Physical medicine and rehabilitation specialist and orthopedic surgeon Brian Krabak, one of the red-jacketed medical volunteers who treated Olympic athletes. J.P. Shilling speedskating at the Winter Olympics. Hopkins Secret Service team (left to right): Drs. Mark Dogoli, Melissa Costello, Ron Elfenbein and Nelson Tang.

For most of the month of February, many of us fell helplessly under the spell of a group of young people in the prime of their lives pursuing a medal dangling from a wide, blue ribbon. Everything was perfect in Salt Lake City. The fit, eager athletes; the jagged, snow-covered mountains; even the television coverage was elegant. Yet behind the impossibly synchronized ceremonies and schedules, it took a network of thousands to make it all look effortless.

While most of us watched from our living room sofas, 1,800 miles away a handful of Hopkins staff made behind-the-scenes contributions to the 19th Winter Olympiad. Each of them experienced the Games from a different perspective. Here's what they did and what they saw.

Mending Athletes

It isn't only skiers and skaters who compete to be in the Olympic Games. Thousands of health care providers clamor to attend to the injuries and illnesses of the athletes, as well, and a minuscule 1 percent are selected. Even with no pay, it's a plum assignment.
Brian Krabak was elated when he won a spot on the medical team, and was stationed at the Olympic Polyclinic, the free-of-charge, never-closed clinic for the Olympic community. Krabak, a specialist in physical medicine and rehabilitation at Johns Hopkins, says that having volunteered for the 1996 Paralympics for disabled athletes helped him get to Salt Lake.

While some Olympic teams provide medical care for their athletes (the United States team of 215, for example, brought along a medical staff of 20), for others the polyclinic-a European term for multispecialty clinic-is the place to go. Many athletes take advantage of their proximity to American medicine, having cavities filled, root canals done and glasses prescribed.

Matters weren't always so pedestrian for Krabak, however, who took care of musculoskeletal problems. He saw everything from contusions and strains to torn ligaments and concussions, all in the heat of the greatest competition of his patients' lives.

"The challenge is trying to diagnose what they have while weighing the pros and cons of competing with an injury," he explains. "When the guy with a concussion from a bobsled accident hasn't competed yet, and you're worried about brain injury, do you let him go ride again?"

Krabak, 34, can appreciate what his patients go through. His sport of choice is adventure racing, a combination of mountain biking, kayaking, rappelling, and running trails over a period of 40 hours without sleeping. When he got to Salt Lake City, he went skiing and tore the anterior cruciate ligament in his knee.

When Krabak wasn't working one of the seven shifts he was responsible for during the Games, he took in as much as he could. He stood in awe at the men's freestyle moguls ("These guys throwing themselves in the air"), chatted with college students from Russia and Norway at the nightly concerts, and got tickets for the men's and women's hockey finals and the closing ceremonies.
His best memory?

"Being in Olympic Plaza, watching the American flag go up, and listening to all these voices screaming the National Anthem when [speedskater] Derek Parra got his gold medal. It was a once-in-a-lifetime experience."

Security Ills

Snowbasin, one of the venues where alpine skiing events, like downhill skiing, occurred.

It goes without saying that the federal agency known for its meticulous planning would have prepared for the flu.

There were some 2,000 Secret Service personnel on hand for the Olympics, with no time to be sick. Some of them were posted atop mountains in such remote areas that getting to a hospital would have been futile. All of them were doing such specialized work in such a high-profile venue that they couldn't be spared. So the Secret Service brought its own medical team.

They were physicians from the Johns Hopkins Department of Emergency Medicine.
Nelson Tang, emergency medical services director, initially was notified of the assignment about six months ago and took charge of organizing his team. The logistics were not trivial. Physicians needed to be chosen, credentials and cold-weather gear obtained, travel arrangements made and medical supplies gathered.

By Feb. 4, the group had arrived for its three-week stint. Each Hopkins physician was paired with a Secret Service paramedic to form four teams. In addition to Tang, they were attending physician Horace Liang, third-year resident Mark Dogoli and two second-year residents, Ron Elfenbein and Melissa Costello.

"We were not a 911 service," explains Tang. "Our job was to be there for urgent and less urgent medical concerns, to shorten the course of illness and initiate therapy as early as possible. Our goal was to keep these people at their posts."

Although this was Hopkins' biggest assignment with the Secret Service, it wasn't the first. Three years ago, the Emergency Services office of the Secret Service approached Hopkins about a collaboration. The agency needed help with training, credentialing and continuing education for its nearly 100 EMS personnel. Hopkins obliged. Tang was named the medical director.

