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Thursday, September 12, 2002
Updated: November 4, 10:44 AM ET
At what price a player's pain?

By Tom Farrey
ESPN.com

Long before a jury issued the largest medical malpractice award ever against a NFL team doctor, before jobs were lost and reputations tattered, before E. coli and staph infections were found in the rotting leg wound of a veteran lineman, before the integrity of Jacksonville Jaguars coach Tom Coughlin was called into question, before the most successful expansion team in league history began its fall back to earth, Jeff Novak stretched out on a trainer's table under a stadium in Charlotte, his fists clenched in pain and anger.

Jeff Novak
Jeff Novak dreamed of following in his father's footsteps and becoming an NFL player. 'You gotta pay the price,' his father told him.
The offensive lineman had just played three quarters of an early August exhibition game against the Carolina Panthers, to the surprise of his teammates. Only one day before, Novak had woken up from a nap at the team hotel in a pool of blood that ran from hip to ankle. His right shin was leaking, again, after he had been cleared to play.

Just as he had been cleared to practice shortly after a hematoma first appeared two weeks earlier.

Just as he had been cleared to practice after the hematoma grew into a massive leg bruise.

Just as he had been cleared to practice after the team doctor noticed Novak could barely walk anymore and decided to cut open the bruise in order to squeeze the thick, coagulated blood out of a one-inch crevice -- like grape jelly from a condiment dispenser.

So, given the go-ahead, Jeff Novak pushed his 290 pounds all over an Ericsson Stadium field made muddy by a driving rain. And when his job was done that wet, sloppy evening, he picked the last of the grass blades from the hole in his bloated shin, shed a pair of bloody socks made pink by the rain, and once again turned to Dr. Stephen Lucie for answers.

Novak plopped his right leg on the trainer's table. With the efficiency of a chimney sweep, Lucie plunged a Q-tip into the soggy wound that had been left open, intentionally, to heal naturally. The raw, burning pain made Novak roar and plead for relief, a more gentle touch. A teammate or two gathered round, in morbid fascination.

Novak wanted to clock the doc. He really did. Especially when Lucie smiled in an amused way that, to Novak, suggested he ought to just toughen up and deal with it. Instead, thick-necked defensive tackle John Jurkovic, watching nearby, laid into Lucie with profanity and invective.

"You think this is funny?" Jurkovic barked at Lucie. "He's telling you this is something that's bothering him!"

Lucie had reason to be taken aback.

He was just doing Vince Lombardi's work.

'That is how you deal with it -- you mask the pain'
Jeff Novak
Jaguars doctor Stephen Lucie operated on Jeff Novak's leg in the training room with his watch on and his hair unbound, as this photo, taken by a team trainer, shows. Novak used the photo as evidence that he was operated on in a non-sterile environment.
Do no harm.

It's the distillation of an oath that all prospective doctors once pledged to honor. Three time-tested words that, in ordinary circumstances, encourage the practice of medicine in a conservative manner. But harm is part of the spectacle in the NFL, where the average player absorbs 15,000 hits each season. Scratch from the game every player who is hurting on Sunday morning, and you might as well scratch every game that afternoon.

"The most disturbing thing I ever heard Dr. Lucie say was 'If you were a normal person, we might do things a little differently, but you're a football player,' " Jurkovic said.

Lucie insists players got the same treatment as regular patients.

His peers say that would be hard to do with any team.

"Medicine in the NFL is different than medicine in the real world," said Pierce Scranton, a former Seattle Seahawks doctor and president of the NFL Physicians Society in 1997, the year before Novak was injured. In the real world, "a patient who falls and hurts his hip probably would be out of work for three months with a hip pointer. In the NFL, that player would be back on the field the next week. He would be shot up with (a painkiller) because, in the eyes of the physician and the player, that is how you deal with it -- you mask the pain.

"It's up to the doctor to make sure they don't cross the line."

But where exactly does pain end and injury begin? It's one of those impossible questions, like: When is a man drunk? Is it when he can't plug the key into the car door anymore? Or merely when he starts to get louder, looser, at the party? Does intoxication occur after one drink, or five, or 10? Society knows the difficulty of this question, but also its importance, so it draws arbitrary lines that must be respected -- .08, say, in the blood-alcohol blow box, even if those numbers suggest varying levels of driver competence for a 105-pound nurse and a 275-pound plumber.

The NFL has never worked hard to make distinctions between pain and injury, to a large degree deferring to the wisdom of the late Lombardi, whose thoughts on healing were both effective and convenient. In Lombardi's view, pain exists only in the mind. Playing with it, he said, was the stuff of champions.

