During his worst moments, after he had dropped 54 pounds and was crawling to the bathroom five times a night to throw up, Justin Duffie still searched for a way, any way, he could return to the football field.
Duffie, a 23-year-old Maryland junior, has kept a solitary goal since Dec. 31, 2002, when he started his first and only game for the Terrapins in the Peach Bowl: He wants to play again. And he wants to play again without feeling like "someone is stabbing me in my stomach."
Duffie is one of more than 1 million Americans suffering from Crohn's disease, a chronic, incurable and painful digestive disorder that inflames the intestines and can cause, among other debilitating complications, diarrhea, cramps and weight loss. At his worst, the opening in Duffie's intestines was the width of a small straw.
Although he underwent surgery 21/2 months ago, during which nearly 14 inches of inflamed intestines were extracted, Duffie's name was listed in bold on Maryland's most recent depth chart. Come Saturday against Northern Illinois, he will start at defensive tackle.
"I wanted to believe every second that I was doing it so I could get back here playing again," Duffie said. "I didn't want to go out like that, where it kind of beat me. I wanted to be back and going out on my own terms. . . . I think someone would have had to drag me off the field and tie me up for me to stop."
The same day Duffie underwent his six-hour surgery at Baltimore's University of Maryland Hospital, he was told about another player, Jacksonville Jaguars quarterback David Garrard, who had recently undergone a similar procedure.
"This is something you can definitely overcome," Garrard, 26, said in a telephone interview. "After the surgery, clear your mind of anything about the disease being inside you. Don't have thoughts of the disease coming back."
More than 100,000 of those with Crohn's or ulcerative colitis, another inflammatory bowel disease (IBD), are children, which is more than cystic fibrosis, multiple sclerosis and hemophilia combined. But IBD is the "quintessential closet disease," according to Rolf Benirschke, a former San Diego Chargers kicker who suffered from it throughout his career.
"Doctors said they weren't sure I would live," Benirschke said. "I wasn't sure I wanted to live."
The symptoms are of a personal nature, which makes it difficult for many to address or even acknowledge. Numerous celebrities, though, including President Bush's brother Marvin, professional golfer Al Geiberger and NHL player Theo Fleury, have come forward as IBD sufferers.
The cause is unknown, although it seems to track within families -- 20 percent of patients have another family member with the disease. "But there is no rhyme or reason," said Julie Perry, executive director of the Crohn's & Colitis Foundation of America's Florida chapter. "It's so miserably frustrating. It's insidious."
Duffie was first diagnosed with the disease at 16. Doctors initially thought it was a virus, but when it proved non-contagious, Duffie underwent additional tests, which revealed Crohn's.
Duffie still played fullback, outside linebacker, tight end and nose tackle at Landon School in Bethesda, where he earned defensive MVP as a senior. He took medicine to avoid a relapse, which, for the most part, was successful.
As a Maryland freshman, Duffie played well in the Peach Bowl, one of two games in which he saw action, recording two tackles and raising the bar for his sophomore year. Entering 2003 summer camp, Duffie had loftier goals: start on the defensive line. But he grew weaker during spring workouts, with a sharp pain emerging in his lower right side.
"How am I supposed to make it through two-a-days when I'm up all night throwing up?" Duffie said. "I was being sick and then going out and being sick during practice. I wasn't approaching it the right way or being smart, but I'm a pretty hard-headed person in terms of just trying to go out and just play."
Maryland's trainers knew about Duffie's disease, but the player wouldn't say anything to teammates. He tried not to let them see him throw up on the field. "I didn't want people to see my weakness," he said. "I'm supposed to be playing in the middle of the defense."
Duffie missed the entire 2003 season and was too despondent to attend games. Winter workouts went fine, though, and Duffie entered 2004 spring practice optimistic. And then the pain started again. He'd almost become numb to it. On days he didn't throw up, he felt like he would.
"I think he feels so alone," said his mother, Judy Duffie. "I think he thinks people don't understand what it means to have this."
At one point this spring, Duffie was taking at least 11 pills a day, including Asacol, an anti-inflammatory drug Duffie would take nine doses of a day and occasionally Hyoscyamine, a tablet that dissolves under your tongue for immediate relief.
By late spring, his intestines had almost completely closed and he had reached a crossroads: undergo surgery or never play football again. Without surgery, his intestines could eventually close and rupture, a potentially fatal scenario. "Justin," said his mother, "this [football] is his life."
Although Duffie has a large frame (6 feet 1), his body lacks significant fat, which allowed him to undergo the laparoscopic surgery technique. It involved a relatively small 21/2-inch incision below his belly button and very small incisions around his stomach. The alternative would have been a lengthy horizontal incision that likely would have sidelined him the entire summer.
"The surgery is one of those intersections of life," Benirschke said. "Ultimately it's a defining moment. There is a maturation process forced upon you at an early age."
After the June 11 operation, Duffie weighed 246 pounds, 54 pounds less than his summer 2003 weight. He was on a liquid diet and remained in the hospital for a week. Teammate Chris Kelley, his best friend on the team, often visited.
"Everyone talks about sprained ankles, you break an arm, whatever," Kelley said. "You think about it, he had surgery on his intestines. They cut him open. You're talking about something life-threatening. I just hope nobody on this team takes that for granted, what he's trying to do for this team."
Duffie couldn't start running until around Aug. 1. Even by mid-August, the team entrenched in two-a-days, Duffie couldn't bench press or perform squats. Still, with a combination of light weight training and an enhanced diet, Duffie had gained more than 20 pounds back in a little more than a month after surgery.
A struggle ensues. He hasn't been able to practice every day. When he does, locking up an offensive lineman is daunting because Duffie's abdomen is not completely strengthened. When his parents attend practices, they see him occasionally throw up on the field.
"He worries about whether it will kill him at some point," Judy Duffie said.
But there have been no flare-ups, Duffie said, no significant residual effects from surgery. Regaining strength and speed remains his toughest hurdle. His doctor, Eric Goldberg, encourages him to drink a gallon of water a day to stay hydrated.
"I've had many, many conversations with Justin about how important playing is to him," Maryland Coach Ralph Friedgen said. "On one hand, we have to be very concerned with his health overall. On the other, he wants to play so bad, he gets very irritable because of that, because of the sickness that he has."
Duffie walked from the practice field Tuesday carrying his helmet and sweating. An observer told him he was scheduled to start Saturday's game. He beamed.
"Yeah, I'm starting," he said. "I'm ready to go, man. It's been a while."