Progress in Pediatric Cardiology 22 (2006) 143–145www.elsevier.com/locate/ppedcard

Obituary

In gratitude: Some thoughts on Robert M. Freedom MD FRCP(C),FACC, O. Ont.

Dr. RobertM. Freedom at the time of his retirement in October2000, was the Head of the Division of Cardiology, The Hospitalfor Sick Children, Toronto, October 2000.

Sadly, Bob Freedom passed away in 2005 before this tributewas completed, after years of more than extraordinarycontributions to the field of paediatric cardiology and thetraining of countless fellows. Included in this issue of Progressin Paediatric Cardiology, are some thoughts from a few of thepeople that knew him well [1,2].

Ursula Sauer and Gerald Graham:There have been few pediatric cardiologists who – since the

pioneering days of the 1940s and 1950s – have had such aprofound and widespread impact as R.M.F. As physician-scientist, teacher, mentor and friend he has been exemplary andmanaged with both kindness and incisiveness to influence allwho have come to know him. His phenomenal memory of

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patients and all the circumstances of their life and disease haveenabled him to collect such rich experience of medicine and lifethat he has always been able to speak with authority fromknowledge. Yet he has managed to avoid the danger that theparticular of a subject would drown out the wider scene, whetherit is personal or medical.

His training in some of the scientific disciplines on whichpediatric cardiology has fed – physiology, pathology, imagingtechniques – absorbed into his work and daily practice, havemade it possible for him to contribute to his chosen subject inmany different ways.

While many of his publications have been the precipitate ofteamwork, his books have been largely the result of his very ownefforts. They have demonstrated not only his wide range of insightand knowledge, but also his phenomenal attention to detail. Hislatest book “Natural and Modified history of Congenital HeartDisease” – published in 2004 – will be a summary of his pro-fessional life's endeavours. As he has lived and centrally parti-cipated in the enormous advances in the science, diagnosis andtreatment of pediatric cardiology, he can truly look over the wholesubject with great insight and compassion.

The contents of this tribute to him “in gratitude” reflect thewide range of people and topics that have been directly orindirectly influenced by Bob's own thoughts and work. But theyalso give evidence of another, very important, aspects of his life:his ability and pleasure in making friends have and inspire somany people he has met over the years. Throughout the world –literally the five continents – he has got to know and taughtunlimitedly several generations of pediatric cardiologists, aswell as others in related subjects. Whether he has helped set upsmall units or big departments, whether he has advised orspoken to the beginner or an experienced colleague, it hasalways been done with tact and concern for others. Talking tohim one felt easy and understood, even if he did not share one'sopinion.

It is this ever-present and unprejudiced concern for others,easily and often accompanied by infectious laughter, that hasmade him a colleague who is widely respected and appreciated,but most of all held in great affection.

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Giacomo Pongiglione:In 1979 I had just passed my ECFMG examination and I was

looking for a pediatric cardiology fellowship in North America.I met Bob at a meeting in Bologna and I was impressed by hispresentation and by his clarity of mind. I had the chance to talkto him at the lunch break and I was fascinated by his charm andfriendly attitude. He suggested me to apply also to Toronto andeventually I ended up at the Hospital for Sick Children. I amconvinced that meeting Bob in Bologna was my piece of luck inmy professional life. The two years I spent there were fantastic.Bob was my preceptor and supervisor and he was always readyto spend time with me, going over difficult cases and strangeangiograms and pathology specimens. His friendship and hisencouragement, together with fantastic colleagues and friends,were determinant to make my staying in Toronto probably thebest period in my life.

Horacio Capelli:I feel honored for having been invited to contribute on an issue

of Progress in Pediatric Cardiology in tribute to Dr. RobertFreedom who has so profoundly influenced the evolution ofcontemporary Pediatric Cardiology with his unique and out-standing medical thinking. I am also honored by our long-lastingfriendship, which I will always cherish.

