Wednesday, May 21, 2014

Tommy and the Ligaments

If you have even a casual interest in baseball, you’ve heard of Tommy John.  You have probably not heard of Dr. Frank Jobe.  And that struck me as unfair.

Although Tommy John had an outstanding career, he is far more famous for the surgery named after him, Tommy John Surgery, known in medical parlance as ulnar collateral ligament reconstruction.  The surgery has become shockingly common.  According to an ESPN study,  one third of all major league pitchers in 2013 had undergone it.  One third.  The surgery has immortalized Tommy John’s name, yet Dr. Jobe, who devised the procedure and was the first to perform it, is relatively unknown.  How can it be fair for the surgery to be named after John, who simply injured his elbow, and not for the doctor who pioneered the procedure?  

It turns out that, well, it’s not that simple.

In 1974, Tommy John was having his best season ever.  At mid season the left hander had already notched 13 wins with only 3 losses, and although he had amassed a solid 124-106 record in his 11 years in the majors, he had never won more than 16 games in a season.  ‘74 seemed like the year he would finally reach the magical 20-win plateau.

But it was not to be.  As Michael Fallon wrote for SABR:

The crisis occurred on July 17, 1974, during a twilight game at home against the Montreal Expos….. Working in the fourth inning with a 4-0 lead over the Expos, John was pitching to Hal Breeden with nobody out and runners on first and second base….   With one ball and one strike on the batter, John released what he hoped would be a rally-killing pitch. That was when everything went wrong.

Later, John said that nothing seemed unusual about his windup or delivery, though he conceded, as a sportswriter later wrote, that his body may have been “too far ahead of his arm at the critical moment when the ball is released.” Whatever the reason, after the throw John felt what he called the “strangest sensation I had ever known.” John’s arm went suddenly dead. “Right at the point where I put force on the pitch, the point where my arm is back and bent, something happened,” he explained. “It felt as if I had left my arm someplace else. It was as if my body continued to go forward and my left arm had just flown out to right field, independent of the rest of me.”

John’s left arm did not experience pain so much as a strange sort of absence and the sound of a “pop” from inside the arm. The ball, meanwhile, “blooped” to the plate, coming in well out of the strike zone. John got the ball back from his catcher, wondering what was going on. He tested his arm, and it felt fine, moving freely without pain. So he set himself again, checked his runners, and delivered another sinker. And the same thing happened: dead arm, bloop pitch, but this time with a “thump” sound (or feeling) in his forearm, as if two hard objects were bumping into each other. John still felt no pain, but he also knew he could no longer pitch. “You’d better get somebody in there,” he told his manager, Walt Alston, when he came to the mound. “I’ve hurt my arm.” The Dodgers went on to lose the game, 5-4, and John went to the trainer’s room with little idea of what lay in store for him.

Initially the team doctors (including Dr. Jobe), prescribed rest.  But after a full month of rest there was no improvement in John’s condition.  He could throw, but his pitches had “nowhere near their normal velocity or movement”.  Dr. Jobe and John began discussing surgery, even though at that time professional athletes considered going “under the knife” tantamount to giving up on their careers. Again, from Fallon’s article:

John himself admitted he was “extremely leery” about undergoing surgery. “At the time,” he said, “operations on arms and shoulders not only weren’t that effective, but were dangerous.” But John had come to trust Jobe. And he knew that without the surgery he stood no chance to get back on the mound.

When Dr. Jobe opened up John’s left elbow on September 17, 1974 and went to repair the ligament, he saw that it was ruptured, and there was nearly nothing left to repair.  So right there in the operating room he made a crucial decision: he harvested a ligament from John’s right wrist and replaced the ruptured ligament in his left elbow.  Then and there, a new surgical procedure was born.