Jeff Novak, who was just out of diapers when the legendary coach died, needs no lecture on the Lombardi ethic. His father was a Lombardi man. In fact, his Green Bay Packers liked Jack Novak so much they drafted him in 1961 out of the University of Miami, where he played two ways on a bad knee and roomed with Jim Otto, the mangled future Raider. Another knee injury with the Packers helped bring Jack Novak's NFL career to a quick close, during training camp his rookie season, but his time under Lombardi was memorable. It would help him raise a son.

"It's always been one of my father's phrases from Lombardi, 'You gotta pay the price,' " Jeff Novak said.

Novak heard those words when he was small and skinny, hardly the best player on his youth football teams in Houston. He heard them when he couldn't make his high school team, when the best chance he could get at playing college ball was walking on at Southwest Texas State. He remembered them when fingers were broken, hamstrings were pulled, shoulders were cut on and shot up, toe nails had to be removed, and an ankle rolled up so hard that a ligament ripped bone from the side of his heel.

Jeff Novak
As a youth football player, Jeff Novak took the mantra of Vince Lombardi to heart.
His mastery of the NFL mind set began earlier than most kids. When he was 10, he wrote a letter to himself, a manifesto he would tack up on the wall of his room in Houston.

I now unchain my competitive toughness and feel the fierce, driving hunger to advance (and) compel me to aggressive workout intensity. I welcome the challenge to greater effort, realizing that I can rise up to meet ANY training challenge because I THINK power, FEEL power and DECLARE power. The strength and power of my desire drives me continually further past the pain, toward massive size and rugged, surging POWER!

A quarter century later in a Jacksonville courtroom, where Lucie had been sued by Novak, one of Lucie's lawyers would ask former Jaguars receiver Keenan McCardell -- black, urban and stylish -- to describe Novak -- white, country and subdued -- as a teammate.

"A guy you would go to war with, as we call it on the football field," McCardell, a witness for Novak, said on the stand.

Novak, as a player, had stopped listening to his body, or at least its distress signs. Once in the NFL, he had handed over total control of his body's limitations to the team doctors, first with the Miami Dolphins, then with the New York Giants, then with the Jaguars when they joined the league in 1995. As with many NFL players, his rule was that as long as the doc cleared him to play, he was going to suit up and knock heads.

Sure it hurt. Sure it seemed odd. Novak screamed like hell that day Lucie cut into his bruise with a scalpel and milked the bad blood from his leg, right there in the non-sterile environment of the training room beneath Alltel Stadium. But it seemed of no great consequence. For a while.

"Yeah, it turned my stomach," Novak said, sitting on a barstool in the living room of his hillside ranch outside Austin, Texas. "But you see so many things playing in the league. You see compound fractures and guys getting shot up and lots of nasty stuff, like dislocated arms and shoulders and elbows and fingers. So it was kind of par for the course. And so when you see something that's unreasonable, there's really not a red flag 'cause you see so much of it."

'Go out there and do what you can do'
Tom Coughlin
Tom Coughlin's fiery temperament keeps referees on their toes and, players said, the Jaguars out of the trainer's room. 'I'm just like any other football coach,' he said.
Coughlin, Lombardi's kind of coach, calls it the Concentration Line. When players pass through this imaginary threshold on their way out to the field, they are expected by Coughlin, the Jaguars' coach since the club's inception in 1995, to set aside all matters not directly related to playing football -- money, family, aches, pains, anything that could distract from the goal of total, full-body commitment to winning.

McCardell, in an interview with ESPN.com, said Lucie was no match for the passion and military-style machismo of Coughlin.

"He's the doctor," said McCardell, whose Pro Bowl career with the Jaguars ended this year when he signed as a free agent with Tampa Bay. "He's supposed to say, 'Hey, he can't practice.' But I think Tom would kind of push him a bit to get that player out there."

Coughlin bristles at this observation, allowing only that he wasn't happy to learn of player injuries.

"Let's face it, I'm a football coach," he said firmly, his crystalline blue eyes offering no sense of uncertainty. "I'm just like any other football coach. I want players to be on the field. You're darn right I want them out of the training room and on the field. But unreasonably? No. And the medical people always have the last word."

McCardell wasn't the only player not to see it that way, though. Jurkovic, who was with the Jaguars from 1996 through '98, said the team's trainers often would reverse medical decisions after Lucie examined players earlier in the day.

"There were a number of times when I had Dr. Lucie tell me I wasn't going to practice," Jurkovic said. "Then he left the facility and I was being told, 'Go out there and do what you can do.' " It was a commonly used term that left players scratching their heads. "Ultimately it meant, 'Put your pads on and get out there to practice and quit your bitching.' "

Said McCardell: "You had to stand strong. If you didn't stand strong, they would just whither you away and get you out there."

