MINNEAPOLIS -- For Sam Maresh, life decisions and football decisions blend together. Everything always traces back to the game.
Maresh epitomizes the eat-sleep-breathe cliché. He's described by those who know him best as born to play football. And given what he's been through to play linebacker at Minnesota, it's hard to argue with them.
Faced with the daunting reality of open heart surgery in June 2008, Maresh made a choice with football very much in mind. When doctors discovered a benign mass in his leg in February, Maresh stiff-armed talk of surgery and readied himself for the start of Minnesota's spring drills.
"If football or sports was a hobby, you'd be looking at it differently," said Maresh's father, Bill. "But it's part of his life. It's part of who he is. He's a physical, fighter-type guy. There was never a decision that was hard. If there was a way that he could play, he was going to take that opportunity. And it's worked out."
On the afternoon of March 24, Maresh, wearing a white No. 17 practice jersey, jogged onto the field with his Gophers teammates for the start of spring ball. He did so with a scar on his chest, a growth in his leg and a look of resolve in his eyes.
Less than nine months after heart valve replacement surgery, Maresh was back, just as he had planned.
"It wasn't a question at all," Maresh said. "I'm playing football. It's what I was born to do."
But this is about more than football. A lot more.
Maresh is attempting to make medical history this fall. Other athletes with his heart condition have returned to compete, including NBA players Ronny Turiaf and Etan Thomas. But no one has returned to play top-level college football.
"We've had a number of athletes that have had this kind of problem that have gone back to playing baseball and basketball," heart surgeon Dr. Hartzell Schaff said. "I don't remember anybody who's gone back to playing football like he's playing."
Gophers coach Tim Brewster branded Maresh the "flag bearer" for the university when the heralded recruit signed in 2008. But Maresh transcends that role.
He has become a symbol for the state, a courageous figure who has received support from Duluth to Mankato, International Falls to Rochester.
Indeed, football is only part of Maresh's story.
It's about a single-minded star, a medical marvel and a local hero. It's about a team of doctors and a support network of family, teammates, coaches and strangers.
It's also about trust. Maresh affirmed his in Brewster by committing to the program and holding true to it through tough times. Now, he wants the same pledge from the coach as he heads down an uncharted path.
"A lot of people are anxious for me to get out there," Maresh said. "This is an opportunity for me to show the coaches that I'm ready."
It all started with a standard sports physical, required of each player entering Minnesota's program. Maresh hadn't had one since his freshman year of high school, but he had no reason to worry.
He was a three-time state wrestling champion and an all-state linebacker at Champlin Park High School in suburban Minneapolis. Two months before the exam, he wrestled at the senior nationals and felt like he was in the best shape of his life.
But on June 2, doctors detected a murmur in Maresh's heart. Further testing showed he had a bicuspid aortic valve, a congenital disorder in which the valve has only two leaflets instead of three, preventing the heart from pumping blood efficiently. He also had an enlarged aortic root.
"They gave us all the measurements and said, 'You're way over [normal]. This is bad. It's severe,'" Bill Maresh said. "They kept saying, 'Are you sick to your stomach?'"
Sam's active lifestyle and sports background likely prevented symptoms from appearing earlier. But the diagnosis meant the 19-year-old would need open heart surgery.
Brewster was stunned.
"It just takes your breath away," he said. "I went directly to the kid. And Sam puts you at ease with his mindset and his attitude. He's so positive. He doesn't want any obstacles in his life.
"He immediately wanted to fix it."
At a news conference at Champlin Park High eight days after the initial exam, Maresh told reporters, "I'm going to play. With my family and everyone supporting me and praying for me, I feel like I will play again."
The first cardiologist Maresh visited held a different opinion.
"He didn't look at me as an athlete," Maresh said. "He looked at me in the long run. He said, 'I don't know if you'll be able to play football after this,' and he gave me a list of sports that I could play.
"That got pretty emotional."
