Authors: Mark Fainaru-Wada
Collins had short blond hair, an angular head that squared off at its crown, and the wiry physique of a distance runner. He was tightly wound and argumentative and sometimes came off as being about as charitable with his peers as he was with Barth. Collins had particular contempt for neurologists, for example, believing that most of them failed to grasp the intricacies of his particular specialty: “There are some incredible neurologists, but ninety percent of them have no clue how to manage a concussion, ninety-five percent of them,” he said. When explaining his work and the science of concussions, he had a habit of punctuating his sentences with a quick check to make sure his listeners were able to keep up: “You following me? Does that make sense?” He was the opposite of his mentor, Lovell, who projected a kind of sleepy calm. But when Lovell went to work at the new sports medicine center that had been established at the University of Pittsburgh Medical Center, joining Maroon at UPMC, he brought Collins with him.
Collins worshiped Lovell. “Mark Lovell is probably the smartest human being I’ve ever met in my life,” he said. “He has vision. He’s a tinkerer. He’s the mad scientist in the room. Smoke comes out from under the door. I’m the guy that sees all the patients and runs around.”
After decades of neglect, concussions were taking off as a research subject that merited serious attention. As Collins had correctly pointed out, examining the brains encased in football helmets adorned with the team logos to which millions of Americans had sworn allegiance was suddenly a sexy topic. There was money to be had and, equally important, prestige. There were headlines and careers to be made. The researchers who got in early—Jeff Barth, Joe Maroon, Mark Lovell, and a few others—soon begat other researchers, and they too began to make discoveries, many of which would prove highly problematic for one of the nation’s leading concussion factories: the National Football League.
Julian Bailes was
a rising star when Maroon recruited him out of Northwestern University in Chicago to join him on the neurosurgical staff at Allegheny General Hospital in 1988. The two men could hardly have been more different in background and temperament. Maroon had grown up in Bridgeport, Ohio, a striver in the blue-collar image of his hustling father. Bailes was
the son of a Louisiana Supreme Court justice. He had spent much of his early life in New Orleans and other parts of Louisiana and exuded the easy charm of a southern patrician, a stout handsome man with a slight drawl and thick dark hair that he swept back from his forehead.
Bailes had been ambivalent about beginning his career in sleepy Pittsburgh. But Maroon possessed one particularly attractive chit: In addition to performing brain surgery, Bailes could join him working the sidelines with the Pittsburgh Steelers, learning from the man who had watched over the brains of Terry Bradshaw and Jack Lambert. Bailes had been an all-state linebacker in high school and had gone on to play at Northwestern State University, a small Division I school in Natchitoches, Louisiana. He still lived and died for football. “I said, ‘Shit, that sounds like as good a reason as any to move to Pittsburgh,’ ” Bailes recalled. “I’m in.” He quickly adapted to his surroundings. “You know, there was no greater feeling than being a single neurosurgeon in Pittsburgh and going to the Porsche dealership and writing a check for $120,000 and driving this Porsche out and not even caring,” he said. “I went through about five of them.”
In the mid-1990s, around the same time Maroon and Lovell were
developing the Steelers Battery, Bailes was introduced to Frank Woschitz, a longtime official with the NFL Players Association. Woschitz had just conducted a health survey on retired players that he hoped would persuade the union and the league to give the players lifetime health insurance. It was a huge problem: Players often left the game so battered that they were unable to qualify for health insurance. But the league refused to provide it.
Bailes had agreed to look at the data for Woschitz—hundreds of questionnaires stacked in cardboard boxes—expecting that it would focus on mundane issues such as arthritis, back injuries, and heart disease. But when Bailes took a closer look, he was stunned. “Yes, they had hyperlipidemia [high cholesterol] and joint pain and cardiac disease, as expected,” he said. “But they were also having all kinds of cognitive problems. It was way out of line for what you would expect.”
Bailes shared this curious piece of information with a New York neurologist named Barry Jordan. In neuroscience circles, Jordan was already something of a legend. While attending Harvard Medical School in the late 1960s, Jordan, one of the few African Americans in his class, had decided to make up his own concentration: sports neurology. “All my classmates laughed at me,” he said. By the time he connected with Bailes, Jordan was one of the preeminent experts in sports medicine in the country and the chief medical officer of the New York State Athletic Commission.
