When he quit doing surgery just five months ago, Richard Rothman, the 81-year-old founder of the Rothman Orthopaedic Institute, vowed to maintain his other role, as a businessman, to the end. "If I have my choice," he said, "I'd like to work in the morning and die in the afternoon."
Dr. Rothman, who died on Sunday at Jefferson Hospital for Neuroscience in Center City after surgery for cancer that had spread to his brain, did not quite get his wish, but he came close.
Earlier this month, he attended a meeting in Iceland with several board members of the giant orthopedic institute he founded nearly 50 years ago. It now employs 210 surgeons and has 36 offices, including one in Princeton that opened on Monday. Dr. Rothman seemed fine, except that he leaned a bit to the left when he walked, said Alex Vaccaro, the institute's president and chairman.
Then, on Oct. 9, during a meeting at the headquarters in Philadelphia, he stood and fell to the left. His coworkers sent him to the emergency department. A CT scan revealed the tumor, and Dr. Rothman had surgery the following Friday. He did well at first, but then his brain started bleeding. He rallied enough to squeeze wife Marsha's hand on Friday (Oct. 19) when she asked if he loved her, but his condition worsened the next day.
Dr. Rothman was one of the first American surgeons to do hip replacements, and went on to develop an international reputation as a surgeon and implant developer. A grateful early patient, Walter H. Annenberg, former owner of the Inquirer and Daily News, donated the money to start the Rothman Institute, which now has offices in Pennsylvania, New Jersey, and New York. Physicians at the institute have served as the orthopedics department for Thomas Jefferson University Hospital and as team physicians for local sports teams including the Phillies, Eagles, Flyers, and 76ers, as well as those of Villanova University. Dr. Rothman estimated that he had done as many as 50,000 hip and knee replacements.
Vaccaro said some members of the staff knew Dr. Rothman was ailing because he was unable to make a scheduled appearance at an orthopedics conference last week, but many did not. "Everyone's in shock," he said. He plans to meet with the staff Tuesday evening to talk about Dr. Rothman's life and observe a moment of silence. There will be a larger memorial service, in conjunction with Jefferson Health, in about two months.
Dr. Rothman's most important legacy, Vaccaro said, is that he "trained the future and present leaders of medicine." By that, he meant that many of Dr. Rothman's former students now head orthopedic departments at other institutions.
Antonia Chen, who names Dr. Rothman as her most important mentor, left Rothman Institute, with Dr. Rothman's blessing, for Brigham and Women's Hospital in Boston at the end of 2017. "The biggest impact he had for me as a person is that he took the time out to talk to everyone as an individual," she said. "That was very powerful to me, and that's something I now carry on."
"Jefferson would not be what it is today without his inspired leadership," said Stephen Klasko, CEO of Jefferson Health. "In anyone's lifetime, if you are fortunate, you might meet one or two people larger than life. Dr. Rothman will be remembered for his amazing accomplishments, his surgical skill, his entrepreneurial spirit, and his inspirational mentorship. But beyond all those aspects of his life, there are thousands of doctors and patients whose lives have been positively altered because of Dr. Rothman's presence."
When Dr. Rothman retired from surgery in May, he said that his health was good and that his wife had urged him to quit at the top of his game. But he had chronic kidney problems that were bad enough to need a transplant, Vaccaro said. At Dr. Rothman's age, it would have been hard to get a kidney from a deceased donor, and Vaccaro asked if anyone on the staff would be willing to donate one. More than 20 people volunteered. One was a match, and Dr. Rothman was expecting to have a transplant in January.
About a year ago, though, he learned he had a rare skin cancer, Merkel cell carcinoma. A tumor was removed from his armpit and he was treated, apparently successfully, with immunotherapy. He appeared disease-free after a PET scan in July, Vaccaro said. However, it was that cancer that was found in two spots in his brain. The plan was to remove one and treat the other with radiation.
Educated at the University of Pennsylvania, Dr. Rothman was a native of Cheltenham. He was the son of a Polish immigrant who arrived in the United States around 1920 with meager savings and little education. The father, who later owned a bathing-suit company, died when Richard was 16.
In 1969, a young Richard Rothman traveled to England to learn how to perform hip replacements from surgical pioneer John Charnley. At that time, he would say later, patients with bad hips had "only bad choices." They could use a walker or have surgeries that didn't do much good. "You were really out of luck," he said last year.
Dr. Rothman was only a couple of years into his practice when Annenberg decided to do something about his arthritic hips. Like other wealthy Philadelphians at the time, he sought out Charnley. But, in a move that would transform Dr. Rothman's career, Charnley convinced Annenberg that his young protégé in Philadelphia would do a fine job.
Dr. Rothman replaced one of Annenberg's hips and, a few years later, the other. After the first, Annenberg asked Dr. Rothman about his goals in life. To build a "center of excellence in hip surgery," Dr. Rothman replied. Annenberg donated several million dollars to Pennsylvania Hospital, and the Rothman Institute was born. Dr. Rothman was in his early 30s.
In the years since, the Rothman Institute — now affiliated with Jefferson Health, Main Line Health, Geisinger, Northwell Health, and Capital Health — has grown into one of the world's largest orthopedic organizations, with 755,000 patient visits a year. Annual revenue is a half-billion dollars. The organization ranks 11th among orthopedic groups in research grants from the National Institutes of Health.
The second generation of a hip implant that Dr. Rothman helped design remains one of the world's top-two artificial hips and has brought in more than $1 billion in revenue to the institute.
Dr. Rothman was a rare doctor, friends and coworkers have said, who was good not only at surgery, but at teaching, research, and business. He had a particular interest in making surgical techniques efficient and evidence-based.
In a physically demanding specialty, in which doctors usually retire in their 60s or 70s, Dr. Rothman was performing surgery two days a week up until this year. He no longer ran the business but was involved in its operation as a partner. He traveled to New York once a week to work as an adviser with the Riverside Co., a private-equity firm, and taught medical students at Jiao Tong University in Shanghai. He was vice chair of the board of Thomas Jefferson University. He was also a trustee of the University of Pennsylvania and the Brandywine River Museum of Art.
He had been planning to go to China for a meeting with Chen next month. He called her the day before his surgery and told her he probably wouldn't be able to come, but he was still making plans for the future.