One of the things Connie Stiles would remember about the day her son died was how routine it was. Treadmill. Starbucks. Late for work. Run home. Let the dog out. McDonald's. Game time.
It was Thursday, October 28, the last day of the Spring Hill High School football season. Stiles' son, Nathan, played running back and linebacker for the Broncos, whose home field is carved out of a cornfield south of Olathe. He had dark hair, broad shoulders and an easy smile, traits that helped crown him homecoming king earlier in the season.
As Stiles raced to make her son's game that evening, Nathan and his teammates traveled 20 miles south on K-7 to Osawatomie High School. The stakes were low: The two teams began the night with identical 1-7 records.
As if trying to make up for a season's worth of futility, both teams kept scoring. Nathan, a 17-year-old senior, ran for two touchdowns in the first quarter, which ended with Spring Hill leading 32-30.
A forgettable season was building toward an epic conclusion. But late in the first half, Stiles noticed Nathan "walking off the field kind of funny." Down on the sidelines, her son complained to an assistant coach, "My head is really hurting." He took a seat on the bench, but then he stood up and collapsed.
The 911 call went out at 8:23 p.m. After making her way to the field, Stiles watched her son raise his left arm before the helicopter airlifted him to the University of Kansas Medical Center. She and her husband, Ron, then made an excruciating drive to Kansas City, Kansas.
Surgeons tried to stop the bleeding in Nathan's brain as the hospital's waiting room filled. Nathan was active in a church youth group and popular at school.
But Nathan never regained consciousness. Doctors took him off life support around 4 a.m.
Suspicion turned immediately to a concussion that Nathan had sustained three weeks before, in the school's homecoming game. He sat out two games and was cleared to play October 22.
A cause of death has not been released. But high school football players who died in similar circumstances provide a clue. A rare phenomenon called "second impact syndrome" occurs when an athlete suffers a head injury before a previous concussion's symptoms — headache, blurred vision, difficulty concentrating — have fully subsided. Even a minor hit can cause rapid, and almost always fatal, brain swelling. Teenagers, their brains not fully developed, are most vulnerable.
Nathan's parents were models of courage in the days after his death. Connie Stiles threw herself into a project to bring young people closer to God by making sure students who attended a memorial service at the school were offered free Bibles. Ron Stiles told the mourners — among them Nathan's teammates, whose jerseys were tucked into dress pants — that the family was not looking for anyone to blame. "This event was no one's fault," he said, resisting the impulse to cope with tragedy by assigning liability.
Ron and Connie Stiles said they wanted their son's example to promote concussion safety. "If you're not well, get well," Ron Stiles told the students at the memorial service.
As it happened, football's capacity to damage brains was already on America's mind when Nathan collapsed. Earlier that week, the National Football League had fined three players a total of $175,000 for a Sunday's worth of violent hits. Stomach-turning video of players launching themselves into one another aired on ESPN for days.
Along with serving as a deterrent, the fines were part of a PR campaign to prove that the league was taking its concussion crisis seriously. The NFL has given $1 million to fund the research of chronic traumatic encephalopathy (CTE), a sort of trauma-induced Alzheimer's disease. The first case was found in Mike Webster, the former Chiefs center who won four Super Bowl rings with the Pittsburgh Steelers. Webster, who finished his playing career in Kansas City, was sleeping in the Pittsburgh Amtrak station at the time of his death at age 50.
But Webster's obituary was written in 2002. The NFL made the $1 million donation in January of this year. For much of the time in between, league officials played down the long-term health effects of concussions. Physicians who worked for NFL teams routinely discredited evidence that linked football and brain damage.
Whether or not image driven, the NFL has had a moment of clarity. As a result, so have the doctors, trainers and coaches who work with young athletes. In Kansas and Missouri, athletes who suffer concussions are now required to get a doctor's OK before they return to action.
But permission slips are fallible, which is why some doctors are pushing even harder — including a former Chiefs doctor who, after enduring the NFL's concussion crisis, is now working to keep fragile minds from becoming irretrievably scrambled.
Rockhurst High School is, by all definitions, a football powerhouse. Perched on the state line between Kansas City and Leawood, the school has won seven state championships under coach Tony Severino. A team shop stocked with $50 hoodies sits under the school's permanent bleachers.
Like any boys' school contender, Rockhurst recruits its players and imports its cheerleaders. On this Friday night in mid-October, Notre Dame de Sion's dance team provides the halftime entertainment. Raymore Peculiar serves as the opposition.
