Editor's note: This story originally published Sept. 12, after Smith made the roster to complete his comeback.
As word trickled out about Washington quarterback Alex Smith's situation near the end of 2018 -- the 17 surgeries, the near amputation -- the thought of him playing football again was secondary. The big question: Would he live a normal life?
Within three months of breaking the tibia and fibula in his right leg on Nov. 18, 2018, at FedEx Field in a loss to the Houston Texans, Smith's attention turned toward football. In February 2019, Smith asked Washington's head team physician, Dr. Robin West, when she would let him play again. West replied: "When the bone has healed."
He asked again two months ago. A few weeks later, at a meeting in northern Virginia shortly before the Washington Football Team would begin training camp, West and Smith's team of doctors told Smith and his wife, Elizabeth, he was cleared. They told him the risk of reinjuring his leg was low.
"We all had those doubts," West said. "Then when I talked to him before we cleared him he said, 'I just want to try it. If it's healed enough and I think I can do it, then I want to do everything I can. Otherwise I'll never know and it will nag me my whole life.' He said, 'If I can't do it or I get cut, that's fine. At least I tried.'"
One person who understood not only Smith's pain, but also his desire to return, was former Washington quarterback Joe Theismann. In a game 33 years to the day Smith was hurt, Theismann suffered a compound fracture of the tibia and fibula in his right leg during a Monday Night Football game against the New York Giants. Theismann and Smith were the same age, 34, when they were hurt. Theismann wanted to come back; Washington cut him the following summer and he never played again.
"He has gone through a lot more than I had to go through," Theismann said. "For me it was a question of the leg healing and then trying to do certain things required of the quarterback position. Alex came within 24 hours of losing his leg. I didn't wind up with complications; he wound up with a tremendous amount of complications. It wasn't just healing from a broken leg. The mountain he had to climb is so much greater. No matter what happens, he's already won the award for comeback player of the year."
Said West: "Once we cleared him that was the good moment. That was the time to see him completely elated and say he's reached this point. He knew physically he could do it."
Then Smith went out and climbed the mountain Theismann alluded to by making Washington's 53-man roster -- a separate journey that played out from July 27 to roster cut-down day, Sept. 5. Here's an inside look at that process, which impressed many -- from former coach Urban Meyer to Green Bay QB Aaron Rodgers -- and caused others to become emotional, such as Alex's father, Doug, and former teammate Colt McCoy.
July 27: Placed on PUP list
Washington took it slow with Smith. On the day he had his physical, the team placed him on the physically unable to perform (PUP) list to ease him into football activity. Smith would work off to the side as the other quarterbacks performed drills.
Washington coach Ron Rivera: "I was skeptical to begin with. But the more and more I learned about his situation, the more and more I learned about his recovery and talked about those things with medical personnel, the more I began to understand."
Washington quarterbacks coach Ken Zampese: "The first thing we have to find out is if he can protect himself, and we'll figure that out as we go and as he passes the certain criteria to get to the next level of getting himself back to the field. The drill work will be very important, how quick is he when he pushes off and those kinds of things, and change of direction."
Aug 4: Side work
As Smith started working out, there were whispers that he looked better than anticipated. But did he look like his old self? The coaches knew they could tell only so much from watching him work with trainers, mirroring drills performed by the other quarterbacks. A big key: Smith wasn't feeling any ill effects the day following a workout. He also was a big help in meeting rooms.
Rivera: "I'll be honest, I was pleasantly surprised to see how far along he is. It's been exciting to watch his progression. He's looked very fluid. ... The big thing is if he can do the things ... that he needs to do to help himself on the football field. He'll be part of the conversation [about starting] most definitely.
"He already knows 75% of our playbook. Can he protect himself when he's on the field? He's going to have to hand the ball off. He's going to have to drop back into the pocket and throw the ball. He's going to have to escape and we have to make sure he can do those things."
Washington quarterback Dwayne Haskins Jr.: "Alex is just a great guy. Alex is what it's supposed to be like for a pro as far as how he handles his body, how he comes into a meeting room, how he's prepared with questions, how he's all ready for practice and what he's going to be working on in practice. He has a game plan already for what he needs for himself and that's something that any player can look at and be like: 'That's how a professional athlete works.'"
Aug. 16: Cleared for football activity
Washington had planned to announce Smith's return to football activity, only to be "scooped" by Elizabeth, who posted a celebratory video on Instagram the previous evening. In it, she and their three kids showered Smith with champagne as he returned home from Washington's practice facility. The cause of the celebration soon became clear.
