Lewis tragedy provides a case study on limitations of modern medicine

August 02, 1993|By Larry Tye | Larry Tye,Boston Globe

BOSTON -- Reggie Lewis' tragic death last week has become national topic No. 1 for many health professionals who are trying to learn from the case and ensure that mistakes allegedly made in it aren't repeated.

Start with doctors and the advice they dispense.

Lewis got the best money could buy, consulting with more than 20 specialists and subspecialists from Boston to Los Angeles. But, like Larry Bird and other sports celebrities with serious ailments, he didn't use an old-fashioned family doctor to help him interpret the conflicting advice and provide the independent counsel that even the best team doctor can't offer.

"The key missing party was a good primary-care physician," said Dr. Michael Grodin, director of medical ethics at Boston University. "Everyone needs that liaison, that trusted person who can help you integrate and understand, who can say, 'Gee, maybe you want to ask these questions.' "

Medical researchers, meanwhile, hope the Lewis case will fuel a search for new ways to reduce the more than 100 sudden deaths each year among athletes. Public health officials say it underlines the need for better training in cardiopulmonary resuscitation and other emergency-response procedures. Sports medicine buffs say it makes clear the need for clearer rules on when to let sick players return -- and when to say no.

But perhaps the most sobering message of Lewis' sickness and death are what they tell us about the promise -- and pitfalls -- of modern medicine.

"Medicine is just not a pure science," said Dr. Paul Thompson, chief of preventive cardiology at the University of Pittsburgh Medical Center. "My diagnosis on any patient is just my best last guess.

"The Lewis case shows the fallibility of doctors."

That doesn't mean doctors aren't looking for ways to learn from their limitations. In fact, many heart specialists have spent the days since Lewis died telling anyone who would listen about the need to take fainting and dizziness very seriously, even among athletes at the top of their game.

"Passing out during exercise is a real wake-up call; it may be something simple or it may be life-threatening," said Dr. Benjamin Levine, head of the Institute for Exercise and Environmental Medicine at Dallas' Presbyterian Hospital.

Dr. Thomas Delbanco, director of general medicine at Boston's Beth Israel Hospital, thinks doctors should trust their instincts more in such situations: "If you told 100 good doctors that an athlete was running along and suddenly collapsed, they would be very leery something was wrong. But then you get into a whirlwind of tests, each of which is imperfect, and end up with a set of probabilities.

"The Lewis case may be an example of where our ever-increasing technologies can confuse rather than illuminate."

Doctors also are trying to eliminate the causes of young athletes (under the age of 40) dropping dead, something that happened nearly 400 times in the last 4 1/2 years, said Dr. Larry McLain, head of the National Center for the Study of Sudden Death in Athletes.

Some youth baseball leagues make players wear chest protectors, since being hit in the chest is the leading cause of sudden death in baseball, McLain said, while doctors generally are learning how to recognize warning signs of heart and other ailments.

Hospitals, even more than physicians, showed a seamy side in the Lewis affair. One of its most lasting images is of the Celtics' captain being transferred late at night -- in a truck, rather than an ambulance -- from New England Baptist Hospital to Brigham and Women's.

"How can you not say there's competition between major medical centers here?" said Thompson. "Having big-name patients in your practice in this day and age is prestigious."

The Lewis case also should send a wake-up call to the public about how CPR can save lives, said Dr. Michael Copass, medical director for the fire department in Seattle, where approximately 50 percent of residents are trained in CPR.

While there's still confusion about what happened when Lewis collapsed in the Brandeis University gym, it's clear that no one gave him CPR in the early minutes, when it was needed most and most likely to work.

The lessons of Lewis' death are even more sobering for the sports world.

First, there's the old issue of team doctors and whether they represent the team, players or both. Bird's back problems presented a thorny situation because his main doctor was Celtics physician Arnold Scheller, and one surfaced again when Scheller and a team he helped assemble advised Lewis in May.

The Celtics and anyone in their employ have an understandable interest in seeing their star player back on the court, said Dr. Barry Maron, director of cardiovascular research at the Minnesota Heart Institute Foundation. Ailing players like Lewis, he added, "need something more objective that takes everybody off the hook."

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