The video is not easy to watch. Daniel Engelbrecht, a 6'1", then-22-year-old striker for the Stuttgart Kickers--the German team for which Jurgen Klinsmann began his senior career--walks along the far side of the field, near the advertising boards. The fans are right there, almost within arm's reach, just behind a chain-link barricade. Engelbrecht's gait suddenly changes. He looks weak in the knees, like a boxer out on his feet. But he hasn't been hit. He's in space, alone, just walking. He takes a couple of steps like this, fighting it, before collapsing awkwardly, his forehead in the grass. He rolls onto his back. He tries to sit, floundering, clutching at his chest, before going limp.
There's something unreal about the scene. This is how an acting student might portray a heart attack. But there he is, unmoving. The seconds tick by. One. His right arm is outstretched, palm up. Two. Players from both teams run toward him. Three. Just as they arrive, Engelbrecht comes back. He sits again. He takes a big breath.
This was on July 20, 2013, in a match against Rot-Weiß Erfurt. It was Kickers' 2013-2014 home opener in Germany's Third Division. The match had that charged, early-season excitement about it: all that preseason work--all those two-a-days, fitness reports, and tactical meetings--had come down to this. For Engelbrecht, it was a particularly special match. The previous January, he transferred to Kickers on loan from VfL Bochum, a team in the more prestigious and competitive Second Bundesliga. Engelbrecht had only managed one game for the first team in Bochum, but at Kickers, he found a home, playing 14 league matches that half season as Kickers successfully fought relegation. The match against Rot-Weiß was his first after making a permanent switch to Kickers.
Medics helped Engelbrecht off in the 78th minute, but, despite the ugly scene, there was little immediate concern about his health. Nobody suspected his heart had nearly failed or that it might happen again. The high that day was 85 degrees Fahrenheit, which is hot for Stuttgart, and the doctors reckoned Engelbrecht suffered a heat stroke. The official Third Division match report mentions Engelbrecht just twice, as a new starter and for his involvement in a good, early move. It makes no reference to his collapse. Rot-Weiß went on to win, 1-0.
"It was really strange, because I felt super," Engelbrecht says of the incident now, on another unseasonably warm afternoon. He's just finished his final training session in Stuttgart before the team goes to a training camp in Tenerife, Spain. He has his iPhone out, rewatching the video. "I was in the form of my life," he says in rapid-fire German, his dark green eyes wide, as though he still can't quite believe it. "I never felt that something was wrong."
In fact, just two days prior to his collapse, he underwent a physical. Doctors told him he was in perfect health.
"And then, during the match, I felt my legs tremble and I got dizzy," he continues. "I couldn't hear anything. I couldn't see anything." The next thing he remembers was sitting there with all those people around him.
Engelbrecht had a searing pain in his ankle after the Rot-Weiß match. He doesn't know where it came from, but it kept him from training for two weeks. Today, he calls it "good fortune." It may have saved his life, but back then it frustrated him. He wanted to play. When he finally rejoined his teammates, he practiced for a couple of days before appearing in another league match. This time, Engelbrecht came on as a 53rd minute substitute. He was helped off, gasping for breath, by a member of the opposition just 32 minutes later, in the 85th minute, after almost passing out. Again, the match report makes no reference to the incident.
It was clear to the medics at Kickers, however, that something besides the heat was bothering Engelbrecht, and he went straight to the hospital. There, the doctors examined him from "top to bottom." They found he suffered from an inflamed heart, a condition known as myocarditis--symptoms and complications include abnormal heartbeat, heart failure, and sudden death--and told him he needed to take it easy for a while. "Three months no sports, no strain, no stress, no exertion," he recalls.
