Dr. Michael Ain stands 4 feet 3. It's the first thing you notice. There's no way around it. He rolls his green surgical pants around the ankles. He climbs a step-stool to reach the operating table. Even then, his colleagues stand a foot or so above him.
He's an orthopedic surgeon, a specialty usually reserved for the jocks of medicine. Ain doesn't exactly fit the stereotype, but he did wrestle in high school, and now he golfs on weekends and fixes bones with big power tools that could tear down walls.
Before long, his height is the last thing you think about.
Ain, who is 36, treats children of all sizes who come to him at Johns Hopkins Hospital with shattered bones, torn muscles, club feet and worse.
But he concentrates on dwarfs -- children who, like him, will remain short all their lives but would like to stand erect and stay out of wheelchairs.
He straightens their legs and spines, realigns their hips and feet, replaces hips and knees -- procedures that require an athlete's strength and a jeweler's precision.
To children who will always stand waist-high to the world, Ain is a guy to look up to.
Average-sized children think so too, describing him as funny and calm.
The word "awesome" comes up a lot.
"He was something different, something unexpected," said Genny Lowe, a 16-year-old of average height who first laid eyes on Ain after coming out of anesthesia.
"But after a while, you didn't notice at all. He's really comfortable, not like a complete stranger. He jokes around and makes you see the brighter side of things."
Said Lowe, a high school tennis star who nearly lost her leg in a boating accident, "Never in my life have I met anyone like him."
Michael Ain came to Hopkins three years ago after winning a coveted fellowship in pediatric orthopedic surgery.
Now, he is one of three full-time surgeons at Hopkins working in the field. Of the three, he focuses most on skeletal dysplasia -- the bone defects that make people abnormally short.
Only a handful of hospitals in the world do this work, and two are in Baltimore.
The other is St. Joseph's Medical Center in Towson, where Dr. Steven R. Kopits is perhaps the nation's recognized "guru" in skeletal dysplasia.
Ain, about 30 years younger, is starting to build a national reputation in the field, too.
He is thought to be the first dwarf in the United States to practice surgery of any kind. But Ain never set out to shatter myths, to be a role model or crusade for anything.
The whole notion, he says, gives him a headache.
Mainly, he wanted to be a doctor, even when others in the profession said to his face that he was a fool to try.
"I try not to think about it," he says of being "first."
"I just want to do a good job, and I don't want to be the first one to screw up, either. I'm not here to run for president."
During a routine day in surgery, Ain is sawing into a patient's thigh. The patient is 41-year-old Alyce Williams, one of many adult dwarfs who come to him, too. Ain replaced her worn left hip a few months earlier; now, he's replacing the right.
Violence in the OR
Ain stands on a plastic stool that's two steps high. Around him are four colleagues who create a pyramid of forms in goggles and gowns. Ain can reach everything, but he gains leverage by leaning into his tools -- a drill with a bit as long as his arm; a chisel with a vibrating, serrated edge; a grater with razor-sharp teeth that glistens in the light.
The air is filled with the sound of whirring power tools and a scent that is both antiseptic and acrid. The work is technically exacting -- a poorly placed hip joint can paralyze the leg -- but it's amazingly rough, almost violent.
Carpenters and car mechanics would feel at home.
Ain, who has built furniture since he was a child, is clearly thrilled with what he does.
"One day you can be doing this fine hand case, working with nerves finer than your hair," he says later. "The next day you might be putting in a total hip. You're banging on this prosthesis with a big mallet, and it's very physical."
With a satisfied smile, he says: "It's the best."
Ain grew up middle-class and Jewish in Roslyn Heights, Long Island. His father was a judge, his mother a travel agent. His sister would become a lawyer.
Michael, the first and only dwarf in his family, said he started thinking about medicine as a young boy because of some unsatisfactory experiences as a patient.
"Sometimes, they treated you not as a person but a thing," Ain said. "They were at times callous, very quick." Ain thought he could do better.
Results of a faulty gene
There are 300 types of dwarfism, each caused by a different genetic abnormality. Ain has the most common type, achondroplasia, triggered by a faulty gene that prevents the long bones in the arms and legs from growing fully. The gene doesn't affect the torso, so when he sits across from taller patients they see eye-to-eye.
