Dr. James Andrews is worried. You can’t see it because his face is placid, and you can’t hear it because his voice, with a sweet Louisiana drawl, is always low and even. But he awoke in the middle of the night, fretting, which isn’t unusual before his operating days on Tuesdays and Thursdays—what he calls his “Super Bowls.” He knows he has some “real hard cases,” as he puts it, “not snap cases,” and he kept running them through his mind again and again, thinking about what he would do. He worries because he knows how much is at stake in each of them: quite possibly an athletic career, since all Andrews’s patients are serious athletes, about one third of them high schoolers (most of them Division I prospects), one third collegians and one third professionals.
Earlier that Monday morning, as he does every Monday and Wednesday on his clinic days, Andrews had flitted from one exam room to another, meeting a dozen or so patients and sizing them up for possible surgery the next day. (He doesn’t wait.) There was Kody Winner, a 14-year-old Little League pitcher from Warner Robins, Georgia. After winning a regional championship game against Alabama, Winner began to feel pain in his elbow “like somebody stabbed you in the arm” and thought he might need Tommy John surgery, named after the former major league pitcher whose ulnar collateral ligament (UCL) in his elbow was replaced after snapping. (Andrews determined Winner didn’t need the surgery; he just needed to stop pitching until the growth plates in his arm closed.) There were a Detroit Lions rookie and a young running back from the University of Georgia, both of whom had torn the anterior cruciate ligament (ACL) in their knees; a major league pitcher who had already undergone a Tommy John and was having problems with the ulnar nerve that ran over the elbow; and a former major league flamethrower who was trying to work his way back after three surgeries.
And then there were the hard cases that would keep Andrews up that night: Brian Henninger, who had come out of nowhere to finish 10th in the 1995 Masters golf tournament and who, at the age of 51, was playing on the Senior PGA circuit when the radial collateral ligament in his elbow gruesomely tore; a 19-year-old minor league pitching star who had one Tommy John surgery and then ruptured the new ligament, pulling his muscle clear off the bone during warm-ups; and Curtis Beach, a recent Duke grad and Olympic decathlete hopeful who had torn his UCL and whose surgery was complicated by the fact that he had chipped his elbow back in sixth grade and that broken spot of bone is where Andrews would normally have attached the graft. All of them had come to the Andrews Institute in Gulf Breeze, Florida for the same reason. As one of them put it, “I feel if there is one person in the whole world who could fix me, this is the guy.”
Andrews would never say that of himself. He says he’s “just an ordinary orthopedic surgeon,” and when it comes to routine surgeries like an ACL or UCL repair, he often tells agents their athletes can get treatment just as good somewhere else. Moreover, he says that “if you operate on the right athlete, a high athlete, they’ll make you look pretty good as a physician.” And as a pioneer promoter of rigorous, doctor-supervised rehabilitation for athletes, he is quick to credit physical therapists for successful outcomes.
But you have only to look at the hallway walls in his new clinic to see he isn’t your ordinary orthopedic surgeon. Those walls are covered with signed jerseys and autographed photos of a veritable hall of fame of athletes who have been Andrews’s patients: Peyton and Eli Manning, Roger Clemens, Bobby Orr, Charles Barkley, Drew Brees, Brett Favre, Bo Jackson, Jack Nicklaus, Emmitt Smith, Bruce Smith, Scottie Pippen, Albert Pujols, Robert Griffin III, even Michael Jordan, to name just a few of the thousands of professional athletes he has treated. If there is a center of the sports-medicine universe, Andrews is it.
Sitting just beyond Pensacola Bay, the Andrews Institute is 127,000 square feet with a salmon-colored brick facade in a modern Floridian style. It has 26 physicians on staff, but there is no doubt that Andrews is the draw. Ninety percent of his patients come from beyond a 200-mile radius, some from overseas; a Japanese baseball player would be arriving in a few days. Player agents call him (“I know most of their voices”), team trainers call him, parents call him, players call him. Doctors call him for advice. He is a medical rock star. Jay Vines, the administrator of the institute, has known Andrews for more than 25 years. He says that when the two of them entered the packed floor at the annual meeting of the American Academy of Orthopaedic Surgeons and the other doctors recognized Andrews, “it was like the parting of the Red Sea.”
