So UFC welterweight champion Georges St-Pierre is disappearing from the fight game for an indefinite and unspecified period of time, relinquishing his title and taking time to rest from a career that's seen him spend more time fighting in the UFC than anyone else ever has. Whether or not he ever returns, this clearly marks the end of an era, during which St-Pierre emerged as the representative of all that's best about a very dirty sport—never more so, perhaps, than when he made the decision to say that enough was enough.
Just a few weeks ago, after a successful title defense in which he took a terrible beating from challenger Johny Hendricks, we all saw a visibly disoriented St-Pierre working his way through a worrisome post-fight interview with Joe Rogan, and an even more worrisome press conference. He admitted to forgetting part of the fight, confessed to having trouble seeing, and repeatedly and emotionally alluded to his need to take time off. Memory loss, vision trouble, and emotional lability are all symptoms of a concussion. It felt darkly foreboding.
Being rightly concerned doesn't make you right, though, and so I recently talked to Dr. Margaret Goodman. She's been a ringside physician and chair of the Medical Advisory Board of the Nevada State Athletic Commission, and currently serves as president and chair of the Voluntary Anti-Doping Agency (VADA). I wanted to know just what she made of it all. Was St-Pierre showing signs of brain damage? Did he take an unusually severe beating? Did Hendricks ruin him? Should this man retire?
"I didn't watch the fight," she said.
We were off to a great start.
As Goodman had it, though, she was better off not having seen it: The limited shots provided by television coverage offer a skewed perspective, a distorted view of events. She did, however, watch St-Pierre's post-fight interviews, and the observations she made are the ones you want; in addition to working with St-Pierre through his participation in VADA, Goodman has also worked his fights. That's important, because if we're going to talk brain injury, it's vital to be able to compare a fighter's current presentation to his or her normal state.
I mentioned my concerns about St-Pierre's statement that he couldn't remember all of the fight. On the one hand, it seems unlikely that anyone would be able to remember an entire fight after sustained blows to the head; on the other, memory loss can signal serious problems. So, is this just business as usual?
"Is it normal for fighters?" she said. "I'm not sure. But what I can tell you is that it's very unusual for fighters to state such things."
Boxer Timothy Bradley, for example, generated quite the response when he openly discussed the damage sustained during his massive brawl with Ruslan Provodnikov. Months later, he announced on HBO's Fight Night that the fight left him with slurred speech for two months.
"It was really interesting listening to him. He had poor memory of what happened after the specific round, and he was very forthright talking about it," she said. "The bad part of this situation is that most fighters won't talk about it."
Watching St-Pierre's defense against Hendricks, it was hard to see how he could not have been damaged by clipping he took. He had that look that remains disconcerting no matter how well fans of the sport come to know it: a certain slackness smooths the face, the jaw ever so unclenched as the fighter shakes off the fog. Sometimes it clears; other times, it's followed by a series of loping, last-ditch efforts to remain cognizant before succumbing to the inevitable. It's the prelude to the drunken stumble of a knockout. You always know it when you see it.
Getting his bell rung. Seein' stars. Shaken up. Right on the button!
"Either the guy is just so into the fight he doesn't have a good remembrance of what actually is taking place, or it's actually symptoms of a type of amnesia that occurs with a concussion," said Goodman. "You can say to yourself, 'Well, wouldn't a fighter get a concussion every fight?' In some respects, that's a possibility, but it's a question of the degree of the concussion, if it really does exist."
A concussion, essentially, does to your brain what an improper shutdown does to a computer. The human body is, among other things, a sack of wet electrics, and slamming your brain into something hard can momentarily disrupt cellular electric activity. When the brain boots back up, things may not be working properly; much the way a power surge causes that unsaved file to blink out of existence, a concussion can bring about memory lapses and headaches. Other hallmark symptoms of a concussion include issues with concentration and cognition, sleep disturbances, emotional lability, and physical symptoms such as sensitivity to light or noise, nausea and vomiting, and issues related to balance, sight, and fatigue.
St-Pierre seemed to describe several of these symptoms, enough for anyone to be concerned about what was going on with him. But Goodman was less worried than you might think.
"Listening to Georges St-Pierre after the fight, irrespective of the comments that he made," she said, "I thought he spoke very clearly. I think he spoke well, he didn't sound confused. He's not the easiest guy to understand, but I thought he sounded pretty good."
OK, speaking clearly, that's good. What about his emotional state?
"Many would maybe state that he sounded over emotional, but you know, after examining thousands of fighters after a fight, I don't think that's all that unusual when you've gone through the stress of preparing for a bout. It's a very emotional sport, as you might imagine, not just because of the inherent risk, but because of everything they do to prepare for this one, isolated event."
One thing was sure: after the fight, St-Pierre looked really rough.
