Smooth Operator

For Roy Tarpley, Jim Jackson, and the rest of the Dallas Mavericks, team doctor Tarek Souryal is more than an elbow-saver or a knee-saver. He’s a career-saver.

January 1996By Comments

IT’S A BALMY AFTERNOON IN OCTOBER, and while Dallas Mavericks team physician Tarek Souryal would prefer to keep fuming about the just-rendered O. J. Simpson verdict, he has another famous-but-troubled athlete to worry about: the Mavs’ terrifically talented center, Roy Tarpley, who was supposed to have shown up for a preseason physical but got sick and had to cancel at the last minute.

Ordinarily, this wouldn’t cause Souryal much consternation. But Tarpley…well, for starters, the seven-footer has been a repeat violator of the National Basketball Association’s substance-abuse policy. He also has a pair of gimpy knees that needed to be checked out for off-season conditioning. And the word around Dallas is that he has suffered intermittent bouts of stomach cramps so severe that he has had to be hospitalized. The problem, perhaps, is pancreatitis—a condition that is no day at the beach for anyone, especially for someone with a history of alcohol abuse. Still, Souryal isn’t disturbed that Tarpley had to cancel his appointment. “We’ll have to see,” he says with a shrug. “It could be something serious.”

Souryal does not make such pronouncements lightly. As the Mavericks’ top doctor since 1992, he is painfully aware that every judgment he makes involves not only the patient’s health but the team’s nightly performance and millions of dollars in salary and bonus money—in Tarpley’s case, around $24 million over six years. Each stroke of Souryal’s pen has legal ramifications and practical complications; careers are saved or ended, playoff berths clinched or lost, crucial players acquired or rejected. It can be a difficult balance to strike—the player’s well-being versus the team’s need for the player on the court—and, in fact, sports doctors like Souryal have come under fire in recent years for being either too solicitous of their employers’ wishes at the peril of injured players or too coddling of spoiled athletes who just want an extra day off to play golf. “Really, it’s not all that uncomfortable,” insists the handsome 39-year-old native of Cairo, his bushy eyebrows dancing with intensity. “The player’s interest, the club’s interest—it’s always the same. I try to leave it to the player, just like any doctor with any patient. For me the critical thing is, if the guy is limping, he really shouldn’t be playing. Who’s going to disagree with that?”

Fortunately, other than Tarpley, none of the Mavs’ top players were limping during the week of preseason physicals. Mavs guard Jim Jackson, potentially an All Star this season, bounced back swimmingly from a savage ankle sprain that ended his season just after the midway point last year. Reserve forward-center Terry Davis, another pricey reclamation project, progressed far beyond what Souryal had expected after a total reconstruction of his elbow two seasons ago.

Then there was the matter of a player who can’t be identified for privacy reasons but whom the Mavericks had considered for their first-round draft pick this year. As far as Souryal was concerned, the player was a nine on a scale of zero (no medical risk to the club) to ten (a high medical risk). Because of the player’s prior knee surgeries, Souryal had decided he was a high medical risk. But the kid had had a spectacular college career, and the Mavericks’ coaches couldn’t help wondering, almost daily, “Are you sure he’s a nine?” Souryal stuck by his assessment. “I just felt that if this was a player that the team was going to sign to a one-year deal, then fine. But for a first-round choice who’s going to command multiple years for multiple millions—all guaranteed money? I mean, this young man, age twenty-one or so, already had arthritis beginning in one knee!”

Team officials got the message and opted instead for six-foot-eleven-inch Cherokee Parks of Duke University, another player they had liked all along. Mavericks fans who watched the draft at Dallas’ Reunion Arena hooted at the choice derisively, but Souryal got the last hoot: As of mid-October the player not taken by the Mavs, who was eventually drafted by another team, was on the injured list after—you guessed it—knee surgery. Parks, meanwhile, was in great shape and was already contributing to the Mavericks’ front-line rotation.

