A slice of Z "The Dream" Gorres' skull remains stored in a biologic refrigeration system at a facility outside San Diego.
The piece of bone, about the size of a man's hand, had to be removed after the bantamweight boxer's Nov. 13 fight at Mandalay Bay's House of Blues. The 27-year-old's battered brain needed room to swell, according to University Medical Center trauma surgeon Dr. Michael Casey.
Had the opening not been made, the swelling within the tight confines of his skull would have compressed his brain stem, shut down his breathing and also his heart. He would have died.
There was another option. Doctors could have put the piece of skull in Gorres' abdomen and stored it there until the swelling receded.
"But that would have entailed another surgery," Casey said. "We thought it was best to ship it to a place where organs and bones that are meant to be reimplanted are stored. They freeze it to a minus 70 degrees. We'll suture it in later after the swelling goes down."
Cutting-edge emergency surgery has led to a remarkable recovery for Gorres, who, Casey said, arrived at UMC "nonfunctional and vegetative," literally minutes from death.
Today, after nearly two months of around-the-clock nursing care and a team of physical therapists who are helping him walk and talk again, Gorres is on the way to becoming a "functional human being who will be able to care for his wife and four children," Casey said.
Within weeks, Gorres should be able to travel back to his native Philippines.
But that good news is tempered by this: In the boxing capital of the world, state law requires promoters to put up only $50,000 worth of medical insurance for each fighter in the ring.
In other words, taxpayers generally take it on the chin whenever a boxer gets seriously hurt. And, according to Keith Kizer, the executive director of the Nevada Athletic Commission, a serious boxing-related brain injury occurs about once a year.
As of early last week, according to UMC records, Gorres' care had cost nearly $500,000.
"You blow through $50,000 in just a couple of days when you have someone who is critically injured attended to by multiple, highly skilled surgeons delivering the most advanced spectrum of care imaginable," said Brian Brannman, UMC's chief operating officer. "And if someone doesn't have insurance, or not enough, taxpayers pick up the difference. That's reality."
As Gorres, whose full name is Zeta Celestino Oliveros Gorres, lay in his hospital bed recently, he was unable to talk. He could not walk without assistance. An oxygen tube inserted after a tracheotomy to help him breathe was still in place.
Still, with his wife, Datches, nearby, he could give visitors the thumbs-up.
When she isn't worried about her husband, Gorres' wife said through a translator, she worries about money. On this afternoon, still thinking her husband would be paralyzed for life, she wondered aloud how she could support four children under the age of 12.
Two friends of the Gorres family, boxing trainer Tony Martin and University of Nevada, Las Vegas, boxing coach Frank Slaughter, stopped by to look in on the fighter.
Martin said Gorres' story is a familiar one in boxing: He fought his way out of an impoverished background. He won three amateur championships in the Philippines before turning pro.
"He was so poor growing up that he was lucky to get one meal a day," said Martin, who has trained fighters in the Philippines. "His older brother was murdered."
In the Philippines, Martin said, many people live on astonishingly little, frequently no more than $4 a day. Indoor plumbing is often just a dream.
Gorres' November fight with Colombian Luis Melendez was seen as a step toward a bantamweight title bout that could earn him a sizeable paycheck, Slaughter said.
Even though Melendez sent him to the canvas with a left cross in the last round, Gorres quickly got up and was so far ahead on points that he easily won a unanimous decision. Gorres circled the ring holding his home country's flag in victory.
But when he was just about ready to leave the ring, he fell unconscious, and ringside doctors rushed to his side.
Though highly ranked in the 112- to 118-pound bantamweight class, the money Gorres made in boxing was a far cry from the millions already earned by his countryman, Manny Pacquiao, the celebrated champion.
"He was supposed to make $10,000 for this fight, but he had to pay taxes, his managers and a lot of other people out of that," Datches Gorres said.
Few boxers before they become champions carry medical insurance, said the athletic commission's Kizer. And even then, he said, many don't.
"They either don't have the money or don't want to pay for supplemental insurance," he said. "Of course, 99 percent of the time, the $50,000 that the promoter has to put up under state law is enough."
Just how much Nevadans have shelled out to care for boxers' immediate brain damage from fights is unclear.
From 1995 to 2005, 10 fighters sustained career-ending brain injuries in Nevada, with two boxers, Leavander Johnson and Martin Sanchez Jr., both dying from subdural hematomas, the same brain hemorrhage injury Gorres sustained.
Because of federal privacy laws, UMC officials were unable to release the medical records of fighters to whom they gave care. Gorres' wife gave UMC permission to release her husband's medical information to the Review-Journal.
Despite the lack of such information, Brannman said Gorres' case is an indication that UMC has not been reimbursed for millions of dollars in care for boxers.
"We're the ones with the best trauma care facilities, so that's where hurt fighters are usually brought," he said.
Obviously professional fighters aren't the only ones without insurance treated for costly brain injuries at the trauma center. But what makes boxing different, Coates said, is that it's predictable that brain injuries will occur when a sport both supports and celebrates blows to the head, particularly those that cause a knockout.
Recent studies have shown that most professional boxers have some degree of brain damage, even if they don't show symptoms. Researchers say the impact of a professional boxer's fist is equivalent to being hit with a 13-pound bowling ball traveling 20 miles an hour.
Coates, whose medical treatment saved the life of magician Roy Horn after he was attacked on stage by a tiger, said he'd like to see promoters and boxers who have benefited monetarily from the sport set up an endowment at UMC for brain injury treatment.
"It would be both a good PR move as well as a good move to ensure that the best trauma treatment remains is in place," said Coates, who often serves as a ringside doctor.
UMC officials are projecting a budget deficit of $70 million for fiscal year 2010, with unreimbursed care a major factor.
Under federal law, any patient who shows up at an emergency room requesting an examination or treatment for a medical condition must be given an appropriate medical screening to determine whether there is an emergency. If there is, treatment must be provided.
"I think any business would find it hard to not to run a deficit when you provide a service and there is no mechanism for reimbursement," Brannman said. "I think when it comes to boxing we have to look at the cost to the community as well as the business it brings. We have to decide what the threshold is for requiring more health insurance for boxers."
Brannman said UMC officials have not been approached by promoter Arum or anyone else in the boxing community about covering the hospital's costs in treating Gorres. To Dr. Raoul Tanayo, who is currently in charge of Gorres' care, it's clear cut more insurance is needed for both boxers, as well as fighters who battle in the increasingly popular mixed martial arts bouts.
"They are very dangerous sports and brain injuries are going to occur," he said. "Vegas does make money from the fights, but this hospital is already in the hole."
Bill Brady, a member of the Nevada Athletic Commission, said "very few fighters get badly hurt. ... but this question of more insurance is something we'll check into."
Arum, the Las Vegas promoter, did not address the health insurance question at any length. His spokesman, Lee Samuels, sent an e-mail: "Bob said medical insurance standards are more of a matter with Keith Kizer and the (athletic commission) which sets the standards. Bob, however, suggests perhaps raising the minimums for world title bouts. However, small and club-level promoters may have a survival problem with those kind of additional costs."
To Slaughter, the UNLV boxing coach, the sport he loves could be in trouble if something isn't done to handle medical costs run up by hurt boxers.
"Will boxing implode on itself if taxpayers have to shoulder the cost of bailing out the underinsured fighter as the fat cats always walk away with a chunk of dough," he said. "You know we've been there and done that with Wall Street, and Main Street got sucker punched."
Contact reporter Paul Harasim at firstname.lastname@example.org or 702-387-2908.