DOC KERLAN: Rx FOR ATHLETES
Every Thursday and most Saturdays during the spring MB and summer, a gray Cadillac drives up to the Turf Club entrance to Hollywood Park in Inglewood, Calif., well ahead of the first post time. An attendant steps smartly forward and opens the driver's door.
"Hi, Doc," he may say to the occupant. "Got any good ones for today?"
A great bear of a man climbs out and gives the attendant a smile, a cheery hello and—if he has one—a tip on one of the horses running at Hollywood that day. Then the man called Doc walks toward the Turf Club gate. His progress is painful to watch. Bending at the waist and shoulders, he moves with the short, constricted steps of an arthritic. Despite the obvious discomfort, his face is cheerful and usually lit with a smile. He nods and smiles at the ticket takers, program sellers and other early arrivals as he moves up the steps and through the flower gardens on his way to the stands.
Sometimes he takes a detour down a short path on the right and goes through an unmarked door to the jockeys' room at the track. Inside, the Pinkerton guard at the door greets him deferentially, and the heads of the waiting jockeys turn his way. As he moves through the room, several of them may ask him about some real or fancied ailment, or pass on the latest piece of jocks' gossip.
One afternoon last May, Doc made a special point of looking into the jocks' room, because an Eastern rider, Walter Blum, had flown out from New Jersey to handle a mount in a stakes race. Doc had treated the ankle fracture that Blum had acquired at Santa Anita a few months earlier.
"How's it feel?" Doc asked Blum, who was booted and ready to ride. "Not too good, Doc," Blum told him. "Particularly when I bend it." Blum sat on a table, and Doc grabbed the booted leg, bending the foot down severely. "Ouch!" Blum said, "that hurts."
"Of course it hurts," said Doc. So they took off the boot, and Doc felt the ankle, kneading it expertly with his thumb and giving it another severe twist.
"How long is it going to hurt?" Blum asked.
"Oh, maybe another year," Doc said airily. "It'll get well. Don't worry about it. Just be glad you're not Shoemaker." So saying, Doc shuffled off to talk to a couple of other riders who needed attention. On the way out, a young jockey named Senon Trevino waylaid Doc and quietly told him to get a bet down in the second race on Kenavo, whose trainer had never before won a race at a major track. Doc was delighted. Nothing brightens his day like a long shot. He passed it along to the elevator operator on his way to the Turf Club, and also to a friend waiting at the daily-double window. Doc paired the long shot with a couple of favorites in the first race, then he went to his front-row box a few minutes before the start.
He sat there with his friends, Fred Astaire and Charlie Wacker—Charles Wacker III, a thoroughbred owner and heir to a Chicago industrial fortune. The three of them go racing as often as possible, and make a few thousand different kinds of bets among themselves, besides the ones they place at the mutuel windows. They nodded without surprise when one of the favorites Doc had in the first half of the double won, but the response was considerably more animated when Kenavo, who went off at 60 to 1, got up in the final stride to provide a double payoff of $419.20. It was a glorious sight to see Doc—bent but joyous—waving his winning tickets in unabashed triumph.
In his more formal moments with his white coat on, Doc is Robert Keith Kerlan, M.D., an orthopedic surgeon; assistant professor of clinical surgery, department of orthopedics, University of Southern California; senior attending physician at the USC Medical Center in Los Angeles County; orthopedic consultant to the Jockeys' Guild, the California Angels, the Los Angeles Lakers, the Los Angeles Kings, the San Diego Padres and, until last season, the Los Angeles Dodgers.
As a result, Kerlan's name keeps appearing in the sports pages (not entirely to his pleasure); sportswriters are his friends, and they want to give him a plug (which he doesn't need). Writers have a fertile field in Bob Kerlan, though. Last April he repaired Bill Shoemaker's fractured pelvis and the year before that his broken leg. He was in charge of Sandy Koufax's arthritic elbow during the last painful years of his career, of Elgin Baylor's knee, of Juan Marichal's back, Duke Snider's knee, Chi Chi Rodriguez' thumb. Tommy Davis' ankle, Robin Roberts' neck, Al Kaline's foot, and so on through the pantheon of wounded heroes who owe him so much.