But here’s the thing about Andrews: If you didn’t know he was the most famous sports surgeon in the world, you would never guess it by meeting him. You might have assumed that at 73 he would be formal, even stilted. You might look at the long silver hair swept back on his head or the neatly pressed beige glen-plaid jacket color-coordinated with a yellow tie and brown trousers or note the courtly bearing and think he was a remote eminence.
You would be wrong. Andrews is folksy. He has that Southern accent of light molasses, and he ends sentences with “man,” as in “We’re going to do this, man,” or “Mama,” as in “Here’s the problem, Mama,” when talking to a patient’s mother. He winks and pokes and joshes. “Yankees are sort of like hemorrhoids,” he tells a Northern visitor. “If they go back up, they’re okay. But if they go down and stay, they’re a pain in the ass.” He eats a plate of KFC during his lunch break. He pulls a battered black leather suitcase on wheels behind him, bulging with his files. He teases a Tennessee associate who tells him his university signed a quarterback also sought by Alabama by needling, “Who told you that Alabama wanted him? His mama?” He seems relaxed and affable. He makes you feel as if you have known him your entire life.
But you wonder: How did someone from the Louisiana backwoods—someone who began his practice as a physician in the flyspeck of Columbus, Georgia—become arguably the most important man in sports, the man expected to save careers and even entire franchises? Then again, once you know his story, you wonder if he would have become that important if he hadn’t grown up in the small-town South.
The first thing you ought to know about James Andrews the practitioner is that athletes don’t beat a path to Pensacola just because he’s an excellent surgeon. Yes, Andrews’s surgical skill is legendary. Doctors come from all over the world to see him operate. But there are plenty of good surgeons, even famous ones. Andrews’s gift is his bedside manner. He acts like a country doctor. He has a lot of patients, but he doesn’t rush anyone. He spends 45 minutes to an hour in the examination room. And Andrews not only spends time, he explains. He holds up the X-rays and talks through the problem and every possible option. As Kody Winner’s father says, “He spoke in human language versus doctor language.”
Perhaps even more important, Andrews not only talks, he listens. He emphasizes the importance of “reading” his patients. “Different athletes have different personalities,” he says. “You have to think the way they think.” He takes this idea so seriously that back in the 1980s, when he was in Columbus and heard the Columbus Astros were going to relocate their local Double-A farm team, for which he was team physician, he went down to the bank, secured a $40,000 loan and bought the team himself. He wound up painting the locker rooms, and some nights he and his wife even ran the concessions. But the reason he bought the team was because being around the players was the best way to learn what they were thinking, which he thought made him a better surgeon.
Learning about the players is also the reason he’s the team physician for the Washington Redskins, on whose sideline you can find him every week during the NFL season. (He takes no salary because he says it would be a conflict of interest to be paid by the team while serving the players.) “If you’re not there on the sidelines with a pro football game,” he says, “you don’t understand the lingo, you don’t understand the psychology, you don’t understand the pressures or anything.”
But the understanding goes beyond knowing how an athlete thinks or feels. Athlete after athlete on whom he has worked will tell you that what really makes Andrews so special is how invested he is in them emotionally, to the point that every time he watches Adrian Peterson get tackled after his ACL recovery, Andrews silently begs him to get up. He cares enough that he will drop everything if an athlete needs him, cares enough that he has always treated local high school athletes for free if they don’t have insurance, even though an Andrews surgery costs in the vicinity of $40,000.
And here is the second thing you ought to know about Andrews’s doctoring: The phone is as important an instrument to him as the scalpel. Everybody seems to have Andrews’s cell phone number. He gets a hundred calls a day—not just from those agents and players and trainers and fellow physicians but from former patients, such as a talented high school gymnast on whom he’d operated 20 years earlier who had written him a letter saying her elbow was bothering her again. And Andrews, clearly pained that the letter had been forwarded to him after several months and worried she might think he was ignoring her, called her persistently.
So that Monday morning, Andrews talked with decathlete Curtis Beach and told him he could have the surgery to his elbow and hope it would work out, or he could give up the decathlon and just concentrate on his best event, the 800 meters, or he could retire entirely and move on. He suggested that Beach and his mama go have a cup of coffee and think it over. He was honest. He said the surgery was no guarantee Beach would be able to throw the javelin again. The procedure was difficult, a challenge. He would usually harvest a tendon from the forearm for the repair, but because of the arm damage, he would have to harvest one from the leg instead, and that could have an effect on Beach’s sprinting. But then he added that he liked challenges, welcomed them, and told Beach what he tells nearly all his patients: He doesn’t want him to give up his dreams. Not just yet.
