‘Like you just have no brain after the game.’ Inside a UNC lineman’s concussion ordeal.

One year has passed since Tommy Hatton took his final hit on a football field, the one to the side of his head that resulted in his fourth concussion – the one that made him decide, after months of headaches, dizziness, light sensitivity and pain, that he could no longer risk his future.

Before that hit, Hatton had been perhaps the most respected member of The University of North Carolina football team’s offensive line, a player who took great pride, in his words, in “just physically dominating dudes for four quarters.” He’d been a freshman All-American, a leader among his teammates. At 6-2 and 305 pounds, he was an undersized but ambitious player set on reaching his goal of playing in the NFL.

After a relatively routine blow to the head on Aug. 3, 2017, he felt debilitating effects that caused him to fear for his long-term health. Hatton remembers little about the hit, or what he felt in the immediate aftermath. The next morning he felt sick. He said it was “like I drank three bottles of Smirnoff.” And so began his journey from football player to case study.

During the past year, Hatton’s story has played out amid a national dialogue about football, concussions and the potential consequences of repetitive head trauma. His story has unfolded, too, amid the backdrop of a prominent university whose opposing interests accentuate the conflict between the violence of football and the scientific quest to understand the carnage unseen.

At UNC, that dichotomy lies in the middle of campus. On one side of Stadium Drive is Kenan Stadium, a cathedral to the sport where tens of thousands gather on fall Saturdays to take in the spectacle. On the other side is the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, where researchers attempt to understand what those fall Saturdays do to the brain.

Hatton came to experience both the adrenaline-charged game days and then, finally, the quiet of the Gfeller Center, where he sought counsel about the damage he’d endured. For the longest time, football was his identity, and his progress in the sport was how he measured his progress in life. After his fourth concussion, everything Hatton knew began to change.

Following his final concussion in August 2017, Hatton spent several weeks alone in the darkness of his room recovering. Robert Willett rwillett@newsobserver.com

Dark glasses, dark rooms

During the first days and weeks after his fourth concussion, Hatton said he felt so incapacitated that “honestly, legitimately, it was almost like I was paralyzed.” The effects were immediate, and relentless. First was the short-term memory loss – the 9 ½ hours he couldn’t account for until he came to in the hospital, still wearing his uniform pants.

Then there was the sensitivity to light, so much that Hatton spent the majority of the next three months either in darkened rooms or wearing special sunglasses. Perhaps worst of all was the severe dizziness, the spinning sensation that made Hatton want to remain still, so as to not disturb the delicate mechanisms in his brain that had been thrown into disarray.

He suffered his fourth concussion during the first week of the Tar Heels’ preseason training camp, a weeks-long event coaches design to maximize football lessons and team-building. Players share hotel rooms. They eat together. They attend meetings together. And, every morning, they ride a bus to practice together.

Hatton could not practice. He entered a “concussion protocol” in which UNC’s medical staff monitors the athlete’s symptoms and recovery. Nonetheless, for the sake of team unity, Hatton was still expected to ride the bus to practice every morning to Kenan Stadium.

It was a short ride, less than one mile each way. Still, the bus created an environment that, for Hatton, was especially uncomfortable in the days following his injury. UNC’s concussion policy calls for concussed athletes to avoid mental stressors – reading, for instance, or texting – and it calls for “cognitive rest.” At times, like on a noisy bus, the natural environment of training camp made cognitive rest a lofty goal.

“I had to be with them the whole time,” Hatton said of spending time with his teammates.

After his fourth concussion Hatton rode the bus for about two weeks, until his father pulled him out of the team hotel and cared for Hatton at the off-campus house Hatton shared with three teammates. Until that happened, the bus rides had been perhaps the worst part of days that stretched on with little relief.

I made the best decision for me. I’m at peace with the decision.

Bubba Cunningham, the UNC athletic director, recently acknowledged that the university could learn from Hatton’s case.

“Any time we have a situation where a student has been injured and we care for them, if the care isn’t to their expectations and (their) parents’, then we certainly try to review it and improve how we care for students,” Cunningham said. “... One with the severity of head trauma or a concussion, certainly we have to look at that, and say transporting them on the bus with other teammates probably isn’t the best practice. And we need to modify our practice that would be more suitable to students in the future.

“And again, you continue to learn, grow and develop your policies based on your experience.”

There are experiences Hatton prefers not to discuss publicly. Talking about the bus rides pushes the border of his comfort zone. Hatton feels a dream was stolen for reasons he’s still making peace with. Yet he feels fortunate, too. He is, after all, still on scholarship, which is standard at UNC for football players who can no longer play due to injuries. His education is paid for by an athletic talent that became too dangerous to pursue. The game hurt him but it also has provided. Hatton feels beholden to it, and to his coaches.

