Caroline Armistead Riely, M.D. February 1st 1944 - December 13th 2012
Authors: Adrian Reuben
Journal: Hepatology (2013)

On Thursday, December 13th 2012, Caroline A. Riely, MD Professor Emerita of Medicine and Pediatrics at the University of Tennessee, Memphis, passed away at the age of 68 years, after a long and progressively debilitating neurological illness. She was cared for with skill and compassion in her later years at the Westminster Canterbury Richmond Continuing Care Residential Community. Dr. Riely is survived by her devoted younger brother, Henry Riely, his wife Clarissa and Clarissa's children, Julian, Evan, and Anna. She is celebrated and called to mind by numerous friends and professional colleagues in the United States and abroad, many of whom have contributed reminiscences and anecdotes that keep her memory alive. Caroline A. Riely, M.D. Caroline Riely was born on February the 1st 1944 to Jean Roy Jones Riely and John W. Riely of Richmond, Virginia, in a small hospital near the White House, as her father was then a lawyer in the US Navy. The Riely family have sojourned in Virginia since 1643; Caroline was a descendant, on her father's side, of Judge William H. Cabell, a Democratic-Republican who was the 14th Governor of Virginia (1805-1808), and after whom Cabell County, West Virginia, was named. Cabell's middle initial -H- was not an abbreviation for a name, but rather a device that he used to distinguish himself from two other William Cabell kinsmen. Perhaps Caroline was emulating her ancestor when she decided that my initials should be AXR, because I have no middle name. Caroline obtained her elementary and secondary education at the all-girls St. Catherine's School, Richmond, in the footsteps of her mother and grandmother. Because of an apparent spelling inability trait that she inherited from her mother, an academic future was not envisioned for Caroline, but this faulty prediction was soon conclusively dispelled by her prolific professional writing. In 1966, she graduated Magna Cum Laude (including a minor in English) from Mount Holyoke College in Massachusetts, another all-girls school that she chose for its emphasis on science. In contrast to that exclusively feminine domain, she received her medical training as one of only 10% women at Columbia University College of Physicians and Surgeons, from whence she graduated in 1970. She completed internship and residency at Presbyterian Hospital in New York City (1970-1973) where she was the sole woman resident for 2 years. Caroline had actually worked in medicine for 5 years after her junior year in high school, courtesy of her father's friend, who was Chair of Medicine at the Medical College of Virginia (now known as Virginia Commonwealth University since joining with Richmond Professional Institute in 1968), and underwritten financially secretly by her father for the first year. As a medical student, she had researched briefly on carbon tetrachloride hepatotoxicity in mice, but it was a 1970 epidemic of hepatitis B that persuaded her to specialize in liver disease. With her characteristic outgoing approach that was a hallmark of her engaging personality, she telephoned the formidable and legendary Gerald Klatskin to apply for a liver fellowship with him at Yale University School of Medicine. In lieu of a written application, an hour's interview in person with G.K. was all that was required to secure the fellowship position she sought. The fellowship (1973-1975) led to junior faculty appointments at Yale in Medicine (1975-1980) and Pediatrics (1977-1980), followed by a promotion to Associate Professor in both departments (1980-1988). She was recruited to Tennessee as Professor of Medicine and Pediatrics (1988), until early retirement was forced on her by ill health (2006). Dr. Charles Mansbach, II, then Chief of the Division of Gastroenterology, to whom I had recommended her, confided that recruiting Caroline "…was the most important hire…" he ever did. Caroline Riely initiated and established a thriving liver program in Memphis. Dr. Riely's professional accomplishments were prodigious, in all facets of academia. She moved quickly from a laboratory-based career to a vocation in consummate empathetic patient care and clinical scholarship. Limited space allows mention of only a few highlights of her achievements. Her strong advocacy of women and family health and welfare was reflected in her studies of liver disease in pregnancy and pediatrics, and in promotion of the gender-specific impacts of decompensated liver disease, and of sexuality and its emotional importance for both genders after liver transplantation. An adult hepatologist by training, she was an autodidact in liver disease in children, and earned the respect of a growing cadre of