NEW YORK -- Eleven years ago, when orthopedic surgeon Robin West worked her first football game as a team physician at Pittsburgh's Carnegie Mellon University, she pulled an offensive lineman out of the game for a suspected concussion after a hit.
She remembers that one of the coaches was furious. He told her no player had ever been pulled out of a game for a concussion before. And back then, as it sometimes still is, players weren't trying to take themselves out of games if their injuries weren't apparent.
"I can tell you, 10 years ago, 11 years ago, a lot of players weren't reporting their concussions," West said.
Much has changed since then but West, assistant team physician with the Steelers since 2003, had the temerity to make the call then and she's been doing it ever since. And not just in football, but for NCAA teams and private patients, from high school to Pop Warner.
A former swimmer, West has a gaze at once intelligent and discerning. She said the past 11 years have brought tremendous change, particularly to the NFL. When she started, a list of injured players might not even include a specific injury -- coaches just wanted to know who was ready and who wasn't.
Now, West points to the addition of concussion protocols, independent neurologists, a team of 27 medical professionals on game day, baseline cognitive tests and a staff of athletic trainers, massage therapists and nutritionists who help players prepare for games and recover from injuries.
"If we can hold the player until they're symptom free, can we prevent CTE?" West asked, referring to chronic traumatic encephalopathy, the brain trauma found in former NFL players like Mike Webster and Tony Dorsett.
At first, West was one of just a few women working in the field.
And she still is, although she noted in a breakfast hosted by the NFL Physicians Society at a Manhattan hotel that the number of women working as team orthopedists doubled this year -- to four.
West's life is hectic. She is on the sidelines of Steelers games, checking injured players and watching a replay of the impact on the field. "We can see the mechanism of the injury," West said. She holds doctor's hours at the team facility, performs surgeries, has her own practice and is an associate professor at the University of Pittsburgh Medical Center. She also has two elementary-school age daughters who play soccer.
That may be why she has noticed the rates of ACL tears and concussions for girls soccer are not insignificant. Football gets a lot of attention, but West notes that injuries for women and girls cause just as much upheaval even when they don't get the headlines.
"If I did have a son I would let him play football," West said. "Why would I let him play football? Because I think the benefits of sports outweigh the risks."
West is a proponent of organized sports, with knowledgeable and informed parents and participants. The past two years, however, she has seen a strong reaction to the emerging science about concussions and their long-term effects.
"Parents come in now and they are very aware of it," West said. "There is almost this fear factor… but there is risk associated with everything."
West said she believes increased awareness -- and a culture that encourages an open and honest discussion of symptoms -- combined with improved detection and treatment, can reduce the incidence of brain trauma among athletes.
"I think there'll be a significant decrease," she said.
She again points to the team of medical professionals working with players, how nutritionists can offer Omega 3 supplements to players recovering from brain trauma and how athletic trainers like Sonia Gysland with the Steelers can help with the injury rehabilitation.
West said she talks to members of the military about returning to work after an injury. Like NFL players, they are diligent about their rehabilitation and are eager to get back on the field. For West, the moment she knows they are ready is when she asks if they could not only go back into battle, but carry another wounded soldier out of harm's way.
That's the gut-check.
With the Steelers, West and Gysland are on the same page about mitigating a mentality that prioritizes a return to play before a player is fully healed. Gysland translates the message from a military perspective to one football players can better relate to.
"You're actually hurting your teammates if you're out there concussed," Gysland said.
For West, this discussion is light years from where things were when she got started. There is a distinct concern for players' health, and she often is asked if injuries have increased in recent years. It may appear that way, but she doesn't think so.
"We are diagnosing more," West said.
Which is a good thing. Football -- or soccer or lacrosse -- will never be risk-free. But West said she believes the risk can be reduced, and that the rewards are worth it.