Warning: This story contains discussion of suicidal thoughts.

Alison FitzSimmons carefully filled the cramped basement in Detroit with gifts from her baby shower, displaying them so she could show her husband when he returned from his road game.

Wives of other Lions players had gathered at the home of Jeff and Regan Backus for the early-December shower that would prepare Alison and her husband, Casey, a tight end on the team, for the arrival of their first child, due in February 2010.

One of Alison’s best friends had flown in from Montana for the party, too, and the next day they went to a pub to watch the Lions play. They talked excitedly about this next phase of life. For years, the couple had skimped: Casey owned only one suit but generally wore jeans and t-shirts from Costco. In the first years of their marriage they had a roommate in their tiny apartment. Now, they were weeks away from schlepping that baby gear back to their dream home in Helena, the town where they’d met as college students, for a winter of nesting and waiting.

Casey, 29 at the time, was in the midst of as unlikely an NFL career as there’s ever been, with a four-year, nearly $5 million deal set to expire. He was a fan favorite and locker-room leader who was fearless on special teams, though. “He was the type of player you absolutely had to have on teams that didn’t have a winning culture,” says his former teammate, Hall of Fame wide receiver Calvin Johnson. “Plenty of guys would sulk; Casey just never quit caring.” Casey figured he’d earn another contract and it would get worked out after the season.

The future seemed as wide open as the blue skies watching over that peaceful homestead they’d retreat to once the season ended.

Casey did get hurt against the Bengals that Sunday, but Ali had already seen him shrug off so much pain in his career. He’d played through broken bones, constant shoulder irritation, deep thigh contusions — generally without ever letting on that he was in much pain or discomfort.

So when she found him at home, in his favorite chair, she bounded up to tell him about the bounty in the basement.

“Come look,” she remembers saying, “I can’t wait to show you all this stuff.”

Casey, the confident and carefree boy she’d started to fall for when he’d shout “Hey, Katie!” at her (she resembles actress Katie Holmes) in the PE Center at Carroll College, sat there. The man she’d gotten engaged to in her junior year – his first season with the Lions – and married a year later, showed no interest. His eyes, which usually bounced when his booming voice filled a room and sparked so much laughter, were cold.

“He was close with my friend,” Alison says. “So she asked, ‘Is he going to be OK?’ And of course, I said he’d be fine.”

Alison could hardly conceal her fear. The NFL was still two weeks away from finally admitting after years of denial that concussions caused lasting damage, but players’ wives already knew as much. For years they talked about the toll of the game, passing around news reports of this thing doctors were calling chronic traumatic encephalopathy, or CTE, for years.

“All I was really thinking was: ‘Is this who he is now? Is this my life?’ I was supposed to grow old with this man,” she says. “Now I’m pregnant and wondering if he’s going to have Alzheimer’s in a year.”

*     *     * 

While the NFL has done more to grapple with the issue of its game leaving some players permanently debilitated, last week served as a somber reminder that football still ruins too many men.

On Tuesday, Dr. Ann McKee, a leading researcher on CTE, announced that she had found the disease in the brain of Phillip Adams, a former cornerback who last year shot six people he didn’t know — including two children — before killing himself in North Carolina. He was 32.

On Thursday, the family of former NFL wide receiver Vincent Jackson revealed that a study of his brain showed that he, too, was dealing with CTE. He was found dead last February, a few days after his former team, the Tampa Bay Buccaneers, had won the Super Bowl. He was 38.

Late Friday night, Sheila Dingus, an advocate for former players, said that “some of” the NFL veterans indicted in a healthcare scam are dealing with the ramifications of brain injuries. She shared two heartfelt letters that Hamza Abdullah, a former player not involved in the scheme, had written to the judge requesting leniency because he knows that players often struggle with the transition to life after football — in part, he believes, because the NFL and NFLPA fail to do enough to support them.

Adams’ family revealed in a statement that he had attempted to get help through the league but was unable to:

“After going through medical records from his football career, we do know that he was desperately seeking help from the NFL but was denied all claims due to his inability to remember things and to handle seemingly simple tasks such as traveling hours away to see doctors and going through extensive evaluations. We now know that these deficits were most likely caused by the disease.”

