The Concussion Crisis

by Linda Carroll

  Melissa still didn’t get the message. She stopped playing soccer, but she continued to work out at the gym and to run laps with her teammates at practice until the coach would throw her off the field. She was in denial. “It can’t be that bad,” she’d rationalize to herself. “How bad could it be if nobody’s seen anything on a CAT scan?”

  Brooks had an answer for that. She sent Melissa to a neurologist for an electroencephalogram to measure her brain waves. Not long afterward, Melissa walked into Brooks’s office demanding clearance to return to play. “I’m getting back on the field,” Melissa announced. “These tests aren’t showing anything. There’s nothing out there proving there’s something wrong with me, except for what’s going on with my body.”

  “Uhhh, how about that EEG?” Brooks said.

  “It’s normal,” Melissa replied. “When I called them, the receptionist said that if the doctor didn’t reach out to me, then it’s normal.”

  “No, it’s not,” Brooks said as she reached for the phone.

  She dialed it and handed the receiver to Melissa. The neurologist on the other end informed Melissa that the EEG was in fact abnormal and that the squiggly lines on the printout revealed she was suffering absence seizures. He told her that the seizures explained why she would space out for a few seconds every now and then, and he recommended that she start taking antiepileptic meds immediately. When she hung up the phone, she looked shaken. Then she suddenly perked up and asked Brooks, “How many seizures am I having in a day? Because if I’m not having so many, I could probably go back to play.”

  Melissa couldn’t understand why she wasn’t getting through to this stubborn neuropsychologist. When her mother suggested that a specialist might know more about concussions than a headstrong patient, Melissa defiantly argued, “I’ve always gotten my way. I haven’t had a doctor sideline me before. This lady’s not going to do it.”

  As relentless off the field as she was on it, Melissa continued to lobby Brooks for medical clearance all through her senior year. She felt lost and frustrated over not being able to play. She felt like she was no longer part of the team she still captained. She felt useless to her teammates and her coaches, pushed aside by everyone as if she were invisible. Here she was, a preseason All-American selection, sitting out her entire senior season just because her neuropsychologist wouldn’t give her clearance. “I’m not hurt,” she’d rail at Brooks. “You’re the one that’s out of her mind. If you won’t clear me, then I’ll just go somewhere else and find someone who will.”

  Even after she graduated the following spring, Melissa couldn’t give up the game she still yearned to play. When she was offered the chance to join a local semipro team that summer, she couldn’t sign the contract fast enough. The only thing that could stop her was the medical release form she needed signed by a doctor. She charged into Brooks’s office, waving the form and shouting, “I know you’re going to sign it. I know you’re going to clear me. Sign it now. I’m standing right here.”

  Brooks shook her head emphatically. The time had come to sit Melissa down and explain the facts of brain injury. “You’re going to have to decide about your future,” Brooks said. “I recommend that you don’t return to play—ever.” Brooks paused before driving home her point: “You can play now, or you can read to your kids someday.”

  Melissa knew in her heart that Brooks was right, especially since some of her concussion symptoms still lingered, but she just wasn’t ready to give up the sport that defined who she was. She kept playing in pickup games and recreational leagues whenever she could. But something was missing. Gone were the adrenaline rushes of competition and the exhilaration of winning. The mere thought of heading a soccer ball now put a knot in her stomach. She didn’t want to risk another major concussion and the disabling symptoms it could bring back. By now, she had married Joe and they were about to start a family. She wanted to be able to read to her kids. The child growing in her womb reminded her that she had responsibilities to others and couldn’t keep playing games with her health for their sake as well as her own.

  She decided it was time to quit. In her mind, that equated to losing a part of herself. For as long as she could remember, the soccer ball had been an extension of her feet; if she couldn’t find a friend or sibling to kick it around with, she’d simply go off by herself and kick it against a wall. Playing soccer had given her not only confidence and self-esteem, but also an outlet that helped her through tough times like her parents’ divorce. She couldn’t imagine life without soccer.

