League of Denial

by Mark Fainaru-Wada

  The first experiments, in 1984, were a disaster. Out of the 100 or so players who participated, there were only a few documented concussions. Virginia was terrible that year, and before he was fired, the beleaguered coach shut down Barth’s experiment in midseason. But Barth persisted. The next year, he expanded his study to include the Ivy League schools and what he referred to as “a real football team,” the University of Pittsburgh. This time, the results were startling: Out of 2,350 players who participated, 195, or more than 8 percent, sustained verifiable concussions. More than half still had headaches at least five days after the injury occurred. About a quarter still had signs of memory loss, nausea, and dizziness. Most of the symptoms cleared within 10 days.

  What had started as an attempt to measure the effects of minor head injuries after traffic accidents had become a harbinger of football’s soon to be tumultuous future. Barth’s major discovery was that concussions might be regarded as “minor” injuries by coaches, trainers, and even doctors, but they weren’t minor to the people who incurred them. He published his results in 1989. “Through further data review and analysis, it is our hope that we can provide the football community, and sports medicine psychologists in particular, with a brief and easily administered set of neuropsychological assessment tools that will aid team physicians,” Barth wrote.

  Now, two years later, Joe Maroon was faced with exactly that scenario. Chuck Noll wanted his quarterback, Bubby Brister, back on the field. Maroon, the Steelers’ doctor, didn’t agree. But he had no real tools to justify his assessment. As it turned out, Maroon had participated indirectly in Barth’s study. In addition to his work with the Steelers, he was the neurological consultant for the Pitt Panthers—the “real football team” from Barth’s experiment. Maroon didn’t have enough concrete data to prevent Brister from playing, but perhaps here was a way to get at it.

  Maroon went to the chief neuropsychologist at Allegheny General, Mark Lovell, and explained the situation.

  “You know what, Mark?” Maroon said of Noll. “He’s right.”

  Brister ended up playing, but that was the beginning of the story for Maroon, not the end.

  To that point, the sports medical community had viewed a concussion as an invisible injury. You couldn’t x-ray it or scope it or put a cast on it, so how serious could it be? Barth had shown that a player might appear normal, but if his brain wasn’t functioning properly—as measured by changes in short-term memory, executive function, ability to reason, and so on—that was an indication the injury hadn’t healed. As simple as it now seems, that discovery was groundbreaking.

  Maroon says he didn’t see a financial opportunity in the diagnosis of concussions until years later, when a colleague pointed it out to him. This was still in the sleepy early days of the NFL’s concussion crisis, and Maroon was merely looking for answers. He approached Lovell to try to figure out a way to better justify his on-field decisions to Noll and the players. But it was exactly the type of out-of-the-box idea that got Maroon’s wheels spinning.

  Joe Maroon was a neurosurgeon with a flair for business. He had picked it up from his father, a Lebanese immigrant who had hustled out a living in the Ohio River Valley by catering to the needs of the miners and rivermen. Charles Maroon operated Bridgeport’s only bowling alley, serviced vending machines throughout the region, and built a truck stop in the northern tip of West Virginia. He owned a building that housed a strip joint called the Lucky Lady Lounge. Maroon worshiped his dad and decided to go into medicine only after thinking long and hard about whether he wanted to defy his father’s wishes that he become a lawyer. Despite his size—about 5-feet-5, 160 pounds—Maroon attended Indiana on a football scholarship, started at halfback for two seasons, and was a scholastic All-American. When he was in his early forties, his wife left him and his father died in the same week. He briefly left medicine and went back to Bridgeport to run his father’s truck stop, a midlife crisis that left him suicidal. Exercise helped save him. He became a health enthusiast and ran triathlons all over the world. Still competing in his sixties and seventies, Maroon wrote a book called The Longevity Factor in which he recommended a number of novel “secrets” to a long and healthy life.

