The Concussion Crisis

by Linda Carroll

  Despite amnesia, insomnia, headaches, and dizziness, Showalter soldiered on all week as if nothing had happened. He continued banging helmets every day at practice, then ratcheted up the intensity on Saturday when he finally got into a game. At the next day’s film session, as he watched replays of the game with his teammates, Showalter couldn’t remember a single play he’d made, not even the block he threw to clear the way for his roommate’s touchdown run. As if by pure instinct, he kept right on practicing each weekday and then playing on Saturdays as a late-game substitute. Every time he made contact, his symptoms worsened—the headaches growing into migraines, the dizziness escalating into vertigo. Within a few weeks, just a hundred-yard sprint down the field was enough to send his head spinning.

  Still, it wasn’t any of the symptoms he experienced on the gridiron that finally persuaded Showalter to seek help—it was something that happened in the classroom. A month after the Wake Forest game, he dug out his spiral notebooks to prepare for midterms. As he leafed through the pages filled with meticulous notes, he started to get scared. Nothing looked familiar. He tried to recall the lectures that went with the notes and realized he couldn’t remember even being in the classes that the handwriting proved he’d attended.

  Showalter had always had the kind of memory that allowed him to read through a page of notes and immediately conjure up an image of the professor actually speaking the words. He was prouder of that detailed and dependable memory—and the academic achievements it helped garner—than any of his athletic accolades. He had graduated near the top of his high school class, earning membership in the National Honor Society with a 3.75 grade point average. He had chosen to attend Rutgers, over universities with stronger football programs, because of the academic opportunities it promised. Once there, despite the full-time commitment of playing big-time college football, he continued to shine in the classroom, making dean’s list with a 3.5 grade point average and securing a spot on the Big East Conference All-Academic Team.

  Now suddenly, before he could complete his first season playing for Rutgers, the athletic prowess that had earned him this academic opportunity was threatening to take it away. Worried he was on the verge of losing everything he’d worked so hard to achieve, Showalter finally was able to push past football’s macho code and admit to the team physician, “Listen, I think something has happened to me.” Exactly what that was would remain a mystery until Showalter went to see the team neuropsychologist.

  • • •

  Jill Brooks looked up from the medical charts spread out on her desk as Dave Showalter stepped into her office for his initial consultation. She was struck by his soft, rounded features and his kind brown eyes. The face didn’t seem to fit the powerful, sculpted form towering over her; and his soft-spoken, easygoing manner didn’t match the intense and fierce temperament usually associated with the position he played. Brooks could see this was not your typical jock.

  When Showalter started to describe what had happened to him, though, it became clear that his story was all too typical. It was a story Brooks had heard countless times in nearly a decade of treating college and high school athletes for concussions at Robert Wood Johnson University Hospital in New Brunswick, New Jersey.

  She started to prod Showalter for more details about the helmet-to-helmet collision in the warm-ups at Wake Forest.

  “Do you remember getting a strange taste in your mouth after you got hit?” she asked.

  Showalter’s large eyes widened. “Yes,” he said slowly. “How did you know that?”

  “Was it a kind of metallic taste?” Brooks asked.

  His eyes widened further. He was surprised that this specialist seemed to know all the details of a bizarre symptom he thought he alone had experienced. “Yes. It’s happened every time I got hit hard. Nobody’s ever been able to tell me what it was.”

  Brooks explained that the taste was a sign he’d suffered an “impact seizure” and that it was not uncommon for badly concussed athletes to experience one. “What it means is that the force of the hit was so hard and so directed that you had a seizure on impact. The electrical activity in your brain was disrupted because of the force. We call it an impact seizure because you might think you had epilepsy if we simply called it a seizure and typically impact seizures are just one-shot events.”

  Showalter was silent, the word “seizure” leaving him too stunned to respond.

  “The other symptoms—how long did it take for them to go away?” Brooks asked.

  Showalter hesitated. He was getting more nervous. “They haven’t gone away,” he said. “They’ve just gotten worse.”

  Showalter told Brooks about his amnesia, the dizziness, and the headaches. He told her that his brain felt foggy and that he’d been having trouble concentrating. He admitted that the symptoms worsened with even the slightest bump by another player.

  Brooks wrote it all down, and then, after a brief pause, told him what it meant.

  A concussion, she explained, was a serious injury. It wasn’t just a “ding” or just “getting your bell rung.”

  “You can’t look at it any other way, because this is an injury to your brain,” she said, “and your brain controls everything that you do—from breathing to moving your extremities to your thinking to your emotions. Your brain controls it all. And if you get repeated injuries and repeated impact seizures, you start having difficulties with thinking in class and with follow-through and with sadness and with all that other stuff.”

  A concussion, she went on, needed to be taken as seriously as any visible injury—more seriously, in fact. She told Showalter he needed to give his brain time to heal. He would have to take time off from all physical activities. There would be no football, no weightlifting, no running, no stationary bike. What Brooks couldn’t tell him was exactly when he’d be better. “If you broke your ankle, I could tell you it would take six weeks to heal,” she said, “but with a brain injury, it’s not like that and there’s no way of telling how long it’s going to take.”

