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William Nack
June 11, 1979
The team physician: is his paramount concern the health of the athlete or is it the welfare of the club?
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June 11, 1979

Playing Hurt—the Doctors' Dilemma

The team physician: is his paramount concern the health of the athlete or is it the welfare of the club?

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The case of Carlton Fisk wasn't the first, or the most dramatic. Nor was it the only one to prompt questions about playing hurt, playing with the aid of drugs and winning at all costs. So explosive and sensitive is the issue that several professional athletes wouldn't comment for the record about medical practices on their teams, including two prominent football players who feared reprisals in the form of trades or being placed on waivers.

During Fisk's ordeal last August, Bill Walton rose up and demanded to be traded from the Portland Trail Blazers. Walton accused the Blazers of misusing four pain-modifying drugs in treating him and suggested that the injection of one of them, Xylocaine, led to the fracture of a bone in his left foot during a playoff game against Seattle. Earlier that season, in another game against Seattle, Blazer Forward Bob Gross had suffered a devastating fracture of the left ankle after it had been numbed by three shots of Marcaine, a local anesthetic.

Doug Collins, the 76ers' star guard, suggested at a press conference in February that the team misled him as to the nature of an injury in order to keep him playing. The team doctor told Collins it was an inflammation of soft tissue in the left ankle. The general manager, Pat Williams, was quoted as saying that Collins had a low pain threshold. Collins went to another doctor, who diagnosed a fractured bone spur that required surgery. Further medical opinion confirmed this diagnosis. Collins received an apology from Williams, and the physicians involved in the case said there had been an honest difference of medical opinion on the need for surgery. Surgery was performed, and Collins was out for nearly eight weeks. After resuming play he suffered a stress fracture in the arch of the same foot and missed the rest of the season and the playoffs.

Shortly after the Collins incident, two former team doctors of the New York Yankees accused club officials of meddling in the team's medical affairs. But it was the Walton affair that really brought to public notice the doctor-athlete dilemma.

Walton, who recently signed with the San Diego Clippers, says he learned valuable lessons from his experience. "The thing that athletes hear most is, 'It won't get any worse, it won't get any worse,' " he says. "They keep trying to tell you it's O.K. to play. You hear time and time again that you can't hurt it any worse. Somebody's got to come to you at some point and say, 'Hey, why don't you think about being champion next year.' Athletes are so competitive. They're so intent on being out there. We grow up our whole lives believing we should be out there. All of a sudden you can't and you don't know why. You hope like heck that somebody can do something to help you out. We learn to trust doctors. Sometimes we shouldn't."

For Pappas, the Red Sox' physician, the conflict is even more explicit. Pappas not only works for the owners but he is also one of them, having just under 4% of the team. "I haven't found this to be a problem at all," he says. Fisk is aware of Pappas' dual role, an unusual situation in professional sports and one that other team doctors have said they would avoid. Yet Fisk and Lee are quick to point out that Pappas, an orthopedic surgeon, is more suited than his predecessor to serve the needs of a baseball team. "He was a urologist," Lee says of the Sox' previous doctor.

"In that respect he [Dr. Pappas] is more qualified for the position," says Fisk. "In the same breath you can say he's got a vested interest in the team and he's going to want to get you back out there. I guess that's part of his job whether he had a vested interest or not. He'd be wanting to get you better, but not with the players' interest at heart. He'd want to get you better for the team."

That he didn't discourage Fisk from playing, Pappas says, had nothing to do with the pennant race. Even if the team had been in the cellar, he says, he would have left the determination up to Fisk. "I still think it's his decision," Pappas says. "It's not that he was making himself any worse. I don't think he's done himself any major permanent damage by playing. I asked him if he'd like to take time off and he said no, he'd rather play. We discussed the injury, and he felt that as long as he was able to participate, contribute to the team, that he would elect to continue playing. Frequently it's the pain that makes the decision as to whether someone is ready to return or not. They're not going to play until I feel, by examination, they're not going to do themselves any permanent harm."

"I don't think I have any resentment, but I'm very wary," Fisk says. "I don't have much trust in one man's opinion—not a specific one, anyone.

"I don't think I ever played where every movement, every upper-body movement, dictated that type of discomfort. When I wasn't actually moving, it was throbbing; every time I moved, the pain was sharp. They gave me anti-inflammatory drugs and, with that and the broken ribs, I wasn't able to sleep at night. They gave me something to go to sleep, and then I couldn't get up the next day—round and round."

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