Risky Business, 5280, August 2007

SiskSmlSteamboat´s Dr. Michael Sisk doesn´t just treat injured thrill seekers--he is one.  

The patch on his work shirt identifies him as Fred.  His stocky frame spills over the examining room chair, knees splayed wide, burly forearms plump as footballs beneath his short sleeves.  Fred lobs tires during the day; nights, he hauls coal.  He´s 65, but retirement is nowhere in sight, and he´s here to see Dr.  Michael Sisk because his shoulder´s been complaining about the workload.  

Sisk sits opposite, studying Fred´s MRI results.  Dressed in cowboy boots, tight Wranglers, a white Western shirt buttoned to the throat, and a flashy belt buckle that reads "High Country Stampede Rodeo," Sisk doesn´t look like a doctor.  He doesn´t talk like one, either.  Before informing Fred that his glory days are long gone, Sisk declares the situation in terms that any patient can understand: "Dude, this is a total shit sandwich."

Fred doesn´t blink; he´s been served plenty of shit sandwiches.  The MRI shows Fred´s bicep tendon as a frayed rope, its fibers thinned to meager threads straining to keep his massive upper-arm muscle stitched to his shoulder.  His bicep is capable of slinging 300 pounds--of that, Fred is fiercely proud--but the tendon is threatening imminent strike.  Sisk lays out the options.  "We can let that muscle drop.  You will lose some power." Fred nods; he´s seen this happen in other men.  "Or, we can reattach the tendon with a fancy anchor, like a harpoon," says Sisk.  "It´s a big-ass harpoon." The surgery would restore Fred to full strength, but there´s a hitch: Recuperation demands six weeks off work, no exceptions.  "If you jack around with that thing, the fish is off.  Frickin´ off." Sisk pauses for a moment to let the warning sink in.  Fred is clearly enticed by the promise of renewed power, but skeptical about allowing the sutures time to heal.  So Sisk plays his last card, the one that never fails to trump all disbelief.  "How about a guy who entered a rodeo six weeks after his own reconstruction, and blew it.  How´s that for smart?"

Rodeo was Sisk´s first profession.  Before medical school, before meeting his wife Megan and becoming a father--before any of that, Sisk rode saddle broncs.  Now 39, he still rides.  For Sisk, pro rodeo is an addiction that refuses to surrender beneath the weight of family obligations or his career as an orthopedic surgeon.  If anything, saddle bronc riding was a gateway sport into additional high-risk pursuits such as skiing, dirt bike riding, snowmobiling, and piloting small aircraft.  If injuries are any measure, Sisk may be Steamboat´s biggest adrenaline junkie.  He´s suffered three spine fractures, a broken pelvis, a broken leg, two wrist fractures, a couple of shoulder tears, and plenty of miscellaneous foot and hand smash-ups--injuries too insignificant for Sisk to bother keeping track of--for a grand total of 13 surgeries, mostly on his knees and shoulders.  His broken back and pelvis were left to heal on their own.  "Which is sorta nice," Sisk says, grinning mischievously, "´cause I can relate."

The cast room at Orthopaedics of Steamboat, where Sisk practices, is plastered with photos of skiers, cowboys, and motorcycle racers frozen in acrobatic poses made possible thanks to the orthopods´ repairs.  Steamboat Springs bull rider Danny Jendral hang on to a rager; bullfighter Bill Bass stares down a charging, half-ton beast; skier Scott Roche pulls an Iron Cross while soaring in space.  All of them, and others, shout out their thanks to Sisk in the form of autographs.  Athletes and working men like Fred gravitate to him because they know they´ll suffer no finger-wagging for having skied off cliffs, kayaked over waterfalls, or squeezed the bike throttle--be it for thrills or for a paycheck.  Sisk understands their need to push themselves to the limit, because he feels the same compulsion himself.  "It´s the adrenaline buzz," says Sisk.  "It´s hard to describe what it´s like to be the next one out of the chute, to settle onto a horse and nod your head.  I can´t even begin to tell you what a rush that is."

With doctor and patient on the same wavelength, both dispense with dissembling.  "He´s direct, a real straight shooter.  You feel like you´re getting all the info, even when it´s bad news," says Deb Holloway, whose snowboarding son, Coleman, is one of Sisk´s patients.  That straight-up approach invites patients to follow suit by asking the questions most dare not ask a doc: What if I don´t wear the brace? Can I ride with this bum shoulder?

Fred decides to hold off on surgery and lean on his failing tendon just a little longer.  It hurts him, but he prefers that pain to the torture of sitting idle, and Sisk nods.  "You´re no pussy, I´ll give you that.  Most guys would be in here bawling and crying about it."

"Well," says Fred in the quiet, undemonstrative tone used for speaking to someone who stands on your side of the fence: "Most guys haven´t been through what I´ve been through."

He´d hit the jump before, but that was last summer; now it was spring, and as he launched his dirt bike into the air, Sisk didn´t know that winter erosion had exposed a rock on the formerly perfect landing.  The rock ambushed his back tire and catapulted him over the handlebars, sending him flying.  He hit the dirt on his belly, and there Sisk thought for a brief second that he´d escaped unscathed; but then his bike fell like a meteor, landing on top of him and shattering his back.  His buddies called for help.  Then they called Sisk´s wife.  "I hope it hurts real bad!" Megan cried into the phone.  Someone called for a helicopter rescue.  

