Field Doctor : Orthopedic Surgeon Waits on the Sidelines but Is Ready to Get in the Game When Teen-Age Athletes Need Him

He was a doctor on Friday-night duty at a football field in Long Beach. Casually dressed and without a black bag, the co-author of “Tears of the Anterior Cruciate Ligament in Young Athletes” was anonymous to the high school players for whom he was there.

“What I do is basically stand here,” Dr. Douglas W. Jackson said from his vantage point along the sideline of the home team, Wilson High, during a recent game against Newport Harbor. “If it looks like a serious problem, I go out there. Most are bumps and bruises.”

Jackson, a tall, athletic man of 48, is a nationally known orthopedic surgeon and knee specialist and is director of the Southern California Center for Sports Medicine at 2760 Atlantic Ave. in Long Beach.

“In sports, the knee is the most vulnerable joint,” Jackson said without taking his eyes off the field. “Each year, each high school football team can expect one to two serious knee injuries.”

Knees would be spared this night, but ankles and shoulders would suffer. As one of about 70 doctors who give up their Friday nights to cover high school football games under the Los Angeles County Medical Assn.’s Team Physician Program, Jackson would screen the injuries and answer the players’ most urgent question: “Can I play?”

The program was started about 6 years ago when it was learned that about half the high school football teams were playing without a doctor on the sidelines.

“There’s a need that teams have for this medical coverage,” Jackson said, “and since I’m in sports medicine, I feel an obligation to try to help fill that need. . . . I enjoy doing it.”

In the dim Wilson locker room at half-time, Jackson examined the injured shoulder of defensive back Jamal Bush and asked him if he wanted to play the second half.

“Yes,” said Bush, who winced but looked neither frightened nor concerned.

Jackson turned to Wilson trainer Ruth Bisom and said, “Why don’t you talk to the coach about using him sparingly?” Then he told Bush: “You’re going to be fine. You bruised a tendon in your shoulder.”

As he walked back to the field, Jackson said Bush could play, although if the game were decided there would be no point in his playing.

In the second half, a Wilson player lay on the ground after slightly turning his ankle, then suddenly got up and ran off the field.

Jackson laughed. “Quick recovery,” he said.

After one second-half kickoff, Jackson spotted an injured player. He propped his popcorn bag against a yard marker and ran across to the Newport Harbor bench. When he returned, he said the player was OK.

“He was walking kind of funny,” Jackson said. “He started to run, and his teammates grabbed him as he started to fall. He just stared. Head injuries frighten you. You fear a kid having a head injury and going home and dying.”

After the game, Jackson re-examined Bush, who, despite his tender shoulder, had made an interception late in the fourth quarter which was needed to preserve the 28-14 Wilson victory.

“I think it would be worthwhile getting an X-ray,” Jackson told Bush’s mother, who held gold pompons in the doorway of the training room. “It’s nothing serious.”

To her son, he advised, “You probably should hold up on contact next week.”

Exposed under bright lights, a knee awaited.

In the cool reality of an operating room at Memorial Medical Center of Long Beach, Jackson was ready to begin an arthroscopic operation. It would be one of more than half a dozen on a recent day, most of them on men in their 30s and 40s, the “weekend warrior” recreational athletes.

“This guy’s a hard-core skier,” Jackson said of the patient, who was sleeping beneath a pale green draping, his head seen only by the anesthesiologist who sat observing dials, graphs and digital displays of pulse rate and blood pressure.

Jackson looked at the MRIs--magnetic resonance images--of the skier’s knee in their box of light on the wall. Depicting ligaments and cartilage in more detail than X-rays, the images resembled aerial views of forbidding terrain with shadowy craters, ridges and valleys.

They suggested, Jackson concluded, abnormal cartilage.

In addition to his surgical attire, Jackson wore two pairs of thick brown rubber gloves that would not look out of place on a construction worker.

He stood over the knee, which had been cut open in two places. From these small “portals,” blood and water trickled down cloths and turned pink the towels at the feet of Jackson and two surgeons who assisted him.

The heart monitor blipped reassuringly.

With his right hand, Jackson inserted into one of the portals a long, pen-shaped cutting instrument. With his left hand he inserted the scope, a small telescope-like instrument that contained a lens and a TV camera. The whole thing was covered with a plastic bag for sterility and was several inches long.

The surgery method revolutionized sports medicine when perfected in the early ‘80s. Jackson said the technique--which can cost from $700 to $3,000--has shortened the period of disability and allowed surgeons to see better while working through smaller incisions. Gone are the days when knees had to be scarred with long cuts and bound in casts during weeks of recuperation.

Jackson studied a TV; the screen revealed the knee’s interior.

“This is a little arthritic,” Jackson said.

The view was murky, occasionally covered by a bloody haze. As in a sea, there were filmy, indistinguishable shapes and floating bits of debris.

His cutter materialized on the TV as a pillaging shark, its teeth snapping at the prey, which was the offending cartilage. “Kind of like mowing the grass,” Jackson said.

