Two weeks later, Mark Lenkiewicz returns to the clinic and aces the test. Based on his ImPACT scores and lack of symptoms during cardiovascular workouts, he is cleared to return to the football field. Still, Diane Lenkiewicz senses some reticence when Lovell says to her son, “What I can tell you is that you’ve had these injuries and you’ve taken progressively longer to get better, and that’s not a good sign. But I can’t tell you not to play, any more than I can tell Ben Roethlisberger not to play.”
As much of a science as Lovell’s test has made of concussion management, no one can say when—or even if—it’s completely safe to return a player to action, for concussion remains the most mysterious and unpredictable of all sports injuries.
• • •
Mark Lovell came by his concussion education the hard way. It was back in the early ’70s, and he was a typical eighteen-year-old with shoulder-length hair standing on the side of the road, thumb out, hitching a ride home from his high school in Grand Rapids, Michigan. When a car finally slowed to a stop, he raced over, jumped in, and slammed the door behind him. As the car peeled away, he looked down and was horrified to see empty beer cans scattered everywhere. Even though the man was driving erratically, Lovell resisted the temptation to panic. But then the sirens started wailing, the police lights flashed, the driver floored it, and the chase was on. The next thing Lovell knew, he was hurtling through the windshield headfirst.
In the emergency room, the doctor stitched up all the cuts on Lovell’s face and sent him for an x-ray. A couple of hours later, looking up at the x-ray of Lovell’s skull, the doctor said, “There’s nothing broken. You’re fine. You can go.”
Lovell spent the next few weeks at home, recuperating from what he now knows was a concussion. After returning to school, he still didn’t feel like himself. His thinking was foggy and he couldn’t concentrate. Friends kidded that he was “kind of goofy.” He had memory problems for nearly a year and migraines for over a decade. Even more time would pass before he connected it all to the auto accident.
Lovell’s first job after grad school was in one of the nation’s busiest trauma centers, at Pittsburgh’s Allegheny General Hospital. There, he was in charge of evaluating the mental status of patients with severe head injuries. What he observed as he examined those patients would jog his memory. They seemed to have the same types of symptoms he’d had after his concussion senior year in high school. He started to think that maybe people weren’t taking concussions seriously enough. It was clear from his own experience that concussions were a form of brain injury—and yet, his colleagues were dismissing them as insignificant bumps on the head and disparaging concussed patients who complained of prolonged symptoms as litigious malingerers. He would often argue, “The brain doesn’t know if it’s been injured playing sports or in a high-velocity motor vehicle crash.”
When Joe Maroon called to enlist his help studying concussions in the Steelers players, Lovell saw a chance to prove his point—and to meld his two passions, sports and brain science. Even better, the playing field would make the perfect impromptu lab. Nowhere else did people have concussions so frequently, so regularly, and so visibly. Besides, no one would accuse athletes of malingering. If anything, athletes—especially professional athletes—were more likely to minimize symptoms in an effort to get back to play sooner.
Over the next decade, Lovell began consulting on concussion management for the National Football League as well as the National Hockey League. He refined the Steelers’ neuropsychological testing program and expanded that model to a few other NFL teams, and he worked with the NHL to develop and implement its mandatory league-wide testing program. In the meantime, he started researching the impact of concussions on college and high school athletes. By the late ’90s, he had published several journal articles looking at concussion in sports as well as in car accidents.
All that research and experience made Lovell the obvious choice when the University of Pittsburgh went looking in 2000 for an expert to set up a groundbreaking concussion program as part of its new head-to-toe sports medicine center. Once there, one of Lovell’s first orders of business was to incorporate his new computerized neuropsych test in the center’s concussion management program and to introduce that software in a handful of local colleges and high schools. But his vision for ImPACT was far more ambitious: he dreamed of seeing the test in every school in the country to give coaches and trainers a more objective way to help assess when athletes could safely return to play. To get enough money and manpower to make that possible, Lovell partnered up with his colleague Michael Collins, Maroon, and the university to form a company that could promote the development and marketing of the test. Over the next several years, ImPACT would become a cornerstone of the center’s comprehensive concussion program, and the software’s use in high schools and colleges would spread from western Pennsylvania to other parts of the country.
