Playing through sickle cell

CHICAGO — Eighteen minutes in with no break, Billy Garrett Jr. finally looks gassed, wiping sweat from his brow while visible sweat stains mark the back of his shirt. Fatigue hits, but not hard like a Mike Tyson punch — more like a Floyd Mayweather Jr. jab. The NBA hopeful starts to cut corners during a cone drill, barely lifting his feet, which are adorned with “Chicago” edition Nike Hyperdunk Low sneakers complete with graffiti and “Chi” on the heel. When he has to dunk, he misses two in a row. Slightly hunched over, the 6-foot-6-inch guard places his hands inches above his knees.

A professional athlete struggling through a workout is nothing to write home about, but special attention has always been paid to Garrett, 23. When he was born in 1994, he was diagnosed with sickle cell disease, a hereditary blood disorder that causes normally round and healthy red blood cells to mutate into crescent- or sickle-shaped cells that can either die altogether or stick to one another and disrupt the flow of oxygen throughout the body.

Garrett has been running through more than a dozen drills at Quest Multisport gym since the morning, when barely any lights were on twinning the overcast weather. Joined by G League Westchester Knicks teammate Duje Dukan — with Minnesota Timberwolves guard and fellow Chicago son Derrick Rose running through a ladder drill one court over — the pair run baseline to baseline, catching and shooting midrange jumpers and 3-pointers until they make 10 apiece. In another drill, Garrett, wearing a blue Knicks shootaround T-shirt and black shorts so short they make the Showtime Lakers look like the Fab Five, dribbles forward with intermediate crossover dribbles as Dukan tosses another ball that Garrett has to deflect back while maintaining his dribble. After switching places, it’s back to the baseline, where they run from one side of the basket, dunk, run to the other side and back, dunk again and repeat, only replacing the dunks with 3-pointers on the next cycle.

Trainer Basil Evelyn then places an orange cone down in front of the two, and each takes turns shuffling his feet 360 degrees around the cone, catching a pass and attempting a 3-pointer — so much movement before the shot is taken that they resemble enlarged Stephen Currys.

After about half an hour, Garrett and Dukan finally get a break. Garrett sits down briefly and grabs a bottle of water.

When asked if this morning’s workout will go over an hour, Evelyn deadpans: “He might die if he does all that.”

It’s hard to tell how literal he’s being.

Anya Covington was a sophomore forward for the Wisconsin women’s basketball team during the 2009-10 season. After the team committed too many turnovers in one game, the players had to run extra suicides at the end of the next practice. Covington, one of the only female collegiate or pro athletes to disclose she had sickle cell trait, a less severe form of the disease, pushed her way through the drills without proper rest and hydration and subsequently passed out on the court.

“I just remember tasting salt on my tongue, and kind of feeling like I was underwater because I was losing consciousness,” said Covington, now an assistant coach at the University of Wisconsin-Milwaukee. “I lost control of all my faculties, all my muscles, everything.

“I did finish the conditioning. I had a pretty strong mental power. But I also almost killed myself trying to do that,” she said, laughing about it now.

Months after Covington fainted on the court, and after a rash of sickle cell-related deaths of college football players in the early 2000s, the NCAA in 2010 required that all Division I athletes be screened for the sickle cell trait.

There are roughly 100,000 Americans currently living with sickle cell disease, and African-Americans, who make up just 13 percent of the U.S. population, account for most of the sickle cell disease population. The federal Centers for Disease Control and Prevention estimates that 1 out of every 365 black births results in a sickle cell disease diagnosis. Internationally, where more than 20 million people are affected, the disease occurs most often in areas affected by malaria; according to the World Health Organization, the African region accounts for nearly 90 percent of global cases of malaria.

For those spared from the disease, there is still the threat of the sickle cell trait, which occurs when a person inherits the sickle cell gene from one parent instead of both. Both of Garrett’s parents have the trait, which gave him a 25 percent chance of inheriting the disease. For parents who both have the trait, there’s a 50 percent chance of their children inheriting just the trait as well.

Between 1 million and 3 million Americans, and upward of 10 percent of all African-Americans have sickle cell trait. Most with the trait are asymptomatic, but under unique circumstances, including intense physical activity, high altitude and severe dehydration, normal red blood cells can become sickled, which means athletes are at higher risk of being affected.

For those with the disease, life expectancy can range from 42 to 68 years. Actor Larenz Tate and singer Tionne “T-Boz” Watkins are two of the more prominent celebrities who have the disease, while jazz musician Miles Davis, The Temptations member Paul Williams and, most recently, rapper Prodigy all died as a result of complications from sickle cell disease.

