The text message from Jeremy Maclin told David Culley that something was very wrong.
"The text said, 'Coach, I'm very concerned about my health.' Period. Nothing else was there," recalled Culley, the Eagles wide receivers coach. "Although you can't feel a text, I felt just from what he said to me, there's something seriously wrong with him."
The confidence Culley knew so well was missing.
By the time Maclin sent that message, he was well into a harrowing summer that involved no fewer than six tests for cancer, hours spent with needles inserted into his chest and back, and a frustrating lack of answers.
The end of the story is well known - Maclin was cleared of having any serious illness, including lymphoma, a form of cancer that his family felt certain he had. He returned to the Eagles and didn't miss a start until sitting out the last three weeks with a hamstring injury, but will be back on the field Sunday in Miami.
Less known is that for Jeff and Cindy Parres, Maclin's surrogate parents, the tense search for a resolution didn't end once their son went back to practice. One doctor still worried that Maclin might have had a rare and less treatable condition.
"I was obviously relieved, but there was a couple other possibilities on the table," Jeff Parres said, including the chance that Maclin might have had an unusual condition called inflammatory pseudotumor. "That thing was always lingering in the back of everybody's mind."
The receiver knew only some of the details when he returned to Philadelphia. But Parres, a urologist who has cared for Maclin since the player's childhood and closely monitored his treatment, still waited and worried in St. Louis, just as the family did all summer.
It scared everybody
For weeks, Parres was sure his son had lymphoma.
Starting in February, he had watched Maclin's energy sag. Home with the family in a suburb near St. Louis, Maclin had a low-grade fever and sweated through his sheets at night. He lost weight, 15 pounds by early April, Parres said. Doctors found signs of internal inflammation, but, at first, nothing that seemed worse than a virus.
Then Maclin returned to Philadelphia, where he met with Eagles internist Gary Dorshimer. Dorshimer thought Maclin's spleen was enlarged.
"I immediately knew then the potential that he might have lymphoma. That was the first thing that came to my mind," Parres said. Until then, "it hadn't crossed my mind that it was anything serious."
A CAT scan showed no signs of cancer, but the symptoms continued and Maclin's hemoglobin count was low. In June, Dorshimer ordered a PET scan, often used to find cancer.
"The PET scan was the thing that really scared everybody," Parres said.
On a scale of 1 to 10, Maclin's lymph nodes were inflamed to a level of 9 and 10.
"From that point forward, it was kind of like, 'He has lymphoma and we've just got to make the diagnosis of how to get it treated,' " Parres said, describing the emotional summer.
More tests were needed, though, for a conclusive diagnosis. Penn doctors used a needle to extract tissue from behind Maclin's sternum. Maclin went back to St. Louis, where Parres connected him with Nancy Bartlett, the head of oncology at Washington University. In July, doctors checked his bone marrow. Next they pulled tissue from a lymph node next to Maclin's aorta.
Maclin was awake as doctors inserted an 8- to 9-inch needle through his back. As it advanced, they stopped for scans to make sure it was on the right path.
"That biopsy was tough," Parres said. "He came home from that and said, 'I'm done. I'm going back to Philadelphia. I don't care what this is, I'm not doing anything else.' "
The frightening PET scan was in June. Now it was late July. Each test was followed by two to three days of waiting. None provided a clear answer. Doctors couldn't say Maclin had cancer, but they couldn't rule it out.
Parres, who works at Washington University's Barnes-Jewish Hospital, had access to Maclin's records. In the days between the tests and results, he would punch up the computer to check for an update.
"Every time you go through one you're expecting some horrible outcome. You're hoping you get an answer but you're hoping it's not the big 'C' word," Parres said. "It made me acutely aware of what people go through when they're waiting for my report . . . it's agonizing."
Lymphoma has many forms, but it is usually treatable. NHL legend Mario Lemieux and golfer Paul Azinger each went through bouts with lymphoma and continued their careers. In Parres' mind, Maclin might need chemotherapy and miss a season, but would be all right in the long run.
Maclin, though, "was depressed, despondent," according to his father.
"Cancer kills people," Maclin told The Inquirer in October. But he said he never worried for his career. "I felt like I was strong enough to fight through it."
(Maclin declined to be interviewed for this story. An Eagles spokesman said he didn't want to revisit the topic).
"[He was] tremendously worried," Culley said. Although Maclin began feeling well, cancer "was always there in the back of my mind."
Finally, doctors decided to remove and check multiple lymph nodes. The surgery was Aug. 11 in St. Louis.
More waiting. But within 48 hours Parres got a call from Bartlett while driving home. No cancer. He arrived home to share the news with Maclin, Cindy, and the Parres' two biological sons.
"We were thrilled, but not to sound greedy or anything, but from that minute forward it was just his drive and push to try to get ready," for the season opener, Parres said.
The game was one month from Maclin's surgery in St. Louis, his hometown. As far as Maclin knew, he was cancer-free and could focus on Week 1. Concern lingered for Parres.
Still waiting for answers
During the surgery, doctors found white spots on Maclin's liver and his spleen looked abnormal.
"What sticks out in my mind more than the discussion about him not having lymphoma was when Dr. Bartlett called me to give me the results of the biopsy," Parres said. "She knew he didn't have lymphoma, but she still didn't know what he had."
High on Bartlett's list was that Maclin could have inflammatory pseudotumor. According to Parres, only 25 people have been diagnosed with the condition. With such a small sample, there is no known treatment. Most patients got better on their own, but about 25 percent didn't. In some cases it was fatal, Parres said.
"That hit me like a ton of bricks," Parres said.
He didn't bring up the possibility with Maclin. There wasn't a firm diagnosis, and even if there was, there wasn't anything Maclin could do but hope to get better with time.
Twelve pathologists examined slides from Maclin's surgery. They were sent to the National Cancer Institute, the Mayo Clinic, and to a specialist at Vanderbilt who studies inflammatory pseudotumor.
No one has come up with a final diagnosis, though after a few weeks, they ruled out the rare condition.
"I've talked to Jeremy about it, but I've never gone too deep into the potential seriousness of what that might have been," Parres said.
Going home to the dome
In Philadelphia, Culley sensed the relief in Maclin's voice.
"All he wanted to do was to go in that dome and play," he said.
The team had to watch him, making sure he didn't overdo his training in his zeal to get on the field. His hemoglobin count was still off, which, in theory, should have sapped his endurance.
"You need red blood cells to carry oxygen, and he was running on two-thirds of normal red blood cells," Parres said. But neither he nor coaches noticed any problems.
"He always wanted a few more reps than we were willing to give him," Culley said.
The night before the game in St. Louis, Maclin and teammates LeSean McCoy and Jamar Chaney joined the Parreses for a big family dinner.
"It was kind of a special deal," Parres said. "I'm kind of a man of science, but sometimes you wonder with a thing like this if there isn't a little divine intervention."
The next day, in his first NFL game in his hometown, Maclin was in the starting lineup. It was as if the entire summer was forgotten, Culley said.
Maclin was still anemic - his blood count only returned to normal in November, Parres said - but he has caught 46 passes for 612 yards, both team highs.
He now takes anti-inflammatory medication every day and has his blood checked each month.
Culley credits Maclin's hard work for allowing him to return so quickly, but believes the time missed in the offseason contributed to the recent hamstring injury.
Parres missed watching Maclin play.
"Sometimes I find myself moping around on a Sunday when he's not playing," Parres said. "Then I think, 'You've got nothing to gripe about.' "
And much less worry.