THE DOCTOR OPENS the door to Exam Room 2. Perched on the table is an 18-year-old male, flanked by nervous-looking parents. He wears shorts and a T-shirt and has a mop of tussled strawberry blond hair. He was once a phenom, albeit a local one. At 14, his fastballs went 80 miles an hour. Then one day, during a practice session just before the start of his freshman season in high school, he felt a "bad twinge," "just kind of a pop," and he hasn't taken the mound since. Now, he tells the doctor, he wants to try out for the baseball team at the college he'll attend in the fall, his goal a scholarship and then who knows. So he has traveled here with his parents, to the clinic of the celebrated orthopedist, to see if the doctor can heal whatever it is that ails that doubtful right shoulder -- to see if the doctor can save his dream, which is why they all come to see Dr. James Andrews. "I don't want to let it go," the boy says.
The doctor's distinctive Louisiana drawl has compelled at least one patient of Northern origin to nickname him Foghorn -- as in Foghorn Leghorn, the Looney Tunes rooster. Over the decades, though, his accent has proved a highly useful clinical tool. Slow and informal, it soothes the frayed nerves of his patients. It carries along on its easeful waves the reliability and trustfulness of the old country doc of American lore. You close your eyes when you hear that drawl, you see the Norman Rockwell pictures. It distracts the listener from the core, uncomfortable truth -- that when an athlete is listening to Dr. James Andrews, he's listening to his best last chance.
THE DOCTOR OPENS the door to Exam Room 5. "Hey, Big Man! Whatchyou been doin'?" This is Charles Morgan, 32 years old, a 285-pound mixed martial artist from the outskirts of New Orleans. His triceps protrude like handles. He has a trapezius muscle that bulges from his shoulders like a linebacker's neck roll. He has come to see Andrews for the elbow he mangled during a bout last year (which he won). He didn't get it fixed then and still fought in a championship match just two days before (which he also won). "Two titles in six months with one arm," he brags.
The doctor again opens the door to Exam Room 2 -- another pitcher, 29, an eight-year veteran of the major leagues complaining of soreness in his throwing shoulder. The doctor sits down in a chair and crosses his legs, presenting for inspection a pair of tasseled cordovan alligator-skin loafers. A meticulous dresser, he wears today a glen plaid blazer in baby blue and a canary yellow necktie with little yachts on it. His hair is white and soft-looking. He peers at the pitcher through steel-rimmed spectacles. "Lemme tell you, the last thing you wanna do -- in your category and your age group -- is have your shoulder operated on," the doctor says. "Seeing you for the first time, a red flag goes up, but it dudn't wave yet. Know what I mean?" He recommends an injection of cortisone and 10 days of rest.
Here at the Andrews Institute in Pensacola, Fla., Mondays are clinic days. It's late April, a month after MLB's Opening Day, and that means a steady influx of shoulders and elbows wounded by the repetitive hurling of baseballs. Today, no fewer than three pitchers present with damage to the ulnar collateral ligaments in their elbows -- the so-called Tommy John ligament, or UCL -- for which Andrews has become one of the world's two or three most-sought-after menders. Other sports are represented as well. A petite female Israeli high jumper with a torn ACL. A journeyman golf pro in his early 40s with early-onset arthritis of the shoulder. An Olympic-medalist-grade javelin thrower, female, who has come to America from across the Atlantic because, she says, the European orthopedic infrastructure remains short on throwing-injury expertise. She has torn her Tommy John.
On Mondays, as on all days, it is hard to keep up with the doctor. He moves from room to room in elaborate, unpredictable patterns. He pops into one, talks to a patient for a bit, emerges, thinks, pops into another, disappears to field a call on his cellphone, comes back and stands quietly in a corner, thinking. He does a lot of thinking, and at such times he hates to be disturbed. "When I walk out of a room," he complains later, "I'm trying to figure out what's wrong with this patient -- I'm trying to figure out: What should I do? -- and people just destroy your whole thought process."
Surgical fellows in coats and ties strive to stay by his side. Presently, Andrews is nowhere to be seen. One of the fellows looks around, then says: "To be honest with you, he disappears. Eighty percent of our energy is just trying to keep up with him." Then from somewhere offstage, Foghorn bellows, presumably into his iPhone: "Hey man! He's got a partial ligament injury that probably hasn't quite declared itself yet. Here's what we're gon' do ..."