James Andrews knows a thing or two about broken dreams. He was born in New Orleans, where his father was stationed in the early days of World War II. When his father shipped out to Europe, his mother moved baby James and his sister to his maternal grandparents’ cotton and vegetable farm in Claiborne Parish in northern Louisiana. Andrews says from that point on he was destined to be a sports doctor. His granddaddy Nolen had wanted to be a doctor himself but had only a first-grade education, so he satisfied his ambitions by administering salves and lotions and potions and various concoctions to his farmhands and neighbors—sort of a local medicine man. Granddaddy Nolen would rock Andrews on the front porch and talk about the boy’s future. That was the medicine part.
The sports part came when Andrews’s father returned from the service and set up a dry-cleaning business in nearby Homer. There were only a few thousand inhabitants in Homer, but they all shared one obsession: sports. The social life of the town revolved around its high school teams, basically, as Andrews puts it, because people didn’t have much else to do. The Homer football team had only 18 players during Andrews’s high school years, so they couldn’t even scrimmage, and the school was so small that the players had to march in the band during halftime to fill it out. But they fought their way to the state championship game and lost to a much larger school.
Andrews’s dad was in the thick of it. He’d been playing football at Northwestern State University of Louisiana when he was drafted, ending his athletic dreams. In Homer, he channeled those dreams into coaching and rooting. Young James was a superb athlete. He played football, baseball and basketball, but he was small, 150 pounds, and (thanks to his father’s prodding) gravitated to pole-vaulting, for which he won the Louisiana state high school championship. That earned him a scholarship to Louisiana State University, where he won the SEC indoor and outdoor pole-vaulting championships and began dreaming of the Olympics.
But at the end of Andrews’s sophomore year, his father suffered a heart attack. He was convalescing when doctors discovered lung cancer that had metastasized. He died quickly. Although Andrews still had two years of college remaining, he applied to the LSU medical school, already determined to become a sports doctor. He was admitted, he says, because the school gave special dispensations to athletes and even paid for their medical education. “I was damn lucky, man,” he says. He hated giving up sports, and he brought his poles to medical school, hoping he might still compete. He never did.
That dream was gone, just as his father’s had been, and the loss still hurts. So Andrews appreciates firsthand that his practice isn’t about ligaments or muscles or bone. He knows it’s all about those dreams. Or as one of his protégés, Dr. Jeffrey Dugas, says of the job, “We manage hope.”
When Andrews, wearing blue scrubs with the pants bottoms tucked into white rubber rain boots, enters one of his four operating rooms—arrayed two to a side behind large plate-glass windows and divided by a wide viewing area—there is absolutely no question who is in command. He studies the X-ray, sits down on a stool next to the operating table and gets to work. He moves quickly, as if he has done this thousands of times before, which he has—about 45,000 times. The first operation is a routine Tommy John. He uses an arthroscope, which is a fiber-optic probe he can insert through a small incision into the elbow so he doesn’t have to open up the entire joint. He can see the inside of the elbow on a large screen above the table, which means he isn’t looking directly at where he is operating. Surgeons call it triangulation, and it is a skill, one orthopedic surgeon tells me, that you really can’t learn. You either have it or you don’t. Andrews is one of the best—a triangulation maestro. “He always said he could probably eat lunch and be talking and looking up there but never looking at the patient, and he could be doing the case perfectly,” says a surgeon who trained under Andrews.
Andrews finishes the Tommy John in under half an hour, threading the graft through a small drill hole in the bone like a deft tailor. Then the window fogs over mechanically so observers don’t see the closing. He emerges into the viewing area, takes a brief respite by collapsing on a couch and sipping a coffee, then gathers himself, gets up and heads into the next operating room for an ACL. There will be another couple of Tommy Johns and another ACL among the nine surgeries he will perform that day, and after each, he plops on the couch for 10 minutes or so, sips that coffee, then gets up for the next operation. But these are the easy ones—the prelunch ones—the ones he can practically do in his sleep. These aren’t the ones that keep him up. The hard ones are yet to come.