Lovell now runs the program from a second-floor office that looks out past the skeletons of abandoned steel mills and the sluggish Monongahela River to the burnished skyscrapers of downtown Pittsburgh. A model brain huddles next to a black and gold Steelers helmet near his computer monitor. Several footballs, gifts from concussed players, are propped against the windowsill behind his desk. One ball sports the autographs of Troy Aikman and Steve Young, the biggest NFL stars forced to retire by concussions. Next to it is a ball signed by former Steelers wide receiver Lynn Swann, yet another Hall of Famer whose career was cut short by concussions. A third ball is covered with the signatures of Ben Roethlisberger and the rest of the 2006 Super Bowl champion Steelers.
Lovell, his hair now neatly cropped and more gray than auburn, leans back in his leather chair, gazes out the window, and reflects on how lucky he is to be working right next door to his “lab.” The Steelers practice so close by that Roethlisberger could heave a Hail Mary pass and hit the Center for Sports Medicine. More to the point, Roethlisberger and his teammates have only to walk across a small parking lot to get from the team’s locker room to Lovell’s exam room.
The Steelers share one indoor and four outdoor football fields with the University of Pittsburgh Panthers as part of state-of-the-art training facilities on the same campus as the Center for Sports Medicine. The forty-acre complex at the base of the Hot Metal Bridge rose from the ashes of the mammoth South Side Works steel mill, which had been a fixture in Pittsburgh since before the Civil War. The green gridirons and gleaming glass buildings stand in a stark contrast to the grimy old mill that was once wedged into this narrow mile-long strip between the river and the railroad tracks built to export steel from the South Side Works.
At its peak, the mill employed thirteen thousand workers and produced more than four thousand tons of metal a day—steel that helped build a nation, from cars manufactured in Detroit to skyscrapers springing up in America’s growing cities. The demise of the South Side Works marked the final collapse of the industry that had given Pittsburgh its economic lifeblood, its identity, and its nickname—The Steel City. Just when the wounded city needed it most, the Steelers, their helmets emblazoned with the iconic logo of U.S. Steel, stepped up to restore a measure of civic pride. After four frustrating decades as lovable losers, the team had caught fire under the iron leadership of new coach Chuck Noll. By the time the mill’s blast furnaces had belched their last plume of sooty black smoke, the Steelers had risen up to replace steel as the city’s identity.
No team in sports could better reflect its community’s character. Noll built a dynasty in the city’s tough, gritty image, fielding brutally physical, defense-oriented teams that embodied the blue-collar roots of their rabid fans. Powered by the smothering “Steel Curtain” defense and an effective no-frills offense, the Steelers brought the city four Super Bowl championships between 1975 and 1980. The bond the team forged with its loyal fans would endure and grow as Pittsburgh rebuilt its economy, now based on medicine, research, and technology.
That fervor for football extended far beyond
Pittsburgh and the Steelers to every community and every school in western Pennsylvania. No region of the country, not even Texas, is more football-obsessed. Locals will happily boast to anyone who’ll listen that western Pennsylvania has produced more legendary NFL quarterbacks than anyplace else, ticking off from their list the familiar names: Johnny Unitas, Joe Namath, Joe Montana, Dan Marino. On cool Friday nights, huge crowds flock to the high school stadiums sprinkled along the Allegheny Mountains. Like the moths glimmering in the night, the fans seem instinctively drawn to the arc lights hovering high over the vast green stage. Throughout the fall, townspeople build their entire social lives around the spectacle that’s come to be known as the “Friday Night Lights.”