Dr. McKee was more blunt:

In the very least, a player that’s having difficulties, a player that is experiencing what Mr. Adams was experiencing — he tried to get help — but this is a man who is not thinking clearly, is having problems with planning and organization. He’s the least able to actually get help. There’s huge obstacles for these former players to find help. They have to make many medical appointments. They have to fill out very extensive paperwork. And that is usually beyond the ability of people who are impaired. If they don’t have an advocate that’s recognizing the issues in these individuals they fall through the cracks, and that I think is what happened for Mr. Phillips. I would like a comprehensive care package, evaluation system offered by the NFL for these ex-players that would give them the kind of care and management they deserve.

Jackson’s death tells another side of the story. According to his wife, Lindsey, he knew and talked about the dangers of CTE — he even forbade his sons from playing tackle football until high school — but seemed either unaware that it could happen to him (he said he never had a diagnosed concussion) or unable to admit that any of his problems might be related to it. As his frustrations with memory loss and managing his emotions grew, his drinking increased and his life tumbled out of control.

So while the NFL and NFLPA have partnered on multiple programs meant to educate and assist players, spending millions upon millions to do so, there remains a disconnect. The help is not getting where it needs to go. I made requests to both the NFL and NFLPA to discuss these issues with the people who oversee these programs so they could respond to the criticisms that arose last week.

The NFLPA shared materials on existing initiatives and said it would have no further comment. The NFL did not reply.

So my mind turned to a ranch in Montana, where a former tight end spends many of his days now riding a horse, right next to his most trusted ranch hand: The daughter whose birth Casey cannot remember because she was born in the midst of post-concussion symptoms that almost drove him to end his own life.

*     *     * 

Casey’s story is in so many ways a football fairytale: He never even played the game until his senior year of high school, but even then it was on an 8-man team in Chester, Montana (population around 800), about an hour south of the Canadian border. That got him noticed by the coach at tiny Carroll, then on its way to becoming NAIA power, and he agreed to try playing there. Even after he’d helped lead the Saints to their first National Championship, finishing as a finalist for player of the year in 2002, Ali couldn’t understand him when he said he’d signed with an agent.

“An agent for what?” she asked.

Somehow, though, Casey found a way. He went undrafted but got an invite to Lions rookie camp because the team needed a tight end on the field for drills.

He not only made the squad but started the first game of his NFL career — and 10 others that year. His style of play – passionate verging on reckless – endeared him to beleaguered fans, and he felt a connection with the people of Detroit, many of them blue-collar workers who reminded him of the folks he knew from his hometown.

He played through lean years, even by Detroit’s standards (but did play a major role in one of the team’s most interesting games, returning an onside kick for the final touchdown in a 34-point fourth quarter to beat the Bears.) The Lions  went 0-16 in 2008 with a point differential of -249. By 2009 there was reason for hope, though: The team snagged Matthew Stafford, a quarterback out of Georgia, with the No. 1 overall pick in the draft and paired him with wide receiver Calvin Johnson, the No. 2 pick two years earlier.

Still, Jim Schwartz’s first season as head had been a slog and the Lions were 2-11 as they headed to Cincinnati to face a Bengals team that would win the AFC North.

The Lions trailed 23-7 when they got the ball for the first time in the fourth quarter. A play that began with 8:05 remaining in the game, a 1st-and-10 from the Detroit 25, would become the last of Casey FitzSimmons’ football career.

He lined up on the right side of the line and, after the player in front of him drifted toward the inside, leaked around and settled underneath a linebacker before turning to present Stafford a target. He caught a pass and turned up field, right into Keith Rivers, who could do nothing but hold on as FitzSimmons drove him back. Casey stayed upright long enough for Tank Johnson, a 320-pound defensive tackle, to reach the play.

Johnson drove the crown of his helmet into the side of Fitzsimmons’ head, knocking his helmet loose. Casey pushed for one final step, before tumbling to the turf. The play gained nine yards. It probably should have only been five, maybe six.

Johnson was also injured on the play.

Casey’s life changed forever.