Back in the 1960s, when Andrews attended medical school, sports medicine wasn’t yet a specialty. All you could do was train as an orthopedist, which is what Andrews did, and hope to work on sports injuries. But during his second year of residency at Tulane, he was watching a slide show about acute knee injuries and saw a photo of Dr. Jack Hughston of Columbus, Georgia, standing in front of the Auburn University sign at the campus entrance. Hughston was Auburn’s team physician, and in that eureka moment Andrews said to himself, Man, there’s my guy. So Andrews phoned Hughston cold and asked if he could shadow him on the weekends when Hughston covered Friday-night high school games, often operating on injured players Saturday mornings, and then covered Saturday-afternoon Auburn games. By the end of the year, Andrews had convinced both Hughston and his residency chief to let him spend his third year of residency in Columbus, studying under Hughston. “It was the greatest year of my life, as far as what I learned,” Andrews says.
But Andrews didn’t want to be just a sports surgeon. He made no bones about wanting to be the very best sports surgeon. When he finished his residency, he essentially went into training, just like a promising athlete. Dragging his wife and young children behind him, he took a fellowship with Dr. Frank McCue III, who was the team doctor for the University of Virginia and who specialized in hands and upper extremities. After that, Andrews immediately took another fellowship, this time in France under Dr. Albert Trillat, who had operated on Olympic skier Jean-Claude Killy and on many of Europe’s top soccer players.
When he returned from France, Andrews went back to Columbus to practice with Hughston. They were a great team, but they weren’t exactly peas in a pod. Hughston was a fastidious man, formal to Andrews’s informality, and was brusque and unappreciative to his staff. Andrews says he learned from that too, developing his own easy manner and his graciousness to colleagues as a reaction.
Still, in his day Hughston was the closest thing there was to the James Andrews of today. Just about his entire practice was sports, especially football players. And Andrews found himself right in the middle of it—tending to those high school players on Friday nights and Saturday mornings, then flying his Cessna 182 to three or four college football games at what he calls “pissant schools” in Georgia or Alabama that nobody else cared about, schools like Troy State and Livingston and North Alabama, where he would serve as the team physician and where injured players would pile into a van and be driven three or four hours to Columbus so Andrews could operate on them, then let them convalesce in his home with his wife cooking them meals, before driving them back to school. He followed that routine for 13 years—years during which he became like a son to Hughston.
In that time his reputation began to rise. But there was a problem. Andrews came to realize that the old man saw his protégé as a threat. He decided he had to leave the practice. Hospitals all across the South had been courting him. One of them, a hospital in Birmingham, flew him and his wife into town on a private jet and offered to build him a facility of his own. Andrews was flattered but wary about competing with a friend of his who practiced in Birmingham, sports surgeon Larry Lemak. Instead, the two agreed to team up, and Lemak’s own hospital agreed to build them a new clinic, complete with a biomechanics lab and a building for a sports-research foundation Andrews wanted.
Andrews left Columbus. And Jack Hughston, who was “madder than hell” about Andrews leaving, never forgave him for it.
Now comes the hard part. Andrews sits on a stool and hunches over the table, focusing intently through his wire-rim glasses. No more arthroscope or screen. These are “open” surgeries, which require that he open up the arm to do the work—surgeries in which there is more drilling, more threading, more moving of muscle, more attachments, more everything. These are the surgeries that require Andrews to rely on his experience and intuition, because he is in uncharted territory. There is Brian Henninger’s ruptured ligament, the one pulled clean off the bone, for which Andrews has to harvest a graft and then attach it. This one takes awhile because the damage is so severe, though Andrews works quickly, his hands fairly flying. (“He has the best hands in the business,” says one of his former fellows.) And when he is done, he does what he always does after each successful surgery: He turns to the window and signals “thumbs-up” to the observers. Then the window fogs again, Andrews emerges again, collapses onto the couch again, rises again and heads into the next operating room again.
Lying there on the table is the young minor league pitcher whose ligament was torn a second time after a Tommy John and whose muscle was ripped away. Andrews isn’t sure he can save this one. It’s another long surgery—one that, with the drilling and screws, looks more like carpentry than a medical procedure. Andrews never looks up. He concentrates fully. The pitcher’s physical therapist is watching through the window, and it is tense—another dream on the line. And then, after close to an hour—an hour in which Andrews doesn’t seem to make a single wasted motion—he finally turns his head to the window and flashes the sign: thumbs-up.