The siren call of life lived in the spotlight is what ultimately lures Mark Lenkiewicz back to the gridiron even after Lovell, in clearing him to return to play, cautions that another concussion could lead to permanent brain damage. Even though he’s already lost his position as a starter, Lenkiewicz is willing to take that risk for one last chance to hang with his teammates, to bask in the adulation of his classmates, and to feel the rush fueled by a roaring throng of twelve thousand fans. When the crowd exceeds over half the population of your entire town, the pull can be irresistible. “Knowing all those people are watching you play gives you a chill up your spine,” he explains.
Western Pennsylvania’s obsession with football made Pittsburgh the perfect place for a concussion clinic to take root and grow. But even there, Lovell initially encountered resistance. Parents would bring their kids in to be examined, concerned about concussion symptoms, but Lovell’s advice seemed overly cautious. How could a bump on the head lead to weeks of missed practices and even classes? He’d have to explain that so-called dings could be serious and life-altering injuries if the brain wasn’t given time to heal. He’d point to the NFL stars recently forced into retirement by concussions. But it was still a tough sell to parents and kids alike. What would ultimately make Lovell’s job easier was his increasingly high-profile work with famous Steelers, none more so than Ben Roethlisberger.
From the moment he arrived in Pittsburgh, Roethlisberger clicked with the fans. With a working-class background, he seemed to embody the soul of the city and its surrounding factory towns. His style of play fit right into the Steelers mold: tough, bold, spare. An imposing six foot five and 242 pounds, the quarterback nicknamed Big Ben quickly became known for getting the job done efficiently if not artistically. Highlight reels were filled with footage featuring a deceptively agile and unflappable player—scrambling around as he searched for an open receiver, ducking and darting away from would-be tacklers, then throwing a pinpoint pass without breaking stride. As a rookie, he took a team that had fallen on hard times and overnight restored it to an NFL power. The next season, at the age of just twenty-three, he became the youngest ever to quarterback a team to a Super Bowl championship. By bringing the city the 2006 title—the first since before Roethlisberger was born—he seemed to be offering Pittsburgh the promise of another Steelers dynasty.
Then, just four months after a quarter of a million fans flooded downtown streets for the victory parade, that promise was almost extinguished. Roethlisberger was riding his motorcycle to practice—without a helmet, as usual—when a turning car suddenly cut him off. He hit the car broadside and was rocketed headfirst into the windshield and then over the roof onto the pavement. Along with massive blood loss, a nine-inch gash in his scalp, a broken jaw, and multiple facial fractures that required seven hours of emergency surgery to repair, there was a concussion.
Remarkably, Roethlisberger healed up fast enough to return for the next season. But in his fourth game back, just as he was releasing a pass, he took a vicious helmet-to-facemask hit that knocked him out cold. The next day, he was back at the Pitt concussion clinic to take Lovell’s test. The scores that Monday were so low that he had to take the test again Wednesday, and although there was improvement, it wasn’t until he took the test a third time on Friday that he was cleared to play. That Sunday, he threw four interceptions in a galling loss, turning in the worst performance of his worst season. The only person who took more criticism than Roethlisberger was the team neurosurgeon. “Where did you get your medical degree?” read a typical piece of the hate mail that flooded Joe Maroon’s inbox. Another read, “Even I knew he shouldn’t go back.”
Faced with a similar decision on the eve of the playoffs two seasons later, Maroon knew the armchair experts would be back out in force. In the 2008 regular-season finale, Roethlisberger was gang-tackled hard and slammed the back of his helmet against the turf. He lay inert with no feeling in his arms for a frightening fifteen minutes. As he was driven from the field on a cart with Maroon steadying his immobilized head, Roethlisberger weakly lifted his left hand and gave the hushed home crowd a thumbs-up. Once again, Roethlisberger found himself in the familiar Pitt exam room. Once again, it would take several tests before Maroon and Lovell would clear him to play. But this time, there would be no second-guessing Maroon’s judgment: Roethlisberger decisively led the Steelers back to the Super Bowl and then hurled a dramatic touchdown pass in the waning seconds to deliver their second championship in four seasons.