After roughly 18 months of relentless rehabilitation, John returned to the Dodgers for the 1976 season and pitched well, going 10-10 with a 3.09 ERA.  In 1977 he reached starting pitcher nirvana - a 20 win season.  He would go on to have 2 more seasons with at least 20 wins, and pitch until 1989.  John actually had 40 more wins after the surgery (164) than before (124), and pitched until he was 46 years old.

Here’s where the answer to my question regarding the fairness of the procedure being named after John and not Dr. Jobe becomes complicated.  For as much as Jackie Robinson’s grace and dignity in the face of unspeakable vitriol was fundamental in his paving the way for diversity in baseball, Tommy John’s resilience and stubborn resolve in the face of what at the time were considered insurmountable odds of recovery were instrumental in making that first procedure wildly successful, and thus ensuring its eventual ubiquitousness.  

The story behind the procedure’s name is actually quite mundane.  Although Dr. Jobe initially considered naming the procedure after himself, his patients kept asking him for what Tommy John had, so that’s the moniker that stuck.  

Clearly, it took John’s dogged determination and grit as well as Dr. Jobe’s skill, inventiveness and courage to successfully pioneer ulnar collateral ligament reconstruction.  Ideally, both their names should be acknowledged in the procedure’s name.

Jobe-John Surgery, perhaps?

Monday, May 12, 2014

No Pressure, Seven

“No pressure”, the man yells sarcastically from the stands, “No pressure at all, seven.  Bases loaded, game on the line.  No pressure,” he yells again as the pitcher, number 7 on his back, prepares to throw.  I cringe.

It's the top of the seventh inning, the last inning in high school ball, in the Regional Semifinals.  The visiting Gulliver Prep Raiders, which the man’s son plays for (as does my own son), were down 8-3 when the inning began, but have mounted an impressive comeback against the hometown Key West Conchs.  They’ve scored two runs, the bases are loaded, and there are no outs.  No matter what happens next, the boys from Gulliver have shown tremendous heart, and would have nothing to be ashamed of even if they lose.  Except, of course, for the behavior of a few of their parents.

The man, who is seated to my right, continues to yell, mocking the home team pitcher, whom he has never met and is all of 15 (or perhaps 16).  I find myself unable to stand next to him anymore, so I excuse myself over to the aisle and walk up the stands to another row, outside of the section where the Gulliver parents have assembled.  I chat with some of the local fans, to whom Key West High School baseball is a considerable source of pride, regardless of the participation of family members on the current team.  There is neither a pro sports franchise nor a college team in Key West.  High school athletics are what they’ve got, and they turn out in huge numbers to watch them.  Particularly baseball.  Only 25,000 people reside in Key West, and at least 3,000 of them are here tonight.  This is roughly equivalent to 600,000 people showing up at a Miami high school sporting event.

The man now next to me beams with pride as we discuss Bronson Arroyo, the Arizona Diamondback starting pitcher, born in Key West, and other major leaguers with Conch connections.  He compliments the Gulliver team’s comeback; I reply that it is all the more impressive given the quality of the opponent.  We wish each other luck, and I head back to my seat.

As is the case far too frequently in children’s sports, the sportsmanship which the coaches try so hard to instill in their players is usually on display on the field or court, but not in the stands, where the line between encouraging your son or daughter’s team and disparaging their opponent is frequently crossed.  How can any adult justify, regardless of the circumstances, taunting an innocent 15 year-old kid just because he happens to play for his son’s team’s opponent that day?

I’ve written before about my dismay regarding the scarcity of sportsmanship here and here.  But in those cases the individuals being derided were professionals, and adults.  Deriding children is in a whole separate category.

By the time I make it back to my seat Gulliver has scored another run.  They are now losing by two runs, 8-6.  The bases are still loaded, now with one out.  A base hit would most probably tie the game.  “No pressure, seven,” the man to my right yells again.  I look askance at him.  He looks back at me, puzzled, not understanding why I would do such a thing.   