Andrews' days, and often his nights, are punctuated by such calls. The contact list on his iPhone has surpassed 3,000 names, among them athletes, agents, trainers, other orthopedists, coaches, GMs, owners. Within a six-month span this year, the list of damaged and diminished players who trekked to one of Andrews' two clinics -- the newer facility in Pensacola, the older and more established in Birmingham, Ala. -- included Redskins QB Robert Griffin III; MLB pitchers Matt Harvey, Sean Burnett, Jonny Venters, Jake Westbrook and Joel Hanrahan, along with second baseman Scott Sizemore and slugging wunderkind Bryce Harper; NBA draftee Nerlens Noel, Celtics point guard Rajon Rondo and Pacers forward Danny Granger; and dozens of other athletes undisclosed by their agents or teams. When his phone rings, it is part of Andrews' ethic that he never doesn't pick up.
Later this very week, Andrews will celebrate his 71st birthday. He has reached his fifth decade as a practicing physician. Since age 30, he has averaged perhaps 1,000 surgeries a year. A typical orthopedist will do 400. He has trained some 350 fellows, who have gone on to populate all levels of the sports medical establishment. He's the originator of a movement that has attempted to stem a widespread rise in overuse injuries among youth athletes. He has treated not only athletic royalty but actual royalty: For many years he served as chief orthopedist to the House of Saud.
All that toiling has made Andrews rich, with the Citation III in the hangar and the Ferrari 599 in the garage and the custom-made mahogany Hacker-Craft on the lift by the dock of his waterside Pensacola manse. But the long hours have taken their toll. Seven years ago, a heart attack almost killed him, and many who know him attribute that event at least partially to overwork. As a consequence, he has in fact slowed down. He sees probably half as many patients now as he did just before the heart attack and performs half the number of surgeries (down from 1,200 a year at his peak, he says). He is fully aware that he has reached "the twilight of my orthopedic career." And yet, and yet ... he can't quite bring himself to hang up his instruments. Not yet.
OUTSIDE OF THE TV doctors Oz and Gupta, and maybe the late former Surgeon General C. Everett Koop, not many physicians have become household names. If James Andrews hasn't, he's come close. His fame has been propelled, in part, by the rise of omnipresent sports media -- along with the corresponding expansion of interest among fans in the ruptured anterior cruciate ligaments, dislocated patellas and medial meniscus tears of their sporting heroes. And, of course, there have been Andrews' many famous reconstructive triumphs across eras: the Roger Clemens shoulder, the John Smoltz elbow, the Drew Brees shoulder, the Adrian Peterson knee. But the fact remains that possibly dozens of U.S. orthopedic surgeons are as capable as Andrews of knitting up these sorts of injuries and sending healed players back out into the arena -- and dozens, in fact, do. So how is it that Andrews has achieved status as the nation's pre-eminent savior of athletic careers?
It might have something to do with the arc of his biography, which is as American as Twain. The humble origins: born in New Orleans, raised in rural Louisiana, in a hamlet called Homer. The grandfather with the grade-school education who became a cotton planter and also a kind of communal medicine man. The World War II veteran father who was a two-way college football lineman, the progenitor of the boy's other loves: baseball, football, basketball, track. The extreme dexterity that allowed him to become, at Louisiana State, the pole vault champion of the SEC (1963). The medical degree from LSU; the residency at Tulane; the apprenticeship under the master, Dr. Jack Hughston, of Columbus, Ga.
Hughston, who died in 2004, is considered a father of the orthopedic subspecialty of sports medicine. For him, Andrews was more than a prized student; he was Hughston's "fair-haired child," as the elder physician once called his protégé. Says Andrews, "He was like a father to me." Eventually the teacher made the student his partner. It was from Hughston, a bow-tie-wearing stickler of the old school, that Andrews learned to never not pick up the phone.
