On Nov. 18, 2018, Washington Redskins quarterback Alex Smith was injured in the third quarter of a Week 11 game against the Houston Texans. The injury was severe. This is a first-person account, from Smith's wife, Elizabeth, to ESPN's Stephania Bell, of the untold story of what happened next. Watch the full story on E:60 at 7: 30 p.m. ET Friday.
Warning: This story contains graphic images.
--- "Our first priority is we're going to save his life. And then we're going to do our best to save his leg. And anything beyond that is a miracle."
Alex isn't Alex anymore.
It's been 57 hours since my husband was carted off the field with a compound fracture in his right leg in a Week 11 game, but now it's Wednesday at midnight and he's not just an injured football player -- he's the patient who's drifting in and out of consciousness as doctors try to figure out what's wrong. Of course, I just want to talk to Alex. But he's ... he's not there.
They're thinking he has a blood clot, a pulmonary embolism. Then we're doing a cardiogram. Throughout the night, it's test after test after test. Alex's fever is through the roof. His blood pressure is dropping.
Everyone -- the nurses, the doctors -- every person is in this room and can hear me asking, "Is everything going to be OK?" They are saying, "We just need to find the root of the problem."
Finally, we learn he has an infection.
The doctors are telling me, "He's septic. It's in his blood. But we don't know what type of infection it is."
Dr. Steve Malekzadeh, one of Alex's trauma surgeons, comes in early the next morning. It's Thursday, Thanksgiving Day. He would tell us later he came in because he couldn't sleep. He knew something was off. He unwraps the bandages from Alex's leg, even though it had been unwrapped just a few hours before. At that time, it looked normal, at least as normal as post-surgical fracture sites look.
But now his leg is black. The blisters are huge. It's clear the infection is in his leg. It's something I couldn't fathom seeing in a war movie, only now it's my husband. It's my worst nightmare.
Alex Smith After undergoing surgery to repair his badly broken leg, Alex Smith developed an infection.
Dr. Malekzadeh says, "We have to go back. We have to take him into surgery again."
Alex's parents are there. The Redskins were in Texas playing the Cowboys that day, but Dr. Robin West, the head team physician, flew back from Dallas to join in on the surgery. I couldn't even tell you how long it was, but it felt like we were waiting for an eternity.
The doctors finally walk in, and they look defeated. Like they had opened Pandora's box. "He has a bad infection," they say. "There was colonization of the bacteria all through his soft tissue. We removed a big portion of the anterior compartment."
"What does this mean?"
"Well, we had to take off a lot of skin, a lot of muscle tissue."
"So, is it fine? Is it done? Is the infection gone?
"No. We have to go back tomorrow. And we're going to do it again. We think this looks like necrotizing fasciitis."
We all look at each other in disbelief. Necrotizing fasciitis? Like, flesh-eating bacteria? This was something I only knew about from reading about it online.
Now it's Friday, and they are going back in to cut out more tissue. Then, the cultures came back and, sure enough, it's necrotizing fasciitis. There is one really rare bacteria in his blood stream, Aeromonas hydrophila, a bacteria typically found in freshwater or brackish water.
So Alex has a flesh-eating bacteria that's eating away his at his leg. He's septic and, essentially, dying. We're being inundated with medical language. Family, friends, everybody is on high emotion.
And I just need some grounding. I need someone to sit me down and tell me exactly what's going to happen. I send Robin (West) a text and ask her if we can meet privately and talk.
We head to the cafeteria annex, which had become my private escape. I said, "Please, can you just break this down for me? My husband is laying here. And he's dying. And it's coming from his leg. I just need to know -- why can't we just -- cut it off? I need to know if I'm going to be able to leave this place with him with me. I can't go home to my children without him with me. We need to make sure he's OK."
And these were her exact words. I can still hear them.
She said: "Elizabeth, we're doing the best we can. And right now, our first priority is we're going to save his life. And then we're going to do our best to save his leg. And anything beyond that is a miracle."
How'd we get here? So let's back up a little.
November 18, 2018, started out like any other home game day. Alex and I, we have a routine. He spends the night before the game at the team hotel. The kids and I, we wake up, do our breakfast, shower, get ready. We'll jump in the car, pick up friends and family in D.C., then head to the stadium. Right before I get to the stadium, Alex gives me a call. He's warming up on the field. We do our little pep talk. We always say the same thing, "Love you," then hang up. It's football, and though Alex is only 34 at this point, it's his 14th year in the league.