  Melissa found a compromise: she became a coach. She started coaching the same youth league club on which she had played as a young girl in Bridgewater, New Jersey. She began with a team of eight-year-old girls and had so much fun with them that she soon added elite squads of teens and tweens. She also coached at the same high school where she had earned All-American honors as a junior and senior. To the kids on her teams, Melissa was a role model talking from experience as both player and patient. She taught them about the dangers of concussions and the need to report all head injuries to coaches, trainers, and parents.

  Before she let her girls out on the field the first day of practice each season, she would introduce herself to them and deliver the concussion lecture. Whether in team meetings or one-on-one chats, she would never miss an opportunity to share with them what she had learned the hard way. She would buttonhole the parents, educating them about the warning signs. She told everyone who would listen about the repercussions that come when young athletes play while still symptomatic.

  Every once in a while, a kid would show up who presented a special challenge. None would resonate more with Melissa than the girl who reminded her so much of herself when she was twelve years old. Not only was this girl the star player on her club team, but she also exhibited the same traits that Melissa once displayed: the speed, the aggressiveness, the determination to win, the stubbornness to play through injuries without ever thinking of reporting them. So when the girl collided hard with the opposing team’s goalkeeper and got up slowly and unsteadily, Melissa sensed this was just the beginning of a long-term issue. Melissa pulled the girl from the game without hesitation and without debate. That was the easy part. It would be much harder to sideline her for more than just that one game. Now Melissa could see what it was like to be on the other side, trying to spot an injury when players were doing their best to hide it and then having to stand up to athletes and parents who pressed coaches for a quick return to play. In this case, the parents turned out to need little persuading. To convince the girl, though, Melissa had to recount her own story of how playing through concussions cut her soccer career short at the age of nineteen. In the end, her own experience became her best argument.

  Melissa was now preaching the gospel according to Jill Brooks. The conversion from skeptic to apostle was complete when Melissa finally embraced her neuropsychologist’s mission to spread the word. Melissa had learned that the congregants who most needed to hear the sermon were already in the pews: her girls. Brooks’s research had shown that high school girls knew even less about concussions than boys—and took them less seriously than boys. When Melissa sought advice on dealing with her concussed players, Brooks explained how societal attitudes complicated the subject. Females, Brooks said, often assume they can’t get concussions because they were told since they were little girls that they don’t play hard enough to get them. Making matters worse, she added, females tend to ignore the most common concussion symptom; because they’re more prone than males to get headaches, females often dismiss them as a sign of stress or a symptom of premenstrual syndrome.

  Brooks didn’t have to tell Melissa what she would be up against as a coach trying to protect her players from concussions. Melissa knew from personal experience how easy it was for an athlete to rationalize away warnings, even when they came from a specialist. She was hardly the only patient who dismissed Brooks as a doctor just being overcautious, a mother hen just being overprotective. Meliss
a could remember many times when, in response to yet another lecture about protecting her brain, she’d tell Brooks only half jokingly, “Stop mothering me.”

  Brooks had been struggling for years to find a way to get through to the girls. Then she stumbled upon the most effective of all educational tools: the athletes themselves. If her patients wouldn’t listen to doctor’s orders, maybe they could be reached by fellow athletes who’d experienced what they were now going through. And who would make a better peer mentor than Melissa Inzitari?

  Melissa had been out of school only a few years when Brooks asked her to meet with another patient, a college field hockey player who wasn’t getting the message. When the two young women were introduced in Brooks’s office, Melissa saw a mirror image of her younger self. The story Katrina Majewski told her that day sounded eerily familiar.