At that time, in the 1960s and '70s, sports medicine was largely preoccupied with the traumas of football, which meant knees; Hughston was a knee specialist. Andrews became one too, but he also gravitated to the overuse injuries of baseball and golf, in which repeated movements wear down bodies over time, producing physical damage less obvious than the gridiron's weekly carnage. He had found his niche. He invited the players on the local minor league Columbus Astros to present with their problems at his office, the better to increase his pool of subjects and his knowledge. When the team ran into financial distress and faced a move to another city, Andrews bought the team with a colleague just so he could continue seeing pitchers and studying their injuries. (They paid $40,000 and sold it 10 years later for $1 million, Andrews says. "One of the best investments I ever made.") Several years later, when he struck out on his own and opened a clinic in Birmingham, he built a biometrics lab to film the throwing motions of pitchers and plumb the data for insights. The studies that eventually arose out of the lab helped popularize the pitch count.
But it was the arthroscope, the fiber-optic device used to examine the interior of a joint -- invented in Japan in 1919, popularized in the U.S. in the early 1970s -- that made Andrews' career. It also helped drive him and Hughston apart. Inexplicable as it may seem today, Hughston renounced the technology, preferring traditional open surgery. At first, Andrews had to use the instrument virtually behind Hughston's back and had to learn how to work it from other surgeons, chiefly from Dr. Lanny Johnson, one of arthroscopy's pioneers, who developed many of the tools that ultimately transformed the scope from a simple visual device into a surgical one. For Andrews, all this turned out to be a piece of good fortune. Once arthroscopy showed a few initial successes, patients in droves began demanding the doctors who were the best and most experienced at using it. Among the first (if not the first) to scope an elbow, Andrews turned himself into one of those doctors.
They say of great athletes that they make their own luck, and maybe so it goes with Andrews. "I can't take credit for lotta things; I've just been there at the right time, right place," he likes to say. False modesty, perhaps. But there is evidence: In early 1984, the team doctor of the Detroit Tigers, impressed by a speech Andrews gave at an orthopedic conference, asked the young surgeon to look at their shortstop, Alan Trammell, afflicted by tendinitis in the shoulder, once the season had concluded. The Tigers went on to win the World Series, Trammell was named MVP, and instead of going to Disney World, the new superstar went to see James Andrews. Also in the early '80s, Andrews examined a teenage multisport phenom from Bessemer, Ala., and later became his personal orthopedist. When Bo Jackson tore up his hip less than a decade later, Andrews only assisted on the surgery, but the media carnival surrounding Jackson's rehab (which Andrews' right-hand man, physical therapist Kevin Wilk, oversaw) served to amplify Andrews' reputation.
In the summer of 1985, a second-year pitcher presented in Columbus complaining of severe shoulder pain. According to the pitcher, team doctors in Boston couldn't figure out what was wrong, so off to Andrews he went. A shoulder scope revealed that a fingernail-size piece of cartilage had loosened and was catching in the shoulder joint. With his arthroscopic instruments, Andrews shaved off the nub. The next April, free of pain, Roger Clemens would strike out 20 Mariners in nine innings at Fenway, setting a major league record. By season's end, he would win the first of his seven Cy Youngs.
Soon enough, players who came back from Andrews' treatments told still other players about this Southern doc with the drawl and the magic scope. The media caught wind. More injured players wanted to come. And as the success stories accumulated, he at some point became known as the world's foremost savior of athletic careers. "He got to a stature where even his failures became successes," says Dr. Champ Baker Jr., who practiced with Andrews at the Hughston Clinic. "If players couldn't get back, they'd say, 'Even Andrews couldn't fix me.'"
THERE ARE THOSE -- rival orthopedists among them -- who suggest that Andrews' outsize reputation stems to some degree from a talent for self-promotion. There are those who believe that Wilk, Andrews' longtime rehabilitation expert, has played a far larger role in Andrews' success than is appreciated outside the walls of the doctor's clinics. There are those who believe that Andrews has people who alert the media whenever a big-name patient presents at his clinics. (Lanier Johnson, executive director of Andrews' Birmingham clinic, who has also served as the doctor's PR man for more than 20 years, vehemently denies this. "I can assure you we have never ever called up the media to say, Hey, so-and-so has come to the office.") There are even those who question whether Andrews' brand has grown so large as to become a cult of personality; those who wonder if it is, in fact, a good thing for a doctor to be the driving force behind the news cycle of Robert Griffin III.
"Jim Andrews has worked hard; I respect him. But he kind of has a PR machine," says the team physician for one NFL franchise.
