When the starting gates open at the Kentucky Derby on Saturday evening, 20 horses will erupt onto the track, straining their muscles and pounding their hooves into the dirt to reach the finish line. Propelling their half-ton bodies to speeds of nearly 45 miles an hour isn’t easy on their bodies. Though bred for stamina and speed, sport horses suffer many injuries—from torn ligaments to chipped bones—as a result of the work they do for humans.

José García-López, the head of equine sports medicine and surgery at Tufts’s Hospital for Large Animals, helps all kinds of horses—racehorses, Olympic-medal hopefuls in dressage or jumping, and low-level amateurs’ mounts—stay injury-free. Born and raised in Puerto Rico, García-López grew interested in the challenges posed by horses’ unique, delicate anatomy, which led him to a career in treating sport horses and teaching at Tufts’s Cummings School of Veterinary Medicine.

For The Atlantic’s series of interviews with American workers, I talked to García-López about how he treats equine injuries, what a hospital for horses looks like, and his favorite kind of patients. Below is a lightly edited transcription of our conversation.

Lauren Cassani Davis: How did you come to be an equine veterinarian?

José García-López: My dad is a physician and teacher at the school of medicine at the University of Puerto Rico. I never thought about a medical career, but I always loved anatomy—how muscles worked, and how athletes exercise. During undergrad, one of my research mates went to vet school a couple of years ahead of me and said, “You should consider veterinary medicine.” I began to explore the possibility, because I love dealing with animals. I grew up with dogs, on and off, and my mother had a Paso Fino mare.

García-López watches a horse for lameness.
(Melody Ko / Tufts University)

I decided to give it a shot and ended up being accepted to the University of Pennsylvania for vet school. During the first semester I developed friendships—in particular with the person who is now my wife, Dr. Kate Chope, a very experienced horsewoman and competitor, very accomplished at the time. She taught me quite a bit. Then I had a professor—an equine orthopedic surgeon—during our first semester who really sparked my curiosity with regards to orthopedics and exercise and athletes.

During the summer, I went back to Puerto Rico and worked on the racetrack with a community of 1,500 horses who needed constant care. I worked with a doctor who was a great mentor to me—not just him but also his grooms, who are lifelong horse people—and really fell in love with it. I love equine anatomy—I am fascinated how amazing and how fragile at the same time the equine athlete can be, and how difficult it is to rehab them compared to a dog or human. That’s what really sparked my interest. It was an unconventional route, as I did not grow up riding horses. I went in as a person who likes biology and exercise.

Davis: How would you describe the demographics of your clients?

García-López: Most of my clients are English-sport-horse owners. We’re dealing with athletes—very few backyard or pleasure horses. I’d say 80 percent of my clients do English sport-riding, like jumpers, dressage, and three-day eventing. The other ones are racing.

Davis: What’s the most common injury you see?

García-López: Chips of bone or cartilage in the joint—joint mice, they're sometimes called in humans. And also soft-tissue injuries within the horse's stifle joints, the equivalent to the human knee, and injuries to tendons and ligaments.

Davis: When you see a patient, what’s the process?

García-López: Our hospital is no different than a human hospital, really. It’s just a little bit bigger. When the horses’ owners come in, they go to the receptionist, they bring the horse out of the trailer and into a 12-by-12-foot holding stall. Then they are greeted by myself, my technician, and my resident. We take a history, do an evaluation and a physical exam. And if it’s a case, for example, that is coming for a lameness evaluation (when a horse moves unevenly due to pain), then we go outside. We have a track, an area in which we jog, trot, canter, and we can lunge (watching the horse move on the end of a long rope).

Sometimes we’ll do some “blocks”—putting some anesthetic in certain areas of the limb—to localize the lameness to a particular area. Then we’ll go into diagnostics—whether it’s an MRI, ultrasound, radiographs, or nuclear medicine—in which we look at the areas of bone activity in that particular region. Once we admit the patient, they get admitted into the hospital ward. The following day they’ll have the procedure done.

A horse sedated and lying on a hydraulic table (Tufts University)

Davis: How do you get an animal as big as a horse on and off of a table for MRI and surgery?

