The Concussion Diaries

It was a one-in-a-million chance or a message from God. In Nov. 2008, Sierra Stites ’14 was standing on the sidelines watching her high school soccer team play. Then, a ball kicked from an adjacent field slammed into her head, whipping her skull forward and forever changing her life.

“My original thought was ‘what did I do wrong?’ But that got me into religion and sinning, and I never felt comfortable with that thought because once you start thinking like that it can lead you down a very dangerous path, and I was already in a precarious position,” she told me, reflecting five years after the concussion.

On that day, she was not playing specifically to avoid worsening the “standard” concussion she sustained after butting heads with an opponent for a jump ball two weeks earlier in a tournament in St. Louis, Mo. The second concussion could not have come at a worse time. In the midst of the junior year rat race to get into top colleges, her test scores plummeted from the 90th percentile to the 30th percentile.  Stites was forced to complete speech cognitive therapy to help her regain understanding of what was happening in class.

“I never took that much time off of school, because I defined myself as a student-athlete, and I already had the athlete part taken away,” Stites said. “I ended up having autonomic injuries as well, which meant that any change of planes – getting up, lying down – would make me really dizzy with black spots in vision.”

Stites had battled back from two torn ACLs – rehab she now calls “easy” in comparison – but that second concussion became an immovable obstacle, strapping her with physical and emotional baggage she was forced to carry with her to Middlebury.

The step from high school to college was especially challenging because Stites lost the direct support from her family. One of the biggest challenges for victims of head injuries is that there are no physical manifestations. Without a cast or crutches, a blinding headache is easily seen as lethargy or even laziness by the outside world.

“I had a friend tell me ‘you were moping there for a while’. Are you serious? I couldn’t think. That was always disappointing to hear but it tells you who your real friends are. But comments like that are why I retreated into my family because my parents were both doctors and knew, at least medically, what I was going through. The stigma is definitely there, but I stopped caring what people thought.”

While the College’s administration and counseling services gave her constant support, Stites struggled to overcome what at times seemed an unwinnable war. During the fall of her sophomore year, Stites’ recovery hit a plateau, her symptoms neither improving or worsening and the constant headache hurting her ability to concentrate. Running out of options, Stites and her father found themselves at the Famed Mayo Clinic in Rochester, Minn. More physical therapy and a semester later, she returned to the College.

During her junior year, the physical symptoms subsided enough that she could stay up past 10 p.m. and drink in moderation, things most students take for granted. But that was only half the battle.

“Part of post-concussion syndrome is the emotional side affects. I struggled with depression and anxiety junior year because I had a lot of trouble finding the support that I needed. I was never someone to tell everyone what I was feeling, and so I had a lot of trouble re-adjusting junior year and by the end I was almost ready to leave Middlebury.”

Even thought she has lived a quarter of her life with a concussion and cannot remember most of high school, Stites still plans on becoming a doctor after graduation and even gives her head injury credit.

“It’s made me a better person and made me more self-aware. People come to college saying they are going to find themselves, and I think I came in knowing who I was and what I’m about. It forced me to grow up quickly and take a hard look at things. I don’t think I would even be at Middlebury if I didn’t have a head injury. It’s been a part of my life for so long that I can’t imagine what it would be like without it.”

A Three Month Headache

Possibly the cruelest part of concussions for athletes is the recovery. People who shape their lives around movement in sport are forced into static solitude, something they are wholly unaccustomed to.

With five minutes left in a weekday lacrosse practice on April 17, 2013, John Montgomery ’14 scooped up a ground ball in front of the net and ran up the field. But a teammates’ stick jarred it loose, and as he jumped to retrieve it, the two players’ heads collided. He blacked-out on contact and blacked-in when he hit the ground, beginning a dizzying five-month journey of doctors, darkness, and frustration.

Montgomery had sustained a concussion playing high school football at St. Mark’s School in Dallas, Texas. While he was “so mentally out-of-it it wasn’t even funny” at the time of the hit, he went back to class within four days of being hit and simply sat out a few weeks. But this one was different.

“I heard horror stories about it, and I’d seen other people get concussions, but I had sustained one, I knew what that’s like, they must have been doing something wrong.”

The day after the initial hit on Youngman Field at Alumni Stadium, Montgomery didn’t feel any of the telltale signs of a concussion ­– blinding headaches or nausea – only a self-described “foggy-headedness.” After consulting with Associate Director of Sports Medicine Kelly Cray, he suited up for practice the next day. While it was supposed to be a non-contact practice, Montgomery ran into a pick from another teammate, hitting the same side of his head for a second time in as many days.

Montgomery was hindered by the fact that the second concussion was not cut and dry. In those crucial five days between the initial hit and the following Monday when he finally shut everything down – now known to be the most important in dictating recovery time – Montgomery most likely exacerbated the concussion.

“When I tell this story, I feel like an idiot because I kept going and going and going. Part of it was that I didn’t know I was hurt, and I had so much schoolwork I needed to do. I couldn’t just sit there and be like, ‘oh well, I got hit in lacrosse, so that’s why I can’t write your paper, Professor.’ Doing work was probably the thing that pushed me over the edge. You wouldn’t ask someone who just broke their leg to go run a marathon. So translating that comparison to a concussion, you wouldn’t ask that person to run a marathon mentally, doing a bunch of schoolwork and writing a bunch of papers. And that’s exactly what I did. It was stupid.”

As the warmer months crept onto the College, Montgomery was bed-ridden, spending 16 hours a day staring at the dark ceiling. All stimulation was forbidden, which in essence, is almost everything. The only contact he had with the outside world was texting friends to bring him meals. After three weeks of darkness in Starr 311 and little progress, Montgomery decided to take incompletes in all four of his classes and fly home to Dallas with the help of his mother. Once home, he went through an array of doctors from a chiropractor to a neurosurgeon, even spending hours in a hyperbaric chamber.

