The catch was routine, the landing a little off. One pass changed a football player's life
Evan Richmond had run the fade route hundreds of times.
Taking off from the line of scrimmage, he would head straight downfield and then fade to the sideline, hoping to catch a pass thrown over his defender's head.
On the first Friday evening last October, it was still in the first quarter of Sun Prairie East's high school football game at Watertown, Wisconsin, when he seemingly ran the route to perfection. Evan, who goes by Richie to everyone but his dad, beat the defensive back covering him, caught the pass thrown by quarterback Jerry Kaminski and landed on his back, the football tucked against his left side.
As the cheers dimmed, he lingered on the grass, just one yard shy of the goal line. After a team trainer ran out for a quick check, he slowly rose to his feet.
“I remember giving him a high-five as we ran off the field,” fellow Cardinals wide receiver Jonathan Vande Walle said. “We all thought he just had the wind knocked out of him.”
Sun Prairie (Wisconsin) East's dominance in the game had prompted head coach Brian Kaminski to start pulling starters at the beginning of the second quarter. With her son not going back in, and still under the impression he was fine, Karen Richmond drove home to Sun Prairie.
But on the sideline, the pain on Richie's left side grew progressively worse, and by the time the game was over, color was draining from the 17-year-old’s face. His father, Todd Richmond, made the decision to drive him to SSM Health Emergency Center in Sun Prairie, about 45 minutes away.
“I’ll never forget that drive. It was black, pitch black,” Todd said. “He’s a tough kid but he was slumped over and quiet. I knew it was bad if he wasn’t talking.”
Karen had barely arrived home when Todd called to say their son wasn't doing well. She headed to SSM Health.
“When they pulled up to the hospital I was waiting for them. I had never seen a human look like that, much less my son,” Karen said. “His face was white. His eyes were black and just sunken in.”
A CT scan confirmed the kidney on Evan’s left side had suffered damage, and a decision was made quickly to transfer him. Within 30 minutes, a trauma team met him at American Family Children’s Hospital in Madison, setting in motion a flurry of activity. His parents heard the words “torn,” “completely shattered,” “ruptured,” and “in pieces.”
Then they were told: Somehow, on what is considered a routine play, their 6-foot-2, 180-pound son's left kidney had been lacerated.
At that point, two questions loomed, as yet unspoken.
The first: Could Richie play football again? He and his family were excited recently when some colleges expressed interest in him coming to play for them.
The second: If he could play, how quickly? Sun Prairie East has just one more regular season game left, and then playoffs began, with potential elimination every week. The state championship game was in six weeks. It would be his last chance to get on the field with his friends.
The clock was ticking.
People need at least one functioning kidney
Two kidneys, each about the size of a fist, are located on either side of the spine at the lowest level of the rib cage. Together, they function as the body's filtration system, with each kidney containing up to 1 million filtering units called nephrons.
The nephrons take in blood, process nutrients the body needs, and remove waste as urine. When a kidney is lacerated, blood, urine, or both, begin leaking into the abdominal cavity.
People can survive without a spleen or gallbladder. But not without at least one functioning kidney.
“You could clearly see the kidney,” Karen recalled from viewing the CT scan. "And the bottom, lower portion was just frayed."
His injury was a first for his coach, and his doctors
Football is a dangerous sport. Roughly 86,600 concussions were sustained nationally by high school players during the 2021 season, according to a study done for the National Federation of State High School Associations, the umbrella group that writes the rules of competition for most high school sports and activities.
Kidney lacerations, on the other hand, are rare. They aren’t even tracked by the national federation.
“Kidneys, to some extent, are usually protected by the ribs. But I think in (his) case, the pointy part of the football was aimed at the lower part of the kidney, which was not protected,” said Dr. Walid Farhat, a pediatric urologist with UW Health Kids and chief of pediatric urology at the University of Wisconsin School of Medicine and Public Health. “I’d never seen a case like his before.”
Neither had Dr. Prasad Dalvie, an interventional radiologist with UW Health Kids and an associate professor of radiology at the University of Wisconsin School of Medicine and Public Health, who described it as a "pretty massive injury."
Kidney lacerations typically are caused by either blunt force trauma — a car crash, a ski or snowmobile accident, a fall from a tree or ladder — or penetrating trauma, like a stabbing or a gunshot wound.