Each time Roethlisberger had one of those nationally televised head injuries, the public got a primer on this new concept of concussion management. From the constant TV and newspaper updates tracking his treatment, parents began to see why players might need to be tested and sometimes sidelined. Suddenly everyone wanted to go to the same clinic as Roethlisberger and his teammates. Parents were now coming to see Lovell with a grasp of the injury’s seriousness and the complexities of its management. What’s more, the newly converted wanted to commiserate over the ignorance of coaches who argued against sidelining players and of teachers who didn’t understand that concussions could affect schoolwork.
With concussions getting more and more media play, the Pitt clinic got so busy that the university had to add satellite offices to accommodate all the kids coming in from suburban schools. Along with the college and high school students, Lovell started seeing increasing numbers of junior high and elementary school kids. Parents were now bringing in children as young as five.
As the public began to take concussions more seriously, Lovell could turn his attention from defending the mere diagnosis to researching better ways to treat severe and prolonged symptoms. This was a paradigm shift: Lovell wasn’t just playing defense anymore—he was playing offense. Instead of simply advising patients to rest their brains until symptoms resolved, he started to take a more active approach, borrowing rehab techniques developed for patients with severe brain injuries. Now there were options for a patient who came in with a brain still slowed and foggy after weeks of rest.
• • •
Doreen Kruth was worried about her daughter. Angelica had smashed her chin on the gym floor in a fall during cheerleading practice and was now in excruciating pain, sipping food through a straw and complaining of pounding headaches. It was hard for Kruth to watch her bright and bubbly fourteen-year-old become so listless and dull.
But what concerned Kruth even more was the host of other odd symptoms that couldn’t be explained by their pediatrician’s diagnosis of whiplash. A straight-A student, Angelica suddenly couldn’t focus in class. Her vision was so blurry that she couldn’t read. She was so dizzy and disoriented that it was hard to walk down the bustling school hallways without banging into other kids; sometimes she felt so unsteady that she had to grab on to the lockers to keep from falling down. Whenever Kruth would ask her what was wrong, Angelica was uncharacteristically snappish and irritable.
Perplexed and frightened, Kruth took her daughter to another pediatrician for a second opinion. But the diagnosis and prescription were the same: a swollen jaw and whiplash to be treated with ice packs and painkillers. Once again a doctor pronounced that Angelica would be fine in a couple of days. Except that she wasn’t. In fact, she was getting worse and worse with each passing day. None of
it made any sense.
In desperation, Kruth turned to the renowned maxillofacial surgeon who helped repair Ben Roethlisberger’s jaw after the infamous motorcycle crash fifteen months earlier. Despite x-rays and CAT scans to the contrary, she was starting to suspect that her daughter’s jaw might indeed be broken—how else could you explain all those severe and disparate symptoms?
Six days after the cheerleading fall, Angelica was sitting in Dr. Mark Ochs’s exam room at the University of Pittsburgh Medical Center, getting her jaw x-rayed yet again. Ochs came in, did a full examination, and then left to read the x-rays. When he came back, the look on his face made Kruth even more worried.
“That kid should have gone right to the emergency room,” he said.
“Emergency room!” Kruth blurted, almost cutting him off. “Why?”
“She’s got a severe concussion,” he explained.
He looked at Kruth’s face and saw worry turning into bewilderment.
“But how can she have a concussion when she hit her chin?” Kruth exclaimed.
Ochs told her that you could get a brain injury without hitting your head. As he dug out some pamphlets on concussion, he suggested that she take her daughter to a brain specialist. Angelica listened to the latest diagnosis with disbelief. “Oh great,” she thought, “another crazy doctor with another crazy diagnosis. You’re out of your mind, dude.”
The Concussion Crisis Page 17
