Rosemary Radley-Smith a pioneer paediatric cardiologist and early paediatric cardiothoracic transplant specialist, died peacefully aged 81, on 1 August, 2020, after a short illness (Fig 1).

Rosemary was born on 26 February, 1939 at the King’s College Hospital. She was the first child of Eric and Eileen Radley-Smith. Her father, Eric, was a doctor, and her mother a nurse, and both trained at the King’s College Hospital. Her other younger siblings included a brother, Nigel, and two sisters, Penelope and Elizabeth. Her father was a consultant surgeon at the Royal Free Hospital, and later at the Royal Ear, Nose and Throat Hospital, London and at the Hurstwood Park Neurological Hospital, Haywards Heath. During World War II, he also worked at the Horton Emergency Hospital, Epsom, Surrey. During Rosemary’s childhood, the family lived in Surrey and Sussex and she went to Parson’s Mead School in Surrey and later Trevelyan School (Fig 2). She then studied at the Cheltenham Ladies College, Cheltenham, from where she gained entry into the Medicine course at the Royal Free Hospital Medical School, London and graduated in 1963. Rosemary undertook junior doctor training at the Royal Free, the Brompton and the Westminster Children’s Hospitals. She subsequently undertook further training in Melbourne, Australia in 1966. It took an enormous amount of dedication, commitment, determination and adventurous spirit for her to start her training in Melbourne by undertaking a potentially dangerous 3 months journey overland by bus across Europe, the Middle East and India, needing the occasional flight and finally a boat trip to reach Australia. In Melbourne, she worked as a Medical Registrar, with a special interest in cardiology, at the Royal Melbourne Hospital. In addition, at weekends, she participated in the “Flying Doctor” service, further highlighting her spirit of adventure. She passed the membership of the Royal Australasian College of Physicians examination after 2 years of working in Melbourne. For her return to the UK, she took a boat trip across the Pacific, through Tahiti, and the Panama Canal in 1968, thus completing a round world trip. Her sister, Penelope, remembers a story about Rosemary, who on her return from Australia, visited Penelope’s farm, where she saw an ewe badly cut by the shearers. She proceeded to stitch the injured ewe, who survived, much to everyone’s surprise.

Figure 1. Photo of Rosemary.

Figure 2. Childhood photo of Rosemary.

On returning to the UK, she was appointed as a Registrar at the National Heart Hospital and subsequently as the Senior Registrar at Great Ormond Street and Middlesex Hospitals. Interestingly, around this time she lived with Jane and Walter Somerville and their family for about a year, because it was convenient for her to travel to the hospitals where she was training. She was appointed as the first Consultant Paediatric Cardiologist at the Harefield Hospital, Middlesex in July, 1971. An interesting story is that Jane Somerville was being pressurised into applying for this post by another colleague, but Jane was not keen on driving 18 miles to Harefield to deal with emergencies at night-time and also importantly, Walter was on the staff at the Harefield Hospital. So after discussions between Rosemary and Jane, they decided that Rosemary should apply for the post (Fig 3).

Figure 3. Rosemary in her office.

In a partnership recognised around the world, with Professor Sir Magdi Yacoub, Rosemary helped develop a paediatric cardiac service, which became world-class and known for its innovation and excellence (Fig 4). Many of their pioneering techniques received widespread acceptance and are now commonly used in clinical practice. These included the two-stage arterial switch operation in 1976 and the one-stage neonatal arterial switch operation in 1982. Other innovations included valve preserving operations in children and adults, and the use of antibiotic-preserved aortic homografts for both valve replacement, and as part of complex congenital heart repairs. Apart from the start of cardiac transplantation in adults at the Harefield Hospital, in 1984, the unit was the first in the UK to start a heart and heart–lung transplant programme for children under the guidance of Rosemary. The unit received global recognition to the extent that patients were referred for treatment from abroad and international clinicians visited the unit for their training. (Figs 5 and 6)

Figure 4. Photo with Sir Magdi Yacoub.

Figure 5. Rosemary at work in the intensive care unit.

