Medicine: Death on The Basketball Court

The collapse, witnessed by millions of TV viewers last week, was sudden and mystifying. One minute a college basketball star -- one of the most promising in the U.S. -- was playing at the top of his form. The next he lay crumpled on the court, dying of apparent heart failure at age 23. But long before Hank Gathers' death, there were warning signals. The Philadelphia-born senior at Loyola Marymount University in Los Angeles had suffered a similar collapse three months earlier. He was diagnosed as having a heart-rhythm abnormality, treated with medication and cleared to play.

The exact cause of Gathers' death will not be known until the results of an autopsy are released this week, but disturbing questions are already being raised. Was his heart problem properly treated? Was he adequately warned of the dangers of continued play? More broadly, what should physicians advise an athlete who faces the conflict between a promising career and a potentially fatal disease? And in the case of someone so young, who should make the decision: the doctor, the patient, the parents or the school?

After Gathers' first collapse, he underwent a series of tests that revealed a cardiac arrhythmia -- an irregular heartbeat that can indicate anything from normal palpitations to a life-threatening condition. Gathers was ordered to report for weekly testing and treated with Inderal, one of a class of drugs called beta blockers. These inhibit the effects of adrenaline and smooth out the rhythms of the heart. Side effects include fatigue and sluggishness.

The side effects were apparently a problem for Gathers, whose prolific scoring and rebounding started to fall off. He complained to his coach that the dosage was too high, and is said to have persuaded his doctors to lower it. But according to a cardiologist familiar with the case, Gathers skipped his stress-test appointment the week before his death and may have stopped taking his medication altogether -- an omission that could have increased the risk of heart failure. "He was told not to play," the unnamed doctor said in an interview with the Los Angeles Times. "We told Hank that if he wanted to live the best, he shouldn't exercise. ((But)) Hank Gathers was going to play basketball. It didn't matter what some doctor told him." Bo Kimble, one of Gathers' teammates and best friends, disagrees. Says he: "I'm sure that if Hank knew that he wasn't supposed to play, he wouldn't have been out there."

The university strongly defends its conduct. Says athletic director Brian Quinn: "We had a clearance for him to play from outstanding physicians." But school officials were concerned enough about Gathers' condition to supply the basketball team with a defibrillator, a medical instrument that could be used to help resuscitate any player or fan who suffered a heart attack. It was used unsuccessfully on Gathers the night of the tragedy.