Medically Barred from the NBA, Isaiah Austin Is Putting Up Big Numbers in China

Leo Sepkowitz@@LeoSepkowitzContributorAugust 22, 2018

Photo via Isaiah Austin on Instagram

As Isaiah Austin moves through China—dropping 41 in Henan, 38 in Lhasa, 57 in Hefei, and so on—he is often asked the same thing by demoralized opponents: Why don't you have an NBA contract?

It is at once a sweet and devastating question.         

If you know Austin's story, then you know the answer: He doesn't have an NBA contract because he's not allowed to have one.

A few days before the 2014 NBA draft, league doctors diagnosed Austin, a two-year starter at Baylor and a first-round prospect, with Marfan syndrome. The condition enlarges the aorta, the artery that carries blood from the heart. The more an aorta expands, the more likely it is to fatally tear. Especially considering that blood pressure increases with physical activity, NBA doctors declared Austin ineligible to play.

But if you don't know all of that—which is the case for many competitors in the Chinese National Basketball League—then all you know is that Austin is frightening at 7'1", bringing the ball up freely, running the pick-and-roll and demanding isolations. His talent transcends the fairly obscure NBL.

"I'm a complete mismatch on the court," Austin says. "I haven't come across someone in this league who can check me."

Austin, 24, is calling from Guangxi, where he is rising to stardom in exile. In his second season there, Austin is averaging 35.1 points per game along with 10.3 rebounds, 1.8 blocks and 0.9 steals. On a super-sized team, Austin plays small forward, and opponents marvel at his versatility. He attempts seven free throws and—yes—seven threes per game, while shooting 53 percent from the field. But most amazing for the man who supposedly risks his life with significant physical exertion: He logs huge minutes, sometimes playing all 48 in a given night.

"I'm in really good shape, which is why it's really hurtful that people won't give me an opportunity," he says. In addition to the NBA, many international teams have been wary of signing Austin so far. "Even after playing these strenuous minutes and working out each day, I've had no regression in health. I'm just getting healthier."

There is an upsetting counterbalance here: The better Austin plays, the more evident his bad luck becomes. His unthinkable endurance, for instance, can mostly serve as a reminder of what he could be, what he should be. It's a unique sort of basketball limbo. I ask whether he feels like he's living his dream.

"In a way I am," he says.

"Right now, we're eating off of these contracts I'm getting in Asia, and I'm having fun. I really am," he adds. "A lot of guys who play overseas told me their love for the game fades, but I haven't experienced anything like that. The love is growing within me right now."


Isaiah Austin Instagram account

In 2014, as Austin faded from the collective eye of NBA fans, his prominence grew in the Marfan community. He appeared at an annual Marfan conference in August of 2014, meeting with patients and doctors. Soon after, he connected with Dr. David Liang, a Marfan specialist at Stanford University. The two of them bonded. While Austin stayed in shape with restrained workouts, he kept in touch with Dr. Liang. A few times a year, Austin flew out to northern California for a checkup.

Dr. Liang recalls Austin being shell-shocked at the time. Physically, though, Austin felt good. Dr. Liang had confirmed the NBA's Marfan diagnosis via genetic testing, but noted that Austin had a "very mild" case.

"Isaiah is in a gray zone," he says.

At age 12, when Austin conspicuously stood six feet tall, he was taken to Children's Minnesota hospital because of his height to check for Marfan Syndrome. He wasn't genetically tested there, and based on diagnostic criteria (Austin's history and physical exam), he didn't qualify. Though he was unusually tall and lanky, Austin didn't display the condition's more severe marks, like curvature in the back or low muscle density. He was cleared.

When he was 14, Austin suffered a detached retina, leaving him blind in one eye, a fairly common occurrence in Marfan patients. But the injury had stemmed from a baseball striking him in that eye. It was hard to say for sure what role, if any, Marfan had played.

As he met with Dr. Liang, Austin wasn't experiencing common Marfan symptoms such as shortness of breath or fainting. At Stanford, frequent scanning showed consistency in the size of Austin's aorta—it wasn't expanding, which was the main concern.

"His aorta technically is abnormal, but it's very mildly abnormal," Dr. Liang says. "If I measure the aorta one millimeter smaller, it's normal."

By late 2015, Austin started to wonder if, someday, he might play again. Dr. Liang wondered the same.

A plan was put in place: Austin would participate in pickup games, so long as he didn't compete at full speed. Meanwhile, Dr. Liang would continue to monitor his heart. As long as Austin's aorta remained stable, he could methodically increase the intensity of his workouts. Austin was eager to get going.

"I asked his buddy, 'When Isaiah is scrimmaging, does he take it easy?'" says Lisa Green, Austin's mother. "He said, 'How am I supposed to answer that, Ms. Green?' I knew in my heart Isaiah was going all out."

Isaiah Austin Instragram account

Austin's body continued to respond well to increased effort. In late 2016, Dr. Liang cleared him for professional competition. But this was no clearance on a sprained shoulder or even a shredded knee. 

"This is an inherently dangerous condition," says Dr. Timothy Dutta, a cardiologist at Weill Cornell Medical College, speaking generally about Marfan. Dutta has handled athlete clearances before, but has not worked with Austin. "There's no such thing as 'clearing,'" he says. "It's all an assessment of risk. You can't tell someone you're cleared and not at risk; that's misleading to people. There's always ambiguities. Life is unpredictable. You can't actually clear someone. You can say, 'Your Marfan is favorable and we'll watch it carefully.'"