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One of them, Larry Fedora, recently created an uproar when he claimed at the ACC’s annual season kickoff event that football was “under attack” amid the quest to understand how participation in the sport might affect the long-term health of the brain. Fedora, entering his seventh season as UNC’s head coach, also questioned the link between football and Chronic Traumatic Encephalopathy, a degenerative brain disease that researchers at Boston University have concluded is “found in people with a history of repetitive brain trauma,” including dozens of former football players.

Fedora’s comments made their way back to Hatton, who said he could understand Fedora’s opinion that the game is under attack. Football, Hatton said, is “a great sport,” and one whose lessons go well beyond the field. Still, Hatton questioned whether Fedora held the necessary perspective to offer an opinion on the game’s link to brain damage.

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“I think coach Fedora does a good job, but he’s not an expert in CTE or concussions by any means,” Hatton said. “I’m not questioning the stuff he does and the environment he creates. I have a long life to live and North Carolina football will keep going on even if I’m a vegetable. But if I kept taking hits to the head. ...”

Hatton’s voice trailed.

“I made the best decision for me,” he said. “I’m at peace with the decision.”

It was a decision that many before him might might not have had an opportunity to make, or ever considered. Fedora, 55, played football throughout high school and then at Austin College in Sherman, Texas. He was a wide receiver. His roots in the sport took hold during a time that “was a little bit different,” he said. When he played, he gave little thought to concussions. He is certain that he experienced them, but his knowledge of his own concussion history ends there. He does not know how many he might have had.

“I mean, from what is considered a concussion today?” he asked. “I don’t know. Numerous ones.”

‘It was bad’

One week after Hatton’s fourth concussion, his symptoms had not improved. Another week passed and then another. A month turned into two. The more time passed, the more questions Hatton, his family and his doctors had about why his recovery was so slow.

When Hatton’s mother, Mindy, traveled from the family home in New Jersey to comfort her son in the days after his concussion, she said she wasn’t prepared for what she encountered. She knew Hatton to be energetic, gregarious, one who brought energy to a room. Days after his concussion, he was none of those things.

I’d have never dreamed that he was as concussed as he was. He was just so out of it and just, really pathetic. It was really pathetic. It was bad.

“I’d have never dreamed that he was as concussed as he was,” she said. “He was just so out of it and just, really pathetic. It was really pathetic. It was bad.”

Hatton remembers little about the hit itself. Teammates later told him that he’d “been going bananas,” as if unable to control his emotions. Medical personnel evaluated him on the field, and then Hatton went to the hospital. A towel remained over his face to shield his eyes from light.

From the beginning, Hatton knew that the hit that caused the damage had not been a ferocious one. It was, instead, ordinary – the sort of head impact that happens nearly constantly throughout a game. Though he knew it had not been a particularly violent blow, Hatton needed months to build the strength to watch the moment over again.

He did so in January, after returning to campus following winter break. With his symptoms cleared, at last, Hatton sequestered himself inside of a film room in the UNC football offices. He found the video from the Aug. 3 practice. With the press of a button he appeared on the screen, back on the field, working toward a future that, in the moment captured, was still possible.

Then came the hit that changed everything. As he watched, knowing all that unfolded, it seemed almost anticlimactic. Hatton watched the screen while he moved up the field, clearing a running lane. A linebacker, Cayson Collins, came into his path. Collins’ helmet collided with the side of Hatton’s. That was it.

“It didn’t look bad at all,” Hatton said.

Yet it felt excruciating. Hatton saw a team of doctors, starting with Dr. Mario Ciocca, UNC’s football team’s physician who has practiced for more than 20 years at UNC. When he began working with the football team in the 1990s, treatments to concussions were crude relative to today’s standard.

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“When I first started dealing with this,” Ciocca said, “if someone got hit and they got dizzy and had a headache, we would watch them and if the symptoms went away in 15 minutes and they looked fine we’d throw them back in the game.”

Such a thing would “never” happen now, Ciocca said. Indeed, schools now adhere to detailed concussion policies that outline when, and how, athletes should be eased back into competition. The kind of circumstances Hatton experienced are not outlined in any policy or guidelines. His quickly proved to be an extreme case.

Every season at UNC, Ciocca said the football team averages between 12 to 15 concussions. Last season, not including Hatton’s case, Ciocca said concussed players needed an average of 11 days to recover and receive clearance from the medical staff to participate in practice and games. Eleven days after his fourth concussion, Hatton still had difficulty functioning. He spent most of his time asleep.