Alex Smith's family gives him a celebratory champagne bath after the Washington Football Team clears him to return.
Rivera: "I said, 'Alex, you have to be able to protect yourself. You've got to be able to show us that you can protect yourself.' That's the thing. For me to sit there and say what his physical risks are, I'm not the doctor. Again, we listen to what the doctor told us. You don't ever want to put a player at risk. I just want to make sure that based on what I've seen, based on what I've heard, we can sit there and make the right decision whether to play him or not."
Doug Smith, Alex's father, on when he thought a return was possible: "Maybe this past spring as I watched him in April, May and got some videos he had sent from his workouts. He was feeling like it's all going in the right direction, it's all getting better. I looked at that and thought, 'He's going to get a shot.' I don't see how he does it. I don't know on one level, but I do know on another about him getting back and striving to do that, and all that is built into him. But then I also think, but why?"
Alex Smith: "In the football world I'm a dinosaur, but I felt like a 16-year-old again. The nerves, the feeling of excitement, obviously anxiety. All that stuff of being alive, the range of emotions of going out there with your teammates. That's why you play. It felt good to get those nerves going again."
West: "I said, 'Alex, no one wants you to get injured again. They saw the pictures and don't want you to go through that again.' When someone like [Washington Nationals pitcher] Max Scherzer asks me, 'Why does he want to play?' I said, 'You have the same drive he does.' But he said, 'Yeah but that's crazy. It's football.' ... But [Smith's] drive is something I've never seen. I've been in the NFL 18 years and MLB for five years. I've never seen someone with that kind of drive."
Aug. 18: 7-on-7 work
Two days after his return, Smith participated in full-pads 7-on-7 work for the first time since his injury. He was matter-of-fact, reserving his one show of emotion -- a pumping of his fist -- for a strike he threw over the middle.
Rivera: "His very first pass, he completed the pass on the swing to his left. What happened was he took his look through the middle of the defense to the side, then went all the way to the slot. You see that he's still in tune with that. He's an old, wily veteran. He went right through his progression."
Washington linebacker Thomas Davis Sr.: "To see him still have the drive and passion and want to come back is inspiring. I'm excited ... [But] I mess with him all the time. We came in with the same draft class [2005], so we're constantly calling each other the old guy. Both of us just still enjoying being here at this point in our careers."
Aug. 20: 9-on-9 work
Two days later, Smith took another step. He participated in 9-on-9 work for the first time, adding the element of two pass-rushers. He was forced to move more in the pocket. On the first of his three reps, defensive end Nate Orchard jumped offside and applied pressure, forcing Smith to slide his feet to the right. On his next two reps, Smith was forced to step up into the pocket. His first one resulted in a bad miss downfield. The second one ended with a strike to tight end Richard Rodgers.
Davis: "There have been several of those plays, whether you see him stand in the pocket and deliver an accurate pass or him just rolling out of the pocket and see him not think about it and not sit there worrying. He's putting the ball on the money. To have a guy that's gone through what he's gone through and compete at the level he competes, you definitely get excited and encouraged as a player."
Former Washington running back Adrian Peterson: "It truly is remarkable. The first time we saw him out there on that 9-on-9 drill, I think everyone was pretty amazed. ... To see him laying out on that field when the injury happened, fighting to not lose his leg, surgery after surgery, fighting to live and now he's out here zipping that ball around, moving around, sprinting out -- if that doesn't motivate you, I don't know what will."
Smith: "The first day out there, I'd be lying if I said I wasn't thinking about it, as far as just how I'd react and if I'd be quick enough or strong enough and things like that. Even just the few days in just how much more natural I've felt out there, I wasn't really thinking about it. I was thinking more about football and playing the game, which has been really, really nice to kind of lose myself in that. I look forward to kind of continuing with that."
West: "A couple players grabbed me and said, 'I saw him walk in and I saw him come on the field and I couldn't believe it. I saw him and I said "I have to work extra hard."' Younger players told me that; it said it really meant a lot to them."
Aug. 29: 11-on-11 work
With practice moved indoors because of weather, Smith participated in 11-on-11 work for the first time in camp. It wasn't a full-pads practice, but he took three snaps and attempted one pass -- a 5-yard checkdown to running back J.D. McKissic. Washington was still on the fence about whether to keep him on the active roster or, perhaps, place him on injured reserve.