The disease, also known as sickle cell anemia, can lead to a range of symptoms, from mild fatigue and infections to anemia and, most commonly, pain “crisis” that requires hospitalization.

Garrett, who went undrafted out of DePaul in 2017, is the first publicly known NBA player to have sickle cell disease. Others have had the trait, including current Sacramento Kings center Willie Cauley-Stein and former forward Carlos Boozer, plus NFL players Tevin Coleman, Ty Montgomery and Geno Atkins. Former running back Tiki Barber is the only known NFL player to have the disease.

Evelyn, 39, has trained Garrett since the latter was 16. The former Chicago State basketball player, short and stocky like an amateur wrestler, doesn’t train Garrett any differently from Dukan or his other NBA clients. Garrett, he says, is in better shape than most athletes, but he does monitor his water intake throughout the workouts.

“I just treat it like any other illness that anybody can get,” Evelyn said. “Somebody can get food poisoning. I treat it the same way, because he’s never gotten sick [with me].”

To prevent the symptoms of the disease from affecting his playing career, Garrett said, he drinks a lot of water, sometimes with electrolyte packets (to “get some salt” in his body, he says), to stay hydrated. He’ll start the day with a bottle of water before his first workout, knowing it’s a “recipe for disaster” if he’s not properly hydrated. Dehydration can cause red blood cells to sickle, possibly leading to a crisis. But during his first workout, he took only a few sips of water for the entire hour.

“I probably should have drank a little more,” he conceded.

In the event he does trigger a crisis, the pain can be jarring. It can affect almost any part of the body, including head, legs, arms and spleen. “It’ll be a dull pain,” he said of a crisis, similar to being given a frog in the arm from someone punching you with their knuckle raised. “Your muscle tightens up and it feels like that to start. And then it gets worse and worse and worse and worse until the point where you can’t really walk.” Garrett’s personal doctor, Lewis Hsu, compared the pain to childbirth when speaking to Sports Illustrated in 2014.

“It feels like a cramp, but imagine the cramp, but the bruise and the pain is shooting,” Garrett said. “It’s extremely, extremely painful.”

For athletes with the disease or trait, it can be harder for them to get into playing shape and maintain. They have to, in essence, work twice as hard to get half as far, and it can feel as if they’re starting over every day.

Kansas City Chiefs running back Spencer Ware comes from a family of those afflicted with sickle cell. Three of his grandmother’s children, including Ware’s mother, have the disease, while Ware, who had 1,368 yards from scrimmage in 2016 before missing all of last season with a torn posterior cruciate ligament, was diagnosed at birth with the trait. He finds it difficult to keep his legs under him.

“Generally, my legs — of course that’s where I do the most of my work at — as much as all the training and the running and the eating and the maintenance on my body, it still finds a way to affect me a little bit,” he said.

For Baltimore Ravens receiver John Brown, who also has the trait, the pain got so bad during the 2016 and 2017 seasons he spent with the Arizona Cardinals (he missed seven total games) that he briefly considered retiring.

“It got to the point where my legs was aching real bad, my whole body was aching,” Brown said. “I couldn’t lift weights. I couldn’t do nothing. I couldn’t run because I was being overworked.”

The key to managing the trait and disease is to take preventive measures, including staying hydrated, getting proper rest and avoiding low oxygen levels or high altitudes, the latter of which caused former Pittsburgh Steelers defensive back Ryan Clark, who also has the trait, to lose his spleen and gallbladder after a 2007 game in Denver. Proper medical care is also essential, which makes it difficult for a disorder that mostly affects black people.

Historically, compared with white Americans, African-Americans have been undertreated by medical practitioners when it comes to pain. There’s a long-held belief that black people have less sensitive nerve endings, thus making them less susceptible to pain. This can lead to race-based discriminatory treatment, if any treatment at all. (The uninsured rate for blacks, according to 2016 census data, is more than 10 percent higher than for non-Hispanic whites.) Carolina Panthers quarterback Cam Newton, based on his size and perceived higher tolerance for pain, isn’t protected by referees the same as white quarterbacks. Tennis player Serena Williams’ 2017 pregnancy issues highlighted the disparate racial treatment of black women by medical care providers. (Sickle cell disease is ammo for race-based trolling: In 1972, Hall of Fame baseball player Hank Aaron received a letter that read: “How about some sickle cell anemia, Hank?”)

Lanetta Bronté, president and chief health officer of the Foundation for Sickle Cell Disease Research, said African-Americans with sickle cell have what she calls the “double whammy” blemish in the medical community and society at large of drug epidemic (think: “crack babies”) and race.

There’s the stigma that sickle cell is a “black disease,” she said. “Everything racially motivated, consciously or unconsciously, in this country, sickle cell falls right into that.”