Perhaps it is not a nice thing to say about any man, but Doc Kerlan is one of those rare public personalities who is virtually without enemies or serious critics. In fact, he is the focal point of so much affection and admiration that opinions of him grow fairly monotonous. "The way we all talk about him," says Jack Kent Cooke, the owner of the Lakers and Kings, "you would think he was dead."
The affection for Kerlan is easy enough to understand. He is that ideal of psychiatry—a round peg in a round hole. Born on Florence Nightingale's birthday (May 12) in 1922, the son of a country doctor in Aitken, Minn., he started his college career on a basketball scholarship at UCLA at the age of 16, when most kids are trying to decide what kind of tonic to put on their hair. Not Doc, as he was known even in those days. He was certain that his future lay in either medicine or sport. After a year's fling at college basketball he opted for medicine, and the losing half of him metamorphosed into one of the major sports fans of our era.
The professional admiration is something else. As an orthopedic surgeon, Dr. Robert Kerlan might well have gone through his career competently, even brilliantly, healing the broken arms, sprained knees, torn ligaments and stiff necks of housewives and businessmen in that western corner of Los Angeles known as the Crenshaw District, where he hung up his shingle 19 years ago. Because he is as capable as he is and as generous with his talent—as physician and teacher—his reputation might have spread clear across town.
But because he was such a sports fan, Kerlan more or less stumbled into "athletic medicine," as he likes to call it. The first stumble came when he and a friend, an internist named Bob Woods, started spending their free evenings at Los Angeles' old Wrigley Field, where the L.A. Angels of the Pacific Coast League used to commit their sins. They decided to apply for the job of team physicians, in return for which they got free seats in the ball park. They were serving in this capacity when Walter O'Malley brought the Dodgers to town.
Kerlan and Woods wrote to Buzzie Bavasi, the Dodgers' general manager, asking if they could continue their duties with the new team when it took up residence in the Coliseum. Bavasi was preoccupied with other matters, so he didn't get around to interviewing the two young doctors until the day before the season started. Even then he thought they wanted to take care of the customers who fainted from heat prostration and the sight of fumbled grounders. They finally made their intentions clear, and Bavasi recently claimed that Kerlan was the most valuable man he signed up for the Dodgers in his 10 years with the club in Los Angeles.
Kerlan's early years with the Dodgers were instructive, if not medically historic. Some of the older players had brought their ailments West with them— Duke Snider a pair of creaky knees that had already been carved on, and Ed Roebuck an arm that was as limber as a medieval drawbridge. So Kerlan began getting on-the-job training in the unique maladies of athletes.
There is a kind of intimate locker room view of sport in listening to Kerlan describe his cases. His is a special language—half clubhouse, half surgical ward. "When Duke got out here," Kerlan recalled the other day, "he had this operated knee, and he was having this recurrent hydrathrosis, or water on the knee. Sometimes in these operated knees an athlete will be bothered by some persistent formation of fluid in the joint on usage. Duke would get an awful lot of fluid, and it would keep him from running properly. I used to drain the fluid occasionally and put in some anti-inflammatory material. One night I took it out before a game, but I couldn't get it all, which occasionally happens, and I was kind of upset. But apparently I'd left in just about the amount the body needed, because it didn't form any more fluid. And I never had to tap Duke's knee again. Since then I've done that on other occasions and found that the same thing happened.
"Roebuck," Kerlan now recalls, "was probably the bravest, toughest player I've ever seen. He had a completely frozen shoulder and would tear it loose by pitching, to such a degree that the whole shoulder-blade area and underneath his armpit would turn black and blue. I told Buzzie he'd never make it, but I was the happiest person in the world when he did, I'll tell you. Guys with guts like that "just don't come around very often."
Kerlan probably is right. And his own physical condition is a good example of what he's talking about. During his med-school days at the University of Southern California, he began to notice pains in his back and legs, strong enough to cause him agony during any kind of strenuous physical activity. While he was in the Army the trouble was diagnosed as a slipped disc, and arrangements were made to operate. Fortunately for Kerlan, the medical unit that was scheduled to perform the operation was shipped out before it could be done. A year or so later a young Army doctor in Pasadena spotted the real source of the pain: rheumatoid spondylitis. "Missing out on that operation was the luckiest thing that ever happened to me," Kerlan says today. "Because this disease can simulate a ruptured disc in its early stages." The ailment, a form of arthritis, not only is not curable but is progressive, and probably means a near-complete loss of mobility for Kerlan in the years ahead. If he is aware of this—and he must be—he has never made the slightest show of concern.