Rivera: "It was a very big step because, again, it's back to football. Sure, we were in shells, but just the fact that he was doing something with 11 guys on the field at the same time is a big step in the direction that we all want to head. Right now it's not just what we're seeing, but how he's feeling."
Sept. 1-2: Passionate meeting
With final roster cuts looming, Rivera met with Smith privately for 30 minutes. Smith didn't want to go on injured reserve for one big reason: He wasn't hurt. It was either cut him or keep him. Rivera gauged Smith's passion for wanting to return. Smith likely secured his spot here, though nothing was official.
Rivera: "He was very passionate about wanting the opportunity to play again, very passionate about making this football team. That really stood out to me because it really just showed, mentally, I think he's past the hurdle."
Sept. 3-4: Clinching a roster spot
Washington's coaches gave Smith what he asked for: extensive work for the first time all summer. Smith participated in his first full-pads 11-on-11 session, and a day later in another full-team session, albeit in shells. Smith took all the backup and scout-team reps.
Rivera: "He stood tall. Guys were all over the place and he stood tall and delivered some good balls, some good passes. To me, that was one of the things I was looking to see, because I kept watching. I kept saying, 'He's just standing tall and guys are all over the place and guys are falling in front of him, falling behind him, bumping him.' So, again, like I said, it's just another step in the direction."
Doug Smith: "We had discussions with [Alex] the week before [cuts]. As of five days before, he didn't know -- not unlike lots of players going into that."
Sept. 5: 'They're going to keep him'
It became clear the previous night that Smith would make the final roster. One source said reporting the news that Smith would make it "wouldn't be wrong." But it was Smith's wife, Elizabeth, who shared the news with those closest to them. She texted West, though the doctor had known the news for a few days based on her conversations with the coaches. However, as West said, all week it was changing.
In an excerpt from E:60's Project 11, Alex Smith and his wife are among those who recall how his successful leg surgery quickly took a turn for the worse. Due to potentially disturbing medical images, viewer discretion is advised.
Doug Smith: "Liz called Friday night [Sept. 4] and said, 'They're going to keep him.' A lot of happiness, real joy for him. At that point, if you had to talk about it, you'd cry. ... The whole journey was quite emotional."
Green Bay Packers quarterback Aaron Rodgers: "Yeah, I'm just really proud to know him. I was asked by a few people, you know, like 'What is he doing?' And I thought I'd be doing the same thing. When you're a competitor and I know Alex is; I've known it for a long time, obviously just the drive that he has. He's been a great face of this league for so many years. I've enjoyed competing against him ... I hope he gets an opportunity to play this year."
Urban Meyer, Smith's coach at Utah: "You get emotional because you love him like a son. ... On a scale of 1 to 10 on intelligence, toughness, competitiveness, spirit, mobility and arm strength, he's a 10 on everything. Work ethic. Incredible leader. I think the world knows after that documentary [E:60's Project 11, a first-person account from Elizabeth to ESPN's Stephania Bell] how tough that guy is. He's one of the toughest I've been around. Not weight room toughness, but fourth-and-1 toughness. There was one game I ran him 20-plus times against BYU in a blizzard. He's a tough guy."
Doug Smith: "Certainly there were some dark, dark moments. It's been getting brighter and this is a bright spot for him. He's really excited to see how far he can get. He keeps talking about how he believes there's more progress in him, more he can gain in terms of his movement and mobility."
West: "His wife played a big role, too. To have someone like that. If you asked us a year ago we were all like 'I hope he never plays.' Elizabeth said the other day ... she really wants him to play now. She knows what drive he has and that he'll never be fulfilled until he tries to break all the barriers."
Former NFL coach Norv Turner, who served as Smith's offensive coordinator for one year in San Francisco: "He's an all-time guy. People that know Alex aren't surprised by it."
Former Washington quarterback Colt McCoy, who replaced Smith in the game he was hurt: "I wouldn't know what to say to him if I was talking to him. I would probably get emotional knowing everything he experienced. Everyone has seen the E:60, but it's so much deeper than that. It's pretty nuts. Nothing is ever a huge deal with Alex. He's so calm, so collected: 'It's all the doctors'; he defers everything. And part of him is right. Dr. West and her staff is amazing. He had the best care in the world. At the same time we're talking about playing in the NFL after dealing with something like that. It's just crazy. He knows I'm proud of him; he knows everyone is proud of him. It's a miracle."
ESPN injury analyst Stephania Bell and ESPN Green Bay Packers reporter Rob Demovsky contributed to this report.