Rethinking Concussions
Sitting in front of me was a man I had watched make incredible plays on the football field. During football season, I would follow this man and watch every single play he ever made. I memorized every stat about this giant of a man. He was incredible! I never would have predicted that he would become a patient of mine. This man was hall of fame material but his career took a nose dive when he suffered a season ending injury. This injury led him to many self-destructive behaviors and he was never able to pull himself together again. Drug use and legal issues plagued him to the point that he became “that famous dude” at several psychiatric hospitals. Looking over his records prior to my first session with him was flat out depressing. This man had gone from rags to riches to rags again. Barely able to walk or speak due to multiple concussions, this NFL player had been reduced to a semi-vegetative state. He was escorted to my office by a buddy of his, also a former NFL player. He was wearing an adult diaper at age 48.
My role was to conduct a neuropsychological evaluation and possibly attempt some rehabilitation of a damaged brain. Damage that most would write off as a lost cause. The evaluation had to take place over several days due to his inability to remain awake or comfortable enough to sit still and answer my questions. I felt like I was agitating him. I put down the testing material and brought my chair over to his side of the desk. I put my hand on his shoulder and said “We can stop.” My heart went out to him. As a clinician, it is tempting to conceptualize neurological deficiencies as just that. But my role extended beyond assessing a man who was not interested in being there. Instead I asked him questions like I would ask to a friend who was in pain. I asked him what he would like to do. His response was one word. “Die.” I sat with him as he put his head down. He drifted in and out of sleep and I just watched him. I considered what he said as his current wish. To die.
Death can be very scary. To live but feel like you are dying, is frightening. As Noman Cousins said, “Death is not the greatest loss in life. The greatest loss is what dies inside us while we live.”
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During lucid moments, I was able to get him to smile. He also enjoyed listening to music and my semi-decent impressions of other athletes. I discovered that the table separating the two of us was a barrier and we began to sit face to face in two comfortable chairs. I learned to listen even when he was incoherent. I learned to care for another human being whose prognosis was poor. I learned to show fondness to someone with a neuro-degenerative condition. I told him that I would never give up on him. He teared up. He saw empathy. That was all I could offer.
Although a concussion is thought to be a “mild brain injury”, the concussions that college and professional athletes sustain are typically not the same as those sustained by a regular non-athlete who suffers a fall. Many athletes have endured multiple concussions. The brain was not created in such a way that these blows to the head can handle with ease. Brains are meant to be handled with care.
Nowadays, we hear more about CTE, or chronic traumatic encephalopathy in high contact sports such as football. This condition usually occurs when the brain has been concussed many times. People suffering from CTE experience personality changes that are irreversible. Aaron Hernandez is an example of the sad state of high contact sports injuries, without a happy ending.
When I taught a course in neuroscience at a local private school in Maryland, student athletes who were considering athletics as a career became frightened at the possibility of becoming a future Aaron Hernandez. It was not my intent to frighten them. I just gave them the facts. One particular student who had suffered two concussions came to me after class and asked me if I could refer him to a neurologist. His face had turned pale during our lesson on concussions. I gave him the name of someone reputable and asked him if he would share the findings.
Several weeks later, the student came back and informed me that he would no longer be playing high contact sports. The neurologist told him that if he had suffered another concussion or two, his speech and thought processes could become compromised. There was already mild damage to the Broca’s area of his brain, the area of the brain in charge of expressive language. Luckily, he was still young and his prognosis was very good if he could avoid becoming concussed again. He declined to speak to the class but was thankful for the referral that would help reshape his career plans.
As young athletes enter the world of collegiate and professional sports, it is time to consider the repercussions of concussions. Long-term planning is crucial as the stakes are high. Aside from the considerations of long-term brain damage, athletes should consider long term fiscal responsibility for their families. Most athletic careers end before the athlete turns 35 years of age. What is waiting ahead of them after their career is definitely something that should be a conversation before considering high contact sports. Lured by the prospects of fame and fortune, these young men and women, do not necessarily consider purchasing career ending disability insurance policies that can help protect them financially. These policies obviously have limits but they are important discussions that athletes should be a part of before they enter the arena. It is time to restart the concussion discussion.
