Dale Earnhardt Jr. retired on his own terms last November, after 18 seasons competing in NASCAR’s top ranks. But the process that led to his decision was riddled with anxiety about the effects of multiple concussions suffered in crashes at more than 180 mph on the high banks of Daytona International Speedway and elsewhere on the circuit.
In a forthcoming book, “Racing to the Finish,” Earnhardt goes into depth about his battle with vision problems, disorientation and mood swings that made him want to quit the sport one week, then jump in the racecar the next. He also discloses the secret journal he kept of his escalating symptoms, to ensure he had some way of telling his story.
The book, to be released Tuesday, details the rehabilitation process that led to his recovery and represents a call to athletes and non-athletes alike to seek medical care rather than pretend everything is fine after suffering a head injury.
Earlier this month at Dover International Speedway, Earnhardt, now an analyst for NBC Sports, sat down for a 30-minute conversation about his medical journey. What follows is a lightly edited, condensed transcript:
Q: Why do you think it’s so difficult for professional athletes to acknowledge head injuries and seek medical help during their careers?
A: I think the main reason is because they may lose their job and there is such competition behind them among guys clamoring to replace them. If you take a few days to get some help, somebody could come in and outperform or easily replace you. Then, when you come back, you’re afraid of skepticism over whether you are truly able to come back and perform at your peak. There is a stigma or a stereotype of head injuries because you can’t see them. People can’t diagnose them and can’t measure them.
Q: As an Earnhardt, as well as NASCAR’s 15-time most popular driver, were you even more reluctant to seek help?
A: With me, all kinds of things depended on me racing. I’m going to list the things I felt depended on me racing; whether they’re real or they’re imagined, I don’t know. But I felt pressure from my fans to race. I didn’t have literal pressure; I don’t want my fans to feel like they are responsible for that. But I felt I had pressure to race for my fans. I felt like I had pressure from my family, from people that worked for me. My success, my job, my brand was important to their success. I felt responsibilities to my team owner, business partners and sponsors to be in the car. Everything that I had in my life — everything and every person connected to me — seemed to be dependent on me being a racecar driver.
So there were a lot of things pushing me to race. For me personally, it was easy to say, “I’ve got an issue. I need to fix it. I need to take all the time I need to get it right.” That was easy for me inside in my heart. In my mind, I never struggled with it. I never missed racing when I was out. I wanted to do what I needed to do to get my head right. But I didn’t feel that same sense of comfort and reassurance from everything around me.
Q: Why do you say this could have been more imagined than real?
A: When you have a concussion, one of the symptoms that is common is anxiety. Imagine having the normal amount of anxieties that everybody shares — about life and meeting people in social spaces, whatever. Imagine that being multiplied by 10, 20. And so your worry over people’s perceptions of you multiplies. Your worries over everything that bothers you in life is 10 times worse. I probably imagined a lot of it more than it was real, but it made the recovery difficult as the anxiety sort of flared up and stayed there every day.
Q: You write that you were “scared to death” before your first appointment in 2012 with Michael “Micky” Collins, director of the University of Pittsburgh Medical Center’s Sports Medicine Concussion Program. What scared you most?
A: The fear was, “Do I have to wake up every day with this?” It wasn’t what’s happening five years from now or what about my racing. When you get a head injury and you’re living with symptoms every minute of the day, you forget about racing. You forget about everything in life. None of that stuff matters. That’s what made retiring so easy because it showed me that racing is not than damn important to me. I love it; I love doing it. But it’s not me. It’s not who I am, it’s what I did. I’ve got a lot of other things in life that I’ll do and be a part of that will be neat and fun. Racing is just a piece of me — not the whole pie.
And so, when I got hurt and I’d wake up with the symptoms, all I thought was, “I don’t want to live like this. Please tell me that I don’t have to wake up with this every day.” My fear, meeting the doctor, was, “How in the hell are you going to fix it? It’s my brain! How do you touch the brain or fix the brain? How? You can’t. You can’t put a screw in it. You can’t put a cast on it. You can’t shock it to life.”
Q: When he told you, “Dale, we can fix this,” what did that mean?
A: I still was skeptical. All doctors have to be positive and say, “We’re going to do our best.” After a couple months, I called him at nine o’clock one night and said, “I’m not seeing any change, and it’s bothering me.” One of the issues that was driving me bonkers was this visual problem. Normally, when you look around, your eyes look together. I felt like mine weren’t together; I couldn’t focus. They didn’t seem to work together as a team. You couldn’t see my eyes pointing in different directions, but as I tried to use them, they fought with each other. When I would move, the world would shake. And when I would ride in the car, it was just violent shaking.