Everyone is tailgating and having a great time. We head into the stadium for kickoff. And that day was just like any other game.
Until, the play. We all stand because we realize it's Alex down. He's lying there and I see that he grabs for his leg. I'm thinking, is it his ankle? Is it his knee? Our 7-year old, Hudson, tugs at me. I look down and he's welling up with tears. He says, "Mom, the cart's coming." And he knows that when the cart comes, it's serious. To everybody else, this is a player that's down. Cart's coming. Game's gonna go on. But for me, our children, Alex's parents, this is more than that.
Alex Smith Alex Smith suffered a spiral fracture that started down in the ankle joint and spiraled all the way up through the tibia to the knee.
My in-laws take the kids, and I head to the tunnels. When I get down there, I hear screaming. In the medical room there are people crowded around Alex -- the doctors, Mr. Snyder, all the medics. Alex screams as they try to readjust his leg. I've never seen him like that before. But in my mind, I'm just thinking let's go. Let's get him on that ambulance, get him the surgery, get this fixed.
As we ride in the ambulance, Alex says, "Pull up the score. How's Colt doing?" He wants to know all the formations. This is typical Alex. He's worried about the team, which is still in first place at 6-3, and how they are doing. He wants to make sure everyone else is OK.
They are ready for us when we get to the hospital. There's a trauma bay open and they get imaging of his leg. Dr. Michael Holtzman is working that night. Dr. Malekzadeh is on call. Dr. West had said to us on the way in, "If you have any trauma, these are the best two guys you want working."
Before Alex goes into surgery, the doctors show us the CT scan and say, "This is a really severe fracture." It's a spiral fracture that starts down in the ankle joint and spirals all the way up through the tibia to the knee. And the fibula is broken. Because of the length of Alex's tibia, they are going to have to put in a few plates and quite a few screws. "It's pretty common practice," they tell us. "You'll go in there, maybe be in the hospital for two days, do a little bit of rehab and then you're on your way."
After surgery, the doctors say it went as well as they could have hoped and everything looked good inside his leg. The bones are lined up great. I even have pictures; it looks beautiful. Since Alex had suffered a compound fracture (a complex fracture with the bone breaking through the skin) they say there is a risk of infection. They had pulled out a little bit of dirty sock from the wound. But, he's on antibiotics.
Alex has a mild fever and is in a fair amount of pain the next day but that was to be expected with a huge fracture repair involving three plates and 20-some-odd screws and pins. The doctors say they will probably keep him on some form of pain medication for the next couple of weeks and we expect to head home on Tuesday.
But Tuesday afternoon Alex is still having a fair amount of pain and running a mild fever. Dr. West stops by to see him before she heads out of town with the team for a Thursday game. Dr. West says, "Why don't you just stay one more night?" Alex resists; he just wants to get home and sleep in his own bed, but Dr. West convinces us to stay. Thank goodness she did because that night he spikes a high fever.
Dr. Holtzman comes in the next morning and unwraps his leg and says it looks pretty normal. Blisters are normal, bruising is normal. But throughout that day, Alex gets progressively worse. By Wednesday night, well, we know we're not going home.
Elizabeth and Alex Smith Alex came home with a PICC line, a device used to give treatments, including intravenous fluids, in his arm.
Saving a leg The doctors make it their mission to save Alex's life and his leg. They say, "You know what? We're going to go in every single day." And for a week they go in every day for a debridement -- cutting skin, tissue and muscle -- until the infection is gone, until they 're certain.
At night, I sit with Alex, not sleeping, and they come in with a pen, a Sharpie. And they write over his leg, where the infection looks to be tracking up. Every 20 minutes another resident comes in and writes -- it's coming up a little bit further. And eventually they take him into the operating room to cut into his thigh to see if the infection is actually moving up that high.
As I'm sitting there watching the infection move up his leg, I'm just trying to make sure that my husband's life is not in danger. I understand now, from the doctor's perspective, had they amputated at the time, it would've been above the knee. And it's a different quality of life whether you amputate above or below the knee.
