CBSSports.com Senior College Football Columnist Dennis Dodd spent the offseason investigating the issue of concussions in college football -- the background on the issue, the competing interests at play in the current debate, and the way forward for the sport. The details of Dodd's reporting will be revealed in a multi-part series throughout the week, with previous installments of the series indexed HERE.
SPRING HILL, Kan. -- For Ron Stiles, there was no need to sue. It just wasn't in him. Not after the Life Flight helicopter pierced throught the Friday night lights three years ago to whisk his son's near-lifeless body from the high school football field to an emergency room. Even after Nathan Stiles had been cleared to play despite suffering a concussion a few weeks earlier.
Even after Ron, president of Spring Hill Oil Co., was called on the same night by the Boston University's Center for the Study of Traumatic Encephalopathy. Research, it seems, doesn't wait. Nathan had gone from playing a whale of a game for the Spring Hill Broncos that night to being the subject of sudden, shocking request from that Boston University center.
They wanted Nathan's brain.
"The whole thing was cloudy," Ron Stiles recalled recently from his wood-paneled office along Spring Hill's Main Street in suburban Kansas City. "You think about the night at the football field, the Life Flight and hospital. You know you'd seen your son for the last time."
Somewhere in the haze of numbing tragedy, Ron and his wife Connie said yes to Chris Nowinski, one of the center's co-directors. Their 17-year old son, who left his room hours before on the last day of his life with the Bible open, would not be coming home. But he would be making history.
Boston University wanted his brain to help unravel the massive riddle of head trauma in sports. The subject is so new that the medical world is just now coming to some agreement on how to treat it. Never mind the ongoing struggle with how to prevent it. Nathan died that night in 2010 of a subdural hematoma -- bleeding on the brain -- only weeks after suffering that concussion. BU's research later showed he was, at that time, the youngest victim of Chronic Traumatic Encephalopathy (CTE), a degenerative brain condition sometimes found in boxers and older athletes involved in contact sports.
CTE is caused by repeated brain trauma that triggers the buildup of tau protein. The result is memory loss, depression and eventually dementia. Former Chicago Bear Dave Duerson was revealed after his February 2011 suicide to have been suffering from CTE. One of Duerson's last requests was to get his brain to BU's center for study.
But why this young? If a teenage kid from Kansas has the beginning of some of the same symptoms of an 11-year NFL veteran, is football itself safe? The NCAA is clearly concerned if for no other reason than liability. It is fighting a concussion suit from four former players in different sports.The NFL is facing a massive class action suit from former players.
The answer will have to wait. Research is just being gathered on the long-term effects of concussions. Some experts say it will take decades.
"[It will take] 10, 20, 30 years to follow athletes out in time," said Vernon Williams, chief medical officer for the Sports Concussion Institute. "What we have to be careful about is extrapolating too soon. If there's a risk from boxing as a professional or football as a professional, does that mean there is a risk from playing college or little league? That we just don't know. In fact it seems like it's very safe to play adolescent and youth sport."
Nathan didn't actually die of CTE. The bleeding on the brain was more closely related to Second Impact Syndrome following that first concussion. It is widely held, although not all medical experts agree, that it is easier to be concussed a second time -- and subsequent times.
"It kind of boggled my mind that this kid had this amazing game in the first half and had all this blood in his head the entire time," said Leslie Nakoneczny, the Life Flight nurse who treated Nathan. "It's creepy how that could happen. From a medical standpoint, it's unbelievable."
So why sue? Defense attorneys no doubt would have zeroed in on this statement by Ron Stiles:
"What Nathan did do is hit his head on everything, forever. Got a golf club in the head one time, a baseball right between the eyes one time. He had staples in his head from hitting it on sheetrock.
"There's a strong possibility, it could have caused some damage."
Football, then, may have had nothing to do with Nathan's death. Such are the mysteries and tragedies of head trauma deaths. The Stiles are spiritual folks who took the incident as a circle of life event. Instead of calling a lawyer, Ron Stiles rose at his son's funeral to say, "If there was anything to be learned from this, it was going to be doctors and not attorneys."
