Column/Opinion

Damar Hamlin’s heart

More than once this week I've heard some say that one of the safest places to have a cardiac episode is in a stadium during a National Football League game.

No doubt this is true, seeing how quick reactions likely saved the life of Buffalo Bills safety Damar Hamlin after he collapsed on the field in Cincinnati during Monday night's game against the Bengals. The NFL says that, on average, there are 30 health-care providers at every stadium on game day, standing by with their equipment. There are ambulances and automated external defibrillators. They need these people there because the game is rough and human beings are flesh and bone.

While these medical people are there mainly for the sake of the players, a filled stadium is the equivalent of a small city, and cardiac events are far more common in the stands than on the field. Fans are generally older, less healthy, and more out of shape than the players they pay to watch. Fans smoke, are diabetic, have high blood pressure and high cholesterol. Fans eat garbage. Given enough hours of football, there would be heart attacks among fans watching the games in stadiums even if watching a football game didn't increase the risk of heart attack.

Which, according to studies conducted in Europe--where the incidence of heart attacks among fans at football (soccer) games is a worrying issue--it definitely does. Not by a huge amount, but a measurable one.

You don't have to be a doctor to understand this. We all understand that stress is a leading cause of heart attacks, and that the highest and best use of spectator sports is as a way to vicariously experience achievement and defeat, to live fuller and more dynamic lives. The more we invest in something that in actuality means very little, the more rewarding it can be when our teams win (and the more painful it can be when they lose).

If you care enough to pay the ticket prices commanded by these games, you're probably invested in the outcome. This investment can leads to emotional stress which increases what cardiologists call catecholamine surge and can lead to what's commonly known as broken heart syndrome--a cardiac condition that mimics a heart attack but without any evidence of an obstructed artery. (Your team could be killing you with its erratic play.)

Part of our enjoyment of a game comes from the increase in adrenaline we experience, the stimulation of our fight-or-flight response. This also increases the chance of a cardiac event, as the hormonal rush increases heart rate, blood pressure and the need for oxygen.

The outcome seems to matter. When the Los Angeles Rams lost the 1980 Super Bowl to the Pittsburgh Steelers in a game in which the lead changed hands five times, heart attack deaths in the L.A. area spiked.

Three years later, when the Los Angeles Raiders beat the Washington Redskins in the Super Bowl, heart attack deaths in the L.A. area fell, leading some to speculation that stress that ends in elation might not be so bad for your cardiac health. While the old mock-Nietzschean aphorism "whatever doesn't kill me makes me stronger" is generally a stupid thing to say, the only way to gain strength is by overcoming resistance.

As I'm writing this, Hamlin is still in a Cincinnati hospital. The latest news is encouraging; a few minutes ago his medical team reported that he had shown "remarkable improvement" overnight and "appears to be neurologically intact." This alleviates the fear that he may have suffered brain damage while his heartbeat was being restored via CPR on the field. A teammate reported he was awake.

We might be cautiously optimistic for a full recovery. He might play football again if it is determined that the cardiac arrest he suffered on the field was due to something flukish that occurred when he was hit in the chest as he tackled Bengals wide receiver Tee Higgins on a play rather than some inherent vulnerability he possesses.

There has been a lot of talk about commotio cordis, a rare event where the rhythm of the heart is disrupted by a blow to the chest during a critical time of the heartbeat's cycle, and the replay seems to suggest it as a possibility of the cause. If Hamlin was hit in the wrong place at the wrong time, there might be nothing wrong with his heart.

Hockey defenseman Chris Pronger suffered what's called a commotio cordis event on the ice in 1998 after he was hit in the chest with a slap shot; he was back playing two nights later. Danish footballer Christian Eriksen collapsed on the pitch after suffering a cardiac arrest in June 2021; he was given cardiopulmonary resuscitation and later fitted with an implantable cardioverter defibrillator. He returned to play eight months later.

My friend and former colleague Jack Schnedler was in the press box at Detroit's old Tiger Stadium covering the Bears-Lions game for the Chicago Daily News on Oct. 24, 1971, when, with one minute and two seconds to play and the Bears leading by five points, Detroit wide receiver Chuck Hughes collapsed and grabbed his chest near Chicago's 20-yard-line.

Hughes was taken off the field in an ambulance and later pronounced dead at a hospital. He was 28. He was later discovered to have been suffering from undiagnosed advanced arteriosclerosis; one of his coronary arteries was 75 percent blocked.

"A blood clot evidently had broken loose, possibly due to a hit he'd taken three plays earlier while catching a pass," Jack writes. The thrombosis cut off the flow of blood to his heart. "In contrast to this week's suspension of play and postponement of the game, the 1971 contest was played to completion. I remember interviewing some stunned Lions in their locker room afterwards. I don't remember what sort of story I wrote for the next day's paper. That's probably just as well."

It is remarkable that Hughes is the only NFL player to have died on the field. At least 14 fans have died at stadiums over the past decade.

As someone who identifies mainly as a failed athlete, I have no brief against football, though I might not encourage anyone to play. It's a gladiatorial game. Those who play it understand the hazards involved and, at the highest levels, are rewarded handsomely. People can decide for themselves what is too dangerous; all living involves the assumption of risk and the pursuit of safety above all else makes for a life that's timid and miserable.

Damar Hamlin's accident--and that, more than anything else, seems to be what it was--ought to remind us of the fragility of our kind and how we are all in this brutal and unforgiving world together. It should give us occasion to think about those we cherish, the inevitability of loss, and how precious is our time together. It ought to make us love one another better, to exercise--and strengthen--our own hearts.

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