As Souryal could tell you himself, sports medicine hasn’t always been so glamorous or high-stakes. As recently as the early seventies, when he first entertained the notion of becoming a sports injury specialist as an undergraduate at Sam Houston State University in Huntsville, sports doctoring was the weekend specialty of orthopedists who happened to be (a) fans of the local college or pro team or (b) friends of the coach. They nursed bumps and bruises and declared players fit or unfit to play, but their impact on the success or failure of a team—on the court or on the bottom line—was negligible.

Yet during the past two decades, professional sports has exploded into an international multibillion-dollar entertainment industry that is every bit as cutthroat as the film business. A player’s health can mean millions, not only in any given season but for years, even decades. Because of the amount of money at risk, team owners and players unions have become increasingly adversarial, and often the bone of contention is a player’s medical condition—past, present, or future. “No question about it,” says Keith Grant, the Mavs’ director of player personnel. “Money in pro sports made the need for quality medical advice at the conference table absolutely necessary.” At the same time, the science of orthopedics has made enormous technological breakthroughs in the treatment of musculoskeletal injuries. Chief among them, of course, was the development of arthroscopic surgery, which overnight revolutionized the treatment of the athlete’s most frequent medical nemesis: damage to the cartilage or ligaments in the knee. By allowing minimal invasion of the joint during surgery, the arthroscopic procedure transformed what had always been considered a career-ending injury into one that was merely career-interrupting, sometimes for less than a season.

The arthroscope—or “scope,” as it is known—turned sports doctors into celebrities, putative miracle workers who could return fans’ favorite stars to the court or field in a matter of months. By the eighties, after Souryal had graduated from the University of Texas medical school in San Antonio and was finishing his residency at Dallas’ Parkland Hospital, the success of the scope in pro and college athletics had created a healthy market among the swelling number of amateur athletes and exercisers who were following the beat of the nation’s fitness movement. Because orthopedics and a sports injury specialty had always been his ambition, Souryal took a fellowship with the Georgia clinic of Jack Hughston, one of the fathers of sports medicine. Then, in 1988, he returned to Dallas, eschewed a cushy position with a large orthopedics group practice, and hung out his own shingle downtown.

It was rough going at first, but Souryal was a tireless promoter of himself and sports medicine. He signed on as an assistant to then—Mavs physician Pat Evans, opened a free weekly clinic for Southern Methodist University students with sports injuries, and began doing volunteer medical work for the high school football team in the impoverished community of Wilmer-Hutchins. By 1992, when Evans retired and Souryal became the Mavs’ team physician, his private practice had grown to some fifty patients a week.

Although it was the arthroscope that elevated sports medicine, it’s interesting to observe how reluctant Souryal is to operate in his private practice. On a given afternoon of rounds there are plenty of pre- and post-scope patients in his treatment rooms, but just as many patients leave without surgery; instead, they’re instructed to rest the injured limb and fol-low a strict rehabilitation program. “The magic of the scope may make players, coaches, and fans think we can perform any miracle,” Souryal says, “but with most injuries it still takes time, rest, and rehab to heal. Almost all sports injuries can have long-term implications—arthritis, for example. The critical thing to understand is that there’s a distinction between soreness and pain. A player can play with soreness most of the time. Real pain is a different matter. Can he do it? Yes. Is it good for him? A lot of times, no.”

Not surprisingly, this deliberation extends to his work with the Mavericks. Indeed, while he has scoped his share of fallen stars during his tenure with the team, his two most recent turnarounds involved more patience and what orthopedists call “carpentry” than miracle working.

Two years ago, during the off-season, Terry Davis was involved in an automobile accident near his home in Virginia. When Souryal got the call from an emergency room there, his heart sank: Davis had lost control of his car and crashed into a tree; the impact completely shattered his left elbow and killed one of his passengers. Souryal couldn’t imagine many worse injuries to a pro athlete. From what the hospital personnel in Virginia said, Davis had a fracture, a dislocation, and an open wound at the joint of his shooting arm. “On a scale of one to ten,” the emergency room doctor told him, “it’s an eleven.” Souryal was dispatched in Mavs owner Donald Carter’s jet to pick up Davis and return him to Columbia Medical Arts Hospital in Dallas. “It really was an eleven,” Souryal recalls. “His elbow had been pulverized.” To make matters worse, the open wound meant it was highly vulnerable to infection.

