Sportsnet ran an article this week: ‘That’s what I’m here for’: Why Ryan Reaves is still looking for a fight. If that’s why Reaves thinks he’s in the National Hockey League, it’s not surprising. The last time I saw Reaves play (on TV), he flattened Edmonton Oilers’ defenceman Darnell Nurse with a filthy elbow to the head. “There needs to be responsibility on the player that’s delivering the hit,” CBC analyst Jennifer Botterill said about Reaves, and she’s right. Hockey is beautiful, but it’s fast, and it can be dangerous – even deadly.
In late 2023, Adam Johnson, a British Elite player, lost his life when an errant skate sliced his neck. I watched the video once. It’s all I could handle, and I’ve seen some pretty gruesome things over the past two decades. While I’m confident Matt Petgrave had no intent to injure Johnson gravely, it’s hard to understand why his skate went so far out if its way to find Johnson’s neck.
For the first time in a long while, hockey seemed especially violent to me last year. Partly because my fifteen-year-old son’s team and their opponents constantly seemed embroiled in dirty hits, fights, and suspensions. One of his teammates was knocked out cold by a deliberate hit that sent him head-first into the boards. One of the teams they played regularly seemed more interested in hurting kids than scoring goals. Ryan Reaves would have fit in well with them.
Last year was also my younger son’s first year of contact hockey. At an away tournament last February, an opponent skated up to him and, well away from the play, took his stick and jammed it up between his legs. He jammed that stick so hard it was as if his assailant wanted to split him in half from the groin up.
As much as I love the game, I was relieved when both boys left competitive contact hockey at the end of last season.
Even the National Hockey League had seen a “rising number of dangerous hits,” with players wanting safety on the ice. “I’ve talked to guys on our team, guys on other teams,” Dylan Larkin, the Detroit Red Wings captain, said in late 2023. “It’s hard to know how to protect yourself.”
I’m not sure how many hockey injuries I see yearly in the ER, but from September to April, there are a few every night, almost without exception.
—
It’s mid-November on a Sunday night when Cam Francis’s* mother wheels him into a treatment room. They’re in Fast Track, an area of our ER for one-touch patients who are unlikely to require much time, testing, or treatment. He stands and grimaces as he eases himself out of the wheelchair and onto the stretcher, still wearing a shirt and tie from his game a few hours earlier. “He took a hit,” his mother says. “It’s been a few hours, and he’s still complaining of pain, so we thought we’d get it checked out.”
I ask what happened, but other than “hard check,” I don’t get much.
“Were you able to get back on the ice?”
“No,” he says. “I missed the rest of the game.”
I glance at his vital signs. His heart rate is at the upper limit of normal, and his blood pressure is at the lower limit, at ninety-five over sixty. Lying still, he looks OK, but when I examine him, his gut is tender, particularly just below his chest. Fortunately, his abdomen is soft when I push. It doesn’t have the rigidity of someone guarding a severe injury. Yet.
“It’s probably just muscular,” I tell Cam and his Mom. This is where I usually stop, telling player and parent to go home, rest, and take some Advil. “But he’s pretty sore, so I’m going to send him for an ultrasound and get some blood work just to be safe,” I say. “And just in case, don’t eat or drink anything.”
“OK,” his mom says. I say this several times each shift, ‘don’t eat or drink anything,’ and almost no one asks why. I wonder how many know that the follow-up to this line is, “Just in case you need surgery, we want your stomach empty before we put you to sleep so you don’t vomit and choke on your gastric contents.”
I see several more Fast Track patients – kids with colds, a woman requesting a prescription, and two cuts requiring stitches. An hour later, Cam’s blood tests are back. His hemoglobin is down slightly at 124 (the mean for someone his age is 140). It’s a number I’d barely notice if his presenting complaint was something other than trauma. Shortly after, Cam returns from his ultrasound. The radiologist’s report is vague. All the organs appear normal in size, other than the spleen, which has a small lump at its base. The lump, as described, is smaller than a cherry tomato. Indeterminate splenic lesion, the report says. ‘This most commonly represents a benign etiology such as a hemangioma. A follow-up elective MRI is suggested.’ The radiologist also notes a ‘small amount of free fluid that may be posttraumatic in etiology.’
Given Cam’s history, the indeterminate splenic lesion is not likely a benign hemangioma.
