by Glenn Stout
Austin hanged himself, Place said.
Nothing made sense. Not suicide. Not Austin. Not the boy who went deer hunting in West Virginia with his father and crafted elaborate zombie-apocalypse defense plans with Walker. Not the young man who always said “Yes, sir” and “No, ma’am” and was adored by his friends’ parents. Not the charmed kid who never got mad on the lacrosse field, who’d scored a goal six seconds into his first high school game.
“If someone came to me and asked me to rank, one to 25, the kids on the team most likely to have problems and the kids who were the most stable, Austin was number one on the stable end of the list,” says Carl Kielbasa, Austin and Cody’s former high school lacrosse coach. “His maturity level was extremely high. Never experimenting with drugs and alcohol. Almost fatherly to his brothers. Had a wonderful sense of humor. He was a great teammate, very attentive and aware, very patient and kind. A big-time leader on the team and in school—he could hang out with the kids who were partyers and be in an honor society meeting the next day. Everyone loved him.”
Austin was taken to Inova Fairfax Hospital, where he died at 2:00 A.M. on Monday. The entire community was stunned. The boy was beloved. Football was beloved. In the Nokesville area, plans were under way to build a new $850,000 youth football complex; elementary school students were let out early on Friday afternoons, the better to high-five Brentsville High players as they made their march down the town’s main road.
How could this have happened?
The Trenums went home. Later that day, their phone rang. Laura O’Neal answered. She was Austin’s godmother, one of Michelle’s best friends. She’d been there for Austin’s first birthday, eating cowboy-themed cake; there when he got his first lacrosse stick, which he carried everywhere, like a scepter. Now she would plan his funeral.
There was a man on the line, Chris Nowinski, a former Harvard football player, calling on behalf of scientists at Boston University.
They wanted Austin’s brain.
The human brain is a wondrous thing. It enables us to throw a football, allows us to breathe, think, and love. In its neurons and glial cells, synapses and neurotransmitters, it is essentially who we are.
And who we are is fragile.
Gerard Gioia opens his laptop. On the screen is a video depicting a brain inside a skull. The brain, he explains, is a spongy mass of tissue. Surrounded by fluid, it moves independent of the skull, just slightly, the arrangement providing a protective measure of shock absorption.
“And this,” he says, “is why the helmet will never be the simple answer to this injury.”
Helmets prevent skull fractures but not concussions. Gioia clicks a button. The head rocks back and forth. The brain smashes against the inside of the skull. The screen flashes like a strobe light, a comic-book pow! Such is the basic dynamic of a concussion, an injury that occurs in football with alarming regularity: according to the American Association of Neurological Surgeons, 4 percent to 20 percent of high school and college players will suffer one during a single season. That’s likely a low estimate—some experts believe as many as eight of 10 concussions go undiagnosed.
“When the head or the body takes force, the brain moves,” explains Gioia, head of Pediatric Neuropsychology at Children’s National Medical Center and an expert on youth and adolescent sports concussions. “It has a certain threshold, beyond which it stretches and strains.”
Gioia loves football—played it himself in high school and college. He wants to make the sport safer. Three weeks after Austin’s death, he met with Gil and Michelle in his Rockville office, where a New York Giants–themed street sign hangs on the wall. Michelle brought a picture frame containing three photos of Austin, including one of him joyfully painting his face before a volleyball game the week before his death.
“Look at this boy,” she said, fighting tears. “Look at these pictures. He wasn’t depressed.”
Shock giving way to despair, the Trenums wracked their brains. Was there something we missed? They talked to Austin’s friends, checked his text messages, read the journal he kept for English class: I heard my favorite Sublime song. Today was good. I forgot to wear my Hawaiian shirt. Bummer.
No angst. No suicide note. No sign that anything was wrong. Nothing. The concussion, they figured—it had to be the concussion. But how? Didn’t they go to the ER, keep Austin from strenuous activity, do everything right? Scavongelli, the Brentsville High trainer, had immediately pulled Austin from the game, protecting him from second-impact syndrome, a rare but horrific condition in which athletes suffer a second concussion while recovering from a previous one, causing rapid, catastrophic brain swelling that ends in severe disability or death.
After a concussion during his junior year, Austin was held out of football practice for a week. A medical-hotline operator advised Michelle to watch for signs of depression. She told Austin. He laughed.
Oh, please, Mom.
“Why?” says Michelle. “Why did he do this? We must have said that seven million times.”
A concussion is not a bruise. It’s a disruption of the intricate system of electrochemical signals that constitute normal brain function. Contrary to widespread belief, concussions don’t always coincide with loss of consciousness. Symptoms include headaches, sensitivity to light, confusion, lack of focus, irritability, and loss of interest in favorite activities.
With rest and a gradual return to regular activity, most athletes who suffer a single concussion experience no permanent ill effects. Some, however, suffer post-concussion syndrome, in which symptoms persist for months or years, in rare cases permanently. Having one concussion may increase the risk of another. Multiple concussions are associated with an increased risk of post-concussion syndrome as well as depression and memory loss.