Figure 6. Rosemary showing Princess Anne around the unit.

For over 15 years, Rosemary single-handedly led the paediatric and congenital cardiology service at the Harefield Hospital, one of the authors (RCGF) joining her in 1991. The intensive care work was supported by adult anaesthetists, who at that stage covered both adult ICU and the Paediatric Surgical Unit. Junior trainee support was provided by the adult cardiology registrars, many of whom changed track after working with Rosemary to become leading figures in the next generation of paediatric cardiologists, including Shakeel Qureshi, John Gibbs and Rob Martin. One of the authors (SAQ) of this obituary provided this personal anecdote about Rosemary.

During my time at Harefield, I was amazed by her memory of patients when it came to research. She knew exactly the operations the children had had and when. Her memory was always correct. She subsequently was a great mentor and guided me in my career. I have very pleasant memories of her concerns about my career and advice and support, especially when I was setting up a paediatric cardiology unit in Rawalpindi, Pakistan for 2 years and she visited our unit with Magdi and the team to help our progress (Fig 7). Overall, a wonderful friend and colleague”.

Figure 7. The Harefield team visiting the Armed Forces Institute of Cardiology unit in Rawalpindi, Pakistan.

Rosemary had a most remarkable memory of all the children she cared for, often well into their adult years, remembering with astonishing accuracy, details of their diagnosis and interventions, as well as family names, where they went to school and holiday destinations. Her dedication to her patients was legendary – as one parent said, “In all of the years that she knew us she never once cancelled our appointment or failed to see us herself”. Another mother commented, “I have never met anyone like her, she was a very special person who always made us feel in safe hands. She said it how it was, no beating around the bush. She was a huge part of a very special team”. She kept meticulous follow-up records on database cards for follow-up of all the patients. These then contributed to clinical research, and she published more than 100 papers in peer-reviewed journals. One of her patients from 1974, who had Fontan operation at that time, remembers Rosemary as being very kind, considerate and generous towards him and for her knowledge about sports, especially football. She was a supporter of Brentford Football Club and gave him the FA Cup Final tickets for him to attend with his father.

Rosemary also recognised the importance of children’s and families’ psychological well-being at a time when many of her medical colleagues were sceptical. She was particularly supportive of Harefield’s first psychologist, Dr Jo Wray, who started at Harefield in 1988 and moved with Rosemary to Great Ormond Street Hospital in 2001, as well as other psychologists, as they joined the team in later years. During the early years of this service, Rosemary was instrumental in developing the clinical and research psychology programmes, offering advice and guidance throughout. She was a Trustee of the Fiona Baird Trust, a charity set up following a TV documentary about paediatric heart transplantation at Harefield to raise money to provide counselling and support to children undergoing transplantation and their families.

Rosemary became FRACP in 1975, FRCP in 1980, FACC in 1983 and FRCPCH in 1997. She was a member of the Editorial Board of Paediatric Transplantation, Journal of Heart & Lung Transplantation and Canadian Journal of Cardiology. She was a member of many societies, such as The Royal Society of Medicine, British Cardiac Society, British Paediatric Cardiology Association, Association of European Paediatric Cardiologists, International Society of Heart and Lung Transplantation, Intensive Care Society, American College of Cardiology and Paediatric Transplant Society. Rosemary also held prominent roles in the medical administration at the Harefield Hospital, as Clinical Director between 1987 and 1999 and Medical Director of the Trust between 1992 and 1998. She was then Associate Medical Director of the Royal Brompton & Harefield NHS Trust from 1998 to 2005. She also contributed significantly to the Deanery and Royal College work in paediatric cardiology.

Rosemary was heavily involved with the Royal Free Old Students’ Association, acting as its Vice President and then President between 1991 and 1997. It continues as the Royal Free Association.