But Novak was in no position to alienate Coughlin. Although valuable because he could play any position on the offensive line, Novak was a career backup. Not a star. In fact, in the June mini-camp before the training camp that Novak played with his open wound, Tony Boselli, the team's franchise tackle, stood on the sidelines recovering from off-season ankle surgery. The contrast in medical treatment led Novak and other players to joke that Boselli had a "no-sweat clause" in his contract. Boselli found it odd, too. "Just months before I was told I couldn't even sweat because I had a pin hole or little holes from the surgery and now Jeff had a quarter-sized hole and was out there practicing," Boselli said in a deposition this May.

Evolution of a Bruise
A series of photos, acquired by ESPN.com, document the progression of Jeff Novak's shin injury in 1998.

Early August:
 

 
A hematoma grows into full leg bruise, from below the knee to above the ankle, as Novak continues to practice with the injury. The swelling prompts the team doctor to cut open the bruise and milk out the coagulated blood.

Mid-August:
 

 
After several bleeding episodes with the wound left open to heal naturally, the hole in Novak's shin gets stapled shut in emergency surgery after a preseason game.

Early September:
 

 
Black dots show up around the wound. Tests determine that Novak has E-coli and staph infections.

November:
 

 
The wound is healing but still shows a rash, as Novak is activated to play again.

Yeah, Boselli conceded, "I was probably going to be given a little more leeway" to stay out of practice.

Novak's swollen leg got so weak during training camp that he was falling down easily, creating piles, endangering the knees of other players. Assistant trainer Robbi Peterson couldn't stand to see any more. Without the authority to do so, he yanked Novak off the field in the middle of practice one day. "I took it upon myself to pull him out because I thought he would continue to hurt himself," Peterson said later in court.

For that, Peterson told the jury, he was reprimanded by head trainer Mike Ryan.

"Anybody else?" asked Pat Dekle, Novak's attorney.

"Tom Coughlin," Peterson answered.

Ryan, through the club, declined to be interviewed for this story. Coughlin told ESPN.com that he knows nothing about the alleged reprimand of Peterson, who is no longer with the club and out of the NFL. Peterson did not return phone calls requesting further comment.

But as court files and interviews show, Novak's situation that summer was quickly becoming precisely the kind of distraction Coughlin loathed. Boselli said when he started "questioning how Jeff was taken care of," he, too, was reprimanded by Ryan. Defensive tackle Don Davey was unnerved enough to express doubts to Coughlin about the treatment of his knee, which would never fully recover from surgery.

Players increasingly began seeking second opinions from outside doctors, to the displeasure of Coughlin. "He would ask, 'Why? We've got good doctors here,' " said McCardell, who at the time was the team's NFL Players Association representative.

But visual evidence is the most compelling. Unlike the joint and muscle injuries that football players often endure, Novak's wound was on display for all in the locker room to observe. And the quality of his care was made more graphic each day after practice when Peterson would delicately replace the blood-soaked gauze from the crevasse dug out above Novak's tibia. For weeks, players stared at the leg like they would some car accident.

"I just remember how nasty it looked," Boselli said.

Like "rotting meat," said former center Michael Cheever.

"Reeked with odor," McCardell said.

Then little black dots began to appear.

'I've seen gunshot (wounds) that didn't bleed this bad!'
The emotional crescendo came on a bus ride from Ericsson Stadium to a Charlotte airport after the exhibition game against the Panthers. Novak's teammates noticed a pool of red liquid beneath the pair of cowboy boots he was wearing, a gift from Dan Marino when they played together in Miami. His leg was leaking again, this time in a big way.

Novak poured the blood from the boot and hopped off the bus. Then on the airport tarmac, another pool started to form as offensive tackle Brian DeMarco frantically called for the doctors.

"DeMarco, who is an Italian kid from up north, he's hollering, 'I've seen gunshot (wounds) that didn't bleed this bad! Somebody get over here!' " Novak said.

For the first time, Novak said, he saw in Lucie's eyes the sense that all was not right. That maybe this bruise was of serious concern. When the plane landed in Jacksonville, Lucie rushed Novak by ambulance to Baptist Medical Center for emergency surgery at 4 in the morning. There, his wound was finally stapled shut.

But Novak's trust in Lucie was expiring. The line between pain and injury, once indistinguishable, was becoming clearer to Novak, and he believed Lucie had violated it.

