Eulogy in celebration of the life of Dr. Robert Ernst Carroll delivered at St. James Church, Madison Ave. and 71st St., October 2, 2009

I want to recognize the Carroll family, his wife Jane, his son Brewster and his wife Minnie, his daughter Judith and her husband Lloyd, his daughter Janet and her husband Howard and their children David and Michael, and Jonathan and his wife Whitney.

Dr. Carroll spoke of family often, his own and his professional one, which was composed of the original thirty three full year New York Orthopeadic Senior Annie C. Kane Fellows in Hand Surgery and the succession of sixteen additional scions that his fellows trained, along with their spouses and their children.   They made up this other “family” of the Robert E. Carroll Hand Club.

I am especially honored and humbled to have been asked by Dr. Carroll to speak today on behalf of his family and to give a synopsis of his professional career and his true legacy to the discipline of Hand Surgery which he in part helped to create and define. 

Having been trained by Dr. Carroll starting as a medical student at Columbia College of Physicians and Surgeons, I had the great fortune to have known him since 1972.  His crisp and forceful teaching style was made abundantly clear to us when he would point to a particularly obvious surface anatomic feature like the flexor carpi radialis and hear us respond with an unsure whisper, “palmaris longus”, only to hear his kind but telling retort, “not even in a medical student”, as if we had license to rename anatomical parts to hide our ignorance.

As I went from his medical student, to his orthopaedic resident, then hand fellow, and with his help ultimately as a colleague and friend, I was able to transition from him being my teacher to being my mentor which continued through my last meeting with him, and made it feel natural to call him Bob.

Bob was born in Fall River, Massachusetts on November 7, 1916 and he was proud of that New England lineage.  He was educated at the Culver Military Academy in Indiana, and went on to Yale University, and then Yale Medical School, graduating in those tumultuous years of WWII in June of 1942.  He started his orthopaedic residency at the Massachusetts General Hospital and rose to Chief resident by September 1944.

Some of that training was under the direction of Dr. Henry Marble, a distinguished hand surgeon and early influence.

Then, like many young men, he was off to war and served with the army in the Pacific theatre on Tinian Island which was the base that launched the Enola Gay and her crew on the atomic bombing at Hiroshima.  Bob was Captain in an orthopaedic surgical unit commanded by Dr. Ernst M. Burgess, whom I will get back to in a moment.  His allegiance to our servicemen and women continued throughout his professional life as a consultant to the Army, Navy, Air Force, Veterans Administration and the US Public Health Service.  His post-graduate training thus interrupted would eventually get back on track with another chief residency at the Framingham V.A. hospital.  Bob was looking for a permanent position when Harvard orthopaedic icon, Dr. Smith-Peteren referred him to Dr. Alan DeForest Smith, then the Chief of Orthopaedic Surgery at Columbia, in 1946 with this observation:  “Dr. Carroll has considerable ability and reasons well.”

That interview on September 10, 1946 changed the lives of many in this room.  Dr. Smith later wrote of his impressions of the young Carroll:  “he has a very nice personality and has had excellent training thus far in orthopaedics.” 

At that time Bob was vacillating between taking a fellowship at NYOH or another residency at the Dupont Foundation with Dr. Shands.

Dr. Ernst Burgess, his superior officer in the Pacific theatre, wrote to Dr. Smith about Bob:  “…he is an intelligent and quick thinking young surgeon and really excellent technician…He tends to be somewhat assertive and needs competition…I believe he will be a leading figure in orthopaedics…He is high caliber material.”

Dr. Smith offered, and Bob accepted, the one year fellowship at the princely salary of $3000 per year.  And with it came the expectation that “(he) work on some problem either in pure research or in clinical investigation.”  Bob responded with “great enthusiasm to work at the New York Orthopaedic Hospital.”  Thus began his sixty two years of association with the Columbia University Medical Center and his beloved New York Orthopaedic Hospital.

There was no specific formula for fellowship in those years, no core competencies in the modern lingo – one just apprenticed themselves for varying periods of time to acknowledged experts.  So Bob ventured forth to visit the leading hand surgeons of the day, as he had by this time decided to become a hand surgeon like his Harvard mentor Dr. Henry Marble.  He visited renowned surgeons like Sumner Koch, Michael Mason, and Harvey Allen in Chicago, and the legendary Sterling Bunnell in San Francisco.

He returned to Columbia with a new vision for training hand surgeons and initiated the first full-year hand training fellowship in the United States in 1959 with Dr. James Hunter as his first fellow.  His philosophy of intensive focus in hand surgery, with anatomy at the core and buttressed by scientific investigation, set the standard for clinical post-graduate fellowships to come.  He articulated this in the Inaugural President’s Invited Lecture to the Hand in 1985.  He did so at the request of 1961 fellow Dr. James Dobyns who was the first of three former fellows (Dr. David Green and Dr. Dean Louis) to become President of the Hand Society.  Many fellows assumed leadership positions such as the President of the AOA, Dr. Harold Dick.  Others assumed roles as orthopaedic chairmen and fellowship directors.

