Lawrence Pottenger, MD, PhD, 1944-2006
September 29, 2006
An orthopedic surgeon with a particular interest in arthritis, the orthopedic problems in the elderly and improving artificial joints, Lawrence A. Pottenger, MD, PhD, associate professor emeritus of surgery and pathology at the University of Chicago, died September 25th at the University of Chicago Hospitals from complications of early-onset Alzheimer's disease. He was 62.
Pottenger worked as a clinician and surgeon four and a half days a week, performing almost 350 operations a year, mostly hip and knee replacements, for 25 years. He helped introduce hip-replacement techniques that avoid the use of cement, which is prone to loosening with use and was an early advocate of less-invasive operations, using smaller incisions.
He also spent time teaching medical students, doing research on the composition of cartilage and the changes that occur in the progression of osteoarthritis, and designing artificial joints. He and colleague Louis Draganich, PhD, associate professor or surgery at the University of Chicago, designed and patented the Two Radius Area Contact (TRAC™) knee to provide a more durable joint with normal range of motion that made it suitable for younger and more active patients. More than 3,000 TRAC™ knees have been implanted, primarily in Europe, where the original trials were performed, as well as Japan and Australia.
The impetus for TRAC™ came from an off-hand comment. "Larry was meeting with the head of a company that made artificial knees and he complained about their products," recalled Draganich. "So the guy said 'If you think you can make a better one, go ahead.' And we did."
"He was a treat to work with," Draganich added, "brilliant but unconventional. As we talked about TRAC™, our research or other matters, he would make unexpected, sometimes bizarre comments and suggestions. Some of them seemed completely out of left field at first, but then I would realize they were brilliant. He just saw things that no one else would think of."
"He was the closest thing to a Renaissance man I've ever met," said Daniel Mass, MD, professor of surgery. "Larry was the guy that other physicians went to see. He became the arthritis doctor for all of Hyde Park, in part because he was a talented and compassionate physician, but also because he was easy to approach and really good at explaining what was wrong. At the same time he had all these other talents. He wrote the original computer program for orthopedics to help us track billing and expenses."
Born May 21, 1944, in DeKalb, Illinois, Lawrence Avery Pottenger earned his SB degree in physiology (1966), PhD in pathology (1972) and MD (1974, with honors) from the University of Chicago.
He did not set out, however, to become a doctor. "It was my goal to do medical research," he explained in a book about the role of "healers" that he began in retirement but never quite completed. He only went to medical school because, "in those days, people doing medical research had to have an MD degree or they would find themselves working for someone with an MD degree."
He completed his PhD and was in his third year of medical school "before I had even the slightest desire to be a doctor," he recalled. But his clinical interactions soon won him over. "Nothing could have prepared me for what I experienced when I started seeing patients," he wrote. "Their stories were fascinating. Their problems were very complicated, real and immediate compared to the abstractions of scientific proofs." He chose orthopedics because the patients were relatively healthy, "except for mechanical problems in their limbs. The emphasis was on making people more functional, not slowing the progression of their decay."
After a five-year residency in general and orthopedic surgery at Johns Hopkins Hospital in Baltimore--where he met a nurse, Barbara Merlo whom he married in 1977--Pottenger was recruited back to the University of Chicago as an orthopedic surgeon in 1979. His wife worked as head nurse in the recovery room until they had their first child. He was promoted to associate professor in 1984 and served as chairman of orthopedics from 1984 to 1986 and as vice-chairman from 1986 to 1992.
He began his academic career as a pediatric specialist, but as his laboratory research focused more and more on the causes and treatments of arthritis, the mix of patients referred to him began to change. "With great reluctance," he wrote, "I became an adult arthritis surgeon. I traded the enthusiasm and pleasant naiveté of children for the fatigue and unhappiness of people in constant pain."
The exchange taught him an important lesson. When there is no real treatment for the disease, he discovered, you provide treatment for the patient. "You begin to be a healer when you start to feel what patients are feeling," he advised colleagues. "Listen to their stories. Let yourself be lost in their stories. Do not judge them or try to fit their stories into your system of values. Do not try to analyze their stories, just experience them. There will be plenty of time for analysis later."
Because of his technical skills, his empathy for patients--and their devotion to him--and his success in the laboratory, Pottenger rose to prominence in the professional societies in his field. He authored six book chapters, 30 articles in scientific journals and more than 60 abstracts. He served on multiple oversight boards and committees for the Association of Orthopedic Chairman, the American Board of Orthopedic Surgeons, the Orthopedic Research Society and others. He was a member of the editorial board for the Journal of Surgical Research and a regular peer reviewer for JAMA.
Although most of his publications focused on cartilage biology, arthritis and joint replacement, in the mid-1980s Pottenger developed a lasting interest in medical ethics after he confronted his fears the first time he had to operate on a patient with AIDS. At the time, little was known about the risk of transmitting the virus to caregivers during a big, bloody operation such as a knee replacement.
"As a doctor," he decided, after weighing all the factors, "I had to do the operation." If he had refused, "I would be the person who was too frightened and too selfish to help a person I cared about," he wrote. "I would spend the rest of my life with a scar on my spirit." He later published several influential papers analyzing his own decision process, the surgeon's obligation to treat, and the attitudes and practices of orthopedic surgeons concerning patients with HIV.
Pottenger was a sought-after scientist in a field that did not, at the time, attract a lot of top-flight basic scientists, said his colleague, Michael Simon, MD, professor of surgery. "But he made it clear from the start that he wanted to be known for patient care," said Simon. "He was absolutely devoted to his patients. He went to their homes. He saw them in clinic without an appointment. Every afternoon he would have 40 little pink messages on his desk and he called them all back himself."
When he developed the first hints of cognitive impairment, however, Pottenger had to leave patient care and focused instead on his book. He stopped seeing patients early in 2003 and went on disability that spring. His health declined rapidly in the last year.
He is survived by his wife Barbara, daughters Katherine and Lindsey, brothers Eugene and Gary, sister Chelon Stanzel, and son-in-law Eric Bartlett. A memorial service will be held at 2 p.m. on Saturday, October 21 in Rockefeller Chapel. In lieu of flowers, donations should be made to the Alzheimer's Association, 225 N. Michigan Ave., 17th floor, Chicago, IL 60611.
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