This story appears in ESPN The Magazine's Feb. 29 Analytics of the NBA Body Issue. Subscribe today!
INDIANA PACERS COACH Larry Bird wasn't even sure which play his team was running because his damn heart was kicking out again. He wondered if anyone noticed him sweating profusely, his shirt drenched under his suit and tie, an all-too-familiar symptom whenever his heart started rattling around his chest like a basketball in an empty trash barrel. The waves of nausea and dizziness overtook him next, muddling his concentration and leaving him feeling light-headed. When the sudden arrhythmia would occur during his training sessions in his playing days -- long before he'd informed any medical personnel about it -- he would always lie down immediately and nap for several hours, because if he didn't, he risked losing consciousness.
But on March 17, 1998, the 41-year-old coach of the Eastern Conference-contending Pacers, in the thick of a hotly contested game with the defending champion Bulls, could hardly recline and sleep it off. "Oh god," Bird thought as he tried to steady himself on the Indiana sideline. "Please don't let me pass out on the court."
Instead, the referees whistled the customary television timeout, allowing Bird to sink into the chair his team dragged onto the court for him during stoppages in play. When Bird had been hired in 1997, he'd made the unorthodox decision to entrust assistant Rick Carlisle with drawing up offensive plays in the huddle. Now, as Carlisle diagrammed Indiana's next move against Michael Jordan and the Bulls, Bird wiped the sweat from his brow (and his wrists and neck) and tried to regain his composure.
He finished the game without further incident, avoiding detection from anyone on his staff. Bird, who has an enlarged heart, was diagnosed in 1995 with atrial fibrillation, an abnormal heartbeat resulting from electrical signals being generated chaotically throughout the heart's upper chambers. With proper medication, exercise and diet, atrial fibrillation can be controlled, but Bird abhorred medication and was prone to skipping his pills. Part of the reason, he admits, was his own fatalistic view of what the future would bring.
"I tell my wife all the time, 'You don't see many 7-footers walking around at the age of 75,'" says Bird, who's 6-foot-9. "She hates it when I say that. I know there are a few of us who live a long time, but most of us big guys don't seem to last too long. I'm not lying awake at night thinking about it. If it goes, it goes."
It's a macabre outlook for Larry Legend -- but he's hardly alone in harboring it. Ask a bunch of NBA big men and the consensus is that their atypical size and the strains placed on their bodies during their careers cause them to deteriorate more quickly and die younger. The bigger they are, the younger they fall -- or so they think. Is it possible they're right?
MOSES MALONE WAS never late.
That's why Calvin Murphy was so puzzled. It was 6 a.m. on a Sunday last September, and Murphy's friend and former teammate hadn't shown up for breakfast at the Waterside Marriott in Norfolk, Virginia. They were expected to tee off at 7:30 in a charity golf tournament. Malone, who hailed from nearby Petersburg, was a tournament regular each year and had joined fellow NBA alums at the Chrysler Hall in Norfolk on Saturday night for a comedy show. A three-time MVP center, a 13-time All-Star, Malone was not just NBA royalty, he was also beloved. He'd mingled with old friends, including Paul Silas, who'd snuck up from behind and elbowed him in the back -- all the better to jar his memory of their battles in the NBA trenches. "I'm glad it's just you," Malone quipped, "or I'd have to do something to hurt you." Just after 2 a.m., Malone, 60, told Murphy he was tired and would see him in the morning. His final words that night: "Don't be late." Now it was Malone who was tardy, so Murphy called his cellphone, figuring Moses might have snuck up to the health club for a quick jog on the treadmill. "Mo was a workaholic when it came to staying in shape," Murphy says.
The call went unanswered. But before Murphy could head up to Malone's room to check on him, tournament organizers urged Murphy to follow the others to the golf course while one of the event coordinators, Sandra White, went to knock on Malone's door. No answer. She summoned security, but when they tried to gain access to the room, the chain was still across the door. When they finally busted in, they found Malone lying dead in his bed, his eyes wide open.
NBA referee Tony Brothers, who runs the tournament, received the news of Malone's passing at the course and pulled aside Murphy, who promptly collapsed at the referee's feet and began sobbing uncontrollably. "I just blacked out," Murphy says. "It caught me off guard. Mo never complained about anything. And now he's gone? I just couldn't understand it."
Seventeen days earlier, in Allentown, Pennsylvania, veteran NBA center Darryl Dawkins -- legendary destroyer of backboards -- had also died of a heart attack. He was 58. Dawkins, like Malone, had no known previous health issues. "First Darryl and then Moses," Silas says. "It just shocked me. It makes me wonder, 'What should they be doing? What should I be doing?'"
He's not alone. During a seven-month period last year, the NBA lost, in addition to Dawkins and Malone, Anthony Mason, Christian Welp and Jack Haley to heart-related deaths -- not one of them was over 60 -- while 52-year-old Jerome Kersey died suddenly of a pulmonary thromboembolism. Current players LaMarcus Aldridge, Jeff Green and Channing Frye have had heart issues. Bulls coach Fred Hoiberg cut his playing career short because of a heart condition and underwent open heart surgery last spring. Seven-footer Eddy Curry was hospitalized with an irregular heartbeat at age 22.
