ALPHARETTA, Ga. — At 4 a.m., they came to take Helen Maroulis’s blood. She was angry. She was confused. Only two years before she had won a gold medal at the 2016 Rio de Janeiro Olympics, defeating the world’s most formidable 53-kilogram female wrestler, silently screaming, “Normal people do win!” at the end because who could have imagined that she, Helen Maroulis of Rockville, Md., could have done something like that?

But by the summer of 2018, she was in a psychiatric treatment center somewhere in Utah, inside a room where the door didn’t close, voluntarily admitted yet not free to leave, the words of her doctors still fresh in her head. Post-traumatic stress disorder, they said. From concussions. From wrestling, the thing she loved the most. And here it was, 4 a.m., she recalled, and someone had come to draw her blood, apologizing for the unavoidable intrusion — there were a lot of patients, a lot of blood to be drawn, and 4 a.m. was when they could take hers.

Maroulis sat there, half awake, with a needle in her arm and thought, “How am I here?”

She had always thought Olympic champions were invincible, but after she became one, her world collapsed. It was a descent that began with a seemingly harmless palm to her forehead during a professional match in India early in 2018 that led to more concussions that led to the confusion, the uncontrolled crying, the voices and the PTSD diagnosis.

For more than two years, she felt hopeless and lost, every attempt at recovery ending with another brain injury. Several times she told herself she was done with wrestling, until finally, last year, she healed. Then this past April, she secured a spot in the Tokyo Olympics, something she couldn’t have imagined happening just months before.

“Wrestling, for the first time in my life, wasn’t my safe place anymore, and it wasn’t kind of my place to just de-stress,” she says, sitting in a lounge at a training camp for the U.S. Olympic wrestling team outside Atlanta. “It actually was the place of all my trauma and of all my pain. And so I actually didn’t like wrestling at all. I hated it.”

Back home in Maryland, her father, John, a Greek immigrant who once wrestled, laments that his daughter “has not been the same since the first concussion.” He wishes she would quit. There were many times in the past three years when she was sure she would, believing she was too broken to go on.

And yet she can’t walk away — not yet. “Something keeps bringing her back,” says Terry Steiner, the U.S. wrestling team’s women’s coach. Wrestling had damaged her, but it also was the thing that had made her strong, the one activity that never bothered her as a shy child, the sport that showed her the world and made her the first in her family to leave the Maryland suburbs of Washington, D.C.

She didn’t give up when boys refused to wrestle her growing up or when she lost in the trials for the 2012 London Olympics, which she seemed certain to make. So she couldn’t give up one last chance at another gold medal this time, no matter the risk of opponents hitting her in the head.

“She’s a fighter,” Steiner says.

‘Something’s not right’

Maroulis had been recovering from a thumb injury that kept her from lifting weights before leaving for India early in 2018. Looking back, she wonders if that left her neck muscles weaker. It’s the only explanation she has for why a seemingly benign hit from her opponent’s palm just above the bridge of her nose left her disoriented, sleeping for most of the next four days.

“Something’s not right,” she kept telling the doctors in India, as well as the ones she saw by video conference in the United States.

They told her to rest, and yet she couldn’t rest. She wanted to leave, but the team’s executives begged her to stay. She was the gold medalist, and people were paying to watch her wrestle. So she continued, sleeping through her days and sitting in the bathroom on event nights with cotton balls stuffed in her ears until it was time for her match.

She felt like she had been “hit by a truck.” Sometimes she wanted to throw up. Still, no one would tell her she had a concussion. She started to wonder if she was making everything up. Maybe she wasn’t injured. Maybe she couldn’t handle the pressure of the league. It wasn’t until she finally got back to the United States and saw a doctor in New York, where she was living, that someone told her she had a concussion.

Maroulis knew little about concussions, having only suffered one — in 2015. This time was different. She had to wear special prism glasses and noise-canceling headphones and spent most of her days indoors, slowly venturing out for a few minutes every few days until she began to get better.

One day, she went to compete against a male wrestling coach. Wrestling men was a regular part of her training, but ever since Rio she noticed men becoming more aggressive in their sessions, trying to prove they were tougher than the gold medalist. The man began smacking her on the head as they wrestled. She knows he knew about her injury, because halfway through their session he started talking about concussions.

“I was dumbfounded,” she says.

The next day, she woke up with vertigo.

She flew to Colorado, where doctors told her she had another concussion and this time her autonomic nervous system wouldn’t regulate. She had trouble with light. She felt dizzy. Things that never bothered her before made her irritable, and sometimes, at the end of more overwhelming days, she heard voices.

“Everything was this perfect storm culminating with all this stuff that hadn’t been dealt with,” Maroulis says. “I felt like a hamster on a hamster wheel, like I was going crazy a little bit.”

She tried to work out with a strength coach she knew, but every time she put her head on the bench to lift weights, she would cry uncontrollably. One of the strength coach’s assistants, a former soldier, suggested she might have PTSD. She went to her psychiatrists and asked what they thought. They, too, suspected PTSD, caused by her wrestling injuries, which led her to the hospital in Utah and 4 a.m. blood draws.