"Why blame somebody for something for what was a fluke, that can't be helped," Stiles said later. "There's plenty of blame that could go around if you start that game. The doctors did everything they could."
"They're probably the few people who handled it the way they did," said Eric Kahn, Nathan's former Spring Hill teammate, now a kicker at Kansas. "They did not point fingers at anybody."
The family started the Nathan Project, an initiative to distribute Bibles. The family bonded with former Oklahoma State player Andrew Hudson. The 6-foot, 5-inch former defensive lineman was injured when he was ear holed on a kickoff by Nebraska's Eric Martin.
"This stuff needs to go," Ron Stiles said. "If you've got a kid sitting on the sidelines and he says his head hurts, he does not need grief. He needs compassion. That's the things that are obvious and need to change."
Forty-seven states have passed concussion legislation regarding those 18 and younger. Kansas is one of 34 states that require youths to get the consent of a health care professional before returning to play from head trauma. The Kansas State High School Activities Association requires a signed waiver that children and parents understand the risks of concussions.
The NCAA is increasingly involved. It recently awarded two concussions experts a $400,000 grant to study long-term effects. Starting this year in the NCAA, players will be ejected if flagged for targeting the head. But that is only part of an industry-wide discussion. Neurosurgeon Dr. Robert Cantu of Boston University is one of the most noted authorities in the world on the subject of head trauma. He says tackle football should not be played by those under 14. Their brains, he says, are still forming.
Cantu might get an argument from Jon Butler, executive director of Pop Warner football. Butler is not the only football lover who extols the character-building virtues of the sport at a young age. A year ago Butler's organization limited full contact practices to 40 minutes per session or one-third of total weekly practice time. Pop Warner claims to have one-third the injury rate of high school, one-fifth the rate of college football and one-ninth the rate of pro football.
"The worst risk of injury is riding a bike," said Butler, a former high school coach. "It's the No. 1 reason kids go to the emergency room."
The Pac-12 recently took the small step of limiting full contact practices to two per week. That seemed non-controversial since several sources said that's the max these days for most college coaches. Except ...
"I'm totally against that [limiting practices]," said former Ohio State coach John Cooper. "If I got back into coaching I don't want somebody who doesn't know anything about the game, telling me how to coach. If I have a young team that needs fundamental work, I should be allowed to do that."
Within that argument is where Nathan Stiles' legacy lies. It inspired Nakoneczny, a 38-year old nurse, to begin giving brain trauma presentations to medical professionals. The inspiration came during that 18-minute Life Flight helicopter ride spent caring for Nathan.
"He looked perfect," Nakoneczny recalled of that short trip to Kansas University Medical Center. "It looked like he was sleeping. He was very handsome, dark curly hair."
It had been only minutes before that Stiles -- who'd already rushed for more than 100 yards and two touchdowns before halftime -- had come to the sidelines in pain and collapsed.
Nakoneczny later met the family in the emergency room. Something stuck with her that night. When she tried to intubate Nathan -- place a breathing tube down his throat -- he was unresponsive. A bad sign. Connie Stiles pleaded with her son to wake up, promising his favorite snack. Nathan briefly raised an arm before lapsing back into unconsciousness.
"I think that's when we lost him," his father said.
The situation prompted Nakoneczny to study brain trauma further. Her power point presentation now includes tips on treatment and the importance of response time. Nathan, she says, had been having headaches before the fatal episode but had kept them mostly to himself. Taking aspirin could have contributed to the bleeding, Nakoneczny said.
"What teenager thinks they're going to die from a headache?"
These days she worries a lot about her sons -- ages 9 and 11 -- playing football.
Why sue? One bright high school player's legacy has been enough for those who knew and treated him.
"Nathan's one of those patients you never, ever forget," Nakoneczny said.
Concussions and college football
Part I: Ex-player's case takes aim at NCAA
Q&A: NCAA's chief doctor answers questions
Part II: Ex-QB Klatt puts onus on NCAA
Part III: Stiles' death may unravel mystery
Part IV: Will college football change? Yes
Quotable: Notable thoughts on concussions