The Road Back

Fifty yards from Everett, on the Buffalo sideline, stood Andrew Cappuccino, 45, an orthopedic surgeon with specialty training in disorders of the spine and for 13 years a member of the Bills' staff under the team's medical director, John Marzo. Eleven days earlier, on Aug. 29, Marzo and head trainer Bud Carpenter had led a 1 1/2-hour spinal cord injury refresher drill at the Bills' field house in Orchard Park, N.Y. Cappuccino had nearly begged off—"I told Bud, 'That scenario is never going to happen,'" recalls Cappuccino, who'd yet to encounter a spinal cord injury at a Bills game in his time with the team—but Carpenter insisted. Now that drill would form the foundation for the seminal moment in Cappuccino's career. And in Everett's life.

A UNIT of physicians, trainers and emergency medical technicians moved onto the field and surrounded Everett. When the training staff determined that Everett had no mobility below his neck, Cappuccino was waved onto the field. He performed a quick battery of tests to assess the severity of the injury, squeezing various parts of Everett's body and asking him to respond. Cappuccino determined that Everett was quadriplegic. He turned to Carpenter and told him, "Bud, we're in the spinal cord drill."

Marzo, a former quarterback at Colgate, spoke to Cappuccino, who played football at Johns Hopkins, in the language of the athlete. "This is your game," he said to his colleague and friend. "Take the ball and run with it."

Over the ensuing seven hours, Everett would receive extraordinary, perhaps unprecedented, care across a wide spectrum of treatments from a team of more than a dozen medical professionals. As the leader of the team, Cappuccino would direct and administer not only first-rate conventional spinal cord injury care but also daring unconventional methods that pushed the standard of such treatment and potentially endangered his own career in a profession in which malpractice litigation is a real concern.

Thirteen minutes after Everett struck Hixon, the Buffalo tight end was loaded into an ambulance driven by emergency medical technician Dan Lengel. Another EMT, Rich Bartel, worked next to Everett's gurney. Cappuccino sat by Everett's head, talking to him as Everett struggled to breathe—a difficulty that often afflicts patients with high cervical injuries. "I felt like I was going to suffocate," says Everett. "That made me nervous. That was the worst part of the whole thing. I had to stay calm and not panic. Dr. Cappuccino was right there with me, talking to me, helping me stay calm."

As he spoke to Everett, Cappuccino recalls, "I was thinking to myself, God, I have children this age. I thought about my 20-year-old son and what he would say to me if it were him on that stretcher. I knew he would say, 'Dad, don't leave me like this.' Kevin was at that moment, frankly, quadriplegic, and I made a decision to do anything I could to try to make him better."

Cappuccino knew there was a flicker of hope. On the field he had applied forceful pressure to Everett's lower extremities, from his ankles to his groin, and had detected a response that was absent with a sharp sensation such as a pinprick. This told Cappuccino that Everett had suffered an incomplete spinal cord injury, probably meaning that the cord was severely damaged but not severed.

Cappuccino then made two decisions, one that has reverberated through the medical world and one that has gone largely unnoticed but might have been just as critical.

First, he introduced mild hypothermia as a part of Everett's care. In November 2006, Cappuccino had attended a seminar of the Cervical Spine Research Society and sat in on a talk by Dalton Dietrich, scientific director of The Miami Project to Cure Paralysis. Dietrich devoted the last 10 minutes of his presentation to the potential benefits of induced hypothermia for neuroprotection—the rapid cooling of the body to reduce metabolic demand and to prevent further damage from swelling and other inflammatory mechanisms. It is a controversial treatment that has not been established as a standard of care in spinal cord injuries and is the subject of considerable debate in the field. Partly motivated by that talk, Cappuccino had instructed the EMTs at Bills games to stock their ambulance with three bags of saline solution in a cooler.

"When we got into the ambulance, Dr. Cappuccino told me to start two IV lines with the iced saline," says Bartel. Cappuccino also pushed 3.5 grams of the steroid Solu-Medrol intravenously, and from the ambulance he instructed the hospital to prepare a solution that would deliver 600 milligrams of the steroid per hour for the next 23 hours. This is a more common treatment in spinal cord injuries, although it has not proved universally effective.