He faced the predictable teasing as a child, but says nobody really got in his way.
"You'd go to the mall and kids would point and say mean things, but I was never barred from doing anything." In grade school, he placed kickball like everyone else, and later joined his friends in Little League.
His stature created remarkably few physical problems; that makes him both unusual and lucky. He had one corrective operation, a procedure called an osteotomy in which doctors straightened his painfully bowed legs by breaking and then resetting them.
He was in a body cast for several months, and moved on.
At the prestigious Phillips Academy in Andover, Mass., he was strong enough to join the wrestling team. At Brown University, he studied science, joined a fraternity and, with his roommate, ran the college Big Brother program. And he was never lacking in chutzpah.
One day, the college baseball coach found a note on his desk. "I'd like to meet you," a student had written. "I'd like to play. My name is Michael Ain."
Knowing nothing about the student, the coach called him and arranged a meeting.
"He got there ahead of me," says former coach Dave Stenhouse, laughing at the memory. "I saw him sitting on the step outside my office. I said something like, 'Hey, how ya doing, young man?' He said, 'Good. I'm Michael Ain.' It sort of caught me by surprise."
Stenhouse, a former pitcher for the Washington Senators, said Ain could try out but wouldn't receive any special consideration. Ain made the junior varsity and later the varsity, playing second base and designated hitter when games weren't on the line.
"He had good fundamentals," Stenhouse says. "He knew how to catch the ball, throw the ball, had a good swing but didn't have strength because of his height. And yes, he did hit the ball pretty good."
"I was no Eddie Gaedel," says Ain, referring to a dwarf who once hit for the St. Louis Browns as a promotional gimmick. Ain says he was a "dead pull hitter" whose main limitation was his lack of speed.
In his senior year, Ain applied to "20 or 30" medical schools ranging from elite Ivy League institutions to "safer" state schools. With a B-plus average, good board scores and Brown credentials, he figured to get into a few.
A college buddy suggested that he leave nothing to chance, and try a mock interview with the friend's father, who happened to be an admissions officer at the University of Pennsylvania.
The interview went well, but Ain rates the critique as one of the lowest moments of his life.
"He said, 'You're an amazing individual, you've done amazing things in your life. Some of the things you've done are incredible. By the way, you'll never get into medicine, you'll never get into medical school. You should think of a different career.' "
Ain had never heard this before, but the doctor could not have been more clear: A man of Ain's size could never examine patients, much less perform surgery.
("Take me to the hospital," Ain pleaded. "I'll bench press more than all your doctors put together.")
Worse, patients needed to respect their doctor -- and they'd never respect one so short.
It was the first of many such insults.
At a state medical school, a faculty member began an interview by asking Ain what he would like to be called. Ain suggested "Michael."
"No," the man replied. "Would you like to be called a midget?" Flabbergasted, Ain asked the man -- a psychologist -- if he'd like to go by the name of an intimate body part.
Ain, who disclosed he was an achondroplast ahead of time so none of the schools would be surprised, was rejected by every medical school he applied to. Over the next months, he waited tables and worked for a brokerage firm.
Then he applied to 20 more schools and was accepted by one, the Albany Medical School in upstate New York. He excelled there, then applied for a residency in neurosurgery -- a field that fascinated him and seemed the most intellectually challenging.
Not one program accepted him.
Finally, he got a pediatrics residency in Irvine, Calif., and the next year returned to Albany to train in orthopedics.
"I didn't do it on purpose, but I wound up going into a field that requires the greatest amount of physical work," Ain says. "It's like the saying, orthopedists are smart as an ox and twice as strong."
Dr. Allen Carl, a professor of orthopedics at Albany, said Ain's physical stature didn't work in his favor, but the ability to overcome size and prejudice certainly did.
"This is a somebody who is comparable to everybody else with full stature," says Carl. "That means he's better than us with full stature. He's a remarkable guy."