Bob’s focus was, of course, the mastery of anatomy and physiology of the hand, as well as surgical technique, but he instilled in all of us the responsibility to learn actively through the extant literature, and most importantly contribute through written works to the advancement of the discipline.  Quite simply, he wanted each of us to feel the angst of writing as well as the pride of authorship.  To paraphrase:  “if it isn’t published it didn’t happen.”  He also made us recognize the value of close and long term scrutiny on the evaluation of clinical outcomes.  He reveled in recounting stories of the forty year follow up on a neighborhood baker with a thumb reconstruction while comparing it to the latest and greatest procedure with one to two years of surveillance.

His scope of practice was modern by today’s standards.  Now our fellows wish to own the entire upper extremity, including the shoulder, and master the functional unity of the upper extremity.  His practice spanned, as he liked to boast, from the opposite cerebral cortex to the pinky and everything in between. 

He had famous tongue-in-cheek battles during orthopaedic grand rounds with another NYOH icon, Dr. Charles Neer, stating that the shoulder was nothing more than the base of the hand and he loved to schedule shoulder fusions and tendon transfers for children and adults with neuromuscular deficits.

His was an orderly and predictable routine with a Monday, Wednesday, and Friday eight a.m. to one p.m. operating schedule carefully documented with photographs (which became the fellow’s nightmare if they didn’t come out).  This was followed by lunch with his colleagues in the Doctor’s Dining Room followed by office hours in the Atchley Pavilion.  Friday afternoon Hand Clinic was sacrosanct:  He was always there and made each resident sign the daily patient log book at their first appearance in the residency or fellowship.  His attention and commitment to those clinic patients was unwavering as was his famous hand conferences of Blue Book case presentations given at four p.m. Friday with all residents in attendance.

Bob attracted the most amazing patients from around the world, many of them children with congenital anomalies and their anxious parents.  Bob would bend towards the scared little tykes and hook his arms under their armpits while grasping their earlobes with his thumbs and to everyone’s amazement and delight he would pretend to hoist them up by their ears which would break the tension of the moment and endear Bob to the entire family.

Having stayed on as hand attending and eventually becoming the Fellowship director and the Robert E. Carroll Professor of Hand Surgery, I have inherited many of these patients who continue to recount their lifelong remembrances of Dr. Carroll into their adult years.

Many were surprised when Bob would routinely pop his head into my examining room on Monday mornings and see their surgeon standing there as though time stood still.  Bob could frustrate and amaze his fellows with his ageless countenance as well as his ability to wear (that is to fit into) the same brocade jacket across decades of Carroll Club meetings or the New York Society for the Surgery of the Hand dinners.  The latter he helped found in 1969 and led as the fifth President in 1974.  Bob also served as the Vice President of the American Society for Surgery of the Hand in 1959 and President of the American Association of Bone and Joint Surgeons in 1970.

Bob, as the legend he was, had contemporaneous friendly rivals like Bill Littler from Roosevelt Hospital and Bob Beasley from NYU.  He often used monikers like “the squire of Wealthy Street” to describe Al Swanson, a good friend, which seemed a double entendre but actually described the office address in Grand Rapids.

Bob never tried to commercialize his knowledge but he was one of the early clinical investigators who used silicone in the hand, which later became a mainstay in arthroplasty and tendon reconstruction as developed by another fellow, Jim Hunter.   Bob did invent and popularized a series of special hand instruments, like the Carroll elevator, which are still used today.  One of the most prized gifts from him was a set of instruments given upon graduation from the fellowship.

Bob loved the NYOH and its residents.  He had special jobs for each resident based on their seniority.  The junior resident had to mark the day of surgery with a red pen.  God forbid if the red pen was lost.  The senior resident assisted Bob, and he made certain that every resident would be competent to perform basic hand operations such as carpal tunnel release and more complex ones like wrist fusion.  At the end of every senior resident’s rotation he or she would be invited to dine with Rob and Jane Carroll at their magnificent Lexington Avenue apartment.  At the door, you were greeted by the most delightful host and hostess, and then given a private tour of the wonderful and extensive art collection which adorned the walls.  Bob advised his fellows on art collecting (if they were interested) with the strategy of “buy what you like, not because some expert says it will appreciate.”  Many of these paintings were donated to the hospital and grace the walls of our offices.

Bob Carroll loved the out-of-doors and the change of venue from Great Island on the Cape in summer and fall, to the hunting preserve in Alabama, to the Florida coast.  He talked of playing Santa at Christmas in NYC for the grandchildren and cooking turkeys at the Cape for Thanksgiving.

He also loved his professional family gatherings of the Carroll Club and never stopped enjoying the renditions of travel misfortunes endured by the group.  He was a fierce competitor in doubles tennis, especially at the net, and the heat did not stop him.

Several years ago at a meeting in Arizona, on a day near 100 degrees, he literally played out of his tennis sneakers as the soles melted to the court and delaminated from the shoe, but play on he did.

