Did Reggie Lewis Have to Die?

In the initial shock, the death of basketball star Reggie Lewis last week seemed a grim parable of the seductive power of professional sports -- of an athlete so devoted to a game and its rewards that he would distort medical truth in order to keep playing. It also seemed an object lesson in the relativity of medical truth, and in the perplexities -- perhaps even the questionable ethics -- of equally eminent specialists making highly public, completely contradictory diagnoses. The details that emerged in the days after Lewis died, however, suggested a medical and emotional situation that was both more complicated and more subtle than either of these views.

Lewis, 27, the top scorer and captain of the Boston Celtics, suddenly dropped to the floor while shooting baskets at a gymnasium at Brandeis University in suburban Waltham, Massachusetts; he was pronounced dead at a hospital 2 1/2hours later. His collapse had been foreshadowed three months earlier, when he passed out during an April 29 playoff game against the Charlotte Hornets. Lewis checked in to Boston's New England Baptist Hospital. A "dream team" of 12 cardiologists assembled by the Celtics' physician, Arnold Scheller, made a diagnosis of cardiomyopathy, an abnormal stretching or thickening of the heart that can cause it to beat erratically. The condition can be fatal if, during strenuous exercise, the heart pounds so fast that no blood enters its chambers at all.

The cardiologists at New England Baptist stressed that their diagnosis was only a "clinical impression," in part because Lewis had built up an "athlete's heart," which is larger than average size and can mask underlying problems. About one thing, though, the doctors were clear: Lewis should play no more basketball.

The brutal choice of giving up his career or risking death was, as Boston attorney Neil Sugarman commented last week, "an unfair choice, a choice no human being should be forced to make." To try to evade it, Lewis surreptitiously checked out of New England Baptist after three days and was taken by his wife, Donna Harris-Lewis, to seek a second opinion at Brigham and Women's Hospital, where she had once worked in the human resources department. There Lewis was examined by a team headed by Dr. Gilbert Mudge, chief of the hospital's cardiology clinic. Mudge's diagnosis, delivered in a televised press conference: no life-threatening heartbeat arrhythmia, but instead neurocardiogenic syncope, a fairly benign fainting condition caused by nerve irregularities during or after peak periods of exertion. "I am confident," said Mudge, "he can return to professional basketball without limitations."

When Mudge's verdict was proved tragically mistaken last week, a public outcry ensued. Mudge reportedly received two death threats, and was placed under 24-hour police protection. He remained incommunicado, but his wife told the Boston Globe that he was taking Lewis' death very hard. Because the conflict between his diagnosis and that of the New England Baptist group was so public, it amounted to a breach of professional etiquette; but it raised no question of malpractice. A wrong diagnosis is different from a negligent one. "The word here is causation," says Leo Boyle, a leading Boston malpractice lawyer. "If Reggie were given different advice, would he have survived? Maybe all the different advice in the world would not have saved him."

Nevertheless, after Lewis' death it emerged for the first time that he had sought a third opinion in June. He was examined by a team of four cardiologists in Los Angeles. One doctor, William Stevenson, director of clinical electrophysiology at UCLA Medical Center, did not rule out Mudge's milder theory but said he "could not arrive at a definitive diagnosis." Another team member, Dr. Nicholas Diaco, of St. John's Heart Institute in Santa Monica, California, concluded that "the first opinion was closer to the truth." They all recommended that Lewis have his heart monitored.

Which, in fact, is what Lewis was doing. Donna Harris-Lewis issued a statement last week describing a cautious plan under which her husband planned to experiment with competitive playing under Mudge's observation. Even if he resumed professional playing, he intended to ask the Celtics to provide a defibrillator (a machine that shocks arrhythmic hearts back to a regular beat) and a cardiologist at each game. "He told me he was 97% sure he'd come back," says Karl Fogel, Lewis' former coach at Northeastern University. "That led me to believe it was really fifty-fifty. An athlete normally talks about 110% when he's sure."

Did the medical profession fail Reggie Lewis? Perhaps he could have used more guidance. "Where was his primary-care doctor?" asks Michael Grodin, a professor of medical ethics at the Boston University School of Medicine and Public Health. "He needed someone with a broader perspective . . . to sort things out for him, to ask the right questions of the specialists." Still, no one knew for sure what caused Lewis to faint on that fateful April day. Not even the results of the autopsy, which are expected this week at the earliest, can be guaranteed to provide the answer. Whatever was wrong, says Diaco, Lewis was clearly sicker than anyone thought: "This could have happened to him sleeping in bed or driving a car."