Concussions still Carson's concern

Even when he was careening around the field as one of the hardest-hitting linebackers in the game, his head seemed enormous.

Today, at 56 years old, he's 8 pounds over his playing weight of 237 pounds, a little softer around the edges. But on so many levels, that noble cranium and its contents still define Harold Donald Carson.

The human brain weighs about 3 pounds and is three-quarters water. And yet there are more than 15 billion neurons, each one linked to some 10,000 synaptic connections. Inside Carson's brain, though, there are almost certainly accumulations of the tau proteins found in punch-drunk boxers. These proteins, created by repeated blows to the head over 13 seasons in the National Football League with the New York Giants, kill brain cells and can adversely affect reasoning and communication and feelings. Carson's brain, the center of his extremely nervous system, the essence of who he is, is permanently altered.

There's no nice way to say it: brain damage.

"I am very accepting of the fact that I am not where I was," Carson said softly last month at his home in Bergen County, N.J. "Mentally, I'm fine. I know the difference between right and wrong, OK? Physically, I have aches and pains, but that comes with playing the game.

"But if somebody tells you neurologically you could sustain some kind of brain damage that will go with you the rest of your life. If somebody had told me that a long time ago, I don't frankly think I would have [played]."

Carson has become one of the leading spokesmen for the NFL's retired players. Passionate and eloquent, he is in some ways the league's conscience on the subject. Whether delivering his Hall of Fame acceptance speech or speaking with a reporter in his home, the emotion is always there, always near the surface.

Changes being made

NFL players are well-compensated, but these mercenaries, who literally butt heads for the entertainment of the masses, also pay a price. The physical damage that can later lead to hip replacements and disc surgery and a daily diet of pain killers is easy enough to see. The neurological damage is more insidious.

On the cusp of this season's ultimate game between the New Orleans Saints and Indianapolis Colts, Carson and others are reflecting on the unavoidable outcome of this game: Brains are bruised.

Less than seven weeks ago, the NFL conceded this for the first time. New York Times writer Alan Schwarz quoted league spokesman Greg Aiello in a phone conversation as saying, "It's quite obvious from the medical research that's been done that concussions can lead to long-term problems."

For millions of Americans, football is simply sport. In fact, it is an incredibly lucrative business. The league's franchises are valued at about $1 billion each, and American sports fans can't get enough. The first 11 entries on the list of the United States' most watched television programs of the past decade are NFL playoff games; last year's Super Bowl XLIII, in which Pittsburgh defeated Arizona, drew a record 98.7 million viewers.

In this nation of voyeurs, people are fascinated by celebrities and, particularly, their dirty laundry. Drivers slow down on the highway when there is an accident, looking for carnage. Cynics such as Carson would say the NFL, leveraging the collisions between men far bigger, faster and stronger than the general population, has figured out how to charge for it.

"It's your body that you give up for playing the game," Carson said. "And people come, they buy their beer, hot dogs, popcorn and they cheer. They don't know the s--- that you have to go through long after the game is over."

This past regular season, Brian Westbrook of the Philadelphia Eagles, Kurt Warner of the Arizona Cardinals and Ben Roethlisberger of the Pittsburgh Steelers sat out games after suffering concussions. Only a year ago, those players might not have been sent to the sideline. And even though Roethlisberger was called out by old-school teammate Hines Ward, this was widely viewed as a game-changer, a paradigm shift.

"Hines Ward initially said, 'Hey, wait a minute,'" said Dr. Joseph Maroon, the Steelers' neurosurgeon for nearly three decades. "Ben's comment was, 'Hey, it's not a knee or an ankle -- it's my brain.'

"It's a huge accomplishment. And indicates the cultural shift that has occurred."

In early December, 15 years after the NFL formed its first committee to study concussions -- named the Mild Traumatic Brain Injury committee -- a series of significant changes were announced for the handling of head injuries, including a stricter approach for allowing a player to return after a concussion.

Carson said he is encouraged by the policy changes; he just wonders what took so long.

"Mind you, they have had 15 years of research being conducted," he said. "Fifteen years … how much longer do you need to come to a definitive conclusion? For those guys dealing with these issues now, they don't have another 15 years, OK?"

The consummate finisher

The original title of the book that Carson's literary agent is shopping around New York publishing houses was "The Scent of Fresh-Cut Grass." It is that sweet smell of stepping onto a field, Carson said, that players always remember. After reading the manuscript, his wife of three years, Maribel, suggested "A Journey to Captain."