  As admired as Maroon was, there was a whiff of opportunism about him that some of his colleagues found distasteful. He seemed to combine his neurosurgery practice and his entrepreneurship in ways that pushed the envelope. Maroon touted the wonders of red wine and fish oil as the keys to staving off everything from depression to Alzheimer’s disease to death itself. No one doubted that he believed what he was promoting—Maroon looked great, a trim man with a full head of graying hair—but he often seemed to have an angle. When Maroon sold his neurosurgery practice to the University of Pittsburgh Medical Center, some of his colleagues were surprised to learn in the Post-Gazette that UPMC had agreed to purchase real estate owned by Maroon for $6.22 million. “Joe has a lot of great qualities, he has legions of patients that legitimately adore him,” said one doctor who worked with him for years. “He’s done well at the professional level in all respects, including with the Steelers. But everything has to have an immediate entrepreneurial angle. You can’t just appreciate it for whatever its value is, you know? There has to be: ‘How can we take advantage of that?’ And that’s the thing that to me is a little off-putting.”

  Shortly after the Bubby Brister affair, Maroon sat down in the cafeteria at Allegheny General with Mark Lovell and laid out what he was thinking.

  Lovell (pronounced LOVE-uhl) didn’t have much experience in sports, but he had personal experience with concussions. During his junior year of high school in Grand Rapids, Michigan, he was picked up hitchhiking by a drunk driver and was thrown through the windshield when the car crashed into a parked car. “My head went through and then recoiled back,” he said. “If you look at my nose, you can see that they kind of sewed it back on.”

  Lovell needed 120 stitches. But what he noticed over time was that the more serious problem was his head. For the next several years he had migraine headaches. “I had a concussion, but nobody called it a concussion,” Lovell said.

  Lovell was reserved and soft-spoken, with straight brown hair, a goatee, and an earnest manner that later made his role as one of the most controversial figures in the NFL’s concussion saga seem incongruous. His specialty was neuropsychology—Jeff Barth’s world—a relatively modern discipline that seemed to baffle everyone around him. Lovell’s father, a Grand Rapids auto mechanic, proudly introduced his son as a “psycho neurologist.” Lovell’s fundamental job was to assess brain function, and Maroon had come to him with an intriguing proposition.

  Maroon wanted to see if Barth’s experiment could be adapted to the NFL. He wanted to know specifically if Lovell could design a neuropsychological test that could be used to establish baseline data for the Steelers and then use that test to assess changes in brain function after a concussion. If there were major changes, Maroon would have quantifiable data to present to Noll and help guide his decisions about whether a player should return. Lovell quickly agreed. The test itself wouldn’t be hard. Barth already had administered it to college players, and so it was really a matter of updating the test—actually a series of tests to measure memory, executive function, and so on. The tests already existed; they were used to assess stroke patients, people with dyslexia, accident victims—any number of neurological disorders. The hardest part was devising an exam that could be administered in the heat of a game. “The thing I learned very, very quickly is that you didn’t have an abundance of time to do this,” Lovell said. “Neuropsychologists at that point would spend four or five or six hours with a patient. That doesn’t work in sports.” At most Lovell would have 15 or 20 minutes, maybe half an hour. He borrowed liberally from Barth’s study and other neuropsych tests that were floating around and tried to keep it all to one sheet of paper.

  Maroon went to Noll and Steelers owner Dan Rooney for approval. The test wasn’t expensive—it was all done with paper
and pencil—but the team needed to make the research subjects—the players—available. Noll and Rooney agreed under the condition that the testing would be voluntary. Anything more would have to be cleared through the NFL Players Association, and that wasn’t likely.

  The players greeted the idea with suspicion. Many thought the team was literally trying to get into their heads by assembling psychological profiles that could be used in contract negotiations. Or secretly administering IQ tests. Or looking for potential deviants. The NFL already put rookies through the controversial Wonderlic test, which Lovell described as “a test to see if you’re too stupid to play in the NFL.” He didn’t want his test to be confused with that. “I didn’t blame the players,” he said. “I said, ‘This has to be seen as something that’s only for injury management.’ ”

  The players were slow to come around. “Their agents called, their mothers called, everyone called until we convinced them that it was to their benefit,” said Maroon. “If they had a concussion and we went by the previous guidelines, they might be out for three weeks. But if neurocognitively they returned to normal, we might be able to let them go back on the field sooner.”

