Head-On Collision

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On May 2, 2012 Junior Seau shot himself in the heart, leaving legions of his fans and friends heartbroken.

Seau was apparently convinced that his unending depression was linked to playing football and wanted to leave his brain intact to be studied. It was the third time an ex-NFL player had committed suicide, in such a fashion. Seau’s death raised the volume of the concussion conversation from a persistent whisper to a fever pitch.

Just 28 days before Seau’s suicide, the New England Patriots played the New York Giants in Super Bowl XLVI, the highest-rated telecast of all-time. Football’s popularity was reaching an ever-escalating zenith just as health and medical leaders expressed concern over the viability of a sport whose veterans were killing themselves or suffering unimaginable brain deterioration.

Across the country over-enthused, under-informed young athletes eagerly lace up their cleats and strap on their helmets. On Sundays, Americans visit the mega church that is the NFL, but Fridays and Saturdays are reserved for local youth football. Communities congregate in their local stadium cathedrals under bright lights that pierce through the night sky, scarfing down dollar hot dogs and taking in halftime festivities. They have gathered to watch high school and college athletes try their hand at America’s favorite game.

Often tragedy ensues. Southwest High School junior tackle Kevin Montes suffered a concussion on what appeared to be a routine collision in the third quarter of a 34-6 game his team trailed. He lay motionless on the field for nine horrifying minutes. An ambulance ground its way past the cheerleaders and dirt track before carrying the still-motionless Montes out of the stadium. Players from both schools began to approach the line of scrimmage and prepare for the next play before the ambulance had cleared the field. Referees put the ball in play and the game resumed within 45 seconds after the 18-minute injury stoppage. Next man up.

“I remember being in the back of the ambulance with my helmet and pads still on,” Montes said. “I was dizzy and my hand started to get real numb. Since I have epilepsy I was afraid it was going to trigger a seizure. It was pretty scary.”

Montes did not have a seizure, but he did suffer from concussive side effects.

“In the first week I had a lot of migraines,” he said. “I would wake up with one, then it would go away, then at night I would get another one. I couldn’t focus that much, a little bit of memory loss. If I was talking to you I might forget what I just said.”

Montes sat out for four weeks with concussion-related symptoms, but now that his migraines have subsided Montes said he is intent on returning to the field.

“I know it’s a danger, but I just like the game too much,” he said. “I was scared at the moment, but I knew I was going to get better and come back to play. If I get hit during the game and it’s just a little migraine well, you know, I’ll just keep playing.”

Southwestern College athletic trainer Dennis Petrucci said combatting youthful naiveté is one of his main challenges as a trainer.

“A lot of these kids have never been injured before, they are young enough to still have that Superman invincibility,” he said. “We tell these kids there’s certain things we don’t mess around with. We don’t mess around with the brain, heart or spinal cord. It’s not like a knee or an ankle where you can go have surgery and we’ll rehab it and get you back.”

Petrucci said treating brain injuries carries an element of uncertainty.

“There are a lot of symptoms, that’s the problem,” he said. “We are talking about your brain, your brain controls everything. If someone has a concussion there is not much you can do, you just wait for the symptoms to be gone.”

Football’s sometimes unsettling level of violence is nothing new. In 1905 Teddy Roosevelt, no shrinking violet, threatened to ban the sport entirely. That year 18 players died. In response to this a rules committee was established to make the game safer.

What has markedly changed, however, is the medical information surrounding head injuries and the sports’ ubiquity within American culture. Imagining the ludicrousness of President Obama attempting a similar maneuver speaks to the game’s meteoric ascension.

In September, Frontline aired a report that said 87 of the 91 former NFL players whose brains were studied, tested positive for chronic traumatic encephalopathy (CTE), the brain disease at the heart of the concussion debate in football. Even more troubling, the lab found CTE in the brain tissue in 131 out of 165 individuals who, before their deaths, played football at any level.

Yet NFL profits continue to soar. Last year, the league’s teams had a total revenue of $9.17 billion and NFL games accounted for 23 of the 25 most-watched telecasts last fall. Both issues, though inextricably linked, seem to have completely no effect on each other. Normally, when an industry has a wide-ranging health concern, support for the industry wanes. It is a legitimate phenomenon.

This dichotomy is creating some ambivalence among football fans. SWC head football coach Ed Carberry said his views on the issue have evolved.