Thankfully, the necrotizing fasciitis never gets above his knee. Alex still has his leg ... well, what remains of it.
After eight debridements, Alex has this completely exposed tibia. He has no anterior compartment. He is missing everything from his knee to his ankle and from side to side. The way the doctors explain his situation is Alex no longer has a sports injury. He has what would be more comparable to a military blast injury.
Alex doesn't look at his leg. He doesn't want to see it.
At that point, Dr. Vineet Mehan, the plastic surgeon, comes in with the orthopedic surgeons and says, "Here are your options. We want to lay out everything you could do."
For the first time Alex is really awake and listening.
"Obviously, one is amputating."
"Two is a muscle transfer. One transfer option would be your lat."
Alex said: "You're not taking my lat. I need that to throw. It's everything. You can't take my lat."
It had to be a large muscle because Alex's tibia was so long.
"We can take part of your quad on your left leg."
"Well, if that's the option, let's take the quad."
Alex Smith The doctors make it their mission to save Alex's life and his leg. He would undergo 17 total surgeries and four hospital stays over nine months.
But they also tell him it might not work. In addition to transferring the muscle, you have to connect arteries and veins and all these things. It's microvascular surgery. And when you do that, like an organ transplant, it's not guaranteed to take. If it doesn't take, you're going to an amputation. And if you have an amputated right leg, now your left leg is weakened. You have to use that leg for the rest of your life.
"It's not to say that you couldn't be athletic and have a prosthetic because there are amazing athletes that have prosthetics," the doctors say. "But we wouldn't want to try that surgery and -- if it doesn't work -- weaken the leg that you would have to use for the rest of your life as the strong leg."
But we're thinking we wouldn't want to have them try that surgery and -- if it doesn't work -- weaken the leg that Alex would have to use for the rest of his life as the "strong" leg.
Alex's parents and I look at each other. "What do you do?"
Alex is participating more in the conversation and he's a fighter. Give him a challenge and he wants to go. As soon as he hears about the transfer, he's like, "Let's do it. Let's go."
After the muscle transfer surgery and a week of recovery, Alex is finally discharged home in a wheelchair with his leg fixated upward. It's now two weeks before Christmas.
The first few weeks out of the hospital are hard. We had to outfit our house to be wheelchair-accessible for Alex to get around. He can't let his leg down. He needs help with everything, whether it be to get out of bed or go to the bathroom. He can't really shower. Alex came home with a PICC line, so I give him his antibiotics every day. The kids all want to care for him, too.
Every time I line up the meds for his shots, our daughter, Sloan -- 2 years old at the time -- helps me push the shots. Our boys help push Alex in the wheelchair. If anyone comes over, our middle son, Hayes, says, "Don't go too close to my dad's leg." He has hand sanitizer ready. They understand. They're just so excited we are all together again.
Once Alex starts bearing weight on his leg, he begins going to physical therapy five, sometimes six days a week. Some days he'll finish PT and say to me, "I think I want to head out to the practice facility and get a little more upper-body work in." His mental fortitude is ridiculous. He pushes himself every day.
It's absolutely incredible how far he's come.
Elizabeth and Alex Smith Elizabeth says Alex needed "help with everything, whether it be to get out of bed or go to the bathroom."
Looking forward Between the debridements, the muscle transfers and microvascular surgery, the skin grafts, the external fixator shortening and removal, and, finally, the replacing of the large circular bone-stabilizing frame with a titanium rod, Alex would undergo 17 total surgeries and endure four separate hospital stays over a period of nine months.
There's no doubt that this has been a challenging time, especially for Alex. But through it all, he has kept great perspective. At one point when we were in the hospital, shortly after he had come so close to losing his life, Alex told me out of nowhere that everything was going to be OK.
"Do you know how many people would love to trade positions with me?" he said at the time. "Millions of people would love to be where I am right now. Do you know the life that we live and the blessings we have?"
"What?" I said, in disbelief.
"And we can't take it for granted, not even for a minute," he said. "Perspective."
I had to admit he was right.
As I think back on the experiences of the last 15 months, I feel so fortunate. We had so much support from family and friends who helped us, especially with the kids, by just loving them and wrapping their arms around them. It's not to say that we weren't there, because they saw us every day. But they helped keep the kids' lives as normal as possible, which was so important to me. Early on there were many nights I spent at the hospital, and I became friends with a lot of nurses. And the doctors were amazing -- they genuinely cared. There were days we all broke down together and days we all cheered and laughed.