Q: When you were in a racecar? Or just driving down the road in Mooresville, N.C.?
A: Every moment! Any movement — taking a step, walking. You walk across the room from the couch to the fridge, and you notice it. You get up and answer the door, and you notice it. You get out of bed and walk to brush your teeth, and you notice it. You couldn’t get away from it. Micky told me he’d seen it before hundreds and hundreds of times. “It’s going to fix itself,” he told me. “You’ve just got to hang in there.”
The funny thing about a concussion, for me at least, it doesn’t get better slowly. It’s like a light switch. Almost overnight, a symptom is better. I woke up one day, and that particular symptom was much, much improved out of nowhere. Once that clicked into place, my confidence in the training, the rehab, the doctor just went through the roof.
Q: After you were seemingly cured in 2012, new symptoms surfaced two years later. Instead of telling anyone, you started compiling a private journal of your symptoms on your phone’s notes app. Why?
A: The severity of the symptoms is hard to measure, and they come and go. They may be worse in the morning and get better in the evening; they may get worse as the day goes on. So as soon as a crash happened, I’d write in the journal what I thought and felt. I’d write again that Sunday night. I’d write again Monday morning, Monday at lunch and Monday at night so that when Thursday came, for example, and I woke up and thought that I felt 100 percent and clear, I could go back and read the notes and understand the progression of the symptoms. That was one reason I wrote the notes: to see a timeline of how the symptoms were changing,
Also, I think I wrote the notes so that if I ever had a crash that left me unable to communicate, the notes would be there, and I could point to the notes and say, “Here’s the history of the things that have been happening to me.” I don’t know how that might have been helpful, if at all, for a doctor. But if I couldn’t tell my story, at least the notes would be there.
Q: Professional athletes tend to be highly goal-oriented. Did that help you tackle the exercises that were part of your rehabilitation?
A: When you have someone with a concussion, that person is not going to have great judgment. They’re most likely going to have some personality changes; anxiety, depression. Things are Debbie Downer and in the dumps. They won’t feel positivity or hope or confidence; all those things are depleted. So when you’re working with a person who has that injury, you have to take that into account. Sending them home with the homework and expecting them alone to manage it is a bad decision. They’re not in position to manage anything. They’re not in position to make personal choices and decisions for themselves. They need help. They need reassurance. They need cheerleading. They need support. They need it all day.
It’s a very depressing experience. And left alone, you spiral further and further and further and further into those depressive thoughts. I think that’s why a lot of those situations lead to suicide — because those people are left alone to deal with these issues. They don’t know where to go or how to get this help.
Q: Is this how Amy (then your fiancee, now your wife) helped?
A: Yes, she was critical. I’d wake up and go, “Yep, all those symptoms are still here.” If Amy wasn’t there, I would have laid in the bed all day and thought about how [lousy] this situation was. Who knows how far down that rabbit hole I would have gone?
But she’d say, “All right, we’re getting up! We’re going to do these exercises. Let’s go!” She wouldn’t take no for an answer. We’d go through all the exercises, and by the time I was done, I felt better about myself. Even though the symptoms weren’t better, I was up, I was active, I was moving. And whenever I felt like I was emotionally slipping, she was right there. I just can’t see how somebody with that type of injury could do it by themselves.
Q: Has your experience altered your view of the NFL?
A: It has. I was a huge boxing fan, but it’s a sport where the guys punch each other in the head. I thought maybe I shouldn’t be a fan of that anymore. Maybe I shouldn’t allow myself to cheer a sport where the head injuries are a big part of it. I battle with that. I don’t know that I’ve come to a solution. I feel the same way about football. I love the Washington Redskins. That’s a big part of my life, a big part of who I am. I love watching football, and I love being in fantasy leagues with my friends, and I love talking football.
It’s disappointing and heartbreaking to see a player who has an injury and wants to play through. They want to show their teammates how tough they are, but it’s a bad decision. It can lead to serious repercussions.
What doctors have learned about concussions in just five years has been incredible. The whole way they look at treating them has done a 180 — from telling people, “Lock yourself in a dark room for months and don’t do anything, don’t see anybody, don’t look at a telephone or TV screen, just shut your brain down” to pure exposure. Now it’s, “Go to places that are complex: concerts, the grocery store. Watch TV. Exercise your mind. Challenge it.”
I don’t believe you shouldn’t not play football for fear of winding up with an incurable head injury. You’d have to shut down a lot of things in life, if you live that way. I just want to encourage people to make the right choices when they’re injured.