by Ken Dryden
To all of my days in bed, despair in hand, suicidal thoughts on my brow, you are cast away with a hug. Your stories will never be forgotten, if not at least appreciated for their candor. Each moment that passes proves hope is real, love can be given, and dark days and shadows may stop by, but leave again.
I resign from your grip.
Your former servant,
Steve
The centre’s final report concluded that Steve had made progress at The Canyon, but that his prognosis was “guarded.” He was prescribed a grocery list of antidepressants:
Lunesta, 3mg. one tablet
Seroquel 100mg. one tablet
Seroquel 25mg. one tablet
Zoloft 50mg. one and one half tablets
And, as needed:
Gabapentin 600mg. one half to one tablet
Propranolol 20mg. one tablet (every four hours)
When he checked out, Steve collected the items he had brought with him. Among them were five books: Lullaby by Chuck Palahniuk, The Practicing Mind, Empire of the Summer Moon, Slaughterhouse-Five, and Zen and the Art of Motorcycle Maintenance. Steve also had in his wallet, besides the usual credit cards of someone his age and wealth, a cheque for $20 million he had made out to himself.
On January 6, 2013, four days before Steve left rehab, the new CBA was agreed to by the NHL and NHLPA. The league ratified the deal on January 9; the players on January 12. The same day, back in Chicago, Steve underwent his physical with the rest of his Blackhawks teammates, and failed.
Ten days later, on January 22, Steve went to see Dr. Terry, who later wrote:
[Steve] says he is essentially asymptomatic when working out and with his activities of daily living. He says he does on occasion get a little bit overstimulated and will have some symptoms. He calls these minor and transient. If he shuts down for a bit they go away. The main thing that does this is when he is out shopping. He still remains on his antidepressants. He is still following up externally with psych. He has been working out and has mentioned he has had no symptoms with working out.
Vally had retired as a player the summer before, and was now the goalie coach of the Bridgeport Sound Tigers, the AHL affiliate of the New York Islanders. Steve had called him often since December, and to Vally he sounded different. “Monty was always so excited when we talked, and loud, and full of laughter, and now there was none of this,” he recalls. “He was repeating himself. He was talking really slow and low. He was saying things like, ‘I’m getting some really tough opinions, and I don’t know if I am ever going to feel normal again.’ I said to my wife, Chrissy, ‘He’s not getting better.’ I felt that if I didn’t get on a plane and help this guy out right away, he’s not coming out of this.”
Late in January, Vally flew to Chicago to see Steve, who picked him up at the airport. For the entire thirty-minute drive to Steve’s apartment, “He was talking and talking about his brain, and telling me all this stuff about what it does, and how synapses work, and all the time he’s taking these really big breaths. Monty always took a breath before he’d speak, that was something I thought was funny about him. But this was like ehhh whoooo, ehhh whoooo. One after another. It was really distracting. He thought it would get more oxygen to his brain.” When they got to his place, Vally says, “I was shocked. In his kitchen, he had this entire counter full, and I mean full, four feet by two feet, of different supplements, all from the vitamin shop, organic this and that. Oh yeah, and two jars of cashews. And Monty knows what they all are, and what time of day to take them.” Vally couldn’t believe the state Steve was in. “Then suddenly, he’s Monty again. He’s telling me, ‘Vally, Vally, you’ve got to promise me one thing. You have to take your omega-threes every day. You need them for your brain. Just promise me.’”
They went downstairs. “He says, ‘This is where we’re going to hang out.’ And that’s what we did. He put on some light-sensitivity glasses and we just hunkered down. We were not leaving that basement. It was really dark down there. No natural light. He was on the phone all day, every day, talking to doctors. We watched the Blackhawks game one night. Another, we did go to a restaurant, but otherwise, we just ordered in. We didn’t leave. I think he was at his deepest, darkest moment at that point. He was so fragile. He was a different guy.”
