By Alan Goldenbach
Washington Post Staff Writer
Tuesday, January 23, 2007
NASHVILLE Davis Nwankwo's 248-pound body hit the floor headfirst with a sickening thud. Vanderbilt's basketball practice on March 6 was routine until that moment during four-on-four drills. Nwankwo's 13 teammates and four coaches froze.
From the baseline, athletic trainer Mike Meyer witnessed Nwankwo's collapse and sprinted to the player's side near the three-point arc and turned the 6-foot-10 sophomore over, onto his back. The 19-year-old from College Park, who starred at Georgetown Prep, wasn't breathing. He had no pulse. A two-inch gash from the fall had opened just above his left eyebrow.
Meyer ordered an assistant coach to call 911. He directed a student trainer to get the automatic external defibrillator from the training room in the tunnel of Memorial Gymnasium. He demanded that the other players head for the locker room. Meyer knew they wouldn't want to see what might happen next.
Nwankwo's heart had stopped and needed to get restarted.
With Coach Kevin Stallings beside him, Meyer cut open Nwankwo's practice jersey. As he did, Nwankwo started convulsing. While his body rattled, Nwankwo began foaming at the mouth.
"Mike, we can't lose him," Stallings said. "We can't lose him."
"I'm doing all I can," Meyer said.
Meyer promptly affixed the AED's two electrodes to Nwankwo's chest. Within seconds, the machine recognized the lifeless heart and gave it a jolt. Meyer administered one rescue breath. Nwankwo didn't respond.
Meyer gave another breath. By that time, the shock from the AED had awoken the heart, and Nwankwo took the next breath on his own. About six minutes after Nwankwo collapsed, paramedics arrived, lifted him onto a stretcher and took him to Vanderbilt Medical Center's emergency room.
Less than 48 hours later, Nwankwo sat awake in his hospital bed with his parents, Adam and Ifeyinwa, and five doctors beside him. He was told three things that would change his life:
· He had hypertrophic cardiomyopathy, a disease that ultimately restricts the flow of oxygen to the heart. It afflicts 1 in 500 people, according to the American Heart Association, and is the leading cause of sudden death among young athletes.
· In a few hours, he was headed for surgery to attach to his heart an implantable cardioverter defibrillator, which would send a shock to his heart if another episode of cardiac arrest arose.
· He would never again play basketball.
"I looked at my mom," Nwankwo recalled, "and said, 'What am I going to do?' "Young and Susceptible
The Centers for Disease Control and Prevention says as many as 7,000 young athletes in the United States die each year from sudden cardiac arrest. Hypertrophic cardiomyopathy accounts for 36 percent of those fatalities, according to Barry J. Maron, director of the Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute. It also is the most common genetic cardiovascular disease.
HCM has claimed several high-profile athletes, including Boston Celtics all-star Reggie Lewis and college basketball all-American Hank Gathers. More recently, San Francisco 49ers offensive lineman Thomas Herrion collapsed and died after a 2005 preseason game.
"There are probably more people in this country with HCM than with full-blown AIDS or with muscular dystrophy," said Steve Ommen, director of the Hypertrophic Cardiomyopathy Clinic at the Mayo Clinic in Rochester, Minn.
HCM is characterized by a thickening of the heart muscle's septum, the wall that divides the right and left sides of the organ, and occurs genetically in 40 to 60 percent of its cases, according to cardiovascular specialists. The disease impedes the entry of oxygen into the heart, which puts athletes at a greater risk because the heart requires an increased amount of oxygen when active.
But perhaps the most disturbing element of HCM is that high school and young college athletes are more susceptible to it because of how the disease develops. Maron concluded that the thickening of the heart wall is not usually evident before age 10, and most likely to be detected after age 12. If it does not appear once the heart is fully grown and developed -- usually between the ages of 17 and 20 -- then it is less likely to occur later in life.
Before that practice last March, Nwankwo never showed any of the typical warning signs of heart disease -- shortness of breath, fatigue, fainting spells or a history of family heart illness.
In fact, immediately after Nwankwo collapsed, his parents each underwent extensive heart examinations. Neither showed any irregularities.
"I was confused," Nwankwo said recently in his first extended interview since his collapse. "I'm a good athlete in great condition, great stamina. Why was this happening to me?"
Before taking the court that March afternoon, Nwankwo ducked into the training room, as he always did, to have Meyer tape his sore ankles. They joked and teased one another, as Meyer, then 30 and in his third season with Vanderbilt, tended to several Commodores.
It was about 15 minutes into practice when the Commodores began their four-on-four fast-break drill.
"We got the rebound and turned the other way," junior guard Shan Foster said. "I turned to [Nwankwo] and he just dropped. I heard his head hit the ground and it was complete silence. Mike [Meyer], coaches and me just ran up to his side.
"The first thing you think is they're dead. I looked at his face and his eyes were in the back of his head. I was shaking."
Stallings said Nwankwo was facing him in the split-second before losing consciousness.
"You could tell everything sort of stopped and he collapsed," Stallings said. "He didn't crumble." Stallings then pointed his right hand straight up and mimicked the fall by dropping it to his desk. "He fell from the top and fell over face first.
"He was just out. No movement. Nothing."
Meyer was across from Stallings, kneeling over Nwankwo as he tended to him. Even though he had never had to use an AED before this moment, Meyer remained remarkably calm.
"I've been in situations like this before, but I had always pulled up to the scene," said Meyer, who was a volunteer EMT while in high school in Johnstown, Pa. "I had never seen it unfold. That training kept me calm, but I knew we were against the clock. There were no life signs."