Bob taught us humility and hubris with the now infamous Fickle Finger of Fate.  This dubious award was given to the Carroll Club member who best exemplified persistence in the face of adversity, sometimes self-inflicted and sometimes inflicted by the cruel fates.  He would carefully cajole us to bear our souls in cases we often dreaded to recall.  “Remember you are among friends,” he would say, as well as, “we can all learn from this.”  He did not spare himself from this trial either.  After all had presented, he would recite the misadventures with a style and spin all his own, and then call for the secret ballots which would determine the winner.

Bob was a luminary around the world as an invited lecturer and member of sixteen International hand societies on all four corners of the globe.  He extended this internationalism by accepting visiting foreign fellows for a full-year of training, and has even extended this to some second generation fellows, most recently Dr. Ueba from Japan.  Dr. Carroll has personally funded continuing fellowship opportunities to surgeons from Germany, Turkey, and Japan.  More than one hundred fifty foreign hand surgeons have been trained thus far.

Following his retirement from active surgical practice at age seventy five in 1991, he continued as Emeritus Professor of Orthopaedic Surgery at Columbia University.  He by no means simply faded away, but rather maintained an active presence on campus and in the department.

He funded part of the eleventh floor renovation of the department’s academic space as well as managed two separate funds for resident support and a foundation:  The New York Orthopaedic Hospital Foundation for Orthopaedic Research.  This foundation has several million dollars for capital equipment and seed research grants for faculty and residents that have helped keep the Columbia Orthopaedic Surgery Service under Dr. Lou Bigliani’s leadership one of the top programs in the United States.

As I have occasion to travel for meetings and invited lectureships, one question always pops up as soon as Columbia Hand Surgery is mentioned:  “How is Dr. Carroll?” inevitably followed by “Let me tell you about the time he said this or did that and I have never forgotten it.”

 Bob had so many classic lines.  One was from William H. McGuffey’s reader.  For those of you who don’t know William Holmes McGuffey:  born in 1750 in Pennsylvania, he wrote the most widely distributed grammar school textbook in 1836 with over 120 million copies sold worldwide and still in use today.  Ever the educator, Bob Carroll seized on this simple but direct primer for his encomium:  “Good Better Best, Never Let Them Rest, until Your Good is Better, and Your Better, Best.” 

None of us who knew him well will ever forget that challenge.  He taught us much:  to know when to operate and when not to.  He abhorred surgery which was nothing more than “a surgical annuity.”  He had strong opinions, to say the least, such as saying ganglion surgery of the wrist was like “trading a bump for a scar.”  He also loved to use analogies when explaining conditions and their expected outcomes to patients.  He likened Dupuytren’s contracture and its predilection for recurrence to “weeds in the garden” that might need to be revisited, and arthritis as “rust on the hinges.” 

He helped develop and popularize a procedure for thumb arthritis called the anchovy tendon interposition with one of his fellows, Avrum Froimson.  One of his senior residents took him literally and placed a real anchovy in the specimen cup to send to the pathologist which got both a laugh and a lecture from Bob. 

Bob was matter-of-fact and a pragmatist.  Instead of haranguing an inattentive circulating nurse, he used a Pavlovian technique and I quote:  “Ten bloody sponges thrown in one spot on the operating floor will bring a bucket to that spot without repeating the original request.”

Bob Carroll was a pioneer in congenital hand surgery and built many hands using bone transfer, distraction lengthening, tendon transfers, and flaps and grafts.  He would finish one of his famous pollicizations, which is taking an index finger and transferring it to the thumb position for a child born without one, and then, without missing a beat, picked up a mop and swabbed the floor to expedite the next patient’s entry into the OR. 

He taught us to master complex as well as simple tasks like using an eggbeater-type hand drill to place a pin inside the bone while chirping “hey diddle diddle right down the middle.”  All of us who trained with him have these independent memories.

I last saw Bob in late June before he went off for vacation, and he was still caring for patients by asking me for a referral for a friend in Tampa, Florida.  His illness took us all by surprise as we illogically felt he might live forever.  His last Carroll Club meeting in Naples, Florida this spring was typical Bob.  He was quite a sight in a safari suit riding in the front of a hovercraft and splashing through the Everglades at top speed.

When he fell terminally ill this summer on the Cape, he was told by his doctor that there was nothing more that could be done, and he felt well enough to be at his home on Great Island.

There he was able to sit and gaze out at the children playing and the boats plying on the waters of Hyannisport.  He loved that compound and the Carroll Club was privileged to share a sun drenched seaside New England clambake with him there just a few years ago.

When I last spoke to him, he was relishing some pistachio ice cream and gazing at that water with contentment, and seemed at peace.  In typical REC style he said, “these things happen you know.”

As a lasting tribute to Bob, his fellows have pledged funds to name the prestigious Annual Founder’s Lecture at the American Society for Surgery of the Hand the Robert Ernst Carroll Founder’s Lecture, and so it shall appear on each and every subsequent program in perpetuity.

Assembled here from around the world, and many who are here in spirit, we salute and thank you, Dr. Carroll, for a life well lived and a legacy that shall never die.


Melvin P. Rosenwasser, MD

Robert E. Carroll Professor of Hand Surgery

Columbia University Medical Center