Thursday, August 16, 2012

Breakout Past: C.J. Patrick and Concussions

The following article, about former Icers captain C.J. Patrick and his struggles with concussions, was reproduced from the March/April 1999 issue of The Penn Stater. Despite the occasional sense of foreboding one gets while reading it, the ending is a happy one: Patrick played in all 33 of PSU's games as a senior and, in addition to his typically-stout defense, had his best offensive season with 22 goals and 43 points - good for third and fourth on the team. Here's some photographic proof that he made it to the finish, in his case the handshake line after the Icers' defeat game that never took place against Iowa State for the championship of the 1999 ACHA tournament (Patrick is number 14, and apologies for the quality - if you saw the original from which I was working though, you'd be impressed).

In all, Patrick played 95 games at Penn State, scoring 37 times and adding 45 assists. As captain in his last two years, he led the Icers to back-to-back national championship games, including a win in 1998. Two other members of the legendary Patrick family tree would follow C.J. to PSU, brother Ryan - who is mentioned in the article - and cousin Curtiss. Curtiss is the son of Craig's younger brother Glenn, himself a former NHLer and the first, and still longest-serving, coach in the history of the Wilkes-Barre/Scranton Penguins. C.J. (Class of 2008) and Curtiss (Class of 2012) are both in the Penn State Hockey Hall of Fame.

Head Strong
After nine concussions, Penn State hockey player C.J. Patrick may be skating on thin ice.

by Chuck Salter
photos by Paul Fetters

The first concussion was in fourth grade. He was zigzagging down his first expert ski slope, and another skier came flying off a mogul and didn’t see the boy until it was too late. The man’s skis struck the boy in the head. The boy’s father had never been so scared, holding his bleeding and delirious son, waiting for the ski patrol to arrive.

The second one happened when the boy, just 16, was playing hockey with 18- to 21-year-olds on the Pittsburgh Penguins amateur team. “I stuck my nose a couple places where I shouldn’t have,” he says with a grin. “I weighted about a buck-thirty, and I raced this one defenseman listed 6’4”, 275 pounds, into the corner for the puck. Unfortunately, I got there first.”

The next few concussions blur together around that same time, his high school hockey days. One time a guy accidentally kneed him in the head, then it was somebody’s elbow that clocked him – routine stuff, he said – and, oh yeah, there was one cheap shot, a stick to the helmet.

“How many is that?” asks Penn State senior C.J. Patrick. He pauses, then ticks off three more concussions from playing for the Penn State Icers. “Is that nine?” he says. “That’s how many I know of. It might be more.”

No wonder Ruben Echemendia, director of the Penn State Psychological Clinic and the Icers’ team psychologist, calls him the “poster boy” for the University’s innovative sports concussion program. C.J. has single-handedly provided Echemendia with a wealth of post-concussion data, because he’s suffered more head injuries than most athletes. Last season, after his ninth concussion, C.J. asked Echemendia what he should do.

If you were my son, I’d tell you not to continue playing.

That wasn’t what C.J. wanted to hear.

He doesn’t like to think about concussion, much less revisit his own, but once he does, C.J. is matter-of-fact about the unpleasant aftereffects. He’s been so disoriented that he’s needed assistance getting off the ice and so sensitive to light that he’s squinted to see. He’s been nauseated and moody. Unable to remember something he’d just heard. Unable to walk without losing his balance. And then there were the pounding, unrelenting headaches.

And yet, he still laces up the skates, still hits the ice, still sticks his nose where he shouldn’t. Neither Echemendia nor the repeated head injuries have persuaded him to quit. Not yet, anyway.

Born into a hockey family (his father is GM of the Pittsburgh Penguins and his great-grandfather is in the Hall of Fame), C.J. learned to skate before he was 2.

Why keep playing? “I can’t imagine not playing,” C.J. says. A team captain his junior and senior years, he relishes the camaraderie, the competition, and yes, even the contact. “You know you’ve popped a guy pretty good when your teammates can hear it from the bench,” says C.J., who’s built like a fullback - 5’10”, 200 pounds, broad-shouldered - and plays center on the checking line, the Icers’ most physical line. He also has a family name to uphold. He’s a quiet leader, teammates say, and he wouldn’t tell you if you didn’t ask, but he’s practically hockey royalty. Three generations of Patricks have played in the NHL, including his father, Craig Patrick, now general manager of the Pittsburgh Penguins.

