Obituary: A Remembrance of William Fisher Enneking MD (1926–2014)

William “Bill” Fisher Enneking MD died peacefully on July 17, 2014. He had a remarkable life journey, which I was privileged to witness and participate in from several different vantage points. “The Boss,” as I always thought of him, had an enormous impact on my life and work. Most importantly, he and his wife Margaret produced a wonderful daughter, Kayser Enneking MD, an anesthesiologist, and my wife of 29 years. Beyond that, he was the inspiration for—and the hands-on guide of—my own career in orthopaedics.

Dr. Enneking (Fig. 1) and his wife, Margaret, were close friends of my parents. When I was 15, I confided to my dad that I might like to be a doctor someday. My dad called Dr. Enneking and asked him to take me on in whatever position he thought suitable. I soon became Dr. Enneking’s cast technician and our relationship, which would ultimately span 40 years, began to take shape. Eventually, I won promotion to the pivotal job of lab technician. I went off to Duke University and came back as one among many of his medical students at The University of Florida. Around that time, Kayser and I successfully concluded our courtship. We married, but only after (upon asking for his blessing) he made me wait in his office for 45 minutes while he talked on the phone with one of his cronies. We came back to University of Florida after training and joined Dr. Enneking at the College of Medicine faculty. We were colleagues for 30 years. I had the great privilege to take over his clinical practice when he retired. You can imagine my efforts to impart my opinion to patients he had treated and previously operated on. I often fielded questions like, “What did Dr. Enneking think should be done?” “How would Dr. Enneking proceed?” and “Could Dr. Enneking take a peek?” I never minded this; I just felt lucky to be surrounded by examples of the patient loyalty excellence in medical care can inspire.

Fig. 1

William F. Enneking MD (1926–2014). Published with permission from Mark T. Scarborough MD.

That said, Dr. Enneking inspired a variety of emotions in those around him: Veneration, respect, amazement, deference, gratitude, love, and occasionally, anxiety and fear. He let it be known to everyone within his orbit, frequently, that if something was worth doing, it was worth doing right. Whether he was teaching his residents to operate, his medical students to differentially diagnose, or his grandchildren to sail, he demanded excellence through fierce example, and on occasion, trial by fire. Pity the medical student who showed up late to class. The late comer would be invited to join Dr. Enneking on stage for the remainder of his lecture, where he or she would be the first recipient of every question he thought a knowledgeable, well prepared student would certainly be able to answer; the ensuing hunt for the outer edges of the student’s competency was merciless. I will leave to your imagination what transpired with the unprepared board examinee.

Dr. Enneking’s impact on the field of orthopaedic oncology and musculoskeletal tumors and diseases is pervasive. He began his career under the great Howard Hatcher MD, whose profound influence remained with him, and others of his generation, throughout his career. He used the strong background in musculoskeletal pathology imparted to him by Dr. Hatcher to create much of the cognitive framework for the diagnosis and treatment of musculoskeletal tumors and diseases. In Outliers [5], author Malcolm Gladwell discovered that truly great people not only are at the right place at the right time, but they take advantage of the opportunity to make their impact. This is an apt description of Dr. Enneking, who developed systems for the staging of musculoskeletal tumors [4], the description of surgical margins [3], the classification of tumor resections [1], and the first functional evaluation system for orthopaedic oncology [2]—all of which greatly impacted musculoskeletal pathology. For these contributions, he twice won the Kappa Delta award. His surgical contributions included some of the first limb salvage procedures, as well as the first THAs in Florida. His educational efforts focused on the intellectual rigor of orthopaedic residencies. Having taught his musculoskeletal pathology course for more than 50 years to thousands of young physicians on six continents, Dr. Enneking liked to say, “You can train monkeys, but you ought to educate doctors.” (Actually, he said men, not in the generic sense. But as he aged, under the heavy influence of five daughters, he came to see the light on this).

A leading expert in the field of musculoskeletal pathology and tumor surgery, Dr. Enneking continuously published for 66 years and provided leadership in several positions in the orthopaedic community, accumulating numerous awards and accolades for his exceptional work. For all of these professional accomplishments, Dr. Enneking regarded his contributions to Gainesville, FL, USA, the community where he lived, as one of his greatest achievements. In the late 1960s, Gainesville was in turmoil due to the long delayed integration of the public school system. Dr. Enneking decided to run for the Alachua County School Board in the belief that integration should be successfully accomplished. My father, an insurance executive, was his campaign manager. With no previous political experience, they ran a campaign on the slogan “E is for Excellence, Education, Enneking.” This was shortened to a gigantic “E” mounted to the top of the vehicles of their friends and families. Forever thereafter he was known to many as “The Big E.” He served on the school board for 8 years.

Dr. Enneking was the father of seven, and the Opa of sixteen grandchildren and seven great grandchildren. He worked as hard at playing as he did at working. His greatest passion was fishing (Fig. 2); it is said that he moved to Gainesville and stayed for life because it is equidistant between the Atlantic Ocean and the Gulf of Mexico. He scheduled the daily sessions of his musculoskeletal pathology seminar around the shifting tides. Bill and Margaret travelled the world many times over; a key to understanding their schedule was the fishing adventure offered as an inducement to gain his presence at an orthopaedic event. He was quite proud of his membership in the 10 to 1 Club of the International Game Fish Association, earned by catching specified game fish with line that had a test weight ratio of greater than 10 to 1. He liked woodworking in the orthopaedic style, mostly ladders, tables, and fishing-rod holders. He was an avid card player, and loved games of chance, sometimes maintaining a relaxed relationship with the rules of the game. In her eulogy, Kayser remarked that the “Big E” sometimes stood for “Egregious disregard of the rules when the Boss was at the card table.”

Fig. 2

A passionate fisherman, the running joke between friends and family was that Dr. Enneking lived in Gainesville, FL because it is equidistant between the Atlantic Ocean and the Gulf of Mexico. Published with permission from Mark T. Scarborough MD.

For 40 years, I had a front row seat to the spectacular career of “the Boss.” Those of us fortunate to have known Bill Enneking well will never forget him. Whether we know it or not, everyone in orthopaedics, physicians and patients alike, has been touched by his contributions.