I have first met Bob in 1977 in Buenos Aires and I wasimmediately impressed by his vast knowledge of PediatricCardiology and his special gift to captivate the audience. Hebecame a nearly permanent guest of the Argentine Congress ofPediatric Cardiology and invariably always turned out to be thebig star and main attraction of it. We have shared the sameinterest in morphology and its association to the clinicalevolution and surgical outcome. We have also shared aparticular attraction by Jane Somerville's medical thinkingand flamboyant personality.

Not only was he a true blue friend who supported and helpedme in every possible scenario but also he kept a long-standingfriendship and respect towards Argentine Pediatric Cardiology.Actually without Bob's determination and fighting spirit BuenosAires would not be today the venue for the 2005World Congress.Likewise modern Pediatric Cardiology would not have been thesame without Bob's mighty contribution.

Professor Jane Somerville:I agreed to write some thoughts about ‘my relationship’ with

Bob. He has been, for more than 30 years a most constantsupporter. Some might say my only one — not quite true. I ammindful of the words of one of my amusing colleagues incardiologywho said, “Your fan club, Jane, could fit in a telephonebox!” He did not know about Bob and was wrong for differentreasons.

This is a difficult brief as there is much to say and think aboutwhat has appeared in the formative decades and the evolution ofpaediatric cardiology, which we have witnessed together.

Late but willing, I am in a perfect place to contemplate clearly,in the shadow of Cawdor Castle, home of Macbeth. I think of allthat we have witnessed, shared, argued about, agreed and of ourdiscussions on plans for the future as the present was extremely

enjoyed. We were so excited by the challenges, discoveries andthe new treatments and triumphs brought about by courageous,talented “surgeons” often showing remarkable ingenuity both todetriment and benefit of patients. I was beginning on theinternational circuit (circus?) where changing dogma, myths andinnovations were exposed and followed. I looked forward toconferences and finding that Bob was speaking, wherever, andthere were some crazy places and people. He brought clarity andsense with his amazing understanding and explanation ofpathological anatomy as seen on angiography. Over many yearswhether in USA, Europe, Asia, Dubrovnik (most memorable) orLatin America where we both felt “at home”, we exchanged frankand trenchant views about the world around, the nonsense talked,the obsession with nomenclature and particularly the vagaries andexploits of cardiac surgeons. We shared admiration of the fewgreat and good and after a while, our crises — the digoxindisaster, the deaths of dear colleagues and relatives, dangerousand/or depressing liaisons, departmental difficulties, the obstruc-tion from European paediatric cardiology to the first WorldCongress of Paediatric Cardiology in the late 1970s for which he,withDickRowe, gave somuch support, the sadness of closing theNational Heart Hospital and forced to join the Brompton. Both ofus were interested in ‘outcomes’ from different perspectives,backgrounds and training. He encouraged me in my thinking thatchange in form and function in congenital heart disease wasimportant and my ‘odd’ views on the acquired nature of fixedsubaortic stenosis, tunnel obstructions and the study of naturalhistory of complex malformations before it was too late to know.Together we looked at and disagreed about Fontan type surgery,Norwood procedures, homografts that did poorly in NorthAmerica initially and much more. We enjoyed wine and OscarWilde and so many good meals in many places. Dinner andlaughter with Bob was the peak of many conferences.

I needed his support and admiration. It is better to have onegood friend than many acquaintances. He has been that. Wespoke of writing a book together — his last. We realised ourdifferent outlooks and experience were complementary. It didnot happen — it is Bob's book and this was not entirely due tomy usual dilatoriness about writing, in contrast to his com-pulsive discipline, knowledge and ability to produce torrents ofinformation about paediatric cardiology. I was honoured whenhe asked me to write the last chapter. He has written all that wasneeded to know so what to call the final chapter and what towrite? He enjoyed my likening of paediatric cardiology andcardiac surgery to the legend of the Ring Cycle, and the simi-larity of the gods, the naughty gnomes, the Walkyrie to thecharacters around our world.

