'There's a core ethical dilemma': How ringside doctors in boxing and MMA approach a difficult job in brutal sports

Yahoo

3 days ago

Margaret Goodman was a young neurologist just beginning to try out the role of ringside physician in her home state of Nevada when she got some advice from Donald 'Doc' Romeo, a man who by then estimated he'd worked somewhere in the neighborhood of 10,000 fights, from Muhammad Ali's destruction of Floyd Patterson to the 'eight minutes of fury' between Marvin Hagler and Thomas Hearns.
'First thing he told me was, 'don't go in the ring,'' Goodman said. 'I was like, what? I'm the ringside physician. If a fighter's hurt, that's what I'm here for. I've got to go in the ring. [Romeo] shook his head and said, 'no matter what happens, don't go in the ring.''
It took Goodman a while to understand what he was telling her. She didn't get it at first. But after she went from working amateur Golden Gloves events to major pro fights in Las Vegas, the epicenter of boxing in America, it started to become clear. Once a doctor steps in the ring, she's essentially on stage, in the spotlight, subject to all kinds of scrutiny.
This is also why Goodman's partner, a fellow ringside physician named Edwin 'Flip' Homansky (the man called in to examine the bite marks on Evander Holyfield's ear that night against Mike Tyson in 1997), asked her if she was sure she'd be able to handle the pressure of this kind of work.
'I thought, pressure? I'm a neurologist. I deal with all kinds of really serious issues. But he was right,' Goodman said. 'Especially somewhere like Las Vegas, where everything is on TV, it is a lot of pressure. It's not just the crowds, either. It's a lot of other people expressing opinions on your work. Commentators, fighters, promoters, other ring doctors. Pressure from the [state athletic] commission. Pressure from the cornermen. You tell yourself none of that is important — and it isn't, because you're still going to do your job and do the right thing — but you realize there's a lot riding on your decisions.'
For starters, there's the obvious. What if you recommended that the fight be allowed to continue, only for one fighter to suffer serious or even life-threatening injuries? What if you put a fighter in the ring who was medically unfit to be there in the first place? What if you failed to recognize the seriousness of a cut, and it ended up costing a fighter his eye?
But what Goodman found, as she got deeper into the work and got to know more fighters and trainers on a personal level, was that she also had people's careers in her hands at times. And since she was one of the very few female doctors in this space, not to mention one with bright red hair, which made her instantly recognizable on TV broadcasts, people tended to remember every call she made — and they weren't hesitant about bringing them up to her later.
'If a fighter loses or gets stopped in a fight, it can really change what happens to them and where their careers go from there,' Goodman said. 'That's especially true in boxing, though also in MMA to some extent. There are implications, so you have to be aware of that. Bottom line, if someone's in danger, you get them out of there. But you do have to be aware of what that's going to mean for them.'
Most fight fans never think about the doctors at ring or cageside unless something bad happens. Maybe the attending physician suggests a fight be stopped due to a cut that really isn't so bad. (Doctors have the power to stop fights on their own in some states, but in others can only recommend that the referee do so, which is a suggestion referees almost always follow.) Even worse, maybe the doctor fails to intervene on time, leaving a fighter to suffer serious injury or death long after the fight should have been stopped.
It can be a tricky tightrope to walk for people who have dedicated so much of their lives to healing and helping people. In fight sports, they find themselves a party to something that has as its stated goal the inflicting of damage on one human being at the hands of another.
'This is the core ethical dilemma of every ringside doctor,' said Kirlos Haroun, an emergency room physician at Johns Hopkins Hospital in Baltimore, who also works as a ringside physician for the Maryland State Athletic Commission. 'Some doctors think about it a lot, and others don't. I've been challenged by some of my mentors who say, are you not consenting to long-term brain damage by being ringside? And I don't have a perfect answer to this. I think, without it being an excuse, this is something that society has accepted. We are allowing people to do this to make money. At a minimum, ringside doctors can be a pathway towards making it as healthy as possible.'
As a longtime MMA fan, Haroun admitted that it's far less fun to watch fights as a ringside physician than as a regular observer.
'As a fan, I'm rooting for a knockout,' Haroun said. 'When I'm a ringside doctor, I'm praying for a decision because I do not want to walk in there.'
But on those occasions when he is called upon to make a decision about which fights can continue, Haroun said, it requires a doctor to tap into a different kind of thinking. Because, quite frankly, none of this is good for the human body or brain. That's a given. But what a doctor is being asked to decide is whether it's suddenly become unreasonably dangerous as opposed to acceptably risky. That can be a strange head space for a physician to occupy.