There are also those who would note that, for a man as famed as Andrews, criticism comes with the territory. "Sports medicine is a very competitive world," says Walt Lowe, a prominent Houston orthopedist. "I will tell you there's a lot of jealousy in the sports medicine world, and there's a lot of jealousy surrounding Jimmy. Another surgeon once asked me, 'Don't you mind being in Jimmy Andrews' shadow?' My reply was: 'What better place is there to be? When the time comes for him to retire or wind down, I just hope I'm one of the guys who has the ability to rise out of that shadow.'"
WHEN ANDREWS OPENS the door to Exam Room 4, he encounters a distressing sight. The patient is a repeat customer. For Andrews, repeat customers represent a form of defeat. Perhaps because of this -- or perhaps in an effort to drown the doubt inside his head -- Andrews enters the room with a burst of bravado. "This kid here's a survivor! See how big he is? Reminds me of Roger Clemens, the way he's built. A young Roger Clemens."
The survivor is a 24-year-old minor league pitcher. He wears black athletic shorts and a white T-shirt, both emblazoned, a little cruelly it turns out, with the batter-silhouette logo of Major League Baseball. Almost exactly three years ago, during his junior season in college, he came to Andrews, who clamped six anchors to his glenoid bone, sewed them to his labrum -- the band of cartilage that rims the shoulder socket like the rubber seal on a Mason jar -- and pulled the loose labrum tight to the socket: SLAP repair (Superior Labrum, Anterior and Posterior). The surgery seemed to work. After college, he signed as a free agent with his hometown Orioles and pitched well enough in rookie ball in the Gulf Coast League last year that he was about to be promoted to the IronBirds of Aberdeen, Md. But then, two weeks before this visit, disaster struck.
During an extended spring training game against the Twins, he took the mound for an inning of work. He wound up for his third pitch, he reached his release point, he released. In the exam room now, he describes the feeling as an explosion. "It felt like somebody shot me in the back of the shoulder." Not long after, the Orioles released him. He's covered in Pensacola by workers' compensation.
The previous two weeks have been "frustrating," the pitcher says. "You want to know what's going on so bad. You want to know if you can come back; you want to know if you're finished."
The pitcher has come to Pensacola with his mother -- late middle age, steel-gray hair, large eyeglasses, vowel-heavy Baltimore accent. Andrews refers to her alternately as Mother and Mama. She sits in the examination room and notes that the week before his latest injury, her son faced Orioles second baseman and former All-Star Brian Roberts. "Popped him up!" she says. "That's probably gonna be his claim to fame! Popped up Brian Roberts." Then she laughs awkwardly, and a little too loudly.
Andrews performs a series of palpations and oblique rotations of the pitcher's malfunctioning limb. He rechecks the MRI. He tells the pitcher it looks as though he's retorn his labrum. "Something acute has happened," he says, and the only way to find out what is to scope his shoulder.
The dialogue in the exam room then circles, at varying distances, around a central decision: Should the pitcher have this surgery? And if he does, what are the chances he'll be able to continue to strive for the majors? Should he attempt another comeback or finally just find another line of work?
"Don't ever go into anything saying, 'Well, I'm not gonna ever play baseball again,' " Andrews says. "I understand where you're coming from, with as much as you've been through ... "
"But realistically, a second scope is ... "
"Is hard," says Andrews, finishing the pitcher's sentence. "It's hard to get back into baseball. Because now you've been released, and teams are gonna hear about all this history of yours. What you might have to do is go play independent ball and maybe get picked up again -- as long as you get your velocity back."
"Yeah, that's the thing," Mama says.
"Anyway. That's where y'all are."
"A lot of ifs," the survivor says.
WHEN ANDREWS IS asked to give public talks, they often take the form of motivational speeches. He likes, for example, to discuss the keys to success, a word that gets refracted through the lens of his accent, emerging as "sussess." And if Andrews were to rank his keys to sussess -- which of course he has -- No. 1 would be "positivity." He has even quantified the concept. As he said in his outgoing speech as president of the American Orthopaedic Society for Sports Medicine in 2010, "Positive thoughts should have a 5-to-1 ratio, and preferably a 10-to-1 ratio, over negative thoughts."
