Teofimo Lopez was risking his life and should have been in a hospital -- rather than a boxing ring -- when he lost his four lightweight belts to George Kambosos last week at Madison Square Garden, according to a doctor who subsequently examined him and reviewed his medical records.
"He could have died, for sure," Dr. Linda Dahl, an otolaryngologist (ENT) with surgical privileges at three Manhattan hospitals, told ESPN. "How he breathed, I can't even explain to you. It's like somebody tied a 300-pound set of weights around his chest ... like his neck and chest were in a vise.
"That's how he fought."
"He's lucky he's not dead," Dr. Peter Constantino, executive director of the New York Head and Neck Institute, told ESPN. "I mean, really lucky."
According to Lopez's medical records, the 24-year-old former undisputed champion was diagnosed with "pneumomediastinum" with "extensive air in the retropharyngeal space" by emergency room doctors during his postfight visit to Bellevue Hospital.
"The air was surrounding his chest wall and his heart and his neck -- places where air is not supposed to be," said Dahl, who worked as a ringside physician for the New York State Athletic Commission. "If he was hit in the neck or the chest -- a certain way, in a certain place -- he could have developed a pneumothorax [collapsed lung]. ... He would have instantly been down and unable to breathe and needing a chest tube."
The likely cause of the air, according to Dahl and records of physicians who saw Lopez later at New York-Presbyterian Hospital, was a small tear in his esophagus. Lopez -- whose diagnosis was complicated by his longtime asthma and a case of COVID he contracted in June -- began experiencing shortness of breath and swelling in the neck area on Friday, shortly before the weigh-in.
"I thought it was just my asthma," Lopez told ESPN, when asked why he didn't divulge his symptoms to his manager or the athletic commission during his prefight examination on Friday. "I fought through asthma before. If I told everybody, they would've canceled the fight. But I chose not to, because of the amount of pressure I was under. I didn't want to hear people say, 'Oh, another postponement.'"
Lopez-Kambosos, ordered as a mandatory defense by the IBF, was a star-crossed promotion from the beginning, with at least eight dates going back to May. What's more, Kambosos was not seen as a dangerous opponent. DraftKings had Lopez -- who cracked boxing's pound-for-pound lists with his 2020 win over Vasiliy Lomachenko -- as a 10-1 favorite.
Dahl, who worked for the NYSAC between 2004 and 2008, said Lopez's condition wouldn't have become apparent in the routine prefight exam, conducted right before last Friday's weigh-in.
"If you listen with your stethoscope -- as I did on Monday -- his lungs sounded fine," she said. "There's no way anybody could have diagnosed this without knowing how severe his symptoms were, then an X-ray and a CAT scan."
After the weigh-in, Lopez and his team -- minus his customary nutritionists, Perfecting Athletes -- went to the restaurant Carmine's to rehydrate and replenish. That's where his symptoms took a marked turn for the worse.
"It didn't get bad until I started rehydrating," Lopez said.
His throat and neck became swollen. His chest felt increasingly tight, and his breathing became labored. Again, he said, "I thought it was just my asthma. I been having asthma since I was 6 years old."
The likeliest explanation, according to Constantino -- familiar with both Dahl and the broad facts of the case -- is that Lopez "fast-stretched his esophagus until the point where he got a tear or something like that."
Lopez's parents -- including his outspoken father-trainer, Teofimo Sr. -- said they figured he might be suffering from acid reflux or dehydration from the weight cut.
"I took a seat in the back of the restaurant, by the kitchen," Lopez recalled. "Everybody's trying to burp me and relax me. They see my neck is swollen. My voice changed. At this point, everybody's a little concerned. I think my dad told me I should go to the hospital and I said 'no' because they're going to end up probably canceling the fight."
After returning to the hotel, they tried a variety of prospective remedies: Gatorade, hot tea, club soda, Pepcid, Tums and hot towels. Nothing worked.
By Saturday morning, Lopez said: "My neck is sore. My chest is sore. My throat is hurting. And I'm like, 'I guess I'm just going to have to fight like this.'" Kambosos knocked him down in the first round.
It marked the first time Lopez -- an overwhelming choice as 2020's Fighter of the Year -- was put on the canvas in his five-year pro career.
"That was not me in there Saturday night," Lopez said.
Despite the knockdown Lopez scored in the 10th round, and his postfight protestations that the judges robbed him, the fight was widely viewed as a clear win for Kambosos. The only scorecard raising eyebrows in boxing circles was judge Don Trella's, who had the fight 114-113 for Lopez.
After the fight, Lopez was given oxygen and directed by an athletic commission doctor to Bellevue, where he received nine stitches for a cut above his left eye. At 4:37 am, a CT scan mentioning "extensive air" in his neck cavity was logged in his records.
On Monday morning, complaining that he wasn't receiving adequate attention in the busy Bellevue ER, Lopez checked himself out against the doctors' advice. His alarmed manager, Dave McWater, called his firm's second-in-command, Ron Rizzo. Rizzo, in turn, reached out to Dahl, whom he knew from his days at the athletic commission.
Dahl met Lopez at his hotel. The now-dethroned champ was headed to John F. Kennedy International Airport, eager to board a flight to Las Vegas to see his son, born just weeks ago on Nov. 16.
"I looked at the scan when I saw him Monday morning," Dahl said. "I just said, 'Thank God you're alive.'"
She told him he could not fly, and directed him to check in immediately at New York-Presbyterian Weill Cornell Medical Center. Doctors there confirmed the pneumomediastinum diagnosis. He was discharged Thursday morning and advised not to fly for at least two weeks.
"I don't know how he went 12 rounds without being able to breathe," Dahl said. "But he has air where it's not supposed to be, and it's dangerous for him to get on an airplane."
Though Lopez was scheduled to have earned almost $3.2 million for the Kambosos fight, the lead-up marked an excruciating period in his young life. In August, he separated from his wife of just two years. In October he said he spoke of "thinking about killing myself" on at least three occasions this past year. That same month, his family -- whom he supports and has frequently feuded with his wife -- moved in with the young fighter. He left for New York on Nov. 20, just four days after seeing his son born. By fight week, Lopez said he had only about $20,000 left to his name.
Money was among the reasons Team Lopez let go of his nutritionists and assistant trainer, Joey Gamache -- both of whom were there for his title victories against Richard Commey and Lomachenko.
Perfecting Athletes, among the most respected nutritionists in combat sports, typically embed themselves with the fighter, basically living with Lopez through those two previous camps. This camp was much the same way until Lopez tested positive for COVID, indefinitely postponing a fight then scheduled for June 19.
"I didn't want to continue to pay them for like nine months without knowing an exact date," Lopez said. "It got too expensive."
Lopez says he knew their hydration and nutrition protocols from the Commey and Lomachenko camps. Still, while Lopez is considered big for the 135-pound weight class, there was no qualified nutritionist on hand for his weight cut. Under normal circumstances, Perfecting Athletes would have closely monitored his weight cut and rehydration periods.
Paulina Indara, the company's executive director, declined comment, citing client confidentiality.
Lopez said he didn't take Kambosos lightly, but his body has physically outgrown the division. He says his next fight will be at 140 pounds.
While he understands how lucky he is to have survived this defeat, he's looking forward to the new year.
"I've been trying to stay positive," Lopez said. "But I've been losing this whole year."