The paediatric cardiac surgical unit at Harefield closed in 2001, and the general cardiac work moved to the Royal Brompton Hospital and the transplantation work to Great Ormond Street Hospital, where she worked until her retirement from clinical practice in 2005. During her time at Great Ormond Street, Rosemary showed patients a different side to her, by attending the annual transplant activity camp run by the psychologists and nurses. The doctors each came up for a day to see the children and participate in whatever activities they were doing. Rosemary came up on a day when the activities involved boats and everyone was assigned a challenge – Rosemary’s was to act out the “Silvikrin” hairspray advert, which entailed immersing her head in the water (from the boat in the middle of a very murky stream) and then shaking her hair to get the water droplets to spray out – she did all of this with very good humour, even though she had short hair, so the “Silvikrin effect” was more difficult to achieve! The patients, however, really enjoyed seeing one of their doctors doing something which was a far cry from the usual clinical encounter.

Margaret Burke, Consultant Histopathologist at the Harefield Hospital, provided this personal anecdote of Rosemary’s time at Harefield: “She was such a gentle person, perceptive of people’s strengths and always encouraging them in their endeavours – but could be stubborn and persistent if she thought an idea was good and deserved recognition and implementation! Her office at the end of the Harefield Theatre Corridor was as busy (and as full) as New York Central Station and if the conversation extended beyond the sinking of the sun below the yardarm it was helped along by a shot (or two) of whiskey to send us home in a cheerful mood!”

Rosemary frequently visited units to help with their development. She, together with Sir Magdi Yacoub, visited one of the authors (SAQ) with a team from Harefield to help with the development of the unit in Rawalpindi, Pakistan. The unit is now fully and independently operational.

Rosemary helped to establish the Chain of Hope charity in the UK in 1995, as Founder Trustee and later also became a Director of the Magdi Yacoub Institute from 2001 onwards. She was dedicated to promoting the setting up and progression of units for treating children with congenital heart disease in developing countries. She jointly led numerous medical/surgical missions to countries such as Egypt, Lebanon, Gaza, Mozambique, Mauritius, Kenya, Ethiopia and Jamaica to evaluate and treat patients, enhancing and developing their services (Fig 8 a–c). For this work, Rosemary was awarded the Pride of Britain award in 2001 (Fig 9).

Figure 8. ( a – c ) Rosemary with patients on charity missions to countries such as Ethiopia, Egypt.

Figure 9. Rosemary with Cilla Black receiving the Pride of Britain award in 2001.

Rosemary married John Hopewell, a transplant urologist at the Royal Free Hospital in April, 1984, becoming stepmother to his two children and grandmother to their children. In retirement, she and John lived in the Old Vicarage in Langrish, near Petersfield. They were fully engaged in the life of their local community, acting as joint editors of the local village magazine, the Langrish Squeaker, from 2007 onwards. She was also committed to working with the Langrish Parish, was Chairman of the local Parish Council from 2015, and was a Council Tree Warden from 2002 onwards and Church Warden from 2016 onwards. They spent many happy and precious years, until John’s death in January 2015.

Aside from her professional life, Rosemary was a knowledgeable amateur botanist, with a passion for wild flowers, and an ability to identify any British species. One popular presentation she gave was entitled “How to kill your partner with plants from your garden”.

Always a keen traveller, after John’s death, Rosemary went to Myanmar and took a trip on the River Irrawaddy and then journeyed by train across Azerbaijan, Turkmenistan, Uzbekistan and Kyrgyzstan. Even at the age of 80, before her illness had its effects, from November 2019 to December 2019, Rosemary enjoyed a cruise to the Falklands and the Antarctica, emphasising her spirit of adventure, with which she began her medical career.

Rosemary had a great affection and loyalty to the Harefield Hospital and its close-knit staff across all disciplines. In late 2018, she generously gave a reunion luncheon at the Athenaeum Club, of which she was a Founder Lady Member. She managed to contact and invite many of those working at the hospital in the 1980s and 1990s. It was a very happy occasion and sadly was probably the last time most of those attending saw Rosemary.

Rosemary will be sadly missed and fondly remembered by all the staff she worked with, the doctors that she trained and, most of all, the patients and their families, in the UK and from around the world, whose lives she enriched and often saved.