Think of your brain as a computer, Gioia says. The tissue is the hardware, and the electrochemical signals are the software. Concussions can scramble both, disrupting healthy equilibrium. Moreover, they leave the brain drained of energy, like a cell phone with a bad battery.
The best treatment? Rest—lots of it. Waking a sleeping concussion patient every few hours to check for brain bleeding has long been conventional medical wisdom, Gioia says, but actually is not a good idea: you should check on them, but not disrupt their sleep. “The essential aspect is allowing the cells to rebalance themselves. Overworking the brain interferes with that recovery. And it’s not just avoiding additional blows to the head. You can’t be out running. You need good sleep. You have to manage school, any activity that involves a lot of thinking.”
For two and a half hours, Gioia and the Trenums talked, going over Austin’s final weekend. As they connected the dots, two things became clear: football had injured his brain, which subsequently was overworked. Texting. Video games. Driving. Studying. Staying up late. Normal teenage activities. All of them too much.
Looking back over the weekend, they saw warning signs, subtle indicators that something was amiss. Austin had trouble sleeping on Sunday morning. He got lost on the way to Cody’s lacrosse game, even though the directions consisted of a single right turn. He forgot what month it was while fishing with his friend Carmen. He had “football headaches.”
When Austin was concussed a few plays before halftime during a football game his junior year, his teammates were the first to notice. In the locker room, he couldn’t figure out how to work his chin strap and began to bawl. Similarly, his final concussion left him cursing out his best friend, Ryan Hall, for an on-field prank meant to make Austin laugh.
Gioia showed the Trenums a diagram of the brain. He pointed out the frontal lobes, about one-third of the total brain mass, the portion just behind the forehead, where so much football contact takes place. These gelatinous hunks of meat, he told them, are our executive control centers. They allow us to reason, to choose right from wrong, to override impulses, to connect current actions to future consequences.
In teenagers, the frontal lobes are still developing; in everyone, they
require a great amount of energy to function properly. Damage or disrupt them, stretch them like Silly Putty, and concentration suffers. Memory gets spotty. The systems governing emotion and reason are thrown out of whack. You might forget how to work a chin strap; you might consider that unbearably tragic. Nothing makes sense.
Austin’s parents believe that their son may have suffered as many as four concussions during three years of playing football. Did those injuries lead him to take his life? Gioia can’t say. There’s no direct causation. The brain remains mysterious.
“My thought to the Trenums was that Austin’s brain wasn’t functioning properly,” he says. “It was drained in terms of overall energy, unusual emotional response was one of his manifestations, and the argument about academics hit at that time. Bam! Those emotions go off, and now the decision-making is not working properly either.”
Meeting with the Trenums, Gioia was more succinct. He told them Austin’s case was a perfect storm.
On the first snap of Brentsville’s first football game without Austin, the school’s quarterback mimed a handoff to his absent fullback, then took a knee. He pointed to the night sky, where cheerleaders with the number 43 painted on their cheeks had released the same number of balloons. The whole school wore white. Cody and Walker wore jerseys bearing their brother’s number, 43, and watched from the sideline. At the end of the game, a Brentsville player carried Walker off the field on his shoulders.
Football went on. The Trenums understood. Gil, 46, had grown up in Ohio and Texas, states where the sport is practically a religion; Michelle, 48, was raised an hour and a half from Odessa, Texas, the real-life setting of Friday Night Lights. She remembers pep rallies and rabid boosters, caravans of cars with shoe-polish-painted windows, what seemed like entire towns turning out for high school games. Gil and Michelle attended Texas Tech, where Austin went to summer football camp. They loved the sport. So did Cody, a member of the Brentsville High JV squad, and Walker, who played on a youth team.
As the Trenums grieved, friends and neighbors brought them food, mowed and reseeded their lawn, even repainted their front door. The family watched football. Tuesday nights. Thursday nights. All weekend long. College and pro. Tackle after tackle, hit after hit. “I don’t know why,” Gil says. “We just did. It was a distraction, something you had to focus on.”
Gil and Michelle kept in touch with Gioia. They had donated Austin’s brain to the Boston University scientists, who were studying the effects of concussions and head trauma. The Trenums came to a frightening realization: like so many others around the country, the Prince William County school system wasn’t doing enough to address athletic concussions. What happened to Austin could have happened to anyone.
Six months before Austin’s death, Virginia had passed a law requiring schools to educate students and parents about concussions and to remove students suspected of sustaining the injury from the field of play until cleared by a medical professional. In Fairfax County, education meant watching a 10-minute online video; in Loudoun County, it meant signing a two-page form. Prince William’s policy was still being written, not scheduled to take effect until 2012.
A member of the Prince William County school board, Gil wanted something quicker and better. A policy with teeth. He lobbied administrators. He had Gioia make a presentation to the board, got input from Nowinski, the former Harvard football player now with the Boston University program. Spurred by his son’s death, Gil was relentless.
Prince William’s new concussion policy went into effect in the summer of 2011, mandating stricter return-to-play guidelines and more thorough education for school athletic trainers. Students trying out for sports are now required to attend an hour-long concussion seminar with at least one parent.