Once the Dodgers moved into their new stadium in Chavez Ravine, Kerlan became a permanent nightly fixture in the press-level box alongside the broadcasting booth of Vin Scully and Jerry Doggett. Now the Dodgers were beginning to get the feel of this jovial, well-adjusted man, who would be in the clubhouse with them each evening before the game, playing cards or kibitzing, sharing in their jokes or problems.
Vin Scully, who has had a lot of time to observe Kerlan, professionally and socially, says, "He didn't need this job, being out every night. But it has served a tremendous psychological need, because Doc had to experience the vicarious thrill of being a jock. He couldn't be one himself because he was sick, but it was the next best thing for him to be in the clubhouse with the sweat and the liniment, and he could live with these kids. He was thrilled when they won, he was flat when they lost. He could go into the dugout and the clubhouse and talk with these guys and clown with them, and they respected his need for their company even if they might not know why it was.
"This is what gives him the great rapport with the athletes, whether it is baseball or basketball or hockey. They feel at heart he's an athlete. He's also anything but stuffy. Bob would just as soon be telling the players a dirty joke, which they love, and they would tell him a dirty joke. He's really one of the boys.
"Also," Scully continues, "the players couldn't con him any. They see him all doubled up with arthritis, and they respect his pain. They don't know anything about it really, but each guy says, gee, I understand he takes 30 pills a day or 60 aspirin a day or whatever it is, and the players respect that."
According to Scully, a major instrument in the orchestration of Kerlan's career has been his wife Rachel, an exceptionally beautiful, dark-haired and quietly shy lady who came from a ranch near Yuma. They met while she was studying to be a nurse and Kerlan was an intern at County Hospital, and they married 19 years ago when their combined salaries were $38.50 a week. When Kerlan opened his first office Rachel was his nurse, bookkeeper, receptionist and general factotum. There were times during that early struggle when a patient would inquire how much he owed, and Doc would say, "You'll have to ask the nurse on the way out." Later he would ask Rachel what she had charged, and often she would admit, "Oh, I didn't have the heart to charge him anything."
Their progress up the financial ladder was slow but steady, not unlike the progress of the rheumatoid spondylitis down Kerlan's back. Through it all, Rachel has been understanding, but, as Scully puts it, "not overly sympathetic. If she had been overly sympathetic," he says, "Doc might have been finished years ago."
Scully tells of the time Kerlan bought a bike and a sweat suit and decided to cycle around the neighborhood each day to keep in shape. On his maiden voyage he took a violent spill before he got out of the driveway, and Rachel, who was watching from the front door, broke up laughing. So instead of ending his trip on the living-room couch with hot and cold compresses, Kerlan remounted with teeth clenched and was off again.
The catalyst for Kerlan's fame, the instrument that converted him from an unknown local orthopedist into a national sports figure, was Sandy Koufax's arm. Kerlan's first efforts on behalf of that golden limb were in the summer of 1962, when Koufax developed an arterial blood clot in his left hand while trying to learn to hit left-handed so he would not have to expose his left elbow when batting. "He was given some medication directly into the artery of the arm, which dissolved this clot," Kerlan recollects, "and he had immediate improvement of his situation. Another day or two and he might have had complete loss of circulation in his index finger, which could, of course, have resulted in portions of the finger being lost.
"The other thing was the elbow, and I'll never forget that. I was at home—it was April Fool's Day—and Buzzie called from Florida. He said Sandy's elbow was all swollen up. Sandy was pitching very well at the time, so I thought I'd play a little joke, and I just said, 'Sure it is,' and hung up. Buzzie called right back and said he was serious and was flying Sandy home, and that's when we first made the diagnosis of his traumatic arthritic condition.
"He had a peculiar thing that doesn't happen very often; he was getting water on the elbow. The joint would swell up to where he could hardly bend it or extend it. The water had to be removed on occasions, and then we used anti-inflammatory agents. Then he had the physical measures, the heat beforehand and then, after he pitched, the ice packs to reduce the metabolic strain on the local tissues.
