Second Impact

by David Klass

  “Oh, here’s a study you’ll like,” she said, clicking through some links on her computer. “This guy took knees from cadavers and studied them.”

  “Just the knees?” I asked, feeling a little queasy at the thought.

  “Yes, just the knees. And he looked for cadavers with ACL damage. And then he attached the knees to this machine he built that simulated the forces of various athletic activities.”

  I was thinking maybe Dr. Abbot had gotten a little carried away. I mean, just because I was willing to watch my own surgery from a happy-juice haze didn’t mean I wanted to think about zombie knees, cut from corpses, hooked up to torture machines. Why would she be going on about this and looking so enthusiastic? Any minute, I was afraid, she would click a picture onto her screen and there they would be, Knees of the Living Dead.

  “And so what he found—and this is really interesting, Carla—is that it’s pretty individual. Some of the male cadaver knees tore right away, some of the female knees with the same forces, no damage at all.”

  “Wow,” I said, trying not to picture it. “Interesting.”

  “But anyway,” Dr. Abbot went on, “it’s pretty clear that even if we can’t specifically identify all the reasons, female athletes are at higher risk here. Maybe it’s the physiology and the hormones, maybe it’s the conditioning, maybe it’s even the style of play. But there are way too many girls—and good athletes, too—getting ACL reconstructions these days.”

  So anyway, I took a lot of notes, and I recorded everything she said. She was so eager to talk about this stuff that she had actually put aside a big pile of X-rays and MRI scans to show me some of her favorite injuries. I mean, it sounds silly to say it that way, because of course she doesn’t want to see people get injured, but it was pretty clear that she just loves talking and thinking about things that can go wrong with the knee and the elbow.

  I spent the whole week working on this, and I’ve done my big story on “Injuries and Athletes: The Sports Doctor’s Perspective.” Sophie is working on some great photos—Dr. Abbot let her photograph a couple of the MRI scan images. The story will run in the Kourier on Monday next week, so I just want to hype it here—but it won’t just be about ACL tears. We also talked a lot about Tommy John surgery, which is something that baseball pitchers get on their throwing-arm elbows. The surgery is related because it’s about replacing another important ligament, the ulnar collateral ligament, with a tendon that you take from somewhere else in the body. We cover why younger pitchers are getting operated on and whether the rules about pitch count really make a difference. The thing is, pitchers don’t suddenly blow out their elbows by landing wrong, Dr. Abbot said, it’s more the wear and tear of throwing hundreds and thousands of pitches. So there’s this belief that if you restrict pitch counts, especially in younger pitchers, that might protect them.

  Anyway, I’m not going to give away the whole article here, but I think it’s pretty interesting. Dr. Abbot gave me some great quotes about what it feels like to repair these things and send kids out again so they can play. I also interviewed Mr. Feldman, the honors biology teacher, about how joints work, and Dr. Abbot connected me with one of the guys she did Tommy John surgery on back when she was doing her fellowship, and he told me about what it felt like to pitch before and after. I also called up Jerry’s mother, and she talked to me some more about doing rehab with athletes. It’s a pretty solid story, if I do say so myself, with a nice Kendall Hospital spin on it. All of which is to say, check out Monday’s Kendall Kourier for “Athletes and Injuries, Part I.” Yup, I’ve decided this is a pretty interesting subject, and I’m going to keep working on it. I mean, what else is my life all about right now?

  So now I’ll stop scooping myself—you’ll have to read the paper to find out what the pitcher told me, and whether his arm really did come back to where it was before, and all the cool statistics I dug up.

  But here’s what I wanted to write about, because it comes back to that story that Jerry told about me at his house. After I did this long interview with Dr. Abbot, and we looked at some of the films, and I was getting ready to close my notebook and turn off my tape recorder and head on home, we got to the question of reinjury and athletes going back out there on the field.

