MARLBORO, N.J. -- The character is still in there.
Five years after Preston Plevretes' brain crashed against his skull in a collision late in a football game at Duquesne University's Rooney Field -- a traumatic brain injury atop a previous concussion -- his speech is a breathy groan, his steps are herky-jerky, his vision is a dark tunnel, and his days are filled with therapy.
Through it all, Mr. Plevretes, 24, remains the class clown, the cut-up, the merry prankster.
He watches National Football League games intently on Sundays, quick to teasingly text his weekday home-health aide when her cherished New York Giants are losing.
He signs into therapy sessions at CentraState Rehabilitation Center in nearby Freehold, N.J., as Santa or Elvis P.
He loves to laugh his throaty, repetitive honk of a guffaw.
But he lives to provide a painfully serious example.
His is the face of second-impact syndrome, said physician Robert Cantu in his deposition on behalf of the Plevretes (pronounced "Plev-REET-ees") family in their lawsuit against LaSalle University, where Mr. Plevretes played football. It is a dread syndrome that so far is found only in those college age or younger, whose brains don't reach maturity until around age 25. A second impact on top of an unhealed concussion causes blood vessels to fail and the brain to swell so violently that within days an athlete can end up in a wheelchair or a coffin.
The study of concussions and second-impact syndrome is gaining new urgency as doctors, players and parents better understand the injuries. NFL Charities two weeks ago announced a grant to University of Pittsburgh Sports Medicine to partner in researching concussions in youths, and the dozens of known cases of second-impact syndrome remain under study elsewhere. As a result, experts consider its precise definition hazy, given final results ranging from brain bleeds such as Mr. Plevretes' to the mild traumatic brain injury of fiber damage and metabolic crises.
There wasn't a recognizable name or a widely accepted diagnosis for what happened on Nov. 5, 2005, when Mr. Plevretes, a 6-foot-2, 230-pound LaSalle linebacker covering a punt, collided with a 215-pound Duquesne player at the visitors' 37-yard line and never got up.
Mr. Plevretes, then 19, had been diagnosed with a concussion at a hospital near his home in central New Jersey following an Oct. 4, 2005, helmet-to-helmet hit in LaSalle practice, his parents said.
Soon after he went back to school in Philadelphia, he was cleared by a campus clinic nurse and allowed by the team trainer to return to play -- despite throbbing headaches that he disclosed to only a few friends.
Then, on The Bluff, came the collision that rattled his brain, his life, his family, perhaps even college football forever.
LaSalle reached a $7.5 million settlement with the Plevretes family 13 months ago. A LaSalle spokesman declined comment for this story, referring to its settlement news release from November 2009 that, in part, read: "... the University does not believe that it would serve any purpose to engage in further discussion about the matter." Days after the settlement, the National Collegiate Athletic Association began mandating changes in concussion policy throughout college football.
"It's so important ... ," said his mother, Tammy Plevretes, her hands on the shoulders of her firstborn as he sits in the wheelchair he requires when he grows weary. "So important for these kids -- and parents, coaches, trainers, everybody -- to understand that it's real."
"Yes," Preston Plevretes added for emphasis.
"We're very passionate about it," Mrs. Plevretes continued. "We don't want anybody else getting hurt. Football took his life away, but he still loves the game."
Mr. Plevretes, his surgically repaired brain and partially paralyzed tongue struggling to monitor air passage from his diaphragm and through his sinuses, pushed out a full sentence in deep, separate, deliberate breaths:
"I don't ... blame the game."
Then he stuck his left index finger into his own chest. Others allowed him to continue playing, but in the end he could have chosen to sit out a game rather than this outcome: sit out a lifetime.
"Teenagers and kids in their early 20s think they're invincible," said his father, Ted Plevretes. "Most of them say: It's not going to happen to me. It did happen [to Preston], and it will happen to some of them. And most of them won't know it, because they'll be dead."
Five years ago, in a 56-14 Duquesne rout, the final 2:42 was called off amid stunned silence because of the LaSalle sophomore prone and unmoving on the field. The collision caused a tear in his brain's major vein, the sagittal sinus, which carries blood from the brain back to the heart. He had three strokes and lapsed into a coma between Rooney Field and UPMC Mercy next door. A neurosurgeon, in emergency surgery lasting more than two hours, removed a 1-inch-thick blood clot across the surface of the brain. He also took off half the right side of Mr. Plevretes' skull, which wasn't replaced for five months while the severely swollen brain healed.
"He was clearly dying," recalled that neurosurgeon, Eric Altschuler. One look at the messy condition of his brain via a CT scan, and it appeared to Dr. Altschuler as if Mr. Plevretes was in "a high-speed car accident. I mean, we were all quite surprised at how badly he was hurt and how quickly he went downhill. We couldn't believe this was from a football injury. Clearly, the worst brain injury we've seen from football.