  A few months earlier, in a field hockey scrimmage at the beginning of Katrina’s freshman year at Rutgers, a ball had deflected off a stick and struck her in the temple. Although so dazed that she staggered to the wrong sideline after being pulled from the scrimmage, she was cleared to resume practicing the next day. Accustomed to playing through pain, Katrina ignored the migraines and the odd symptoms that began bothering her seemingly out of nowhere. She was nodding off in class, unable to focus on lectures. She sank into depression, sleeping and crying all the time. She was often irritable, sometimes snapping at her teammates. Since it was early in her freshman year, her new teammates and coaches didn’t recognize how uncharacteristic her behavior was. But her mother noticed it during their daily phone conversations and she confronted team doctors, insisting that Katrina get further medical evaluation. Which is how Katrina wound up getting referred to Brooks, the neuropsychologist for Rutgers athletic teams.

  Brooks’s diagnosis of post-concussion syndrome shocked Katrina, who had always assumed that a concussion required loss of consciousness. Not only had Katrina sustained a concussion in that preseason scrimmage, but she had also suffered at least seven undiagnosed ones in high school by Brooks’s count. The cumulative effect explained why her symptoms now were so profound and persistent, why her cognitive deficits were so pronounced, why this honors student would need special accommodations to help with such routine tasks as taking notes and taking tests.

  Brooks refused to clear Katrina to return to the Rutgers field hockey team. What’s more, Brooks told Katrina to refrain from all physical activity until her symptoms completely resolved and to think seriously about giving up field hockey because of the risk of permanent brain damage. Katrina had dreamed of playing college field hockey too long to accept that concussions could stop her before she could play a single game for the Scarlet Knights. When Katrina continued to talk about how much she wanted to get back on the field, Brooks suggested she meet Melissa to get the perspective of a peer who had been through a similar experience.

  As Katrina recounted her story in Brooks’s office, Melissa nodded knowingly and sympathetically. Melissa told Katrina her own story and talked about the factors that influenced her decision to finally walk away from something that had once defined her. Then Melissa uttered the words that gave Katrina pause: “You can fulfill your dreams as an athlete now, or you can have a normal life and read to your kids someday.”

  Melissa was speaking from the heart as well as from experience, having recently given birth to her first child. Playing the “kid” card turned out to be her trump. It convinced Katrina to give up her dream and her sport, and it converted her into another of Brooks’s apostles. As a mentor in this growing network of one-on-one support groups, Melissa played the kid card with all the other young women whose concussions brought them to a crossroads in their lives. “I’m past that point in my life, I have kids,” she said. “If some of these athletes don’t stop, they’re not going to get to that point. They’re not going to be able to enjoy their kids or read to them or any of that stuff.”

  Melissa still had some post-concussion symptoms, but at least she could read to her daughter, Alyssa. The lingering symptoms—headaches, sensitivity to light, short-term memory problems—wouldn’t stop her from going back to school to become a registered nurse, raising a growing family, and continuing her concussion crusade. Nor would it stop her from being a soccer mom to dozens of girls—including her own daughter.

  When Alyssa turned seven, she started playing youth soccer on a coed team. As a soccer mom, Melissa couldn’t help but worry about head injuries. While other parents shouted encouragement for their kids to score goals, Melissa would be hollering, “Don’t hit ’em in the head!” At Alyssa’s age, the kids look more like Weebles than soccer players, the ball stays on the ground, and the goal is fun rather than winning. In a few years, when the games become ultracompetitive, the play superaggressive, and the impacts inevitable, Melissa knows she might feel differently about Alyssa’s participation. At least Melissa can take comfort in knowing that her daughter will have been regularly schooled on the importance of playing safely and of telling adults about any injuries. Before Alyssa started playing soccer, Melissa sat her down and explained the facts of brain injury. Not long afterward, Melissa overheard Alyssa telling someone, “You know, Mommy lost part of her brain.” That reminded Melissa about the need to tailor the message to the age of the audience.

