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Dr William I NORWOOD MD, PhD. (21.04.1941 - 13.12.2020)
It is a great sadness to announce the death of Dr William (Bill) Norwood who passed away peacefully following a short illness in the presence of his family last Sunday 13th.
Few doctors can claim to have impacted the practice of medicine and surgery as profoundly as Bill. Over time, thousands of surgeons in all disciplines have designed and refined a huge variety of operations some of which carry the name of the surgeon who pioneered the technique. It is the ultimate professional honour for a surgeon to have their name remembered in this way. Some of these operations have been superseded and confined to history.
In congenital cardiac surgery the Norwood operation stands out as arguably the pinnacle of surgical skill and overall institutional competence. I think it is right to say that it represents the last of the really “new” operative procedure to carry the name of the pioneer surgeon. Others more recent tend to be modifications of an established procedure. Also, it is unlikely to be superseded easily though there are many attempts but all funnel back to the Norwood in one way or another.
Up until Bill started treating HLHS, then generally referred to as mitral atresia, these babies had no hope. In the UK most were discharged home to die with their family. Prostaglandin was not available until the early to mid-1980s so temporary support was impossible. Bill, aware that the reciprocal conditions, tricuspid and/or pulmonary atresia with intact septum could be managed surgically, thought that something could and should be done for these babies with the aim of achieving a Fontan circulation. His attempts were controversial and many senior surgeons, cardiologists and paediatricians thought it was wrong to aim toward a Fontan even suggesting that the operation was unethical. I can recall one venting his wrath at the concept while another perhaps with some justification said he could not get enthusiastic about an operation that had a Fontan as its end point.
Bill took no notice and kept trying. Gradually he refined the technical details of the initial operation first at Boston Children’s Hospital and then as Chief at CHOP where he moved in 1984. For those who survived the first stage in those early days, completion Fontan was undertaken in a single operation with a challenging recovery period. It was Bill supported by Marshall Jacobs who conceived the two-stage approach to Fontan completion which revolutionised the outcomes. Today the Fontan operation is a straightforward procedure with low mortality and comparatively minimal morbidity thanks to the Norwood operation.
I was privileged to work with Dr Norwood when he joined me at Guy’s as honorary consultant for a year 1995-1996 and helped launch our surgical program for Hypoplastic Left Heart Syndrome. It was a huge learning experience not just how to do the operation but the spin-off lessons on how to better manage single ventricle physiology led to improved results in all areas of our practice.
He was an exceptional surgical technician. Born naturally left-handed he was ambidextrous having trained himself by writing lecture notes as a student with his right hand. As he sutured he would pass the needle-holder from hand to hand without any noticeable change in dexterity or speed. Quite mesmerising to behold and something I have never seen anyone else do. However more crucially he had a deep understanding of the physiological impact of the operative procedures. That was the lightbulb moment for me and my colleagues that illuminated how to do the Norwood operation and get the baby safely through recovery. I and all of British paediatric cardiology owe him a huge debt of gratitude. I doubt there will ever be another like him.
It would be remiss of me to not give credit to Jodee, his scrub nurse at Boston who moved with him to CHOP, then to Switzerland and back to Nemours Hospital Wilmington, Delaware from where he retired in 2003. When I invited Bill to help at Guy’s I asked if he wanted any of his colleagues to accompany him. Straight away he said “my scrub nurse Jodee”. I agreed knowing personally the value of a familiar person at your right hand when operating difficult cases. As a double act operating together they were extraordinary. She anticipated his every move and there is no question she was crucial to his success and he would be the first to highlight that.
Jodee survives him having been his professional and personal “other half” for 40 years and to her we extend our deepest sympathy and gratitude for a life well lived. The same to all his family and the many professional colleagues who like me will miss him.
“In the end it is not the years in your life that count but the life in your years” (attributed to Abraham Lincoln)
Few have left this life with a legacy to humankind that equals that of Dr William I Norwood. May he rest in peace and may his memory live on in our hearts and mind.
Professor David R Anderson
Consultant cardiac surgeon
Evelina London Children's Hospital