Offside
II.III.IV
OFFSIDE
With my rotation in geriatric medicine being a pretty chill one, I suddenly found myself with more free time on my hands than ever.
It was around this time that I started working part-time as a team physician with the Malta Football Association (MFA). I was never really interested in football – hell, I actually kinda resented its existence, partly because I sucked at it and partly because if you suck at football in Malta, it’s something akin to a crime. That said, working as a doctor with a football team had a few undeniable perks. First off, the money was great. Second, I got to learn a bit more about sports medicine. And third? I’d get to go on all-expenses-paid trips while still getting paid.
I can’t say it wasn’t daunting at first. For starters, I hadn’t done my emergency medicine rotation yet – meaning I wasn’t exactly well equipped to deal with major emergencies if they cropped up. On top of that, working pitch-side meant having far fewer resources than I was used to in hospital.
Understandably, I was given a briefing session before starting, where the sports medics explained what the job entailed. My role would mainly involve treating minor injuries like superficial abrasions, sprains, and the like. Occasionally, I might encounter a fracture or dislocation that I’d have to manage on site – and given my limited experience, I was given a few tutorials on reduction techniques. At worst, I could be faced with a seriously injured player. In that case, I’d have to rely on what I’d learned during my Advanced Life Support (ALS) course to stabilise them before arranging urgent transfer to hospital.
The first few matches I attended were all characterised by one thing – fear. I guess it was the first time in my life I was actually paying attention during a football match.
My eyes were glued to the players, silently wishing they’d all remain safe and sound. But injuries do happen. The first one I had to manage was a direct kick to a player’s shin. He could barely stand, there was visible bruising and swelling over his tibia, and he was screaming like a madman. I panicked internally, trying to figure out how I’d realign bone fragments if the leg turned out to be fractured. Then the physiotherapist stepped in, sprayed the leg with freezing spray, and off the player went, continuing the game as if nothing had happened.
That set the tone for most matches. I’d be called onto the field for what looked like serious injuries, only for the physiotherapist to take over once it became clear the problem was muscular, ligamentous, or bony. My role felt rudimentary at best – with the steady cashflow making it one of the best jobs I’d ever had. It would’ve been the perfect job had they been playing Quidditch, or literally any other interesting sport.
At times, though, my input was genuinely needed. I’d perform neurological examinations on players with head injuries, auscultate chests, and check oxygen saturation in cases of thoracic trauma. These situations were straightforward enough. I guess it was luck more than anything – I never once encountered a scenario that required full stabilisation or hospital transfer. Still, even on the quiet days, I was always aware that things could go sideways at any given moment.
After gaining a bit of experience, I decided to join the national under-16 football team on a trip to North Macedonia, where they’d be playing against the host country’s team.
I gotta admit, I felt like a fish out of water – and straight into lava – when I was introduced to the team at the airport before departure. The kids called me “Doc” and looked at me with this odd mix of reverence and curiosity. The coaching staff spoke to me formally and treated me with a level of respect I wasn’t used to. I guess these people still thought of doctors as highly valued members of society. Little did they know that back in hospital, junior doctors are more likely to be spat at, vomited on, screamed at, peed on, or crapped on than respected. So yeah, the contrast was… refreshing.
The trip felt like a school outing. Kids at the back of the plane, adults at the front. Kids being loud and unruly, adults telling them off. Kids sprinting around the airport on arrival, adults corralling them onto the shuttle. When we finally reached the hotel in Skopje, I could only imagine what the poor receptionist thought when fifteen feral teenagers descended upon her. Needless to say, I kept my distance. I was there for one reason only – to manage injuries. Nothing more, nothing less.
That, of course, turned out to be wildly inaccurate. Apart from match-day duties, I was expected to be with the kids at all times in case something cropped up – fair enough. I’d also have to reviewing players with old injuries to determine fitness for play – the only task I actually felt qualified to do. But then came responsibilities that had never been mentioned beforehand. Like monitoring what they ate to ensure perfectly balanced meals with the right carb-to-protein ratios (apparently doctors are also nutritionists). Also attending physiotherapy sessions, where I mostly stood around staring blankly while someone waved a massage gun.