Along the sideline, Joseph Waeckerle limps his way back and forth. A bushy white mustache affirms his status as one of the team's elder statesmen. Waeckerle attended Rockhurst in the early 1960s. Like many graduates of the Jesuit-run school, he feels a connection that makes him to want give back. A semi-retired physician, he now volunteers as the head-and-neck guy for the school's athletic teams.
There may not be a high school in the country with a more accomplished doctor on its sidelines. Waeckerle has testified before Congress about disaster preparedness and has published articles on wound care. He helped write the original test certifying sports-medicine specialists. And he's an expert in sports-related concussions, as anyone with his experience must be: Waeckerle was a member of the Chiefs' medical staff for 20 years before his contract expired in June.
A Kansas City native, Waeckerle started his career in emergency medicine. And on July 17, 1981, he attended to one of Kansas City's best-known emergencies. It was 6 p.m., and he had just finished a shift at Baptist Medical Center near Brookside. Waeckerle played rugby in those days, so before he left the hospital, he got in some cardio by running up and down an 11-floor stairwell.
After he finished exercising, Waeckerle heard what everyone else would soon hear: that a fourth-floor walkway had collapsed on a tea dance at the Hyatt Regency. The director of Kansas City's emergency medical system from 1976 to 1979, Waeckerle learned that his replacement was out of town. He rushed to the scene.
When he arrived, he grabbed a bullhorn. With a voice of calm amid the chaos, he organized the medical response. "It was just like a bomb going off in a hotel," he says.
Waeckerle and the other rescuers spent hours crawling through the wreckage, extricating survivors, performing amputations and giving morphine to the ones who weren't going to make it out. The grim tally: 114 dead, 216 injured.
"It was bad shit, bad juju," Waeckerle says, sitting in the office of his Leawood home.
Waeckerle became a star in emergency medicine, chairing task forces and editing journals. He honed an expertise in sports medicine as both a player and a physician on rugby clubs. "Believe me," he says, "rugby was the ultimate educational testing grounds."
The Chiefs asked him to be a team doctor in 1990. His tenure spanned Mike Webster's final season and the day a collision knocked quarterback Trent Green out of the season opener. With Green and others, Waeckerle saw how far professional athletes pushed themselves to stay on the field, even when they became woozy after a blow to the head.
"They're motivated to go back," he says. "They don't want to lose their job. They don't want to lose their income. They don't want to lose that year of productivity. They don't want to miss a game. They certainly don't want to miss the playoffs or a chance to go for a ring."
Though Rockhurst regularly contends for a state title, only a handful of Rockhurst Hawklets play football at the next level. But everyone will need his brain. So Waeckerle says he works to establish a rapport with the players.
"If you tell them, 'If you come talk to me, I'm pulling you out of the game and you can't play anymore,' especially at the high school level, they're not going to come tell you," he says.
There's compassion in his voice, which you might not expect to hear from a founding member of the NFL's concussion committee: doctors who came to be portrayed as apologists for barbarism.
In 1989, Mike Webster came out of retirement to help lift the Chiefs out of the dregs.
The franchise had appeared in one playoff game in the 17 years before his arrival. New General Manager Carl Peterson and Coach Marty Schottenheimer wanted Webster, who had been released by the Steelers after the 1988 season, to work as an assistant coach. But Webster ended up starting all 16 games that year, and the team finished with a winning record. The next year, they made the playoffs.
Garrett Webster was kindergarten-age when his dad played for the Chiefs, his final two seasons. The organization invited the elder Webster to return as a coach in 1991. "Carl Peterson gave him sort of a token coaching job," Garrett says. "Carl knew he was struggling. Dad really couldn't even handle that."
Mike Webster's job as a coach — like his later job as a broadcaster — was brief. His post-playing days became a blur of failed business deals, tax liens, and an arrest for forging a Ritalin prescription. He subsisted on pills, sugar and chewing tobacco, and he filled journals with paranoid scribbles. When Garrett was a teenager, he and his dad shared an apartment outside Pittsburgh. Garrett had to place a flag in the window to help his father find his way home.
With help from a lawyer, Mike Webster filed a disability claim with the NFL. He managed to squeeze partial disability payments from the league in the final three years of his life, though there was nothing partial about his inability to function. The way Garrett saw it, the NFL pension board looked at his father as a "classic eccentric athlete who's having money trouble and is just trying to get a last payday."