Histopathical image of myocarditis at autopsy in patient with acute onset of congestive heart failure. Image via WikiMedia Commons
For Engelbrecht, this downtime was excruciating. His mother, Marion, remembers how he began playing soccer on the streets of Cologne as a five year old, and how all he ever wanted to be was a professional footballer. He'd finally done it. The Third Division might be a long way from the Champions League, but that didn't matter. He'd bounced around for years on B-teams and in regional, semi-pro soccer. Now he was making meaningful contributions for a professional squad in a nationwide league. At 22, if all went to plan, his career wasn't even half over. He could still improve, still step up a level. The Bundesliga was right there, just overhead. But instead of reaching for it, he was sitting in the stands, watching his teammates.
After the three-month break, Engelbrecht went in for another checkup. He can rattle off the date without thinking: November 13, 2013, the day doctors told him they doubted he'd ever play soccer again; continuing to do so would be to gamble with his own life. Engelbrecht, of course, was devastated. Still, he didn't slide off the examination table, shake the doctor's hand, and throw his cleats in the garbage. He sat there and begged them to do something, anything.
"They told me to go home," he says. The doctor promised him he'd meet with specialists in the field, some of the very best, and figure out if anything could be done.
The call came one month later. The doctors wanted to implant a defibrillator into his chest and then try and sort out his abnormal heartbeat.
Art by Maddison Bond
If you've never heard of a defibrillator, chances are you've seen one on TV, if not in person. Hardly an episode of ER or Grey's Anatomy or Scrubs goes by without the panels on a patient's chest; the high, whining sound of an electrical charge gathering power; a doctor shouting, Clear! In the sports world, they've become nearly ubiquitous over the past decade. The high-voltage charge they deliver has the ability to reset a failing heart rhythm, and today defibrillators are on the sidelines at many sporting events in case an athlete suffers the kind of life threatening episode for which Engelbrecht was at risk. They're effective. A pitchside defibrillator helped save Fabrice Muamba's life in 2012 when the former Bolton Wanderers midfielder suffered sudden heart failure in a match against Tottenham Hotspur.
In the hospital, Engelbrecht turned to the doctors and said, "Let's do it." Five days later he received his implant.
Engelbrecht pulls down on his shirt collar to reveal a three-inch, purple scar high on the left side of his chest. Below it, there's a lump under his skin that looks square, about the width of a pack of cigarettes, but the implant is actually shaped something like a flattened bean. The small wire that runs from the unit to his heart is invisible to the naked eye. If it senses he's in danger, the implant can hit him with upwards of 800 volts, which is more than six times what you'd get if you jammed a paper clip into your average American electrical outlet.
In addition to the defibrillator implant, or the "defi" as Engelbrecht calls it, the doctors wanted to surgically correct his irregular heartbeat. The heart beats to the rhythm of an electric signal that originates from a group of cells on the heart itself known as a node. Sometimes, however, electric signals can come from other cells on the heart that aren't nodes. These rogue signals can be unpredictable, coming on with no warning. For most people, this isn't dangerous, but for some it can be lethal. For a fit male athlete in his early 20s, a resting heart rate in the low 50s is considered normal. When Engelbrecht had an episode of heart palpitations, his heart rate could jump to more than 300 beats per minute and induce something called ventricular fibrillation, a life-threatening condition in which the heart fails to beat completely.
"You have no control over your own body," he says of the palpitations. "You think you're going to die. One minute your pulse is normal and the next," he puts a hand to his chest and dramatically gasps for air, "it's suddenly much faster. It's so weird. It's the worst feeling."
In order to stop the rogue node from telling his heart to beat, doctors had to find it and disable it. They did this by inserting a catheter into Engelbrecht's groin that ran all the way to his heart and then waiting for the palpitations. When they found the rogue node, they could burn the area around it to disable its ability to transmit the electric signal.
The way Engelbrecht describes the scene in the operating room is straight out of a sci-fi or horror movie, depending on your point of view. In the operating room, there were between six and eight doctors, as he remembers it. Beside his bed, a wall full of monitors. "On one screen you could see [the inside of] my heart, on another my pulse, on another my blood pressure--all distributed like that," he says. Engelbrecht remembers all this because he was awake the whole time.
