He’ll tell you it gets harder every day, the sense of loss, the wondering what might have been. But at least Kenneth Gee has an answer as to why his son, Michael, collapsed on the ice and died suddenly at 15 – and he knows he did everything he could to ensure his son was safe to play.
Unlike most junior hockey players and other elite-level young athletes, Michael underwent extensive and regular screening, including magnetic resonance imaging. Even those sophisticated tests didn’t reveal the defect that would claim his life in 2005.
“Both of our kids went and had regular testing and MRIs,” said Gee, whose own diagnosis with the heart defect arrhythmogenic right ventricular cardiomyopathy (ARVC) led to the testing for his children. “It’s a hard thing to detect. At the time, [Michael] was cleared to play.”
The death this week of 16-year-old Jordan Boyd, who collapsed during his rookie tryout with the QMJHL Acadie-Bathurst Titan, has led to calls from some advocates for greater screening of young athletes who play at an elite level.
The cause of Jordan’s death is not yet known, and although an autopsy was performed last Wednesday, results could take weeks, and could point to other factors.
In the hockey world, Jordan’s death has focused renewed attention on the extent of screening that should be mandatory for young athletes – a debate that eludes simple answers or recommendations for broader testing.
Basic diagnostic tests such as electrocardiograms (EKG) aren’t conducted as a matter of course for junior players.
In the QMJHL, as in other leagues across the country, it’s up to individual teams to decide how far they want to go in their screening. Typically, a player is examined first by his family physician – most major-junior league rookies are minors and must receive their parents’ consent – who completes the medical history questionnaire.
Then, the player submits to a second, more cursory physical by the team’s trainer or head therapist when he arrives in rookie camp. Returning players typically undergo more thorough fitness testing once the main training camp begins.
Sports physicians in any discipline are always on the lookout for previously undiagnosed conditions, and heart ailments in particular.
“It’s certainly something that’s on the radar of team doctors everywhere, we always consider the possible risk factors, but unfortunately these things can’t always be picked up ahead of time,” said James Kissick, who currently serves as the team doctor for Canada’s national sledge hockey program, and is a former Ottawa Senators physician.
Cardiologists stress EKGs don’t always reveal a full picture of what’s going on in the heart – it measures electrical activity and heartbeat frequency – and that even more involved and costly tests such as an echocardiogram, which allows doctors to see what’s happening inside the heart, sometimes fail to identify underlying conditions.
Such tests are often performed on NHL players and Olympic athletes, but there’s disagreement in the medical community regarding the value of advanced tests, which are more common in Europe, among younger athletes.
While some cardiologists in North America believe there should be broader and more systematic testing of younger athletes, that view doesn’t represent a consensus. As one doctor put it in an interview: Many congenital heart problems are essentially undetectable, and “in other places, this kind of testing is a profit centre; in Canada, it’s a cost centre.”
There is a sense in the medical community, however, that it is generally worthwhile to do routine EKGs and other tests with adult elite-level athletes.
But there are few certainties in life or in medicine.
In March of last year, then 24-year-old Bolton Wanderers midfielder Fabrice Muamba, who had represented England internationally at the youth level, collapsed in front of 36,000 fans during a game against Tottenham Hotspur.
He survived, narrowly, but was forced to cut short his professional soccer career (cardiologists estimate the survival rate after a sudden cardiac problem at about 50 per cent).
“He would have been tested and screened multiple times over the course of his career,” said David Birnie, an arrhythmia expert at the University of Ottawa Heart Institute and a consulting cardiologist for the Canadian Soccer Association.
The current guidelines endorsed by the major medical and heart associations in Canada and the United States call for a full physical exam and the completion of a detailed medical history prior to competition.
“We do actually pick up a lot of abnormalities that way, particularly the genetic ones,” Birnie said.
It’s up to sporting federations and provincial governing bodies to determine their screening practices. In the case of hockey, the sport’s national governing authority has instituted precautions even for children who play at a recreational level.
“From a minor-hockey perspective, Hockey Canada has a program that puts a safety person on the benches who are aware of SADS [sudden arrhythmic death syndrome],” Hockey Canada senior manager Todd Jackson said. “We do bring awareness to it. It’s on our radar. The key is watching for the warning signs – such as a fainting and dizziness – knowing them, and passing the information on to parents, coaches and players.”
According to a QMJHL official, all teams in the league require a complete physical and issue a questionnaire aimed at filling out the gaps in a player’s family medical history.
Further complicating the picture, some teams such as the Windsor Spitfires of the OHL have opted to go the extra step in ordering EKGs on players. The Spitfires instituted the measure after 19-year-old captain Mickey Renaud died suddenly of an undiagnosed congenital heart condition in 2008.
Several other teams in the OHL, and a handful in the Western Hockey League and QMJHL, also conduct EKGs.
A spokesman for the Canadian Hockey League, the umbrella group for the OHL, WHL and QMJHL, said each league is responsible for its medical policy, but couldn’t confirm whether any changes had been adopted in light of Renaud’s death.
Even teams that do routine EKG testing are quick to point out its limits.
“[An EKG] is not a reliable test as far as being a predictor of someone dying on the ice,” Portland Winterhawks certified athletic trainer Rich Campbell said. “It’s still better to know the [player’s] history, the family’s medical history, and to have a physical exam where a doctor listens to the heart with a stethoscope.”
As Jordan Boyd’s family and friends prepare to mourn his passing at a Saturday funeral in Halifax, more details have emerged on the moments leading up to the tragedy.
A timeline issued by the QMJHL indicates that before stepping on the ice at the K.C. Irving Regional Centre around 10:20 a.m. local time, Jordan participated in a 45-minute stretching session with his new teammates and the Titan physical therapist, and he “was in good spirits, even joking with the group.”
Players at the rookie camp were accompanied by “group leaders” throughout the day, and after a team meeting to discuss the practice drills, Jordan and the others headed onto the ice.
After a four- or five-minute warm-up skate, the players were split into groups for a pair of passing drills, which totalled about 10 minutes. The players were then given a short break to drink some water, and broken up into units for line rushes. Jordan, a 6-foot-1, 174-pound forward, was in the third grouping.
The coaches whistled for the first group to start the drill. A few moments later, they whistled to signal the second group, and it’s when they noticed a player missing after a third whistle that a coach saw Jordan sprawled on the ice.
The timeline says the team athletic therapist leaped over the boards and, after arriving at Jordan’s side, she yelled for someone to call 9-1-1 and began efforts to revive him – the arena is equipped with a portable defibrillator (all QMJHL teams are required to have one at hand).
Jordan’s parents were in the stands, looking on in horror as their son was loaded into an ambulance and taken to a nearby hospital, where he would be pronounced dead.
For Kenneth Gee, Jordan’s death was eerily familiar to his son’s.
The Gees were in the stands of a Drayton Valley, Alta., hockey rink for Michael’s tryout, when he collapsed near the boards. Team officials rushed to his side and applied CPR. No defibrillator was used. Gee went to his son and held his hand.
Michael was taken to a nearby hospital and later pronounced dead.
“Since [Michael’s death], there have been a few other situations with children,” Gee said.
“It’s terrible. It’s harder every day, but at least we’ve had a lot of support from the hockey community and friends.”