"He pitched like that for three years, but the last year he was obviously in a lot of pain, and he wasn't pitching as well. I made no particular suggestions to him about retiring; I don't think that's up to the doctor. I think you can answer objective questions by the patient and then let him make his own decision on the basis of the answers you've given him. But sometimes they ask you questions that are difficult to answer. As he was losing some movement of his elbow, Sandy was worried about how much it would interfere with normal pursuits like golf and things like that—even washing his face and shaving—after he quit. Also, he developed spurs that couldn't be removed, and a synovitis, which is an irritation of the lining of the joint.
"The human arm isn't built to pitch a baseball. There are unnatural stresses placed on it, and some fellows place more stress than others. I know in the case of horses that some horses with the greatest ability try too hard and put out so much that they're difficult to keep sound. I think that's the way it is with some athletes, too."
Ultimately, of course, Koufax opted for retirement, and he says of Kerlan today, "The important thing about Doc is his ability to distinguish between the treating of athletes and the treating of regular patients. In our case, it wasn't so much a question of getting well as being able to perform. We can get well in the off season.
"Another thing about Doc that is important to athletes is that he is such a terrific guy," Koufax adds. "His own physical problems are far more serious than most of those he treats, and yet he is always having a good time—telling jokes, kidding people and getting kidded in return. I always liked him as a doctor, but more than that I liked him as a man."
When the Lakers moved to Los Angeles in 1960 Kerlan was soon retained by the then-owner Robert Short. His first serious job for the Lakers was Elgin Baylor's left knee, which had been injured in the first game of the 1965 NBA playoffs against Baltimore. Jumping for a rebound, Baylor had suffered a hairline fracture of his kneecap. In an extremely delicate operation Kerlan removed the upper one-eighth of the kneecap above the fracture and reattached the quadriceps tendon to the rest.
Baylor remembers waking up in the operating room while still under sedation and wondering whether he would ever play again. Kerlan, who was standing by, assured him he would. "He told me the recovery would be a slow and difficult process—one thing about Doc, he never kids you." As part of the rehabilitation, Kerlan prescribed a 37-pound weight for Baylor's shoe, which he lifted 200 times a day throughout the summer months.
When the new season began Baylor still had little faith in the strength of his knee and played cautiously for several months. Just before a game one night in January 1967, Kerlan was in his regular seat on the floor of the arena, and the thought occurred to him that Baylor might need "a little mental stimulation." So he called Baylor over and said, "You know, Elgin, you've got to test this thing one time or another. If you're not going to go out and play, if you think you can't, come on over and sit with me. I've got an extra seat here, and you can just forget about playing."
From then on Baylor went all-out, and in a matter of weeks he was again the superstar he had been in the past. It was from a similar courtside seat two weeks ago that Kerlan witnessed an injury to Wilt Chamberlain that bore a grisly resemblance to Baylor's. Going after a lob pass in a game against Phoenix, the Stilt came down badly on his right leg and crumpled to the floor. Kerlan was at his side in seconds, made a quick—and, it turned out, correct—diagnosis (a ruptured tendon) and had Chamberlain taken to the hospital. The next day Kerlan and his associate, Dr. Frank Jobe, reattached the tendon to Wilt's right kneecap in a one-hour and 40-minute operation. Kerlan was pointedly vague about Wilt's prognosis, but some observers found significance in the fact that he and Jobe came out of surgery smiling.
Typically, Kerlan disparages his own role. "It was an operation that every orthopedist in the country would have performed in the same manner," he says. "I just happen to be lucky that I'm treating athletes of that stature who make the orthopedist look good."
Through the past year and a half Kerlan has had more public attention than ever, thanks to Bill Shoemaker, who has run into a spate of bad luck after more than 19 years of riding without a serious accident. In the winter of 1968 Shoemaker had a wicked fracture of his thighbone when his horse fell at Santa Anita.
After examining the injury Kerlan told him there were two choices. He could have the bone set by traction measures and then remain in traction in bed for 10 weeks. After that the leg would be in a cast for another three months. Or Kerlan could perform an open reduction and run a pin through the marrow of the bone to hold it in place. Though the latter might involve more complications, Kerlan pointed out, it offered the better chance of quick recovery since the muscles would not atrophy as much. Shoe chose the pin.