But health concerns for NBA bigs extend beyond cardiac distress. Six-foot-11 power forward John "Hot Rod" Williams died in December due to complications from prostate cancer. He was 53. Seven-foot-7 Manute Bol left the game at 36 due to rheumatism and died at 47 from acute kidney failure. The NBA's all-time leading scorer, Kareem Abdul-Jabbar, underwent quadruple coronary bypass surgery last April at age 68, six years after the 7-2 Hall of Famer battled a form of blood cancer.
Then there's legendary 6-11 center Bill Walton, who suffered from such debilitating nerve pain in his back that in 2008, at age 56, he says he contemplated suicide. Walton -- whose book, "Back From the Dead," will be published in March -- estimates he's undergone 37 surgeries, including fusion surgeries on both ankles. "When you are in that never-ending cycle of pain, it puts you in a space of darkness, sadness and overwhelming depression," Walton says. "You go through stages. The first one is, 'Oh my god, I'm gonna die.' The next stage is, 'Oh my gosh, I want to die.' And the third stage is, 'Oh my gosh, I'm going to live, and this is what I'm stuck with.' That's the worst stage of all."
In 2009, Walton underwent an 8½-hour spinal fusion surgery that required four bolts, two titanium rods and a metal cage -- akin to an Erector Set -- to put him back together. Now he travels the country advocating for athletes to be proactive in their treatment. "We athletes are our own worst enemies," Walton says. "We don't listen to our bodies, we don't listen to our doctors. We don't realize until later in life that health is everything. Without it, you've got nothing."
EVOLUTION IS A blunt instrument. If growing to be 7 feet tall were advantageous to longevity, the world would be full of 7-footers. It's not.
Perhaps because of this, there is a paucity of research on the correlation between extreme height and longevity. As David Epstein notes in his book "The Sports Gene," a 7-foot-tall American man is so rare that the Centers for Disease Control doesn't even list a percentage for the height. Seven-footers are so anomalous that an absurd 17 percent of them who live in the United States will at some point play in the NBA. They're so uncommon off the hardwood as to be unworthy of study.
"Instead of everyone going their separate ways, we have one spot we can go and just enjoy each other's company. It just continues to build the camaraderie that you need to be successful from year to year."
Still, studies on the impact of height on life span abound -- and although they often contradict one another, they generally support the notion that bigger is far from better.
Researchers at the University of Tromso in Norway found that potentially fatal blood clots were 2.6 times more likely to develop in men 6 feet or taller. A study in the Journal of Epidemiology and Community Health found that increased height correlates to a greater risk for most types of cancer. According to a study in Medicine and Science in Sports and Exercise of more than 2,600 Finnish athletes, cross-country skiers, who were, on average, 6 inches shorter than basketball players, lived almost seven years longer. And researchers from the University of Hawaii Kuakini Medical Center and the U.S. Veterans Affairs didn't just find that shorter men live longer, they determined an underlying cause: They are more likely to carry an enhanced version of FOXO3, a stress-resistance gene that promotes longevity.
Thomas Samaras is the founder of Reventropy Associates, which, according to its website, provides "critical analyses of the various impacts of larger body size on our society and the earth." Samaras, who started Reventropy Associates in 1993, says his research shows that people with shorter, smaller bodies are likely to live longer and less likely to suffer from age-related chronic diseases. In 2012, he and colleagues published a study in Biodemography and Social Biology on a population of Sardinian males who were tracked from their youth to their death, and shorter men were found to have a better survival rate. In an additional study cited by Samaras, researchers reported that Spanish men lost 0.7 years of longevity per centimeter of height above average. Samaras attributes this to a number of factors, including the fact that taller men have trillions more cells, thereby increasing the risk of cancer and disease. He also says the research shows that taller people -- and bear in mind that the average NBA player is 6-foot-7 -- are more likely to have higher blood pressure, greater left ventricular hypertrophy, atrial fibrillation, blood clots and lower heart-pumping efficiency.
BILL WALTON DOESN'T need studies. He only has to roll-call his 1986 Celtics championship team. Both members of that starting backcourt -- Dennis Johnson and Danny Ainge -- suffered heart attacks. Ainge had his at age 50 and survived; DJ, at age 52, did not. Add Kevin McHale's now permanently impaired foot and Bird's and Walton's struggles, and the nucleus of one of the greatest teams of all time is, 30 years later, deeply damaged goods.'
Bird, who turned 59 in December, says more research is clearly needed. "I have my own philosophies on that," Bird says. "Guys that played the hardest in the league -- big guys who ran their asses off -- they are the ones in the most danger, I feel. Moses was one of those competitors. We build our hearts up when we are playing and then we quit performing at a high level, and our hearts just sit there. I don't work out like I used to. I can't. I can't go out and run. I jog and have a little sauna, that's about it. My body won't let me do more than that."
