When I moved from New York City to Dallas in 2004, I needed to make many personal adjustments. Surprisingly, one of the most prominent shifts was related to – baseball.
In New York, baseball was essential to the city’s identity. Whether someone rooted for the Yankees or Mets (or Brooklyn Dodgers), baseball was tied inextricably with the legends of the metropolis. Baseball represented a mechanism of integrating hundreds of immigrant cultures, which could find a common bond in their love of the game. It is not surprising that Jackie Robinson broke baseball’s color line in Brooklyn, and that in 1957, New York City had three baseball teams. Half of New York hates the Yankees because of their appalling sense of privilege, a theme that mirrors the economic inequalities that have permeated New York for more than 200 years.
But in Dallas, football was king. If your child went to high school in Texas, the weekly football game was your main social event, and excellence on the field was a player’s ticket to personal greatness. The Cowboys had long been known as “America’s team,” and their dominance of football gave Dallas national prominence at a time when the city was still in its youth. If you didn’t like football, you could fall in love with the Mavericks basketball team, and many did. But if you loved baseball, you were all alone. The Texas Rangers’ home field was just outside of Dallas, but hardly anyone paid attention. When my son and I decided to attend a game 15 minutes before its start, we could always buy premium tickets at a discount price without ever waiting in line.
The only time when the Rangers played to a packed house was when the Yankees were the visiting team. Thousands of Dallas residents with roots in New York City flooded the stadium to see their dream team play. The crowd erupted with approval when the Yankees got a hit, but remained silent when the Rangers did well – even though the game was being played in Texas. In 2010, by some divine intervention, the Texas Rangers defeated the New York Yankees to win their first American League pennant, and suddenly, Dallas fell in love with baseball. But it didn’t last very long.
In 2004, my 9-year-old son was a southpaw pitcher, who joined a team primarily composed of his classmates. After a year, the head coach (an attorney whose son played for the team) found obligations to his legal practice made it impossible to devote the time that the team needed. The team needed two coaches, typically to be drawn from the parents of the players. Most of the fathers declined, knowing the time commitment would be extraordinary. But two parents raised their hand and volunteered to lead the team. I took the head coach position, and another became the assistant coach. And amazingly, we were the only physicians in the group. I was a department chair at the University of Texas Southwestern, and the other coach was the leading vascular surgeon in Dallas. Both of us adored baseball, but neither of us had played the game in any serious manner. To complicate matters further, both of us were in our mid-50s, ill-suited for the rigors of countless baseball practices.
What would motivate two overcommitted out-of-shape physicians to volunteer to lead a baseball team? Is there some undiscovered overlap between medicine and baseball?
It is not difficult to consider the possibilities of overlap. Baseball and medicine are highly cognitive activities that require rapid multilevel strategic problem-solving, often with insufficient data. In baseball, the focus is on the interplay between the pitcher and the batter, and medicine revolves around the interplay of the physician and patient. For much of the time, the rest of the team might appear to be doing very little, whether on offense or defense. But every player must show up at the plate when it is their turn to bat, and everyone’s turn at bat is important. Both baseball and medicine are grounded in powerful durable traditions that dominate both fields. The goal in baseball is to defeat the other team; the goal in medicine is to defeat death.
But these meager parallelisms pale in comparison to the real reason why baseball and medicine are emotionally intertwined. Among nearly all sports teams, there is a clock that limits the duration of play and limits the possibilities of comeback miracles. If one team has a 20-point lead in football or basketball with a minute to play, it is mathematically impossible for the trailing team to rally to victory. But in baseball, it is possible to be 10 runs behind in the ninth inning and still win. It is not likely, but it is possible. In 1952, the Cubs trailed the Reds 8-2 with no one on base and with two outs in the top of the ninth. But the next nine Cubs batters reached base safely, allowing the team to go up 9-8 and ultimately win the game.
We see miraculous comebacks in medicine all the time. A patient with overwhelming sepsis and end-organ hypoperfusion turns the tide and survives. A patient with extensive metastatic cancer responds magically to a treatment that has an overall efficacy rate of only 5% to 10%. A patient paralyzed from the neck down finds a way to use their limbs and walk again, and another wakes up from a prolonged coma. These events are not likely, but they are in the realm of possibility. The occurrence of these unlikely (but not impossible) events provides physicians with the sense of wonderment they desperately need to be the best they can possibly be.
Therefore, the real overlap between baseball and medicine comes down to one central theme: Hope. In both baseball and medicine hope is never lost, and the impossible might happen. In both endeavors, one never runs out of time – until the end is irrevocably established. The endless possibilities provided by hope are epitomized by the famed Yogi Berra aphorism, first uttered in 1973: “It ain’t over till it’s over.“
Physicians inherently know this more than anyone else.
