NEW YORK — Thursday, when Toronto Blue Jays shortstop Bo Bichette was hit in the helmet by a 93-m.p.h. fastball, he was up off the ground and heading to first base before his manager Charlie Montoyo had even reached home plate. Montoyo had to pull Bichette back by the arm and force him to confer with Toronto’s head athletic trainer Nikki Huffman.
See, Bichette doesn’t like coming out of games. If he can play through something, he will. A few weeks ago, he fouled a ball off his leg that left his shin black and blue. He didn’t miss a plate appearance. Three years ago, during his first season as a professional, an 18-year-old Bichette played weeks with an appendix on the verge of rupturing. He had 35 hits in 22 games that year.
But no athlete should be reckless with a potential brain injury. So, Bichette conferenced with Huffman and Montoyo for a few moments to make sure everything was copacetic. He felt fine, and said as much — even cracking a couple jokes. The ball had caught the bill of his helmet, not the side, so maybe it was just a close call. Remaining in the game, he ran hard from first to third without issue minutes later. He even made a strong play in the field during the bottom half of the inning, changing directions while charging in to barehand a dribbler before firing strongly and accurately to first.
But the tough thing about a concussion is its symptoms don’t always present themselves immediately. It can take as long as 24 hours. And while Bichette felt fine initially, his brain was not. It finally caught up to him in the on-deck circle prior to his next plate appearance. He felt groggy, nauseous. Like things around him were strangely slowing down.
Huffman noticed that as he stood in the on-deck circle, Bichette didn’t take a single warm-up swing. She thought that was pretty unusual. Then, after he struck out on four pitches, missing a couple of them badly, Bichette walked slowly back to the dugout where Blue Jays first baseman Justin Smoak asked him if everything was OK.
“I was like, ‘I don’t know, man — I feel weird.’ And he told me, ‘Hey, this is nothing to play around with,’” Bichette said. “So, that’s when I decided I probably should let somebody know I felt different.”
Having never experienced one before, Bichette wasn’t familiar with the symptoms of concussion. He was confused, wondering if he was tricking himself into feeling that way. Maybe he was just expecting to have some aftereffects from taking that fastball where he did. But when Huffman heard what Bichette was experiencing, she immediately got him out of the game and quickly confirmed Bichette had suffered a brain injury.
Now, nearly 48 hours later, Bichette spends much of his day with a headache. He’s having trouble getting to sleep. He’s more tired than usual and sometimes nauseous. He’s been improving slightly over time, but he’s still not feeling like himself. Saturday, the Blue Jays lost to the New York Yankees 7-2. Rather than watching from the bench where he’d be exposed to the unpredictable noise of the Yankee Stadium crowd, Bichette watched from the locker room on a television with steady volume.
“Yeah, it sucks. I’ve never had any head injuries. But, obviously, you’ve got to be careful. You’ve only got one brain,” he said. “For me, it’s just trying to be as smart as I can with it. Talking to my parents and stuff, they’re very concerned about how quickly I come back and how I’m feeling. Because I’m the type that will say that I’m feeling good when maybe there’s still a little bit to go.”
Bichette isn’t the only one. Professional athletes are famously brazen with brain injuries, often destructively so. It’s part of the reason why all major North American leagues have instituted concussion protocols.
Per MLB’s policy, when a player takes a blow to the head, there’s a standardized list of questions the club’s training staff will ask immediately following the incident. Do you know where you are? Who are we playing? Who scored last? If they clear an initial assessment and continue playing, the athlete will be asked how they’re feeling after every half-inning. Have you developed any headaches? Are you experiencing any nausea?
If symptoms do develop and a player is diagnosed with a concussion, the training staff asks the athlete a six-page list of graded questions that produces an overall percentage meant to objectively reflect how severe their injury is. Following that initial evaluation, the athlete is asked around 30 of those questions each day to measure their recovery. Some of the questions are broad. Are you feeling not quite right? Are you having difficulty concentrating? Some are emotional. Are you sad? Are you irritable? Each question is rated on a scale of zero to five, from none to mild to severe.
“Usually, over the first 24 hours, they get a little bit worse — the symptoms increase because their brain is chemically trying to return to homeostasis,” Huffman said. “And then they’ll start to improve from there.”
That’s where Bichette is improving, but still symptomatic. His answers to the questions are telling Toronto’s staff that he’s not yet ready to attempt to return to play. Once he is, he’ll progress through a series of physical exercises at varying intensities and see how he feels. He’ll get his heart rate up on a bike, run sprints, hit, throw — and he’ll have to be asymptomatic after each test in order to proceed.
Then, there’s a neurocognitive impact evaluation completed on a computer. The Blue Jays baselined Bichette’s results on that test when he was drafted and have updated them intermittently since. He’ll have to reach or surpass that baseline in order to demonstrate his brain’s operating the way it should. Only then can he be cleared by Dr. Gary Green, MLB’s Medical Director, to return to game action.
But that won’t be all for Bichette. The Blue Jays have their own internal concussion assessments for him to clear, including vestibular ocular motor tests he’ll need to undergo before he returns to the field.
Similar to the neurocognitive impact evaluation, Bichette will have provided baselines during spring training on a number of vision and reaction tests that he’ll have to reach again. That will assess how Bichette’s eyes are working in concert with his brain, and whether he’s able to perform on the field at the level he did prior to the injury. There’s a difference between health and performance, and while MLB’s concussion protocol is thorough, it mostly assesses the former. The Blue Jays protocol helps address the latter.
It’s possible that an athlete can be asymptomatic and cleared to return to games while still experiencing residual effects that impact their ability to perform the many fine motor skills baseball demands. Think picking up the spin on a breaking ball. Or using depth perception to judge a groundball coming in at a high rate of speed. It’s one thing to be healthy enough to play. It’s another to be able to perform at a high enough level to compete in MLB.
“He has a lot of hoops to jump through,” Huffman said. “But you can jump through those in as little as a couple of days or as long as weeks and months, depending on how you do with each of them. He’s still in the symptomatic part. He still has some symptoms today. Those could go away tomorrow, they could go away in a couple days, or they could go away in a couple weeks. Everyone’s different.”
Considering all that, it’s impossible to say whether or not Bichette will play again this season. Of course, he’d like to. But he also would’ve liked to remain in the game when he wasn’t feeling right. There was a time not that long ago when Bichette’s approach to this injury would have been much more reckless, thanks to the prevailing ignorance of brain injuries — and needlessly macho attitudes — across sports. But like Smoak told him, a concussion’s nothing to play around with.
“I would say, probably back in the day, if nothing hurts physically in your body, then you should play. And, to be honest, that’s kind of what I was thinking, too. When I started to feel it, I didn’t really want to come out of the game. But obviously, some people noticed some things and I couldn’t really hide it anymore,” Bichette said. “And I’m thankful that Smoak came up and said that to me. Especially with him being the veteran voice, to tell me to go say something — that kind of gave me the OK.”