Monday Morning MD: When your examination room is the 50-yardline

I have faithfully written a weekly column (plus other features) without a break since October 14, 2013 when I started my post team physician media adventure. After a total of 153 thousand-plus word articles, I am taking my first break this Memorial Day weekend. Last week at the Marshall Faulk charity fundraiser, I ran into the author of this Physician Magazine piece written 15 years ago who has graciously allowed me to reprint it. The feature was unusual as the Chargers allowed unprecedented game day access in a time that was well before the first HBO Hard Knocks. I hope you enjoy it.

When Your Examination Room Is the 50-Yardline

Every professional sports franchise has them—team doctors. In this special Physician report, we follow an NFL team doctor on Game Day. by Mike Yorkey December 15, 2001: 12:07 p.m. It’s two hours before kickoff against the Oakland Raiders, and San Diego Chargers’ All-Pro linebacker Junior Seau is all over Dr. David Chao. “Hey, everybody, a reporter is here to do a story on Chao!” hollers out an animated Seau, who’s obviously enjoying seeing the tables turned for a change. “Doc’s going to be famous. C’mon and see this everybody!” I’ve just arrived in Dr. Chao’s cubbyhole office, which adjoins the Charger training room and locker room underneath the west grandstands of Qualcomm Stadium. In this quiet, windowless environment, it’s difficult to believe that the Chargers and Raiders will square off in a noisy nationally televised game two hours from now. Several half-dressed players—some of the biggest human beings I’ve ever seen up close—pop in their heads to see what the commotion is all about. Meanwhile, Junior continues to tease Dr. Chao. “This is what you gotta write,” he says. “You gotta tell everyone that he’s the best doctor in the whole wide world! You don’t have enough paper to print everything I’m going to tell you about him.” I shoot a glance toward Dr. Chao, whose grinning smile is a mixture of pride and embarrassment. “Now, Junior . . .” “Take a look at my fingers and hands,” says Junior, as he fans out his massive, battle-scarred extremities. I peer at his supersized fingers, which resemble long, gnarled tree branches. The digit and middle fingers on the left hand make several intriguing zigzags, but what’s especially interesting is the double-sized knuckle on the middle finger. How did that happen? Junior, however, wants to show off Dr. Chao’s handiwork on his right hand. “See this scar?” he says, pointing to a nasty gash below the padded thumb area. “Chao was trying to write my initial, so gave me this S.” Junior is right. I have never seen a set of simple interrupted sutures come out in the shape of an S, but that is how his brutish scar healed. “I got sewn up during a game, but it doesn’t matter,” says Junior, as he turns serious for the first time. “Chao is a good man. He’s done a lot for the kids in my foundation,” he says. As a native San Diegan, I am well aware of Junior’s foundation and his remarkable story. The son of American Samoa immigrants, Junior grew up in nearby Oceanside, where he made good on the gridiron and starred at USC. He was a first-round pick of the Chargers in 1990, and when riches and glory came his way for becoming one of the best linebackers in NFL football, he formed the Seau Foundation, a non-profit charitable organization. “How does Dr. Chao help?” I ask Junior. “Let’s say a kid on the Oceanside High football team goes down with a serious knee injury and comes to us for help,” replies Junior. “The boy doesn’t have medical insurance. We cover the cost of the surgery bay and materials, which are given to us at cost, while Chao donates his surgical skills. I would say that Doc’s done ten kids for me,” says Junior. “He’s a good man.” Dr. Chao is still smiling like a Cheshire cat. 12:45 p.m. For the last ten minutes, I’ve been playing straight man to Dr. Jerry Hizon, a Charger team doctor who must have moonlighted at the Comedy Store during residency. “You know where David went to high school?” “No, I’m afraid not,” I reply. “Think 90210.” “You mean Beverly Hills High?” “You got it. And did you know that David thought Harvard was too easy?” “He went to Harvard?” “Sure, but you probably want to write about David’s water polo days at Northwestern. He was All Big-10 while he was in med school.” I look at Dr. Chao, and he’s rolling his eyes again. Now, I’m really confused, which causes Dr. Hizon and the rest of the doctors in the room to crack up. I feel like I’m part of a freshman hazing. Welcome to the sports medicine world of NFL football, a fraternity that David Chao has belonged to since 1997, when he joined the Chargers. The 37-year doctor is affiliated with Oasis Sports Medical Group, the official team physicians for the Chargers. As the lead doctor, David is on-call 24/7 throughout the season, which lasts six to seven months. He also flies with the team on all road trips, which often start with a Friday morning flight to points east and doesn’t end until the team plane returns to San Diego on Sunday evening. During the week, David maintains his practice with Oasis, seeing patients, performing surgery (usually knee, shoulder, and hip repair) and making “house calls” at the Chargers’ practice facility near Qualcomm Stadium. For today’s game against the Raiders, David is quarterbacking the medical coverage. Dr. Hizon, a family practitioner, and another Oasis doctor, Dr. Paul Murphy, an orthopedist, will assist him. This trio works all games, home and away. Dr. Bob Speer, a pediatric anesthesiologist, Dr. Calvin Wong, a family practitioner, and Dr. Stan Sherman, a trauma anesthesiologist, will handle back-up roles. Finally, an orthopedic fellow, Dr. Chris Pallia, is on hand to observe the action. With seven doctors on the field, you could say that the Chargers are ready for anything, but experience has been a stern teacher in the violent world of NFL football. We are ninety minutes before game time. A dozen players drop by David’s office to have their sore joints and muscles checked—ankles, knees, hips, ribs and shoulders. Many are linemen and all are gargantuan: the typical size appears to 6-foot, 5-inches tall and 300 pounds. These players will be slamming their bodies in the trenches with devastating impacts. When an irresistible force meets an immovable object, something has to give, and it’s usually a joint, a bone or a ligament. “The guys are big and the size is good, but I think what you have in the NFL is the last of the warriors,” says David. “Injuries are a big part of the game, however. Out of 53 guys on the team, I would say that I operate on 15 to 20 during and after the season, and I’ve operated on more than half the players on this team at one time or another.” No wonder why Dr. Hizon told me that the NFL stands for the Not For Long league. The players have incredibly short careers. The talk turns to what Dr. Chao does during the game. “What’s it like running out on the field with a capacity crowd and all those people on TV watching you treat a player for an injury?” I ask. “What I’ve found about sports medicine is that you have to keep a little perspective,” says David. “I’m here as a doctor and a physician, and my job is to see the players, and that’s it. The fans are here to see the players play, not the doctors. If I’m not noticed in a game, then I’m happy. In fact, I’m the only guy on Sunday that team owner Dean Spanos wants to do nothing. My goal is to stay out of the way and in the background.” “But don’t you have to make quick judgment calls?” I ask. “The easiest part about sports medicine is the medicine itself, if that’s where you keep your focus. I remember when I was working at the X Games in San Francisco. There was a doctor who was helping me, and we had a freestyle motocross rider go down with a lunate dislocation. I evaluated and treated him, and then I sent him off with another X Games doctor to the hospital with instructions to get X-rays and call me back with the results. About an hour later, I received a call on my cell phone from the other doctor, and he said, `It’s a non-displaced radial fracture. I’m going to put him in a cast and bring him back.’ ” “I asked whether he was sure, and he said yes, but I asked him to bring me a copy of the X-rays when he returned. When I got a look at them, he said that it's the only fracture, the radial head, but I immediately noticed that his lunate was dislocated. It’s a common error to make, but an error that I am 100 percent sure that he would not have made if he was back in his own office. With everything else going on at the X Games, his focus was off, which was a reminder to me to take care of the medicine first.” 2:07 p.m. We run out onto the field with the Charger players, and the wall-to-wall noise of the capacity crowd creates intense energy. Everywhere I look, everyone has his game face on. We are minutes away from kickoff against the first-place Raiders, the evil-dreaded Silver and Black who have been the Chargers’ bitterest rivals for forty years. This late-season matchup has drawn the third-largest home crowd in franchise history—67,349—and filled Qualcomm Stadium to the brim. Unfortunately for the Chargers, two-thirds of the fans appear to wearing black Raider jerseys. David stands amongst the coaches and players on the Charger sideline. As soon as the opening kicking sails through the air, he doesn’t take his eye off the action. He must concentrate on the players because a career-ending—or life-threatening—injury is just a snap of the ball away. It’s also not a good idea to direct your gaze away from the action if you value keeping your body in one piece. “I’ve covered high school, junior college and college football, but NFL games are different,” says David. “At the high school level, if there is a pitch coming toward me, I will wait until the players are right on top before stepping back. In the college game, I start to think about moving when I see a sweep coming my way. But NFL `game speed’ is so fast that if quarterback Doug Flutie even looks my way, I’m backing up because they are coming hard. As you see on TV, the players will fly 10, 12 yards out of bounds sometimes. They are on top of you in a split-second because their speed and quickness are so unbelievable.” 2:25 p.m. Injured player! The game is only a few minutes old when the Chargers’ rookie cornerback Davis Sanchez is slumped on the grass, writhing in pain. David and team trainers James Collins and Scott Trulock sprint out to midfield, where they take several minutes tending to the young player. After they gingerly assist him to his feet, Sanchez nearly collapses from back spasms. They half-carry him to an examination table behind the bench for a further look, but Sanchez is grimacing with each step. He looks done for the day. Before the game, David told me that decisions about whether an injured player can return to the game are made as a team. James Collins, as the head trainer, is the first to make an evaluation. If it’s an orthopedic question—a tender back, an injured knee, or a deranged shoulder—then Dr. Chao takes the lead. If it’s a possible concussion or something internal, then Dr. Hizon is the go-to guy. Earlier in the season, quarterback Doug Flutie was knocked silly in a game against the Kansas City Chiefs. Dr. Hizon proceeded to ask him several standard memory questions:
  • “What’s the date?”
  • “Who are we playing?”
  • “What’s the score?”
  • “Who did we play last week?”
When Flutie didn’t have the answers, he was through. “Football players are proud,” said David. “They do not like to be carried off the field. If they can get up, then they will walk off as best as they can. I’ve had players with dislocated shoulders, with ACL tears, even with ankle fractures, refuse to be carried off the field. Then there are some players you just can’t keep from playing. I’ve seen James Collins carry their helmets so they couldn’t go back in. “The best story I can tell you happened in Oakland. Late in the first half, Junior Seau hurt his leg, and when I ran out onto the field, I was worried about a fractured tibia. He continued to limp and play, but during halftime, we accompanied him to a special room and took some X-rays. Afterward, I told him to wait until we could determine whether there was a fracture. We didn’t want him to hurt himself anymore. “The X-ray developer took forever, but when I finally got a look, I could see that his tibia was negative. I ran as fast as I could to the field to tell Junior that he was okay to play, but just as I arrived, I heard the public address announcer say, `TACKLE MADE BY JUNIOR SEAU.’ That pretty much sums up Junior and all the players—they will play with pain.” 3:20 p.m. Already, David has made four “field visits” as the first half winds down toward the two-minute warning. No major injuries; just the usual bang-ups. Suddenly, Carl Robbins, a 70-year-old member of the chain crew, collapses like a sackful of football helmets and hits the ground with a thud. At first blush, it doesn’t look good. Dr. Chao is first on the scene since the older man toppled within a few yards of him. Heart attack? Stroke? Dr. Chao works to clear the breathing passage and stabilize him as EMTs rush to the scene. Technically speaking, Carl Robbins is not David’s medical responsibility since the chain gang member is working for the NFL, but those technicalities are naturally brushed aside as moments like this. An EMT places an oxygen mask on the man while they wait for a sled to arrive. Play cannot resume, however, since the chain-crew member collapsed just a few yards from the sideline. It will take 20 minutes before Robbins can be driven off in a cart and taken to nearby Kaiser Medical Center. (Later, it was learned that Robbins passed out in reaction to some blood pressure medicine he had taken. “I've gotten calls from Florida and Philadelphia, people who thought I was dead,” he said, adding that he was grateful for the quick medical attention.) 4:59 p.m. We’re deep into the second half, and for the eighth time, David runs out onto the field to help an injured player. Normally, David is out on the field two or three times, but today’s game seems to be an exception. One injury looks career threatening: Charger receiver Curtis Conway’s legs twisted around like a pretzel while trying to make a catch. Instead of a fibular fracture or torn ACL, however, Conway was able to shake off the pain and even return to the game. 5:12 p.m. Drats! The Chargers have just lost another tight game in the last minute, 13-6. Dr. Chao runs to the middle of the field for his post-game handshake with his Oakland counterparts—the Raider team doctors. Then we hustle off the field and into the locker room with the disappointed players. Dr. Chao beckons me to follow him. Charger team chaplain Shawn Mitchell is about to lead the team in its post-game prayer. David bends one knee, bows his head, and places his hand on the shoulder of a Charger player; I do the same with Dr. Chao. “Thank you, Lord, for Your protection today, and we ask that you help any weary and injured players on our team and on the Raiders,” says the Charger chaplain. “Please heal anyone that’s hurt, and we give You all the glory, amen.” Dr. Chao and several doctors return to their cubbyhole office, where they will be available for the next 90 minutes or so. Sometimes after a game, it takes the players some time for the adrenaline to wear off—and that’s when the body starts sending signals to the brain that something hurts. When that happens, they need to see a doctor who understands what they’ve been through. Fortunately for the players, they will be evaluated by an all-star team of sports medicine physicians led by Dr. Chao.