  Twenty-seven Steeler guinea pigs ultimately volunteered after Maroon and Lovell guaranteed that the results would remain private. It was now 1993, and Maroon and Lovell were trying not to offend anyone. “To be honest with you, I thought it was pretty cool to be nerds and get to do this stuff, to work with athletes,” said Lovell. “We didn’t want to get ourselves thrown out by becoming a pain in the neck.” He tried to be as inconspicuous as possible. A speech pathologist administered the baseline tests during training camp. Lovell kept the data locked in a filing cabinet in his office.

  The immediate hope was that the data would be used to help decide when a player was ready to return after sustaining a concussion. But almost from the beginning it went well beyond that.

  One of the first guinea pigs was Webster’s former roommate Merril Hoge. He wasn’t totally sure why he signed up. “You couldn’t be forced to do it, and I actually didn’t want to do it,” Hoge said. Like everyone else, he thought that on the spectrum of potential career-ending injuries, a concussion wouldn’t even register. “I mean, I got a helmet on,” he reasoned. But he shrugged and took the test.

  In his six years since being drafted, Hoge had learned a lot about the speed and brutality of the NFL. What he hadn’t learned from Webster, he had experienced himself. He found that there was a primitive quality to the pro game: Those who survived ate, paid their mortgages, and supported their kids on football. “No wonder it’s so intense,” he thought to himself. “This is people’s livelihoods.” He was astonished at how nakedly cutthroat it all was. One day at practice, an injured player violated Noll’s edict to keep away from drills. The rule was a not-so-subtle message: If you’re injured, not only are you of no use to us but we don’t want you tainting the rest of the team. The player had wandered too close to the drill, apparently trying to impress the coaches, when Noll spotted him and said: “Go on. Get out of here.”

  The player moved closer, not totally comprehending. “No, get your stuff,” said Noll. “You’re done.”

  “He cut him right there on the field,” Hoge said.

  Hoge made his mind up that he would compensate for whatever physical limitations he had by following the rules and making himself indispensable. He made the Steelers in 1987 as a third-string fullback. His second year he started eight games but led the team in rushing. By his third year, Hoge owned the job. He was the quintessential Steelers running back—tough, a grinder. He reminded some people of Rocky Bleier, another rugged back who blocked well, caught passes, churned out yards, and, above all, never gave an inch.

  At some point in his career, Hoge decided he understood why the rule makers of professional football created the huddle: “It’s a chance for everybody to pause and go, ‘Okay, does anybody want to quit?’ It’s so physically challenging that you need that 35 seconds to revisit” your decision.

  One afternoon against the Philadelphia Eagles, Hoge caught a pass and turned upfield when he ran into the linebacker Seth Joyner. The two men had collided on a similar play the previous year, with Hoge getting the better of Joyner. This time the collision triggered a melee. After the two men were separated, Hoge screamed: “I’ll whip your ass, Seth, you punk!” The two players returned to their respective huddles but continued to jaw across the line. Finally, the Steelers were backed up near their own goal line when Brister called for a draw play. He handed off to Hoge, who found himself staring into a human wall. It consisted not only of Seth Joyner but also of Jerome Brown, a defensive tackle, and Reggie White, one of the most feared defensive ends in the history of the NFL.

  Hoge thought: I’m gonna fuck them up. I’m gonna hit them as hard as they’ve ever been hit in their life.

  He plunged headfirst into the wall. “When I hit, I felt like my internal organs just went out my ass,” he said. “It was like poof!”

  He struggled to the sideline and sidled up to his friend Tunch Ilkin, the Steelers offensive tackle.

  “Hey, Tunch, look around at the back of my pants,” Hoge said. “I think I shit my pants.”

  Ilkin at first couldn’t detect anything. Hoge lifted up his jersey.

  “You shit your pants,” said Ilkin.