Art by Maddison Bond
The reason Engelbrecht had to be awake was because the doctors needed to induce the palpitations in order to pinpoint the exact location of the rogue node. They induced the palpitations by injecting Engelbrecht with adrenaline. The first try failed: they couldn't find the node. But they tried again, and during the next operation something else happened: Engelbrecht's defibrillator went off.
When his heart rate jumped from 180 to more than 300 and his palpitations began, the defibrillator sensed he was in danger. "In that moment I thought I was going to die," says Engelbrecht. "Time for a final thought and, Pshhh! I could see my life flash before my eyes and I knew that was it. In the moment when I was just about to go under, but still conscious, [the defibrillator] kicked in and I flew across the hall."
It was after this second catheter operation, or catheterization, that Engelbrecht hit rock bottom. The doctors believed they'd found the source of the irregular beat, but they hadn't been able to stop it. They also had some bad news--Engelbrecht's defibrillator could kill him.
Engelbrecht was so scared of the defibrillator that he couldn't sleep alone, he couldn't go out on the street by himself. He suffered frequent panic attacks. "All we could do was just be with him," Marion says. She and his two younger brothers, Dustin and Domenic, suggested he quit all this and take up a different career, one that doesn't involve the strenuous activity that might cause his heart palpitations. He says he never really considered it.
Instead, he went in for a final operation on May 20, 2014. This one was performed by one of Europe's leading heart surgeons, according to Engelbrecht. The operation lasted eight hours. The doctors successfully disabled the rogue node, which he says was on the exterior wall of his heart--an unprecedented location that the doctors considered "unlikely and extraordinary." (Engelbrecht's doctors were unable to comment for this story and have asked to remain anonymous.)
Engelbrecht hasn't had a palpitation since leaving the hospital. He feels fit, he says, although he's not yet strong enough to go for more than about "35-40 minutes, maximum." He credits his family, friends, and Kickers for helping him through it all. "I've talked a lot with [the club], and with the coach, who has always told me, 'Take the time you need. We'll give you a lot of time and we believe in you. We know what you can do. If everything goes well, we'll celebrate, we'll be happy of course, but the the main point is that you recover.'"
Engelbrecht is just starting to repay that loyalty. He returned to competitive soccer on November 15, playing 14 minutes in a Cup match against FV Ravensburg, a semi-pro team in the 5th tier of German soccer. Kickers lost 1-0. After the game, Kickers coach Horst Steffen expressed disappointment at the loss. "On the other hand," continued Steffen, "it was just a game, and Daniel's story shows me that we should enjoy every day that we are healthy, and in life there are things more important than football."
Soon after came a Third Division match against SV Wehen Wiesbaden. It is the match that made Engelbrecht famous, that got him on national television in Germany, that prompted a journalist as far away as Brazil to inquire about an interview.
The video of this incident is easy to watch. Engelbrecht comes on in the 83rd minute. Strapped to his chest, beneath his baby blue and white Kickers jersey, he wears a pad on top of the defibrillator, protecting the area around the chest implant, which is still sore to the touch. The home crowd is in full voice. Everyone there knows what he's been through.
"It was 1-1, the last minute, the last kick," remembers Engelbrecht's teammate, Canadian international Randy Edwini-Bonsu. "Against one of the top teams. We needed to win this match. And then, it was crazy. [Engelbrecht] came in, everything was going right for us. We were pushing, pushing, but no luck. Then one of our midfielders played a great ball to him, and--" Edwini-Bonsu claps his hands, "the ball was in the net."
"For me," continues Edwini-Bonsu, "this was the best comeback in sports."
After the goal, Engelbrecht rips off his jersey, exposing his undershirt and the implant padding. He runs over to hug Steffen, tears already on his cheeks. On his undershirt is the German phrase "Nichts ist unmöglich" in big, white letters: Nothing is impossible.