Not since Edgar Allan Poe has there been a telltale heart that produced more drama and mystery than the heart of Reggie Lewis, captain of the Boston Celtics. Over the last two weeks, since his frightening collapse on the parquet floor of the Boston Garden on April 29 during a playoff game with the Charlotte Hornets, Lewis's heart has come to haunt a diverse group of people.
That group includes Lewis, who has endured an agonizing medical netherworld in which he has been told that he may or may not have a life-threatening condition, and who may or may not play in the NBA again. It includes the Celtic organization, which may or may not have to overhaul its roster, depending on whether Lewis, the team's leading scorer, can play. It includes the Celtics' team doctor, who should or should not have sent Lewis back into action after his collapse, but who certainly talked too much and too publicly about the case. It includes the staffs of two of Boston's premier medical institutions—New England Baptist Hospital, and Brigham and Women's Hospital—who were left bickering over the protocol and ethics involved in a bizarre late-night incident in which Lewis and his wife fled Baptist for Brigham accompanied by a top administrator from Brigham, a security guard and a police dog. Finally, and perhaps most surprising, it includes a number of Boston's best cardiologists, who have been dragged into a public debate over two radically different diagnoses: 1) that Lewis's heart is damaged in a manner that could threaten his life or 2) that it is essentially normal.
The night he collapsed Lewis was playing like a man possessed. He scored 10 points in the first three minutes. Two and a half minutes later he crumpled to the floor, where he lay unable to orient himself for several seconds before rising unsteadily and walking to the bench. Arnold Scheller, 45, the Celtics' team physician, later said that he assumed Lewis had "had his bell rung," and he allowed Lewis to return to the game following three minutes on the sidelines. But Lewis was still wobbly, so after playing another minute, he and Scheller retired to the locker room.
After watching tapes of the game during halftime, Scheller realized Lewis had not been struck before collapsing. That meant he had fainted—a fact that raised serious medical questions. Lewis insisted that he felt fine and that he wanted to return to the game. Celtic CEO Dave Gavitt grilled Scheller about whether he was "100 percent comfortable" with the idea of Lewis's starting the second half. According to The Boston Globe, Scheller replied, "There's nothing there that I can determine other than maybe it's low blood sugar or just he's so excited." Lewis started the second half, lasted six minutes before appearing to be unsteady again and was removed from the game for good.
Scheller's decision to let Lewis reenter the game raises the classic conflict-of-interest question facing team doctors: Which comes first—the interests of his team or the interests of his patient? The situation is often further complicated by the athlete's desire to return to action sooner than he should. Arthur Caplan, director of the University of Minnesota Center for Biomedical Ethics, defines the issue this way: "The team doctor too often treats the player only in the context of the team. He must consider the patient and his family. There is more at stake than fitness to play. The needs of the public are secondary. The ethical duty must be to the patient first. But there's always a danger that a team doctor will shade his diagnosis more toward the positive than he should."
Marc Rodwin, an associate professor at the Indiana University School of Public and Environmental Affairs who has published widely on medical ethics, told the Boston Herald, "Any employed corporate physician has his loyalty compromised. He may act with the best of intentions, but he knows who he's working for." In fact, a former NFL team physician told SI that an association with a professional team can be such a boon to a medical practice that some team doctors actually pay teams to serve in that capacity.
In defense of his decision to put Lewis on the floor in the second half, Scheller said, "When someone gets light-headed in athletic competition, there can be any number of reasons. The most common are dehydration or low blood glucose." He points out that Lewis's blood pressure was stable and that he showed no sign of arrhythmia, meaning an abnormal rhythm of the heart.
However, Caplan asks bluntly, "Why doesn't fainting result in automatic benching for the day?" And Dr. Robert Cantu, president of the American College of Sports Medicine, told The Boston Globe that, in his opinion, when a player faints during vigorous exercise, "you need to rule out a cardiac problem before you allow him to go back to strenuous physical activity."
Indeed, Scheller had responded with alacrity to hints of a cardiac problem only four days earlier—albeit under totally different circumstances. An Army reserve officer who is also trained as a Ranger, the Army's elite guerrilla fighters. Scheller had been climbing Mount Kilimanjaro in Tanzania as part of a promotional trek for a new all-terrain hiking boot made by a shoe company with which he has a contract. Also on the climb was a 45-year-old commercial photographer, who complained on the way up of symptoms that could have been indicative of a heart problem. No second half for this fellow: Scheller sent him down the mountain, pronto.
Some experts say that Scheller's failure to see potential peril in Lewis's playing after he had fainted was understandable. Robert E. Leach, a former Celtic team doctor and currently the editor of the American Journal of Sports Medicine, the leading magazine in the field, puts it this way: "When you are a team doctor taking care of top athletes in their 20's, you do not expect a heart problem. This is not a 58-year-old man with chest pain. This is a young man performing at the highest level of athletics. It takes you by surprise."