Number seven throws, and the Gulliver batter hits a line drive up the middle.  The Key West shortstop makes an outstanding leaping catch, then steps on second base to complete the game ending double-play.  Conchs win, 8-6.  The Gulliver players take it hard.  Their season is over.  There are tears.  But there are no disparaging remarks, and no excuses.  The Gulliver head coach has successfully inculcated a culture of sportsmanship in his dugout.

He needs to work on the stands.

Monday, May 5, 2014


He turned around in his bar stool, assuming that the target of the woman’s gesture was some guy behind him, but saw no one there.  He looked at her again.  She smiled and pointed again.  This time he realized that she was pointing at him.  Him!  Elated, he moved a few stools closer to her at the bar.  She did the same.

“What are you drinking, water?”, the woman asked.  He slid his short tumbler in front of her.  She tasted the straight Ketel One.  “Oh, I’ve had plenty of that tonight,” she said.  “Would you like another?” he asked.  “Sure, why not”.  He ordered her a Ketel One with a splash of cranberry juice.

She was profoundly alluring, possessing the kind of exotic beauty only possible as the result of a diverse background.   No wonder he couldn’t believe her initial gesture was directed at him.  That sort of thing only happened in his imagination.  She told him she tended bar there, but was done working for the night.

They spoke of everything and nothing, her background (indeed, diverse), her plans to spend a year exploring Australia, SCUBA diving, work.  She was as charming as she was beautiful.  Her name, Giordana Alonso, suggested Italian and Cuban heritages,  just two of the many represented in her exquisite features.

An unintentionally cruel co-worker broke the spell, as he came by and announced that he was leaving.  He was her ride.  

They spoke for a few more minutes.  Although they said they would see each other again since she worked at the bar and he lived nearby, deep inside he knew that the magic would never be repeated; that this evening was nothing more than a stolen, single, isolated moment.  As she stood up to leave, she kissed him on the cheek.  After taking three steps, she turned around.  Perhaps compelled by his doleful expression, she came back, put her arm around his neck and kissed him on the cheek once again, before walking out of the bar and into the warm South Florida night.

As he finished his dinner, he realized that whatever else happened (or, more likely, didn’t happen) with Giordana, no one could ever take the memory of that magical evening away from him.  However, lacking  Curly's wisdom, he was already looking forward to seeing her again.

A few nights later he walked over to the bar for a late-night drink, hoping she would be there.  Indeed she was, busy making drinks, serving food, processing payments.  He sat down at the bar and enjoyed watching her work, eagerly anticipating her reaction upon seeing him.  

Damn it.  He should have known.   The other night it was the vodka in her system, not anything about him in particular, that compelled her to talk to him.  She just felt like talking, and he happened to be there.  The magic of their conversation took place only in his mind.  She probably barely remembered the conversation itself, never mind the content.  That second kiss goodnight, the one he had so eagerly (and naively) taken to mean, “I really enjoyed talking to you and would like to get to know you better”, was really an empty gesture, sort of like a beauty queen making eye contact with bystanders while waving from her parade float .  He should not have expected anything more than the indifference with which she (barely) acknowledged him.

Still, he was crushed.  And he had had a few drinks.  So when he paid his bill (leaving an overly generous tip), he drew a sad face on the receipt.  With tears coming out of its eyes.  How pathetic.  How lame.  He walked out of the bar, knowing neither if she even saw his artwork, nor if she would understand its meaning.

Weeks later, he is walking around the mall where the bar is located.  He sees Giordana, walking in the opposite direction, toward him.  When she sees him, she rushes forward, grabs his face with both hands, and kisses him fully on the lips.  He responds in kind, oblivious to the rubbernecking crowd all around them.  “I’m so sorry about the other night”, she says, “I so much wanted to talk to you, but my boss was breathing down my neck, and I couldn’t afford to risk my job by lingering with a customer.  Your sketch broke my heart.  I’m so happy I ran into you!”

As he starts to respond, the spell is broken, this time not by an unintentionally cruel co-worker, but by the insistent tones of “Oxygen”, the alarm sound on his Nexus 5.