pediatric hepatologists. Her seminal and landmark observations in Alagille syndrome were rewarded by spending a 6-month sabbatical with famed pediatric hepatologist, Daniel Alagille (1925-2005) himself, in 1984, as a visiting scholar in the Departement de Pédiatrie, L' Hopital de Bicêtre, in the southern suburbs of Paris, France. Naturally, she learned French for the venture. Caroline Riely had a scholarly interest in all things hepatological, including genetic metabolic disorders, viral hepatitis (especially hepatitis C and its treatment), occupational liver disease, fatty liver disease, and liver transplantation, before these studies were fashionable. She participated fully in the governance and public face of Hepatology, she held office in many local and national committees, and participated regularly in grant review. Accordingly, she acquired recognition, and many honors and awards. She was a member of a dozen professional societies, and was for a long time Women's Health Representative for the American Association for the Study of Liver Disease, and sometime a Councilor-at-Large to the Association. Her sense of humor, practicality, and calm demeanor—actually knitting during board meetings—reduced the angst level of the proceedings. She mentored fellows and graduate students at Yale and in Memphis, was a frequent reviewer of articles, and a popular invitée to lecture in Europe, South America, South Africa, and Australia, as well as in North America. Caroline's effervescent personality, her sense of humor, and adventurous bent paralleled her intense kindness, compassion, and good works, both civic and personal. In his terminal years, she made frequent trips home to be with her ailing father. When my wife and I were temporarily "homeless" in New Haven, because our house purchase fell through, unsolicited she unhesitatingly offered us (and our dog) refuge in her famous 1870s "pink" house that she had tastefully renovated. Renovating old homes was another of her hobbies. Caroline was the most disarmingly color-, age-, race-, ethnicity-, religion-, and lifestyle-blind human being whom I have ever met. She could move effortlessly from a party at the mansion of the President of the University to an evening of movies and pizza with the house staff and the fellows—and frequently did so. She was an inveterate traveler of the US and the world with her friends, including her annual winter trip to Virgin Gorda in the Caribbean, and summer escapes to Lake Squam in New Hampshire. Caroline never met a beach that she could not swim. While not as athletic as her tennis champion mother, she learned scuba in the Yale Gymnasium swimming pool, and no matter the depth, the wildness of the waves, or the threatening rocks, she always had to see what was beneath the surface. Her compassion encompassed humans and animals alike, including making a single-handed attempt (until help arrived), while dressed in all her finery and signature raccoon coat, to transport her wheelchair-bound stroke victim friend to the symphony. She would drive one of her beloved but Addisonian dachshunds across state lines to a distant and expensive animal hospital for therapy. How tragic that she ended her days totally disabled, wheelchair-bound herself, and unable to think or communicate. How sad that she, who bonded with her patients to put them at ease, no matter their lifestyle or behavior, was herself all "locked in" and "shut out" at the end. Death is nothing at all. It does not count. Nothing has happened. Everything remains exactly as it was. I am I, and you are you, and the old life that we lived so fondly together is untouched, unchanged. Whatever we were to each other, that we are still. Call me by the old familiar name.… Speak of me in the easy way which you always used. Put no difference into your tone. Wear no forced air of solemnity or sorrow. Laugh as we always laughed at the little jokes that we enjoyed together. Play, smile, think of me, pray for me. Let my name be ever the household word that it always was. Let it be spoken without an effort, without the ghost of a shadow upon it. Life means all that it ever meant. It is the same as it ever was. There is absolute and unbroken continuity. What is this death but a negligible accident? Why should I be out of mind because I am out of sight? I am but waiting for you, for an interval, somewhere very near, just round the corner. All is well. Nothing is hurt; nothing is lost. One brief moment and all will be as it was before. How we shall laugh at the trouble of parting when we meet again!… A close friend said of Caroline that she was a unique Southern lady, with the best academic qualities, who had the miraculous ability to communicate with anyone in minutes, and have such an impact as to last a lifetime.