A federal appeals court saw it differently and awarded the family $1.5 million — in 2006, four years after Mike Webster died. The official cause of death was heart failure. But it was football that broke the player known as Iron Mike.
Webster's death was an early alarm but not the first. In the mid-1990s, agent Leigh Steinberg began to speak about his concern for the football players he represented. He told chilling tales of sitting in a hospital with Cowboys quarterback Troy Aikman and having to remind his client every five minutes about the game his team had just won.
The NFL established a concussion committee in 1994, and it tapped several team doctors, including Waeckerle, to serve on it. The committee collected data from 1996 to 2001, and determined that more than half of NFL players who suffered concussions returned in the same game. Even players who lost consciousness made it back on the field — about a quarter of them. The stat reflected the warrior's code of the NFL, where coaches and players alike equate commitment to team with playing through injury.
But it was the long-term effect of that culture that undid that first concussion committee. Starting in 2004, the doctors published a series of articles in the journal Neurology. In one, the authors improbably argued that players who suffered concussions were not more susceptible for future ones. The finding validated the mindset of the coaches — and the players themselves: If you can stand, you can play. It also put a seal of approval on how the team doctors were managing concussions. Of course, Waeckerle and his co-authors happened to be those very same team doctors.
The paper predictably was panned by physicians who didn't work for the NFL. Robert Cantu, a neurosurgeon and Boston University professor, wrote that the NFL's experience "seems to be at odds with virtually all published guidelines." Another doctor faulted the design of the study, along with its "message that it is acceptable to return players while still symptomatic, which contradicts literature published over the past twenty years."
Another article was even more controversial, although Waeckerle's name wasn't on it. In it, the doctors claimed that there was no evidence of "widespread permanent or cumulative effects" of single or multiple concussions.
It was the NFL's official position, in other words, that Mike Webster was just an outlier, a sad freak.
The sports pages were telling a different story. Another former Steeler, Terry Long, killed himself in 2005 by drinking antifreeze. A year later, Andre Waters, a Philadelphia Eagles defensive back who battled depression in retirement, shot himself in the head. A hard-hitting safety in his playing days, Waters once told a reporter that he stopped counting his concussions at 15. When the players' brains were dissected, microscopes found the same abnormal proteins that had ravaged Webster's mind.
With anecdotes colliding with the committee's findings, the media began to dismantle the league's position one brain-battered player at a time. Then, in late 2006, ESPN the Magazine ran a story questioning the competence of the concussion committee's inner circle. The story depicted the committee's chairman, Jets team doctor Elliot Pellman, as a sloppy researcher and a bit of a fraud. (Pellman attended medical school in Guadalajara, Mexico, which he made an effort to conceal.)
Pellman resigned as the concussion committee chairman in 2007. Congress got involved soon after, and late last year, members of the House Judiciary Committee ridiculed the league's concussion experts, comparing them with the tobacco executives who denied the link between smoking and disease. The two men who succeeded Pellman resigned, and an embarrassed NFL Commissioner Roger Goodell said he would name new committee members who would bring "independent sources of expertise."
Waeckerle survived the housecleaning. But he's uncomfortable talking about these events. Besides, he says, "I'm just a country doc from Kansas City. My job is to take care of people."
The truth is, he remains a skeptic. Although CTE has now been diagnosed in more than 20 dead NFL players, Waeckerle isn't ready to say football is killing guys like Mike Webster. Maybe it's genetics. Maybe it's steroids. Maybe it's a combination of things. "We don't know if there's a cause and effect yet," he says. "We're studying it."
But if the scientist in Waeckerle still needs convincing, the caregiver in him acknowledges that concussions need to be managed carefully to keep athletes from going into nursing homes before they turn gray.
"I don't know the answers. But I know this is a possibility. And if it's a possibility, then I'm going to do everything I can to minimize the possibility," he says. "That's the safest approach, the most conservative approach. My dedication of my life, like most docs, is, I gotta do the best for my patient. I don't want to get embroiled in the debates."
Waeckerle won't, however, second-guess the treatment he gave Chiefs players. He chafes at a suggestion that the league was callous about head injuries. They just didn't have the data, he says.
"I hope I will never be able to say to you, I never did the best I could," he says. "God, if I do that, I better quit, immediately."
Are we supposed to take our shoes off?"
Steve Hawkins, an athletic trainer at De Soto High School in western Johnson County, is inside his office on a weekday afternoon. The students are starting to show up, and they're wondering about the shoe situation.
