Dr. Al Rhoton: The giant on whose shoulder we stand.

What a piece of work is a man! how noble in reason! how infinite in faculty! in form and moving how express and admirable! in action how like an angel! in apprehension how like a god! the beauty of the world! the paragon of animals! And yet, to me, what is this quintessence of dust?

—William Shakespeare, The Tragedy of Hamlet, Prince of Denmark, Act II, Scene 2

This obituary was written by William Friedman and publised in the Journal of Neurosurgery: 2016 Jul;125(1):1-3. doi: 10.3171/2016.3.JNS16524 with permssion.

I think that question, which neuroscientists might call the mind-body problem, is what partially drove and fascinated Dr. Rhoton for much of his life. In other words, how does that “quintessence of dust” we call the brain become the angel?

Albert Loren Rhoton Jr. was born November 18, 1932, in rural Parvin, Kentucky, in a log cabin without electricity or plumbing. The midwife who delivered him was paid with a bag of corn. His early schooling took place in a small 2-room school that housed all 8 grades. His mother was a teacher, although she held no degree. Nonetheless, he made it to Ohio State University, where, during part-time work with groups of disadvantaged children while a student, he decided to pursue a degree in social work. He noted in a later interview that all of his social work courses were well attended by the football players! Due to the influence of a spectacular teacher in physiological psychology, he decided to become a neurosurgeon and switched his major to pre-med. He flunked all of his initial exams and realized that he needed to stop working so many hours and spend more time studying. He wrote his father, a wonderful man whom many of us were privileged to know well, who responded, “it does a boy good to go hungry.” Fortunately, a friend was able to loan him some money, he took advantage of the extra study time, and he wound up with A's in all his courses. He went on to graduate first in his medical school class at Washington University. After a 2-year stint at Columbia University in New York, he returned to Washington University for neurosurgical training.

After residency he joined the Mayo Clinic faculty and, in 1972, was recruited by Ed Woodward to become chief of neurosurgery at the University of Florida. There were only 2 faculty members at the time. Since then, the department has grown to 18 clinicians, 13 research faculty, 21 residents, and additional clinical and research fellows. During his tenure as chairman, he landed the first $1 million donation in the history of the University of Florida system. He subsequently obtained funding for 10 endowed chairs for research and education in cerebrovascular, pediatric, spinal, computer-assisted and stereotactic surgery, and microsurgery and neural regeneration. At the time of his transition out of the chairman's position, his former residents, donors, and friends contributed more than $2 million to be matched by another $2 million from the state of Florida to create the Albert L. Rhoton Jr., M.D., Chairman's Professorship in the Department of Neurological Surgery. He played a key role in the development of the McKnight Brain Institute, a 6-floor building devoted to neuromedicine, which opened in 1999.

He became active in the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) soon after joining the Mayo staff. He was elected to the Executive Committee of the CNS in 1972 and president in 1978. During his presidency he began efforts that led to the development of the Joint Section on Spinal Surgery of the AANS and the CNS and the transformation of the Joint Socioeconomic Committee into the Council of State Neurosurgical Societies. He was elected treasurer of the AANS in 1983 and president in 1990. He also served as president of the Society of Neurological Surgeons, the Florida Neurosurgical Society, the North American Skull Base Society, the International Interdisciplinary Congress on Craniofacial and Skull Base Surgery, and the International Society for Neurosurgical Technology and Instrument Invention. He also served as chairman of the Cerebrovascular Section of the AANS and CNS, governor of the American College of Surgeons, director on the American Board of Neurological Surgery, and a member of the Appeals Panel of the Accreditation Council for Graduate Medical Education (ACGME), which accredits neurosurgical residencies. He also served on the medical advisory board of the Trigeminal Neuralgia Association and The Best Doctors in America Foundation and as chairman of the advisory board for the Acoustic Neuroma Association. In 1981 he received the Distinguished Faculty Award from the University of Florida. He earned numerous other honors and awards throughout his career. He was the honored guest of the CNS and the Cushing Medalist of the AANS. He was the honored guest or was elected to honorary membership in more than 20 neurological societies throughout the United States, Latin America, Europe, Asia, and Africa. He was an invited faculty member at more than 50 universities and gave numerous keynote lectures including those at the 60th anniversary of the Montreal Neurological Institute and the 40th anniversary of the Beijing Neurosurgical Institute. He also gave numerous named lectures including the Olivecrona, Krayenbühl, Mayfield, Donaghy, Magnus, Ratcheson, Mayer, Jameson, and many others.