Even so, it was almost a year before Shoe was back in the saddle. He started with a bang, riding three winners out of three mounts on his first day back at Santa Anita last February, but his return to steady form was slower. By April he was at last nearing full strength again—with just a slight limp—when, in a freak accident at Hollywood Park, a filly reared up and fell over on him in the paddock, fracturing his pelvis and damaging some internal organs. This time there was no question of what to do; Kerlan put him in a cast for the fracture, while a urologist handled the internal problems.
"Kerlan was the carpenter, and the other guy was the plumber," Shoe likes to say. This time the healing has been more rapid.
Just being with Shoemaker was a labor of love for Kerlan, for his abiding interest in racing goes back to his boyhood. Young Bob was a strapping lad, who grew rapidly to 6'3" and 220 pounds, and when he wasn't helping his father on the lonely trips to faraway patients he was playing all the sports and following the horses at the county fair in summertime. Later, as an intern at County Hospital, he discovered Santa Anita and the Racing Form.
"Once I got interested," he says, "the next logical step was to have a horse. First I went into partnership on a horse with a guy named Charlie Russell, but later I decided I wanted horses of my own. From then until I lost a horse at this last meeting at Santa Anita, I've always had at least one thoroughbred in training and sometimes two or three. I've had thoroughbreds every way—I've bred them, I've bought them at yearling sales, I've bought them privately, I've claimed them—and I've never had a horse that ran as high as an allowance race. Ever. They were all claimers. I've won a few races, but damn few. Anyway, I've learned a lot." Kerlan laughs, as if it were some kind of marvelous joke on himself.
"Once I claimed a horse that had lost 54 consecutive races. I knew he was a bleeder, but he had some class, and I thought he could be treated. I had a lot of confidence in my trainer, Jimmy Jordan, so we laid the horse up and treated him with vitamin K and things like that for three or four months. I got very interested in what to do for bleeding horses, and some radiologist friends of mine thought that if you could get a tumor dose of X ray into a horse's turbinates in his nose where the bleeding arises, you could probably sizzle all those vessels and they'd never bleed again.
"In fact, we were even going to put some gunnysacks on his feet and have somebody lead the horse into the radiology lab next door to my office in the medical center one night and have somebody hold a switch with a leaded glove and give him some X ray in the office. One of the partners decided against it, because we were going to have to take part of the door off to get him in.
"We finally started him on the first of January at Santa Anita—Lightning Jack was his name—and he won that very first start and paid $18.40. The next time we got Shoemaker to ride him, he ran into a blind switch at the quarter pole and ran out of the money. Shoemaker said later that if he hadn't he should have won by five lengths."
Kerlan's newest hobby is harness horses. He is a stockholder and director of the Western Harness Racing Association, which is just branching out into night racing in California, and together with half a dozen of his jollier friends he has a partnership in something called Twilight Farms, which owns 12 standardbred racing and broodmares.
Despite all his sporting interests, however, Kerlan remains most devoted to medicine, particularly now that he cannot be sure how long his ailment will let him carry on actively. Already he has restricted his surgery to very special cases, and the slack has been taken up by Jobe, one of two younger men Kerlan has taken into his office.
Working side by side with Kerlan, Jobe has become an all-out disciple. "I think Bob is a genius," Jobe says. "His superiority as a doctor is in his head. It's the ability to evaluate a situation and come up with a good judgment. You can't really get that out of books; it's something that you have or don't have. As Bob says. 'You can teach a chimpanzee how to do a surgical operation, but it's knowing when to do one that's important.' You could say he didn't perform a great operation on Koufax, but he kept him pitching by being very sensitive to the needs of that elbow and taking care of it with little things. He's that way with his regular patients just as much as he is with athletes."
Kerlan believes that "the major impact on my career" was made by Dr. Vernon Thompson, one of his professors at USC. "He was a very conservative orthopedist." Kerlan explains, "and I am also very conservative due to his teaching. He was a strong advocate of finding out what the natural process of any orthopedic problem is. In other words, what would happen if you didn't do anything. Thompson impressed one thing on me: you're an orthopedic physician first and an orthopedic surgeon second. Sure, the surgery itself is important, but it's only one of the things."