Over the next thirty days, Souryal operated on Davis’ elbow six times—several times simply to remove the shards of bark and glass embedded in the tissue. The ball and socket of the joint were reconstructed, and the bone mass of the elbow was pieced back together. When he had finished this bit of orthopedic handiwork, Souryal was certain of what he’d accomplished as a physician: He had saved a young man’s limb and, at that, restored it so he could use it in everyday life. Yet Souryal couldn’t be sure whether he’d accomplished what he wanted to as a sports physician. Davis could eat, write a letter, carry trash to the alley, drive a car. But had his elbow been fixed to the extent that he could still reach for a wild rebound off the back of the rim or sink a twenty-foot jump shot with ease?

For the first three months after the operations, Davis could flex the damaged elbow surprisingly well. But soon enough, as is commonly the case with reconstructive orthopedic surgery, scar tissue began to tighten the joint up, severely reducing his range of motion and causing stabs of pain when he attempted to use it with force. Souryal had a dilemma: He could go back into the joint and remove the scar tissue, but he could not guarantee a miracle—as scar tissue grows into place, it often traps blood vessels and nerve tissue inside. He had to admit that the nerve tissue might be damaged during such an operation, perhaps causing Davis’ elbow to be even more immobile. But Davis was willing to take a chance. He was a big kid who knew best—maybe only—how to jump and play rough under the backboard, and he made about $2 million a year doing it. He told Souryal he would do whatever it took to get back to peak performing condition.

The operation lasted 3 hours and 45 minutes, as Souryal meticulously identified and removed the scar tissue in Davis’ elbow and left tender nerve tissue intact. He then nervously watched Davis’ recuperation. His range of motion came back, slowly but surely, through careful rehabilitation. By the time the season started, he had tripled his range of motion, but he was still undergoing rehab and did not play. This year, though, he’s come back with a vengeance and has one of the team’s top shooting percentages. “This injury really should have been career-ending,” Souryal says. “There were many chances for it to jump back up and bite us.”

The same could be said of Jim Jackson’s badly sprained ankle, which plagued him last season—such a radical shredding of the outer ligaments of his joint that it seemed at first to be a dislocation. Souryal was relieved to find that the injury was only a sprain, though it was one of the worst he’d ever seen. An ankle sprain is a stretch or tear of one or all of the four ligaments of the ankle; the more ligaments involved, the more severe the injury. Jackson had torn three ligaments while stepping on another player’s foot at high speed. And surgery wasn’t an option. “An ankle sprain like that one can almost be worse than a fracture,” Souryal explains. “All you can do is ‘boot it,’ tell him to stay off it, and let nature take its course.”

In a few weeks Jackson was walking fairly normally on the ankle and felt little pain. But with only a month left in the season, the question was whether he should try to play full-time on it. The ankle was not as strong as it had been; if he tried to play on a weak joint, he could reinjure it—or injure some other part of his body. As he generally does, Souryal left the call up to the player, and Jackson decided that since he couldn’t dunk the ball off the ankle, he didn’t want to play at all. After several months of intensive rehabilitation, he complained that he still didn’t have confidence in the ankle, but now, according to Souryal, he’s playing as well as he ever did.

Whether Roy Tarpley will play as well as he ever did remains to be seen. He did eventually show up for a physical—many of them, in fact. Souryal found that in addition to his mysterious internal problems, he had lost weight during the off-season, as well as strength and endurance in his legs. Since he wasn’t in shape to pass the full team physical, the Mavericks labeled him “suspended-unable to play” for a short time, then shifted him to the injured list.

As of mid-November, Tarpley was working with Souryal and the team’s strength coach to pass his physical and get in shape. Even if he does, there will still be the lingering problem of his pancreas—yet Souryal will have done all he can. “Once he’s physically fit to play,” he says with a trace of relief in his voice, “it will be a coaching decision.” On, then, to the next miracle.

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