And the truth is, there’s no conclusive evidence that C.J. is jeopardizing his health by playing. He might be, he might not, and that’s good enough for him. “I suppose if I take a big hit, it could be bad, but nobody knows,” he says. “It tends to worry you a little bit. But when I get on the ice, I don’t think about it too much. If you’re scared to get hit or go near the boards, you might put yourself in a worse position and get crushed. So the best way is to be fearless.”

Much about concussions remains a mystery, and diagnosing concussions is especially difficult. On impact, the brain gyrates violently and sometimes bounces against the skull, Echemendia says. The sudden movement stretches or tears the axonal fibers that connect neurons, so that these brain cells no longer function or relay information normally. But doctors can’t see the microscopic lesions in a CT scan or an MRI, the way they can detect a broken bone or a tumor. Echemendia tracks the symptoms through a battery of neuropsychological tests, comparing an athlete’s cognitive abilities before and after a concussion. The player doesn’t resume playing until the scores return to normal and the symptoms go away.

Each brain and each head injury are different, which makes predicting the severity pure guesswork. C.J.’s next concussion could be worse, or perhaps milder. Echemendia can’t say for sure. But research suggests that someone like C.J., who’s sustained previous concussions, is more likely to get one than other players, Echemendia says. Maybe two times as likely, maybe four. However, it’s not clear whether there are cumulative or lasting effects from prior concussions; with rest, the brain seems to heal. So as far as Echemendia can tell, C.J. has fully recovered from his previous concussions. He’s lucky. In 1994, football safety Josh Kroell ’95 Lib left the team after three concussions gave him memory lapses and dizzy spells. And, a couple of years ago, the Lady Lions’ Stacey Hrivnak ’98 H&HD had to give up basketball after two concussions left her with amnesia. Her post-concussion symptoms lingered more than a year.

Ruben Echemendia, director of the
Penn State Psychological Clinic and
the Icers' team psychologist
The real danger is when someone sustains a second concussion while the brain is still repairing itself from the first one. The results can be career-ending, permanent, even fatal. “You have uncontrolled swelling of the brain,” explains Echemendia. “And the skull is finite.” The cerebral pressure becomes so great that the cells stop functioning. The person dies.

The concussion that almost ended C.J.’s hockey career were the eighth and ninth ones.

Upstairs in an office at the Penn State Ice Pavilion, Echemendia slips in a videotape labeled “C.J. Patrick’s Hits” into a VCR. Here’s C.J. racing down a loose puck at Kent State last season, his No. 14 jersey obscured by two forwards bearing down on him in the corner. You can see the collision coming, like cars in a high-speed chase. The first player knocks C.J. off his feet. The second slams him into the boards. “That’s the first concussion,” Echemendia says, watching it again in slow motion.

Cut to the next game, at the University of Findlay the next night. While fighting over the puck, a defenseman checks C.J. high into the boards. As C.J. falls backward, his helmet slips off, and the Findlay forward cross-checks him with his stick - in the head. “And that’s the second,” Echemendia says grimly.

Back at State College, C.J. knew what was coming. He calls them “the Ruben tests.” In one, Echemendia recited a grocery list, then asked C.J. to repeat it back. But he couldn’t remember more than a few items. C.J. knew he hadn’t just had his “bell rung,” the players’ dismissive description of a mild concussion. This was serious. He had frequent and severe headaches. While walking across campus, he would suddenly lose his balance and stumble. He was moody.

After two weeks, his scores returned to normal on the neuropsychological tests, but the headaches continued. “He’d be sitting at the computer and he’d have to stop reading and press a finger to his head because it hurt so much,” says Cameron Dowler, C.J.’s girlfriend and high school sweetheart. “I knew he wanted to keep playing, but I didn’t know if it was the right choice.” Neither did his mother. “I said, ‘Maybe you ought to consider hanging up the skates for the rest of the year,’” recalls Sue Patrick. “But my words fell on deaf ears.” So did those of Charles Burke, the Pittsburgh Penguins’ team physician. “He looked at me like I was nuts,” C.J. says. “He told me to quit and get on with my life.”

Not yet, thought C.J. Not after he had already sat out most of his freshman season two years earlier with a knee injury. Not now, when the Icers were 20-6 four months into his junior season, putting them into contention for the American Collegiate Hockey Association title, the national championship for schools with club hockey teams. The last year Penn State won it was 1984. [Editor’s note: It was actually 1990 at that point.]

Why keep playing? C.J.’s father knows. “If hockey gets in your blood, you can’t get it out,” says Craig Patrick, who suffered his share of concussions throughout his NHL career. After one, he had no recollection of finishing the game, or of being taken to the hospital that night.