The hospital terrified her. She describes the experience as being “straight-up institutionalized.” She needed out, so she called her father from a phone at the nurses’ station and in Greek asked him to tell the doctors to let her go back to Colorado. The next day he did. She started training for the upcoming world championships, never telling anyone with the team about the PTSD or the hospital in Utah. She went to worlds, mentally lost, her body tense, unsure about wrestling. In her first match, she tore her rotator cuff completely from her shoulder.

In the training camp lounge, Maroulis pauses to catch her breath. She has been telling her story for close to two hours almost without stopping.

“We didn’t even get to the rock bottom yet,” she says.

‘It was so miserable’

That July, Maroulis felt well enough to start training for wrestling again. While working to get in shape, she helped coach the U.S. women’s Junior Olympic team, only to get accidentally swatted across the ear by one of the girls during a light wrestling session. The hit wasn’t that hard, but instantly she had a ringing in her ear.

That night she had all of the same strange thoughts as before, the weird feelings, the noises in her head. The doctors sent her to another hospital that dealt with PTSD, this time in Colorado. Unlike in Utah, she intended to stay, certain she was losing her mind, “I was walking around, going, ‘I’m so broken down,’ ” she says.

It wasn’t until a couple of days later when she realized she actually had the signs of another concussion. She explained this to the doctors at the hospital, who released her at the end of the hospital’s mandatory 72-hour hold. Later, she would be diagnosed with an inner-ear injury that had the same symptoms of a concussion.

“I just remember waking up and being like, ‘I just want to lay in bed all day and just pray that I just make it to tomorrow and that at some point this gets normal,’ ” she says. “There was no quality of life like it. Like, I couldn’t drive. It was so miserable.”

In December she went home for Christmas. Her parents were shocked. She looked lost and worn out. At one point she told her father, “I don’t recognize myself in the mirror.” They convinced her to stay at home for a few months to rest.

She had told herself she was done with wrestling, but she started visiting a local gym mostly to say hello. Eventually she did some light workouts, only to have panic and anxiety attacks. She started to wonder if her reactions weren’t related to her last concussion but more to her PTSD. Her therapists had said one of the therapies for PTSD is to talk about the cause until the response lessens. She decided to try the technique with wrestling.

She increased the workouts to three days per week, retreating home to bed afterward, but she would also talk about the experience with her therapist. Each week her panic decreased and she felt better. She realized that, instead of running away from wrestling, she needed to confront it. Her physical risk of getting a concussion wasn’t greater, but she had been so worried about getting more concussions that anytime her head was touched, her body would tense. That was putting her in more danger. Part of her fear, she noticed, was the thought that people were trying to intentionally hurt her by hitting her head. She started working harder, and for the first time she thought about the Olympic trials scheduled for April 2020.

That February, two months after coming home for Christmas, Maroulis went to a pretrials tournament. The first woman she wrestled immediately clubbed her head. Maroulis knew the blows were intentional and her opponent was aware of her concussions, but a strange thing happened. The tactic didn’t bother her.

“It was such confirmation that I had done the work, the mental, emotional and spiritual work and it was like: ‘You’re healed,’ ” she says.

When the trials were canceled because of the coronavirus pandemic, she stayed with her parents and worked with a local coach. She felt stronger, healthier and happier, more like her old self. At this April’s rescheduled trials, Maroulis had a bye into the final, which she won with a pin in the third round.

“It was kind of like a PTSD release,” she says. “I just felt like I was still just purging stuff from the past, and it was like: ‘Wow, I can’t believe this happened. What a gift.’ ”

‘Why don’t people talk about this?’

Over the phone, John Maroulis’s voice goes sad. Every night he prays for his daughter. Not to win the Olympics again, but just to be healthy. He hopes after Tokyo she will quit wrestling for good. He jokingly tells her she should “find a nice Greek boy and settle down.”

“The first time around [in Rio] I was gung ho, but right now, after seeing Helen suffer for three years, my heart is not into it,” he says.

So many times, these past three years, he and Paula have asked Helen why she didn’t stop when her head began to hurt. Why didn’t she leave the league in India? Why did she keep continuing to train for tournaments when she should have taken at least a year away?

Each time she tells them how she has always had to prove herself in wrestling, that even after winning the gold medal there’s the part of her that doesn’t forget the coaches who wouldn’t let a girl in their gyms when she was young, or the fathers who didn’t want her wrestling their sons, or the men who said wrestling wasn’t for women.

“For 20 years, it’s been like, ‘I’m like not backing down,’ ” she says. “And if you’re like, ‘Oh, I’m tired, this hurts,’ or whatever — well, a guy can do that, but when you do it, it’s like, ‘You don’t belong here; you don’t belong in this sport.’ So I just think it was just so deeply ingrained in me that . . . I was always going to go hard until I was told that was it.”

Maroulis knows she is taking a risk in talking about her concussions. Her opponents are listening. In a recent tournament in Poland, she faced a wrestler whose only approach was to hit her head repeatedly. But she also doesn’t want to be silent. She remembers crying at one particularly low point in the office of a doctor at the U.S. performance center, saying she must be the worst case the doctor had ever seen, only to have the doctor say she would be surprised how many athletes come in with mental health issues.

And all Maroulis could think was: “Why don’t people talk about this?”

So she wants to start. She hopes other athletes will listen.

But, now, in the training camp lounge, she thinks about everything that has happened and smiles. She is back to feeling like herself, going to an Olympics that so many times she was sure she would not make.

“I actually think I have a great brain,” she says. “A healthy brain.”