Dr. Rhoton was an outstanding teacher of residents and neurological surgeons. He began a series of microsurgery courses at the University of Florida in 1975 that have been attended by more than 1000 neurosurgeons and residents. He served on the editorial board of a dozen journals including Neurosurgery and Surgical Neurology. He published more than 400 scientific papers and chapters, as well as 3 books. He contributed many full-issue supplements to Neurosurgery, featuring his outstanding neuroanatomical studies, which have truly changed the way that all neurosurgeons perform microsurgery and improved surgical outcomes for uncounted patients.

Dr. Rhoton's accomplishments in the areas of surgery, research, and training, some of which are noted above, are legendary and Herculean. But much more than those great things, we must admire the man.

I attended Ohio State Medical School. The neurosurgical chair at the time was William Hunt, a graduate, like Albert Rhoton and many other chairs at that time, of Henry Schwartz's Washington University neurosurgical residency. When I asked Dr. Hunt where I should apply for residency training, he gave me the usual list and then added, “and you should go see young Al Rhoton in Gainesville.” That was 1975. I interviewed at Minnesota; Washington University; University of California, Los Angeles; University of California, San Francisco; and Florida. I met the chairs: Shelley Chu, Sidney Goldring, Gene Stern, Charles Wilson, and Al Rhoton. I was profoundly impressed by how different Dr. Rhoton was from the other chairs. Even as a medical student, it was clear to me that he had deep-seated elements of compassion, gentleness, and kindness. I knew that the crucible of neurosurgical training would imprint me to some degree with the characteristics and habits of my faculty. I wanted to be like Al Rhoton, at least as much as I could, so I went to Florida. I have never regretted that judgment or that decision.

As Osler said, and as Dr. Rhoton endlessly demonstrated, “happiness lies in the absorption in some vocation which satisfies the soul; that we have here to add what we can to, not to get what we can from, life.”1

Rhoton said in an editorial, “our lives have yielded an opportunity to help mankind in a unique and exciting way. Our work is done in response to the idea that human life is sacred, that the brain and nervous system are the crown jewels of creation and evolution, and that it makes good sense to spend years of our lives in study in order to be able to help others. The skills we use are among the most delicate, most fateful, and to the layman, the most awesome of any profession.”2

During an incredible interview in the University of Florida History of Medicine series, Dr. Rhoton was asked the following hypothetical: “If God came to you and said that if you worked as hard as you could through college, medical school, and neurosurgical training such that you could save one and only one life, would you do it?” He responded, “Absolutely yes.”

In the brilliant movie “Schindler's List,” Steven Spiel-berg recounted the story of the Schindlerjuden, the hundreds of Jews saved by the actions of Oskar Schindler during World War II. In gratitude, one of them made, as a present for Schindler, a gold ring from extracted dental fillings. On it he inscribed an ancient Talmudic saying, “He who saves one life saves the world entire” (Mishnah Sanhedrin 4:9; Yerushalmi Talmud, Tractate Sanhedrin 37a). Of course, Dr. Rhoton and his many students have saved not just one life, but thousands. Thousands have lived because Dr. Rhoton lived.

Richard Selzer, a Yale surgeon, wrote:

I do not know when it was that I understood that it is precisely this hell in which we wage our lives that offers us the energy, the possibility to care for each other. A surgeon does not slip from his mother's womb with compassion smeared upon him like the drippings of his birth. It is much later that it comes. No easy shaft of grace this, but the cumulative murmuring of the numberless wounds he has dressed, the incisions he has made, all the sores and ulcers and cavities he has touched in order to heal. In the beginning it is barely audible, a whisper, as from many mouths. Slowly it gathers, rises from the steaming flesh until, at last, it is a pure calling—an exclusive sound, like the cry of certain solitary birds—telling that out of the resonance between the sick man and the one who tends him there may spring that profound courtesy that the religious call Love.3

Dr. Rhoton loved his patients.

For those of us who loved him and were fortunate enough to call him teacher, mentor, colleague, friend, brother, father, grandfather, great-grandfather, a bit of light has forever disappeared from our world.