Nothing seemed terribly wrong on the evening of Sept. 11 when John Avila staggered off a high school football field in Alexandria, complaining of dizziness. It had been a warm and humid evening, after all. It was the third quarter of a fiercely contested game between J.E.B. Stuart and Thomas Edison. It was the first time Avila had gone "both ways" on the Stuart varsity, and he had participated in every offensive and defensive play. So when Avila wobbled to the team bench, John Dwyer, the Stuart trainer, was not alarmed. "I thought maybe John had just gotten his bell rung," Dwyer recalled.

In the moments that followed, the reality of Avila's condition became frighteningly evident. Far from having his "bell rung" -- being disoriented after a blow to the head -- Avila was losing consciousness. Dwyer waved an ammonia capsule under his nose. There was no reaction. He shone a penlight in Avila's eyes. No reaction. Dwyer then turned to a student manager: "Call the ambulance."

As he attempted to disperse the crowd that had formed around the bench, Tom Arehart, the Stuart football coach, was scolded by a gray-haired man who had a distressed look on his face. "He said, 'You should never have played this boy both ways,' " Arehart recalled. "I said, 'Sir, I don't know who you are, but we just do the very best we can with our football players.' "

The man gently lifted Avila's head, as if to give it support. "I didn't realize who the man was until I heard him trying to talk to John," Arehart said. "The man was saying, 'My son, my son.' "

More than seven weeks have passed since Moises Avila watched his son -- his only son -- collapse at that Friday night game. Today, John Avila, co-captain of the Stuart Raiders' football squad, lies comatose in the intensive care unit of Alexandria Hospital, the victim of an acute subdural hematoma, a blood clot caused by ruptured veins between the skull and brain.

The prognosis for Avila's recovery is chilling: If he survives, his doctors say, he will live in what they call a "primitive, vegetative" state.

"The doctors tell me there is little hope for my son," Moises Avila said in a recent interview, his eyes welling with tears. "But we still have hope that John will recover, that one of these days he'll wake up."

The tragedy that struck 17-year-old John Avila has focused attention on one of the most troublesome questions in all of sport: Are catastrophic injuries inevitable in high school football?

Of the 931,176 boys who participated in the sport last season, 17 died and five suffered irreversible brain or spinal cord injuries. This season, six high school football players have died. Although catastrophic injuries are proportionately rare, at least one football-related death has occurred each year since 1931, when statistics were first kept.

Stuart and Fairfax County school system officials said they have not determined the exact cause of Avila's injury. "The game films don't show an obvious play in which John was hurt," Arehart said. "I don't know what happened. I'm not a doctor. It could have happened on the field or he could have slipped in the shower at home. I just don't know."

Avila's neurosurgeon, Aldo Rosemblat, said there is little doubt the injury was sustained during the game. "A subdural hematoma is caused by trauma," he said. "I received a guy dressed in full football gear in the emergency room. Did it happen because he fell in his bathtub or did it happen on the football field? You answer the question."

In many ways, John Avila -- 5 feet 8, 170 pounds -- was the quintessential high school athlete. In the fall, he prided himself on finishing first in the wind sprints and having the most nicks, or "battle scars," on his helmet. In the spring, he worked tirelessly as a member of the Stuart baseball team -- even though he was a second-string catcher who rarely played.

Avila was not a particularly noteworthy football player. He was strong, he was determined, he was intelligent. But he was not big, he was not fast, he was not what major college recruiters would call a "prospect."

Clearly, Avila played high school football because he loved high school football -- not because he expected to become a Sooner or a Trojan or a Buckeye.

"John had other plans: He wanted to go to medical school to become a dermatologist," Moises Avila said.

He was speaking over a bowl of soup in the Alexandria Hospital cafeteria, having just spent several hours in the presence of his comatose son.

"We worried about John playing football," Moises Avila continued. "John was strong but many of the other players were bigger and taller. I would tell John, 'If the other players are taller or heavier than you, don't try to stop them because maybe you will not make it.' But John said, 'No, father, I can't do that.' "

Moises Avila sighed. "John told me that the game of football was like a fight. He said: 'You have to kill the other guy, and the other guy has to kill you. You know, you have to hit hard.' I told him I didn't like it. But John liked it. So he played."