And yet Andrews also likes to say: "The only results you ever remember are your bad ones. That's what you dwell on." And as long as there are such negative outcomes, Andrews will have what he calls his worry list. "This patient, that patient -- the ones who are struggling to recover." The list haunts him. Early on Monday mornings, the list will present itself to his mind and he will wake up suddenly, the various and distressful complaints of the players on the list crowding out all other thoughts. He will spend the rest of the day trying to reach "this patient" and "that patient" on the phone.
Andrews, of course, will not reveal the names of the patients cloaked by the pronouns "this" and "that." (A high-profile example might be former Cubs pitcher Mark Prior, who had his shoulder operated on by Andrews in 2007 but who never regained top-level form.) He will not go into detail on his most challenging cases. And he positively bristles when asked: Have you ever had an outcome that you feel put your reputation in jeopardy? There will be a long pause. He will stare at the questioner.
He will say: "Not really. Not a good question. That's a negative question. So I don't answer those kinda questions."
He will then, in a way, answer the question: "You know, everybody has to go back and mend fences. If you have a patient that you didn't get the operation done quite as well as you wanted to, then you gotta really shower 'em with kindness and attention to try to get 'em through it. Because there is room for error, and they can still recover. You have to work harder with rehab and spend a lotta time with 'em, when you hadn't quite been able to fix 'em as good as you want. And maybe it's not possible to fix 'em as good as you want. Everybody's got to face failyahs during their career. You can't be scared of failyahs. Because that's what you build your whole career on, being able to get through the failyahs. If you think all you're gonna have are sussesses in medicine? Surely you are going to be disappointed."
According to a search of the available public records since Andrews began his private practice, he has been named in only one malpractice lawsuit, a 1999 case by pitcher Jack McDowell against numerous doctors and hospitals, later dismissed. Given the prolific nature of Andrews' practice, it's a rather extraordinary fact. Still, a patient struggling to recover has a tendency to put Andrews, in his words, "down in the dumps." But he has a remedy. He makes sure to ask each patient, post-op, to text him photos of the healing wounds, the improving ranges of motion. He searches now through the photos stored on his iPhone. It takes him several minutes to find the right one. When he does, he holds it up for view. It shows American decathlete Trey Hardee in the moments after he crossed the finish line in the 1,500 meters, the last event of his silver medal performance in the 2012 London Olympics. In the photo, Hardee is holding up his arm for the camera and, more specifically, for Andrews. Visible there on his forearm is the scar from the surgery the doctor performed nearly a year earlier -- a Tommy John repair, crucial for javelin tossing. Whenever Andrews is feeling low, he looks at this photo and is cheered.
ON SURGERY DAYS -- every Tuesday and Thursday, his game days -- Andrews likes to tuck the trouser legs of his aquamarine scrubs into a pair of white shin-high Wellingtons. His masked attendants await him wordlessly, the lights blazing down. Just after he enters the operating room, a nurse stands behind Andrews and helps him into his long-sleeved outer-layer smock, like the valet of a duke. Andrews has prepared for this performance by sitting silently by himself in another room, thinking, visualizing, gathering himself into the zone. Now he sits down on a stool before his patient: a 19-year-old pitching prospect drafted a year earlier by the Blue Jays. One of Andrews' surgical fellows has already dissected the forearm. As is typical, Andrews arrives to execute only the toughest, most integral portion of the procedure before he moves on to the next OR to do the same. (He will perform eight surgeries on this day.)
This is somewhere around Andrews' 4,000th Tommy John operation. (The doctor himself has lost track of the number.) The procedure involves harvesting a tendon from elsewhere in the body and using it as a graft. The graft is nestled into the remains of the damaged ligament, and the two are rolled up together, the cells of the tendon transmogrifying over time into the cells of a new UCL.
No orthopedist other than its inventor, Dr. Frank Jobe himself, is as closely aligned with the Tommy John procedure as Andrews, mostly because of sheer volume. He has become its most practiced practitioner. But he has also made two important modifications to the original Jobe method. First, he moved the funny bone. The funny bone isn't a bone at all but a nerve (called the ulnar nerve) that runs from the vertebrae of the upper spine to the pinky finger, and that turns out to be white and thick and almost shocking in its nonorganic resemblance to an iPhone cord. It also runs straight across the UCL. In all Tommy Johns, the surgeon must move this nerve out of the way so he can engage unimpeded in the main surgical action. But instead of putting it back in its natural position, Andrews essentially leaves it where it is when he's finished. Thus, according to Andrews, the repositioned nerve makes it less likely these patients will aggravate their elbows -- or have the pleasure of feeling that weird funny-bone-bonk sensation again. Second, to access the damaged elbow ligament, Andrews doesn't detach the muscle mass in the forearm that blocks it. Rather, he figured out how to get at the ligament by sticking his instruments underneath the muscle. The resulting procedure is less invasive.