*     *     * 

There would eventually be nights, months or years down the road (the timeline is so vague in his memory), when Casey worked his way well into a 30-pack of beer just to get up the courage to be around people. Being that drunk also gave him an excuse when his mind went blank; he’d forget something somebody just said, or hear friends talking about a shared experience that he simply could not find the memories of in his own head.

The commotion of a large gathering, even of close friends, was too much for him. His brain could not process what was coming in, nor find a way to regulate what was going out.

That all came later, though. First, Casey had to work his way through a hit that resonated like none he’d ever taken. He remembers nothing of his final football play, or the days after. In fact, most of the next two to three years, he says, “are a blur, and it’s bizarre to even try to look back at them now.”

Calvin Johnson remembers how jarring it was to no longer have Casey in the locker room. “He was always so happy, chipper. A guy who was so passionate about the game. Loved to play, hated to lose.” Alison wondered if that man would ever return.

According to more than 100 pages of medical records he provided to For The Win, doctors reported the symptoms of Casey’s final concussion got worse in the hours and days after the hit. He was described as being “clear and lucid” after the game, but complained of a headache, lightheadedness and ringing in his ears. “On examination at the time, everything was normal,” the report stated.

He was seen again the next day, Dec. 7, and was deemed to be “doing reasonably well.” The report from that visit says “His examination is entirely negative neurologically.”

On Dec. 10 he tried to return to work, including lifting weights, but his symptoms worsened and a cognitive test administered by a neurologist revealed that he had “a significantly elevated symptom score” and was experiencing 10 out of 22 symptoms used to judge the severity of a concussion. He reported “headache, dizziness, fatigue, sleeping less than usual, drowsiness, irritability, feeling slowed down, feeling mentally foggy, difficulties concentrating, difficulties remembering.”

By Dec. 15, Dr. Kenneth Podell, a neuropsychologist specializing in concussion treatment, recommended Casey sit the rest of the season and even consider retirement. Casey’s symptoms were lingering, and his cognitive test showed only minor improvements and remained below a previous baseline test.

Dr. Podell also noted that Casey “had difficulty engaging in his conversation. He made no eye contact, and had no questions.” He has a memory of “flipping out” on a doctor around this time; if it happened, it is not noted in the records.

During the 10 days following the hit against the Bengals, Casey also reported photophobia (sensitivity to light), phonophobia (fear of loud sounds) and “depersonalization (feeling he is more distant from objects than he really is)”, according to records from the time.

Many of those symptoms would linger for weeks, months or years. Looking back, Casey is unsure of how honest he was during the assessment: He’d long before then figured a way to cheat such tests and says he previously convinced trainers to let him play even though he’d been vomiting and forgetting things that same day.

“The only way you can play in the NFL,” he once told me, “unless you’re one of the very best, is to play through anything.”

Even the greats concealed pain, though: “For us back then it was just, ‘Get your bell rung, get back in,’ ” Johnson says. “If you need to, take a day. Or, just hide it. We all knew how to do that.”

Alison remembers the months after the hit were filled with both hope and dread. Casey had awful days: Once he tried to take the dog on a walk but made it less than 100 yards. On other days he was more his usual self. They returned to Montana and Casey toggled between hoping his career would continue and the realization that it might be over — and that he might suffer through many of his symptoms for years to come. By his own admission he was “manic” and “erratic.”

He began writing things down in a notebook so he could remember them. He became a father. He talked over his condition with doctors. Finally, in April, he announced his retirement, saying that he would’ve preferred to keep playing if the medical people had given him the OK.

Casey was prepared to turn to his next career, with only one catch: He had no background or training in running a cattle ranch. He’d had a friend whose parents operated one, and he’d helped there when he could, but that had merely sparked his interest, not given him an understanding of what actually needed to be done.

For that, he’d hoped to use skills honed as a football player: Both his capacity for physical labor and the mental acuity needed to run complex offensive systems and study opposing teams in intricate detail. He worked hard and learned quickly.

Only now, neither his brain nor his body worked the way they once did. He developed severe headaches every day in the late morning that layered over a constant low-level throbbing and ringing in his ears. Those would last three to four hours; sometimes, they returned at night. He found himself getting easily frustrated and felt volatile. He was always tired but rarely slept. At night, lying awake, his mind catalogued regrets and worries; he felt he had no control over it, and that enraged him all the more. He’d always known he could lean on the close-knit community of ranchers nearby, eagerly asking questions and seeking advice, but he often had to show restraint: At the slightest hint of confrontation he found himself ready to escalate the situation into a full-blown feud. “I would just go off,” he says, “without even waiting to know why.”