Like many of his classmates at J.E.B. Stuart -- a school of 1,527 students, named after a Confederate general -- John Avila comes from a family of immigrants. Moises Avila closed his carpentry shop in Bogota, Colombia, to bring his wife and two daughters to the United States in 1968. "We wanted more opportunity for ourselves and our children," he explained. "And we knew that if things didn't work out we could always go back to Colombia."

Avila worked in the construction business in New York, then New Jersey, and things worked out. A son was born to the Avilas in 1970, and they moved to Northern Virginia seven years later. Although they spoke Spanish in their home, Moises and Teresa Avila encouraged their children to adopt what they called "the American ways."

John Avila adopted that most American of sports: football. He played on several youth league teams, then became a two-way performer on the Stuart junior varsity. Explaining why Avila played linebacker and offensive guard, Arehart said: "John liked to hit. He was a very intense player."

When he joined the varsity last fall, Avila was told he could start on offense but not defense. "I said, 'John, you can't start on defense because I've got to get more people involved in the program,' " Arehart recalled. "John was disappointed. He kept bugging me to play him both ways."

That opportunity came this fall when an injury sidelined one of Stuart's top defensive players. "When I told John he'd also be playing linebacker in our second game, he beamed," Arehart said. "John was on cloud nine."

Not so with Avila's father. On the night before the second game, Moises Avila told his son he did not want him to play "on both sides." Although he knows little about football, Moises Avila said he knows plenty about soccer "and how you can get very tired if you are playing too much."

John Avila told his father not to worry, that he was in excellent physical condition. "John wanted to play, so what was I going to do?" Moises Avila said with a helpless shrug. "I told John to be careful." A Teen-Aged Workaholic

On the evening of Sept. 11, a crowd of 1,500 gathered to watch Stuart play Edison. Several minutes before the 8 o'clock kickoff, Stuart co-captains Avila and Mark Maldonado walked onto the Edison field for the coin toss. "John was funny, as he always was," Maldonado recalled. "He said, 'Do you want me to call it?' I said, 'Yeah, you call it.' Then he looked at me and said, 'All right, what do I call? Heads or tails?' "

Edison took a 7-6 lead at the half. Although he had participated in every offensive and defensive play, even helped out on a special team, Avila did not appear tired.

"John prided himself on not getting tired," Arehart said. "He was kind of a workaholic."

"John's tough," said Stuart defensive end George Lambiris, a close friend of Avila's. "I mean, he would never get hurt or anything. And if he did, he wouldn't dare say he was hurt."

Edison's game plan was simple: run the ball straight at 'em. In the second half, the strategy worked. "We were averaging about six yards a carry," an Edison coach recalled. "There was a lot of hitting going on."

During Edison's first possession of the third quarter, Avila collided with an opposing lineman "helmet to helmet, shoulder pad to shoulder pad," according to Stuart Athletic Director Dave Morgan. When he returned to the huddle, Avila clutched his stomach. "I've got cramps, I've got cramps," he was heard to say.

Several players waved to the sidelines, trying to attract the attention of Dwyer. The Stuart trainer noticed the waving but did not believe anything was wrong. "Nobody was lying on the ground, nobody was holding a knee," Dwyer would later explain. "There wasn't any indication that somebody was in distress."

A Stuart player attempted to call time out, but play was about to resume. The ball was given to an Edison tailback, who was tackled by several Stuart defenders. Although the tailback was down, Avila fell onto the pile. "You teach the kids to make sure the runner doesn't fall forward to get a couple extra yards," Arehart said.

While his teammates returned to the huddle, Avila remained on the ground. After a few seconds, he stood up, then lowered his head. "I can't see, I can't see," he was heard to say.

Avila walked off the field, dropping his mouthpiece. Moises Avila, watching from the stands, did not believe his son was in trouble. "I thought, 'Thank God. He's now coming off the field to relax a little bit,' " Moises Avila recalled.

Avila removed his helmet and staggered to the team bench. He seated himself near the 50-yard line, leaned forward and placed his forearms on his thighs.

"He had the blank stare that comes from someone who's got their bell rung," Dwyer remembered.