Steve had always wanted to know everything. Every new thing he learned offered him the promise of something better. Now, the more he knew, the worse things seemed to be. Every new doctor asked him the same questions, gave him the same tests, told him the same thing. The tests said, you’re fine, above-average this, superior that; but it was the headaches and “spaciness”—what the tests didn’t reveal. They were the problem. When they went away, he’d be fine again, he knew that; then he could play again, he knew that; unless they came back again.
He was doing all the right things. Every day he lived smartly: he ate the right food, he got the rest he needed. On the ice, he was so incredibly careful about what he did, and the other guys were so incredibly careful around him. Then he’d get the tiniest bump—one that for all of his hockey life wouldn’t even have counted as a bump—and it was like he’d been run over by Scott Stevens. How was it possible that such a nothing could be such a something, especially for a big, strong guy like he was? The point is: it wasn’t possible, it couldn’t be possible—and that’s why he knew that the next doctor, the next treatment, the next something would be the answer. And if it wasn’t, the one after that would be.
And the doctors saw this the same way he did. It was so clear in their reports. They believed in science, and the best science they knew was incorporated in the tests they administered—and the tests said there was nothing fundamentally wrong with him. So he kept going to see them with a problem that came from some nothing little bump, and they kept telling him he was okay to play, because their science, the best that they knew, told them that there was no reason he couldn’t play. The doctors knew there was a lot they didn’t know, but they are people of science, and they knew that someday they would know, because there are answers. They didn’t want to shut him down. They didn’t want to tell him he can’t play. It was his life, and he wanted to keep playing, and trying—and besides, the answer might be just around the corner.
But now Steve was starting to hear a different message from some of his doctors. One, a “world-renowned Indian doctor,” as Vally described him, “told Monty that the damage to his brain was irreparable.”
Steve was depressed—because of the setbacks that never seemed to end; because the lockout was over and the season had begun without him; because the end of his career was closing in on him and his life ahead was uncertain. Who wouldn’t be depressed?
And he was depressed because he didn’t like this new version of himself. He didn’t like what he was thinking. He could feel himself getting weaker, and he didn’t know what he would do next. This wasn’t the same as it was seven years ago, when he checked into rehab and started going to AA. This wasn’t even the same as it was a few weeks before, at The Canyon Rehabilitation Center. He was just beginning to realize that AA and rehab centres weren’t the answer for the problem he had. He was beginning to realize that he was depressed because the damage to his brain had caused depression. Chemicals that had always moved from one part of his brain to another, chemicals that influence mood, behaviour, and function—they were no longer moving the same way, or they weren’t being created in the same amounts. Steve’s depression was physiological, not just psychological.
Going into rehab at this point was for “maintenance,” as he put it, to stop his fall—even if only for a month or two—not for a cure. If there was a cure anywhere, he knew it wasn’t with Terry or Pieroth or Kutcher, or even with Carrick or Bailes or The Canyon Center. It wasn’t with the best science at that moment. They were all trying, all doing their best, as if their best was the answer. But it wasn’t. What they knew couldn’t help him. Because what happens when the damage is already done? When it’s not about medicine or research or trea
tment, or about what you can do now? When it’s about what you did before? Sometimes treatment isn’t the answer. Sometimes only prevention is.
What Steve was getting was the equivalent of hospice care—that’s all it was—and he didn’t know it. He was becoming a different person because he was a different person. And he was about to face the biggest test of his life without his best self.
When Vally thinks about those days he spent with Steve in Chicago, and when Steve visited him at his new house only a few months before, he says, “Things went from pure joy to pure misery. This was a completely new Monty.”
—
Vally left Chicago on January 27. The same day, Steve saw Dr. Terry, who wrote in his notes:
[Steve] says that he does feel like he is doing a little better today. He did have some episodes where he noticed some symptoms. These are minor, sporadic and infrequent. He says since he is seeing a therapist currently he is taking antidepressants as well. He says that this seems to be helping. He has been doing some workouts. We have encouraged him again to not work out through symptoms especially, [and] if he has any worsening of any of his symptoms he should stop. He understands this.