His wife, meanwhile, was learning to be a mother, picking up on what her newborn needed based on the way she cried or squirmed. But she also had to re-adjust to Casey, who was trying to re-learn how to live.

“It was just that I always had to read him,” she says. “He was not ever a person who was going to open up fully about his emotions, or whatever pain he might be going through, but this was different. A part of him was gone. It just was not there. So I had to figure out based on how he acted, ‘Is this a good day? Is it OK for me to mention something to him, or should I wait?’ ”

Casey had saved his money to get the ranch started in part by attending seminars given by the NFLPA on managing finances and other post-career issues. Teammates mocked him for sticking around the facility on off hours and taking everything so seriously, but he was determined to turn his fleeting football career into something he could do for the rest of his life.

He also learned, through the NFLPA, that there would be help for him if he had to leave the game due to head trauma.

Or so he thought.

*     *     * 

Toward the end of 2010, Casey’s continuing pain and anxiety drove him to seek assistance, so he began applying to the programs for former players that would help connect him with neurological care and provide financial relief for what he believed had become a permanent disability.

He’d been told by people in the NFL he had to stop playing football. Surely that meant he qualified for something.

He was told to see a doctor from San Diego for an examination that attempted to assess the damage done to both his brain and his left shoulder. Pages 3 through 9 of the report are taken up entirely by a list of Casey’s injuries and doctor’s visits.

During the interview portion of the appointment, Casey told the doctor that he’d had “6 or 7 concussions.” To this day, Casey often says “I had six or seven documented concussions, and maybe six or seven that weren’t.” The word “documented” weighs heavily there; even the concussions he thought the Lions knew about sometimes weren’t included in the records that were eventually turned over to him after his career ended. Others are mentioned only briefly, with emphasis placed on his eagerness to return to action (in 2005, Casey suffered what he believed were concussions in back-to-back games; one on Sunday and another in a Thanksgiving game four days later. He reported his symptoms after the fact but was still able to play in Detroit’s next game.)

The doctor in San Diego concluded that Casey had “at least four documented concussions” and noted that he appeared to be suffering from depression and declared him temporarily unable to work. He said it was possible for Casey to improve with treatment, but also noted “Permanent residuals cannot be excluded.”

Casey’s claim for Total and Permanent Disability Benefits was denied; he did receive Line-of-Duty benefits but those were smaller payments that could only extend up to 90 months. He was seeking money from the NFL because he didn’t believe he would live long and needed to stockpile money for his family to survive.

It was clear to Alison that there was no way Casey could work a regular job. Some days he had the energy to work 14 hours. On others, he couldn’t last 30 minutes. A flexible schedule was imperative, but so was not having to deal with noise or other people. Where else could he find that sort of leeway, beyond owning his own ranch? He’d once dreamed of joining the FBI but that idea, by then, was laughable.

He decided to begin working with a local doctor to get a better understanding of how his brain was functioning and in April 2011 had an extensive neurospyschological evaluation done. It concluded his “overall level of performance … was significantly different from his expected performance level and falling in the low average range. He is slower in processing auditory information. His ability to organize verbal information into a usable form is also limited and efficiency at learning new information was impaired.”

Armed with this report, he again sought assistance. The NFL asked him to fly to Los Angeles for another evaluation. By this time he had difficulty flying and found unfamiliar surroundings — especially in crowded cities — disorienting. However he sat for two days of testing and was deemed not permanently disabled.

His doctor and agent pushed back against the finding, pointing out that the NFL-appointed doctor had failed to take into account practice effects — Casey was getting better at these tests the more he did them. Eventually he traveled to Missoula to see a doctor specializing in physical medicine and rehabilitation. His findings, delivered three and a half years after Casey suffered his final concussion, were clear: He “would be considered permanently and totally disabled unless he has a benevolent employer” and “… it is unlikely that he would be able to successfully work in his academic fields and/or related fields on a sustained and regular basis. He likely would be terminated due to absenteeism due to his headaches if not due to cognitive errors.”

