Deadly aftershocks

Concussions have captured the headlines, but it could be somewhat more complicated than that. In fact, Cantu says it is "the total brain trauma" that a player absorbs and "not just the number of concussions" that leave him vulnerable to CTE (which Cantu thinks has been generally misdiagnosed as Alzheimer's disease). Consequently, Cantu says that while NHL players are hit just as hard or harder than NFL players, NFL lineman such as Webster, Long, McHale and others were at jeopardy because of the way their heads were "violently shaken" on every play - not enough to cause a concussion perhaps, but enough to cause cumulative injury from repetitive subconcussive insult. Says McKee, holding up a slide of a McHale sample: "What we have is a continual acceleration/deceleration of the brain inside the skull."

She points to the border of the hippocampus, a curved ridge of tissue in the cerebral hemisphere associated with memory. "There can be no disputing the facts," McKee says of the area, the discoloration of which stems from an accumulation of tau. "And you do not have to be a doctor to see it. Here it is. You can either pretend that it is not happening or just accept it."

She shrugs and with a sigh adds, "We are not splitting hairs here."

John Grimsley was an avid outdoorsman who was so adept at handling firearms that his wife Virginia used to call him "Grimsley Adams," a play on the old TV show about frontiersman Grizzly Adams. So when the former Houston Oilers linebacker accidentally shot himself while cleaning a pistol in February 2008, it seemed inconceivable to Virginia that her husband could have been so careless with a weapon. "I just wondered, 'How the heck could this have happened?' " says Virginia, who adds there was no indication that it was a suicide. In fact, the dying Grimsley reached for a cleaning rag to stanch the blood flow from the wound in his chest.

"John would have never wanted to leave this earth," said Virginia, whose husband was 45 when he died. "John loved life, and I know he would not have done that to me and our two sons. What I think happened is that he just forgot that there was still a bullet in the chamber."

Virginia had been worried about John. He had indeed become forgetful. Exasperated, she would find herself saying to him: "Honey, I told you that five times today." Worse, the "laid-back, slow-to-anger" man that she had known since they were teenagers in Ohio had developed a short fuse. Virginia would stare at him when he snapped at her and say: "Who are you?" Always, he would come around later and apologize, and Virginia would shrug and "just chalk it up to a bad day." But along with the personality change she saw in him there were other problems: headaches, insomnia and an increasing reliance on alcohol to numb the pain that shot through his shoulder and hands. Virginia explained it as a function of just getting older until she saw a documentary on Nowinski and the problems other former players were having.

Virginia told him, "Honey, you know we have always joked that you were hit in the head once too often. But this is not funny anymore."

"Oh, well," John replied. "We all took our blows to the head. That was just part of the game."

Virginia told him he should watch the documentary if it came on again.

He did.

"And he just sat there looking at the screen not saying a word," Virginia says. "And that just spoke volumes. I could see that he was scared."

No one looked beyond the here and now when it came to head trauma in the era that Grimsley played. In fact, former Baltimore Colts safety Bruce Laird says taking a blow to head was "a badge of honor." Laird had four concussions during his career and adds, "And that does not count the number of times I was knocked around." He remembers once he was so woozy that the team doctors took his helmet away and hid it to keep him from playing again. Laird says, "I found it and went back in anyway." Even if it remained unspoken by coaches and teammates, it was the expectation that a player would "suck it up." In the case of Laird and countless others, that commonly occurred with the aid of what he calls "ammonia snappers."

"What they would do if you were out of it is break one open and give you a sniff of it," says Laird, who is a CSTE donor. "It would be like taking the cap off an ammonia bottle and taking a whiff of it. I remember I used to have our trainer carry them on his belt like bullets. I used them liked candy."

What it comes down to as far as former NFL linebacker Isaiah Kacyvenski is concerned is taking the decision to play or not to play out of the hands of the player, of establishing strict protocols that would essentially protect the player from himself. Kacyvenski says he had 15 concussions during his playing career at Harvard and in the NFL with the Seahawks, Rams and Raiders. "When your livelihood depends on hitting people, you have no choice but to 'tough through it,' " says Kacyvenski, a CSTE donor who remembers being blindsided in a game. Kacyvenski says he "wandered off the field, not sure of where I was." He says he was so out of it that he had no sense of smell, even when he took a deep whiff of an ammonia capsule. Says Kacyvenski: "So they gave me two. Huge whiffs - nothing. Close to a half-hour later, I was allowed to go back in the game."

But whatever hazards exist are shoved aside by young players trying to crack into the league. As he walked off the Eagles' practice field at the NovaCare Complex last week, guard Mike McGlynn said he was not sure if he has ever had a concussion. "I have had some headaches," says McGlynn, in his second year out of Pittsburgh. While he is well aware that players in the NFL are replaceable parts, he says he would not withhold a head injury from the coaches if he happened to get one. But safety Reshard Langford, an undrafted rookie out of Vanderbilt, says he could understand why a player would do it. He says: "What is the average length of a career - 2, 3 years? So the turnover is high." Second-year cornerback Jack Ikegwuonu, out of Wisconsin, adds that head injury can be preventable "if you are taught well and learn how to tackle." While he says he has not had a concussion yet, he would not hesitate to report it, saying: "Your body is your temple." Ikegwuonu adds that he has never heard of CTE.

Because the symptoms of CTE are undetectable by screening and take years to develop, there is a palpable fear among players that they are in store for a sad reckoning, that old age could be some form of the misery that has engulfed former Baltimore Colts tight end John Mackey. Few players in the league were as articulate as Mackey, the former president of the players association. Laird says Mackey is institutionalized, unable to speak and has the characteristics of a small child; he and his former Colts teammates were instrumental in founding a program in honor of him called the "88 Plan" that has been co-sponsored by the NFL to lend aid to close to 100 other former players. Well aware of the pattern of disability that has ensnared some former players, which Nowinski thinks of as an "emerging lost generation of non-functional men," the 31-year-old Kacyvenski says it takes him longer to do the same things he did 10 years ago, and that he slips in and out of depression.

"Do I worry about the shape I will be in 20 years from now? Yes, I do," Kacyvenski says. "But I take it day by day. I have a wife and two children, and I want to contribute to society in whatever positive way I can."

Says Cantu: "Insofar as developing CTE is concerned, the fact that we have found it in 10 of 11 cases is not to say that this will be the batting average for the NFL. But what we know is that it does not show up during their playing careers, which is why Troy Aikman and Steve Young are not out of the woods yet. Both of them took poundings and are well-spoken enough to do TV. But it will not be clear for 15 or 20 years if they have developed CTE."

McKee says that the delay seeing symptoms of CTE is part of the problem. "Because the delay is 10 years or more, people no longer connect it to a head trauma they suffered 20 years ago," she says. "But I wonder whenever I hear a former player has beaten his wife, or lost his business because they were gambling like crazy, or ended up dead at the end of a scary police chase. Is there evidence of brain damage?"