In Richie’s case, it was something of a mix. The tip of the football rammed into his kidney, more pointed than blunt force but not penetrating the skin.
"I’ve rewatched that play a thousand times to try and pinpoint exactly when it happened," Kaminski said. "I've been coaching for 26 years and I've never seen an injury happen like that."
As the urologist on the trauma team, it was Farhat’s job to monitor Richie’s airways, blood pressure and circulation, the ABC’s of trauma care.
“We look at the amount of bleeding from the kidney, we make sure the collecting system is not injured, and we want to make sure the patient, overall, is not bleeding profusely,” Farhat said.
Tracking Richie’s blood pressure, heart rate and hemoglobin levels was the best way to do that. When Richie first arrived, his hemoglobin level — the oxygen-carrying component of red blood cells — was 12.8 grams per deciliter. Farhat considers 12.5 to 16 acceptable, so Richie was at the low end.
With every follow-up blood test, his hemoglobin continued to drop: 12, then 8.6, then 7.6.
“All night and into the morning he was in so much pain,” Todd said. “The protocol now is to try to let the body heal itself and to be the least invasive possible. I couldn’t believe that protocol was correct.”
Blood vessels and arteries lose their elasticity as people age. In someone Richie's age and in his physical condition, the vessels still instinctively clamp down to prevent bleeding.
“They kept saying he is young and he is healthy,” Karen said. “They wanted to see if his body healed on its own.”
Farhat attributed Richie's relatively stable blood pressure and heart rate on Friday night and into Saturday morning to his vessels still working as intended. But Richie's hemoglobin levels became increasingly concerning. Doctors ordered another CT scan.
The scan confirmed blood vessels in his kidney were still bleeding.
“Based on those facts, we made the decision to go in and identify the bleeding vessels,” Farhat said.
It took five coils to stop the bleeding
Unlike surgeons, who open up parts of the body with scalpels to access internal tissue and organs, interventional radiologists enter using small skin incisions barely larger than a pinhole.
Then, using multiple images as their map, they manipulate tiny tubes and wires to navigate around the body. The benefits, besides saving organs, are numerous: lower infection risk; faster recovery time; lower medical costs due to shorter hospital stays; and minimal scarring.
“You can go through an artery in the wrist or in the leg and get to any organ in the body,” Dalvie said.
Dalvie and his interventional radiology team decided to treat Richie’s bleeding kidney through the femoral artery in his right leg. A catheter less than 2 millimeters in size was inserted and guided toward his kidney through the aorta, the large artery that carries oxygenated blood from the heart to the rest of the body. A smaller microcatheter was then used to access smaller distal arteries and treat them.
Two types of X-ray-based imaging techniques were used, creating a road map of sorts by injecting dye through the tiny tubes and into the arteries. The resulting images are viewed in real time on screens in the procedure room.
“The dye shows us which vessel we are currently in, and helps us navigate our path” Dalvie said.
Richie's parents were told it would take roughly 90 minutes for the interventional radiology procedure. As the first hour gave way to the second, they moved from the waiting room to the hospital cafeteria, even though neither could eat.
“We were in full panic mode,” Karen said.
They would later learn his vessels were clamping down, making the procedure more challenging.
“The body’s natural instinct is to clamp down vessels to stop or slow down bleeding," Dalvie said. “This is a protective mechanism which also helps maintain blood flow to vital organs when there is significant blood loss."
But the more the vessels constricted, the harder it was to move through them during the procedure to get to the areas that needed treatment.
Nitroglycerin, a drug that dilates blood vessels, was injected into the vessels to counter this. A steerable microcatheter, a newer device, was then used to further navigate into small arteries deep in Richie's kidney.
Dalvie and the interventional radiology team discovered three arteries that were actively bleeding. To stop the bleeding, metallic coils 1 to 4 millimeters in size were inserted inside the bleeding vessels to essentially clog them — a procedure known as embolization.
It took five coils to stop the bleeding. By that time, Richie's kidney had leaked roughly six pints of blood into his belly.
Blood is an irritant when it's not where it's supposed to be. That accounted for at least some of the pain and discomfort Richie felt the day after the procedure.
"Sunday was bad," Karen said. "He was miserable. He was having lots of bladder spasms and had to stay in bed."
