The football player lay face down on the turf, not moving. Spectators in the stadium held their collective breath, the way they always do at such moments, unsure whether they should be preparing to applaud or grieve.
A physician raced out from the sidelines and crouched down to examine the young man. It turned out the player had just had the wind knocked out of him. The game resumed, and Jeremie Axe, a third-year orthopedics resident at Tufts Medical Center, reclaimed his seat on the sidelines, where he kept an attentive eye on the proceedings, ever watchful for how his young men were faring in the gridiron battle.
In the past year, a small cohort of Tufts students, residents and faculty members have volunteered their time and expertise to the athletics program at nearby Cathedral High School, improving safety for the student-athletes, advising and mentoring the players while reassuring their coaches, and seeking an ever-deeper community involvement that benefits everyone concerned. It’s a rare, perhaps unique initiative in the Boston area that’s been driven by a mix of abiding passion for sports and love for the kids. It’s also good medicine.
Catherine Logan, M12, came up with the idea. A few years ago she worked as a physical therapist in New York City, where more than once she had accompanied a sports medicine team from the Hospital for Special Surgery that visited the city’s high schools offering clinics on physical fitness and injury prevention.
The model stayed with her, even after arriving at Tufts. She wondered how the medical school might reach out to a high school in the vicinity—or, to turn it around, how some local kids might better connect with the resources of the medical school. She consulted with her mentor in orthopedics at Tufts Medical Center, Elizabeth Matzkin, an assistant professor at the medical school, who gave her community outreach notion an enthusiastic thumbs-up.
People in orthopedic medicine tend to be hard-core about physical fitness and sports. A high percentage of the doctors in the field have sports backgrounds and continue to race from one thing to another like sprinters long after they’ve donned their white coats. “It’s the most physical specialty there is,” Axe contends. “Orthopedics is a full-day sport.”
After scouting out Boston schools that might gain from some intervention, Logan’s pick was Cathedral High School, a small co-ed, private Catholic school with meager resources located about a mile down Washington Street from the medical school, where Jimmy Lynch sat behind a steel desk in his small, nondescript office off the lobby of the gym, awaiting her call.
Cathedral has an active sports program, and its boys’ varsity basketball team has won state championships in their division three of the past five years. But there’s not a lot of cash to fuel the enterprise, or safeguard its players. “Our school runs on donations and generous acts,” one coach says with a shrug. Cathedral’s 250-member student body is 98 percent minority. Ninety percent of students come from families living at or below the poverty line.
Lynch, 25, is nearing the end of his second year as athletics director at the school. Like almost everyone who’s part of this story, he’s a jock at heart, with a lanky, easy movement when he walks and an indelible belief in the power of sports to instill structure and discipline in the lives of those who need it most.
Growing up in working-class Philadelphia, he saw this happen firsthand amid his circle of friends. The playground was both their convenient gathering spot and the fulcrum for their lives. So when Catherine Logan showed up last year with her idea of putting the weight of Tufts behind the Cathedral athletics program to make it safer for the kids involved, well, she didn’t have to say it twice. “Safety is priority one for us,” Lynch affirms.
Risk of Injury
Safety is a widespread problem in high school athletics in the best of times, and it’s among the first things to go when money gets tight. According to a 2006 survey by the Centers for Disease Control of nine major sports, “high school athletes account for an estimated two million injuries, 500,000 doctor visits and 30,000 hospitalizations annually.” Boys’ football was by far the most injury-prone, followed in order by boys’ wrestling, boys’ soccer, girls’ soccer, girls’ basketball and boys’ basketball.
What role do coaches play in a typical medical emergency? Not much of any, in fact. Cathedral’s assistant football coach, Collin Johnson, reports that he, like all coaches, got some basic first-aid training—“they gave us a crash course in ankle-taping,” he says—that leaves them all wondering what to do in many situations they commonly encounter on the field. “An ankle sprain, we can handle that, but a neck injury or a dislocation, no,” he says, his voice trailing off.
Concussions pose a special risk. Players who are temporarily dazed or “get their bell rung” fall largely under the average coach’s radar, even as experts estimate that 10 percent of high school athletes in contact sports suffer a concussion each season and the severity of these blows is steadily more appreciated.
For Americans between the ages of 15 and 24, sports are second only to car crashes as a cause of traumatic brain injury. The concern is nothing abstract for the kids at Cathedral. One of the football team’s away games this year was played on the same field where, just a few years ago, an opposing player had crumpled to the ground and died from a concussion.
Massachusetts law requires that each high school have an EMT/athletic trainer on site for football and ice hockey games, and Cathedral took pains to comply in the days before Tufts arrived. But arguably the greatest value that Tufts has brought to the school has to do with how much more than the basics—that is to say, the legally required minimum staffing, or its medical equivalent—they have delivered.