She continued: “If there’s health care disparities in other diseases that impact minorities, sickle cell sort of has a double whammy: It’s a minority disease, and then they have the opioid, drug-addict tag.

“There’s a whole culture that is not conducive to minority health needs in this country.”

Brown, who signed with the Ravens this season and already has three touchdowns, wasn’t educated on the effects the trait could have on his life and career until injuries derailed his final two seasons with the Cardinals.

“I wasn’t really brought the information. It wasn’t brought to me until the injuries started happening and they was trying to figure out what was what,” Brown said.

Garrett, meanwhile, said a hospital in New Jersey reluctantly treated him during a crisis in the middle of his freshman season at DePaul because they didn’t understand his sickle cell diagnosis and thought he wanted to “swindle some pain meds.”

“That can be a thing,” Garrett said. “Sometimes you’ll find sickle cell patients who struggle to get treatment just because the hospital says, ‘You were just here three weeks ago.’ It can get ugly.”

The hospital ended up giving him pain medicine (hydromorphone hydrochloride) that was too strong and left him dehydrated and vomiting.

“I’m in such bad shape. I’m disoriented,” he remembers of the day. “I don’t really know what’s going on. I was drugged, essentially. This whole time the pain is just increasing, increasing, increasing. It got bad.”

It took being transferred to a sickle cell center for Garrett to be properly cared for.

“It’s crazy to think about,” he said. “Somebody’s going to take time out of their day to go to a hospital and beg and plead for pain medication?”

After finishing his workout at Quest, Garrett heads to P.R.O. (Perform. Realize. Obtain.) Sports and Fitness Academy, where he does his cardio and strength conditioning. Sandwiched between a Mexican restaurant and convenience store, P.R.O. is smaller than a typical training facility, maybe half the size of your local CrossFit gym.

Inside, Garrett, along with Dukan and three other trainees, stretches on a patch of synthetic grass that sits behind a couple of power racks. He works with P.R.O. co-founder Derrick “D.B.” Baker on strength drills to help Garrett get leaner and more explosive.

At the end of the workout, Garrett “cools down” with eight minutes on the VersaClimber, where he moves all four of his limbs up and down at the same time like Spider-Man scaling a New York high-rise. His goal is to hit 1,200 “steps” in the eight minutes.

Body completely drenched in sweat, Garrett finishes with 1,100 steps.

He’s asked, if it came down to a roster spot on the Knicks, whether he would push his body past the boundaries sickle cell disease has forced him to construct. He sends back a look as if he’s never considered the question.

“I’d say I’d do what I need to do to make the team,” he said. “If it came down to that, your health’s always important, but I wouldn’t see it as an obstacle and I wouldn’t want a team to see it as a reason to not give me an opportunity.”

Garrett has better managed the disease over the past few years. So well that he has trouble remembering when he had his last crisis. It was his junior season at DePaul in 2016. On second thought, it was his senior season. No, that’s not right either. He finally remembers it was last fall while training at UCLA, but it was, relatively speaking, a minor crisis; he only had to stay overnight because the wait time at Cedars-Sinai Medical Center in Los Angeles stretched over two hours and worsened the pain. (When he was younger, hospitalizations could last up to five days.)

At times his diagnosis scares him, but the more he’s asked about the disease, the less it appears Garrett’s actually considered his own mortality. He rarely thinks about what the next 30 to 35 years of his life will entail, or whether he will even live that long.

“I mean, if it is going to happen, there’s not really anything I can do about it. I don’t really think about it. I do what I do,” he said. “If that’s the case, and I start having complications at 45, 50, 55, I guess we’ll just have to deal with that when we get to it. But right now I’m healthy, so I don’t really know.”

But he also has to consider others. Garrett eventually wants to have children. If a future partner has the sickle cell trait, there’s a 25 percent chance he’ll pass the disease along. “I gotta be precautious in deciding who it is I decide to have children with just because I wouldn’t want my kid to have to go through the sickle cell crisis and things like that at a young age.”

Is it a deal breaker if his partner has the trait?

“I would be reluctant, but if it’s somebody that I felt like I can’t be without, then I would go through with it.”

For his third and final workout of the day, Garrett heads to his alma mater for a series of pickup games with the DePaul men’s basketball team. Months of training have prepared his body for this much daily work, especially with Knicks training camp around the corner. (On Oct. 4, the Knicks signed Garrett before releasing him the following day for G League salary purposes.)

Through it all — the crossovers, jump shots, dunks, stair climbers — he somehow keeps a smile on his face. Even when he’s hunched over after a drill or resting from dead lifting or discussing his own future death, a large grin usually appears.

“I play basketball for a living,” he says. “I don’t have any worries.”