'It's mitigation,' Haroun said. 'It's not removing risk, because you can't. The core idea here is to cause traumatic brain injury and knock the other person out. Personally, I think I'm usually able to disconnect it. But every once in a while I'm sitting next to a friend watching fights and they ask me, 'are you OK with this?' I do have these moments of ethical dilemma, and it's hard. It's hard.'
Manjit Gosal is not only the medical director for the British Columbia Athletic Commission, he's also a family practice doctor and lifelong martial arts practitioner. This, he said, gives him a certain perspective on the work, since he knows what it feels like to push through pain in competition or insist he's fine when he knows he's not. He also knows what it feels like to suffer a concussion from a well-placed strike.
'I think it was one of my patients who first told me there were MMA events going down on one of the reserves here, back before it was legal,' Gosal said. 'So I thought, well I have to go help out and keep an eye on these guys. … I remember I got a call from the B.C. Athletic Commission — this is, again, way back before MMA was legal here — and they wanted to slap me on the wrist for it. I said, well, I'm a physician. I can help out any person who's in need, anywhere necessary. Then about a year and a half later, as MMA was getting legalized here, they called me back and said, 'we've heard you do these kinds of events. Would you like to work for us?''
Gosal said he's been present for every UFC event in Vancouver since the promotion first starting bringing shows to British Columbia in 2010. He's also worked multiple regional events over the years, watching the sport grow and change in the process. In that time he's had to stop fights over the protests of fighters and their corners.
'Initially, maybe they think they're fine to continue, they can push through this,' Gosal said. 'But I've never had a fighter afterwards say to me, 'how dare you stop that fight.' They've always acted respectfully and said, 'thanks for looking out for me, doc.' I tell them what I'm there to do is protect them, so they can still walk down the stairs and bring a fork to their mouth in their later years. And they understand that.'
Many people think cuts come with the toughest judgment calls for a doctor, Gosal said, but it's generally not the case. Most facial lacerations produce more blood than genuine cause for concern. And those that are worth stopping a fight over tend to announce themselves with a certain obvious clarity.
'You're asking yourself, is it in a high-risk area? Is it blocking the vision?' Gosal said. 'If it is, that's pretty simple. It doesn't matter how big the fight is, if I can see bone and it's in an area where the next blow could damage the nerve, over the eye for example and affect this person's vision for the rest of his life, then the fight's got to stop.'
The really tricky ones, in Gosal's experience, are the eye pokes that continue to plague MMA, with its open-fingered gloves. Those often come with controversy, as fans argue over what's inadvertent and what might be purposeful, as well as which fighters might be making it out to be more severe than it is in hopes of a point deduction or even a disqualification victory.
A lot is left to interpretation in these instances. Sometimes a fighter's vision can clear quickly after an eye poke. Other times it might be impaired for hours or even days. The ringside doctor has a limited time in which to conduct an examination in the cage and make a decision.
'If it's accidental or whether it's deliberate, that doesn't really matter,' Gosal said. 'But there's two aspects to it. Can the athlete see or not? You can assess that, but it's a very short exam that you do when you're in there assessing somebody. You want to be very direct, very quick and get an answer. … But it's going to happen from time to time where those can be used for a way of getting out of a fight, which is fine too. If a fighter wants out, you want to stop it. But I'm sure the fighters sometimes make some calculations on that. Is it the first round? Is it the last round? Am I ahead? That's part of the game as well.'
One thing Goodman learned from all her years working boxing and MMA events is that deception is always part of the fight game, and in many different ways. Fighters are constantly trying to trick each other, but also referees and doctors and maybe even their own coaches. That includes not just what happens in the ring or cage, but what's happened in the weeks or months before.
'One of the hardest parts is that you don't know where everyone's coming from,' Goodman said. 'You don't know what's happened in training, if they got hurt in the gym. To really do this job well, I think you need to do as much preparatory work as you can to know who you're dealing with, what might have happened to them in other fights in other jurisdictions.'
This, Goodman said, is one reason why it's important for athletic commissions to share information with one another. Without a shared database of fights and fighters, it's left to individual doctors to know who might be coming off a knockout loss too soon, or who's had eye trouble in the past that could become an issue again in future fights, for example.
'But no matter what you think you know,' Goodman said, 'one thing about this sport is you can always have something happen that's never happened before. Then you have to make a decision.'