Bob, you have helped me, made me believe I had somethingto contribute, encouraged me to make the World Congress ofPaediatric Cardiology in 1980 honoured me by making me its'president 21 years later, understood about the importance andneed for the grown up congenital heart (GUCH) services, andbeen a good and constant friend. I salute your enormouscontribution to paediatric cardiology. I used to have a notice onmy office door “The courage to be imperfect, under my name”.Thank goodness you have it and are! Thank you for being myfriend.

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Andrew Redington:I first met Bob Freedom, when he visited the Brompton

Hospital in London in the late 1980s. At that time, I was pursuinga career in adult cardiology, and beginning to wonder about thepossibility of jumping ship to become a Pediatric Cardiologist.Bob spent two days with Bob Anderson, giving lectures, andproviding commentary on our research endeavors. By the end ofthe visit, I knew that I wanted a career in congenital heart disease.Bob has remained a mentor and friend ever since. His enthusiasmand knowledge of our specialty is legendary, and his contributionsunsurpassed. At a personal level, his genuine interest in bothyoung and established clinicians pursing a mutual interest in ourfield is inspiring. I visited The Hospital for Sick Children in 1990,having recently been appointed as a staff pediatric cardiologist atthe Brompton Hospital. I was amazed when taken into Bob'soffice upon my arrival that not only did he remember who I was,but what I had presented to him 3 or 4 years earlier, as well as justabout everything in between! It is difficult to define this sort ofleadership, but it is as important as many a scientific contribution.Nonetheless, there is hardly an area of pediatric cardiology thatBob Freedom has not touched with his intellect and writtencontributions.

Professor Robert Anderson:Bob Freedom has been, and always will be, larger than life. It

has been my privilege now to count him as a friend andcollaborator for almost 30 years. I first met Bob in the mid 1970s,when Anton Becker and I were touring together as a “lecturingduo” through the major centres in North America.We covered, onthe one hand, arrhythmias and, on the other hand, congenital heartdisease. In all places we were treated most royally, but thehospitality offered by Bob was truly spectacular. Shortlythereafter, I was fortunate enough to win a prize that permittedme to travel theWorld for a period of six months, accompanied bymy wife, visiting centres of excellence. Based on my previousvisit, I asked Bob if Toronto could be part of our Tour. Once morewe were entertained in spectacular fashion. Since then, we havecontinued our friendship unabated, and Bob continues to surpasshimself in terms of generosity, not only of spirit, but also of pocket.

Whilst our social interchanges have been outstanding, thesehave been more than matched by our scientific collaborations. Itis no secret that the European school of morphology, and theexpert group based in Boston, rarely see eye to eye. Bob hasnever tired in his attempts to achieve consensus between the twoapproaches, which in reality are not that much apart. I havealways been impressed by the comments of A J Ayer, one of thebetter-known English philosophers of the late 20th century.Writing in the preface of one of his more seminal books, Ayerrecounted how it was the remarks of his sternest critic that wereoften most helpful in refining his concepts, even if the critic didnot necessarily agree with the concept itself. So it has been withthe criticisms levelled by Van Praagh against many of theconcepts advanced by the European school. Although we oftenfelt our concepts themselves had been misconstrued, thecriticisms almost always permitted us to improve from ourstart point. The tempering influence of Bob in helping usconstruct the final versions has been invaluable. Bob, in thisrespect, is unusual, since he is just as much at home in theautopsy room, and at the morphology workbench, as he is in thecatheterisation laboratory. Others better qualified than I willattest to his excellence as an angiographer, but he is equallyskilled when examining and photographing the dissected heart.When these skills are added to his inexhaustible enthusiasm,and his capacity for hard work, it is fair to say that it will beunusual if we see his like again.

References

[1] Benson LN, Anderson RH. Robert Mark Freedom. M.D., FRCPC, FACC,O. Ont. Cardiol Young 2005;15:206–12.

[2] Anderson RH. In-Memoriam — Robert Mark Freedom (1941–2005).Cardiol Young 2005;15:331–2.

Lee BensonThe Hospital for Sick Children, 555 University Ave., Toronto,

M5G1X8 Ontario, CanadaTel.: 416 8136141.

E-mail address: benson@sickkids.on.ca.