Some surgeons, however, worried that Ain would disrupt their rhythm in the operating room. He'd block their view, even contaminate the patient by standing too close. "He overcame those problems pretty well," says Carl.
He stood on a stool, wore altered gowns, leaned when he couldn't reach, and used his natural strength.
Putting patients at ease
And, far from alienating patients with his size, he possessed an uncanny ability to make people feel at ease. He was funny and warm, and explained medicine in plain English. Much of this came naturally, but Ain was perhaps chastened by the experience of being a patient.
The idea of specializing in skeletal dysplasia, he says, occurred to him when Carl remarked during surgery that he had just read an article about a couple who raised an achondroplastic girl. The couple, from Southern California, felt dejected until they met a dwarf who had become a doctor.
Upon hearing the family's name, Ain recognized the doctor as himself.
"I did some soul-searching," he recalls. The world was full of excellent orthopedic surgeons. "You could go to me or go to someone else. But I actually felt I could make a difference going into skeletal dysplasia."
Ain married an average-sized woman, Valerie, who takes care of their 2-year-old child, Alexa, at their home in Towson and works odd shifts as a nurse. "I dated one small woman -- all the others were averaged sized," says Ain. "Why? There are more tall women than short women."
Though Alexa's pictures fill his office, Ain declines to discuss the issue of her size, saying only that she is "the most beautiful child in the world."
At Hopkins, Ain spends about 20 percent of his time taking care of children of short stature. With so many genetic variations, the condition presents endless challenges.
Problems develop when cartilage doesn't form properly, when bones and tendons grow at different rates, when vertebrae press against the spinal column.
Kristi Paquette, a 10-year-old from Connecticut who stands 3 feet tall, came to Hopkins this spring to have her spine straightened with two metal rods. Like many dwarfs, she's a veteran.
In previous operations, doctors widened her spinal canal and removed a tumor from her back. She also spent seven years with a breathing tube in her throat.
"He's nice, he's honest," she says of Ain. "If there's anything serious, he tries to make jokes about it so I'm not scared or anything."
His size is the last thing she talks about, but it clearly matters: "I don't know, I just thought it was pretty cool that I had a doctor who was just like me."
Dr. Paul Sponseller, the chief pediatric orthopedic surgeon, says Ain received excellent recommendations from Albany. And he came at a good time. Hopkins wanted to expand its program in skeletal dysplasia, but also needed someone with broad training in children's orthopedics.
"And he probably has more personality than anyone I've ever met," says Sponseller. "There is never a silence around Mike. If nobody is talking, he has something to say. He always maintains a good time, a good atmosphere."
Colleagues insist his size is never a hindrance.
"He has to get a little bit more of his body over the [patient] than most people need to, but he's able to make some adjustments that are pretty subtle," says Dr. Barry Berger, a 6-foot-5 resident who also describes Ain as a respectable "bogey golfer."
Dr. Benjamin Carson, an esteemed neurosurgeon who has collaborated with Ain in many cases, says he's not aware of any limitations and can imagine Ain becoming a national leader in skeletal dysplasia. "There isn't very much he doesn't think he can't do, and that's more than half the battle right there."
Sponseller says he didn't hire Ain because he was a dwarf, but says that short patients take to him easily. "They are often quicker to tell personal things to him than to other people," he says. "The physical difficulties -- putting on clothes, cleaning yourself, going to the bathroom."
'This little relationship'
In clinic recently, 4-year-old Sydnee Colpitts hands Ain a packet of cheese and crackers that's dripping with saliva. He thanks her, and slides it into his shirt pocket. "We have this little relationship going," he says.
Sydnee has red hair, a flattened nose and a little mouth that forms an upright triangle when she smiles. She is tiny and may never grow much taller. Recently, Ain performed the second of two leg-straightening operations on her. Now, she wears an external fixator, a cage that will stabilize her leg until it mends.
Walking to a light stand, Ain admires a series of X-rays that show the Erector Set project that is Sydnee's leg. He points to a band of scar tissue -- evidence that the leg is mending well -- and nods.
"Everything that could go wrong, which is considerable, didn't," he says. "It's strange how sometimes we know what we're doing."
Pub Date: 9/06/98