Then, a hemoglobin reading came back even lower than it had been prior to the procedure. Discussion began among doctors over whether Richie would need a blood transfusion.
Again, the doctors wanted to see if his kidney was still healing itself. By noon, the hemoglobin lab results started to trend in the right direction.
“Thirty, even 20 years ago, he would have lost his kidney,” Farhat said.
In mid-afternoon, Farhat delivered the news they'd been waiting for; Richie still had two functioning kidneys. The damaged kidney had lost 20% to 30% of its function, but it was still filtering urine, still doing its job.
“That was the first bit of good news we’d heard in 48 hours," his dad said.
The following Tuesday, just four days after the injury, Richie was able to go home.
Farhat scheduled a follow-up appointment with Richie for Nov. 15.
Richie would need to be medically cleared before playing a full contact sport again. Farhat made no promises about the time frame. If Sun Prairie East continued to win, and if his body had recovered and if he was cleared to play, he might be able to play in the state championship game.
The game was three days after the appointment.
Doing rehabilitation as the team stretches out the season
Nov. 18, 2022.
That's the date Richie and had circled on his calendar, etched in his mind, for nearly a year. All the Sun Prairie East seniors had done the same. It was the date of the state championship football game at Camp Randall on the University of Wisconsin-Madison campus.
A year earlier, when there was just one high school in Sun Prairie, the football team had advanced to the Division 1 title game before losing to Franklin High School. During the offseason, Sun Prairie had divided into two high schools — East and West — and dropped from Division 1 to Division 2.
Still, this was the last chance the senior players from either school had to win the title.
"That loss is when it started, that next step, next level of dedication and work ethic," Richie said at his home three weeks after the kidney injury. "The Monday after that loss, we were still juniors but we felt like the senior players on the team. It was our team now."
When summer came, an intensive training regime began. Richie, fellow wide receiver Vande Walle, quarterback Kaminski, and several other players were getting up at 5:30 a.m., driving to Waunakee to work with a strength and conditioning coach on speed, and then lifting weights back in Sun Prairie for an hour. Three times a week they practiced running routes on-field.
"Five days a week. That's what a day would look like in the summer," Richie said. "That was a new step in our work ethic."
That commitment and dedication paid off.
Richie was named one of four team captains and a starting receiver.
“Your teammates are the guys you know that you’re going to go to battle with," said Kaminski, Richie's friend since fourth grade and the high school coach's son. "You want them to succeed just as bad as you want to see yourself succeed.”
It was Kaminski, Vande Walle and a few other players who brought over chicken wings the night Richie got home from the hospital.
"I had no appetite. I couldn't eat it. I remember thinking, 'I should be running around with you guys. Not sitting here under a blanket, barely able to eat a piece of chicken,'" Richie said. "That's something I'll never forget."
Richie's father, an Associated Press reporter based in Madison, tried to help by doing what he was trained to do: Dig for answers. All he could find were a few pro players with the same injury — wide receiver Keenan Allen, tight end Zach Ertz, quarterback Andrew Luck — but nothing on how they trained to come back.
On Oct. 14, his friends were back on the football field for their final regular season game of the season. Sun Prairie crushed Stoughton, finishing the season 7-2.
“It was surreal watching another kid playing his position,” Todd said. "That game was a really low point for me. There I was, at the game, and he is at home 10 to 15 pounds lighter. It was a hard night for me. That's when it hit me in the face. I don't think he's coming back."
Following the regular season, Richie was named All-Badger Large Conference honorable mention and the Wisconsin Football Coaches Association Academic All-State team.
He also earned Sun Prairie East's strength and conditioning award. His teammates, coaches and trainers watched as he went from barely being able to walk around the house without becoming short-winded to lifting weights, cycling and using the elliptical. He had injured his knee twice before during high school; he knew the effort needed in rehabilitation.
"That's why I'm doing this rehab stuff — for the chance that we win and I can suit up and play one more time," he said in early November.
But no amount of exercising and strength training can make an organ heal faster.
In the first round of the playoffs, Sun Prairie defeated Oregon, keeping Richie's hopes alive. In the second round, the Cardinals advanced again, beating DeForest — which had defeated Sun Prairie West a week earlier.
Two more games and the team would be back in Madison for a championship game.
