Steve Young took the first hit on his chest, just under his chin and at the top of his red No. 8. Then, in whiplash action, the back of his helmet caromed off a teammate's knee and the grass surface of Sun Devil Stadium in Tempe, Ariz.
Just like that, the intense quarterback for the San Francisco 49ers was revisiting no-man's land last Monday night. Out like a light for several long seconds, Young's past and future conspired to paint one frightening picture of a proud athlete on the edge.
When consciousness returned, Young found himself back in the center of a controversy over how to deal with an injury that endangers wide receivers and defensive backs as well as quarterbacks. His fourth concussion in three years focused attention on how sports leagues handle concussions and whether athletes should have the final say in deciding when -- or if -- they can resume playing.
For those seeking signs of progress in the NFL, there is this. In 1997, when Young was kneed in the head in the first quarter at Tampa Bay and suffered his third concussion in 10 months, he was allowed to re-enter the game in the fourth quarter.
On Monday, when he was knocked out of a game against the Arizona Cardinals on a clean but fierce hit by Aeneas Williams, he was not permitted to return. Although he tried.
"He asked me [to go back in]," 49ers coach Steve Mariucci said the next day. "I simply said, `Steve, you're not going in.' He says, `I can play.' The doctor was there and I said, `Doc, what do you think?' He said, `Hold him out.'
"I told Steve to stay out. He's a lawyer, he's going to debate, he's going to negotiate, he's going to try and convince you that his point of view sounds good."
In the rush to return to action, oft-concussed quarterbacks like Young and Troy Aikman of the Dallas Cowboys are caught in the middle of a riddle. Do you play on or do you play it safe?
And who ultimately makes the decision about when and whether an athlete can return to the field for practice or a game when he has had a head injury?
In Young's case, as with most players, it is a combination of opinions.
Doctor and patient
"I think the doctor has the predominant say because they have the most experience and as much diagnostics as possible," said Young, who has been ruled out of today's game against the Tennessee Titans and perhaps next week's game at St. Louis.
"And I have a lot of say, too. If I'm honest with myself with what happened and what has happened [in the past], then clearly you talk to your family, your girlfriend, and all of the people that are really important to you."
It is equally clear that evolving research needs to arrive at an agreed-upon protocol that makes it more difficult for the star player or the obsessive coach to second-guess or overrule a medical decision.
Scientific research has established that once a player has a concussion, he is more at risk in the next game, week and season. That makes an impartial decision more vital. One of the problems with the system now is that the injured player does have a voice. And denial does play a role.
"Certainly, athletes in general -- especially elite athletes -- have a much stronger sense of invincibility than the rest of us," said Dr. Andrew Tucker, a team physician with the Ravens and director of primary care sports medicine at University Sports Medicine at Kernan. "Whether it be a head injury or a muscular-skeletal injury, their acceptance of that comes a little slower.
"On the other side of the coin, you're talking about an injury that does affect judgment. It's like trying to figure out a person's judgment when they're under the influence of alcohol."
Many careers ended
Concussions have driven any number of players from the game, among them quarterbacks Roger Staubach and Stan Humphries and wide receivers Al Toon and Don Beebe. In a book written by Ronnie Lott, the former 49ers safety estimated he had no less than 12 concussions in his career -- and lied about his recovery to get back on the field.
Aikman suffered the seventh concussion of his career in a 1997 game against the Philadelphia Eagles, and played the following week against the 49ers.
Humphries was forced to retire from the San Diego Chargers after the 1997 season, when he endured three concussions in two months, and two in successive weeks. The one that ended his career came after a hit under his chin by Cincinnati's Reinard Wilson.
"It was one of the worst," said Humphries, who estimated he had between 10 and 12. "I lost a little feeling in my right leg for an hour or two. It was real scary. That was the last time I was on the field."
The list of concussion patients this season already includes some prominent names:
Miami Dolphins linebacker Zach Thomas suffered one in a preseason scrimmage Aug. 1, and when he tried to come back a few days later, saw flashes of light when he made contact. He sat out two weeks of training camp but missed only one preseason game.