The Mareshes sought a second opinion and went to Dr. Rick Nishimura, a cardiologist at the famed Mayo Clinic in Rochester, Minn. Nishimura was realistic about Maresh's situation, but he didn't entirely close the door on a return to the gridiron.
"He had significant heart disease," Nishimura said. "We told him that in most instances, not only would we not allow a person to play, but a lot of people might elect not to play because there always is a small risk after an operation.
"I said, 'If you decide that you still want to go ahead, there are a number of hurdles you have to overcome.'"
Patients have two options with the type of surgery Maresh was facing. To fulfill his dream, Maresh had only one.
If his aortic valve needed to be replaced, Maresh could have either a mechanical valve or a tissue valve installed. The mechanical valve likely would prevent another surgery but would force him to take Coumadin, a blood thinner that would prevent him from playing college football. The tissue valve doesn't require a blood thinner but necessitates a second surgery in 12 to 15 years.
"So hopefully after I'm done with the NFL," a smiling Maresh said, "I'll get the mechanical one in there, and I'll be all set."
The night before an appointment with the surgeons, Maresh and his parents watched Game 1 of the NBA Finals between the Boston Celtics and the Los Angeles Lakers. The telecast featured a story about Turiaf, who underwent aortic replacement surgery three years earlier and returned to the court with the Lakers.
News of Maresh's situation soon reached Turiaf, who called the Gophers recruit days later.
"He was very supportive," Maresh said. "It was pretty sweet to hear from a professional athlete who went through the same thing."
There were two big questions heading into the surgery, which took place June 26 at the Mayo Clinic. Would Maresh's enlarged aorta need to be repaired or replaced with a tissue valve? And how big of an incision would the doctors need to make in his sternum?
If Schaff could do a partial sternotomy, which he anticipated, Maresh would have an easier time healing and, hopefully, getting back to football. A full sternotomy would make things harder.
"If you don't divide [the sternum], it doesn't have to heal up again," said Schaff, who also performed Thomas' surgery in 2007. "And for Sam, that's a huge issue."
Maresh spent the weeks leading up to the surgery playing softball and hanging out with friends. Aside from a minor ear procedure as a young boy, he hadn't had any surgeries, but he wasn't intimidated until the night before.
"He asked me some questions that made me know [he was scared]," Bill Maresh said. "'Dad, so what is this heart-lung machine? So my heart won't be beating?' I said, 'No, it won't be. They take your blood and it goes through a machine that oxygenates it and brings it back in. Your heart's not doing that.'"
The Mareshes watched an educational DVD about the surgery. Then Sam went to sleep.
"It was midnight, and I had surgery at 5:30 in the morning," he said. "I woke up, and that's when I got a little jittery, like, 'This is really happening.'"
Schaff made the smaller incision and brought Maresh's aorta down to normal size. Unsatisfied with the repair attempt, however, he opted for the tissue replacement.
The surgery was deemed a success, and Schaff performed it needing only a partial sternotomy, much to the relief of the dozen or so family members in the waiting room.
"They'd come in and say, 'Sam is on the heart-lung machine,'" said Julie Maresh, Sam's mother. "And then when he was done, they said, 'He's back breathing OK.' We were like, 'Whew.'"
Two days after the surgery, Brewster and Minnesota linebackers coach John Butler visited Maresh. They brought a No. 17 Gophers jersey with his name on the back and a poster shaped like the state of Minnesota that all the players had signed.
Maresh had a surprise for his coach, too.
"'C'mon, coach Brew, you wanna take a lap around the floor?'" Brewster remembered Maresh saying. "And he's dragging wires and all this stuff. They're telling him, 'Don't do it.' Sam's like, 'Watch me. I'll be fine.'"
Despite Maresh's hospital-ward display, the surgery took a toll. He struggled to sleep. He lost 15 pounds in three weeks. His athletic exploits were limited to miniature golf with friends, after which he would "just pass out."
Thomas Allison, an exercise physiologist at the Mayo Clinic who has worked with many athletes, put Maresh through a testing program to ascertain what his heart could handle during rehab. Maresh was prohibited from lifting weights or engaging in any contact exercise for six months.