  “No question,” she said, “some of the repairs and reconstructions we do leave girls at higher risk to hurt their knees again. It’s not supposed to be like that. The reconstruction is supposed to solve the problem, but you have to work with the materials you have.”

  “What about emotionally?” I asked.

  “What do you mean?”

  “Do you ever find that people play differently after they’ve been hurt? That they’re more cautious, or more self-conscious?”

  Dr. Abbot isn’t a fool, and I could see that she knew I was talking about myself. She leaned forward across her desk, and I could see a thin gold chain around her neck, hanging down into her scrubs, but I couldn’t see what was on the chain.

  “Sure,” she said. “For some people, maybe especially some athletes, maybe especially some young athletes, it’s kind of surprising news that they can really be hurt, they can really be stopped by an injury. Just like that, one minute you’re fine and your body is doing what you tell it to, your athlete’s muscles are working, and your athlete’s heart is pumping away, and then something slips or something breaks or something sprains and you just can’t tell your body what to do. And that’s kind of a shock to the system in two ways, first because of the pain and the medical effects of whatever you’ve done to yourself, and second because you just can’t will yourself over this particular hump.”

  I flipped my notebook closed, but I left the tape recorder running.

  “When my knee heals,” I said, “when it’s finally all better—”

  “Which it will do,” she said, and smiled at me. “It will heal and it will finally be all better.”

  “Well, when it does,” I said, “the thing is, I don’t know if I want to get back out there and play. You know, if I want to get back on the horse.”

  There, I had said it. I had even captured it on tape.

  “Ah, yes,” Dr. Abbot said. “The proverbial horse.”

  “You know what,” I said, and I realized I was talking kind of fast, because I was so relieved to have finally said this, on my own terms, “I don’t think I would enjoy trying to make myself play really, really hard, like you have to if you play serious soccer, when all the time I’d be thinking about what I went through with my knee. And I’d just be waiting for that random twist, or that bad landing, or that kick that gets a little out of my control, and there it is, I’ve undone the whole thing. I’ve broken it again, all the healing was for nothing, and all your work was for nothing, and the pain comes back … I don’t mean that this would happen, I just mean how would I ever play without thinking about it a little, and won’t it get in my way?”

  “It might,” she said. “There are people who are so relieved to be playing again that nothing gets in the way. There are people who have to psych themselves up in a whole different way. But as I’ve just been showing you, there are probably some training regimens that can change the odds for you, so if you decide you do want to play—”

  I interrupted her. “I’m not sure I want to play,” I said, a little too loudly.

  Dr. Abbot looked at me with a kind of considering look, like she was adjusting whatever she had planned to say.

  “For years I’ve figured that my senior year would be all about convincing colleges that I was their future girls’ soccer varsity player. But now it turns out that my senior year is going to be about arthroscopic surgery, pain, and rehab—”

  “And so that’s making you rethink?”

  “I don’t know,” I said. “It’s complicated. Part of it is that I’m thinking, well, I’m not selling myself to colleges as this big soccer player, so does that mean I don’t have to be a big soccer player once I get there? That maybe I can do other things for the next four year
s, and know some different people, and just kind of keep my options open?”

  I had meant to sound confident, but when I listen to that part of the tape, I can hear that my voice gets kind of squeaky.

  “That’s how I felt,” Dr. Abbot said. “I had a knee injury back when I was in college. I didn’t need a graft like you did, but I had to have a repair done, and I had lots of physical therapy. And I just realized that, well, I was actually more of a weekend warrior.”

  “What do you mean?” You know, my dad always says that surgeons are weird—can you imagine that she’s been checking my knee and taking care of my knee and operating on my knee and up till right then she never mentioned that she had had knee surgery, too?

  “I thought about it, after I spent most of a semester on crutches—we weren’t rehabbing people as quickly back then—and I realized that if it were really up to me, I would play pickup games with friends every now and then, but I wasn’t cut out for serious college sports, especially combined with premed. And that’s what I told my coach and my teammates. I told them I needed to buckle down and get the pre-med grades, and that was my priority. And it sort of was. But it was also this realization that I was, well, like I said, a weekend warrior.”