Alex Smith Elizabeth on Alex returning to football: "I know at the end of the day this is his fight -- physically, emotionally and mentally. ... And I support him."
Alex and I joke that everyone wants their daughter to grow up to be Dr. West. Not only is she an incredible doctor, mother, woman -- she's a friend. Dan Snyder and the entire Redskins organization have been incredibly supportive throughout the entire process, ever since the moment Alex was injured. I don't think I could ever have imagined a better team than what we were given.
There have certainly been moments along the way that have reinforced the concept of perspective. Traveling to the San Antonio Military Medical Center, for instance. What a humbling experience. It just put Alex's injury in a whole different light. There have been so many soldiers who have had this type of injury. And it is because of them -- not only fighting for our freedom but through their injuries, the medicine and the technology learned as a result of caring for them -- an athlete is reaping these benefits. It's incredible.
It may have been intimidating for Alex at first when we arrived. He said, "There are people here that are Army Rangers, Special Forces ... do you know what kind of badasses they are?"
They're doing things that an NFL player couldn't do. But they had that mental fortitude and that perseverance; they were going to get through it. And I think it gave Alex that extra little, "I can do this. I got this." I don't think it's easy for anyone, especially an athlete to go from the peak of your profession to not being able to walk. I think you need motivation to get back to that spot. To watch him light up, to get that inner drive again, it was pretty awesome. On the way home from San Antonio was the first time since the injury that Alex talked about playing football again.
When I think about Alex returning to football, there's part of me that wants him to do whatever he has the inner drive to do. If that means stepping back on the football field and throwing on those pads, then I want him to prove that to himself. But obviously there's part of me asking, "Is it worth ever doing that again? Do you know what we just went through?"
But, I know at the end of the day this is his fight -- physically, emotionally and mentally. I want him to have something to fight to get back to. And I support him.
6. "If a person's past is preperation for their future" In response to Reply # 0
Then he was prepared for this in some way.
Granted being a professional athlete is not directly like recovering from a potentially life ending injury. But Alex has had to push along in his career against some real sports-adversity (multiple coaches not knowing how to maximize his ability, finally breaking thru in San Fran and then being passed over there and in KC). He's had to believe in himself simply because very few people did.
And that mental muscle is guiding his life back to normalcy.
The part that stood out to me was his perspective when the course of his life could have turned tragic. I don't know if he felt that way because he believed it or he had to in order to calm himself. But seeing someone in that situation see the potential in his situation is remarkable.
I used to diss him because he didn't turn out like Rodgers, the other QB taken in that draft. But he seemed to carry the doubt about his football ability well and it's refreshing and heartening to see someone's character remain intact while life isn't at its best.
He's a good guy by all accounts and it would be nice to see him back on the field at some point.
7. "Man i haven't been able to read anything or watch anything about it" In response to Reply # 0
i know it is that gruesome of an injury and happening to probably one of my top 5 favorite players of the last ten years. I was at the catch 3 game and that was one of the most fun experiences of my life. Dude was a gem for the people of SF outside of football and has been the consummate professional his entire career. Part of me wants to see him make it back but the main part of me wants him to be safe and healthy and i hope he just lets it go and lives.
10. "Cleared by his surgical team for full football activity (swipe)" In response to Reply # 0
Friday, July 24, 2020 Washington QB Alex Smith cleared by his surgical team for full football activity By Stephania Bell
Washington quarterback Alex Smith, who suffered a devastating tibia and fibula fracture in 2018, has received clearance from his surgical team to return to full football activity.
Smith, who spoke to ESPN while filming an update for his E:60 documentary, "Project 11," is in the process of going through COVID-19 testing and expects to report Monday to the team's facility, where he will undergo a team physical.
Once there, the team is expected to determine the next steps for Smith's eventual participation in training camp.
Smith and his family spent the past few months in Hawaii, where he continued to train and prepare for the coming season. While he could sense that he was continuing to progress as far as his strength, conditioning and agility were concerned, he said it was impossible for him to know just how well the bone itself in his right leg was healing.