Plan administrators remained unswayed. Casey knew that other players had complained about the process being weighted against them, but he grew increasingly frustrated. Alison recalls how impersonal the process was.

“Casey would just get a call and be told to drop everything and go somewhere to be seen by strangers,” she says. “That’s difficult to do with a family and a bunch of cows to care for.”

Casey would take one more trip, this time to Salt Lake City. He recalls walking into a clinic that looked nothing like a regular medical facility, with loud fans running and kids darting around the office. He had to sit for an hour, giving his history — again. The people working on a test that would determine whether he could get the help he thought would protect his family treated him “like an animal.”

He was done.

“You could just tell you were being doctor shopped,” Casey said. “And you f**king knew what the results were going to be before you even got them.”

*     *     * 

Casey says he spent the two years after his retirement “waiting for a chance to kill myself.” Over time, though, testing and consultation from doctors in Montana helped him understand his issues, and he began to take better care of himself. He stopped abusing painkillers but found a regimen of 15 other pills that helped ease his pain and regulate his mood enough to start thinking clearly.

He quit drinking around the time of the birth of his second child, a son.

Through a Facebook group, Alison sought advice from other wives of ex-NFL players on helping Case navigate a new life while dealing with TBI. A shocking number of them, she says, were going through the same thing. Members of the group constantly shared notes on how to cope.

“What I remember most was trying to be patient,” she says. “I knew where he could end up. I knew how difficult this could be. There was no way I was going to let him get there, if I could help it.”

“I was never a piece-of-shit husband,” Casey says, “but what really changed my life was when I opened up and really started talking to my wife.”

Alison remembers those conversations taking place after the kids had gone to bed. Casey was timid at first but soon figured out how to describe his mental state and tell her what he felt. Never a marijuana smoker, he began using edible cannabis to help manage his pain and anxiety. He spent his spare time reading, which he saw as exercise for his brain.

Ali and Casey had two more sons and family life took over. Casey grieved the death of his father and helped move his mother to Helena so she could be closer to her grandkids. The headaches persisted. The depression never fully lifted. But he managed. Working his own ranch meant he could pace himself.

His relationship with football became constrained. He still loved the game but rarely watched it. When he did, he’d snap back into the player he was. His eyes would drift to the edge rushers on the defense he would have had to try to stop. How would I block that guy? He’d study the linebackers or safeties who might have had him in coverage. What’s a weakness I can exploit?

He’s thankful for what football gave him and angry about what it took away. But mostly he is resentful that the powers overseeing the sport still do, in his opinion, far too little to actually help former players.

Casey still feels reverence toward the Ford family for giving him a chance with the Lions and believing in him, but he’s furious with the broader NFL and NFLPA for continuing to fail players. We first began talking in late 2016, after I wrote about the death by suicide of former NFL running back Rashaan Salaam. By then he had given up on any idea that the league or players’ association would offer help and, as one of the few former players with no desire to work in big-time football again, decided it was time to speak out.

“So many of us, especially in the first few years, think that we’ll get asked back,” he says. “There’s something about being in the club of football, that draw is so strong. You don’t want to break the code. I get it.” (Indeed, the coach of the Lions is now Dan Campbell — who also played tight end in Detroit with Casey.)

But as he drifted further from the sport, the empty rhetoric about football being a “brotherhood” ate at him as he read — or heard privately — about players struggling.

“The thing that gets to me is that so many guys don’t have support systems to get through something like this,” he says, “because their support system is built around them. They’ve always been the star athlete, and they’re the ones who signed the big contracts, and people relied on them, and so nobody is going to question them or stand up and get help when something is wrong.”

Casey believes the NFL should implement a proactive program that monitors former players and removes hurdles to treatment and financial assistance.

Reformers have pushed to change the system, with little to show for it. Concussion Legacy Foundation established its own help line to assist former players and their family in finding help.

“Asking these guys to sit through 8 hours of testing is almost like you’re trying to frustrate them into quitting,” says CEO Chris Nowinski. “That’s frustrating and I’m endlessly disappointed that this process hasn’t been improved.”