Hopkins physicians also provide medical support to the Secret Service on overseas missions, and have made more than 20 trips to Africa, South America and Southeast Asia. "We send a physician along when the protectee is traveling to a place with inadequate local [medical] resources or when the mission is particularly high-risk," says Tang. "We've traveled to some unbelievable places."

Tang was hoping for a domestic assignment like the Olympics, a declared "national security special event" (like the Super Bowl) where the Secret Service takes charge of security. "I was sure we could offer a significant service," he says. "I just wanted to get out there and prove it."

The teams were supposed to work 12-hour shifts, but often worked much longer. They were always on call. A lot of their time was spent on the road, traveling to treat patients in their territory-more than 900 square miles of northern Utah. In addition to the Secret Service, they also aided many other law-enforcement agencies-the Customs Service, the Marshals Service, the Border Patrol. By the end of three weeks, they had treated upper-respiratory infections, sinus problems (because of the altitude), orthopedic injuries and even dental complaints for nearly 400 people.

Tang also considered part of his job to be preventive medicine. When too many agents were getting sick in the 20-below temperatures on mountain tops, he and his partner drove two hours to deliver 140 space heaters to those standing post. He advocated for his patients to be moved out of suboptimal hotel rooms when the living conditions weren't helping them get well.

For Tang, the number of patients alone was enough to justify Hopkins' involvement. "There was a tremendous need that we filled," he says. "We had agents stop in every day to thank us for being there. It made a big impression. That's probably what most of us will carry away. Just this feeling of really being able to help some folks."

Admittedly, the medical teams didn't see much of the Olympics. Tang saw about an hour of the Opening Ceremony before he had to leave to treat a patient. "Logistically, we were very isolated," he says.

But he doesn't reveal even a twinge of resentment. "This was tremendously fun for me," he says. "This was bringing medicine to the front lines, treating on the go. At Hopkins, we're used to patients coming to us. We're sometimes rigid about our practice. This was a great educational opportunity for our folks, because it forced us to realize there were much larger operational concerns at hand. It was humbling."

View from the Stands

J.P. Shilling comes by his skater's legs honestly. His mother, Joan Clark, was a competitive figure skater in her youth. Then, after a lapse of many years, she tried speedskating. She started competing when she was 40, and by the time she retired from competition in 1996, Clark, who even today has a trim and powerful-looking body, was the national champion in her age group for both short-track and long-track speedskating.

"I was successful because there's not that many old women who do this," says Clark, faculty and academic affairs coordinator for Oncology.

For most of Clark's second career on the ice, she was only at Baltimore's Northwest Ice Rink because of her son. J.P. started skating at age 6. In 1980, after watching Eric Heiden win five gold medals in speedskating, Shilling announced that one day he would skate in the Olympics, too.

He got through his teen years without dropping out of the sport, which his mother had half-expected. After high school, he was accepted at the Olympic Educational Training Center at Northern Michigan University, where students go to school for half the year, then compete for the other half. In 1995, Shilling made a world team for the first time.
A place on the U.S. Olympic team, however, kept eluding him. Then, the week before Christmas, in Park City, Utah, where he had been living and training at high altitude for the past year, he qualified for the 1,500-meter race. He made it by 1/100th of a second. The next day was his 30th birthday.

When Joan Clark arrived in Salt Lake, she hardly saw her son before his event. At the Opening Ceremony, Clark couldn't find him in the parade of athletes, but later found out that relatives back home saw him clearly on television.

On the day of the 1,500-meter race, Clark watched tensely from the stands, with the same feelings she's had since her son was a small boy. "It's so helpless being the parent," she says, "just wanting them to do the best they can do."

A skater must attack the 1,500, which is described as an "endurance sprint," and Shilling did just that. He skated at a world-record pace until the last lap. But in the end, the American speedskater Derek Parra took the gold, and Shilling finished 14th out of a field of 48. At one minute, 46.29 seconds, he was just two seconds off the winning time.

Shilling was happy with his performance, which was a personal record for him. Afterwards, he posed with Eric Heiden, now an orthopedic surgeon and the team's doctor. Exhausted, Clark and her husband went to bed that night at 9:30. "We felt like we'd been beaten by sticks, we were so emotionally worn out."

Clark watched the Closing Ceremony from home, and admits to feeling melancholy. Her son has three more world meets before he'll come home at the end of April. Then Shilling is hanging up his skates. "This was his last try," says Clark. "He's tired."
Skating has given her son a lot, says Clark. "He's been around the world, he's gotten his education out of it. It's been pretty unique. And how many people live out their dream?"

Back home, Clark and her husband viewed the video that J.P. took at the Opening Ceremony. "The pictures were lousy," she says. "You could tell he kept forgetting to turn it off. But you could hear all these voices, and you could hear their excitement. It made you cry."

-Mary Ellen Miller