Something More

Foreword by Coach Joe Paterno

Alexander Kalenak, M.D. took care of Penn State football players for twenty-two years. He joined the Nittany Lions as team orthopedic surgeon but he contributed far more than strong bones and joints.

. . . . . His values, attitude, and integrity were a perfect match for our program. He talked honestly to those kids in the training room, on the field, and, if necessary, in the operating room, and treated every one of them as if he was his own kid with a whole life on the line.

On game days, you could see Al’s intensity as he followed the plays. You would think he was anticipating what could possibly happen out there by watching the players’ mechanics. As a result, he saw not only the injury but what caused it, and that helped him plan a timely treatment, effective rehabilitation, and a prevention plan for the future.

Al Kalenak cared about the players; he cared about their lives and their futures. They bonded with him and loved him for it. Through the 1970s and 80s, Al brought the vision and skills to help us build a state-of-the-art sports medicine program at Penn State. Sue and I are 100% behind his efforts to do the same with a palliative care program at the Penn State Milton S. Hershey Medical Center.

For a team to succeed, it is not enough for individuals to make singular, or even stellar, contributions. It is necessary for them to make their teammates better. This is what Al Kalenak did, day in and day out, year after year. Al Kalenak was my teammate, and I was a better coach because of him.

Joseph Paterno March, 2009

Chapter 1 : Migrations, Foundations, and War

You open your eyes one morning and there you are. You’re never aware of becoming a person in your own right, but when you think back, it’s as if one day you woke up to the whole world with yourself in it. You are surrounded by your family—taken for granted, of course—your home, your culture of specific smells, sounds, tastes and routines, the bath of language, and an environment that gradually expands from the bars of your crib outward to the kitchen walls, the front steps, down the hill, around many corners, into town, and far beyond.

My story starts well before I was born. Who knows what child would have emerged, even from my own two parents, had not the situations in Eastern Europe driven them both to seek a fresh start half a world away from their homes. As my memories take shape in specific anecdotes and narratives, I am continually reminded of how the threads of our lives are interwoven with so many other lives and with the events and developments of our time.

My twin sister Anna and I were born on July 27, 1935, as the tenth and eleventh children of Michael and Anna Gemiter Kalenak of Nanty Glo, Pennsylvania. As children, we were influenced by many things, but perhaps the most influential were the character and examples of our parents, siblings, and teachers and the conditions of living in a small Pennsylvania coal town before, during, and after WWII. All of these, including the town of Nanty Glo itself, are major figures in the stories that follow. This is not the complete story; how could it be? These are tales and remembrances, a few glimpses at night into lighted windows, a streak caught in the corner of your view as a boy runs by, and some peaks and valleys that stick out from the plateau of our daily lives.

***** Players, Injuries . . . . Friends

Most of what I did was routine care for a broad spectrum of minor and major injuries. Of course there were a few more dramatic situations during games when sixty or seventy thousand people might be watching you in person with a couple million more on TV. There were a couple of these, even in my rookie year, 1973. During that first football season Cappaletti didn’t play in the Syracuse game. We had a couple of other running backs that took his place. One of them was Woody Petchell. Woody Petchell's dad played on the 1947 Penn State team when they tied for the National Championship in the Cotton Bowl. He was a running back who ran with abandon, nearly flying. Everyone called him the “Flying Fragment.” He would plow at anybody. His son, Woody Petchell Jr., played for us in 1973. Unfortunately, he blew out his knee on a play at the goal line in that Syracuse game. He tore all of the ligaments on the outer side of his knee. He also ripped out a big tendon. Fortunately, he didn't rupture the nerve that goes to the rest of his leg, avoiding a paralyzed leg for the rest of his life.

That was the first day I had to take some rapid action during a live game. I ran out to the field, examined the leg, splinted it and got him off the field. He would need surgery as quickly as possible. I went up to the press box and called the medical center in Hershey. I called the operating room to schedule surgery as soon as we could. An ambulance met us at the airport in Harrisbug. I alerted my residents and staff to get ready to do the operation as soon as we could. That was my initiation into making arrangements as expeditiously as possible for an emergency situation where we wanted the surgery done urgently to achieve the best possible outcome for the player.

****** Research: Some of my research was focused on advances in surgical technology and instrumentation adapted to the burgeoning field of endoscopy. The advent of fiber optics in the 1970s was a major breakthrough. We could now bring a concentrated light within the joint, but it took a lot of technological innovation before we could use it reliably. Fiber optics would provide a good, clear light, but if it was focused, it could also burn tissue. There had to be fluid floating around it to absorb the heat. Urologists who had been scoping urethras and bladders for decades helped us a lot. The first challenge was learning how to get into a joint. Then we needed to develop techniques for exploring it safely and for determining what is normal anatomy and what is not normal anatomy.

The pioneers of arthroscopic surgery were in Japan. They had been looking into joints with incandescent bulbs since before WWI. In the 1970s in this country we were looking into the joints and trying to develop appropriate instruments to perform a surgical procedure. We borrowed from ENT and Neurosurgery and any other discipline that would help us in our quest for appropriate instrumentation. We needed to develop shavers to smooth worn cartilage and graspers to extract pieces of cartilage. We needed little drills to create tiny holes in bare areas of the bone. Drilling into the bone marrow opened channels and stimulated the bone marrow and stem cells to grow new cartilage. All of this instrumentation was vital to performing actual surgical procedures inside the knees. Some people threw up their hands and said, “That's never going to work!” All the naysayers were proven wrong. Now it is routine to do major ligament reconstruction inside a knee joint with arthroscopic techniques.

In the 1980s we were making significant advances. We learned how to harvest a graft as a substitute for the torn ligament, put it into a joint, fix it and anchor it at each end and make it function normally. It took years of research in the laboratory to come up with the technique and the instrumentation to make it happen. Ligament reconstruction was time consuming, arduous work. In the mid-1980s, in order to be as scientifically accurate as possible, the tension applied to the graft was measured. If it was too tense, the graft would rupture. If too loose, the procedure failed to provide stability. In a series of cases where the surgeon aimed for a specific spot in the center of the knee, the tension would be almost perfect each and every time. We did away with the time consuming task of measuring tension. This helped speed up the operation so you could reconstruct the ACL in an hour or les