Multiple concussions

Hatton’s case personifies what doctors and researchers so often articulate when they attempt to explain how difficult it is to treat concussions: no two are alike. Kevin Guskiewicz, the dean of the UNC College of Arts and Sciences who built his reputation in academics as one of the foremost concussion researchers in the country, has described concussions as “snowflakes” – similar from a distance but unique upon closer examination.

Hatton’s fourth concussion resulted in his most severe symptoms, by far. And yet the severity of those symptoms, and the slow recovery, confused even Hatton’s doctors, all of whom understood that treating concussions didn’t necessarily come with a widely applicable blueprint. No one could offer a complete explanation, Hatton said, of what made this concussion so traumatic. It simply was.

His mother has wondered whether its severity could be traced to how quickly Hatton returned from his third concussion, which happened during his first preseason training camp at UNC. By then, Hatton had already been diagnosed with two concussions – the first when he was in seventh grade, and the second during his sophomore year of high school.

The third one happened like the fourth: in an early-season practice, during a drill that invited contact from a defensive player. At the time, Hatton hadn’t had much of an opportunity to prove himself. Every practice – every opportunity to impress a coach or make a name for himself – was an opportunity that could not be squandered.

Tommy Hatton, left, huddles with the North Carolina quarterbacks at the start of practice in March 2018 in Chapel Hill. Robert Willett rwillett@newsobserver.com

In the context of building a name and earning respect, Hatton’s third concussion presented another opportunity: one in which he could prove his toughness – that he could take a hit, suffer the consequences and work his way back. After that concussion, Hatton sat out for about two weeks, he said, before he was cleared to resume practicing. He said he didn’t feel pushed into returning.

The medical staff at UNC was aware that Hatton had suffered two concussions before he arrived on campus. That information was on the medical history form he completed before he enrolled. Fedora and the coaching staff, meanwhile, were not aware of Hatton’s concussion history, Fedora said. He said it wouldn’t have made a difference in the decision to recruit Hatton.

Even now, Mindy Hatton wonders, like all mothers would, whether her son was really ready to play again after his third concussion. In hindsight, Mindy, who affectionately describes Hatton as “a monster” on the field, has concluded that Hatton “rushed to get back because he was a freshman.”

“So I think that that was more of a pride (thing) and a wanting to fit in and be viewed as tough than it was that he was really symptom-free,” she said. “We’ll never know.”

You’re banging for three and a half hours, you know? Your head is just like – you literally just felt like you just have no brain after the game.

There’s another unanswerable question: What about the hits whose effects were noticeable, but might not have risen to the level of a concussion that could be diagnosed? A couple stand out in Hatton’s mind. After one, in high school, he became confused and walked back to the wrong sideline. His teammates turned him around, he said, and he wasn’t evaluated for a concussion.

Then there was UNC’s game at Miami in 2016. During one play, Hatton said, he was “cracked,” though in his description he stretched out the word for emphasis: “caaaaaah-raacked.” Immediately after, Hatton said he saw stars.

“For 10 seconds, I blacked out,” he said. “The whole stadium was just black. And then I heard the play-call, I took a hit, and I swear to God, this is my take on it, I got hit again and it, like, un-concussed me or just made me snap right back into the situation.”

He never told a trainer or a member of the medical staff. Hatton continued to play. On the plane ride home, he said, pain pulsed through his head but that wasn’t anything out of the ordinary after a game. It was, in fact, ordinary to feel that way.

“You’re banging for three and a half hours, you know?” Hatton said. “Your head is just like – you literally just felt like you just have no brain after the game.”

And so it’s difficult for him to take inventory, exactly, of the events that led to his fourth concussion, and its devastating effects. His doctors told him his previous concussions likely magnified the effects of the fourth one. And then there are all the other hits that might have compounded little by little over the years, some worse than others, until such an ordinary hit became the final one.

Culture shift

Despite the ongoing research, and despite the growing awareness, the question of what defines a concussion still isn’t black-and-white. Hatton unquestionably suffered a concussion the morning of his final football practice. But what about the hit at Miami? Or the one in high school that had him stumbling back to the wrong sideline?

The sport of football is still experiencing a culture shift surrounding concussions and head trauma, one that places the game at odds with its past. Fedora is hardly alone in his inability to recite the number of concussions he suffered. He has no way of knowing, in large part because when he played more than 30 years ago players and coaches weren’t paying much attention to head trauma.