When he finally got cleared to start jogging, he had to make sure his heart rate didn't go above 125.
"Nothing like a wrestling workout," Maresh said, nodding at his dad, who had coached him in wrestling at Champlin Park High.
Things began to get easier, and Maresh, who originally had targeted a 2010 return, made remarkable progress. Three months after the surgery, Maresh started thinking about participating in spring ball.
He wanted to start training at the university, but the Gophers' staff couldn't work with him until he officially enrolled in January.
There also was the risk of Maresh returning too soon. Minnesota had never had a case like his before, in which the athlete played football.
"The university's very nervous," Bill Maresh said. "They've got this kid, and they don't want to be liable. Here we are, pushing, going, 'Will you start working him out? Get going, already.' It took a while to get on the same page."
Added Sam: "They were surprised at where I was, as far as a recovery standpoint. They didn't know what to do."
Cleared for running and lifting, Maresh finally started working out with the Gophers in late January. The trainers followed a plan mapped out by Nishimura, which called for gradual reintegration.
"He was a little bit out of cardiovascular shape, which was fully expected," Gophers head football trainer Ed Lochrie said. "We'd let him do half a workout and then ride the rest on the bike at a slower pace. And in the weight room, he'd do a lot less weight, and he started with the group that lifted the least amount.
"So we just watched him."
Still, a spring return, once impossible, suddenly seemed realistic for Maresh.
If only the pain in his left leg would go away.
Maresh had experienced leg cramps throughout high school, but he always would ice the cramp and be fine in a day or two. The pain returned when he started running after heart surgery, and it didn't improve. A chiropractor told him he had a strained calf, but he eventually went for an MRI, which revealed a mass.
"It was irritating," Maresh said. "Why am I back at the doctor? I told my dad, 'Maybe God doesn't want me to play football.'"
The growth likely was not cancerous, but Maresh still underwent a biopsy. It showed that the mass was benign, mostly scar tissue left over from a previous injury.
Surgery was once again a possibility. And although not large, the mass was located deep in the calf muscle, close to nerves and an artery.
Doctors told Maresh that if he had it removed, he'd have only a 50 percent chance of playing college football. That made Maresh 100 percent sure of what he wanted to do: play through it.
"There was a pretty big risk of taking it out," Maresh said. "I've tried to set that aside, basically told myself that it's nothing. I'm running on it now, and everything's working out."
On the morning of March 24, Maresh and his parents sat at a table inside Minnesota's Hall of Fame at the Gibson-Nagurski Football Complex. His first college practice, a goal some thought he'd never reach, would take place that afternoon.
"We went through a lot of stuff to get him to this point," Julie Maresh said.
Almost exactly two years earlier, the Mareshes were in the same building, attending another Gophers spring practice. Minnesota had been Sam's first Football Bowl Subdivision scholarship offer, but others soon followed -- Wisconsin, Michigan, Michigan State, Miami.
Maresh didn't grow up a Gophers fan, but the high school junior immediately clicked with Brewster, who, upon seeing him, always asked, "How's my Urlacher doing?"
After attending a portion of the practice that day, Maresh and his parents hopped in the car to drive home. They barely had crossed the Mississippi River bridge on Interstate 35W when Maresh told his parents he wanted to commit to Minnesota.
Bill turned the car around and headed back to campus. Sam walked into the indoor facility and spotted Brewster conducting drills with a group of tight ends.
"I came up to him and said, 'You think I could still have No. 17?'" Maresh said. "He said, 'You bet your ass you can!'"
Brewster hadn't coached a game at Minnesota. The program had been mediocre, at best, under Glen Mason.
"He kind of stuck his neck out for me," Brewster said of Maresh. "It wasn't the most popular thing as an in-state kid to stay at home and go to Minnesota when you've got opportunities to go elsewhere."
Maresh's choice became even less popular when Minnesota went 1-11 in Brewster's first season.