Joe Rogowski, executive director of sports medicine and research for the National Basketball Players Association, says trends are emerging from preliminary research of former NBA players. "We know there's a difference [from the general population], but what do the numbers mean?" Rogowski says. "That's what we want to find out."
After the sudden deaths of Dawkins and Malone, the NBA and the NBA players' union embarked on a joint effort to provide health screenings for retired players. The first one, under the direction of Rogowski and a fleet of cardiologists, was held Dec. 12 in Houston. There, the upper concourse of the Toyota Center, home of the Rockets, was transformed into an outpatient clinic with labeled stations to examine a plethora of potential health issues. Around 25 players showed up that day, each man escorted behind a curtain to embark on a trip down his own personal medical rabbit hole. Men who were once among the most elite and well-conditioned athletes in the world now sat in a johnny, waiting in their curtained cubicle, allowing their imaginations to run wild about what the doctors might find.
"THERE HAVE BEEN enough incidents for us to ask, 'What's going on?'"
So says former 1981 NBA first-round pick Kevin Loder, who played three seasons in the NBA with the Kansas City Kings and San Diego Clippers. By 2008 he had ballooned to 453 pounds. Over the next three years, he altered his diet and exercise regimen, became more proactive with his medication and pared down to 315 pounds. He believed he was on a path to recovery.
Loder, the vice president of the Houston chapter of the Retired Players Association, encouraged members to attend the free health screening last December but was shocked when his own test results revealed dangerously high glucose and cholesterol levels and a level of viscosity in his blood that set off alarms with the cardiologists. "When the doctor tells you, 'Your blood is so thick it's like syrup,' you'd better do something with that information," Loder says.
Dr. Manuel Reyes, a cardiologist at Houston Cardiovascular Associates and a member of the union's advisory board, says the medical staff discovered "dramatically uncontrolled" hypertension, undiagnosed cases of diabetes and some players who unknowingly suffered from atrial fibrillation. The screenings included blood work for diabetes and high cholesterol, an EKG to detect abnormalities in the heart, a carotid artery ultrasound and tests to detect sleep apnea. Each patient was given the results and referred to a cardiologist if further testing or treatment was required. Doctors also tested for Marfan syndrome, a hereditary disorder of connective tissue that can be fatal if gone undetected.
"We've known for a long period of time that the athletic heart is different from the nonathlete's heart," Reyes says. "The echocardiogram of an athlete can mimic that of a severe cardiovascular disease, like hypertrophic cardiomyopathy. The differences can be subtle. Our job is to figure out which is which, and it can be very, very tricky."
Dr. Andrea Natale, a cardiologist who has patented a device to treat atrial fibrillation, is also an adviser to the union. He points to genetic predisposition, being overweight, sleep apnea and hypertension as reasons NBA players are at risk for heart abnormalities. He also says arrhythmia reveals itself in the general population when adults reach their 60s and 70s, but there's emerging data that suggests that athletes experience irregular heartbeats earlier, often in their 50s or even their 40s.
HALL OF FAMER Bob Lanier turned 67 in September and says he was "shocked and frightened" by the recent spate of deaths. He also says he struggles to stay active because of limited mobility and constant pain from 14 seasons of NBA pounding in the post. The 6-11 250-pounder did not have the benefit of cutting-edge footwear. He frequently played on concrete surfaces. There was no sport science, no analytics to chart overuse. No coach was advocating rest or minute management. The players flew commercially and stuffed their large frames into cramped airline seats. A torn anterior cruciate ligament in Lanier's day was often career-ending.
"When we finished playing, we stopped exercising," he says. "It was so painful for our joints. You get to the point where you say, 'Do I want to go through this aggravation anymore?' Wayne [Embry], Willis [Reed], they all had injections to try to get rid of the pain. Some have had stem cell treatment, knee replacements. I'm scared to do it. I'm scared of the rehab. Bill Walton keeps telling me, 'Bob, ride a bike. It's low impact.' I haven't done that. Why? I'm probably just lazy, or afraid of the pain. I'm not sure which one."
Walton has made it his charge to counsel patients like himself who were driven to suicidal thoughts by chronic pain. His own routine includes sessions in the pool and the weight room and on the bike.
"I worry about all the guys," Walton says. "I see Kevin dragging his foot around because he won't have the ankle fusion surgery he needs. I talk to Larry about his health. But the greater the athletes are, the prouder and more stubborn they are."
Rogowski says the next health screening will be at the end of February in Atlanta and will include orthopedics as part of the program. Last spring in Houston, while Rogowski was still employed by the Rockets, he helped organize a free screening for former Houston players. Only eight people showed up. One of them was Moses Malone, who learned from those tests that there were concerns regarding his heart. "I was in the room with him," Loder says. "Moses was complaining of heart fibrillation. He went to a cardiologist after that, but I'm not sure he ever got conclusive evidence on what was causing it."
Lanier and Loder continue to mourn Malone, their friend, and wonder what they could have done to help him. Sometimes, Lanier admits, he thinks the way Bird does. How many NBA big men live to see 75? "Not a whole lot, I don't think," he says. "But I'd like to be one of them."