Dwyer approached the bench to assess Avila's condition. It was approximately 9:35 p.m. Dwyer said the conversation went as follows:

Dwyer: "What's wrong?"

Avila: "I feel dizzy."

Dwyer: "Is there anything else wrong?"

Avila: (Silence).

Dwyer: "Do you have a headache?"

Avila: (Silence).

Dwyer: "John, were you on the bottom of the pile?"

Avila: "No."

Dwyer: "Do you know what the score is?"

Avila: "No."

When Avila failed to answer several other questions, Dwyer laid him on the bench. Now Moises Avila was worried. "I thought, 'Oh my God, he's very tired. Maybe something happened,' " he recalled.

Dwyer walked to his training table, about 10 yards away, to get an ammonia capsule. When he returned, Avila was lying on the ground behind the bench. "I was told he was put down there by some players," Dwyer said. "They thought he was vomiting and they didn't want him to aspirate."

When Avila did not respond to the ammonia, Dwyer instructed a team manager to call the emergency medical technicians who were stationed nearby with an ambulance. Team physicians are not required to attend games and, since Stewart's doctor was not there, Dwyer directed another manager to locate Edison's physician, Gerard Engh.

With the game in progress, Engh walked around the perimeter of the field to reach the Stuart bench. "No one had told me there was any dramatic urgency," Engh recalled, "so I didn't go running across the field."

When Engh arrived, Avila was barely conscious and secretions were dribbling out of his mouth. Engh placed Avila flat on his back, tilted his head to the side and inserted an airway tube in his mouth so he would continue to breathe normally.

Within seconds, Avila lost consciousness and his pupils dilated -- an indication of abnormal brain activity. Then Avila suffered what Engh described as a muscular seizure.

At approximately 9:40, an EMT arrived to assess the injury. "Where's the ambulance?" Moises Avila was heard to say. "Why is it taking so long?" It is standard procedure for an EMT to evaluate a patient's condition before summoning an ambulance.

An ambulance arrived between one and two minutes later, according to Engh and Dwyer. Avila was suctioned, connected to an electrocardiogram monitor and a blood pressure cuff was wrapped around his arm. But the ambulance was not moving. Engh turned to the EMTs. "Why aren't we moving?"

An EMT responded that regulations did not permit him to transport a patient until he was stabilized by paramedics, according to Engh. The EMTs had already called for an advanced life support ambulance.

Engh told the EMTs he would take full responsibility if they left immediately for Alexandria Hospital. At approximately 9:45, the EMTs agreed to leave. (Fairfax County Emergency Medical Services chief Doug Casey said in an interview that an EMT team leader has the option of waiting for paramedics or leaving immediately with a doctor. Engh said he does not believe Avila's condition was affected by the time elapsed.)

A light rain fell as the yellow and white ambulance pulled out of the Edison parking lot, its sirens sounding. They arrived at the hospital about 10 minutes later. Avila was comatose.

As Avila was being treated, Engh, an orthopedist, attempted to reassure Moises and Teresa Avila and their daughter, Patty. "I related the story of an Edison football player who'd had surgery for a head injury about seven years ago," Engh said. "I told them that this boy had come out of it okay."

After the game (won by Edison, 27-14), Arehart, Dwyer and Morgan joined Avila's family in the hospital waiting room. "I had the feeling John was going to make it okay," Arehart remembered.Reality Sets In

All optimism faded several minutes later when Rosemblat walked into the waiting room, closed the door and informed Moises and Teresa Avila that their son was severely brain damaged.

"I told them that really he had about a 5 percent chance of really making it," Rosemblat recalled. "I also told them that in neurosurgery, the worst thing that can happen to you is not actually to be dead but to survive in a very handicapped condition."

In addition to the subdural hematoma, or blood clot, Avila also suffered from a venous infarct (extensive destruction of brain tissues below the hematoma) and hydrocephalus (excessive spinal fluid within the brain), according to Juan Jammes, a neurologist who later treated Avila.

Although the prognosis was poor, Rosemblat told Moises and Teresa Avila that since their son was an otherwise healthy 17-year-old who still had brain stem activity, an operation could be attempted to relieve the pressure on his brain. The Avilas agreed.