With the kids’ schedules packed with training sessions, physio, and tactical meetings, mine was just as full. We barely got to explore Skopje – just a couple of short walks taking in a handful of highlights like Macedonia Square, the cathedral, and the city park. While I can’t say I loved what little I saw, it still felt like a crime to travel and not properly experience the place. The highlight of the city – at least for the team – was the FFM Stadium. This was where everything revolved. Training, preparation, and finally, the match against North Macedonia.
Despite my indifference towards football, it didn’t take long for me to get swept up in it. I’m not gonna go so far as to say that I’m now a fan, but this experience truly did change things for me.
It probably started at the airport, watching the kids buzz with excitement at the thought of playing against a foreign team. They’d trained their whole lives for moments like this and couldn’t wait to prove themselves. Their enthusiasm was infectious. I remember thinking what a shame it was that I’d never experienced that kind of camaraderie growing up. Maybe there was more to football than just chasing a ball and yelling at whoever lost it.
Then came the training sessions. Standing in the changing room while the coach went over tactics, I was stunned by the kids’ focus and discipline. Before this, I’d pegged them as spoiled, entitled brats. During training, they were anything but. They were tiny professionals, completely immersed in their craft. It dawned on me that I was watching the next generation of Maltese footballers in the making. And while Maltese footballers aren’t exactly renowned to be the best, I have to say that they were much better than anyone I’d ever seen playing back in school.
By the time match day arrived, I was fully invested. I wasn’t just waiting for injuries anymore – I was cheering, celebrating goals, and mourning missed chances. Every goal felt personal. I knew how much work had gone into getting them there, and I could already picture them playing professionally in the years to come. I felt like their own personal cheerleader.
The match itself was mostly uneventful, injury-wise. A few knocks here and there, most dealt with by the physiotherapist.
Then came the cases that actually needed me. One of our players collided head-to-head with a Macedonian player. He was dazed, complained of a headache, but was otherwise stable. I performed a full neurological exam and, given his persistent dizziness, made the call to substitute him. He protested, insisting he was fine, but that wasn’t a debate – his wellbeing was my responsibility. Also, substitutions exist for a reason.
Then came my moment of glory. Another player attempted an overhead kick and landed badly, hitting the ground with a scream that sent me sprinting over. The diagnosis was immediate – a visibly deformed left shoulder. A dislocation. A friggin’ shoulder dislocation. I’d never reduced one before. I knew the theory inside out, but there’s a massive difference between knowing and doing. Ordinarily, this would’ve meant analgesia and transfer to hospital. When I explained that, he flat-out refused. Turns out he’d had recurrent dislocations on that side and usually managed to pop it back in himself – only this time, he couldn’t. He insisted I try, without pain relief.
Legally and ethically, it was murky territory. But after assessing him thoroughly, confirming neurovascular integrity, and agreeing on one single attempt, I went for it. Using the Kocher technique, I adducted his arm, flexed the elbow to 90 degrees, and slowly externally rotated while elevating the arm – all the while hoping to God I wouldn’t cause more harm. POP. Just like that, it was back in place. I rechecked it to make sure it was still neurovascularly intact and then I allowed myself to celebrate my victory.
I’ll never forget that moment. Elation. Pride. A surge of confidence I hadn’t felt before. Relief for the kid, whose pain vanished in seconds. Satisfaction at sparing him a hospital trip. And, if I’m honest, feeling like a complete badass in front of the team. But more than anything, I felt relief. Because that was when it hit me – the stakes were too high. Without proper training, I couldn’t keep doing this. I’d been lucky so far. Dumb luck. What if something catastrophic happened? Sure, I could arrange transfer to hospital, but what if my skillset wasn’t enough to stabilise someone long enough to get them there? I had ALS certification, but it’s not like I practised those skills daily.
Once the drama passed, I retreated to the bench and let the game take over. It went to penalties after a tense 3-3 draw. Sudden death decided it, and unfortunately, North Macedonia edged us out. The kids were gutted, but we applauded them for an incredible performance. To me – a football idiot – they were exceptional. For the first time in my life, I remember thinking to myself that it’s not just about winning, it’s all about having fun – and these guys surely knew how to do that.
The way back to the hotel felt bittersweet. The kids, understandably, felt defeated. In a way, I was too. As I reflected on all that had happened, I came to a sad conclusion. As much as I loved this job, I knew this would be my last stint – at least until I’d completed my emergency medicine rotation and Foundation Programme. It was a disappoint decision, but a necessary one.