Chris Kapilovic wasn’t, either. He is the Tar Heels’ offensive line coach, and the man who most closely worked with Hatton every day in practice. Kapilovic played two years of college football at a Division I-AA school in 1989 and ‘90. He doesn’t doubt that he suffered concussions but, like Fedora, putting a number on it is an impossible task.

“When you got your bell rung, when I was playing, you kind of sat out a play or two or shook it off and then you kept going,” Kapilovic said. “And now that’s not the case. So I couldn’t tell you how many I had, but I did have some, yes.”

Fedora and Kapilovic and UNC’s other coaches make their living in a cutthroat world in which their livelihoods are defined more than anything by wins and losses – a world in which injuries can affect the bottom line. They did last season at UNC, where the Tar Heels finished 3-9 after more than a dozen players were lost for the season. All of them except for Hatton suffered from injuries that could show up on an X-Ray or an MRI scan: a broken bone or torn ligament.

Injuries that affect the brain are more difficult to diagnose and treat and are arguably several degrees more dangerous than the ones that require surgery and a cast to repair. Sometimes, like in Hatton’s case, the effects of those injuries linger, unexplained. Coaches, like the scientists who research concussions, are learning more, too. Yet it can be difficult to break away from an antiquated culture – the mindset that when “you got your bell rung,” as Kapilovic put it, you simply shook it off.

“What I’ve learned is that there’s no cookie cutter,” Kapilovic said. “A guy gets a concussion, he can be good in a week. He can have symptoms for three weeks. it’s different. It affects everybody differently.”

For the first month of UNC’s 2017 football season, the coaches wondered when Hatton might be able to play again. Hatton wondered, too. He hoped to be back against Notre Dame, halfway through the season. Instead, when the date arrived, he could only attempt to watch in person. Hatton took his place on the fifth floor of the Kenan Football Center, where floor-to-ceiling windows and a balcony overlook one of the end zones.

Down below, the pageantry of a fall Saturday in Chapel Hill played out: the marching band and the cheerleaders, the smoke-filled entrance of the players and then, finally, the main event. A crowd of more than 50,000 cheered the collisions, welcomed the hits, rooted for the team in light blue jerseys and white helmets to punish the team in white jerseys and gold helmets. It was the signature game of UNC’s home schedule, and it represented all that Hatton loved about football, and had always loved.

And yet by then he knew his story personified the inherent tension of the sport. He knew that what made football so attractive to so many – the violence and physicality – could also come with unseen and not-well-understood consequences. That Saturday Hatton could only take so much. More than two months had passed since his concussion and though he was healing he was still hurting, too. He didn’t make it to halftime.

“The noise,” Hatton said, “and my head was hurting so bad. I remember. And I just went home and slept. Like, I couldn’t even sit in there.”

Unexplained absence

In the weeks and months after his fourth concussion, Hatton sought answers from five doctors. He visited with a headache specialist, and an expert in treating balance disorders. Hatton said he was prescribed, at various points, 20 medications, some for pain management, some for anxiety, some for sensitivity to light.

“I looked like a junkie,” he said.

He missed the first two weeks of classes at the start of the fall 2017 semester. When he returned, he took a reduced load – two classes. For months, he began his days with two Tylenols and one Diclofenac, another pain reliever. The people closest to Hatton, his family, friends and teammates, knew what happened to him, that he’d been hurting.

It bothered him that others didn’t. The coaching staff at UNC never explained Hatton’s absence. Fedora maintains a policy of not discussing injuries, and so a mystery grew. Word got back to Hatton that people who didn’t know him were suggesting he was soft. When reporters asked Fedora and other coaches about Hatton throughout last season, they received no answers.

“It makes you look bad,” he said. “… It’s like, this is my identity. This is how people perceive me.”

Informed of Hatton’s experience, Fedora said it wouldn’t affect how he discloses injuries. To him, there’s no difference between not discussing an ankle sprain and not discussing a concussion. Injuries are injuries, even the ones that others might not be able to see.

“It won’t change my policy,” he said when asked whether he should be forthcoming about concussions. “Even though it is what it is, there’s still no reason to make that public at that time. ... And whether you have a concussion or an ankle sprain, we don’t talk about it. And people who are — people on the outside, they’re going to say what they want to say, anyway.”

At times, especially as his symptoms subsided after months, Hatton had visions of proving his toughness once more. Maybe he’d still be able to play, he thought. Maybe after going through what he’d gone through, it couldn’t get any worse. Sometimes he talked about it with his roommates, three football players, and they tried to talk him out of it.

He remembered one conversation when someone asked Hatton if he could take another hit to the head.

“I’m like, I don’t know,” Hatton said.