It took the headache and accompanying symptoms three months to fully subside, after which he finished his class work and completed a truncated internship in Houston, Texas.

The bravest, or most foolhardy, part of the story is that Montgomery plans to play lacrosse this coming year.

“It’s a large gamble. I already have a job after I graduate and I would hate to have that taken away from me because of my decision, but at the same time, when you fall off a horse, you always get back on to show yourself and the horse that you can do it, and I don’t see how this situation is any different.”

A Concussion Speaks

If you talk to enough athletes who have sustained concussions, you start to notice a common trend. While few can remember the crucial moments – many black out – every one I talked to can remember the exact date and time of day they were concussed, even years later. The odd paradox speaks to the unintended consequences and importance a concussion has.

For ex-skier Emma Kitchen ’14.5, that was just after dark on Dec. 1, 2010. On her bike, bombing down the hill on College Street below St. Mary’s Church, Kitchen collided head on with another student at the intersection with Shannon Street. The impact left her in the intensive care unit for three days with a fractured skull, hemorrhaging, and cerebral contusions that kept her bed-ridden with no screens for six months.

Kitchen’s recovery came in meager steps. At six months, she was able to get her heart rate above 150 beats per minute. At eight months, she started drinking with her friends. Finally, after nine months and 11 doctors, she made a full recovery.

The unending days of confined darkness became some of the hardest in her life.

“You’re locked in a prison, and if someone tells you otherwise, then they haven’t done it. Recognizing that it hurts to live, that’s terrible. The problem I had was that I felt like I was lying there for someone else. Everyone from a neurosurgeon to a psychotherapist told me the same thing: ‘go lie in a dark room. You’ll recover slowly, but we don’t know when.’ It was really frustrating in that regard. There was nothing else out there. It made me feel like an addict who had done something wrong.”

But necessity became the mother of invention. Frustrated with the lack of alternative therapies, Kitchen and Kait Surdoval ’12 founded Concussions Speak in Jan. 2012.

“The idea came from me not being able to talk about my concussion. It was just a matter of finding more people like myself, who had gotten their sport taken away from them,” Kitchen said.

After Director of Athletics Erin Quinn sent an email petitioning athletes to share their concussion stories, the group received ten stories.

“The similarities between the stories were uncanny. Everyone has a similar story of the denial stage, the depression stage, and then the very slow recovery stage. It is really painful and difficult. I found that I didn’t trust anyone who hadn’t been through it because it impacts every second of your life. Everyone has the same experience of not feeling 100 percent there. We realized that it was fine to tell these stories, but what we really needed was a way for people to connect, talk about it, and answer questions.”

Today, Kitchen said she speaks to a different concussion survivor about once a week. Concussions Speak has grown from a modest Facebook page to full-fledged non-profit, traveling to speaking engagements far beyond the College. Most recently, Kitchen, Stites and Surdoval spoke to a group of kindergarten through 12th grade students Hammond School in South Carolina on Nov. 22.

Reflecting back on her years at the College, Kitchen may be the only athlete who calls her concussion “the best day of my life.”

“The ski culture is very insular. You are required to spend so much time with the team because it’s such a demanding sport. They are always on the hill, or preparing to be on the hill. On a time perspective, I would not have had the opportunities to do what I’ve done since. If I had gotten through half my Middlebury career and then decided I didn’t want to ski, there would have been a lot of emotional detachment for letting the team down. I was brought here to ski, and I found them to be a family-oriented bunch, and to let them down like that would be hard on me. I didn’t have to go through any of that. The decision was made for me.”

Challenging Traditional Treatments 

The high-intensity community that the College is praised for makes treating concussions often a fool’s errand. The first five days are the most critical in determining the severity and length of recovery. While the College has a four-step diagnostic process, asking students at the College to push pause on their entire lives is often a task many fine impossible to embrace.

“Another challenge is getting concussed students to slow down and allow their brain to recover. The pressure to keep up with academic work is one of the most significant and detrimental factors impairing recovery from concussion,” wrote Medical Director, College Physician and Team Physician Dr. Mark Peluso in an email.  “Students that try to push through symptoms to keep up with their academic work tend to require a longer recovery times than students who rest and follow our symptom-based recovery process.

In light of the imperfect treatments and challenging atmosphere for recovery at the College, concussions are not going anywhere. Peluso said that between Parton Health Center and Sports Medicine, he treats between 15 and 30 concussions a year, which is rising nationwide because of better patient reporting.

During the five-day period after Montgomery was initially hit, he did anything but rest, attending class, practicing multiple times, and taking numerous tests. After weeks of bed rest at the College, he decided to go home early, which he called the “best decision” he made over the course of the whole ordeal.

When asked what advice they would give to students who have recently sustained concussions, both Kitchen and Montgomery were critical of the bed rest treatment program.

“Past a certain point it actually works against you. I told my parents that I didn’t think I would ever have this much time to sit and think unless I went to prison in solitary confinement. You just sit there and think, ‘do I have a headache? Do I have a headache?’ Eventually, you are going to give yourself a headache. I felt like I was starting to go crazy by the end of it,” Montgomery said.

Peluso wrote that to a certain extent, prevailing medical methods of treating concussions are starting to change.

“More recent expert opinion suggests that lying down in a dark room fir several days may not be helpful. The concept is known as sub-symptom threshold recovery, and allows concussed students to gradually increase class attendance and school work activities in small graduated intervals based on symptoms.”

Kitchen encouraged people to take recovery into their own hands.

“The part that hurts the most is when you are lying there because someone told you so, in your own prison. Don’t let someone tell you cannot go outside,” she said.