Dr. William Howard rubs his hand through his stubbly crew cut and sighs. With his legs dangling over the examining table and his blue eyes darting around the room, he looks more like an anxious patient than a fearless surgeon. There's good reason: In between treating a stress fracture and scoliosis, he's spent the last three hours talking about himself -- his motivation, his ego, his competitive spirit, his drive. Say what you will about a life unexamined, the good doctor believes otherwise. He wants to confess.
"You know," he says, "I'm about as introspective as a cabbage."
He doesn't look like any vegetable you've ever seen. In fact, he has a body like a gnarled tree and a bedside manner like a drill sergeant. No matter, though. Patients swear by him (and occasionally swear at him) and local doctors respect him as well.
"He's one of the best surgeons we have in Baltimore," says Dr. E. George Elias, secretary of the Maryland Chapter of the American College of Surgeons. "He would be my No. 1 choice to treat me or my family."
At 6-foot-1 and 205 pounds, his thick build shows the ravages of rugby games gone awry. His nose has been broken so often it curves off his face, his elbows look as if someone's attached Christmas balls to the ends, and his fingers, some of which have been broken, bend like misshapen twigs.
The irony is that this happens to be the man who directs Union Memorial's Sports Medicine Clinic, one of the oldest local programs in the hot medical field. Sports and medicine are so intertwined in his life that he often talks about surgery in terms of wins and losses, about feeling defeated by the death of a patient, about the perfect case being akin to the perfect wave.
The impetus to found the program 13 years ago grew out of his own life. "I personally have had every sports injury known to man," he says, rattling off the many ways he's mangled his body: He has broken his nose 11 times, had four concussions, torn up both knees, lost one tooth, broken one ankle, broken one big toe . . .
The question looms: What made him return to the playing field?
?3 "That's part of the game," says Dr. Howard, 58.
A macho man
It's easy to understand why people call him cowboy. Aside from the John Wayne picture in his office ("It was a gift," he says) and his Army past, he exudes a tough-guy persona. He can turn just about anything in life -- from sports to surgery -- into a competition.
"Macho is a perfectly good word," he defends. "It's used in a pejorative way, which is wrong. It kind of aggravates me."
He once tore ligaments in his ankle while playing with the Baltimore Rugby Club in Pennsylvania. But rather than have his team play one man down (substitutions weren't allowed), he taped his ankle to his shoe to relieve the pain and finished the game. Teammates still recall their surprise when he showed up for practice days later in a knee-high cast.
"Bill Howard will compete over anything," says Greg Szoka, a friend and fellow retired rugby player. "I've seen him make a competition out of who can spit the cherry pit the farthest."
Yet Dr. Howard takes his losses in stride, except when it comes to medicine. There, he makes no apologies for his take-no-prisoners style.
"Most surgeons are cocky enough to believe we can cure anything if we try," he says. "If I was being operated on by a surgeon, I wouldn't want a guy who said I think I can do that. . . .
I'd want a guy who says I can do it."
On this day, he must apply that philosophy in two arenas. He spends the morning treating patients in the "home to injured jocks," as he calls the sports medicine clinic, and the afternoon doing general surgery in the operating room. Rather than feeling pulled in two directions, Dr. Howard, who is also assistant chief of staff at Union Memorial, finds the dual roles energizing.
Healing the healthy
"It's a break to leave the world of disease to enter the world of basically healthy people with injuries," he says. "It's fun to get somebody well -- whether it's a minor injury or major. . . . If that doesn't get you charged up, nothing will."
By noon, he's seen a thirtysomething cyclist with tendinitis, a runner with a stress fracture of the ankle and a young baseball catcher with scoliosis. They have pain, swelling, tightness, even nausea, but their final question is always the same: When can I get back out there, Doc?
When Dr. Howard replies not yet, they listen. He's known for his no-nonsense approach to recovery, which at times has startled patients. He doesn't coddle them, often believing that the body has its own way of slowing people down.
Yet, he also has a soft side. He once smuggled in sherry for an elderly patient who missed having an after-dinner drink. He finished rounds and turned up in her room with Harvey's Bristol Cream and two cups. By the time she had recovered from a broken pelvis, they had polished off five bottles.