For one thing, Lynch contends there’s been a shift in attitude that’s tangible to the athletes. “The EMTs who could cover our games last year would show up at the field and leave at the last whistle,” he explains. “That’s not the case now, when Jeremie [Axe] and Catherine [Logan] and the others will commonly show up before the game to see the kids, and then travel on the bus with them to the football field.”
Other, more obvious gaps have been filled as well. Working together, Lynch, Axe and Logan have created a small training room in what used to be part of the school gymnasium lobby. The space features three long, thin training tables donated by Logan’s former physical therapy employer in Wellesley, Mass., and its cabinets have been stocked with new braces, bandages and liniments.
Lynch came in on weekends to help knock the space together. “I remember one time I looked out and saw Jeremie unloading material from the trunk of his car,” Lynch says as he shows off the freshly painted room. “He had driven down to Delaware over the weekend to get a bunch of free stuff given us by his father, who has an orthopedics practice there.”
Getting Back into the Game
The symbol of change in an athletics program can be as simple as a roll of tape. Sage Philippe, a sophomore on the football team, still can’t believe the excellent job of ankle-wrapping that Axe gave him one day last season. “I injured my ankle a bit in the first game, and the doctor, he taped it up,” says Philippe, with a rising inflection of surprise on the last three words. “He did it really good, too,” he continues. “Before Dr. Axe came along, the coach used to do it, but he would always do it too tight. I’m a linebacker, and I need to be able to move around some. It was way better when Dr. Axe did it.”
Is it reassuring to look over to the sideline and see Axe waiting there with his expertise? “Tsss, definitely,” answers Philippe with a hiss of disbelief. “ ’Cause this is football. There’s no telling what’s gonna happen.”
Nicole Webbe can appreciate the feeling. As a player on the girls’ volleyball, basketball and softball teams, she has drawn her share of game-day injuries, including hip and knee bruises. “I had a lot of injuries, playing volleyball,” she says cheerfully.
Now, whether the medical staffer on hand for a given day is Logan, Matzkin, Axe or one of the other residents who show up as their schedules permit, Webbe gets individual attention. “They are able to talk to me, calm me down, give me ice and get me back to volleyball,” she says. “It’s like having your own doctor there, right away.”
Before, she explains, she would have gone to the coach with her complaint. “They want to help you,” Webbe says collectively of her coaches, in an understanding tone, “but they have all the other kids to think about.”
Johnson, the football coach, makes a similar point from the coach’s perspective when he remarks that having someone like Axe on the sidelines keeps an injury-related distraction at arm’s length. “It relieves a lot of pressure. So instead of me worrying is this kid OK or not, I can be coaching the game,” he says.
The students suggest there’s a lot more than good time management on display. In a way similar to Philippe, Webbe detects something special and unexpected in the nature of Tufts’ commitment to her school. “They really care,” she comments, making that last word ring like a chime, “because they’ll come in and say, ‘Hey, Nicole, how’s it going?’ When I see Dr. Axe, I think it would be cool to be like him. He’s always helping people.”
Frayed Social Net
Most kids at Cathedral come from relatively poor backgrounds, a fact that lies just below the surface of much of what they have to say. Unlike kids from more affluent backgrounds, they are not used to having resources of any kind lavished on them.
Their medical routines are different as well. When one student-athlete at Cathedral is asked what his family would do about getting him to a doctor’s office to have an injury looked at, he says, well, that would take some time to be arranged, with the implicit message that it might never happen. Another student, quizzed about her family’s schedule of medical visits, is more direct. “My parents are kind of lazy,” she says bluntly. “They don’t always get around to things like that.”
A frayed social net has obvious implications when you’re talking about raising the standard of medical care for high school students. Medicine costs money, and a doctor’s bill represents another drag on the family budget. “Say you go down with a sprained ankle,” suggests Lynch, the athletics director. “Some of these kids would have to wait like a month to see their doctor.” In the meantime, a twisted knee or muscle sprain could well turn into something more serious.
Another effect of not having ready access to doctors is that players may be naturally tempted to conceal injuries from the coaching staff if they know the consequence is they will remain on the bench until they are cleared by a physician. “This way they’re not holding back,” Lynch offers. “I know what that’s like, because I’ve been an athlete who was dying to get back in the game.” Under the emerging Tufts partnership, any injuries that occur can be identified and treated promptly.
That partnership had its big inaugural event last August when Matzkin and a handful of medical students and residents from Tufts Medical Center put on a “Sports Physical” night for student-athletes in the school gym.
