Last Saturday, after taking a very large shoulder from a very large Shark directly to the head, Gabriel Landeskog- youngest captain in the NHL and the next great hope of the Colorado Avalanche- went into a quiet room somewhere in the bowels of the Pepsi Center for concussion testing. Fifteen minutes later he came out again.
No one but Landeskog and the doctor who treated him knows what happened in that room, but we all know what happened after: he came back out and finished the game, in fact playing almost the exact same amount of minutes he’d played in every game before. We also all know that Monday, two days after the hit, the Avs announced he would not be playing in the next game. Leg injury. And, oh yeah, head injury too.
So, reading between the lines (it ain’t hard, there’s enough space between those lines to write the Bible and then some), Landeskog was cleared to play despite having possible/probable concussion. This isn’t an uncommon thing in the modern NHL. Just off the top of my head, I can think of four players- Armstrong, Letang, Peckham, and Crosby- who’ve taken hits, played, and then been pulled later for concussion symptoms. This is not an Avs problem, this is an NHL concussion policy problem.
Concussion symptoms can, of course, be ambiguous. They can slow-play you, starting off mild and building over time. It’s completely possible for a player to take a concussive hit and not show the kind of immediate, dramatic impairment we associate with the injury. Not everyone crumbles and gets taken off on a stretcher, or struggles sloppily to the bench, or forgets his name and who the president is. Sometimes there are no signs except a glassy stare and a slight slowness of speech. Sometimes there are no signs at all.
But in the NHL, the inherent ambiguity of the symptoms is compounded by an additional ambiguity of motives. When a player goes into the quiet room, a calculation is being made: is this injury severe enough to warrant pulling this guy out of the game? There are, then, two issues being weighed. On the one hand, there is the severity of the injury, on the other, the consequences of sitting the player. It’s easy to say that only the injury should be considered, but it’s easy to say pretty much anything.
Think about what Landeskog means to the Avalanche. Second overall draft pick. Third leading scorer last season, +20, dominates possession, devours huge minutes and doesn’t so much as burp after. Captain. Leader. Face of the franchise. With O’Reilly still holding out and the season shortened, his on-ice value is immense. His symbolic value is nearly infinite.
Everyone knows this: how essential he is, how urgent the need, how much yet to prove. The moment the young captain goes into the quiet room, everyone from the GM in his high box to the fans at home to the linemates waiting on the bench tenses up, and they won’t relax until he returns. His absence is a distraction, an injection of dread right into the middle of the game. It begs for resolution. There are literally thousands of people, at that moment, crossing their fingers and praying that he’s okay.
And we all know what the power of prayer can do.
There is a tendency to imply malice aforethought in the decision to send a player back out onto the ice after a collision. Team doctors have a reputation in hockey for being as rough and stoic as their patients- sew it up, freeze it dead, and get ‘em back out there. The revelations that have come out about how team doctors treated Derek Boogaard reinforce this image. Here was a player suffering from crippling pain, addiction, and psychological disintigration, and his doctors did little more than open his mouth and dump it full of pills. The core principle of medicine is supposed to be “first, do no harm”. In sports medicine, it often seems to be “first, make sure they play.”
But while some doctors may be directly culpable, either through negligence or corruption, for players taking to the ice when they shouldn’t, just as some players might intentionally hide concussions they know they have, a decision like the one that put Landeskog back in the game doesn’t necessarily require any conscious wrongdoing by either party. If the symptoms are ambiguous, it is likely that the simple wish that he be okay, held jointly and firmly by both sides, is enough to cloud judgment. Everyone knows what outcome they want, and that makes it possible to see the evidence that favors that outcome come through loud and clear, while making any countervailing evidence seem minor, or even invisible. That’s the power of positive thinking. He wants to be okay. The doctor wants him to be okay. The clock is ticking. The game is tied. Are we really surprised that this situation resulted in the most convenient choice? Oh, look, praise and hallelujah, he’s fine. Just like everyone wanted.
Protocols and policies can compensate for ignorance, prevent negligence, and maybe even catch malice, but they can do nothing against self-delusion. So long as both the player and the doctor are mired in a system where they both need the best possible outcome, their interpretation of the facts- especially mid-game, with points on the line and everyone holding their breath- is going to be affected by their desires.
No professional hockey player is ever going to be able to see around his desire to play, certainly not in the middle of playing, so in order to counteract the power of self-delusion, we have to look to the doctor. We need doctors whose investment in the correct diagnosis and the long-term health of the patient is stronger than their investment in the outcome of a game, a season, or even a career. Our own Jo Innes (@Jonana), a sharp observer and critic of hockey-medicine, spent a chunk of Monday afternoon on Twitter going over possible alternatives to the team doctor, and found that none of the options are unproblematic. For example, League doctors might have just as much of an incentive to underestimate concussions, albeit for a different reason (i.e. preserving the image of the NHL). State or local government oversight would mean paying for services for a private business out of public money, and it’s hardly fair to ask non-hockey-fan taxpayers to shoulder the burden of paying for a hockey problem. It’s possible the NHLPA could kick in, but as previously noted, players want to play, and it’s hard to imagine them investing their salaries in doctors whose express purpose is to bench them when needed.
But nevertheless, every time a player comes back to the ice after a big hit and, days or hours later, gets put on the IR with a head injury, it’s another piece of evidence for something we should all know already: the system is not working. It’s myopic to point out hypothetical imperfections in alternative plans when the plan we have is obviously riddled with real imperfections that are damaging to both the health of players and of the game. We are in the middle of a full-blown concussion panic right now. There’s no way- repeat, absolutely no fucking way in hell- that any strategy designed to downplay and minimize the problem is going to work in the long run. All it will do is make the NHL look ignorant at best and sadistic at worst. This is one place where moral principle and public relations agree: the only way to manage the problem is to get out in front of it. Take the head injuries seriously. Hire doctors that take head injuries seriously. Risk over-diagnosing rather than under-diagnosing. Bench guys. End careers. It’ll look bad at first, and people will get hurt. But they’re being hurt worse now.