For 10 of his 13 seasons, Carson was the Giants' captain, the gatekeeper of a ferocious defense. By design, the devious schemes of coaches Bill Parcells and Bill Belichick funneled ball carriers directly to Carson.

"My job," Carson said, shrugging, "was to hit people."

Outside linebacker Lawrence Taylor produced some sumptuous strip-sack highlights, but Carson, the consummate finisher at inside linebacker, led the team in the bottom-line category of tackles five times. He played in 173 games as a professional as well as nine playoff games, the 50-odd preseason games, training camp two-a-days, four-a-week practices in season -- many with full pads -- not to mention playing youth football in South Carolina, for Wilson High School, McClenaghan High School and, later, South Carolina State. It is impossible to know the precise number, but Carson likely experienced tens of thousands of collisions, increasingly more violent as he worked his way up football's food chain. A daunting number, no doubt, involved his head.

And yet, Carson said, not one of those collisions was formally documented as a concussion.

"When you got dinged or got your bell rung, you just blew it off," Carson said. "You didn't even tell people about it. It was one of those things that you just played through because you were a warrior, you were trained to suck it up and go."

Players used to believe that concussions occurred only with a loss of consciousness. Today, it is known that any temporary disturbance of the neurological function after a traumatic head injury constitutes a concussion. Have you ever seen white stars? An orange sky when it should be blue? Forgotten what day it is? Or where you are? They're all concussions.

Carson describes a jarring collision with Redskins running back John Riggins at old RFK Stadium that momentarily caused his vision to fade to black. When Belichick flashed in signals to call the defensive set, Carson couldn't comprehend what they meant. A teammate, seeing his distress, called the defense, and Carson played the rest of the series.

That was one of the 12 to 18 concussions that Carson today estimates he suffered.

Even while he was still playing, Carson noticed a change in his thought process. Always one of the most well-spoken players in the Giants' locker room, Carson sometimes couldn't find the words to adequately express himself. Sometimes he would lose his train of thought in midsentence. His hearing worsened; sitting in a crowded restaurant, all those swirling, ambient conversations caused physical pain. He suffered blurred vision and was visited by awkward, embarrassing moments totally lacking in muscular coordination. Even the scent of certain perfumes could bring him, retching, to his knees. He says he was often anxious and depressed. Sometimes worse. One day, driving across the Tappan Zee Bridge to practice, he says he seriously considered steering his car through the guardrail and into the Hudson River.

In 1990, two years after he retired, Carson consulted Kenneth Kutner, a clinical neuropsychologist in New Jersey. After a series of cognitive tests, Kutner's diagnosis was mild post-concussional syndrome. Carson, he observed, had difficulty with his speed of information processing, higher-level reasoning, long-term memory, attention and concentration.

"His post-concussional syndrome," Kutner concluded, "is seen to be related to his series of concussions which occurred while playing professional football. His cognitive [difficulties] are likely to be permanent in nature."

Carson, who had feared a brain tumor of the sort that killed former teammate Doug Kotar in 1983, was almost relieved. He just knew he was going to live. Aggressively attacking the problem, Carson listened to words on tape to recover his vocabulary, read aloud to himself so he could practice his pronunciations. He learned to avoid dark rooms and flashbulbs that invariably set off migraine headaches. He was forced to focus intensely on things that most of us do unconsciously.

It wasn't enough to save his broadcasting job at the Big East Network. A sideline reporter, he once froze while interviewing Syracuse football coach Paul Pasqualoni -- completely forgetting his name. The next day, Carson said, he was fired.

To this day, Carson suffers most of the above symptoms. Last month, on a flight to Hawaii, a baby started crying and, at 30,000 feet, Carson almost lost it.

His oldest son, Donald, suffered a concussion while playing football at Savannah State in Georgia. But a few years later, while he was considering a free-agent tryout with the NFL, he was diagnosed with aplastic anemia, a rare condition that reduces the bone marrow's ability to produce blood cells. Carson never told him, but he was happy Donald wasn't going to play in the NFL. Ecstatic, actually.

His youngest son, Kip, is 6-foot-5, 275 pounds. This year he went out for the football team at Auburn University, but doctors discovered an elevated blood pressure, and he failed his physical.

"It was a blessing," Carson said. "I didn't want him to play football."

The missing link

Seven years after finishing one of the great careers in NFL history, "Iron Mike" Webster sat down for an interview with ESPN in 1997.

The Steelers center for 15 seasons and winner of four Super Bowl rings seemed sluggish and distracted as he talked about the frightening things that constantly veered through his mind.