I explain the results to Cam and his mother. I tell them that it’s possible that there is internal bleeding and that it’s coming from the spleen. He’s still tender when I re-examine him, perhaps more so than before. “I’m going to order an urgent CT scan for a better look and I’ll repeat his hemoglobin. If his hemoglobin is dropping, it means he’s bleeding, and the degree of the drop will tell me how fast he’s bleeding.” I ask a nurse to take Cam to the acute room where he can be closely monitored. “I’m also going to give you a medication through the IV called Tranexamic Acid,” I say. “It promotes clotting, so if there is bleeding, I want to get ahead of it.”
An hour later, the radiologist calls me. “Your patient with the spleen,” he says. “He has a pretty big laceration, there’s blood in the belly, and I think I see active extravasation.” The CT scan was performed with intravenous contrast, and extravasation means the radiologist sees contrast leaking out from the spleen. In other words, he’s actively bleeding.
Fortunately, Cam’s hemoglobin has barely dropped – 126 to 124. The degree of haemorrhage is small. For now, anyway. The surgeon on-call comes down, and we discuss Cam’s options. Most splenic injuries are treated non-operatively. Patients are kept in hospital until the injury settles, followed by several weeks of rest until healing is complete. In case of severe hemorrhage, the spleen has to come out urgently. I’ve seen two catastrophic splenic ruptures from hockey injuries, and in both of these cases, the spleen ruptured several days after the patient had left hospital with a seemingly stable injury. Fortunately, both were taken to the ER immediately, and both survived. There is, however, a third option to consider. His injury is severe, grade five on a one-to-five scale of severity. However, his hemoglobin is practically unchanged, so his bleeding seems minimal. Embolization is an option. It’s a procedure in which a catheter is fed into the splenic artery so that it can be occluded to stop bleeding.
I’ve seen the hit on a small, grainy video. I’ve watched it dozens of times. Cam is skating into the offensive zone with an opponent giving chase. The opponent is right on Cam’s back, practically on top of him. As Cam crosses the blue line, another player skates into him from the left side (you could say he’s blindsided). Just as this second opponent makes contact with Cam, he falls or is pushed from behind. The players spin, and Cam’s opponent’s knee lands directly on Cam’s gut. “Shattered spleen,” a radiologist would say on the next day’s scan. And at the point of impact, there is cheering from the crowd.
Cam is transferred to the Children’s Hospital downtown. There, he is treated conservatively with bed rest and observation. The following day, his hemoglobin is only slightly lower, at 119. A repeat CT scan shows a large amount of blood surrounding the spleen. On day three, Cam develops shortness of breath and requires supplemental oxygen via nasal prongs. A chest x-ray shows fluid around his left lung, just above the injured spleen. His hemoglobin is now 106, twenty points lower than the day of the injury. He is monitored closely throughout the day incase urgent surgery is needed.
Although there is more fluid around Cam’s lung on day four, he gets up and moves around for the first time since the hit. From then on, he continues to improve until on day eight, the injury is deemed stable. The fluid around the lung has dissipated, and he’s finally discharged home. He’ll be off the ice for at least eight weeks, he’s told, but it could have been much worse.
—
During an NHL game last New Year’s Eve, a Minnesota Wild forward deliberately jammed his stick into the face of an opponent. Jamal Mayers, a former player and hockey analyst with Sportsnet, defended his actions, calling it a “message.” “There is an element of meanness,” he said. “There is an element of not being nice out there. And if you don’t like that element, then maybe you don’t like playoff hockey.”
His fellow panelist was Jennifer Botterill, the analyst who called for player accountability after Reaves’ hit. A Harvard Graduate and three-time Olympic hockey Gold medalist, she was the voice of reason: “You’re OK with that? If it’s your son playing? And he takes that two-hander to the face? That it was a good message to send?” She called it “archaic, cheap, and dirty,” and she’s right. It isn’t a message; it’s assault with a weapon. But this is the way some people in hockey circles think. It’s a problem at the professional level, and it trickles down to all levels of the sport.
—
Cam made it back for playoffs last year, fourteen weeks after his injury. It took some time to get back into form, but by Spring, he was flying once again. This year, he’s back at the top of his game and has attracted some attention from college and junior-level scouts.
And my boys, they’re still playing this beautiful game, just without the hitting. My older son is playing recreational-league hockey on weekends, and my younger son moved to competitive non-contact.
*all identifying features have been changed
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I’m so happy to see your new posts!