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Five Takeaways From Alex Smith's E:60 "Project 11" Documentary

Washington Redskins' Alex Smith before an NFL football game against the Dallas Cowboys in Arlington, Texas, Sunday, Dec. 29, 2019. (AP Photo/Michael Ainsworth)
Washington Redskins' Alex Smith before an NFL football game against the Dallas Cowboys in Arlington, Texas, Sunday, Dec. 29, 2019. (AP Photo/Michael Ainsworth)

ESPN's documentary on Alex Smith's recovery from his gruesome leg injury just concluded. Here are five takeaways from "Project 11."

1. He vividly remembers the day of his injury.

Smith remembers the moments that led up the injury that changed his life. He remembers the play and making a protection adjustment.

And then Texans players Kareem Jackson and J.J. Watt converged on Smith shortly after the ball was snapped, and as he was brought to the ground, his leg buckled and broke.

"Immediately, I remember thinking, 'The season's over," Smith said.

X-Rays revealed that he had a fracture that started at his tibia and ended at his knee. There was bone protruding from skin, meaning he had to be sent to the operating room immediately.

Smith had two plates and multiple screws placed in his tibia and a third plate placed in his fibula. Doctors were ecstatic with the results of the surgery, but Smith's injury was about to take a dramatic turn.

2. His infection started slowly, then got progressively worse.

Smith's injury was gruesome; his leg was torqued, according to orthopedic surgeon Dr. Steve Malekzadeh. But it didn't initially appear to be life threatening.

The next couple of days after the injury were filled with Smith walking around the hospital on crutches. He had a slight fever, but that was normal. The fever lingered, though, and then it spiked, forcing the doctors to perform blood cultures. Still, everything looked fine.

But then his fever "went through the roof", according to his wife, Elizabeth Smith, and his blood pressure was dropping quickly.

"Alex is not Alex anymore," she recalled.

Smith's blood cultures came back positive, meaning he had bacteria in his bloodstream. The doctors unwrapped his leg to find his skin black and covered with large blisters. They rushed him back to the operating room to reopen his injury, and then his mother, Pam Smith, heard haunting words from the surgeons.

"We're in life-saving mode now and leg-saving mode, but it's in that order."

3. Flesh-eating bacteria in his leg that threatened his life.

There were four different types of bacteria in Smith's leg; two were fairly common while two were not, but none of them were regular bacteria, Malekzadeh said.

Malekzadeh is still not sure how the bacteria got into Smith's leg, but they were causing the black spots. It was dead skin and muscle tissue caused by necrotizing fasciitis, otherwise known as flesh-eating disease.

The disease acts quickly, so the surgeons had to act accordingly. What's more, the bacteria was moving up his leg. The focus went from simply saving Smith's leg to saving his life, and doctors were uncertain if they could control the infection.

"If we can't, then what do we do?" asked head team physician Dr. Robin West.

The process took days. It took eight debridements, which is the removal of damaged tissue from the body, to finally get the infection under control, but it came at a cost: much of the muscle on Smith's leg was gone.

Smith had two options: amputation or limb salvage, which would involve taking muscles and skin from other parts of his body to replace those taken away from him.

"I didn't want to have to be choosing between these two things," Smith said. "But I decided to do the limb salvage, to try to save it."

4. "Do you know how many people would love to trade positions with me?"

The procedure, which involved moving part of Smith's calf and covering it with overlying skin, was a success, but he couldn't move his ankle or foot without some assistance.

"I was pissed off," Smith said. "You're getting a little of the 'why me? How did this happen?' mentality.

But despite those thoughts creeping into Smith's mind, he didn't lose perspective. He told Elizabeth that everything was going to be OK, and then he asked her a question: "Do you know how many people would love to trade positions with me?"

"I was like, 'What?'" Elizabeth said. "He said, 'Do you know the things and the blessings we have? And we can't take it for granted, not even for a minute.'"

Thirteen surgeries and 59 days after the injury, Smith was cleared to leave the hospital. West told Smith the scenario was that if the leg healed, it would function normally. But Smith could barely move without assistance, and a full recovery seemed far away.

"I'm completely helpless," Smith said. "I can't get up by myself, I can't do anything. Am I ever going to be normal. Functional? [I was] really having a strong doubt in my head that that was going to be a reality."

5. "Football might not be out of the question."

Smith had something more akin to a military injury than one suffered on the football field. The severity of his injury granted him special clearance from the U.S. Secretary of Defense to receive consultation from the military at the Center for the Intrepid in San Antonio, Texas.

He also spoke with service men and women who had suffered severe injuries to their limbs. Some had managed to save their legs; others had not. But Smith saw people who were trying to move on with their lives.

"You certainly didn't see anyone feeling sorry for themselves," Smith said. "You saw a lot of people trying to get better. This was about life, waking up in the middle of the night, showering, playing with my kids."

Smith began rehab, and he didn't even want to think about football. But then he threw a football for the first time since his injury, and that's when he decided that "football might not be out of the question."

"To watch him light up, to watch him get that inner drive again," Elizabeth said. "He kept his gratitude, kept a good perspective, but not so much the drive. I saw it again."

The process has taken much longer than Smith originally thought, but he was pushing sleds, squatting and rehabbing with his brace. Before the brace was finally set to come off -- 239 days after the injury -- Smith broke down.

"I don't feel like I'm a mushy person," he said through tears. "It's just a lot that so many people...have put into this. I never thought this day would actually come."

It's been almost 10 months since the brace was removed, and doctors have been amazed by his progress. Now, Smith is anxious for the next steps.

"I'm feeling pretty good about the rest of my life," he said. "Regardless of what happens with football."