When Washington quarterback Alex Smith left FedEx Field on the afternoon of Nov. 18, 2018, his right leg had been shattered in two places, with bone having pierced the skin in a compound fracture. He rode in a red cart to an ambulance. The ambulance’s wailing siren could be heard over the roar of the crowd.

That was before the operation to fix the break, the bacterial infection that set in and wouldn’t leave, the fight to save his leg and eventually his life when he became septic, the months in a wheelchair, the struggle to walk, then run, then the seemingly foolhardy decision to play football again. Ultimately, he had 17 surgeries on the leg, which cost him gobs of tissue and muscle and left him with a limp for which he must wear a special titanium brace.

So on Sunday afternoon, when Washington starting quarterback Kyle Allen left with an injury late in the second quarter and Smith stepped into an NFL game for the first time since that fateful day nearly two years ago, Smith probably didn’t notice that he was just four yards from where the ball was snapped on the play that broke his leg.

It was “almost a blessing” that he had no time to think before going into the game, he said after Washington’s 30-10 loss to the Los Angeles Rams.

That Smith completed only 9 of 17 passes for 37 yards and was sacked six times Sunday hardly mattered. For most of the past two years, almost anyone involved with Washington’s team had said Smith’s return was impossible. Not long after Smith’s release from Inova Fairfax Hospital in December 2018, a person familiar with Smith’s condition said the quarterback would have a “normal life” but added that a normal life would never allow him to evade a pass rush in a professional football game.

So certain was the team that Smith would never play again, it acquired his replacement, Dwayne Haskins, in the first round of the 2019 draft. Even after Smith pushed through 2019 in a remarkable recovery that became the subject of an ESPN documentary, it was still difficult to imagine him back on the field. When doctors cleared Smith to practice this past August, Washington’s new coach, Ron Rivera, was cautiously optimistic but moved ahead with Haskins as the starter and Allen as the backup. Smith appeared more like a decision to be put off for another time.

But then Rivera suddenly benched Haskins last week, turning Allen into the starter and Smith the backup.

“I’d be lying if I said there weren’t a lot of days when I didn’t think it was going to happen,” Smith admitted Sunday.

In Section 10, Row 15, Seat 15, Smith’s wife, Elizabeth, felt as if she was “going to vomit” the moment her husband entered the game. Allowed in the stadium for the first time this year with a small group of players’ family members, Elizabeth Smith sat with their three children, Hudson, Hayes and Sloan, certain Alex, as the backup, wasn’t going to play.

She had cried when she saw him run onto the field for the first time as an active player again before the game. Something about seeing him in a uniform after everything that had happened made her weep. She and her children were the ones who endured the bulk of her husband’s time in the hospital. She was the one who consulted with the doctors while sitting beside Alex’s bed, trying to comprehend the disastrous news she was being given about his deteriorating health.

“Just for him to be able to come to this point was incredible,” Elizabeth Smith said. “We were at a place where we weren’t certain he’d be able to walk and live, all these things, and to see him work so hard and accomplish so much — when this guy puts his mind to something, he just doesn’t stop, and I think that was something really special.”

She took a deep breath and exhaled. The game was over, her husband’s two quarters and two minutes played in a steady downpour. She wore a yellow disposable rain cover and a black mask with Alex’s No. 11 in gold sparkles, and she moved between elation and exhaustion as she talked while standing in the stadium’s main concourse.

“For so long it wasn’t plausible, it wasn’t ever going to happen, and then as he would slowly start to work out and go through physical therapy and all these things and he’d come home and be like, ‘You have no idea what I just did today,’ thinking that he’d never be able to do each step. And then each step he got closer and closer, and then you have those long pillow talk conversations of: ‘Is this going to happen? Are you really gong to do this? Is it really worth it?’ And I understand as a wife, had he never come along and done this, he’d probably never be okay 20 years from now. It’s something he needed to work through and get to that point.”

So many times in the days after the doctors had cleared Alex to practice at the start of August’s training camp, he had told her the one great test for him was to be tackled.

“I’ve got to take a hit,” he would say, “just to get that boost of confidence.”

But all Elizabeth could do was think of those days in the hospital, the drives to rehabilitation, the workouts, the pain, the worry that one wrong move while his leg was still entrapped in a cast could start the recovery process all over again. The last thing she could imagine was seeing him hit again.

“For me, I don’t get that same boost of adrenaline. Anxiety is the way I’d put it,” she said.

Then she laughed.

“But, yeah, we’ve come a long way,” she added.

Sitting in a Memphis sports bar, Joe Theismann watched Smith jog onto the field and smiled to himself. Theismann, Washington’s all-time leading passer, had his career end after a leg injury almost identical to Smith’s. Coincidentally, his injury happened exactly 33 years before Smith’s, Nov. 18, 1985, but medicine then was different. There was no way for Theismann, who was 36 at the time — the same age Smith is now — to return. Theismann, who was in team owner Daniel Snyder’s suite at FedEx Field the day Smith was hurt, was certain Smith was done, too.

“It’s absolutely phenomenal,” Theismann said by phone from his seat at the bar. “I’m living vicariously through Alex right now.”

Theismann already had seen Smith take that hit Smith wanted to experience so much, and he had “exhaled” when Smith stood back up. He has felt a kinship with one of the few people in the world who could know what it was like to have an injury such as this. To see Smith actually come back into a game was overwhelming.

“I know the hill he’s had to climb,” Theismann said. “I don’t care what anyone else does this year in the league; he’s the comeback player of the year right now.”