2004-11-20 14:59:15 UTC
The Toronto neurosurgeon operated on thousands of patients and yet his
best known case was a 12-hour procedure performed on two little girls
from Karachi, Pakistan
By SANDRA MARTIN (Toronto Globe and Mail)
Saturday, November 20, 2004 - Page S11
In a surgical career that spanned 30 years and thousands of operations,
Dr. Harold Hoffman will always be remembered for operating on two
little girls named Hira and Nida Jamal.
The two-year-old twins from Pakistan, who had been born with their
heads joined, had been confined to intensive care at Karachi's National
Institute of Child Health where they might have languished if Benazir
Bhuto, then prime minister of Pakistan, hadn't intervened. In 1995, Ms.
Bhuto committed $100,000 in government funds for a global search for a
surgeon willing to take on the challenge of separating them.
It was to be Dr. Hoffman's most celebrated case.
Dr. Hoffman and his team at the Hospital for Sick Children in Toronto
spent more than 12 hours in the operating room. Dr. James Rutka, who
served as Dr. Hoffman's assistant during the operation, remembered it
well. "At one critical juncture in the case when a blood vessel which
joined the twins had let loose and was bleeding profusely, Harold
quickly hooked the vessel with his index finger and clipped it with his
other hand," he said in a eulogy to Dr. Hoffman this week. Both twins
survived the procedure, which Dr. Rutka said was "miraculous," but Nida
suffered a stroke a month later and died.
Harold Joseph Hoffman was born in Toronto, the only son of Louis and
Goldie Hoffman. His parents, who were both tailors, had emigrated from
Poland after the First World War. They opened a dress shop on Bloor
Street West and lived with her mother Rachel and their two children,
Harold and Lorraine, in a small apartment above their store. Even as a
little boy, Dr. Hoffman wanted to be a doctor and his parents, who
placed a great value on education, did everything in their power to
"Their world revolved around him. My grandfather used to tell the story
about how he made sure everyone stayed quiet when my father was
studying" recalled Dr. Hoffman's second son Andrew, a real-estate
developer. Lorraine Hoffman Allan, seven years younger than her
brother, also excelled academically. She earned a doctorate in
psychology from McMaster University, where she continues to teach.
Dr. Hoffman graduated from the University of Toronto Medical School in
1956, with a panoply of academic scholarships to his credit. The next
year he married JoAnn Shulman and together they had three children,
Richard, Andrew and Katie.
After completing a residency in neurosurgery under the late Dr. Harry
Botterell, Dr. Hoffman joined the staff of the Hospital for Sick
Children in 1964. There he worked with Bruce Hendrick, the first
pediatric neurosurgeon in Canada, and Robin Humphreys. Collectively,
the three men, who were called the 3Hs, co-authored definitive
publications on pediatric neurosurgery and drew students from around
the world. More than 120 international fellows and 200 University of
Toronto residents trained in pediatric neurosurgery under Dr. Hoffman.
By 1986, he had risen to become Neurosurgeon-in-Chief at the Hospital
for Sick Children, a position he held for a decade. Two years later,
the Harold J. Hoffman/Shoppers Drug Mart Chair in Pediatric
Neurosurgery was established at the hospital in recognition of his
achievements and his international reputation.
Although the operation on the twins netted Dr. Hoffman an enormous
amount of attention, it wasn't the biggest achievement of his career,
according to Dr. James Drake, a former student who is the current
holder of the Hoffman Chair in pediatric neurosurgery at HSC.
Besides working full time as a surgeon, Dr. Hoffman published 200
articles, edited and contributed to numerous textbooks, pioneered
innovative techniques on seemingly inoperable brain tumours and facial
abnormalities and amassed a research collection of more than 40,000
slides based on his clinical experience that have been digitized and
placed on the University of Toronto Neurosurgery website.
Pointing out that many of Dr. Hoffman's publications were landmark
articles that are still cited today, Dr. Drake said: "His breadth of
innovation was incredible. He was a technical genius and he embraced
new technology even towards the end of his career when it gets harder
to do that. He looked for any way he could to improve his surgical
>From all accounts, Dr. Hoffman played as hard as he worked.
Fred Epstein met him at the first international meeting of pediatric
neurosurgery in Japan in 1973 and they became fast friends and
As a surgeon, Harold Hoffman was "somebody who felt he could do
anything," Dr. Epstein said from his home in New York. "He felt that
whatever he did was the right way and the only way. He was convinced
that he was the best in everything -- and he was. He was very, very
The two men, who worked together to design one of the world's first
Uni-shunts (a device that helps avoid problems of disconnections and
breakages when diverting blood flow), were in demand as lecturers and
surgeons around the world. When they weren't working, they loved
playing games with each other and on each other. "We were very
competitive," said Dr. Epstein fondly. "I would buy a watch and he
would buy a watch. I would always try and one-up him and he would try
and one-up me."
Dr. Rutka said his mentor possessed eccentricities as well as genius,
including the wearing of a monocle and, on formal occasions, a
For many years, Dr. Hoffman was such a committed pipe smoker that his
son says "for the first 15 years of my life he had a pipe in his mouth
every waking minute other than when he was in the hospital." According
to a story that his family swears is true, Dr. Hoffman., pipe in mouth,
once fell out of a canoe in rough water. He went under and popped up
again still clenching the pipe between his teeth and continued to puff
After he retired in 1998, Dr. Hoffman took up painting. He signed up
for art classes and with his typically prodigious energy he painted
some 20 canvasses in about six months. These paintings, which are
mainly landscapes, are now hanging on the walls of the family cottage
at Lake Simcoe and in the homes of his wife and three children. "They
are quite special," said Mr. Hoffman. "People see these paintings and
ask who did them and are quite blown away that [they were painted by]
my father during his illness."
In a ghastly twist, the internationally famous brain surgeon who saved
the lives of thousands of children developed frontal lobe dementia. The
disease manifested itself shortly after he retired.
"The dementia got progressively worse," said his son-in-law Jordan
Atin. "Speech was the first thing to go and then he couldn't walk or
move his arms." Describing his father-in-law as "a very tall man and a
very striking figure," he said it was "tragic" to watch his decline.
Dr. Hoffman had a great career and he was never able to enjoy the
aftermath, lamented Dr. Drake. "He had a tremendous amount to
contribute in terms of his teaching and his continued involvement in
pediatric neurosurgery and he was denied that. It was horrible."
A legacy that his son says is a great comfort to the family are the
letters and phone calls from former patients in places as far away as
Japan and Israel attesting to the impact Dr. Hoffman had on their
lives. "You hear a lot of gratifying stories," he said, mentioning the
case of a 13-year-old girl diagnosed with an inoperable brain tumour in
the 1970s. "My dad pioneered the removal of that type of tumour and she
says she owes her life to him."
Dr. Hoffman's confidence and enthusiasm rubbed off on his patients,
observed Dr. Drake. "He was optimistic no matter how bleak things
looked. He never quit and they really loved him for that."
In a final request, Dr. Hoffman asked that his brain be donated to the
Canadian Brain Tissue Bank for research purposes.
Harold Joseph Hoffman was born on May 12, 1932. He died in Toronto on
Nov. 14, 2004. He was 72. He is survived by his wife JoAnn who, even
though she suffers multiple sclerosis, cared for him at home during his
final illness. He also left his children Richard, Andrew and Katie.