"She´d frickin´ had it with me," says Sisk, now fully healed from his worst-ever injury, which required a month in bed and two months in a back brace.  He´s suffered fewer major injuries with rodeo, though he repeats the sport´s mantra: "We all get hurt.  It´s just a question of where, and how bad." Shoulder and knee injuries are common, but concussions lead the list, amounting to nearly half of all rodeo injuries, which is hardly surprising.  Kevlar vests are now standard equipment in bucking events,; however, almost no rider will substitute a helmet for that most iconic of Western accessories, the cowboy hat.  

But adrenaline is powerful stuff, capable of silencing any whisper of what could happen if you misjudge the bucking horse beneath you, if the rope locks around your fist when it´s time to break free, or if you land under the bronc, where its thousand pounds hammer down on you from above.  "Obviously I know how bad that can be," says Sisk.  "But playing chess does nothing for me.  Plus, I figure you only live once, so it may as well be full throttle."

If those lines sound a little rehearsed, it´s because Sisk has had plenty of practice explaining why he risks so much for an adrenaline buzz.  "What if you break your hand?" is one question the surgeon has tired of hearing, so he´s developed tidy responses that deflect inquirers--and maybe himself--from the deeper answers.

That answer may simply be that rodeo, and dangerous stunts in general, are in his blood.  Sisk rode horses as a kid growing up in Rifle, a tiny Western Slope ranching town where his dad wasn´t only the local doctor, he was a mountaineer who landed two spots on a 1990 Everest expedition: one for himself as team physician, and one for his son.  So at 23 Sisk stood on the top of the world, an achievement he ranks as his riskiest caper ever, if only because he derived so little satisfaction from it.  "I couldn´t frickin´ wait to get off that mountain," he recalls.  "That wasn´t my passion.  It was my dad´s."

His own passion was rodeo, which Sisk promptly resumed upon his return from Nepal.  As a student at the University of Colorado at Boulder, he traveled from state to state competing in rodeos and developing a knack for covering the most unorthodox horses, the rookie broncs who bucked every which way.  Summers, he rode in the biweekly rodeos at Jackson Hole, Wyoming, where he got thrown a lot.  The docs who pieced him back together sparked a new passion: orthopedics.  So while riding these bone-breakers, Sisk entered CU´s medical school.  Juggling the two pursuits often meant blazing out of the hospital and driving 800 miles to a rodeo, lowering himself into the saddle, then turning right around to make it back for tests, cramming 400 pages of medical text all the while.

In orthopedics as in high-risk adventure sports, there is no room for error.  But while it´s common for doctors to specialize in sports medicine, far fewer are also athletes themselves, and virtually none competes at the pro level.  Even the Justin Sportsmedicine Team, the preeminent orthopods who cater exclusively to rodeo athletes, includes no pro riders among its members.  Sisk, however, has continued to compete alongside rodeo´s top names at the National Western Stock Show in Denver every year, and he still rides in Steamboat´s weekly pro rodeo series, one of the top-ranked small rodeos in the country.  

Yet he is not a cowboy--real cowboys make their living outside, not in the decidedly less rugged hospital environment--but the distinction is lost on his patients.  They figure if he walks like a cowboy and talks like a cowboy, then heck--maybe he´s a frickin´ cowboy.

Sisk strides into the examining room to visit with his last patient of the day, a bespectacled young man in a green zip-T fleece who greets his physician with "Hi, Michael," because, at Sisk´s request, no one calls him "Dr." The patient settles into a disconsolate silence, sitting behind his knees as if they are not part of his body, but rather a desk.

His name is also Michael, and he was a superstar hockey goalie and skier until one day, the wheels came off the bus.  His knees simply quit.  Over the course of a year, Sisk has thrown a world of technology at the problem. While Michael relates a litany of dilemmas involving everything from insurance claims to pain medications, Sisk strokes his chin with the back of his hand, traces his eyebrow with his finger.  His perpetual focus is gone; his attention has drifted elsewhere, and for the first time all day, his eyes stare at nothing in particular.  

Ordinarily, Sisk´s job isn´t just rewarding, it´s reassuring.  Every time he takes a disastered person and restores him to working order, it reaffirms his belief in orthopedics´ power to repair almost anything, innumerable times.  It is the Phoenix´s magic, capable of helping broken people soar once more.  At least, that´s true for 99 percent of Sisk´s patients.  But Michael just won´t fly.  And if orthopedics fails Michael, what´s to say it won´t one day come up short for Sisk himself?

"You and I are similar," Sisk says.  "I would be going looney tunes by now." But he can offer Michael more than just sympathy.  There´s one more avenue they haven´t yet explored, and that´s total knee replacement.  "At least there´s light at the end of the tunnel," Sisk concludes.  "It doesn´t seem like it sometimes, because it´s so damn frustrating.  But we´re not out of options." And in the quiet that follows, it´s hard to know whether it´s doctor or patient who holds out greater hope for the last magic bullet left in the gun.