“I’ve done a complete 180 degrees on this issue,” he said. “Back then people would get hit, everything would go black for a second and it was fine. In the early years when I coached high school football, I was the coach and the team doctor. If you came back to the sidelines and gave me an audible sound, you were going back in. That’s how it was 30 years ago. Now at the college level we have a trained staff and whatever they say goes. There’s never an argument.”

Carberry said he believes football will remain unfettered.

“I think football will continue to maintain the level that it has attained,” he said. “My wife and I were in Texas recently visiting a high school, they have two freshman teams and two junior varsity teams with 80 to 100 players a piece coming out for them.”

Just nine miles from where Kevin Montes sustained his concussion, Chula Vista High School senior linebacker Yusuke Titmus suffered a similar hit in the fourth quarter of a game between two winless teams. The game was paused as he lay on the field. After four excruciating minutes of minimal movement, the training staff helped him to his feet and attempted to walk the clearly shaky linebacker to the sidelines. He collapsed again halfway to the bench. As the staff attempted to gather him again, the announcer informed the fans that they could use this break in the game to purchase $1 hot dogs that were almost sold out.

After being inspected by the training staff on the sidelines as the game went on behind him, Yusuke said he was unsure of his future.

“The plan is to keep checking on me every 30 minutes,” he said. “If my headache gets worse we’ll go to the hospital to make sure my skull isn’t fractured. If everything is fine we’ll go to the clinic tomorrow.”

Yusuke said this was not his first time going through this procedure.

“I’ve already had two concussions,” he said. “It’s depressing to think that my career might already be over. After three concussions you can’t play anymore. I’m hoping it’s not a full-on concussion so I can still play football.”

His parents anxiously sat behind him, vacating the bleachers and taking up residence on the sideline bench next to his teammates.

His parents, Matthew and Josephine Titmus, said they were not pleased with how his injury was handled by school staff and game officials.

“I think they should have evaluated him more, it was not good the way he was walking, especially with spinal and neck injuries,” said Mr. Titmus. “That was messed up.”

Mrs. Titmus agreed.

“Yes, I did not like that,” she said. “I saw it, I really saw it. My son could not walk. I was shocked.”

Mrs. Titmus said watching games is not fun.

“I’m really scared the whole time until the game is completely finished,” she said. “I have no peace of mind, I’m so nervous. Is this a part of the game? Some of this is not normal play. Some of this is crazy. They have to make this safer.”

Her husband interjected.

“Yes, it’s a part of the game.”

Petrucci said that as a sports trainer he has always been aware of the dangers of concussions, but was surprised by how many people are affected by some of their more harmful side effects.

“We were aware of the possibilities, but I don’t think we realized to the degree that it was happening,” he said. “I think we knew (prolonged depression) was possible, but I thought it was rarer. Once I saw all these ex-NFL players file suit and say they had all these issues, that’s when I tapped the brakes a bit.”

Petrucci said as a lifelong fan of the sport he is conflicted.

“There was this YouTube sensation, she was this little girl,” he said. “She was running guys over, she was amazing. And I thought, this is the coolest thing I’ve ever seen. But then you realize how many hits she’s taking and how young she is and you realize, that can’t be good. I have two daughters, 6 and 4. I told my wife, I’m glad we don’t have a son so we don’t have to make that decision.”

Three weeks after Yusuke’s concussion, his life still had not returned to normal.

“Ever since the injury, school has been sort of difficult,” he said. “Not to the point that I can’t do it, but I get random headaches from time to time, like if read something or work on a worksheet.”

Yusuke said his symptoms had been improving until a recent setback.

“Just a couple days ago I had a major migraine out of nowhere,” he said. “I had been stable, nothing too crazy. It was during class. I had to leave to go the nurse’s office. She gave me Tylenol, I normally don’t take it because it doesn’t work. But I was desperate so I took some. It didn’t help.”

Persistent, intense headaches have caused Yusuke to reconsider his intention to return to the game.

“I was set on returning to play, but as the days went on, I would keep getting these headaches and I hated them, they bothered me so much. I was limited on doing things, like watching TV. So I’m done playing football. What if I played and I got another concussion? It could happen again. I’d never know.”

His father said he and his wife were happy his son’s football days are behind him.

“It’s been hard watching him, he gets pretty bad headaches,” he said. “You can see other effects too like tiredness and being forgetful. Since he’s an intelligent kid, people around him have been telling him not ruin his brain over something like this because life is more important than high school football.”

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