knows the name Tommy John: the name attached to the triumphal solution
to a failed elbow.
Dodger fans had watched another phenomenal lefthander, Sandy
Koufax, surrender to a failed elbow a decade before. Neither Sandy
Koufax nor Tommy John was able to undergo an MRI of their elbows—
MRIs were not commonplace until the 1980s. A torn elbow ligament (the
medial collateral ligament) was only a clinical (“hands-on exam”)
diagnosis. Following a traumatic injury in the midst of the 1974 season,
Tommy knew that he couldn’t throw anymore—his injury was not the
subtle presentation that most baseball docs see today, but was instead a
grossly unstable, floppy elbow.
Dr. Jobe examined John’s elbow at Dodger Stadium and initially
recommended placing the southpaw’s arm in a cast for a trial period. No
doubt Dr. Jobe was thinking about Sandy Koufax and the collapse of his
career in 1966. Two years earlier Dr. Jobe had operated on Tommy’s left
elbow, removing bone chips, and following dedicated rehabilitation,
Tommy returned to excellent form. Now, Tommy John was facing certain
doom and the end of his career. Realizing that splinting was a failure, and
sitting together in Dr. Jobe’s office, the two men discussed reconstructive
surgery. After a “night to think on it” Tommy said, “let’s do it.”
Tommy John’s willingness to undergo surgery underscores the change
in mindset away from surgery as a last resort. No surgeon, however, had
operated on the ulnar collateral ligament of the elbow. While a
professional athlete often equates a career-ending injury with death, most
sports medicine operations are entirely elective; life could easily go on
without surgery. Tommy was sailing into uncharted waters, placing his
limb and his career entirely in Dr. Jobe’s hands, trusting that Dr. Jobe had
the creativity and skill to accomplish what no other surgeon had.
What makes a great surgeon? From William Halsted to today’s
notables, a requisite set of characteristics sets apart the heroes. Many
patients don’t realize that many, perhaps even most, surgeons are not
superlative. A high percentage of surgeons have adequate hand control, but
not special. Very few practitioners are true innovators who have
breakthrough creativity when thinking about injuries and diseases. They
have a three-dimensional understanding of anatomy—the kind you can
“feel.” It’s a concept that is difficult to describe, but is most like someone
marcin
(Marcin)
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