When he felt normal again, he sought answers. The meeting inside the Gfeller Center happened in December. The center is named for Matthew Gfeller, who made the varsity football team as a sophomore at R.J. Reynolds High in Winston-Salem. In his first varsity game, Gfeller sustained a hit to the head that resulted in a traumatic brain injury. He died two days later.

Inside the Gfeller Center, Hatton and his parents sat in a room with Ciocca, the team doctor, and Guskiewicz, the concussion expert. Hatton and his parents came prepared. They asked about how he could reduce the likelihood of suffering from another concussion, and the answer was to switch positions – essentially an impossible task for an offensive lineman. They discussed whether a more technically advanced helmet might help, and there were hardly any certainties there.

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Hatton asked about players who’d experienced a high number of concussions and played on anyway, like Steve Young and Merril Hoge, and then asked about Luke Kuechly, the Carolina Panthers linebacker whom Sports Illustrated described last year as “the poster child of the concussion problem in the NFL.” That prompted a brief cost-benefit analysis that Hatton could still recite months later: “Kuechly’s playing for $20 million a year. You’re playing for nothing.”

If he tried to continue working toward a future in the NFL, Hatton wondered: “How many more hits am I taking to the head?”

“It’s like, if I’m getting so concussed now, imagine if I take a hit from Gerald McCoy,” he said. “You’re playing with fire when it comes to your head.”

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During the meeting, Guskiewicz, who through a school spokesman said he would not discuss the specifics of Hatton’s case, explained some of the science. There is much that researchers are still working to understand about concussions, but it has become clear they can raise the likelihood of dementia and depression, and contribute to mood swings that might include heightened anger. Hatton took home some studies to read.

The most convincing insight he said he received, though, was this: “Guskiewicz said if you were my son, I would definitely not let you play. Like, you’re in a really bad category – a category you don’t want to be in in terms of concussions.”

By the time he and his parents left the meeting, Hatton found clarity. He could have kept playing, had he chosen. No one would have stopped him. Yet now he knew there was no choice to make.

Tommy Hatton watches his teammates as offensive line coach Chris Kapilovic works with the team during practice in March 2018 in Chapel Hill. Robert Willett rwillett@newsobserver.com

Rebuilding his identity

The ride back to New Jersey for winter break was emotional. One second, months earlier, he’d been preparing for what he hoped would be a breakout season. The next, after 9 ½ hours, he’d awoken in a hospital bed, his journey to an early retirement already in motion.

Hatton had regained his mind but lost his dream. Playing in the NFL had been his life goal since his sophomore year of high school. He’d put it in writing, in black sharpie and capital letters, and hung the sign above his bed.

Now that sign is gone. His mom took it down. It’s in the house somewhere, Hatton said, but he has no interest in seeing it. Back at his place in Chapel Hill, Hatton has written new goals and stuck them to his bathroom mirror:

“Read a certain amount of books,” Hatton said, reciting them. “Be less of a yes man.”

The time he used to spend on football, he’s dedicated to various business projects. Now along with a few other current and former UNC students he’s part of a team that’s trying to launch an app to help college athletes learn their playbooks. For much of the past year, Hatton has been rebuilding his identity.

He has gradually disconnected from football. After serving as a student coach last spring, he recently informed the coaches that he wouldn’t pursue a role with the team this fall. He wants to focus on the app, and school. He plans to graduate in December 2019 with a degree in political science.

Robert Willett rwillett@newsobserver.com

There are things he misses about the game, that he knows he’ll continue to miss: the “physically dominating dudes;” the camaraderie of a team. Hatton considers himself a connoisseur of trash talk, and he’ll miss his creative outlet there. He will not miss the constant banging, the repetitive hits.

“My dome doesn’t need that anymore, honestly,” he said. “It did me in.”

Though he was generally aware of the risk of concussions before, Hatton now has an understanding of the potential long-term consequences. He has read the academic papers and said they were “scary.”

My dome doesn’t need that anymore, honestly. It did me in.

“I’m not going to lie,” he said. “But at the same time, I don’t know. I’m not really worried about that. If that is something I have to deal with down the road then I’ll deal with it, you know? I’ll figure out how to deal with it and get the help I need.”

One morning early last spring, Hatton drove to campus and parked in a deck near Kenan Stadium. His first class was in a building on the other side of the stadium. He walked through a tunnel, down the home sideline, empty stands surrounding him. Being inside of the stadium brought little nostalgia, he said. In his old life he’d have arrived hours earlier to watch film or lift weights. Now he walked in and walked out, his mind clear, on his way to somewhere else.