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?