State

Dec 18, 2012 3:30 PM by Lauren Molenburg

Lessons learned from near-tragic concussion

KERSEY, Colorado (AP) - In October, at halftime of a Platte Valley High School football game, the team's student manager approached Marilyn Johnson as she sat in the visitors' bleachers and relayed a vaguely ominous message.

"Trey's acting weird."

A former emergency-room nurse, Marilyn rushed to check on her son. Sixteen-year-old Trey Johnson, a wide receiver and defensive back, sat in a hallway outside the locker room and complained that the top of his head hurt. He begged her to make the pain stop.

"It hurts bad, it hurts bad," he said.

When he started vomiting, Marilyn told the trainer to call for an ambulance. Then, Trey lost consciousness.

Marilyn pingponged between the role of mother and nurse in the frenetic moments that followed: His blood pressure was good. His breathing was normal. But even after emergency responders administered oxygen, he wasn't responding.

She recognized the signs of a severe concussion and knew that without quick medical intervention, she could lose him.

Marilyn rode in the ambulance that transported Trey to North Colorado Medical Center in Greeley from the Eaton High School football field. As it sped away, Trey's father, Michael Johnson, and Trey's twin sister, Haley, also headed for the hospital.

Michael, shifting to what he later described as an unemotional "go mode," phoned Trey's older brother, Cade, to meet them there.

"I wanted him to be there," Michael recalled, "if Trey died."

At the NCMC, Trey was given a breathing tube, run through a CT scan and determined to have bleeding on his brain. He was quickly airlifted to Children's Hospital Colorado in Aurora.

A vigil began that Friday night in the intensive-care unit, where dozens of Trey's friends, teammates and neighbors from his hometown of Kersey slept in a waiting area, frightened but hopeful.

"It was weird, because he wasn't moving or anything," said Logan Sitzman, the team's quarterback and a longtime friend. "He wasn't breathing on his own. I didn't know what was going on. I didn't know if Trey would be Trey anymore."

By early Saturday morning, Trey was able to squeeze hands and nod in response to voice prompts. But about 12 hours later, the swelling in his brain caused him to take a turn for the worse.

"You cling to things," said Marilyn, who looked to the flashing numbers on Trey's monitors for solace. "His pulse rate and blood pressure - I watched them pretty close."

Twelve days into the watching and waiting, as Trey emerged from a medically induced coma, his eyelids fluttered and blinked. His eyes opened, but as Michael noted, "he was in a different world."

They all were.

"I didn't think it would happen to our team," said Caleb Creech, a junior linebacker who grew up east of Greeley with Trey. "It's stuff you usually just hear about."

This wasn't a typical concussion, and its precise origin remains a matter of conjecture. In the real-time flow of the game, no single impact or even multiple collisions appeared clearly responsible. And to this point, Trey recalls nothing about the game.

The drama unfolded in a time of heightened awareness of sports-related head injuries, when laws have been enacted in Colorado and elsewhere to underscore that concern. Coaches and staff are trained to detect possible concussions and required to pull players at the first hint of abnormality. Athletes need written medical clearance to return.

But what family, coaches and doctors credit for averting possible tragedy that autumn night reflects what they consider a subtle but significant sports-culture shift - among the players.

Platte Valley coach Troy Hoffman describes exceptionally close ties that bind this team - ties that extend beyond the band-of-brothers mindset that propelled them to a 10-3 season, a second-place finish in the state playoffs and a slew of individual records. Ties that may have made all the difference for Trey Johnson.

"In the end," Hoffman said, "they probably saved his life."

For some of the boys, the bond was forged as early as age 6 or 7, and they literally grew up playing sports together. Friendship melded with the idea of mutual reliance, of having the other guy's back, and all of that dovetailed perfectly with football's unspoken code of toughness.

Trey Johnson, part of what his parents call a "core group" of friends who played such a pivotal role in Platte Valley's success, rocked that familiar tough-guy attitude.

"That's just how Trey is - and all of us, pretty much," said Sitzman, who rewrote the school's passing records this year. "We don't want to let anyone down."

Sports tend to magnify that notion of teenage invincibility. Players find it difficult to imagine an injury that would move them to ask out of competition. Alissa Coufal, the certified athletic trainer who works with Platte Valley's sports teams, suspects that some perceive her - unfairly - as the killjoy whose job is to keep them from playing the sport they love.

Even Marilyn Johnson, who oversees the concussion-testing program at the school, sees the attitude play out.

"It's so hard with that age group," she said. "I know my kid. He would've been on the field to the minute he dropped."

Starting in 2006, Platte Valley student-athletes were among the first in the state to undergo baseline testing, a battery of computer-based exams administered every two years that measure the speed and accuracy of responses to tasks geared to particular cognitive skills.