  Showalter took a few moments to process all the new information. Finally, he said, “I’ll be back by next season, right?”

  “Dave, you should not be playing football,” Brooks said, drawing a deep breath. “You should never think of playing football again.”

  Showalter stiffened. A swarm of thoughts spun through his mind: “This can’t be right. She’s just being overprotective. I’m young; I’ll heal; I’ll be fine by next season.”

  As Brooks watched him mulling over the unwelcome advice, she worried that she had not driven her point home. The silence was going on too long.

  “Dave, this could be permanent,” she said finally. “You’ve had multiple concussions—there’s no way of knowing how many—and the effects can be cumulative. Your brain might not heal one hundred percent. Your memory might never come all the way back.”

  • • •

  The short walk back to campus from the hospital was all a blur as Showalter desperately tried to get his mind around everything Brooks had just told him. As he passed the school’s colonial buildings and the site where Rutgers had hosted the nation’s first intercollegiate football game in 1869, Showalter pondered the doctor’s orders to give up the sport that had defined his identity for as long as he could remember. He had walked into Brooks’s office still harboring dreams of playing in the NFL, and now he suddenly had to resign himself to this new reality that didn’t include football at all.

  Over the next few months, Showalter followed her prescription for allowing his brain to heal. By the end of the school year, all the concussion symptoms seemed to have resolved. His memory was back, his brain clear. He felt so much better that he figured he could ignore Brooks’s recommendation to give up football.

  He played the next season for Rutgers without being sidelined by concussions—but his transcript was starting to reflect their impact. That semester, he failed a course for the first time ever as his grades spiraled downward. He couldn’t understand
why schoolwork, which had always come so easily, was now impossible. He was embarrassed by his grades, and depressed.

  To make matters worse, when Showalter’s injured ankle failed to rebound the following spring from a third surgery, his coach pulled him aside and said, “You’re done.” Cut from the team, Showalter tried to concentrate full-time on academics. But by then, not even all the extra study time could help. He would read the same paragraph over and over and over again, and still not remember a word. That semester, he failed three of his four courses. When fall rolled around, Showalter felt even more depressed, and alone. Unable to count on his brain anymore, he decided to drop out of school.

  He moved into a tiny one-room apartment above a corner store, just a short walk from the classrooms where he once felt at home. He traded the semester’s scholarship check for a $3,000 car so he could support himself making daily deliveries for a local bagel shop. When Rutgers officials noticed that he had cashed his check but not shown up for classes, they demanded the money back. He immediately started paying down the debt in $25 weekly installments.

  In 2007, six years after dropping out of college, Showalter was still living in the same ten-by-ten apartment with a futon for a bed and a hot plate instead of a stove. He still had the delivery job and had begun working with autistic children in the afternoons and evenings at a New Brunswick community center. Some days, he’d sit back and survey his sparsely decorated room and reflect on how his life had turned out. He’d think about the careers he once considered pursuing—teaching, public relations, medicine. This certainly wasn’t where he thought he’d be at age twenty-eight. When he left the modest two-story brick house that his parents bought with money scraped together from their jobs at the phone company, he thought his possibilities were boundless. Of the six Showalter children, Dave had been the one everybody knew would make it big. Now he could only dream of someday going back to Rutgers and resuming his studies.

  Trying to make some sense of it all, Showalter started giving occasional lectures on the dangers of concussions to coaches and trainers. “I feel like I got lost in the shuffle,” he’d tell them, “so it’s important to me to raise awareness about brain injuries. They can make a huge impact on a person’s life. I mean, I can’t even remember much of what happened my last two years in college.”

  The cautionary tale would always amaze his listeners. Who would ever think that seemingly innocuous bumps on the head could erase entire years from a memory and derail a life?

  Chapter 2

  The Emerging Epidemic

  In the classic image of a concussion, a player is lying motionless on the turf with teammates hovering over him and a trainer racing across the field. Smelling salts are waved under his nose, and the player shakes his head as he comes to. The trainer asks him, “How many fingers am I holding up?” The player’s answer is the same as always: two. That’s because the trainer makes it easy by always holding up the same number of fingers and then rewarding the correct answer by sending the player right back into the game.

  That inside joke among players and trainers depends on the belief that concussions are as harmless and transient as the cartoon stars floating around Sylvester the Cat’s head every time he gets bonked. Even the words used to characterize a hit to the head—from merely getting “dinged” to just getting your “bell rung”—make light of any possible consequences. It’s hard to take seriously an invisible injury with subtle symptoms that often seem to pass quickly.

  Since even before the first recorded wrestling matches five thousand years ago in Mesopotamia, concussions have been an unavoidable part of sports. Nevertheless, they have remained at once the most common and most confusing of head injuries. Only in the past decade have brain injury specialists finally come to a consensus on what constitutes a concussion: any change in mental status such as confusion, disorientation, headache, or dizziness following a hit or jolt. And they all agree that a concussion, contrary to popular belief, does not require loss of consciousness or even a bump on the head.