His experiences with injured athletes have led Kerlan to think more and more in terms of preventive measures or what he calls "the area of prophylaxis." As an example, he cites the Texas A&M football coach who discovered that a lot of knee injuries result from players getting their heel cleats caught in the turf and how he minimized these injuries by designing a shoe with two soccer cleats in the heel. Kerlan himself has designed some basketball pants with pockets in the rear for inserting small plastic shields that protect the sacroiliac joint when a player falls on his behind. The players haven't accepted them yet, largely for esthetic reasons.
The conservative approach to medicine is most apparent in Kerlan's attitude toward drugs. "I don't believe in giving stimulants to athletes," he says emphatically. "Dexedrine and medications like that are meant to get them real high for a particular game, and I don't believe in that. On the other hand, we use anti-inflammatory medication all the time. If we're treating an athlete who is bothered because he has a chronic or an acute strain which has then caused swelling or pain, then it's rather routine. We use Butazolidin on Baylor and West and Chamberlain. This is to treat them so they can play in a normal manner. It isn't used to stimulate them or build them up for one contest and then not used for a lesser game.
"There is an application of this to the problem of horses," Kerlan adds. "Drugs like Butazolidin and indocin are anti-flammatory agents, not painkillers. If an animal is having pain because there is an inflamed joint or an inflamed tendon or an inflamed muscle, these medications treat the symptom, not just eliminate the pain."
Kerlan anticipates the day when athletic medicine will become a legitimate offshoot of orthopedics. Discussing this notion, he says, "I see a lot of young residents at the hospital who are interested in learning more about this, and their formal training doesn't include much of it at present. Fellowships could be set up under individuals who have been doing this for some time, and just as the subspecialty of hand surgery developed from orthopedics, I'm sure that a subspecialty in athletic injuries will develop. There are more and more orthopedic meetings set aside for just this subject, and they're very well attended."
As Kerlan points out, the problem of athletic injuries is no longer confined to the more violent participation at the high school, college and professional level. The ailments of those people are now shared by Little Leaguers as well as the middle-aged weekend overdoers with a passion for fitness or, at least, an urge to look reasonably young and healthy. "The aging process does cause some loss of elasticity of the soft tissues," Kerlan warns, "and if the tissue isn't quite as elastic it's much easier to get an injury to it. A typical example of that is the number of torn Achilles' tendons you see in the older people who play games that require quick stopping and starting—tennis, paddle tennis, handball and the like."
Conservative as he may be, Kerlan used pills on one occasion that caused his sportsmanship, if not his ethics, to come under serious indictment. That was during the 1967 World Series in Boston. Kerlan had gone there with Bavasi, with whom he has developed one of the closest friendships of his later years. They and their wives often take holiday trips together, and when Bavasi moved to San Diego as president of the new National League franchise there, he made Kerlan a director of the club. (Kerlan has since resigned his post with the Dodgers.)
Prior to the Boston excursion, Mrs. Bavasi warned Kerlan that her husband was a very raucous snorer. Bavasi takes the story from there. "We got to our suite and to bed early, and Bob said, 'Here, I'll give you a pill that will put you to sleep right away, and you won't snore.' So I took two of the pills and stayed up all night, never got a wink of sleep. I found out the next morning he had given me some pills to keep me awake so that I wouldn't snore. Very funny!"
In his more serious moments Kerlan sometimes reflects on the last decade—the extraordinary escalation of his personal and professional fortunes, the friends he has made at the ball parks and the racetracks, the exceptional athletes he has treated such as Koufax and Baylor and Shoemaker, Don Drysdale and Don Carter, the bowler, and Tony Lema and Willie McCovey, and the whole splendid array that he refers to as "those wonderful champions." He thinks about them, and he sighs and says, "Sometimes I have to pinch myself when I realize I'm getting paid for this."
Kerlan's patients all claim that they're the lucky ones.
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Laker superstar Elgin Baylor and Kerlan discuss the progress of Baylor's knee since surgery.
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With old friend Buzzie Bavasi, Kerlan relaxes over lunch at the Turf Club at Hollywood Park.
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