The tests provide a comparative measure of brain function that can serve as a tool to gauge their fitness to begin a post-concussion, return-to-play protocol that can take days or weeks. The players regard the baseline testing with bored resignation at best and utter disdain at worst.

"I hated it," admitted Sitzman. "I would cheat to make my score low so if I had a concussion, I could get back playing right away. I figured it would never happen to me or anyone I knew."

And for weeks this season, nothing happened.

But on Oct. 12, in a Friday-night game at arch-rival Eaton, Trey suffered a severe injury that did not appear to arrive with a single vicious hit. In fact, only in retrospect do observers - from players to coaches to Trey's own family - zero in on plays that may have triggered the life-threatening bleeding and swelling in his brain.

With Eaton up 7-0 in the first quarter and driving toward another score, Trey - from his cornerback position on defense - watched the quarterback roll to the left and spot an open target. He read the play perfectly. As the quarterback released his pass, Trey cut in front of the intended receiver and intercepted the ball.

He headed upfield and, finding his path clogged with tacklers, reversed direction and headed for the far sideline. But an Eaton lineman had the angle on him.

Trey tucked the ball under his left arm and extended his right to ward off the tackler. With Trey's hand in his face, the lineman grabbed for whatever he could find, gripped Trey's jersey and pulled him forward. Trey fell headfirst to the ground, unable to use either arm to break his fall.

Even now, after reviewing it, neither coaches nor Trey's family consider it anything but a hard, clean play. An official threw a penalty flag - but it was against Trey, a facemask call on his attempted stiff-arm.

Trey popped up immediately, energized by the interception, with no obvious ill effect. Winded from the return, he sat out a play and then entered the game on offense as a wide receiver.

A few plays later, Trey lined up wide to the right. Sitzman surveyed the defense, recognized single coverage on his wideout and knew immediately that he would target Trey, angling across the middle of the field.

"Trey can beat anyone one-on-one," Sitzman said, "and he had a height advantage."

At 6-feet-2 and a wiry-strong 165 pounds, Trey hauled in the pass and scrambled into the end zone. With the interception - his fourth in five games - and now a touchdown reception, he looked to be on his way to a stellar performance. After a string of nagging hamstring and knee injuries, his football career finally seemed to be taking off.

It wasn't until late in the second quarter that anything seemed amiss.

With Eaton driving into Platte Valley territory, the quarterback threw a pass up for grabs to a receiver surrounded by Platte Valley defenders. The Eaton player leapt and made an acrobatic catch.

Trey closed on him immediately and went for the tackle - again, not a particularly hard hit - but oddly failed to wrap his arms around the receiver and bounced off. He ended up sitting on the turf as the opponent scampered through the remaining defenders for a touchdown.

Sitzman stood on the sideline, watching the defense, and remembered the play as remarkable only for what didn't happen.

"It seemed like a simple tackle for Trey," he said. "The guy got the ball, and Trey was right there, and usually he doesn't miss him. But he did. It seemed a little different, I guess. But I didn't think anything was wrong."

Trey returned the ensuing kickoff, and a few plays later, after Platte Valley turned the ball over, was on the field again, performing his appropriate defensive coverage, when Eaton scored another touchdown.

Linebacker Creech - another part of that core group of childhood friends - noticed something definitely un-Trey-like. Normally, in a situation like that, he would have spewed anger, at himself and anyone else involved in the play.

Now, he stood emotionless.

"Dude, you all right?" Creech asked.

No response. Creech repeated the question.

"I don't know," Trey said.

"He was just acting funny," Creech recalled. "We know each other pretty well; we know when something's wrong. He was just not being Trey. I asked if he was all right, and he just grabbed his head."

After the extra point, Creech went to the sideline and, while Eaton kicked off, approached his head coach.

"You got to check Trey out," he said.

"What do you mean?" Hoffman replied.

"I don't know. He's just not with it," said Creech. "You've got to check him out."

On one point there is general agreement: Trey Johnson never would voluntarily remove himself from a football game. But for Creech, the idea that his teammate and friend wasn't right - even in some vague, ill-defined way - meant something had to be said.

"It's not like the game's life or death," he said. "I was more worried about him. It's a personal thing."

But while the player shrugged off his actions, his coach recognized significance in their exchange. It spoke to the idea that players looking out for one another could be a first line of defense against blurring the line between playing hurt, through bumps and bruises, and playing injured.

"The biggest thing is the closeness of that group," Hoffman said. "They've been that way since first grade. Not that Caleb wouldn't have said something about somebody else, but it was definitely his personal knowledge and friendship with Trey that led to 'Hey, are you OK?'"

After the kickoff return, which yielded no significant contact on Trey's part, Hoffman immediately pulled him off the field and instructed Coufal, the trainer, to assess him.