"He does have that kind of skin that bruises or cuts more easily than some individuals," she said. (This inside information made me feel cool immediately; the feeling was just as immediately replaced with intense curiosity as to where my own skin falls on this secret skin injury scale.)
Perhaps some of his cuts and bruises were due to his stated inability to see out of one eye. Given the need for two eyes to judge distance, having one out of commission seems like an awful way to land and dodge blows. So what about St-Pierre's admitted vision troubles?
"If a fighter tells you they can't see, that is complete indication to stop a fight."
Oh. Shit.
"It could be from a retinal detachment or damage from the cornea," Goodman said, "or it could be they got thumbed in the eye or they got Vaseline in their eye. So there's a whole bunch of different reasons for that, but if a fighter tells you that they can't see, you have to stop the fight no matter what. I'm sure he never mentioned that to anybody, otherwise it would have been a different situation if either the referee or the physician knew that."
The paradox of the ringside physician is that you're caring for patients who are in the process of being injured and do not want it to stop. Frankly, it seems a little bit impossible. How do fight doctors do it?
"There's a whole bunch of things that you have to consider," said Goodman. "Number one, you have to try as best you can to know that fighter. It's just like a doctor in their office, the first time a patient comes in, it's more difficult to examine them and figure out what's going on if you don't have history."
Her voice sharpened as she castigated the sport for failing to widely share medical records between jurisdictions. The combination of wildly differing standards of care amongst the state athletic commissions and the poor availability of medical histories places the fighters at undue risk. And if not having access to medical history is bad, the time physicians spend with fighters makes things worse. Fight physicians have to work fast. Really fast.
Here's how it works. The pre-fight exam typically takes a few minutes. It's completed at the weigh-in and covers blood pressure, pulse, a quick listen to the heart, as well as a once-over of the lungs, eyes, ears, nose, and hand.
Next comes the fight. It's like pressing pause on a car accident to check a laceration, and then letting the car crash once the cut passenger has been cleared. It sounds brutal, but let's be honest: The passenger wants to finish the crash, and millions of people want to watch it. Fighting for entertainment is brutal, and it's a disservice to the athletes to pretend it isn't.
And then the fight is over. Sometimes, the post-fight physician has been able to watch his or her patient in the ring. Other times there's just one physician back in the dressing rooms, tending the card, seeing fighter after fighter. As you might expect, post-fight exams are speedy affairs as well, and the emotional nature of what's going on doesn't make anything any easier.
"As a privately practicing neurologist," said Goodman, "I can tell you that when someone comes in after a car accident, their adrenaline is pumping and it's common for them to not notice symptoms."
After the fight, the ringside physician may run into the ring or cage and see how they are doing. This is a check-in that, if it happens at all, usually lasts for 20 seconds or less. Then, a doctor examines the fighter in the back, and may do nothing unless the fighter has complaints. It's all symptom driven; the doctor might ask about hands, face, head, eyes, but everything moves very quickly. A few minutes is all it takes, after which follow-up tests might be recommended, and the fighter will be sent home or to the emergency room.
A beat-up fighter, though, victorious or not, is not going to be in the best state to be thoughtfully self-referential. This is a problem. Which brings us back to St-Pierre. After the fight, I remember him wet and purple and swollen and emotional, standing there next to Joe Rogan, reaching for the mic like a very polite drunk person. And it was in this state that he did something most unusual. He was honest.
Goodman loved this.
"How brilliant is that? It's like the smartest thing he could do."
She was effusively supportive, noting that he's one of the few who could speak so honestly, and quick to condemn the angry backlash to St-Pierre's statement. "For someone to criticize that, it's absurd to me. I think more power to him. I wish more fighters would take the time to know their own bodies and brains."
And this is the problem. Fighting is a sport in which someone as highly credentialed and experienced as Goodman can look at the same post-fight interviews that horrified hardcore fans and see nothing especially unusual. The sport itself is so damaging that it's nearly impossible for an observer to objectively assess whether or not the damage it's doing is too much for the fighter. That's a decision for him or her to make.
There's no union in the fight game, no federal commission to oversee the sport. The availability of medical records is abysmal, the exams to qualify for a fight license vary wildly, and the burdened post-fight doctor has mere minutes to assess a fighter's medical state. With so much at stake, the pervasive cult of silence about the consequences of a fight hurts, more than anyone else, the athletes who get out there and beat each other senseless for the enjoyment of millions of viewers. Fighters, perhaps those best conditioned not to do so, are also perhaps those who have the most to gain by telling doctors exactly where it hurts.
"I think it's sad," said Goodman, "that these guys have to pretend to be so tough, even to themselves."
Leigh Cowart is a freelance journalist covering sports, science, and sex. Her work has appeared in Vice, The Classical, and NSFWCORP, among other places. Follow her on Twitter @voraciousbrain. Not for the faint of heart.
Art by Sam Woolley