On February 1, Steve saw Patrick Becker, the Blackhawks’ physical therapist. Becker reported that Steve didn’t skate that day but did “his normal routine of cardio instead like he does most days (treadmill, bike, elliptical). Also did about a 30 min. workout in the gym, mixture of strength, balance/vestibular exercises, and flexibility. Monty does express enough sense to shut it down when he doesn’t feel good, which he describes as ‘spacey’ and [having] some trouble with focus.”
Steve saw Becker again a few days later: “He skated for the first time. Looked off, as I anticipated….One thing I am trying to get him to do is not go so hard on one day, then to suffer the rest of the day or next, leaving us to take a step back every other day. The largest challenge with him is not overdoing it, as his ‘bad days’ don’t get bad until later in the day, not necessarily during or after the workout.”
On February 6, Beckert reported: “Says he got ‘dizzy’ a few times, but that resolves quickly and did not feel like symptoms escalated too greatly.” When Steve saw Dr. Terry a few days later, he told him he was feeling much better, and that the antidepressants had helped him “tremendously.” He said he was back doing some informal drills and wanted to start into regular practice, including contact drills. Terry advised him against this.
On February 21, Terry wrote:
Steve came to the office today and said that he has been completely asymptomatic. He has been beginning our testing protocol and has done well to this point. He has said that he has been under restrictions with no contact although he says that he has asked other players to undergo some contact and collision activities with him. I said that he has done this with the understanding that this was against our wishes but he has not had any ill effects from them. At this point he is going to re-engage in practices. He is going to be on limited contact until he is cleared. He understands the game plan.
Later in the month, the Chicago Tribune reported that Steve hadn’t experienced concussion-related symptoms in weeks, had been skating and taking some contact, and was close to returning to the lineup.
In his March 1 dictation note, Terry wrote: “[Steve] presented to discuss his concussion. He is currently still symptom-free. He has been skating with limited contact with no issues whatsoever.” Four days later, Steve’s Fitness to Play Determination Form, signed by Dr. Terry, read: “Not disabled. Return to play.”
The Chicago Tribune reported that even if Steve does begin play with Rockford, the Blackhawks’ AHL affiliate, and not with the big team, he “couldn’t be happier.” He was quoted as saying, “Here we are. I can smile and talk about it a little bit and get on the ice. It’s a brand new day.”
CHAPTER TWENTY
Dr. Alain Ptito and Dr. Karen Johnston began working together at the Montreal Neurological Institute in 2001. Johnston had been dealing with Montreal Alouettes football players—these athletes had shown symptoms of brain injury but routinely told her that they were fine and wanted to play. Johnston wasn’t so sure, and was looking for some way to measure when it was safe for them to return to action. But the players hadn’t taken any neuropsychological baseline tests earlier against which any new test might be compared. She also knew that players were conditioned to see past injury—and as with Steve, were very unreliable witnesses. Johnston needed more information.
Ptito, a neuropsychologist, had worked with and assessed several NHL players. He and Johnston decided to conduct studies together using functional magnetic resonance imaging (fMRI) that would allow them to see beyond the basic structure of the brain, which they knew, no matter the technology they used or the injury suffered, almost invariably looks normal. They would put the players into the fMRI, direct them to carry out tasks, and compare the brain activation patterns they saw on the screen to those of normal subjects. Later, McGill University agreed to give a baseline test to every varsity athlete before their seasons began. For Ptito and Johnston, this was the start of their collaboration.