Trey took his helmet off and stood blinking at the stadium lights. Coufal noticed a cut on his face, around the bridge of his nose, and asked him whether his helmet had caused the abrasion. Trey sounded confused.

"Right then," Coufal said, "is when I knew we've got a problem."

The ensuing weeks were a zigzag of highs and lows as Trey adapted to his rehabilitation routine. Visitors to Children's, particularly his close friends and teammates, would perk him up and reveal extended glimmers of the Trey they knew - including an ability to recognize the team's defensive hand signals.

Communication remained a challenge. Trey could grunt and emphasize syllables, but his facial muscles strained to pronounce words. He used a small whiteboard and a marker to articulate his thoughts.

And then, as he progressed, he gradually became more aware of his limitations. At times, he would grow tired and frustrated and lash out, almost in slow motion, at his therapists - even his mother.

It meant he was progressing. But for his parents, it was still difficult to watch.

"One of the things that's good about this hospital is they prepare you for that," Marilyn said. "For us, it was just a matter of staying focused. Early on, we had so many ups and downs that there was a lot more emotion. And so we've become pretty guarded now. You focus more on an outcome."

Trey now progresses through a regimen of therapies as he battles to regain his speech and fine motor skills with a goal of returning home before Christmas. Still, his recovery has miles to go.

When the Platte Valley football team assembled in the school cafeteria last week to celebrate its season, Trey was present, if only digitally. Although doctors said no to a personal appearance, Trey was able to take in the festivities via a two-way, live video feed on an iPad. From his hospital room an hour away, he could see the stage where his coach at times choked back emotion in describing the bonds that defined an exceptional team.

Trey saw Hoffman announce that, even in a season cut short, he had been voted honorable-mention all-Patriot Conference defensive back by the league's coaches. Trey's teammates also voted him the co-winner of an award as the team's best defensive back. And although Trey continues to improve, Hoffman relayed the family's request that the Kersey community hold off on visits for a few days while their son concentrates on his therapy and regaining weight.

Dr. Michael Dichiaro, who oversees Trey's care at Children's, noted that he has made great strides. It's not unusual, as in Trey's case, for the physical recovery to outpace cognitive recovery.

"I don't think there's any reason to say at this point he's going to slow down in his progress or that there are limits to his progress," Dichiaro said, noting that the journey back could cover months or years. "There's no reason to think he's going to stop any time soon."

One recent afternoon, Michael told his son: "You're going to keep getting better because you're tough."

Trey uttered a reply but couldn't quite form the words. He grabbed his whiteboard and wrote: "That's because I'm just like you."

Trey's parents see another opportunity for progress in the way young athletes approach the growing concern over concussions. Marilyn calls this "the steepest part of the learning curve," where players need to take responsibility for one another.

Coaches are being educated, and parents are learning more. But the experience with their son has convinced the Johnsons that there's value in having other eyes watching for telltale concussion signs as well.

"Troy is ripped up about this," said Michael, sympathizing with his son's coach. "But he can't watch all the kids. They know each other intimately. The kids are the key to this."

Hoffman recently sat in the school computer lab, as he has many times since that Eaton game in October, watching videotape of the play in which Trey intercepted the pass and got flung headfirst to the turf.

"This is a great play by Trey," he said, narrating. "He undercuts it; he picks it. Right here's the end of the play. ... He bounces up. ... He's running off the field. And no worries."

He skipped through the video, following Trey's movements on offense and defense, looking for any trace of abnormality - lining up wrong, missing an assignment, anything.

He has found nothing. But that doesn't stop him from second-guessing himself.

"I'm responsible for these boys," he said. "But there's nothing in this game that led me to believe there was anything we did wrong. Nothing. But honestly, if Caleb hadn't said anything, we wouldn't have checked him when we did."

Marilyn Johnson, whose concussion talks for the Platte Valley program have focused on coaches, referees and parents, now wants to emphasize a role for the players. Hoffman hopes to take the lessons of the near-tragic ordeal within a storybook season to anyone who will listen: Players can't be afraid to tell a coach when they think a teammate might be concussed.

"At Platte Valley, we have a living example," he said. "Other places are going to have to hear us talk about it and drive it home with their own athletes. What I want everybody to hear from Trey's situation is you learn by taking care of the people you play with."

That's what happened at Platte Valley, although young linebacker Caleb Creech seems a little uncomfortable taking credit for something he figures anyone in his situation would have done. Trey Johnson's parents count it as something more than that - nothing short of lifesaving.

"They said 'thank you,'" Creech said, "but I never really thought about it like that."

___

Information from: The Denver Post, http://www.denverpost.com

(Copyright 2012 The Associated Press. All rights reserved.)

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