Head Games

I'm thinking of doing a little series of posts about sports and head injuries, and about the NFL in particular. I'm not committing to it, because of school mainly, but I've had some thoughts kicking around in my head for a while that I think I'll write about. So let's pencil it in for now: Head Injuries and America's Gladiators.

Yes, I am a woman, but I also grew up as the only daughter in my family. My father is a football man, my older brother as well, and especially on Sundays, if I wanted to relate to most of my family, sports were necessary. It took me some years to become a true sports fan in my own right, but as an adult I came to love football, and then baseball, and then all sports.

But along the way, I became a trauma nurse, too. There are trauma nurses who love full-contact sports like football, but a lot of us have a hard time watching them. The first time I was turned off of football was the fall of 2000, when Curtis Williams, a safety for the University of Washington, sustained a spinal cord injury in a helmet-to-helmet collision while playing Stanford. At that time I had recently started working in trauma critical care and had taken care of many high quadriplegics and seen the devastating effects of these injuries. Curtis was a C2 quad and died just 18 months after he was injured, at age 24. Over time I took care of football players while working at Harborview, including a Seahawk who had sustained a career-ending head injury--his third head injury in 3 weeks, actually, which resulted in surgery to evacuate blood from his brain.

Watching 350 lb men flying into each other's heads and spines lost its joy for me. After every field collision I was watching the man at the bottom of the pile to see if he was moving. I understand that professional athletes are paid well for the work that they do, which is often what sports fans told me when I would express my reservations about football. And I accept that injuries and danger are parts of the sports we love. But most sports don't place their players' lives at such risk. Nearly everything that makes a person who he is, exists in the brain. Most people do not understand just how devastating even a mild head injury can be, how long it can take to recover, and what an impact it has on the sufferer's life. As for spinal cord injuries, they aren't as common as head injuries are in football, but they are at least as devastating. Most people don't relish the thought of being completely mentally intact but trapped in a body that no longer works, and at the complete mercy of others to accomplish every activity of daily living, even to breathe. Certainly other sports have their risk of injury, and you can get a head or spinal cord injury doing any sport, doing anything really, but for the most part you don't have nearly as much risk of losing your personality or your ability to care for yourself as a baseball or basketball player. I can watch Ken Griffey Jr. wreck his hamstring again, or any number of NBA players wreck their knees and ankles, but a head injury? That's not what sports are about for me.

Over the past few years, I've been drawn back into football, and the major cases of obvious head trauma and spinal cord injury have seemed to be fewer, which lulled me back into watching the game again. I gradually became less concerned for the massive bodies flying about the field. Let's face it, it's an exciting game, not only the sport and its players, but the pomp and mania that surrounds the football season. But recently I listened to a public radio program called The Infinite Mind. The episode was A Different Kind of Sports Legacy: Head Injuries and Concussions. The show featured Chris Nowinski, a former Harvard football player who became a pro wrestler for WWE (as "Chris Harvard") whose career ended after a series of concussions left him in constant agony. He couldn't figure out why his concussion--which is an injury most athletes learn not to take very seriously, and actually can't even accurately recognize--wasn't seeming to clear up after months. So, being a Harvard-educated guy, and a medical consultant, he hit the stacks and started looking at all the published research about concussion and particularly post-concussive syndrome. He wrote a book called Head Games: Football's Concussion Crisis, which is an excellent handbook for laypeople about concussions and sports, and upon which I'll base a lot of my series of posts on. Chris learned a number of things that really startled him about concussion, but the main things that spurred him to write the book were that it is estimated that only 10% of concussions that occur on the field are ever diagnosed, and the worst thing you can do after getting a concussion is go back out and play, which is almost always what happens, from the pee wee leagues to the NFL.

The worst case scenario for athletes who receive 3 or more concussions is cumulative trauma encephalopathy, or dementia pugilistica. This kind of brain damage causes personality changes, progressive dementia, depression, and has led to suicide in several prominent former NFL players, and probably to the suicide and double homicide committed by Chris Benoit, the former WWE wrestler. Sending young athletes back out on the field too soon after a concussion can also cause a rare but devastating brain condition called Second Impact Syndrome, in which the brain loses its ability to regulate the size of the blood vessels and massive cerebral edema ensues, which can rapidly kill the athlete. SIS is much more rare than CTE, but receives a lot more attention--perhaps this gives the public the impression that the serious sequellae of concussions are very rare, when in fact for a football player, or a wrestler, or boxer, or anyone who receives numerous blows to the head, CTE is not rare but is certainly devastating to the athlete and to his family.

If the NFL took care of its players after they received these injuries, it would be easier to cut them some slack. But Mike Webster, "Iron Mike" to Steelers fans, left the game completely debilitated by the effects of an estimated 25,000 on-field collisions over the course of his 17 year career. Instead of enjoying his retirement and Hall-of-Famer status, Mike ended up homeless, living out of his car, unable to remember where he was at times, incapable of making sound decisions, and begging his children to stun him into unconsciousness with a Taser so he could get some sleep. When he died at 50, his brain was examined by a neuropathologist who studies CTE, and found to have severe, extensive brain damage consistent with CTE. While Mike suffered, he applied to the NFL's retirement plan for active players' disability, but was denied. The owner of 4 Super Bowl rings didn't even have health care insurance. His story is extensive and sad, but also illustrates the lack of regard that the NFL has for the men who put people in the stands and who make money for the owners, and also the lack of knowledge about the "invisible" head injuries, which often aren't as obvious when they happen as a knee in a brace, or a guy on crutches.

In future posts, I'll talk more about the 4 NFL players who were recently diagnosed (post mortem) with CTE, as well as Chris Benoit's case, which the media and public fairly quickly (and inaccurately) dismissed as "roid rage" and forgot about. I'll talk about how athletes are taught to play injured, how coaches pressure trainers and teams pressure doctors to get players back out there, and about other famous athletes whose careers ended with post concussive syndrome. I also might talk about what football could do to reduce concussions and their sequellae (no, it's not better helmets). In the meanwhile, I'd highly recommend picking up a copy of Head Games, if this subject interests you. It's very well written, intended for the public, and particularly athletes at all levels and their families. It's a quick read, check it out.