Jordan agreed that the survey findings were off the charts. He wasn’t entirely surprised. Jordan had done a lot of research into boxing, in which the issue of chronic brain damage had been known since the 1920s, and had been expecting to see it show up in other contact sports. As early as 1999, he wrote that chronic brain damage “has been described primarily in boxers, but it
may be anticipated in other sports such as American football, ice hockey and perhaps soccer.”
Now, if Frank Woschitz’s survey was correct, retired football players were showing dramatically elevated signs of incipient dementia in huge numbers. Bailes and Jordan followed up with a survey of their own. To avoid tipping off the players that they were specifically looking at brain damage, Bailes and Jordan asked questions about a broad spectrum of injuries. Again, the numbers were dramatic.
In May 2000, Bailes and Jordan presented their findings at the
American Academy of Neurology’s annual meeting in San Diego. Out of 1,090 former players, 60 percent reported that they had sustained at least one concussion during their careers; more than a quarter reported more than three. The players with concussions, most in their fifties and sixties at that point, were reporting significant neurological problems: memory loss, confusion, speech or hearing problems, and headaches.
The news, preliminary as it was, was in many ways worse than what researchers such as Barth, Lovell, and Collins were uncovering. Those studies had shown that concussions had to be taken seriously, with symptoms that often lingered for days or weeks or even longer. But it was assumed that with time those symptoms eventually went away. After the release of his first paper in
JAMA
,
Collins told the
Detroit News
: “If you give the brain time to heal, there’s no reason to see long-term deficits.”
But Bailes and Jordan were suggesting that that wasn’t necessarily the case. They were saying something quite ominous: that the head-banging endemic to the NFL might have far-reaching—even permanent—consequences.
Bailes vowed to study the issue further. He believed “a trove of information” was contained in Frank Woschitz’s cardboard boxes, a researcher’s gold mine. Later, those early results would remind Bailes of another health crisis he had witnessed. “It’s like when HIV started coming out; I was here in Chicago, and we didn’t know what it was,” he said. “There were these young men, 22, 23 years old, showing up with Kaposi’s sarcoma and other weird things that you shouldn’t get when you’re 23. It was the HIV suppressing their immune system.”
Looking back, Bailes believed that he and Barry Jordan had stumbled onto “the first whiff” of another new disease.
The early scientific breakthroughs of the 1990s involved almost exclusively men who toiled in white lab coats beneath the fluorescent lighting of hospitals and universities. But there was a connection between the growing interest in concussion research and the carnage unfolding in stadiums across the country. In many ways, the research was being fueled by the dawning awareness of football fans, who began to notice that the big hits they so relished seemed to produce a sobering
by-product: the vacant stares of their heroes lying motionless on the field.
In the tenth week of the 1992 season, the New York Jets traveled to Denver to play the Broncos. The Jets’ premier receiver at the time was Al Toon, an elegant contortionist whose jazzy surname perfectly fit his improvisational style. Toon stood 6-4 and once made the Olympic trials in the triple jump. He frequently hurled himself into space to make impossible catches, climbing above defenders who lacked his speed and balletic grace. Toon often paid for it: The Steelers’ Lloyd once knocked him out cold, then
slapped the turf with his palm next to Toon’s splayed body as if he were counting him out.
In Denver, Toon caught a pass and was falling near the sideline, his head about a foot off the ground, when linebacker Michael Brooks flew over him, catching the back of his head with his elbow. It was not a particularly dramatic hit—Toon would later say that Brooks “grazed” him—but the effect was like “
a cannonball hitting me on the back of the head,” he said. From that point forward, what Toon recalled about the play was gleaned largely from film and information he picked up from the Jets’ trainers.
As he lay on a training table in the dank basement of Mile High Stadium, Toon found that there were many gaps in his memory. They included: How old am I? Do I have kids? What am I doing here? What year is it?
“I had to go through
a process of remembering who I was,” he told ESPN’s Greg Garber.
Toon’s symptoms—the headaches and disorientation, the projectile vomiting—had always dissipated, but this time they didn’t: They grew worse. The concussion stayed with Toon like a “lingering flu.” Loud noises, bright lights, the motion of a passing car, all made him swoon. He spent the next two weeks “in bed, in a dark room, curtains drawn, no noise, no kids, no conversation.” As he lingered in his cognitive netherworld, the Jets put out an estimate that the concussion was the fifth of his eight-year career. Toon believed it was more like 10. He confided to Garber that he had contemplated suicide.