On Nov. 4, four weeks after injuring his kidney, Richie put on his football jersey — without pads or cleats. He was not cleared to play, but he was strong enough to join the other team captains at midfield for the pregame coin toss.
Then, in the pouring rain, he watched from the sidelines as the team lost to Kettle Moraine in the state quarterfinals, 27-6. Kettle Moraine went on to win the WIAA Division 2 state championship.
"He was drenched and just sobbing. All the players were," Todd said. "I went up to him, gave him a hug and told him he had nothing to be sorry about. I told him I was proud of him and how hard he'd worked. It was a good run."
Eleven days later — three days before the championship he had so much wanted to play in — Farhat gave him medical clearance to play football again.
"Playing in that game was the best-case scenario," Richie said following the appointment with Farhat. "Do I wish I could have suited up one more time and played? Of course. The big picture is I am healthy. I'm cleared to play, and I am moving really well. I wouldn't have been able to say that six weeks ago."
Richie makes a decision on his next steps
Karen remembers the day clearly. She drove Richie, then 4 years old, to soccer practice, but he refused to get out of the car. That was the end of his interest in soccer.
Todd didn't mind. He just kept tossing a football back and forth with his son in the backyard.
“I remember when he was young, 6 or 7 years old. He started crying after we watched the Super Bowl,” Todd said. “He finally told us he was upset because the season was over.”
When Richie started playing flag football in second grade, Todd was the coach. He coached his son’s football teams through eighth grade, adding on volunteer roles to support and help raise money for his son’s athletic teams and leagues. During Richie's senior season, Todd was president of the Sun Prairie Quarterback Club.
With high school football over, Richie's focus turned, like so many other high school seniors, toward college.
"This injury is frustrating him," his mom said in late November. "He has always been interested in the human body and the medical field. He knows everything about bones and muscles. But this is an injured organ. He kept asking, 'What am I supposed to do with an injured organ?'"
What he did was follow the advice of trainers and listened to his doctors, especially Farhat.
"He was a great teacher, easy to listen to," Richie said of the pediatric urologist. "When he described my injury, it made sense. Especially with my interest in medical stuff, I was locked in the whole time he was talking."
Farhat drew pictures, a visual for Richie and his parents to better understand what had happened to the kidney. And his explanation linking red blood cell counts to endurance levels stuck.
"Red blood cells carry oxygen," Richie said. "The more red blood cells, the more oxygen is moving through the body. My counts are back up (from the time of the injury.) I don't have to limit anything."
On Nov. 27, Richie was watching Green Bay play Philadelphia when Eagles safety C.J. Gardner-Johnson collided on his left side with Packers wide receiver Christian Watson and couldn't immediately get up.
“I knew right away when I saw the hit,” Richie said.
The team would later confirm Richie's suspicians: Gardner-Johnson lacerated his kidney.
Richie spent an increasing amount of time in December lifting weights in his basement. Every time Karen saw him coming back upstairs, she knew what was on his mind.
"I can tell you are preparing for another football season," she told him.
He didn't respond in the moment but her comment stuck with him. He was working out to get faster, stronger, better to again play sports. He was preparing for something.
"She was right," Richie said. "If I have the opportunity to play football again, I should take it."
There was never any doubt his academic interests would revolve around science, medicine or physical therapy. But would the best option be a big university with no realistic chance to play football, or a mid-size school with a good pre-medical program and a chance to play, just for the love of the game?
In mid-January, Richie announced his decision.
He plans to study exercise and sport science at the University of Wisconsin-La Crosse, then pursue graduate studies in physical therapy or medical school. He's also going to play football.
Later that month, he joined five other Sun Prairie East teammates in a signing ceremony at the high school honoring the seniors moving on to play college ball.
"Things can change so quickly," Richie said. "The play I ran my last game was routine. I had done it hundreds of times before. But that time, I landed on the ball funny and that was the end of my high school career. All I can do now is look back and say, 'It was a good year.'"
Before he becomes an Eagles football player, however, there is one more season to represent the Cardinals. Richie is preparing for his final season as a pitcher for the school baseball team. His endurance and strength are back. The first game is April 1.
As for his injury?
It's just a "really unique injury that happened in a really unique way," he said.
Jessica Van Egeren is the enterprise health reporter with the Milwaukee Journal Sentinel. She can be reached at jvanegeren@gannett.com.