"Hell, I don't know what I'm saying," Webster said after four futile attempts to complete a sentence. "I'm just tired and confused right now, that's what I'm saying. I can't really say it the way I want to say it. I could answer this real easy at other times, but right now I'm just tired."

It got worse. Wandering around in a haze created by all those blows to the head throughout the years and a dizzying array of painkillers, Webster slowly, sadly lost his mind. He urinated in the oven, tried to superglue broken teeth back into his jaw, tasered himself into unconsciousness when the drugs weren't enough to dull the ache. He'd sleep at the Amtrak station in downtown Pittsburgh, surviving on potato chips and dry cereal. He sometimes called friends and family from gas stations when he got lost driving between Wisconsin and Pittsburgh.

He died in September 2002. He was 50.

Carson said he was the only non-Steelers player to attend the funeral. He spoke with Webster's son, Garrett, asking about Mike's deteriorating condition in his last days. Carson told Garrett he felt guilty, that he believed all those forearm shivers he had laid on Webster's helmet in their 13 regular and preseason encounters probably contributed to his demise.

"Football players are very prideful individuals," Carson said, tears filling his eyes. "When a player loses his dignity and dies the way Mike died, it makes me angry. The person who I saw in that casket was proud, but he was in that casket. That could have been me."

Dr. Bennet Omalu, a young forensic neuropathologist in the Allegheny County (Pa.) coroner's office, had seen the television reports of the fallen football star. On a Saturday, four days after Webster's death, Omalu had the body on his autopsy table.

"Nobody really mentioned any link [between] his postretirement profile and the repeated impacts," Omalu said. "In my mind, I made the link, but I did not have the physical evidence to establish the link."

Eventually, he found it. Looking through a microscope, he discovered tau proteins in thin slices of Webster's brain. The damage was similar to what he had seen in the brains of dead elderly patients who had suffered from dementia. Omalu identified the syndrome as chronic traumatic encephalopathy, or CTE. It had never been found in the brain of a former NFL player. Three years later, in 2005 -- a decade after the formation of the league's first concussion committee -- he published his findings.

Three doctors on that committee demanded a retraction.

"When I published this paper, my objective was to enhance the game, to shine light on a problem that we've always ignored," Omalu said. "I was very shocked, surprised at the response that I received."

Two years later, even after Omalu had found CTE in the brains of former Steelers guard Terry Long (who died after drinking antifreeze) and former Eagles safety Andre Waters (self-inflicted gunshot wound), NFL doctors still were disputing Omalu's findings.

"Anecdotes do not make scientifically valid evidence," said Dr. Ira Casson, one of the three doctors who signed the critical letter, at a 2007 concussion summit organized by league commissioner Roger Goodell. "In my opinion, the only scientifically valid evidence of CTE in athletes is in boxers and some steeplechase jockeys."

By 2009, however, the climate was changing. In September, an NFL-commissioned study reported that Alzheimer's or similar memory-affecting diseases appeared to have been diagnosed in its former players at a rate of 19 times higher than the general population for men ages 30 through 49. In October, the House Judiciary Committee convened hearings on the NFL's approach to head injuries. Goodell was peppered with questions by a not-so-awestruck Congress. At one point, California Congresswoman Maxine Waters, whose husband had played in the league for six seasons, said it might be time to scrutinize the NFL's antitrust exemption. Linda Sanchez, also of California, produced the sound bite of the hearings.

"I hear the concern from some of the witnesses on the panel today," Sanchez said, "that the NFL kind of has this kind of blanket denial or minimizing of the fact there may be this link, and it sort of reminds me of the tobacco companies, per-'90s, when they kept saying, 'No, there's no link between smoking and damage to your health.'"

Why not acknowledge the link, Sanchez continued, "so there isn't this sort of sense that the NFL is slow-walking this issue to death by saying, 'Well, we've been studying this issue for 15 years, we're going to maybe study it another 15 more years.'"

Twenty-seven days later, the NFL announced that the co-chairmen of the concussion committee, Drs. Casson and David Viano, had resigned. Teams would consult with independent neurologists after a player's concussion. The league also introduced several education and research initiatives. Eight days after that, the league announced a stricter protocol for a player's return to action after a concussion.

Longtime followers of the issue noted the timing.

"You have people who are in Congress now who are a bit more educated on the issues of retired players," Carson said, "especially this issue of traumatic brain injury, who sort of held certain people's feet to the fire. I think by acknowledging it, it would have opened up the floodgates to potential lawsuits coming down the pike for players who have played the game."

Robert Fitzsimmons is intimately familiar with lawsuits. He was the attorney who won retroactive disability benefits of approximately $2 million for the estate of Mike Webster, the first successful case against the NFL's pension plan.