One would like to say everything was thumbs-up for Andrews himself when in 1986, at the age of 44—not exactly a kid anymore—he left Columbus for Birmingham. But there was a hiccup. It turned out there wasn’t enough money to build the new hospital Andrews had been promised, which antagonized an ambitious health entrepreneur named Richard Scrushy, who had agreed to provide Andrews with physical therapists. Scrushy got so frustrated with the hospital’s foot-dragging that he finally decided to have his company, HealthSouth, buy the hospital and build Andrews his $50 million addition. The wing went up in less than a year. Andrews designed the whole thing.
And that is when the practice really started to take off. Andrews says modestly that he was “in the right place at the right time”—but it wasn’t all luck. It was that Southern charm of his and his emotional connection to the athletes. Former patients remembered Andrews fondly. A number of the baseball players Andrews had treated in the minor leagues were now major leaguers, and they not only came to Andrews, they recommended him to friends and teammates. A number of those college football players, including a few from the “pissant” schools, were now in the NFL, and they made recommendations too.
But what turned Birmingham into the Lourdes for injured athletes was what Andrews calls “signature patients”—big names who brought Andrews big recognition in the sports world and in the media. One of the first was golfer Jerry Pate, who hailed from Alabama and on whom Andrews would operate six or seven times to repair a recurrent shoulder problem. Pate spread the word. Another was Jack Nicklaus, on whose knee Andrews operated. Nicklaus sent everyone he knew with orthopedic issues to Andrews, and the two remain good friends.
The biggest, however, was a strapping young Boston pitcher who had suddenly and inexplicably lost velocity. The Red Sox team physician couldn’t figure out why. It was the pitcher’s agent, Randy Hendricks, who heard about Andrews and directed his client to Columbus, when Andrews was still working with Hughston, to have the doctor take a look. Andrews quickly determined that the pitcher had a torn labrum in his shoulder. He scoped him. Eight months later, Roger Clemens was striking out 20 batters in a game, and Andrews had decamped to Birmingham. As Andrews puts it, “Roger is the kind of guy who tells all of his buddies where to go, what to do.” Andrews says it changed his life.
After Clemens, the floodgates opened. Andrews was seeing up to 60 patients on his clinic days and performing more than 40 operations a week. He became known as a miracle worker. When Bo Jackson, the two-sport pro athlete, wrecked his hip during a Raiders game and needed a hip replacement, Andrews, who knew him from Auburn, helped fix it. (Jackson’s contract stipulated that he could circumvent the team physician and go directly to Andrews.) When young Clippers point guard Shaun Livingston suffered a multiple-ligament injury to his knee—“More like a football injury,” Andrews says—and Livingston’s career seemed over, Andrews fixed him. Perhaps the biggest testament to Andrews is that he became the team physician simultaneously for Auburn and its chief rival, Alabama, roles that to this day necessitate that he fly to Auburn games every Saturday and then, after the final gun, fly to Alabama games. He wears a diamond-studded Auburn 2013 SEC championship ring on his right ring finger.
Those were the good times, and they lasted nearly 20 years. He had a sterling reputation, a wife he loved and six children—all of whose names begin with A, for the alliteration. And to top it off, Scrushy had decided to move him to a brand-new $300 million state-of-the-art, all-digital facility. But the ride wasn’t quite over. It turned out there were still a few more speed bumps ahead.
It is Thursday and Andrews is off to San Antonio for a graduation ceremony, but he always seems to be flying off somewhere in his Citation III, be it to a game or a conference. One season he toted up all the football games he and his wife had attended; it came to 55. He works every week of the year except Christmas, and he spends much of that week watching football games on TV and wincing when a player goes down, knowing he might be called to action.
Andrews isn’t working tirelessly because he needs the money. His wealth has been estimated at $14 million. He can’t rest, because when you dig far enough, you find that folksy demeanor hides a deep competitive streak. Andrews once raced yachts with great success, and he even headed an America’s Cup syndicate. Medicine, though, is where he has really channeled the competitiveness that he sacrificed when he gave up pole-vaulting—not competition against other doctors but competition against those dream-threatening injuries. He won’t say it, of course, but a man who has been around athletes all his life is on a mission. He is out to be the Michael Jordan or the Peyton Manning or the Jack Nicklaus of sports medicine. He isn’t content to do surgeries. He wants to change the entire face of sports medicine so that no one ever has to surrender his or her dreams again.
