With just a few steps into Red Lion's gymnasium the last three winters, Michael Fox stood out.
He was the tall one, 6-foot-5 by his senior year, roaming the baseline with a smooth jump shot and no hesitance to throw around his slim frame.
For Bonnie Fox, each of her son's jumps, collisions and falls came with fright.
"I can't even watch sometimes," said Bonnie Fox, looking back on the last four years. "I just close my eyes."
Michael suffered from pectus excavatum, a deformity that causes the chest to sink inward. To correct it, doctors inserted a small, flat steel bar under his sternum just before Michael's freshman year at Red Lion. The hunk of metal remained there for all four years of his high school basketball career.
Throughout that time, he reached the 1,000-point plateau and earned all-league honors from area coaches on multiple occasions.
Michael seemed to inherit a passion for basketball from his father, who played professionally in Italy after being drafted in 1987 by the Chicago Bulls out of Millersville. He also received some height from his 6-9 father. The sunken chest also runs in the family, as John's father and oldest son, Matthew, had the affliction.
Michael was diagnosed as an 8-year-old. John and Bonnie Fox hoped Michael wouldn't need the Nuss procedure, which installs a stabilizing bar to correct a child's sunken chest.
"It's opening up either side of your rib cage, inserting a steel bar and flipping it over, popping your sternum out," John Fox said.
The procedure is typically done for cosmetic reasons. Neither John's father nor older son needed it, but Michael's chest sunk by four inches. The final sign Michael needed a correction came in his eighth-grade year during a spring tournament game in Kutztown. Racing around the gym, he felt weary enough to pass out.
"All I could see was black," he said.
John Fox coached the team and sensed trouble as he rushed to midcourt.
"I just remember a desperate look in his face, like 'I can't breathe,'" the father said. "Then we knew it was time to seriously consider the surgery."
Going this route had been suggested at the time of Michael's diagnosis, but John and Bonnie sought a second opinion. They found one at Johns Hopkins and were urged to wait because of a failure rate in children who receive the procedure too young. Typically, the bar remains in place for three to four years. Michael wound up keeping his for four years, two days. His doctor told him, once it's removed, his bone structure should be developed enough that his chest wouldn't again sink.
By autumn of his freshman year, Michael recovered in time to play on the junior varsity team. He even earned some varsity minutes and said he hardly felt the foreign object inside him, except for the clips on each side of his rib cage. The occasional metal detector at an airport also reminded him.
Nick Kocman, a football and basketball player at Red Lion, remembers how much Michael would push himself as a basketball player.
"Mike, relax man," he told him. "You have to realize your body needs to recover."
Kocman knew this as well as anyone. He had surgery the summer before his sophomore year of high school to repair a hole in his heart. He recovered to play football later that fall. A year later, he spotted a freshman who "seemed like he was stressed or overwhelmed. I thought, 'Oh he's a younger guy getting used to JV or varsity.'"
Once he learned Michael's situation, they developed a bond. Michael would pull himself from games to throw up, but he learned how to balance his cardiovascular limits with his competitive nature.
"We tried to get him to a point where he'd tell us," Lions coach Steve Schmehl said. "A lot of kids don't want to do that, especially with how competitive he is."
Few people outside of the Red Lion community knew of Michael's condition. Every time he stepped on the court, he ran the small risk of a collision that could potentially shift the steel bar inside his chest.
Like the time during his freshman season, when he stepped in front of Central York senior Ricky Mosley.
Trying to take a charge, Michael said he just wanted to prove himself — even against Mosley, an athletic 6-4 forward who loved to attack the rim.
"You just hold your breath and hope everything's OK," said John Fox, who watched from the varsity bench.
Any time another player cut under Michael while positioning for a rebound, his parents worried.
"Did the bar move?"
It did early in his sophomore year.
"You have to figure," John said of Michael, "he's probably 5 or 6 inches taller now than when he had the bar put in. He's probably 40-50 pounds heavier."
Those growth spurts caused movement. One day, Michael woke up and felt a shift. Later, he noticed a lump from a muscle that became agitated by the clip on one end under his chest. An X-ray revealed the clip at the edge of his left side moved a few inches. His doctor deemed the bar still adequately supported the sternum, but John and Bonnie talked among themselves and with Schmehl about sitting Michael out for a season.
"I wanted to play my sophomore season," Michael said. "I knew I was going to have a bigger role."
He wound up sitting out for only a week, but Bonnie took precautions.
The family purchased protective padding, which could wrap around Michael's lower torso. Bonnie sewed a second one to create a shirt that could protect her son's chest.
She still cringed from the stands.
Even as he approached 1,000 career points in February, she worried more for her son's safety than his feat. The Fox family has a picture of Michael driving to the basket, and Bonnie can be spotted in the stands hiding her face in her hands.
"Hopefully it's not going to be like that when he's in college," she said.
He at least no longer has the bar.
Michael underwent an hour-long procedure in July to have it removed. Two weeks later, he ran the court at Penn State York and tested himself with former teammates Judge Kunce and Wyatt Tyson. They took turns in shooting drills during a lunch break from coach Parrish Petry's summer camp. Later, Michael progressed to 3-on-3 drills.
He felt a little winded but otherwise the same.
"Throughout high school, I didn't really think about it being in there," Michael said of the bar. "When you get it out and see it, it's weird to think I had it in me for four years."
Michael is unsure whether he will again suffer from queasy lapses this fall at the University of Sciences in Philadelphia, where he will study to be a pharmacist and continue to play basketball. Some feelings never go away: the urge of cutting through a crowd to set a pick or spotting up for a jump shot. At one point during camp at Penn State York, he made four straight.
Still no worries there.
Contact Matt Goul at 771-2045.
About pectus excavatum
Pectus excavatum also is known as "hollowed chest," "sunken chest" or "funnel chest." It is the most common chest wall deformity seen in children. The cause is PE is unknown but often tends to run in families.
The defect commonly worsens during puberty until age 18. According to Johns Hopkins, safe repair of PE is best performed in children older than 5. The preferred age is about 14.