  “I played a whole quarter like that,” Hoge said. “We’re in the huddle, and everyone’s like, ‘Gawd, does it stink!’ ”

  Hoge thought concussions were the least of his concerns. But he did notice that the effects were varied and sometimes bizarre. One Sunday at Denver’s Mile High Stadium, he ran into Steve Atwater, the Broncos free safety, and found that he couldn’t remember the plays or the snap count. He went to the sideline to sort it out and suddenly, without warning, burst into tears. He felt humiliated. Only later did Hoge learn that this was another symptom of a concussion: If the area of the brain that controls emotions becomes damaged, people sometimes cry unexpectedly.

  Often, the most devastating hits occurred in practice. One day, the Steelers’ first-team offense was playing against the first-team defense, when a play was called that required Hoge to block the strong safety Donnie Shell. Shell weighed just 185 pounds, but his technique was so refined that it was like he turned himself into a tactical missile. When Hoge heard the call in the huddle, he began to pump himself up. He weighed 225 pounds and figured that his greater mass would win the day. “I’m gonna bust that little punk in half,” he thought. Hoge wheeled around end and headed straight for Shell. The two men collided in the open field at full speed.

  “When I hit him, it was like a lightning bolt ran right through my body, like I’d been paralyzed and electrocuted at the same time,” Hoge said. “My helmet got knocked off, and literally on the left side I was numb. I couldn’t move.”

  Hoge was still lying there when he heard Noll’s voice ring out: “That’s it! Now that’s how you got to hit him!”

  Through his haze Hoge heard: “Run it again!”

  In 1994, one year after he participated in Maroon and Lovell’s experiment (and promptly forgot about it), Hoge signed as a free agent with the Chicago Bears. It would not be a long and fruitful relationship.

  During an exhibition Monday-night game at Kansas City, Hoge caught a pass out of the backfield and headed toward the goal line. Several defenders closed in, including nine-time Pro Bowl linebacker Derrick Thomas. As Hoge braced himself for the collision, Thomas plowed his helmet into Hoge’s ear hole.

  Hoge lay on the turf, motionless. “I’ve never been in an earthquake, but the first thing I thought was, ‘Holy cow, man, the earth is shaking,’ ” he said. “It was shaking so bad I couldn’t get up. I had no equilibrium. I was like, ‘This damn earth won’t quit shaking.’ ” Tim Worley, a former Steelers running back who had come over with Hoge, was one of the first people to arrive on the scene. “Aw, damn,” Worley said, looking down at his obliterated friend.

  Worley was about to motion for the
trainers, but then, amazingly, Hoge got up. His brain was on autopilot. It was as if Webster were inside his head screaming: “Get up!” Hoge made it through one more play and then stumbled to the sideline.

  “Where are you?” a trainer asked.

  “Tampa Bay,” he replied.

  Asked why he thought that, since he was standing on the field at Arrowhead Stadium, Hoge said: “Because I can hear the ocean.”

  The Bears sent him to the hospital for a computed tomography (CT) scan. At one point, Hoge wandered off and was found in a waiting room three floors up. He had no idea how he had gotten there.

  As he prepared to board the team plane that night back to Chicago, Hoge already was thinking about the next game.

  “Do you think I’ll be able to play?” he asked Bears physician John Munsell.

  “We’ll let you know tomorrow,” Munsell said.

  When Hoge arrived at the Bears’ training facility the next day, he looked in the mirror and was shocked. His face was white. His head was pounding “like I had been hit with a bat.” But still he wanted to play even though the next game was also an exhibition. When the head trainer, Fred Caito, informed him he’d have to sit out on Munsell’s orders, Hoge asked if he could call the doctor and try to talk him out of it. The trainer said no.

  Hoge came back the next day.

  “Did you guys change your mind?” he asked Caito.

  The answer was still no. Hoge now set his sights on the season opener, two weeks away. He desperately wanted to play. The Bears, who had just signed him to a three-year, $2.4 million contract, wanted that too, of course. Unlike Pittsburgh, the Bears had neither a neurological specialist like Joe Maroon nor a diagnostic test to measure how Hoge’s brain was functioning. It was all an educated guess as to whether Hoge, chomping at the bit, was fit to play again.