Shortly before midnight, Avila was transferred to the operating room, where over a 4 1/2-hour period, Rosemblat performed a craniotomy, in which he removed the subdural hematoma and a portion of the skull, relieving pressure on the brain. The surgery did not change Avila's condition appreciably.

At approximately 4:30 a.m., Rosemblat returned to the waiting room, where, speaking in the Spanish of his native Argentina, he told the family that as the swelling in Avila's brain peaked anything could happen, including brain death.

"He was using the example of Karen {Ann} Quinlan, the girl who was in a coma for I don't know how many years," Patty Avila recalled. "He gave us an example that John was going to be like her, that he would be surviving but with an artificial life."

Rosemblat also asked the family if they would be willing to donate the boy's organs if he became brain dead.

"When he talked about that, I cried and I started shaking," Avila's mother remembered.A Time for Sadness

At 8 that morning, Arehart, who had neither slept nor showered, addressed the Stuart varsity and junior varsity teams.

"It looks as bad as it can look," Arehart recalled telling the players. "I don't think John is going to live." Arehart cried as he spoke to the players. "I know I have to be strong for you guys," he continued. "But I'm human, too."

Two days later, on Sept. 14, several hundred students gathered for a prayer service at St. Anthony's Catholic Church in Falls Church.

Stuart principal John Randall read from the Book of Ecclesiastes. "There is a place and time for everything," he began. " . . . A time to be born and a time to die . . . A time to weep, a time to laugh . . ."

Later, Lambiris stood before his classmates to read from the First Letter of Peter. He began tentatively, blinking back tears. "All of you should be . . . sympathetic," he said. "Loving toward one another." He had not been at the pulpit 10 seconds when he paused in mid-sentence, bowed his head and cried.

"I felt like I was going to fall down," Lambiris would say later. "It wasn't that I was nervous -- I wasn't because I knew most everybody there. It was just that, I felt this was the end. I felt we were doing this service because it was the end of John. That was hard to accept. It was also hard to accept that football could have done such a thing to John Avila."

In the days that followed, Lambiris thought often of his friend. He remembered the Sunday nights they would spend in Georgetown, making the scene. He remembered the laughs Avila would get in the school cafeteria, imitating singer Janet Jackson. And he remembered the fights they would pick with each other -- silly fights, the kind brothers would sometimes have.

Several days after the prayer service, Lambiris made an emotional visit to the Alexandria Hospital ICU. "I know this sounds dumb, but I had something to tell John," he said. "It was about those fights. They weren't serious fights, but I felt guilty about them. It was weird, but I felt really guilty."

When no one else was around, Lambiris leaned forward and spoke to his friend. "John, you know, we got into a lot of fights with each other," he recalled saying. "But you know that I care about you, John. And I know that you care about me, too."

Lambiris wasn't the only Stuart player who had difficulty coping with the trauma.

"We all felt, if we had done this or done that, maybe . . . " Maldonado explained. "Some players thought, maybe if I would have made that block, he wouldn't have gotten hit, or maybe if I would have made that tackle before he did . . ."

"I'm worried about some of the guys," Arehart said early that week. "Some of these guys just aren't talking."

On Sept. 16, Arehart invited Joan Mayer, a psychologist for the Fairfax County school system, to meet with his team. At a closed-door session, 35 players -- whites, blacks, Asians and Hispanics -- sat in an oval, their heads hung low, their faces pained.

At first, the players seemed reluctant to share their thoughts. Then, gradually, they spoke: of regrets they had for not assisting Avila when he complained of stomach cramps ("I should have called a time out," one player said), of Avila's compassion for his teammates ("He never laughed at other guys' mistakes"), of playful moments outside of school (one boy spoke of pulling down Avila's shorts in a pizza restaurant) and of the violent nature of football ("I hit hard but I don't try to kill anybody," one player advised his teammates).

After an hour and a half, Mayer asked the players how they would like to end the session.

"On a positive note," one said.

"With everybody thinking of John with a big smile," another suggested.

Mayer offered a closing thought. "You're going to be the closest team in Fairfax County this year, no matter how many games you win or lose," she said. "That's something that John Avila has given to you." Safety Warnings

Could anything have been done to prevent this tragedy? "Unfortunately, I can't think of anything," Dave Morgan said, echoing an opinion shared by other Stuart and Fairfax County officials.