When little black dots later showed up around the wound, he went to a doctor not connected to the Jaguars and begged not to be treated like an athlete trying to get back on the field.

"Hey, I'm not a Jacksonville Jaguar," Novak told the doctor, a local plastic surgeon. "I'm a guy off the street. What are you going to do to fix my leg?"

The plastic surgeon called the stadium three days later. Cultures from the wound showed evidence of E. coli and staph infections, according to documents used in the court case.

Novak was sent home, taken off the game day roster, and given time to heal. It was the beginning of the end of the wound -- but also of Novak's NFL career. Novak was reactivated briefly in November but then was cut after the season by the Jaguars, truncating a career that quarterback Mark Brunell contended would have lasted another three to five years. Novak said he never regained total strength in his leg.

Hardy Nickerson
Hardy Nickerson once was a Pro Bowl linebacker.
The Jaguars' doctors never regained the total confidence of all the players, either. Two years later, in 2000, a survey conducted by the NFL Players Association showed just 63 percent of Jaguars players rated their medical staff as "good" or better. Only five teams had lower ratings of their doctors. That was the year after Novak filed his lawsuit. It was also the year linebacker Hardy Nickerson was lost for the season when Lucie performed surgery that Nickerson said he believed would allow him to return within a few weeks. The more extensive surgery turned out to be successful, but Nickerson's anger toward Lucie at the time may have only further undermined the doctor's locker-room reputation.

The Jaguars, who came into the year with Super Bowl aspirations, went 7-9, their first losing season since the expansion year of 1995.

Lucie then resigned. He says now he wanted to spend more time with family.

'They saw it, smelled it ... and haven't forgotten about it'
In July, a Jacksonville jury found that Lucie had committed medical malpractice and awarded Novak $4.35 million, plus another $1 million for his wife Kim for her loss of his services and comfort. It was easily the largest jury award ever against an NFL doctor -- and a lot of money for a player who had never made more than $600,000 in any of his five seasons in the league.

I think it's probably the toughest environment a doctor can have in the whole world. You've got players who want to be on the field. You've got coaches that want them on the field. You've got physicians who are tied up in wanting that team to win as well, and wanting to make the coach happy so he can be there again next year as the team doctor of the Jacksonville Jaguars.
Jeff Novak
More than a week later, the U.S. Circuit Court judge presiding over the case threw out the verdict. In a post-trial order, Judge Frederick Tygart ruled that he saw no evidence of negligence by Lucie, offering no elaboration on his thinking. Presumably, his decision was influenced by the testimony by two sports medicine doctors that Lucie called as expert witnesses, who stated, in contrast to the opinion of Novak's doctors, that Lucie's decision to perform surgery underneath Alltel Stadium was not improper.

The wildly divergent opinions of judge and jury underscore the ethical uncertainty of treating pro athletes.

"I think it's probably the toughest environment a doctor can have in the whole world," Novak said. "You've got players who want to be on the field. You've got coaches that want them on the field. You've got physicians who are tied up in wanting that team to win as well, and wanting to make the coach happy so he can be there again next year as the team doctor of the Jacksonville Jaguars."

Lucie blames no one for his predicament. Not Coughlin, whom he said did not force him to clear injured players for games. Not Jaguars owner Wayne Weaver, who naturally would expect some return on his investment in players. Not the business interests of his firm, Jacksonville Orthopaedics, which since 1995 has used its designation as the official team doctors to help grow its business three-fold, to 123,000 patients a year.

"Each step of the way you're in the trenches," he said. "You have to make decisions, and as I look back, they were good decisions."

Lucie considers himself a vindicated man, but he doesn't look the part. He has the tired visage of a doctor who thought he was providing a service, and found out he was playing with fire. He's ready for the headlines to go away, for people to stop questioning his judgment based on his care of that oddest of clients, an NFL player. In recent weeks, the case was resolved in a manner that will avoid an appeal and another ugly trial; neither side is talking about any settlement that may have been reached, citing confidentiality restrictions.

"It's been very hard on me and my family," he said.

As for Novak's family, a couple members are now flag football fans. Novak wouldn't mind in the least if one day his sons, Cade, 9, and Cole, 7, try to make a career in the NFL, just like their dad and their dad's dad. Novak says he loves the lessons that the game offers, about accountability, responsibility. But, he adds, his boys also have seen what can happen when the Hippocratic Oath gets recast by the ghost of Vince Lombardi.

"They saw it, smelled it, at age 5 or 6," Novak said of his wound, "and haven't forgotten about it."

For now, they'll let other kids tackle that game.

Tom Farrey is a senior writer with ESPN.com. He can be reached at tom.farrey@espn3.com.