  “Maybe that’s what I am, too,” I said.

  All of a sudden, and I’m not sure why, I wanted to know all kinds of things about Dr. Abbot. I wanted to know whether she always knew she would be a doctor, and whether she always knew she would be this kind of a doctor, and whether it ever grossed her out to think about cutting the knees out of corpses, but I also wanted to know what her house looked like, what she actually did on her weekends (besides attend the occasional Kendall football game), and whether she was married, or had a boyfriend, and what she really thought of my father and the way he was running the hospital. I had been in her office interviewing her for almost an hour, and I suddenly wanted to start all over again with a whole new list of questions.

  But she was already answering the question I hadn’t quite asked.

  “You can’t decide that right now, Carla,” she said. “Or at least, you shouldn’t. You’re in pain, you’re too close to the surgery. Concentrate on the physical therapy, concentrate on getting better. This is a bad moment for life decisions. Your body’s still traumatized, and so is your head. When you feel better, when your knee is working, when you aren’t spending every day playing games with yourself about when is the pain so bad I need a painkiller—”

  “How did you know that?” I asked.

  “I know athletes,” she said. “I would bet anything you don’t like the fuzziness that comes with the painkillers. I bet you’re toughing it out through the school day—”

  “And then,” I said, “when I get home, I don’t want to cloud up my brain because that’s the time I write. That’s when I blog, that’s when I do my articles.”

  “But you’re in a lot of pain by the time you get home, too, I bet.”

  “Sometimes,” I said.

  “So wait till this all gets better. I promise you, I’m not just saying to get back on that damn horse. I’m telling you this is the wrong moment to make decisions. Get better, get your body back, and then think it over.”

  So that was the interview, with Carla’s little therapy session thrown in for good measure. I packed up my tape recorder and my notepad and the research articles she had printed out for me.

  I thanked her for her time and told her what a great subject it was, the athletes and injuries. She said I should think about some of the other categories of injuries and even about the whole history of protective equipment, especially for football. You could write about spinal injuries, she said, and about head injuries. You wouldn’t want an orthopedist for that. You’d want to go after a neurosurgeon.

  So I’m working on it. I haven’t tracked down a neurosurgeon yet, but I’ve learned a lot about the brain and about the ways that you can protect it, even when huge, strong guys are trying their best to tackle one another. I’m planning to talk to a couple of athletes who’ve had these injuries and hear about their version of rehab, and so on. So read part one and watch for part two!

  View 3 reader comments:

  Posted by user StrongerThanEver at 11:13 p.m.

  I had my ACL repaired two years ago, and the first time I set foot on the soccer field after that I was running on egg shells, but pretty soon you forget everything that happened because it’s true what they say: it heals stronger than it was to begin with. I’m running just as fast and cutting just as hard now as I ever did; I even run stairs! Your body will let you know when it’s ready and then, if you love soccer, go for it!

  Posted by user SoccerMom at 11:13 p.m.

  In my opinion there needs to be more emphasis on conditioning in girls’ soccer from the youngest ages. There’s not enough stretching and not enough drills that strengthen the important muscles. Science has shown that girls’ bodies are demonstrably different from boys’, and the only way to protect the feminine physique from overexertion and irreparable damage is to engage in regular stretching and conditioning.

  Posted by user @SoccerMom at 11:14 p.m.

  Also, they look hot in Lycra when they’re stretching …

  Comment deleted by user Ms_Edison at 11:15 p.m.

  SAND RIVER

  Posted by user JERRY on November 22 at 8:47 p.m.

  It started snowing during the night, an early season dusting, so that when I woke up and looked out my window, the dawn light that filtered through my curtains and glistened off my trophies seemed to sparkle with magic dust. A name came to me right away. Sam Taggart.