Calvin Johnson wants the league to normalize players speaking with psychiatrists. Conversations he had with one hired by Lions coach Jim Caldwell helped him plot a post-career path in which he has focused his energy (and investments) in helping former players deal with change and pain. He discussed his own experience with football in one of  most honest Hall of Fame speeches ever given, surprising those in attendance with his candor over how badly he hurt. He’s continued to advocate for fellow NFL veterans and is still mourning the loss of his friend Demaryius Thomas.

“I spoke with him not that long ago,” he says. “But it’s not like he’s going to open up to me about everything going on. NFL players, we have shields. But the league needs to make it so we know we have somewhere we can go to really talk about what’s going on, see what help there is and to figure out a way there.

“What they need is to have somebody come through and make it user-friendly. Some of these players didn’t have the best end with the team, or with the NFL. There’s no trust there. It needs to be easy, independent. You can’t ask players to go through obstacles when they’re already going through so much. That really is the message: Take care of those who took care of you and helped you make all of those profits.”

*     *     * 

Over the summer, Casey decided to disperse most of his existing commercial herd and veer into a different area of the cattle business. He purchased a herd of registered purebred cows and began focusing on breeding bulls to sell to other farmers.

Working with purebred cows is a more intricate process: It requires meticulous record keeping regarding breeding pairs and the resulting calves. Casey, now 41, spends his time now studying genetics and carefully evaluating the characteristics of the cows in his herd. Whether a rancher has a good year or not can often come down to the slimmest of margins: How much supplemental feed they have to use to get their cows to the ideal weight, or what percentage of their product is given the coveted “prime” designation when taken to market.

For Casey, it feels a lot like the NFL. Teams poke and prod players and try to build squads with the right mix, and then games are won or lost based on inches. There’s something about the process of working with his herd now that reminds him of his past life and that, finally, is welcome.

Casey is still limited by the damage done to him as a football player. He rarely goes into Helena and still tends to avoid social events. He’s turned down speaking engagements and is reticent to travel. Alison is relieved that her husband has found equilibrium but admits he’s not the person he was 15 years ago.”I wish my kids could know that version of their dad,” she says. She also doesn’t know what the future holds, and tends to avoid reading the news when it focuses on another dead former NFL player.

Casey pays attention, though, and rages. “When a league can pay its commissioner $40 million just to be a shield but won’t find a better way to take care of players? That’s not f**king right.”

This is one way he has changed for the better, Alison says. “Everything he went through, dealing with so much pain and realizing that others had it, too, that gave him empathy that I don’t think he ever would have had otherwise.”

Nobody would call Casey FitzSimmons lucky, but several things worked in his favor. That quirky anecdote about him never playing football until his senior year of high school? That saved him from thousands of blows to the head that may have made his later concussions even worse (Adams, for instance, started tackle football when he was 7 and had a severe case of CTE for his age.) Casey also never really dreamed of being a pro player, or trusted it would last, so he always had a backup plan; other players arrive to the league after being touted recruits and All-Americans playing in front of 100,000 people, sure that a long and lucrative NFL career awaits — only to see it dissipate in a few years. They spiral faster and further (it turns out Jackson drank himself to death.)

Finally, Casey had a spouse who had studied to be a counselor, was engaged in the discussion of brain trauma with other wives and refused to let her husband slip away.

“Most guys don’t have all of that going for them,” Casey says one day, the sounds of his ranch — a bark, a moo — muffled in the background. “That’s who I’m speaking for, why I have to do this.”

The last few years have been, he says, the best of his life. Working with purebred cows is a new challenge and his mind feels refreshed. Part of what he has to do now is go out and meet other ranchers looking for bulls to purchase, and to convince them that his are the right choice. A man whose head for so long drove him to stay away from other humans is now building his business around his ability to earn the trust of others.

“That’s a lot for me,” he says. “But it’s something I’m ready for now.”

He knows he’ll have to make the rounds and meet new people. But he will skip the big corporate ranches that have proliferated. He prefers the smaller family operations, many of which have been around 100 years or more, because he understand what matters to them.

“I like to know,” he says, “that the people care about the cows and what they’re doing.

“From start to finish.”

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