen Lake and Lino Lakes before it was turned into an adult prison, and the St. Croix Forestry Camp, which he describes as "a rough place, deep in the woods.
"That place was another level," he recalls, "a stepping stone to prison."
Finally, knowing that soon he would be facing prosecution as an adult if he kept on the same path, Maddaus decided to enlist in the Navy—ironic given his stepfather's background. And there, at last, he began the first halting steps toward turning his life around.
"Boot camp was good for me," he says. "I got cleaned up and physically fit." The months he then spent in drydock in San Diego, however, were not so good. Bored to death, he began using drugs and drinking again. But at the same time, a stretch of duty chipping paint convinced him that he didn't want to go through life as a high school dropout, so he started taking classes, completed his G.E.D. after his discharge, and enrolled in a community college.
Not that he was out of the woods yet. He shared digs with a friend from the old days and "regressed with some regularity," smoking dope and hanging out at Moby Dick's, a notorious Block E bar in Minneapolis. It was after a night of heavy drinking there that he experienced the negative epiphany that finally straightened him out for good.
"I was working full-time at the IDS center as a janitor, going to college on the G.I. Bill, and owned a Chevy Vega that cost me $1,500, which was a lot of money for me in those days," he says. "That night I went out to Moby's and then drove my car straight into a cement pole under a bridge on Hennepin Avenue."
The next morning, hungover, suffering liver contusions, he woke up to find himself strapped to a gurney next to a nurses' station in Hennepin County Medical Center, hurting all over and forced to undergo the indignity of relieving himself in a bedpan in the crowded hallway.
"I almost died," he says now. "It was as simple as that. I realized that my behaviors were putting my life at risk. . . . I'll never forget that moment. I'll tell you, I couldn't get out of there fast enough. It was literally a case of never coming back there or continuing down a path that guaranteed I'd end up in the same spot."
***
Even though Dr. Stacy Roback, a pediatric surgeon with Children's Hospital in Minneapolis, was busy with the demands of moving his family into a new home in Edina, there was something about the young man who delivered and installed furniture for the house that captured his attention—some native intelligence or drive that led Roback to take time to chat with the worker, ask him to return after the furniture was installed to help assemble a backyard swingset, and inquire about his plans in life. Eventually this unlettered but promising young fellow, Michael Maddaus, became a family friend, hanging out at the Robacks' to watch football games and share Sunday dinners.
"He was raw back then," recalls Roback, an adjunct professor in the Department of Preventive Sciences at the University. "But one of the things that struck me was that he was unusually ambitious given from whence he came. People from his kind of background usually throw in the towel by 22 or 23. But there was a spark there, a fuse you could easily light."
Newly sobered by his experience at Hennepin County Medical Center, Maddaus had taken a job with Thomas Design, a high-end, avant-garde Minneapolis furniture store, and had begun a total transformation of his life. Taking his cue from the store's milieu, he'd rented an efficiency apartment in a swank building near Lake of the Isles, furnished it piece by piece with things from Thomas Design, and begun instructing himself in the better things in life. On a visit to his apartment, Robin Schiebel was struck by how even his taste in music was undergoing a transition, with classical music replacing Black Sabbath on the stereo.
Meanwhile, his experiences volunteering at a children's rehab center, in particular the warm relationship he developed with a boy suffering from a severe case of cerebral palsy, alerted him to the fact that he had "a nice streak in me, a humanistic side." This led him to consider a career in physical therapy. When he shared this dream with Roback, however, the doctor gave him some startling advice: Why not become a doctor yourself?
"He thought that that was a hilarious suggestion, given that all he had at that point was a G.E.D.," says Roback. "But I told him I thought he could do it."
"I thought, 'I'm not going to be a doctor,'" Maddaus says. "'I'm not smart enough.'" Finally though, with help and further prompting from Roback, Maddaus completed his bachelor's degree at the University and applied for and was quickly accepted to the Medical School. The rigorous course of study can be demanding for the best-prepared medical student, and Maddaus's lack of formal education had left him with serious deficits in grammar, writing, and general knowledge. And there were other ways in which he had to catch up.
"Socially, I had a psychological transition I had to go through," he says. "I didn't relate to the other folks in medical school. I had a resentment of people who had more than me. I was looked down upon by kids from Kenwood, and kids from my neighborhood hated them in return." It wasn't until he was a resident, in fact, that Maddaus says he developed a "comfort zone" with himself that reduced some of the unease he felt around his medical comrades.
Maddaus finished medical school in 1982, then went on to do an internship and residencies in surgery at the University. After completing residencies in cardiac and thoracic surgery at Sloan Kettering in Toronto, he was hired as assistant professor at the University of Minnesota in 1992.
When he completed his residencies, minimally invasive surgery was relatively new and confined, for the most part, to a few simple procedures. For the kind of complex surgery Maddaus was practicing, open surgery was standard.
After returning to the University, however, he became increasingly aware of innovations taking place in minimally invasive surgery, especially at places like Emory University in Atlanta and the University of Pittsburgh. The "lightning rod" for his conversion to the new techniques was his encounter with Dr. John Hunter, a surgeon from Emory who came to the University a few years ago as a visiting professor. Among other things, Hunter, now chair of surgery at Oregon Health Sciences University in Portland, is one of the doctors who perfected laparoscopic surgery to relieve gastroesophageal reflux.
