By John Perrotto

PITTSBURGH -- The thought is in Brandon McCarthy's mind each time he throws a pitch.

It is not necessarily at the forefront of the Arizona Diamondback right-hander's very active brain every time he releases the baseball. But it is there.

It is a dark thought, one that causes so many kids to walk away from the game at the Little League level or before, but one almost every major league player has conquered long before he reaches the pinnacle of the game.

It is, quite simply, a fear of the baseball.

Baseballs hurt when they strike human flesh and they can do an incredible amount of damage, too, which no current major leaguer understands more than McCarthy.

The video clip has been shown plenty of times over the last year and baseball fans not prone to squeamishness have likely watched it more than once. The line drive off the bat of Los Angeles Angels shortstop Erick Aybar strikes McCarthy, then with the Oakland Athletics, in the head and the force of the impact causes the ball to carom directly to third baseman Josh Donaldson.

McCarthy suffered an epidural hemorrhage, brain contusion and skull fracture on that afternoon of Sept. 5, 2012. He underwent two hours of emergency surgery in what was termed a life-threatening situation. It is not being overdramatic to say that no pitcher in major league history has come closer to losing his life from being hit by a batted ball.

Nearly a year has passed since the scary incident at Coliseum and McCarthy, who signed a two-year, $15.5-million contract with the Diamondbacks as a free agent Dec. 11, has made 14 starts and pitched 83 2/3 innings in an injury-plagued 2013 season. While that might seem to be sufficient enough time and experience to put the incident behind him, it hasn't.

And that's what sets McCarthy apart from so many others in his profession. He is willing to admit that he carries some fear and vulnerability to the mound in each of his starts, even if both lessen just a bit with each turn through the Diamondbacks rotation.

"The only thing coming back off last year that is there is the kind of a spillover effect," McCarthy said. "It's hard to pitch and try to have full confidence when what happened is still in the back of your mind. It's like if you're in a bad car wreck. You know every time you can drive there's that thought in the back of your mind that it could happen again.

"So you try to go out and pitch well every start, try to put it further and further away and separate it in your mind."

Yet there are moments when McCarthy can't help but think about it. Two pitchers, the Toronto Blue Jays' J.A. Happ and Tampa Bay Rays' Alex Cobb, were skulled by line drives during games at Tropicana Field this season and had lengthy stays on the disabled list. The incidents were played over and over on a seemingly endless loop -- just like McCarthy's last season -- on television sports highlight shows.

McCarthy has had his own lengthy DL stint this season, sitting out from May 31-Aug. 3 with right shoulder inflammation. He has also had two harrowing incidents this summer, one off the field and one on.

Three days after going on the DL, he suffered a seizure as he was dining with his wife Amanda at a Phoenix-area restaurant. While related to his brain injury, the seizure was not severe and he has responded well to anti-seizure medication.

In his first start after being activated, McCarthy was pitching in Boston when Red Sox right fielder Shane Victorino sent a line-drive single whistling back through the box. McCarthy ducked just in time to avoid injury.

 "It was the first time I've been shaken in a game," McCarthy said. "Then there was a great sense of relief when I realized I was about an inch away from going through everything I went through all over again, if not worse.

"You want to push it to the back of your mind but it's still there and I'm not alone. Other pitchers have been hit and you've got to get around that others who have been in that situation."

McCarthy does not fit the professional athlete template, as he isn't prone to giving cliché-riddled answers dripping with machismo.

As any of his nearly 120,000 followers of his @BMcCarthy32 Twitter account can attest, McCarthy is humorous, thoughtful and insightful. He is that way, too, in a face-to-face setting when not limited to talking in 140-character bites at a time.

Being an entertaining figure in the Twitterverse and admitting to feeling vulnerable on the mound seems to fly in the face of everything the Diamondbacks are about. Led by general manager Kevin Towers and manager Kirk Gibson, the organization has placed more emphasis on grit and guts and less on talent. Witness the Justin Upton trade in January.

Gibson likes McCarthy though, and the sentiment is genuine because the manager does not fake things.

 "He's done a really good job for us and we're very happy with him," Gibson said. "The unfortunate thing is that he's been injured this year but he's thrown the ball well, better than his record shows."

McCarthy is just 2-7 with a 4.84 ERA.

However, McCarthy is an aficionado of sabermetrics -- something, ironically, the Diamondbacks have de-emphasized since Towers replaced Josh Byrnes three years ago -- and knows advanced statistics paint a better numerical picture than the regular measures.

McCarthy has a 3.74 FIP, which is more than three-quarters of a run better than his ERA. FIP, an acronym for Fielding Independent Pitching, measures what a pitcher's ERA would be assuming that performance on balls in play are league average. Hitters have a .335 batting average when they made contact against McCarthy, 42 points over the .293 league average.

However, McCarthy doesn't use sabermetrics to write off what has been a poor season to this point.

"How you get a win is a different thing and a lot of it is out of your control but the losses still matter," McCarthy said. "They are losses and they mean your team lost the game and that's the really important thing. In that regard, I haven't been good enough. It's because I've made bad pitches at the right time and haven't held up my end of the bargain."

Not a lot has gone right for McCarthy since that fateful day in Oakland last September. Yet he again did not fall into the default mode of saying that surviving such a scary moment has helped put his struggles in perspective.

"It probably has if I really sat and thought about it, but I don't sit and think about it," McCarthy said. "I try to take each start as an individual thing. I try to take what I can take from my last start and do better in my next start. That's how I was before and that's how I still am. My outlook hasn't changed a whole lot. I still want to win every game as much as ever and the losses still sting."

So while McCarthy retains the competitiveness necessarily to survive in the major leagues, the fear of the ball might occupy a small place deep in his mind. When it was suggested to a statistical-savvy pitcher that the odds of being hit in the head twice by batted balls in his career seem long, McCarthy looked to his right in the Diamondbacks' clubhouse and relief pitcher Brad Ziegler.

"Zieg's been hit twice in the head," McCarthy said. "Then there's a guy who has been struck six times by lightning. You never know. I will never take it for granted."

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John Perrotto has covered professional baseball since 1988 for such outlets as USA Today, The Sports Xchange, Baseball America, Baseball Prospectus and the Beaver County (Pa.) Times. You can find more of his work on Facebook or follow him on Twitter.