Book Review: A Matter of Inches

I stayed up late several nights over Christmas break reading Clint Malarchuk’s memoir, A Matter of Inches. Malarchuk is the former Buffalo Sabres goalie best known for having his jugular vein severed by a skate in 1989, and returned to play 10 days later. The book also covers his struggles with mental illness, alcohol abuse, and suicide attempts.  As a Buffalo native, hockey player, paramedic, and psychology major in college, I found each aspect of the book fascinating.

I have been interested in Malarchuk’s story since I was 10.  I first learned about his injury when my family returned from a spring break trip.  My childhood friend, with whom I followed the paramedics around our Buffalo suburb on bicycles with, had mailed a newspaper clipping to my house with the famous picture of Malarchuk holding his neck over a pool of blood on the ice in front of the net. (While my friend went onto a successful career in college sports, I never grew out of the allure of lights and sirens). The following year we were at a swim camp, and during the say-not-to-drugs lecture our coach told us about how Malarchuk survived his injury, but ruined his career after mixing pain pills with alcohol. I remember Malarchuk was also the backup goalie for the Sabres on my first Super Nintendo hockey game.  Ten years later I learned that a manager at my first ambulance service cared for Malarchuk both when he was injured at the Sabres game and a near-fatal overdose at his residence. Since then I have come across his name in various hockey publications and had wondered what happened to him.  When I saw he had a memoir it was at the top of my Christmas list.

Malarchuk wrote about his struggles with obsessive-compulsive disorder and depression. that began long before his injury. He described the near constant anxiety and self-doubt during youth and junior hockey, where he wondered if he was going to get cut from a team or if he was better than other players. There was also unexplained abdominal pain and a fear of germs at his elementary school that lead to him being hospitalized. His anxiety fueled a desire to exercise and train harder than the other players and he made it to the NHL. The feelings he described brought back my own memories as a new paramedic. While it fueled a desire to be a good one, I became much happier, and better, after learning how to let that go.

Regarding depression, he writes:

“Let me tell you. I’d rather have a broken femur or a broken back, any physical pain, than that depression. Clinical depression is just-I mean, I asked God take me. Kill me. I didn’t have the balls to do it myself. But feeling the way I did, I didn’t even want to live”

Malarchuk described how his OCD, post-traumatic stress, and alcohol addiction fueled several destructive behaviors. He experienced a nearly constant paranoia about germs, people coming to get him, being cut from teams, his wife cheating on him, long periods of insomnia, and nightmares. This lead to bar fights, domestic disputes and failed marriages, overdoses, stints in rehab and relapses, and suicide attempts. His OCD and PTSD were misdiagnosed several times, and he was prescribed the wrong medications after it was. One of Malarchuk’s encounters with law enforcement occurred after he was asked to leave a bar, which he went to after escaping from a hospital before being committed. Several police officers responded, and the situation escalated when one of the officers taunted him.  He described “feeling like a mad man” while he fought with them, that he would fight to the death, and that once his adrenaline passed a certain point there was no room for reasoning. His wife and former coach stood by watching, and told the officers that he needed medication while they repeatedly kicked his ribs before getting handcuffs on.

Malarchuk clearly presented a safety threat that needed to be mitigated, but I wonder if the outcome would have been different if the officers had crisis intervention training. These programs give law enforcement and EMS a better understanding of mental illness and deescalation techniques. Malarchuk’s symptoms during this episode are also consistent with excited delirium, which is a frequent cause of in custody fatalities. Having EMS available to administer sedatives after he was restrained by law enforcement would have benefited everyone on scene, and he could have gone to the hospital instead of jail.

In my career I have cared for hundreds of people who have engaged in similar destructive behaviors as Malarchuk, and I was not always nice to them. I  wondered what they could possibly be thinking, why they would repeatedly make choices that lead to such damage, and why their loved ones stay with them. I understand a bit more now. I do not excuse these behaviors, but after reading Malarchuk’s story will be more empathetic towards my patients who engage in them.

Clint Malarchuk’s memoir is a fascinating story that covers emergency medicine, mental illness, and life in the NHL.  I strongly recommend it to anyone interested in these areas.


  1. Save that book for me. Malarchuk really went through life’s wringer, and its amazing he lived to write this book. I hope someday medical advances will result in mental illnesses being treated like chronic physical diseases like diabetes, without the stigma is still has today. While progress has been made, we are still in the dark ages concerning this matter. For example, the number of veteran suicides, even from non-combat people, is shocking and is not being handled well.

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