"Uh-huh," Hawkins answers. "See how clean the floor is? I vacuumed today."
As the shoes pile up in the hallway, Hawkins begins taping ankles and tending to sore shins. The room is not much larger than his training table. His hands are a blur as he tapes the various body parts that come his way between the final bell and the first whistles. "I tell my wife, 'Don't call me during prime time,'" Hawkins says.
Hawkins is 6 feet 4 inches tall and has spiky, dishwater-blond hair. He became a certified athletic trainer 26 years ago. He now works for Olathe Medical Center, which has a contract with the school.
Hawkins remembers when torn knee ligaments preoccupied his profession. Today, concussion management is the priority.
Still, most high schools don't have someone with the education of Waeckerle or Hawkins, who has a master's in sports medicine, working with their students. Even fewer do the concussion testing that Hawkins does.
De Soto has access to ImPACT, a computerized concussion-evaluation system. Before the season begins, student athletes sit in front of a computer and take a test that measures reaction time, problem solving, and other aspects of cognitive function. This establishes a baseline, and if players become concussed, they retake the test. It lasts about 20 minutes. The scores are then compared to determine if the fog has lifted.
All NFL teams and most colleges subscribe to the service, but ImPACT is slowly reaching the high school level. De Soto is one of 14 Kansas high schools that tests its athletes. "It's a shame that it has to trickle down that way, instead of the reverse," Hawkins says. "If you look at where the most participants are, they're at the high school level."
More trickling still needs to happen. Hawkins was working at another school when he watched a wrestler's head get slammed to the mat. An attending physician looked at the young man and said he was good to go. Hawkins told the referee that he disagreed.
The fact that the doctor was a podiatrist made it easier for Hawkins to speak up.
"I said, 'I don't know how many concussions that podiatrist has seen,'" Hawkins recalls. "'I'm going to err on the side of caution. I don't think he should go back.'"
Sometimes the athletes need convincing. On a cloudless night in late September, Hawkins was working a De Soto football game. In the third quarter, one of his players lay writhing on the field. The player eventually walked off the field, favoring a leg. Hawkins stayed by his side. "Leave me alone, Hawkins! Jeez!" the player finally pleaded.
As the game wore on, the player wanted back into the game. "Why are you trying to keep me out right now, Hawkins?" By the fourth quarter, he was back on the field.
Hawkins didn't diagnose any concussions that night. (One of his tricks is to ask for a locker combination, even though he has no way of knowing if the answer he gets is right.) If he had found a head injury, the ImPACT test would lessen the likelihood that a player returned to play too quickly.
Louisburg, De Soto's opponent, is not an ImPACT subscriber. The team traveled to the game with a chiropractor.
Although he's just a volunteer, Waeckerle's commitment to his Rockhurst players is profound. He's at the school three or four days a week. "I truly hope they believe I'm there for them, that I'm dedicated to them," he says.
Now 64, Waeckerle is at a stage in his career where he can be more selective about how he spends his time. He has backed off the 100-hour workweeks that went into building his 24-page CV. But he remains engaged. Though his time with the Chiefs came to an end, he has continued to serve on the league's concussion committee. He's also a member of the brain-injury committee of the NFL Players Association. Not part of Pellman's inner circle, Waeckerle escaped the NFL concussion battles with his reputation intact.
He now wants to make his knowledge about brain injuries more widely available. He and a prominent local neurosurgeon have discussed starting a regional concussion center in Kansas City, similar to programs at the University of Washington and the University of Pittsburgh. Patients referred to the center would have access to specialists from different fields — neuroradiology, neuropsychology, ophthalmology and the like. Waeckerle imagines himself as the "point of the spear," determining needs and protocols.
The center would concentrate on young people because they spend more time in cleats and on skateboards. Waeckerle says brain injuries simply aren't being treated with the best possible medicine. The return-to-play permission slips are effective only if the physicians signing them know what they're doing.
"It's pretty hard to be up to snuff in every area," Waeckerle says. "These are my areas. I want to make sure kids get the best possible advice and treatment and have access to be the best possible care."
After Nathan Stiles died, Waeckerle says, he spoke with Rockhurst students and their parents about devastating injuries.
"It may happen at Rockhurst no matter what I do," he says. "That's just a fact of life. But I tell you what, we're going to bust our tail — and we have busted our tail — to make sure we can do everything we can do to prevent any bad outcomes. But there are always going to be bad outcomes because we're all human beings. We just want to minimize them."