"We spoke and I somewhat embarrassingly said, 'Here's my situation, I've been thinking of getting into this,'" Maddaus says. The upshot of the conversation was Hunter's invitation to Maddaus to come to Emory to observe minimally invasive procedures.
"He came down and we had a great time," says Hunter. "Since then, he's come on very quickly. He's even come out here to Portland and given grand rounds and shown us some of his work."
Back at the University of Minnesota, Maddaus began performing laparoscopic procedures, but, feeling that he needed more training, he went to Pittsburgh to work with Dr. James Luketich, a renowned thoracic surgeon with the University of Pittsburgh Medical Center.
"He's an extraordinary person," says Luketich. "He's the kind of guy that can come in and watch an operation and in a few short months be an expert in it. Some guys I train spend a year or more working with me. Mike came in and watched, and then asked specific questions, and then went back to his own medical center and not only reproduced the procedures but came back here and offered suggestions on how to improve it." As perhaps the world's leading surgeon in minimally invasive esophagectomy, Luketich admits that having Maddaus catch on so fast "was a very humbling experience. . . . Among surgeons around the world, he is perceived as one of the 'go-to' people for complex minimally invasive surgery," he says. "He acquired that reputation by going around the world and meeting with people like me to learn everything he can."
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There is no easy explanation for why some individuals from woefully disadvantaged backgrounds grow up to become not just successful, but exemplary leaders in their fields.
"To do what he's done, you have to have intelligence, but also a strong sense of purpose," Hunter says. "I think people who come out of 'nontraditional' routes make better surgeons because they have seen the other side of life and they have a drive that other people might not have."
Maddaus himself claims no special insight into his own climb out of the gutter. "The answer is, I don't know. Sheer willpower, I guess, and nothing else," he says. On the other hand, he does admit that some characteristics he acquired as a child growing up in a chaotic environment have undoubtedly served him well in his new life. All those smoldering wounds to his self-esteem, the feelings of being looked down upon, instilled in him an "intense persistence."
Among other things, that persistence has shown itself in his collaboration with Dr. Sayeed Ikramuddin, his co-director of the Center for Minimally Invasive Surgery, to get the center up and running, as well as in his willingness to travel anywhere, anytime—Europe, Asia, the Americas—to enhance his skills in minimally invasive techniques.
"I've been told that I remind people of the character played by Ben Kingsley in Sexy Beast," Maddaus says of the intense, willful gangster in the 2001 British film. "I don't take 'no' for an answer. When someone tells me I can't do something, I immediately say to myself, 'They're wrong.' Once I get on to something, I just can't stop until I succeed."
Richard Broderick is a St. Paul-based freelance writer.
 | | | |  | | A Port to Minimally Invasive Surgery | This spring, the University of Minnesota’s Department of Surgery, in collaboration with Fairview-University Medical Center, opened the Center for Minimally Invasive Surgery. The center, part of an expanding surgical field, will be the foundation of minimally invasive surgical education, training, and research at the University.
Under the leadership of Dr. Michael Maddaus (B.S. ’78, M.D. ’82) and Dr. Sayeed Ikramuddin, the center brings together faculty from the departments of Surgery, Obstetrics and Gynecology, Orthopedic Surgery, Otorhinolaryngology, and Urologic Surgery. Minimally invasive surgical techniques allow surgeons to operate through tiny incisions, or ports, using specially designed instruments, a small video camera, and other high-tech tools.
The center’s mission:
o To become a local and national leader in minimally invasive surgery
o To train future surgeons in cutting edge minimally invasive surgical techniques
o To facilitate continuing medical education programs in minimally invasive surgery
o To develop novel minimally invasive surgical techniques via research, device testing, and clinical application
Areas of specialization:
o Thoracic and Foregut Surgery
o Obesity Surgery
o Colon and Rectal Surgery
o Abdominal Surgery
o Vascular Surgery
o Urologic Surgery
o Cardiac Surgery
o Transplantation
o Gynecology
o Neurosurgery
o Orthopedic Surgery
o Otorhinolaryngology
Procedures:
At least 125 surgical procedures are now being done with minimal invasiveness, including coronary artery bypass, hysterectomy, pituitary surgery, optic nerve decompression, rotator cuff repair, colostomy, splenectomy, breast augmentation, lymph node dissection, prostatectomy, and treatment of varicose veins.
Patient benefits:
Patients experience less pain, shorter hospital stays, minimal scarring, and faster recovery than with open procedures. The costs for minimally invasive surgery are also lower.
What’s next:
Surgical robotics expands the applications of minimally invasive surgery. With the use of surgical robotics, current procedures are being performed better and operations that were previously considered impossible can now be performed.
A surgical robotic system is comprised of a control console with 3D vision feedback and robotic “arms” that position endoscopic instruments and cameras. By integrating computer-enhanced technology with surgeons’ technical skills, a surgeon’s natural hand, wrist, and finger movements on instrument controls outside the patient’s body translate to corresponding micro-movements of the instrument tips positioned inside the patient through small incisions or ports. Incorporation of a surgical robot in advanced laparoscopic surgery will provide better visualization and easier manipulation of instruments, resulting in lower operative time and less operative morbidity.
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