  Melissa developed a whole new perspective when she became a soccer mom. She remembers how her dad broke down in tears the day in Brooks’s office when he learned about the concussion problem she had kept hidden from him and everyone else. That memory fuels her resolve to make parents allies in the war on concussions. “You can’t be a friend to your kids all the time,” she’ll tell parents. “When my daughter cries and says, ‘You’re a bad mom,’ it breaks my heart. But in the end, every time she goes out to ride her bicycle, I don’t even have to say, ‘Get your helmet.’ She has it in her hand.”

  • • •

  If Alyssa isn’t growing up in the same concussion culture her mom did, it’s only because Melissa Inzitari is an anomaly, an enlightened crusader at a time when brain injury is only beginning to come out of the dark ages. Most Americans still don’t see concussions for the traumatic brain injuries they are.

  Chapter 4

  Sudden Impact

  Over the past decade, it has become clear that damage from concussions can add up. And the result can sometimes be as debilitating as a severe brain injury. Scientists are beginning to believe that all traumatic brain injuries—from concussions to severe head traumas—have a similar impact on the brain; these injuries are simply at different points on a continuum. The reasons will become clear if you look at the symptoms suffered by someone with a severe TBI, be it from a wartime bomb blast or a horrific car wreck.

  I

  The sun was just peeking over the horizon as Sergeant Brian Radke and three other soldiers loaded their Humvee for the day’s mission. A few wisps of cloud mottled the brightening Baghdad sky, and the deep reds and purples of the sunrise reminded Radke of mornings back home in Arizona. Normally, his brain would have been racing and his heart pumping as he psyched himself up to venture beyond the relative safety of the Army base. But today, the memories of home and the beauty of the sunrise brought a surprising sense of serenity.

  As the team loaded the last of the equipment into their Humvee, the soldier who was supposed to man the gun turret asked Radke to swap positions. Though Radke would have preferred to keep his assignment as driver, he could see that Specialist Jeremiah Robinson was feeling queasy and clearly not up to standing in the turret on constant alert for snipers and warning signs of a roadside bomb.

  The Humvee rolled slowly through the gate past the coils of razor wire that surrounded Camp Liberty, and Radke poked his head up through the turret. Once on the smooth four-lane highway, he was struck by how light the traffic was and how pleasant the cool desert air felt against his face. “This is a nice day,” he thought.

  As the Humvee powered past the broad fallow fields that bracketed the highway, Radke stood
in the turret, swiveling the .50-caliber machine gun right and left, his eyes searching for any indications of danger. After several uneventful miles, he spotted the section of highway where another Humvee from his platoon had been blown completely off the road a week earlier by an improvised explosive device. The IED blast had killed a buddy from his unit, the Arizona National Guard’s 860th Military Police Company.

  Normally traffic was fairly heavy in this area, but today it was so quiet that Radke started to feel uneasy. As they approached a pedestrian overpass where insurgents would often toss grenades down into the turrets of passing Humvees, he looked up to check the railing for anything suspicious. The overpass was deserted, so he turned his attention back to the road. A broken-down van on the right shoulder beneath the overpass caught his eye. Because abandoned vehicles were often used as car bombs, Radke ducked down into the Humvee for safety. With his left hand holding on to the roof and his right hand clutching his M4 assault rifle, he continued to scan for danger through the windshield as they passed under the overpass.

  Then he heard a click.

  Everything after that seemed to pass in slow motion. He felt himself blown backward. As he lay on his back, he noticed the brilliant blue sky through the turret. He glanced to his left and saw smoke pouring in through the driver’s side. He peered through the smoke looking for the driver, his close friend Jeremiah Robinson, and saw a body with no head.

  Suddenly Radke realized the truck was still moving—without anyone to steer it. “We’re out of control,” he thought. The Humvee lumbered on through the barren fields with Radke slipping in and out of consciousness, briefly coming to each time it hit a bump. He was jolted awake when the truck crashed through a brick wall and then finally came to a stop after smashing into the front of a house. With the engine stalled out, there wasn’t a sound. The unexpected quiet made him nervous. He wondered whether he was the only member of his team to survive the blast.