“I have families contacting me all the time, telling me they can’t thank Gil enough,” says Kendra Kielbasa, an advocate for youth concussion care and the wife of Austin’s former lacrosse coach. Working with Gil to draw up a policy that stresses post-concussion cognitive rest—the kind Austin didn’t know enough to get—Kendra had drawn on her own experience. Her son, Connor, was concussed after being dropped on his head during a seventh-grade wrestling match. Emergency room doctors checked Connor for a brain bleed and cleared him to return to school the next day. Three weeks later, with his grades plummeting and his emotions off kilter, he asked his mother if he could lie down.
“Sure,” Kendra said. “Why don’t you go to your room?”
Connor looked around the living room. “I don’t know where it is,” he said. “Can you take me?”
“The hardest part is that people don’t understand—your child looks like he is fine, but he’s not,” Kendra says. “People have to understand that it’s not just a bad headache for a day or two. And it’s not enough to do [concussion education] in the high schools. We have to bring it to the middle and elementary schools.”
Would more education have saved Austin’s life? The Trenums think so.
Last fall, Cody played in a lacrosse tournament in Williamsburg. Michelle was in the stands. A boy from another team was hit hard and concussed. As his parents pulled him off the field, a woman approached. She said she was a nurse. Michelle could overhear their conversation. The boy was dazed, struggling to remember things.
“Well, he’s not passed out,” said the nurse. “That’s a good sign.”
Actually, Michelle thought, episodic amnesia is more of an indicator of serious problems than passing out is.
The nurse continued to offer medical advice, much of it dated. Michelle began to panic. As soon as the nurse left, she ran over to the parents. “Take your son to a doctor,” she implored. “A neurologist. Get him some rest. Keep a close eye on him.”
The parents asked, “Are you a doctor?”
“No,” Michelle said. “But my son died last year after a concussion.”
“That scared them,” she says. “And all I could think was, At least your son will live.”
The brains come here, to a red-brick building in suburban Boston. Each is weighed, photographed, and examined for signs of trauma and disease, then carefully sliced in half. One half goes to the upstairs laboratory, where scientists create tissue samples 10 microns thin, chemically stained and mounted on slides for microscopic inspection. The other half is placed in a closet-size, stainless-steel freezer, preserved for future study.
“There are more freezers,” says Victor Alvarez, a researcher at the lab. “We’re always looking for more space.”
Football has a problem. The sport kills too many players. Some slowly, some all at once. The evidence is in the freezers and in the stacks of slides cluttering the office of Ann McKee, a neuropathologist and codirector of the Boston University Center for the Study of Traumatic Encephalopathy.
Each brain tells a story: former Pittsburgh Steelers lineman Justin Strzelczyk, dead at age 36 after leading police on a high-speed chase that began with hallucinations and ended in a fireball; former college football player Mike Borich, dead at 42 from a drug overdose; former Philadelphia Eagles safety Andre Waters, dead at 44 from shooting himself; former NFL safety Dave Duerson, dead at 50 from shooting himself in the chest—specifically in the chest—after scrawling a note to his family asking that his brain be donated to science.
Austin Trenum, dead at 17.
Last summer, Gil and Michelle came to McKee’s office. They looked at slides of Austin’s brain. Through the microscope, they saw axons, the long, slender fibers that connect nerve cells and conduct electricity in the brain. In a healthy person, axons run together like fiber-optic cable, straight and smooth. Austin’s were twisted, bulbous, broken. In scientific language, it was a multifocal axonal injury; in layman’s terms, the equivalent of frayed automobile wiring. Turn on the radio and the windshield wipers might move; turn off the lights and the whole car might shut down.
Michelle choked up. This, she thought, is my baby. This is what ended his life.
Austin’s case isn’t unique, McKee says. T
here have been other sudden, inexplicable suicides following concussions—some in the military, some among high school football players. Scientists are struggling to understand the connection. But something is happening. Something terrible.
“It’s the same pattern,” McKee says. “They have disordered thinking and electrical impulses in the brain. They have a minor irritation. And they just want to end it. It’s like having a fly in your room and deciding to blow up your house.”
A decade ago, McKee wasn’t studying dead football players. Nobody was. That changed when Bennet Omalu, a forensic pathologist and neuropathologist, examined the brains of former Steelers linemen Mike Webster in 2002 and Terry Long in 2005. Both had suffered slow, puzzling descents into erratic behavior and madness, with Long ultimately killing himself by drinking antifreeze and Webster dying of heart failure after an extended period of living in his truck in which he sometimes shot himself with a Taser gun in order to sleep and other times sniffed ammonia to stay awake.
Omalu found that each had suffered from chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disease similar to Alzheimer’s and linked to the absorption of repeated blows to the head, a condition previously associated with prizefighters—in layman’s terms, “punch drunkenness.”
Evidence suggests that CTE is caused not only by concussions but also by subconcussive trauma. Little hits—the ones inherent in football that occur on every snap, like the 1,000 to 1,500 hits to the head that Boston University researchers estimate the average high school lineman takes each season, some at forces equivalent to or greater than a 25-mile-an-hour car crash.