The team sent him to multiple neurologists. The one who led the case, Ira Casson, like Barry Jordan, had studied boxers and chronic brain
disease and had even examined Muhammad Ali’s CT scans, determining that Ali had had brain damage even before the end of his career. Casson knew as well as anyone the ravages of the injury, what someone with an overpounded brain looked like. A decade earlier, Casson had led a landmark study that examined 10 boxers who had been knocked out. He discovered “cerebral atrophy” in half of them, an indication of chronic brain damage. Toon already had decided to put his fate in the hands of his doctors, and Casson, for one, had grave doubts: “I’m not sure that you should do this anymore,” the neurologist told Toon. “I don’t know what the next concussion is going to do to you.” Toon interpreted this to mean that he might never wake up.
Toon had an economics degree from Wisconsin, making the dean’s list his last two years, and was known as
one of the smartest players in the league. He had recently signed a three-year, $4.1 million contract but was already financially secure, having acquired his real estate license and used it to expand his own business. He and his family lived on a horse farm outside Madison. That made the decision easier.
Weeping softly, Toon, still five months shy of his thirtieth birthday, announced his retirement on November 27, 1992, three weeks after his injury.
By the time Hoge went down two years later, writers were proclaiming 1994 the “Season of the Concussion.” One bloody Sunday in October, three quarterbacks were knocked out: Troy Aikman, Chris Miller, and Vinny Testaverde. That season, an idea was floated to send defensive players to an NHL-like
penalty box for flagrant hits on quarterbacks. Aikman’s concussion had been caused by Wilber Marshall, a 240-pound linebacker. Marshall, then playing for Arizona, plowed the crown of his helmet into Aikman’s chin, splitting it open and
lacerating his tongue. Aikman, a bloody mess, made it to the sideline, where he was asked
three questions by the Dallas doctor: What day is it? What month is it? What year is it?
“I think he scored 33 percent,” said the doctor, J. R. Zamorano. Aikman was aware only that it was Sunday.
As the grisly episodes were recounted, one phenomenon was not lost on the fans and the media: The current generation of players was noticeably bigger, stronger, and faster than the one that preceded it.
The prototypical new player was Giants linebacker Lawrence Taylor, a tornado of
violence who single-handedly launched a nationwide search for unique specimens who embodied the same combination of size, speed, strength, and, more inexact, ruthlessness. Wilber Marshall, in fact, was one of those people.
The physical consequences of this new phenomenon were obvious: As the game got bigger and faster, the destructive force behind the hits grew. Any fan could see this, but one of them happened to be an atomic physicist. Tim Gay liked to boast that he had played football at Cal Tech (“La Verne College used to kick our ass on a routine basis”). At the University of Nebraska, where he worked, his primary focus was polarized electron physics. Gay’s works included
Use of Partial-Wave Decomposition to Identify Resonant Interference Effects in the Photoionization-Excitation of Argon
, but Gay also had carved out a niche as the resident expert on the physics of football. On Saturday afternoons, with a voice like a carnival barker, the bow-tied, bespectacled professor delivered one-minute lectures on the science of the spiral to 75,000 Cornhuskers fans who watched him on HuskerVision.
Gay eventually turned his side project into a book,
Football Physics
, in which he explored, among other things, changes in kinetic energy as
football players got bigger and faster. He focused on the line of scrimmage, the Pit, where the battle for territory is most pronounced and the biggest players smash into one another on every down, creating huge amounts of destructive force. Hoge called it “the Box,” a qualitatively different world from the perimeter, the place where “the big boys play.” Drawing on figures from the NFL Hall of Fame and other sources, Gay calculated that the average mass of a lineman had increased by 60 percent between 1920 and 2000, reaching almost 300 pounds (that figure would climb to 310 by 2011). The average speed had increased by about 12 percent. Gay didn’t want to limit himself to the static force elaborated by Newton’s second law of motion (force = mass × acceleration). He wanted to measure the potential for destruction inside the Pit; hence his focus on energy. “Energy is actually what goes into breaking bones and causing concussions,” he said. “It’s how much I crush him.”