In Andrews' hand now is an instrument that looks something like an awl but is actually called a curette. With it, he is boring tunnels into the bones that make up the elbow joint: the ulna and the humerus. He pushes hard with the curette -- disconcertingly hard. He leans into it. At one point, Andrews grunts. Through these tunnels he next begins to weave the graft tendon, a white strand of fibrous ribbon 16 or so centimeters long. From a distance, it could be a huge albino earthworm. Guide sutures attached to the tendon help Andrews pull its length through the tunnels. The sutures' threads gather in loose spider-webbing bunches at each end of the bone tunnels. The interior workings of the elbow are intricate. The surgery is essentially in miniature, and as Andrews sews his complex interlacings, needle holders in one hand, forceps in the other, his eyeglasses down at the tip of his nose, performing it seems akin to building boats inside bottles. As with certain highly specialized artistic or athletic acts -- philharmonic-grade first violin, Cirque du Soleil–scale acrobatics -- watching it makes one wonder how anyone could ever summon enough will across enough time to acquire the skill necessary to achieve mastery over the act.
AT THE ANDREWS Institute in Pensacola, the operating rooms have windows. Four of them, each the size of storefronts, surround a central observation area. Family members are invited here for the money portion of each surgery, or when big decisions need to be made. Like now. Into the room comes Mama. Her son -- the survivor, the repeat customer, the young Roger Clemens -- is being scoped by the master. A cranelike device holds her unconscious son's right arm into the air at about a 60-degree angle, demonstrating his impressive wingspan. By the time Mama sits down on the bar stool in front of the window, Andrews has had a sufficient look around inside. His voice booms through the intercom.
"Better take his biceps off!"
It emerges over the next few moments that what Andrews is referring to is the Curt Schilling procedure -- the still-uncommon, still-controversial operation by which the biceps brachii muscle is snipped from its natural moorings at the shoulder socket, lifted out, then reattached to the arm bone farther down. It is typically used on aging civilians suffering from wear and tear to their biceps tendon, the tissue that connects the muscle to the cartilaginous rim of the shoulder socket -- the labrum. Far less typically, it has been used on pitchers with stubborn labral tears, à la Schilling in 2008. The idea is that by relieving the labrum of the weight of the biceps muscle, the labrum will be better able to heal. All of this remains contentious, more than a little experimental. But if all else has failed -- if, as with Mama's son, the pain returns after a previous labrum surgery -- it may be the only option, other than retiring from baseball.
At least that's the current thinking of Dr. James Andrews, who is now standing in the operating room over Mama's unconscious son. He says to Mama through the intercom now: "If he wants to throw again, it would be better to take his biceps off, sew it into the bone down here. So it'll quit pullin' on all-a-this."
Mama leans in toward the window. She needs to make a decision. She puts her face closer to the intercom's speaker: "Do the biceps. Do the biceps."
ONE OF THE reasons Andrews was driven to leave the Hughston Clinic and start his own practice was that Hughston, like some medical Lear, refused to name a successor as he grew old and approached retirement age. Hughston did not like even to broach the notion that his career was coming to an end. When Andrews gave Hughston a hunting shotgun for his birthday one year, "he got mad at me!" Andrews says now with bemusement. The older physician took the gift as a kind of mischievous hint: You'll need this thing, old man, for all that quail hunting you'll be enjoying when you soon retire for good. Hughston also couldn't bring himself to cede much decision-making power to his young partners. "I think I finally realized that Dr. Hughston wudn't ready to let me go to the next level," Andrews says now. "He wanted to control everything himself -- which was his privilege. He deserved it. But sooner or later, it's sorta like when you let an eagle fly, y'know?"