García-López: We have this process in which we sedate them in an induction room that’s padded—they get squeezed, then they fall down to the ground and get hoisted onto a hydraulic table. Once we do whatever kind of procedure we need to do, we’ll move the horse into the recovery room, which is completely padded and softened. The room has a mattress and also ropes that are attached to the horse’s head and tail—an assistant is controlling the ropes to get them up. Once they’re up, the ropes are released, they are left there for 10 minutes or so, and then they walk back to the stall. Typically those horses will go home the following day.

Davis: What kind of equipment do you use? Is it different to treat a horse’s joints, versus a human’s?

García-López: We use the same MRI machines as they have at the human hospitals in Boston. And if you look at our surgery tower, our instruments are all human products from the medical market. If you look at the camera we use to look inside of the joint, it’s basically the same kind of view that a human orthopedist would have.

Davis: What does physical therapy look like for a horse?

García-López does a flexion test on
a horse’s hind leg. (Tufts University)

García-López: We start with exercises like hand-walking (where a person leads the horse from the ground), leaning on the affected leg, flexion and extension and massaging, to walking under saddle with a rider. We don’t do it any more often than 6- to 8-week intervals. One of the challenges is that the horse is always standing and putting pressure on the injured area all the time, and all four legs need to be equally weight-bearing. There are some aqua-treadmills in the area, sometimes I will send horses there so that they start doing some exercise on the treadmill underwater.

Davis: Are there ever situations when people’s ambitions for their horse go against what’s best for the animal?

García-López: With the English sport horses, fortunately I don’t have much of that problem, because the owners are usually very attuned with their horse. If a horse is ready to be retired, they’re usually very good about it. But you can run into a situation where you’ll have an owner that says, “This horse is supposed to be able to do this,” and we say, “I’m sorry, it’s not going to be able to do it.” A lot of times they will try to get a second or third opinion somewhere else, and you hope that they don’t try to put the horse at risk by doing something that’s unscrupulous.

Actually, some of the worst clients might be the horses owned by human surgeons. Especially orthopedic surgeons. Because they have their expertise, they think that a human is the same as a horse, and that it should be pretty straightforward. They don’t understand that when you repair a meniscus (a kind of cushion found in the knee joint) in a human, you don’t put them standing their weight of 1,000 pounds on it right away.

Davis: Do you have a most memorable case or favorite patient?

García-López: That’s a tricky one, just because there are so many. We’ve had horses that have gone to the Olympics or Pan Am games and won silver and bronze medals, with soft-tissue injuries that we’ve been able to rehab. That is obviously extremely fulfilling—to see an athlete at that level able to continue to perform and do well, along with the rider, who is also invested.

A horse under anesthesia (Tufts University)

We also have some low-level athletes that are hugely important to people. One dearest to my heart is a pony that is probably not worth $800—a child’s lesson pony in the Vineyard. He’s still alive—his name is Flash. He was teaching every kid in the Vineyard how to ride, even kids with developmental issues and incapacities. A pony you can trust like that is hard to put a price on. Flash developed a fracture of his hind limb—his leg from the hock down became dislocated. It was the cutest thing: The kids from the barn raised the money with their parents to pay for the treatment, and with two surgeries, and three plates, seven or eight screws, and patience, he was able to go back and teach for another 10 or 12 years. And he’s still alive, he’s retired. I used to get cards every year from the kids thanking us because they have their Flash to be able to continue having their lessons.

Here in Massachusetts, there’s a nonprofit group called Friends for Tomorrow, which is a therapeutic riding program, that has this herd of horses—they’re amazing, these Icelandic ponies and other breeds that provide such a critical service to children and young adults with disabilities. It puts tears in your eyes when you see some of the interactions that the kids have with the horses that they don't have with anything else—and also how their parents respond.

My wife and I deal with most of those horses’ musculoskeletal issues. Obviously, I’m fond of the silvers and bronzes but those, to me, are groups I always remember—the ones where you feel that you make a big difference in a number of people’s lives.

This interview is a part of a series about the lives and experiences of members of the American workforce, which includes conversations with a taxi driver, an airport crew chief, and a truck driver.