Indeed, Dr. Liang himself emphasizes that he did not clear Austin in the conventional sense, or give him the green light, as was reported at the time.

"My philosophy is, it's not my job to tell people what they can and can't do,'' Dr. Liang says. "It's to let them understand what the risks are."

He adds: "What I'm trying to weigh is his physical risk as well as his psychological and emotional risk," Dr. Liang says. "I have a good feeling of the cost of playing; this is what I do for a living. When I first met Isaiah, the cost of not playing was, 'He's going to be happy, able to function and enjoy his life—in which case, alright, just don't play'. As time went on, it became clear to me that if he didn't have a chance to play, it would have left a big wound in him emotionally and psychologically. That's what changed for me."

Dr. Liang and the family agreed on a plan just like before: While Austin launched his pro career, they'd monitor his aorta. The Austin family was ecstatic.

"I knew in my heart Isaiah was coming out of a deep hole," Green says. "I saw him smile again."

Austin marched his case to the NBA, ready to begin a long career, still in his early twenties.

Teams were interested. Some asked if Austin would come by for a tryout or sign in the G League. It all seemed to be happening.

Only it wasn't.

Isaiah Austin Instagram account

Austin had to take another physical through the NBA, which confirmed the Marfan diagnosis, and he remained ineligible. While there is no written league policy that bars a Marfan patient from playing in the NBA, the league follows a recommendation written by the American Heart Association and American College of Cardiology, which says that athletes with Marfan Syndrome “should not participate in any competitive sports that involve intense physical exertion or the potential for bodily collision.” A league spokesman declined comment on Austin's particular case, citing medical privacy laws.

After all, there have been cases of basketball players dying from other types of cardiac issues. Among them are collegiate star Hank Gathers, in 1990, and G League player Zeke Upshaw, this past March. The nature of Marfan—which can lead to an aortic rupture and sudden death—adds extra gravity to Austin's situation.

So while Dr. Liang may have given Austin his blessing, the NBA wasn't willing to do the same. NBA teams had to follow the ruling. Even abroad, teams were passing on Austin, worried about both his health and his lack of pro experience.

During that time, Green recalls Austin sinking to a "really dark place."

"When Isaiah was released to go play but nobody wanted to take a risk, he was like, 'Is this some sick joke?'" Green says. "I'm like, 'Isaiah, you have to be grateful and have gratitude that you're even alive.' He looked at me and said, 'Just because I'm alive, doesn't mean I'm living.'"


On Jan. 7, 2017, Austin signed his first pro contract, in Serbia. The deal included a medical waiver that stated the team wouldn't be responsible for any cardiac issues. For Austin and his family, it was a monumental triumph.

It also marked the big man's first time living alone, and it took time to settle in a far-off land.

"It was different just having to be alone and coping with that loneliness for those first couple months," Austin says. "Getting there and not knowing any Serbian and trying to figure your way around the city, and your Google Maps isn't loading—it's those types of things that you have to learn."

He came to appreciate the experience. His team set him up with an apartment, and he picked up enough Serbian to get by. He went to the local bakery for breakfast and cooked his own dinner. Some meals were spent with teammates, and he learned to enjoy their company. Eventually, his girlfriend joined him, and their son was born in Belgrade, the country's capital. He averaged just shy of 10 points per game.

Isaiah Austin Instagram account

He then signed on with Guangxi, where the life adjustment has been more difficult.

For starters, he is 8,000 miles away from Texas, where his family lives and where he last starred on American turf. Austin lives in Yulin, a remote city in Guangxi. The nearest big city is the capital, Nanning, a three-hour drive away.

Austin has found little to occupy his time. He mostly travels to and from the gym and plays Fortnite. FaceTime helps, but the afternoon for Austin is the middle of the night back home, and he often loses service when he travels. That's another thing: Traveling in the NBL means 12-hour journeys across China. Even eating can be frustrating. Austin is still figuring out what to order and how. He can communicate with his translator and two of his teammates, but that's about it.

Still, he maintains admirable perspective.

"I'm just happy I can play the game again, because that was the main thing missing from my life," he says. "It was killing me slowly being away. Pursuing a pro career and making a nice amount of money to take care of my family is something I'm very thankful and grateful for."

Austin's heart is still scanned regularly, and the images are sent back to Dr. Liang, who notes that Austin's aorta still "hasn't changed one bit" over the years. Unlike many Marfan patients, Austin takes no medication for the condition.

"I don't ever think about my health when I'm playing," he says. "I know how I feel, I know my body, I know I'm healthy."

In the past, superior international leagues spurned Austin over medical and basketball questions, but he has done all he can to answer those. Time will tell whether he's done enough, or whether that's even possible. With the NBA no longer an option, an ideal next move for Austin might be the renowned Chinese Basketball Association, or the EuroLeague, where each team makes its own medical judgment on players.  

In the meantime, the playoffs in Guangxi begin on Aug. 29. The Rhinos are stomping along at 20-8, and Austin says he's set on leading them to a championship.

Then it'll be back to Dallas, Texas, to spend time with family. His child is 15 months old now. Austin's mother, who also lives in Dallas, expects Isaiah will buy a house nearby and settle down soon. Not yet, though. There's been enough moving, hustling and stressing lately. Once Austin returns home from his long journey abroad, he really only has one goal: to take his son to Disneyland.

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