In 1986 he set up his own shop 140 miles from Columbus in Birmingham, partly on the basis of the city's proximity to the major schools of the SEC. That also meant relocating his second wife, Jenelle, and his five children, ranging in age from newborn to 18. Hughston considered the move a betrayal -- "It was a devastation to him," says one former Hughston employee -- and held it against his protégé for most of the rest of his life. Andrews has never quite gotten over it either. One of his keenest regrets, he says, is never having fully reconciled with his mentor. "I guess both of us were too hardheaded to do it."
The year Andrews opened his Birmingham clinic, Hughston turned 69. Andrews himself has now surpassed that mark by two years. Long ago, he promised himself he would do all he could to avoid treating his own retirement as Hughston did: hemming, delaying, avoiding, hawing. He once told Johnson, "Don't ever let happen to me what happened to Dr. Hughston." He even went so far as to essentially bequeath his Birmingham practice in 2008 to two of his own young protégé partners: Dr. Lyle Cain and Dr. Jeff Dugas. But letting go, as Andrews has learned, is easier delayed than done. Consider the Sunday morning in January 2006, as he was looking into the mirror and tying his necktie, getting ready for church, when the infarction hit. In cardiologic circles, the event is known as "the widow maker." Mortality rates are upward of 90 percent. As it happened, though, a fortuitous series of events kept Mrs. Andrews from being made a widow -- in particular, when Andrews arrived by ambulance at the hospital that Sunday, one of the state's best heart surgeons was by chance right there in the cath lab, basically scrubbed in and ready to go. "Probably more people have walked on the moon than have survived a left main occlusion," says Dr. John Richardson Jr., a Birmingham cardiologist who two months later would perform Andrews' quadruple bypass. Now consider that not long after the heart attack, still in the ICU, Andrews was somehow able to smuggle his cellphone into that strict no-cellphone zone and was fielding patient calls until Richardson, almost forcibly, had to take the device from him. Then consider that three days after the attack, Richardson opened the door of Andrews' hospital room to find the orthopedist standing on his bed -- the Foley catheter still up inside his bladder, his split gown failing to conceal all of his pale backside -- as he examined from above the worn-out shoulder of aging Astros slugger Jeff Bagwell.
"It's hard to retire," Andrews says. "I can understand Dr. Hughston now, not wantin' to give it up."
IT IS LATE on a Friday afternoon, and Andrews is sitting in the VIP waiting room of his Birmingham clinic, inscribing copies of his recently released book, Any Given Monday, which details what he believes will be his most lasting professional legacy: his efforts to curtail overuse injuries in children who play sports. Stacks rise from a table, awaiting Andrews' Hancock, and as he works through them, he grows cryptic on the subject of his eventual withdrawal from the arena. "People always want to know: 'When you gonna retire?' Basically my thought process is you should never tell anybody when you're gon' retire. I may be planning on retirement next week, but I wouldn't tell you that." His eyes rise from the book he's signing. "I'm not, though," he says.
The consensus among his friends and colleagues is that Andrews will work right up to the bitter end. As Richardson says, "I think if he could die right there in that operating room, that's what he'd want to do." Andrews himself doesn't quite put it like that. Instead, he enjoys deflecting questions about the end of his career with a riddle. "Another thing people always ask me: 'How many operations have you done?' And the answer to that is, more than I can count, but not enough to quit."
How many would be enough to quit? "Who knows. I mean, when you start losing your technical drive and your ability in the operating room, you don't need somebody else to come tell you, 'Hey, it's time for you to quit.' That's what happens with a lotta doctors. Everybody around 'em knows it's time for them to quit, but the doctor dudn't know. But the doctor should know. Athletes have a hard time figurin' that out too. I never met an athlete who didn't want two more years."
Andrews finishes signing the last book when his phone rings. "Oh Lord, I ruined my day seein' that X-ray," he says into the phone. The person on the other end is a trainer for a major league club of perpetual hard luck. The subject of their conversation is a pitching prospect in the team's farm system who underwent Tommy John surgery more than a year ago. While the pitcher was throwing in a recent game, a piece of bone in his repaired elbow came loose. Andrews explains to the trainer that this is an exceedingly rare occurrence but that it does happen from time to time, "about 1 in 400 cases." The condition is serious. The pitcher will likely require another operation. The pitcher's career is likely at risk. Andrews leans over and rubs his forehead as if already recalibrating his worry list. "Tell him I'm just distraught about it," he says. "But I don't know what else to do, other than fix it."