Excited by their work, about four years ago Ptito approached Geoff Molson, CEO and principal owner of the Montreal Canadiens, about doing similar testing with the team’s players. By this time, Johnston had relocated to Toronto. When Gary Bettman and Dr. Ruben Echemendia, director of the NHL’s Neuropsychological Testing Program and co-chair of the NHL/NHLPA Concussion Working Group, were in Montreal, Molson arranged for the three of them to meet with Ptito. This was a big moment for Ptito. He, Johnston, and others had spent years seeking better answers for their patients. When some new idea or direction seemed promising, they had fought for what had become increasingly scarce research grants in order to know more and know sooner. Now Ptito had some encouraging new approaches and he had in front of him the commissioner of the NHL, the most important person in the most important league of the most popular sport in the country, who so obviously had a fundamental stake in the future health of the league’s players; also a fellow scientist who appreciated the potential impact of his research; and the owner of a team with a history of doing the right thing, whose family had a tradition of giving to hospitals and educational institutions.
“We showed them some pictures and images, and told them what we were doing. And they responded well,” Ptito remembers. “And the fact they were coming to see us seemed to show that they were open to listening.” Ptito offered some ideas for research that the league might support, but more importantly he said to them that he thought this was the right moment for a pilot project, and that the Canadiens were the ideal team to be involved in it.
“The NHL has the money to be able to sustain this kind of research,” he remembers thinking. “They could change things, and they could say, ‘Of all the teams, let’s start with the Montreal Canadiens.’ The whole team could be scanned before the season started, and if something happened to any of the players we could retest them, and compare, and see how they’re doing. That would be fabulous.” He was excited at the prospect and what it might mean for the future. “Because then, I knew, we could avoid a lot of recurrence of concussions.”
Ptito also understood the limitations of the basic neuropsychological test that teams were using, and so did Echemendia. “The players are so familiar with it,” Ptito explains, “that at baseline they can ‘fake bad,’ so that if they get a concussion and do the test again, no matter how badly they do, it will come out favourably to the way they were at baseline.” Athletes with a concussion, Ptito adds, “have a tendency to ‘fake good’ in the later test because they want to return to play. They want to keep on doing the things they love to do. It’s different from somebody who’s been in a car accident, where they’re in litigation, they try to ‘fake bad.’” Baseline fMRIs, Ptito believed, could help the league avoid the problem of wrong diagnoses.
“But nothing came of it, really,” Ptito says of the meeting with Bettman, Echemendia, and Molson
in 2013. “We never heard from them again.” Maybe the league believed that other projects were more promising. Ptito heard indirectly that cost might have been a factor. “To do an fMRI, with analysis, would [cost], I don’t know, about $2,000 each time. But are we really talking about a huge amount of money? With the money that is going around in the league, I’m not so sure. And if you can prolong a player’s career? It’s like they want the players to stop when they’re thirty. Because we’re seeing more concussions, and with their cumulative effects the players lose their ability earlier in their career.”
But Ptito thinks there is a more basic problem, too. “People are afraid of change. Why try to fix something that doesn’t seem to be broken? It looks good, what the NHL is doing, and there has been an improvement, and as they will tell you, ‘We’re doing neuropsych testing at baseline, and we’re repeating it. We’re taking the players out of the game.’ And yes, this is a good thing. But certainly it’s not enough.” To Ptito, it comes down to one point: “I don’t know to what extent they’re committed to saying, ‘We have to help the individual.’”
Ptito has to believe that Bettman and the others are committed. Ptito is a researcher and a clinician. He is also human. He knows the value of what he and others like him are doing. He knows the consequences of brain injury; he sees it in his patients. He has to be hopeful. And he knows that Bettman, Echemendia, and Molson were listening. He knows they are sensitive to the problem because he met them and saw them up close that day, and how could they not be? He knows that listening is not just tilting your head and furrowing your brow in a certain way, that listening is responding, and sensitivity is responding with action of a magnitude similar to the magnitude of the problem. Otherwise, both are just pretend. This isn’t about doing something, he knows. It is about achieving something. But every so often he is drawn away from his hopefulness, and he sees what isn’t being done. Then a darkness creeps in.