Avila's helmet was in perfect condition, these officials said. His preseason physical indicated he was in excellent health, they said. His coaches had taught him the proper tackling and blocking techniques, they said. A doctor, trainer and ambulance were present at the game, even though none is required under Virginia High School League rules. As for playing both ways, that is a common practice in high school football, particularly at lower-enrollment schools.

Moises Avila said he believes the injury may never have occurred if his son had been better rested. Arehart said he has had other two-way performers in his program, and he has no regrets about having played Avila both ways. "He wasn't a scrawny little kid who was terribly out of shape and had terrible techniques," Arehart said. "He was one of our best-conditioned players."

Engh, who has been Edison's team physician for 17 years, said he does not believe the injury was related to Avila playing both ways. "But playing both ways can be a problem if a coach doesn't use good judgment," he said. "These boys do get tired."

Engh is more concerned with the violent tackling he has witnessed at recent high school games. "Somebody's going to have to look at the rules," he said. "The head-to-head contact, the way people are tackling today, there's more violence than there used to be. When the tackler is putting his helmet into the other kid's helmet, it's almost like delivering a knockout punch. Their aim is for the head. And that worries me about the game."

Spearing -- head-first tackling -- was outlawed by the National Federation of State High School Associations in 1976. To emphasize this prohibition, the VHSL recommends that its member schools send each player and his parents a written warning concerning the dangers of improper blocking and tackling.

"Do not use {your} helmet to butt, ram or spear an opposing player," the warning states. "This is in violation of the football rules and can result in severe head, brain or neck injury, paralysis or death to you and possible injury to your opponent. There is a risk these injuries may also occur as a result of accidental contact without intent to butt, ram or spear. NO HELMET CAN PREVENT ALL SUCH INJURIES."

Moises Avila said he never received any warnings from Stuart about his son's safety. Arehart said, "We didn't give that {printed warning} to the players but we talk constantly to our players about safety. A warning is inside their helmet and we tell the players, 'It's a contact sport.' "

Could a head-first tackle have caused Avila's injury? "That's a possibility," Arehart said. "But John's technique was as good as anybody I've ever coached." The coach added that, although players are warned of the dangers of spearing, at times head-first tackling cannot be avoided.

"The kids are taught the right way to tackle, but sometimes they'll inadvertently butt helmets," he said. "That's just something you're not going to take out of the game."

Catastrophic injuries: Are they inevitable in high school football?

"Let me repeat a quote from the movie "War Games," Rosemblat said. "The quote is: 'The only way to win the game is not to play.' " The Aftermath

Three weeks after Avila's injury, an 11th grader at Stuart, Manny Fierro Jr., quit the football team at his father's request. "Just seeing what happened to John brought a lot of conflicts in my mind," said Manny Fierro Sr., who has acted as a liaison between the Avila family and representatives from the school, hospital and news media.

"Seeing John's parents in the hospital, I said to myself, 'My God, what a helluva situation we could get into. This could happen to us.' "

Moises Avila estimates that his son's medical and doctor bills already have exceeded $100,000. What his medical insurance doesn't cover, a Fairfax County liability policy may pick up -- if the family agrees never to file suit against Stuart, Fairfax, the VHSL or the national federation.

"I'm not thinking about any of that now," Moises Avila said the other day. "I'm only thinking about the health of my son."

Every day, Moises and Teresa Avila visit the intensive care unit of Alexandria Hospital, where their son (whose weight has dropped 40 pounds) is being maintained by a respirator, tracheotomy, gastrostomy, foley cather and central venous line.

At times, they see their boy move his head from side to side, a reflex against pain. "Is there hope?" they ask the doctors and nurses. Speaking in Spanish, Rosemblat has told the Avilas again and again that there is little hope, that for all intents and purposes their son, as they once knew him, no longer exists.

"The doctor tries to talk to us in simple words so we can understand John's condition," Moises Avila said. "In one conversation, Dr. Rosemblat told us, 'El murio en el campo de futbol {he died on the football field}.' "

Moises Avila shook his head. "I understand what the doctor is saying," he said. "He doesn't want us to hope any more. But we hope. We still hope. We hope that someday our son will wake up."