Nwankwo's collapse bore an almost eerie similarity to that of Gathers, who was stricken almost 16 years before to the day. Gathers's collapse raised the awareness of the need for AEDs to be courtside -- the lack of one that day in 1990, many believe, played a role in Gathers's death.
As Meyer worked, Nwankwo began convulsing. Stallings leaned into Nwankwo and said, "Davis, calm down."
"He heard my voice and he just stopped," Stallings said, becoming emotional as he retold the story. "A kid you love like your own is sitting there for two minutes like he's gone."
When Nwankwo collapsed, Meyer used one of three AEDs on Vanderbilt's campus, and the only one inside Memorial Gymnasium. Two months later, he told Vanderbilt's athletic department leadership that the school got lucky.
According to HCM's rate of incidence, 13 of Vanderbilt 6,400 undergraduates probably have the disease. Meyer wanted an AED nearby if any of them went into sudden cardiac arrest.
Without hesitation, the school approved the purchase of 13 additional AEDs (Meyer said each cost $1,900) and training for every coach on how to use them and administer CPR. An AED is at every athletic venue on campus. With the length and width of a laptop computer, an AED easily accompanies Meyer to all Vanderbilt road games. In addition, each incoming Vanderbilt varsity athlete is required to undergo an electrocardiogram.
"Had this incident not happened," Meyer said, "no way we would have spent $20,000 on AEDs. No way."
In a 2005 report enumerating the eligibility recommendations for competitive athletes with cardiovascular abnormalities, the American College of Cardiology suggested that an AED be administered to a victim within three minutes of cardiac arrest. Essentially, an AED should be no more than a two-minute brisk walk from any spot where a victim could be. According to the American Heart Association, chances of survival from sudden cardiac arrest decrease by 10 percent for each minute defibrillation is not provided.
"Every school that sponsors an athletic program needs to assess their reaction program," said Jonathan Drezner, associate professor of family medicine at the University of Washington, who has specialized in the use of AEDs on athletes in sudden cardiac arrest. "Can they get to an athlete within three minutes?"Still Involved
Davis Nwankwo's experience has given him a new outlook on college, one that pleases his parents, both of whom have master's degrees. He plans to earn his bachelor's on time, with a double major in economics and engineering science.
He still is a member of the team, and, with the title of student-coach, is on the bench at every game, home and away. He still is on scholarship at Vanderbilt. He attends every practice.
"I started focusing more on school and taking advantage of it," he said about the months since his collapse. "It's very hard. Every kid wants to go to the NBA, and that was my dream. But I'm grateful to still be involved with the team."
Whether he is around campus or back home, Nwankwo cannot avoid the questions that his large frame brings.
"People see me and they say, 'How tall are you? Oh, do you play basketball?' " he said, smiling. "I don't say that I don't play basketball anymore. I just say I play at Vanderbilt. It's tough to say I don't play anymore."
This season is particularly tough for Nwankwo to watch. Vanderbilt (13-6, 3-2 Southeastern Conference) has only 10 scholarship players, because of Nwankwo's prognosis and the offseason transfer of another. Couple that with an injury to center Alan Metcalfe, and the Commodores are starting four guards. Nwankwo's 6-9 body would be just what Vanderbilt's front court needs.
"Especially when we're short on big men," Nwankwo said, "I want to get out there and help, but I can't."
Stallings said, "He would probably be starting for us at center right now, but I don't let my mind go there."
Meyer said Vanderbilt is trying to get Nwankwo an appointment with Mark Estes, professor of medicine at Tufts University School of Medicine and a cardiologist at the New England Medical Center, specializing in cardiovascular disease in athletes.
Estes said some athletes' rigorous training causes a temporary thickening of the heart wall that appears to be HCM. He said after four to six weeks the thickening recesses and it's clear the athlete does not have HCM.
Estes has examined and counseled several professional, collegiate and Olympic athletes with HCM, and said it is very difficult for them to accept that their careers are over because of a symptom they can neither see nor feel.
"Initially, it's denial," Estes said of his patients' reaction to his recommendation. "Then, anger. A few try to find a way out of it by doctor-shopping, but ultimately they accept the restrictions. But it takes awhile, weeks or months, sometimes longer. These individuals should be restricted from competing in athletics.
"I have them speak to athletes who in the past elected not to take my advice. Then they suffered another [episode of cardiac arrest] and that flips the switch for them."
According to the American College of Cardiology, someone with HCM can participate only in the lowest classification of competitive sports, which includes billiards, bowling, cricket, curling, golf and riflery.
Nwankwo knows he cannot run. He cannot ride a bike. He cannot lift weights. The extent of his daily exercise, he said, is about 125-150 push-ups each morning, just to maintain a little bit of muscle.
"I set a limit for myself," he said. "I don't sweat that much."
And when it comes to playing basketball, Nwankwo can do no more than light shooting.
"I can still dunk, but nothing thunderous," he said. "I miss the physicalness of the game."
Even if a doctor were to clear Nwankwo to return to the court, Nwankwo is not sure what he would do. The ICD attached to his heart serves as a watchdog, ready to shock the heart if need be (Nwankwo said he has yet to require a jolt), but he doesn't want to rely on that.
"I'd definitely feel hesitant because I have this defibrillator in me," Nwankwo said. "One big hit or one tough day could really hurt me. I'll still jump at the opportunity if I can get one. I still have hope."