  This definition, however, has yet to permeate the sports world. Many athletes don’t even realize when they’ve sustained a concussion. Unless they’re knocked senseless or seeing stars, they’ll dismiss symptoms as no more worrisome than a scratch and cover them up for fear of appearing weak. For their part, coaches, trainers, and even team physicians don’t understand concussions much better than athletes do.

  Because people take them so lightly, concussions often go undiagnosed and undocumented. That’s why nobody really knows how many athletes actually sustain concussions each year, let alone how many Dave Showalters are living with permanent brain damage from them. Estimates by the Centers for Disease Control and Prevention (CDC) range anywhere from 1.6 million to 3.8 million sports-related concussions in the United States annually. Whatever the actual number in a nation with more than forty-four million kids playing sports from youth leagues through high school, there’s one thing experts agree on: the problem has reached epidemic proportions.

  It’s remarkable how poorly understood concussion remains today considering that the condition was formally identified over a millennium ago. In the year A.D. 900, the renowned Persian physician and alchemist Rhazes introduced the concept of concussion to the medical world, defining it as a transient impairment of mental status following a jolt to the head. After that, the misconception of concussions as mild, short-lived phenomena would stick stubbornly in the public consciousness. They were the butt of jokes in popular culture everywhere from the Three Stooges to Wile E. Coyote.

  But all the concussion jokes stopped being funny when stories started to circulate about kids dying after seemingly innocuous hits on the football field. These weren’t highly paid pro football players being knocked out in a profession predicated on violence; they were kids playing a kids’ game. Suddenly, the symptoms weren’t subtle anymore. They were dramatic and deadly.

  • • •

  On a brisk fall New England morning in 1984, Dr. Robert Cantu could be found hiking up and down the sidelines of the local high school football field, eyes scrunched in concentration and hands stuffed deep inside his jacket pockets for warmth. Each time one of the teams moved the ball downfield, Cantu would stride after the players and reposition himself on the line of scrimmage. As the sideline physician for high school games in and around Concord, Massachusetts, he wanted to stay as close to the players as possible so he wouldn’t miss any potentially serious spine or head injuries.

  With a young son already playing Pop Warner football, Cantu had stepped up when town officials came looking for a volunteer to fulfill the state’s mandate that a doctor be present at every high school game. He figured that a neurosurgeon, like himself, would be best prepared to spot and to handle the types of injuries inherent in football. So each Saturday morning, the slim, redheaded physician would pull on his jeans, running shoes, and, depending on how bitingly cold the weather was, a windbreaker or parka and then drive over to monitor that week’s game. Although Cantu always felt a little nervous as he looked out for injuries, he enjoyed watching football, especially from a vantage point so close to the action.

  But on this particular Saturday, Cantu was more worried than usual. As he strode up and down the field, he couldn’t get his mind off an article he’d recently read in a medical journal. That article described the death of an unnamed nineteen-year-old college football player three years earlier following a seemingly minor jolt to the head.

  In late October of 1981, Enzo Montemurro, a compact five-foot-eight, 190-pound fullback on Cornell University’s freshman team, took the field at Dartmouth College eager to show the moves that had made him Toronto’s high school MVP. Right from the opening kickoff, Montemurro looked like he was going to have the best game of his young college career, gaining a total of thirty-two yards the first six times he carried the ball. Then, on a routine play where his assignment was to block would-be tacklers from getting to a ball-carrying teammate, Montemurro bumped an opposing p
layer. The contact hadn’t been particularly solid, so everyone was shocked when the college freshman suddenly collapsed on the sideline after walking off the field with no apparent problem. The team physician and trainer immediately raced over to help, but within seconds Montemurro lost consciousness and became completely unresponsive. He was loaded into an ambulance and rushed the quarter of a mile to the Dartmouth hospital.

  The instant Montemurro was wheeled through the emergency room door, Dr. Robert Harbaugh, the neurologist on call that day, recognized that the situation was dire. Montemurro was in a deep coma, and his breathing was so irregular that he had to be put on a ventilator. A quick test suggested that the pressure in his head was dangerously high. Harbaugh promptly paged the hospital’s chief of neurosurgery, Dr. Richard Saunders, who was in the midst of morning rounds. Saunders ordered a CAT scan, which confirmed that there was extensive swelling on the right side of Montemurro’s brain.

  As the two doctors conferred over what would be the best course of action, Harbaugh looked down at the young Ivy League athlete lying motionless on the hospital bed and thought, “This is a person who has his whole life ahead of him—we’ve got to do something.” Saunders told him that the only hope was to remove a section of Montemurro’s skull to relieve the pressure on the brain. Saunders wasn’t optimistic about Montemurro’s chances, but he agreed that they should do everything possible to try to save the teen’s life. Although the operation successfully relieved the pressure on Montemurro’s brain, it didn’t improve his condition. Four days later his family decided it was time to disconnect the ventilator, and Enzo Montemurro died.