Part of that effort is the research Andrews has done and part is a fellows program he initiated with Hughston that now has 350 alumni, many of them team physicians. But the part that seems nearest to his heart is the effort to prevent youth injuries, which he says have increased tenfold since 2000. He calls this his passion. Andrews is adamant that the reason there are so many Tommy John surgeries today—more than 40 in the major and minor leagues this year—is that kids like Kody Winner begin throwing too many pitches generally and too many breaking pitches specifically at too young an age, and it catches up with them. So he conducts research that focuses on children and provides guidelines on limits that he thinks should be placed on children’s sports, and he has written a book about how to prevent youth sports injuries. He calls this his legacy. In effect, he would like to put himself out of business.
But when it comes to legacies right now, Andrews’s most visible one is the imposing institute that bears his name. It is not something he sought. It just happened. He was waiting for his new hospital to be finished when Scrushy suddenly came under federal investigation in 2003 for inflating his company’s profits. HealthSouth was over. Eventually another hospital moved into the breach, but everything was scaled back, and Scrushy’s $300 million facility sat unfinished—an empty shell. For Andrews, it was crushing.
And then in January 2006, after flying home from treating an injured Redskins player after a playoff game, treatment that didn’t end until the wee hours of the morning, Andrews was taking a shower when he began gasping for breath. He was rushed to the hospital with a massive heart attack—an attack that almost surely would have been fatal had there not been, by sheer coincidence, a cardiac surgical team at the hospital that had just finished working on another patient.
The attack should have been a sign that Andrews may not be as easygoing as he appears, and it should have been a warning for him to slow down. He didn’t, but the heart attack did get him to think about succession, which prompted him to tap two of his favorite fellows to be his heirs. “Better than I was,” he says. And that put him at loggerheads with his partner, Larry Lemak, who had intended to turn the practice over to his son. The divide was unbridgeable. So in 2006 Andrews reluctantly underwent his second medical divorce.
By that time a physical therapist named Chad Gilliland, who had worked with Andrews in Birmingham, had resettled in Pensacola and was advising a hospital group named Baptist Health Care, which wanted to expand its orthopedic services. Baptist Health Care asked Gilliland to invite Andrews to Florida to recommend doctors it might hire. Gilliland and Andrews were in the physicians’ lounge, talking about candidates when Andrews blurted, “What about me?”
And so began Andrews’s newest phase. He sat down with a yellow pad and wrote a wish list of all the things he desired in a hospital: not only the operating rooms and clinic, but also a biomechanics lab, a rehab center and a separate performance-enhancement wing where athletes could go simply to improve themselves. Baptist Health Care committed $50 million to build the new facility. It opened in January 2007.
Andrews said he intended to stay in Birmingham and visit Pensacola only once a week, but the one-day-a-week arrangement lasted just a few years. He now spends four days a week in Pensacola and one in Birmingham: Friday. By his own admission, he hasn’t lost any enthusiasm or willingness to learn. He says the next big advance in orthopedics will be biologics—stem cells, tissue engineering, DNA therapies—and there are another 3.5 acres on the Andrews Institute campus, on which he hopes to build a new lab. “Somebody asked me if I feel old,” he says. “I said, ‘No, the only time I feel old is when I look in the mirror. So I stopped looking in the damn mirror.’ ”
Andrews has been operating since seven in the morning, and now he comes to Curtis Beach, the decathlete with the cracked elbow and torn ligament. It’s another open surgery and another grueling one. If the minor league pitcher’s surgery was like carpentry, this one is more like sculpting. Andrews chisels away at the elbow until a chunk of bone the size of a half-dollar falls off. He grabs it with a forceps and plunks it into a silver tray, then forages back into the elbow, pulling aside the ulnar nerve that runs like a thin rubber tube all the way down the arm. Now he has to find a place to attach the graft. He finds it, drills the hole and carefully threads the ligament. The room is absolutely silent. He lays the ulnar nerve over the muscle and begins to stitch up, lightning fast, almost quicker than the eye can follow.
Then he turns to the observation window, gives his signal, and the glass fogs over.