"I think we have to take a careful look at the game we play, particularly with kids. We have a fascination, me included, with football in this country. It's an odd fascination [because of the inherent dangers]. It's almost like asking a doctor: Is it OK if I smoke?"
Preston Plevretes was rugged, handsome, ever smiling, ever wise-cracking. As a high-schooler, he once dressed up in a blond wig and girl's clothes to play the female lead in a "Grease" skit -- a photograph with a prominent place in the family kitchen. He was a football captain, a basketball player, a javelin thrower who finished second in state track.
Mrs. Plevretes leafed through a scrapbook with just one word scrawled on the black cover: his first name. Inside are pages of newspaper stories, from his first varsity game as a freshman to the list of top-20 senior running backs in New Jersey, him included. The scrapbook ends with a copy of the LaSalle news release detailing his incident and injury.
"So you get an idea of who Preston was," she said.
He seemed to have it all. A close football team that had cookouts on his back porch weekly. A bunch of buddies. A girlfriend. A college career ahead. A blueprint to play either arena football or elsewhere on his way to broadcasting.
A road never traveled.
Instead, he spent seven months in hospitals or rehabilitation centers. Health aides come to his home from 8 a.m. to 6 p.m. each weekday, with his parents handling the rest of the time. He travels one hour each way to Parsippany, N.J., every weekday for 60 minutes of oxygen therapy inside a hyperbaric chamber.
He has no peripheral vision, and his speech is reduced to fits and spurts of breathy words. His right arm is difficult to move and he has balance problems when he walks. He goes to weekday physical and occupational therapy at CentraState.
His grand mal seizures, uncontrollable and as many as 10 a day, were so acute that doctors offered a radical remedy. The Plevretes agreed in July 2009 to allow doctors to disconnect the right frontal lobe from the rest of his brain. "That set Preston back," his mother said. "Way back."
Mr. Plevretes started over, almost as if it were November 2005 again.
"He makes a lot of progress, then something happens to him to knock him back down -- the surgeries and all that," said Eileen Graham, his 8 a.m-to-3 p.m. home health care aide and the Giants fan he tortures. "He fights every day. He's got a great personality. Got a great outlook on life. He's always happy, always willing to work hard."
His parents this summer are planning to take Preston to Germany for a third round of stem-cell treatments, in which millions of his own stem cells are implanted in his body for a "boost," as his father explained.
"Five years, every day," Mrs. Plevretes said. "We're always, always trying ... ."
"Always," her son added.
" ... to give him some kind of life," she added.
It has been an arduous journey for them all. As his mother put it, "God and I had a lot of fights."
Last February, Preston Plevretes put on a suit and stood in front of a concussion-awareness gathering of trainers and coaches to give his personal testimony. In March, they went to Trenton, N.J., where Mrs. Plevretes retold their story before a legislative committee for a concussion bill that the governor signed into law three weeks ago. He joined his parents at a congressional hearing in New York in May. Without speaking at the hearings, Preston helped to send a message.
"It's the education around the kids that makes the difference," Ted Plevretes said. "So educating the kids, the families, the coaches, his teammates that they have to raise their hands and report somebody, that's what will save their lives."
"All they need to see is, this is real," Mrs. Plevretes added. "Look at my son."
She once told her eldest son how sorry she was that this happened to him. "I'm not," he replied. Why? "Because I wouldn't have met all the wonderful people I have."
If he isn't watching football while plopped on a chair in the living room, he has a laptop, cell phone and a hands-free device within reach. Facebook and texting make him again a vital part of his circle of family and friends.
"At first, when he started doing that, everyone thought it was me," his mother said. "He's in there. He can think. He just can't move, he can't speak. [By text or Internet,] that's how he communicates. That is his lifeline."
That and football. Due to Mrs. Plevretes' roots -- her parents came from around Herminie in Westmoreland County -- mother and son remain ardent Steelers fans. When Preston's favorite player, Troy Polamalu, returned an interception for a touchdown against the Cincinnati Bengals on Dec. 12, Ted knew it once he walked into the living room to find Preston with arms raised in a touchdown signal. Still loves the game, all right. Ted, who works in finance, turns 65 soon. Tammy, 50, talked at the dinner table not long ago about growing her small, financial-data gathering business to a certain level before exiting. They could sell the three-story house in this middle-to-upper-class suburb and move into a one-story home.
As she related those retirement plans, Preston shook his head and shot her a serious look.
"I will ... take care ... of myself."
Chuck Finder: firstname.lastname@example.org .