Sidebar

Up Close and Personal Dr. David Chao Age: 37 Marital status: single Education background: After graduating from Beverly Hills High with honors, David attended Harvard University, where he majored in psychobiology. He then attended the Northwestern University School of Medicine (where he was a standout water polo player), served his residency at Northwestern Memorial Hospital in Chicago, and a fellowship with the Minnesota Vikings, Timberwolves and Twins. Current team physician duties with: San Diego Chargers, Point Loma Nazarene University, United States International University, X Games (Winter and Summer), and various San Diego high schools. Notables: He is considered a worldwide expert in hip replacement surgical techniques. Sidebar What Are You Doing Friday Night—or Monday Afternoon? Dr. David Chao says that you don’t have to work in the NFL to work the sidelines. In fact, there are probably high schools in your hometown that could use your expertise during the game and afterward in the surgical bay. In addition to taking care of the Chargers’ medical needs, Dr. Chao says doctors around the country can make it a ministry to help injured high school players without insurance or the ability to pay. “I just started my own foundation to help high school players in San Diego who need surgical care,” said Dr. Chao, who added that he probably does 20 plus free operations on injured high school football players during the year. “A foundation can pay for the hard costs—the screws, the equipment, and hospital—so all the professional costs are free,” said David. If you would like more information on setting up a foundation in your hometown, contact San Diego Sports Medicine Foundtation. I hope the readers enjoyed this guest column with a small peak behind the curtain. Thanks to the author, Mike Yorkey, for allowing me to re-publish it.
Dr. David Chao
Two decades of NFL team physician experience including two Super Bowls and two Pro Bowls. Providing unique perspective to injuries and the NFL sideline/locker room. Successful orthopedic surgery and sports medicine practice in Southern California.

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