In an effort to answer that question, Smith underwent another round of imaging, including X-rays and a CT scan upon returning home to Washington. His team of doctors -- including orthopedic trauma surgeons Steve Malekzadeh and Michael Holtzman, plastic surgeon Vineet Mehan and head Washington team physician Robin West, as well as Dr. Joe Alderete from the Center for the Intrepid (who served as a consultant throughout Smith's post-operative care) -- discussed the imaging results before meeting with Smith and his wife, Elizabeth, to share their findings.
"Everyone was in agreement that my bone was in a really good place," Smith told ESPN. "I had healed a lot. They said that given the combination of the rod and where I was with the healing process, I had zero limitations and could even resume some football activities.
"To hear them say that, from a life standpoint, they wouldn't restrict me from doing anything -- I could go skiing or snowboarding tomorrow if I wanted -- then on top of that, to get the green light that I could practice, get contact, that I had healed up, that much was pretty wild to hear. I didn't know if I would ever hear those words."
The 36-year-old Smith, whose contract runs through 2022, acknowledged that this is just the first step, albeit a critical one, in the process of trying to return to football.
"For me, all eyes are on practice," Smith said. "That's the next step. I have to go prove to myself and certainly to everybody else that I can go practice."
Smith also touched on current issues the Washington franchise is facing, among them the team's commitment to rebranding after dropping its nickname.
"As football players, you sign up to play football, you love it and everything that comes with it," he said, "but the logo you wear on the side of your helmet, the name on the front of your jersey, it is a part of it. So I'm really proud of the organization for making a change, as I think all my teammates are. I am excited about new beginnings, excited about the new coaching staff, getting back to winning ways. But as I said, I'm proud of the organization for making the change."
He also said he was "embarrassed" and "disgusted" by the recent Washington Post report about 15 women who accused team executives of sexual harassment.
"We're football players and out on the field, but there are a lot of parts of the building that go into game day and a season and the whole business side of the building, and to hear that some of this had been going on, I certainly don't think players ever knew about it. But it's not something any of us are proud of, and it needs to be changed," Smith said. "I have a wife, a daughter, two sisters, and to ever think about something like that happening to them disgusts me and pisses me off; so hopefully, we get to where we need to be -- an environment and a culture that's acceptable for everybody and lets everybody thrive and is safe for everybody."
11. "man, these dudes are truly, different..." In response to Reply # 10
I’m terrified at the thought of him even being tackled, again. Listening to him on Bomani’s pod...detailing all the grueling work he had to put in, just to get back to here...cats are a on another level.
...cleaned up my act, made a few violent songs...but, they wack like Glen Rice with New Balance on - Sean Price
12. "This guy had a torsion fracture from the ankle joint " In response to Reply # 0
All the way up to the knee, and it was a compound fracture because it broke the skin, and the fibula was also broken. I wonder if Joe Thiesman went through a similar thing with his leg fracture.
All the muscles and skin was removed from the anterior part of his leg, dude had no compartment.
The crazy thing is when they told him they needed to take some muscle from a part of his body, and they recommended to do it from from the Lat, he said no. He stated that he still needed to be able to throw. Dude’s life is on the line, and he is thinking about getting back on the field....He has a strong mind and body, and I guess that is the frame of mind of a football athlete.
Is it really worth it at the age of 36? He will have a screw and a rod in his leg for the rest of his life. You have a second chance to walk and run with your kids. Football is just a luxury, and he has already proven the critics wrong. That’s why coaches, advisors, etc, have to come in and make the right decisions, and look out for the health of the player. A player will run through a tree if you let him, and think he can do it.
Wish him the best, but he should just move on to coaching.
14. "Dude has earned plenty of money. The logical move is to walk away" In response to Reply # 12
>Wish him the best, but he should just move on to coaching.
This reminds me of an old Friends episode where Monica was dating a CEO who wanted to be an MMA Champion (played by Jon Favreau). He refused to quit until he became champ, but he just kept getting pulverized.
Alex Smith has taken more of a beating than any QB deserves to take - the Mike Nolan/Mike Singletary years were hard to watch as a Seattle fan. There were literally times where, as an opposing fan, I was hoping we would stop wrecking this dude because it felt like a snuff film. Then to have it end in Washington on such a brutal injury...
He needs to walk away with the rest of his life in tact. Best of luck to him in his journey either way.