A few minutes later, as he left the room Jackson said, “He’ll ski well.”

Lunchtime. Jackson, eating a sandwich and chocolate-chip cookies in the doctors’ cafeteria, said he enjoys the orderliness of the operating room and the precision of his profession. Then, with a quiet laugh, he described it as “a lot like carpentry . . . measure twice and cut once.”

“(But) there is pressure,” he admitted. “You’re in a person’s life, and they have expectations. You’d like every surgery to be perfect . . . but you have to deal with failures.”

Jackson, a graduate of the University of Washington and a native of that state, was the physician for athletic teams at West Point in the early 1970s. He moved to Southern California because “it was an area with a tremendous number of athletes and no one was doing what I wanted to.”

Like many orthopedic surgeons, Jackson is an athlete himself. He has run both the Los Angeles and Long Beach marathons and frequently takes weekend bicycle rides of more than 60 miles.

“We tend to be very physical,” he said, adding that it may be because of the fairly physical nature of the work itself, the maneuvering of limbs and instruments.

But Jackson also enjoys scholarly pursuits, attending clinics, lecturing at symposiums and writing articles about the intricacies of the knee.

“He’s a real whiz when it comes to this stuff,” said Dr. Randy Schaeffer, an orthopedic surgeon associated with the sports medicine center. “He’s very hard working, extremely particular. Very low-key for as big a name as he is.”

“Nothing gets him flustered,” said Dr. Ed Atwell, who also works with Jackson. “He never screams in the operating room, never throws things,” as some other surgeons do.

The first case after lunch was a man who injured his knee when he fell off a ladder and chose surgery rather than rehabilitation so he would stand a better chance of being able to play baseball with his son again.

Jackson, Atwell and Dr. Jack Goldstein stood at sinks and scrubbed with an antiseptic solution that smelled of iodine. Suds dotted the floor.

Then they went into the operating room and, within an hour after the procedure had begun with the snarl of drills boring through bone, had trimmed a tear in the man’s meniscus cartilage and reconstructed his anterior cruciate ligament.

“A torn anterior cruciate is probably the most common disabling ligament injury,” Jackson said. “That can occur just by cutting and twisting and turning. People can live without their anterior cruciate ligament. . . . Ten years ago I only operated on 30% of the ones I saw. Now I operate on 70% to 80%.

“We still have a fair number of people who elect to live with theirs and give up a few things. I don’t know right now in my stage of life what I would do. You can cycle without a cruciate, some people can jog straight ahead, and some can’t. If you can still do your work, the question is: Do you want to go through all that?”

After the operation, Jackson phoned the patient’s wife. “I was pleased with the way everything went,” he told her. “He needed surgery.”

It was now 3 p.m. and Jackson was driving his Mercedes down the San Diego Freeway, headed for Memorial Health Center in Huntington Beach, where he would see patients. Classical music came from the radio.

Only minutes removed from the operating room--there had been two more cases, a dockworker and a softball player--Jackson was impeccable in olive pants, a blue shirt and striped tie.

“Even in well-controlled (athletic) programs, you’re going to have” knee injuries, he said. “You can reduce them by having people in good shape. Technique and form in sport allows you to get the maximum out of your muscles skeletal system without damaging it. So take a gymnast who’s dismounting. If they come off twisting and turning, there’s a lot higher chance of injury. Any time you increase the body’s movement and forces, there’s a chance for injury.

“Some of the most serious knee injuries occur when a player slides into second base and their cleats get caught. They’ll tear all the ligaments in the knee--anterior, posterior, medial, lateral--and they’ll tear the artery. Those are infrequent, maybe one or two a year.”

In a small room at the medical center in Huntington Beach, Jackson checked a patient, on whose knee he had recently operated, and told him that he could begin therapy.

“It feels fantastic,” said the man, who is in his mid-20s. “Thank you; just fantastic.”

Jackson appreciated the man’s enthusiasm, but as he moved on to the next room, said, “It’s early yet.”

The surgeon said 20% of his patients aren’t pleased after surgery because they are no better. A small percentage, he said, are a little worse than they had been.

“I tell them what we found, what my best judgment of the future is for their knee problem,” Jackson said. “It boils down to what do you say to yourself going in. Like the fellow we operated on today. He wants to ski, he knows he’s going to have some trouble, knows his arthritis is going to progress very slowly. He can switch to bicycling and swimming and stretch that out further or go ahead and use it and worry about it later.

“Some people are aggressive and some are conservative. I try to give them enough information that they can decide (whether to have surgery). I tell them as long as it’s not real painful when they’re doing it, as long as it doesn’t swell when they’re doing it, that they probably aren’t doing a lot of damage” to the injury.

He thought about the day’s surgical patients, back in Long Beach in various states of recovery, perhaps already pondering the rehabilitation ahead.

“The people we did today will probably all go back,” he said. “The skier will ski, the softball player will probably play softball.”

That thought made Jackson happy, as did the realization that his long day was over and that by 6:30 he would be home with his wife and three children in Naples.