Some day trainers and coaches might even get, if not assistance, at least not resistance, from an injured player’s teammates. Because teammates matter so much to each other and don’t want to let each other down, because they’re 17 years old and immortal, the natural, normal, adolescent pressure to keep playing is almost irresistible. Not long ago a slogan was introduced about drinking and driving that reflected, and helped to create, a powerful new attitude – “Friends don’t let friends drive drunk” – and a culture that seemed impossible to change has been transformed. Some day, why not a similarly powerful slogan between teammates – “Friends don’t let friends play concussed.”
THE MORE WE KNOW
Each new piece of information raised at the conference seemed only to highlight more things we don’t know. New imaging devices can see abnormalities in the brain that couldn’t be seen before. What caused these abnormalities? Do they relate to concussions? What effect do they have on the player? And crucially, with these abnormalities what should a player do? Better imaging ahead will only mean more questions without answers. Should the player continue to play? What about an NHL star whose whole future seems tied to the fame and fortune he can achieve from a few short years of play?
There’s a mystique about athletes. They ask their bodies to do the unimaginable, and often their bodies deliver. When it seems their bodies will break, they don’t break. The athletes’ doctors adapt to them as they adapt to the special qualities of their other patients. But sometimes it’s more than that. Coaches, trainers everywhere; media; thousands of fans in the stadium or arena, millions more at home: this is no simple doctor-patient relationship, or so it seems. This is another world, where another world’s rules may apply.
Some doctors become unsettled, if not star-struck, around athletes. As fans, too, some of them hope too hard and want too much for injured players to be fine and to play. A lot rides on what the doctors say – a game, a season, a championship for everyone; happiness or despair for many; and (often an unfair accusation too easily made) a lucrative practice, a sports injury clinic, a little stardom for themselves. They have seen players do and overcome almost anything. By seeing them and treating them as almost super-human, they sometimes treat them as almost sub-human. Maybe players’ shoulders and knees can overcome almost anything. Maybe brains are different.
Athletes are vulnerable, athletes at every age and level. Absorbed in what they’re doing and surrounded by hope, mystique and (for a few) dollar signs, they often need others to see for them. The knowns about them are so big and obvious – money, fame, the championship to win – that at the crunch moment, to play or not to play, their unknowns – their health now and in the future – can seem less consequential. Yet an athlete is a patient, not also a patient. Theirs is a doctor– patient , not doctor– player relationship.
In Zurich, highly professional doctors wrestled with these apparently complicated questions: Is an athlete different from a non-athlete, a young athlete from an adult athlete, an amateur from a professional? Should one be treated differently from another? After two or more concussions, should one be advised differently about his or her future? The doctors asked these questions to help them find answers, and to help them find explanations, perhaps justifications, for what they felt.
It’s easy for a doctor not to understand an athlete. It’s also easy for a doctor to try to understand him or her too well. It’s not up to a doctor to be the athlete, to imagine the athlete’s choices and make those choices for him. It’s up to the doctor to pass on what he or she knows as a doctor. It’s up to the athlete – youth-adult; amateur-pro – as a patient, a human being, to decide. If strong-minded, capable doctors can’t stop themselves from being distracted by the trappings of sports, if their distraction is all so inherently human it may never go away, how do we protect the athlete?
ONE MORE BIG QUESTIONChronic traumatic encephalopathy (CTE) has been found in the brains of many former football and hockey players including Bob Probert, Rick Martin and Derek Boogaard. It is a degenerative condition in which there is loss of brain tissue, and an abnormal buildup of deposits in nerve cells of a protein called tau. CTE’s sporting trail goes back to a study of boxers in the 1920s and a condition then called dementia pugilistica, “punch drunkenness.” CTE, it seemed, was triggered by repeated non-concussive and concussive blows. That’s now less clear. Research today makes the possible link between CTE and other progressive degenerative diseases such as Parkinson’s and ALS. Yet fewer than 100 cases of CTE have ever been confirmed. Confirmation requires an autopsy, and an autopsy requires a reason to conduct an autopsy. Until recently, there was rarely a reason.