"Sam had all the perspectives," Bill Maresh said. "It was, 'Wow, we're so proud of you for staying in the state,' and, 'How stupid can you be to stay on this football team?' Press people were afraid he was going to change his mind. Why would you stay in a 1-win program?"
Bill rapped his hand on the table.
"And he'd keep saying, 'I'm a Gopher. I'm not changing my mind. I'm not leaving coach Brewster.'"
As the season approaches, Sam Maresh needs Brewster to take the same leap of faith.
Doctors have green-lighted Maresh to run, hit and tackle. They have told him that with his condition, it's better to be the player delivering the blows than the one absorbing them. But if he feels symptoms like light-headedness or shortness of breath, he knows to shut it down.
"He's going to be pushing his heart to do things that most people wouldn't," Nishimura said. "It's going to be a combination of the amount of effort he's going to put out as well as the contact."
The risk is still there, but Maresh has cleared most of his hurdles.
"Most patients after surgery don't notice their incision, even if they've had a full sternotomy," Schaff said. "So once it's healed up completely, patients don't have a disability. But those are normal patients. Those aren't guys trying to stop a running back."
"His health is the most important thing," the surgeon continued, "but again, we don't see any reason he shouldn't try this."
The only reason, perhaps, is that no one else has.
Brewster has dealt with players coming back from torn ACLs, dislocated shoulders, even bigger-picture injuries like concussions. He never has had a football player come back from open heart surgery.
"I'm probably going to be more cautious with Sam than he wants me to be," Brewster said. "I'm a father of three sons, and I like to say I treat my 117 players like they're all my sons. You just can't help but take a more cautious approach, and that's what we're going to do. We're going to make 100 percent certain that he's 100 percent ready to go."
As a fellow coach, Bill Maresh empathizes with Brewster. But he also knows his son.
"He wants to move up the depth chart," Bill said. "That means that everybody's got to trust that he can. And think about being a coach, knowing, 'Well, what if I put him in there and something bad happens?' I talked to [Sam] and said, 'You're going to have to be kind of a driving force here.'
"That's going to take some pretty mature statements, saying, 'You need to put me in. If you don't put me in, you can't see where I fit here.'"
Sam Maresh spent Minnesota's first spring practice working with the third-string linebackers. He seemed to favor his left leg when running but participated in all the drills.
His conditioning isn't up to par yet, but he hasn't lost his football instincts.
"He's not looking at this like, 'I'm just happy to be out on the field,'" Butler said. "His goals are no different than they are for [Gophers defenders] Simoni Lawrence or Traye Simmons. He wants to play football in the NFL.
"Regardless of how his career ends up, whether he plays a down or whether he's a four-year starter and an All-American, you can't question that the kid truly wants to play football."
Brewster didn't hold back on national signing day in 2008, calling Maresh the "flag bearer for this university."
Maresh hasn't logged a play in maroon and gold, but his story has drawn interest and support from around the state and the country.
Well-wishers have flocked to the CaringBridge.org Web site the Maresh family set up to provide updates on Maresh during his comeback. His mother prints out most of the posts, which have come from places as far away as Arizona and Texas.
Some of Maresh's favorite messages have come from players and fans from rival high schools.
"I was the enemy," he said. "And it was really cool to see families from Blaine and Anoka, say, 'Hey, we're behind you. Who better to represent the state than you.'
"There are certain posts that leave you breathless. It really hits you how much support and comfort there is."
All that support will be packed into TCF Bank Stadium, Minnesota's new outdoor, on-campus facility, as it opens Sept. 12 with a game against Air Force.
Maresh thinks about the game nearly every day and admits he'll be nervous and a bit overwhelmed. But when it's time to take the field, he'll be ready.
"He's going to be out front, carrying that state of Minnesota flag into the stadium," Brewster said. "And nobody deserves it more than him."
Adam Rittenberg covers Big Ten football for ESPN.com. He can be reached at firstname.lastname@example.org