The gym contained tables set up as medical “stations” where students could stop by and be examined. Complete musculoskeletal and cardiopulmonary examinations were provided free of charge to 50 kids, most of whom had signed up for fall sports and were able to get their clearances to play on the spot.
Doctors at the event also had a chance to advise students—and in some cases their parents—about good health habits and injury prevention. There was more. Soon after the school year began, Tufts opened a free walk-in clinic on Thursday afternoons at the school, in the newly created training room.
Here, an individual athlete might need to be fitted for an ankle brace, or just want to discuss some personal aspect of his or her life in sports. “It gives them an avenue,” says Axe, who staffs the clinic as often as he can.
Beyond the Dunk
Rock music is laying down a hard, sizzling beat. The gym is filling up with fans, and there’s a feeling of excitement as the boys’ sneakers squeak repeatedly on the gleaming hardwood floor and the basketball team’s practice shots clang off the rim. This is not a bad place to shoot hoops. Cathedral High, founded in 1926, has a two-story original main building that holds classrooms and offices and looks a bit sanded down by the years. The newer adjacent gym, in contrast, is a cube of glass that invites a certain flash.
Tonight’s opponent is Bishop Fenwick, a school that’s three times the size of Cathedral. The game has been scheduled as a fair contest, Lynch explains, because of the smaller school’s winning record. And so the game begins.
You certainly wouldn’t know Cathedral was a top competitor from watching them. They are sloppy and listless-looking, like a team of sleepwalkers, or slack-jawed commuters lingering at a bus-stop. Where’s the talent? Fenwick offers the counterpoint, moving crisply up and down the floor and draining shot after shot in a predictable minuet of swishing sounds. After 10 or 15 minutes, the visitors are dominating, 25–18.
“Just wait,” Axe says under his breath. He is seated on a folding chair at courtside, having raced cross-town to Cathedral and arrived minutes before, following a long day of performing multiple surgeries at Newton-Wellesley Hospital. Leaning forward eagerly in his seat outside the training room, watching the home team’s players move in a pack around the floor with a keen eye, he is in his element. If the game were a meal, he would be eating it with a knife and fork. “That number 32, serious air,” he says appreciatively.
The kids in the gym are stamping their feet and cheering in unison. Everyone is on edge, hungry for the dunk that will ignite the home team. Then it happens: a Cathedral player goes up to get a routine-looking rebound off the rim, grabs the ball with both hands in mid-air and slams it through the net. Whoa! People rise from their seats. A roar fills the gym. “Here we go,” Axe and Lynch (standing beside Axe) murmur in unison.
Cathedral wakes up big-time. The pace on the floor quickens, and the team’s shots start to drop like nickels and dimes through a coin slot. They are suddenly completely in control of the game as Fenwick seems to recede before our eyes. Axe whoops happily and unselfconsciously when a play is sublime, which is often now. (The final score is 83–63 in Cathedral’s favor, a drubbing). Whether he’s bent down tending a fallen athlete or yelling with abandon at courtside, Axe doesn’t look at all like an outsider, or someone who has shown up out of curiosity; he’s more like a man who has always been here in spirit and simply took a while to find the address.
“I’ve asked around, and there are not that many ortho programs that have their own high school—and this is our high school. We love it,” Axe says unabashedly. “We didn’t fall into it, we didn’t inherit it, we began it.”
The relationship is still young, of course. Plans are in the works for Tufts to expand its health coverage for Cathedral by hosting public seminars for students and their parents on topics such as sports nutrition, injury prevention and more. Some changes will reach into the classroom. Loni Rogers, M14, has volunteered to work with Lynch on devising an elective course for the high school seniors on how to make better food choices in their daily lives. The new curriculum should be ready by the fall.
Matzkin, who has brought her trio of young daughters ages three, six and nine to sit in the bleachers and cheer at basketball games, has her own personal and professional reasons for wanting the budding Tufts/Cathedral partnership to thrive long-term. “For those of my residents interested in sports medicine, this is an incredible opportunity to take on responsibility,” she remarks. “My hope is that they will take ownership of this and pass it down from year to year.”
Time will tell. Right now the program’s only certain gain takes the form of a junior varsity basketball player who approaches Axe shyly at halftime to say he was scratched on his cheek by an opposing player in a game earlier in the day, and is there anything he should do to treat the scratch? Axe responds quickly and respectfully to the request, fetching a small vial of antiseptic cream and a gauze pad from the training room. “Here you go,” he tells the young man. “Put some of this on before you go to bed. It should be fine.”
This story first appeared in the Spring 2011 issue of Tufts Medicine magazine.
Bruce Morgan can be reached at firstname.lastname@example.org.