Throughout my career, I have met a handful of physicians – all cardiologists – who have given up promising careers in professional baseball to go to medical school and devote their lives to medicine. On one occasion, I asked a dear friend about his greatest career regret. Sitting in his office and surrounded by photographs of his major achievements, I thought he would mention some past decision that would have changed the trajectory of his medical career. But my friend just looked at me and said, “I could have played baseball. I could have pitched in the major leagues.”
Every physician goes to work every day motivated by the endless possibilities of hope. And every baseball movie depicts hope as a central theme. Hope is the dominant motif in the “Field of Dreams,” one of the best baseball movies of all time. In the movie, Burt Lancaster plays the role of Archie “Moonlight” Graham, who purportedly played one game for the New York Giants in 1922 but never got to bat. In the movie, Graham leaves baseball to become a very successful physician, favorably impacting countless lives. But in 1972, he dies without fulfilling his dream of batting in the major leagues. The Field of Dreams (built in a remote cornfield in Iowa) gives him the chance to do things right again. (I have seen “Field of Dreams” more than a dozen times, and I always break down in tears at the end.)
But the most remarkable story of the interface of medicine and baseball is the true life of Bobby Brown, who first played in the Major Leagues in 1946. He was Berra’s roommate in Triple-A baseball, and on one night, Berra was reading a comic book, while Brown was reading Boyd’s Pathology, because he really wanted to be a physician. Coming to the end of his comic, Berra asked Brown: “So, how is yours turning out?“
Brown starred in several World Series, and after playing for the Yankees from 1946 to 1954, he went to medical school, became a very successful cardiologist, and practiced in Dallas until 1974. He then took a leave of absence to become interim president of the Texas Rangers, subsequently becoming president of the American League. (Given the flow of this essay, my readers might think all these extraordinary coincidences are too good to be true. But we all know that life is often more surprising than fiction.)
Famously, in 2019, Brown recalled a story of when he started dating the woman whom he later married. When his future wife asked him how she should describe Brown to her parents, he said: “Tell your mother that I’m in medical school, studying to be a cardiologist. Tell your dad that I play third base for the Yankees.”
My last game as the head coach of my son’s baseball team took place in 2007 at Dr. Pepper Park (now known as Riders Field), just outside of Dallas. It was the first time we had played in a professional baseball stadium. The stadium has won architectural awards for its authentic feel, and it has hosted exhibition games for the Texas Rangers. Our 2007 championship game was held on a weather-perfect evening (after the Texas heat had subsided); we played under the lights, with the stands filled with families, friends, and well-wishers. (The stadium can seat over 10,000 people). The game even had an announcer, and there were men and women hawking food for those in the stands. Everything about the setting made one feel that this was “real,” but it felt real only because it was so dreamlike.
At the start of the game, I walked to home plate to give the head umpire my player roster, and in accordance with tradition, I shook hands with the opposing coach (a tall man in his 30s), and we exchanged a pleasant conversation. He told me he was a professional baseball player and manager, hired specifically by various teams to hone their skills to the most competitive level possible. His team had a reputation for being exceptionally strong, with a fearsome batting lineup that was the envy of the league. When I confessed to him that I was a cardiologist, he had the most mischievous grin, thinking (understandably so) that his competition on that night would be weak.
But he was wrong. My son pitched the first three innings, holding the other team scoreless. And every member of our team did something miraculous, performing at a level that exceeded all expectations. Our center fielder made three on-the-run catches of deeply hit fly balls that would have been inside-the-park home runs on any other day, a feat that was extraordinary since he would often miss routine pop-ups during the regular season . We won 11-5. I have not stepped on a baseball field since.
I have had the privilege of presenting the main results of many large-scale practice-changing clinical trials at many cardiology meetings over the past three decades. And in 2007, I was the overall Principal Investigator of a $ 33 million NIH grant to the University of Texas Southwestern. But on one special evening in that same year, I played on a Field of Dreams, and my memories of the event dwarf anything I have ever done professionally. At one magical point in time, my experiences as a physician and a baseball coach converged with unprecedented clarity. There is always hope, and miracles can happen exactly when you need them. And in your moments of greatest exaltation, you can be forgiven for wondering if you are awake or dreaming.
During the past 3 years, Packer has consulted for AbbVie, Actavis, Amarin, Amgen, AstraZeneca, Boehringer Ingelheim, Caladrius, Casana, CSL Behring, Cytokinetics, Imara, Lilly, Moderna, Novartis, Reata, Relypsa, and Salamandra. These activities are related to the design and execution of clinical trials for the development of new drugs. He has no current or planned financial relationships related to the development or use of SGLT2 inhibitors or neprilysin inhibition. He does not give presentations to physicians that are sponsored by industry.