There’s also the family connection. So many Patricks have had their names inscribed on the Stanley Cup that it could easily be mistaken for their personal family tree. C.J.’s great-grandfather, Hall-of-Famer Lester Patrick, was a hockey legend as a player, coach, general manager, and team owner in the early half of the century. Along with his brother Frank, Lester brought pro hockey to the Pacific Northwest and was instrumental in shaping the game - they introduced the penalty shot, line substitutions, and numbered jerseys. Later, Lester helped found the New York Rangers, a team that he, his son Lynn, and his grandson Craig have coached over the years. C.J. grew up following the NHL when it still had the Patrick Division, named after his family. “Maybe there’s a little pressure there,” Craig says, “but C.J.’s always been his own person.”

C.J.’s father has a photo of him holding a hockey stick before he was a year old. His mother taught him how to skate the following year. He always preferred playing hockey to watching it, often skating before and after his father’s practices. When Jaromir Jagr joined the Penguins as a teenager, C.J. and his younger brother Ryan practiced with the future superstar. A few years later, the brothers skated on the same line at Fox Chapel High School, just like the Patricks before them had in the pros. As a teenager, C.J. was in the locker room when the Penguins won back-to-back Stanley Cups. His Penn State teammates spotted the blonde-haired C.J. in a video of the championship.

C.J. still prefers playing to watching. Being benched last season, after his ninth concussion, was “the most frustrating thing I’ve ever had to go through,” he says. He couldn’t sit with the assistant coaches and watch the Icers games without flinching, as if he were on the ice dishing out punishing checks. He couldn’t walk through the stands without someone asking “When are you coming back?” (“As soon as my headaches go away,” he’d reply.) Worst of all, he couldn’t do anything to rush his recovery. He could only rest, then rest some more, and continue taking anti-inflammatory medicine and keep a log of his headaches for Echemendia. Every game, C.J. asked him the same thing: When can I play?

Three months after his concussion, C.J. was finally symptom-free. Echemendia and Penn State team physician Margot Putukian agreed that he had fully recovered, so they cleared him to play, but not before reminding him of the risks of future concussions. C.J. understood. When he returned to the ice, he wore a helmet with extra padding and a mouthpiece with extra shock absorption. A month later, at nationals, his checking line didn’t allow a goal the entire tournament. The cover of this year’s Icers program tells the rest: the jubilant Penn State players are crowded around a big, fat silver trophy, and nearly every had is pointing “No. 1!”

Will there be a tenth concussion? C.J. doesn’t expect it, so he doesn’t think about it. But Echemendia does. To avoid multiple concussions in C.J., or other athletes, he knows he must detect an initial injury, so prior to every season he reminds Penn State athletes of the symptoms and the risks, and then he implores them to confide in him or the trainer. “There are players who want to get back on the field or the ice who tend to minimize their problems,” says Echemendia. He attends the Icers’ home games to personally keep an eye on certain players, C.J. in particular. If C.J. comes off the ice hanging his head, the trainers check on him immediately: C.J., you OK? You feel all right? Between periods in a particularly physical game, Echemendia visits him in the locker room, looking for subtle signs of a concussion, anything unusual.

It’s hard to believe that anything good could come of getting hit in the head, but Icers head coach Joe Battista ’83 Bus thinks the injuries have given C.J. a deeper appreciation of the game. “When he came back last year, I’m telling you he came back with a vengeance,” Battista says. “I think he was more physical than before, and he was already a physical player. That first game, he killed off a five-on-three penalty single-handedly.”

At the end of that championship season, C.J. could have walked away from the game with dignity. But he came back to play this season - his senior year, most likely his last hockey season. Although his father tells him he has the skills to make an NHL roster someday, C.J. doesn’t think so. Besides, he figures he’ll earn more as a highly recruited management information systems major than he would as a minor-leaguer.

In the future, C.J., an ACHA Academic All-American, would rather use his head than risk injuring it. “I’m accustomed to the speed of the game at this level,” he says. “I’d be a sitting duck at the next level. I’ve seen players up there get absolutely smoked. So in that sense, I am thinking about my concussions.”

At the same time, he’s still headstrong, determined to quit the game on his terms: at the end of his senior year, after nationals, and not a day sooner. But even that seems too soon for him. I can’t imagine not playing. Yet he knows another concussion could end his career before then, this game, or the next. Will he really tell Echemendia if he gets one, even a bell-ringer?

“I haven’t been faced with it yet, so I don’t know,” C.J. says. “At the moment I get it, I’m probably going to sit down on the bench and pretend nothing’s wrong. That’s my first reaction. But when I get up to go in, I’m going to smarten up a little bit, I think.”

Echemendia hopes - and believes - that he will.

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