At 8:30 a.m., orthopedic surgeon Richard Rothman was scrubbed and shrouded in protective blue paper in a Thomas Jefferson University Hospital operating room, poised to give Gail Cunningham her second replacement hip.
She was in very experienced hands. It was, roughly, Rothman's 12,500th hip replacement since he did the first in Philadelphia in 1970. Rothman, who turns 80 on Dec. 2, estimates he's done another 12,500 knees.
The business that bears his name, the Rothman Institute, is one of the world's largest orthopedic practices, with 145 doctors and 24 locations. It provides care for all four national sports teams in Philadelphia and boasts annual revenue of about $475 million, said president Alexander Vaccaro.
Rothman, who trimmed his surgical load from 20 operations a week to 15 about five years ago, started the day of Cunningham's surgery at 4:30 a.m. He speed-read three newspapers and began work at 6 a.m., doing one case himself and helping on another before Cunningham, 66, was prepped. There would be four more after that. Then business, exercise, and a work-related dinner.
Rothman has made a science - and business - of surgical efficiency. With the aid of an OR team he likens to a well-rehearsed orchestra, he confidently sliced, sawed, and pounded his way through the exchange of painful, arthritic bone for new joints made of glossy titanium, pink ceramic, and highly cross-linked polyethylene. Rothman helped design the hip joints he uses.
It is hard, repetitive physical work that might remind you of a master carpenter in his workshop, right down to the spectacularly sleek drills and caulk gun that Rothman uses. The air smells of flesh burned to prevent bleeding. Bits of bone and marrow fly about like sawdust. One member of the OR team, the hook holder, pulls flesh away from bone with curved instruments that look like claws. It is absolutely astounding that patients are not incapacitated by pain afterward. Most will be on their feet by afternoon.
Rothman works without a hint of fatigue. He says the routine nature of the surgery doesn't bother him.
"It takes a certain peculiar personality to do 25,000 operations . . . and not get bored," he admitted.
He keeps doing it, he said, because he gets pleasure from doing a good job. "Repetition is how you get excellent." Giving his patients a more active life still feels like a "miracle." He thinks that staying engaged and productive helps keep him young.
"I don't know what the true percentage of people who truly love their work is," he said, "but I'm in that small fraction."
Cunningham went home to Estell Manor, in Atlantic County, N.J., that afternoon. She went to the Rothman Institute for her first hip replacement in 2015, and was surprised she got the man himself as her doctor.
"I was just very happy that I actually got the Dr. Rothman to do my surgery," she said. "I was ecstatic."
She liked how her new right hip turned out and asked for him when the left went bad. She sensed his love for his work.
She and Richard Mercadante, who got a new knee the day she got her second hip, had no concerns about Rothman's age.
"Why should I?" asked Mercadante, who is 80. "I know what I can do."
Rothman alternates between taking charge in his OR and helping out in fellow surgeon Antonia Chen's. The work is so physically demanding, she said, that a study found surgeons burned about 340 calories an hour, about the same as running at 6 miles per hour.
Most surgeons give it up at 65 or 70. Rothman, she said, "doesn't consider surgery a job. He considers it a passion."
Joshua Jacobs, chair of orthopedic surgery at Rush University Medical Center in Chicago and former president of the American Academy of Orthopaedic Surgeons, said doctors in academic medicine often talk about "triple threats," physicians who are good at teaching, research, and clinical treatment. Rothman, he said, is a "quadruple threat" because he is also a canny businessman.
"I would use the word Renaissance man to describe him because he's so good in so many areas," he said.
Jacobs said "a number of" prominent surgeons have worked into their late 70s and early 80s. His group has no guidelines on when to stop.
Rothman knows some might have qualms about a surgeon his age. He's surprised that it rarely comes up. Maybe he just doesn't hear about the patients who choose someone younger. But he still has a two-month waiting list, as he has had for decades.
As a concession to age, he gets a checkup from his primary-care doctor and ophthalmologist every two years. A partner observes and evaluates his work. He said he has told his team to alert him if he starts slipping.
"What I tell people is if I'm not still throwing my fastball, to tell me I should be an administrator or a teacher rather than a surgeon," he said.
Vaccaro, a spine surgeon, said Rothman is "at the top of his game."
Rothman is tall and well-built, neither wiry nor conspicuously muscled. He moves with an ease and erect posture unusual at his age. He still uses the joints he was born with, though years of marathon running tore both his Achilles tendons. They have been fixed.
He is proof that chronological and biological age can diverge, a fact that fascinates him. Genes may be a big part of our destiny - both his parents died in their 70s - but he thinks a healthy lifestyle can add 10 or 15 years to one's life. He eats a spare, low-carb diet and tries to exercise for an hour every day.
For many years, he dragged Rothman Institute surgeons to Washington each year to run in the Marine Corps Marathon. There were annual mountain-climbing expeditions, too. He ran his 15th and last marathon at 65. He hasn't climbed a mountain in four or five years. He suspects the staff is pleased. Spinning is his exercise of choice these days, though he also works on strength, balance, and flexibility.
He's not much of a sports spectator. "I'm not going to spend any time watching a bunch of millionaires throw a ball around," he said.
A Cheltenham High grad, he was a history major at the University of Pennsylvania and retains a liberal arts major's interest in arts and literature. He collects works by Jamie and Andrew Wyeth. He reads a couple of novels a week, often historically accurate mysteries and spy stories.
"Every day, when you scrub with him for a case, he'll quiz you about all the editorials in the Wall Street Journal or the New York Times," Vaccaro said.
It's no fun to admit you were too tired to read. "There's a look of disbelief in his eyes and a moment of silence." Vaccaro's solution is to say he "looked" at the papers and quickly add, "What do you think?"
Rothman chose medicine because he liked helping people. As for orthopedics, he said the smartest students in that era picked internal medicine. "I figured I'd rather be the smartest guy in the slow class than the dumbest guy in the smart class," he said.
He got in on the ground floor of joint replacement, training in England with Sir John Charnley, who pioneered the field. Walter Annenberg, the publisher and philanthropist, was an early patient. After his surgery, Annenberg gave Rothman the money to start the Rothman Institute.
Rothman, who also has a doctorate in anatomy, was an early adopter of techniques to improve efficiency and quality. He enjoys running a business, perhaps because his Polish immigrant father owned a bathing-suit company. It was the first to market suits with built-in bras.
Rothman takes pride in hiring good people and keeping them. He makes praise a priority, shaking each team member's hand after every procedure. The business took off, he said, when he started using a partnership model. "Every partner here gets the same contract I do."
Rothman Institute is now expanding its footprint in New Jersey. He'd like to see it go national in the next five years.
Rothman also spends a day a week working as a senior adviser to the Riverside Company, a private-equity firm.
When he can no longer do surgery, he wants to continue using his business skills. He'd also like to keep working with patients by helping them choose treatments. "I think what I do the best is to give advice," he said.
What he's not so good at is keeping quiet when he hears the English language brutalized. "It's the worst indignity to correct somebody's English, . . . but I just can't bite my tongue and suck it up," he said.
He has also struggled with work-life balance. In the early years, he worked "seven days a week, night and day." These days, Marsha, his wife of 37 years, four children, and grandchildren are a higher priority.
"I'm much better the last 20 years than the first 20 years of my career," he said.