  I lay in bed and watched my trophy shelf come alive, and thought about the matchup to come. We hadn’t faced each other last year, because of my suspension, but now it would happen. I was the best at my position, and he was the best at his. I wanted to throw in his direction, at him, over him, and through him. Taggart was being heavily scouted by major college teams, and I wanted those scouts to see us going at each other full on, mano a mano.

  I pulled on an extra layer for my morning run and headed over to Danny’s house. I rapped on his back door, and when he opened it he was zipping a fleece jacket over a thick sweatshirt that I believe covered a long-sleeved cotton team practice jersey. His dad spotted me from the kitchen, where he was making coffee. Mr. Rosewood is the deputy captain of our town’s police force.

  Danny’s mom died of cancer when he was four. His dad nursed her through the long illness and then raised Danny on his own. They’re as close as a father and son can be. I remember riding with them in a police car when Danny and I were six, and Mr. Rosewood let us turn on the siren and flasher, and even speak through the loudspeaker. At the time, I thought it was the coolest thing a dad could do.

  He turned to me and waved with his coffee mug. “Hey, Jerry. Kick some butt today.”

  “Gonna try, Mr. Rosewood. You coming to the game?”

  “Yup. Freed myself up for it. I’ve been reading the sports pages. Taggart sounds like a beast.”

  “The Monster of Sand River.” I nodded.

  “You’ll slay him,” Mr. Rosewood said.

  Danny came out the door pulling on what looked like ski mittens and banging his hands together as if they were already feeling frostbitten. “Let’s get this over with.”

  “Sure you’ve got enough layers on?” I asked him.

  “Unlike some people, I’m not part Eskimo,” he grunted.

  Actually, my ancestors are mostly Irish, and I doubt I have any Eskimo blood kayaking around in my veins. But I do like the cold. There was a sharp bite in the air. “Football weather,” I told Danny. “You gotta love it.”

  “I hate it,” he said, and took off down the block.

  The fresh powder was still soft enough not to be too slippery. Wind gusts stirred up snow devils that hovered and swirled before disappearing back onto the roadway. We ran three miles side by side, our breaths fogging the winter air, and I knew the same name was hammering away at both of u
s with every footstep.

  “You ready for Taggart?” I asked Danny as we circled the old factory. “Or should I throw away from him?”

  He gave me a look back that said he welcomed the challenge of being covered by the best pass defender in the county. “Just make sure you lead me.”

  “Danny, I gotta say, I think he can run step for step with you,” I told him.

  “We’ll find out soon enough,” he responded with his usual mix of modesty and quiet confidence, and picked up the pace.

  I stayed with him for half a block more and then started to fall back. I could only watch as he set sail for home through the silent white streets of Kendall, his elbows swinging rather than pumping and his track shoes rising and falling in that loping stride that should have been a jog but ate up ground like a full-on sprint.

  During my darkest days, when I was picking up trash for community service, keeping my distance from the team, and wondering who my friends still were, Danny made it a point to jog by every day. I’d spot him far off, motoring toward me with that easy stride, and he’d stop to chat and tell me some news from the team or a bad joke. Then he’d flash me that goofy grin of his and say, “Don’t get too down on yourself, Jer. You’ll be back soon.”

  Now it was game day at Sand River, and Sam Taggart was waiting for both of us. I knew Coach Shea was thinking about sitting me out for one more game, to be supersafe, but I was determined to play. Of course, when you get your bell rung as hard as I had against Midland, it’s always in your mind that you could get hit again, even harder, but I pushed the fear as far away as I could.

  I had looked up concussions online and was sure that mine had been mild. I hadn’t completely blacked out or had any memory loss. I had no repeat vomiting, no dizziness or ringing in my ears, and no drowsiness. Except for a headache that soon went away for good, none of my symptoms had come back. I had taken a pop, let it heal, and now I was good to go. I’ve played whole seasons without taking a hard shot to the head. What were the odds I’d take another one in my very next game?