"They had the perfect product," Fitzsimmons said last month in his office in Wheeling, W.Va. "And a head injury -- think about the devastating effect if somebody comes in and wants to remedy the problem. I think it was the fear and a lack of knowledge, really, that they really didn't play it out: If we do something, if we recognize this condition, if we take proper steps, what is going to happen?

"Are we going to lose the game? Are we going to lose our product?"

Still the captain

One of the many perks of being voted into the Professional Football Hall of Fame is the bronze bust. Each enshrinee receives a replica of the one on display in Canton, Ohio.

Carson, after a long and traumatic journey, wanted to make sure it correctly captured his powerful image. In 2006, he and his wife traveled to the studio of sculptor Tuck Langland in Granger, Ind. When Maribel said the eyes didn't burn with the proper intensity, Langland deftly scooped out a gob of sand-colored clay. There were other adjustments: The chevron-shaped divot between his eyebrows was deepened, the nick in his left ear enlarged, his cheeks were "Botoxed," according to Carson, and he was given the full head of hair of a younger man.

You can find Carson's bust looming on the mantel in the well-appointed family room of his Tudor-style home. His friends will tell you they never thought it would happen.

For Carson's relationship with the Hall of Fame has been marked by turbulence. During a run of 13 consecutive years in which he was passed over by the football writers who vote, Carson asked that his name be withdrawn from consideration. As it turned out, he didn't have that power. He was ambivalent about the honor, but eventually, family, friends and former players persuaded him to don the cream-colored jacket and accept.

Carson knew they couldn't censor his acceptance speech, so he got right to the point.

"I want to implore the NFL and the union to look at the product that you have up on this stage," he said, not referring to notes. "The honor of making it into the Hall of Fame is great, but it was even greater to have the opportunity to play in a league with 18,000 individuals.

"I would hope the leaders of the NFL, the future commissioner and the players' association do a much better job of looking out for those individuals. You've got to look out for them. If we made the league what it is, you have to take better care of your own."

Less than three years later, one of those players, Brad Van Pelt, died in February 2009 at age 57. His death hit Carson particularly hard. Van Pelt, a fellow linebacker, played alongside Carson for eight seasons and was only two years older.

Because he has been outspoken about the league's treatment of retired players, Carson has been getting a lot of phone calls lately. Not just from former players, but more often from those players' family members. Carson believes the issue will escalate into what he called "an epidemic."

"When these guys start committing suicide, when they start having these issues, it's only, in my opinion, getting worse," Carson said. "Because there are going to be more and more players who are going to feel like a Terry Long, who are going to feel like a Mike Webster, who are going to feel like, 'Nobody knows what I'm going through and I am in this pain. What can I do? OK, let me take drugs and let me overmedicate myself -- even to the point of driving my car down the wrong lane of a highway and run into a tractor trailer to end it. Or let me just put a gun to my head and blow my brains out.'"

These days, the leading question in the minds of retired NFL players is: How many suffer from permanent brain damage?

The Steelers' Dr. Maroon, a member of the NFL's concussion committee for the past three years, believes the number, with very strict qualifications, is low.

"Because we know that there are millions of high school kids, college kids, youth leagues, as well as other who play football annually, I think we are not seeing the epidemic at that level people are speculating about," Maroon said.

"I'm not saying that there is not a relationship [between football and brain damage]. I think that number is low. That's my personal opinion."

But including players in youth leagues, high schools and colleges in the equation means there's a larger pool of athletes and, thus, a lower incidence of brain damage. What's the percentage in the NFL, where the forces of physics are so much greater? There is no way to know exactly, but some experts believe that the anecdotal number of 20 percent cited in dementia pugilistica (punch-drunk syndrome) studies might not be far from the truth. That would be roughly one for every offensive line.

Carson has turned down a request for his brain upon his death, saying, "there's no need --I know what I know." On a gray January day in northern New Jersey, with squirrels bounding over the snow around his yard, Carson was moved to tears during a nearly two-hour interview about football and concussions.

"If people say there is no correlation between what happened to them and playing -- bulls---, bulls---," he said, jaw trembling. "And people can call me anything they want. They can call me a malcontent, a baby -- whatever the f--- you want to call me. But nobody is going to shut me up from talking about what I know.

"When these guys call me, it breaks my heart. I was their captain, and I'm still their captain. I will do whatever I have to do to help these guys. There are certain people who sit in positions of power -- they don't know. They don't know what it takes to play."

Greg Garber is a senior writer for ESPN.com.