During his ordeal of chemotherapy treatments for leukemia, he watched games from his bed with his wife, communicated with players and assistants by phone and text messages and scoured game film on his home computer. The Colts responded with one of the greatest turnarounds in league history and an improbable run to the playoffs.
On Monday, the Professional Football Writers of American selected Indianapolis' inspirational coach as its George Halas Award winner for overcoming adversity.
"I am honored and humbled to receive this award," Pagano said in a statement released by the team. "The encouragement I received from my family, friends, the Irsay family, the Colts organization, the city of Indianapolis and fans around the country was overwhelming. The outpouring of prayers, love and support from a community that hardly knew me, made me realize how fortunate and proud I am to serve this organization and city."
Hired in January 2012, Pagano was diagnosed with leukemia in September and took a leave of absence after only three games.
The team began winning under offensive coordinator Bruce Arians while Pagano underwent treatment for 12 weeks.
Under their guidance, the young Colts rebounded from a 2-14 mark in 2011 to 11-5 in 2012 and the most surprising playoff berth of the 11 the franchise has had in the past 13 years.
Arians often acknowledged that Pagano gave the Colts a sense of purpose. It was never more apparent than the comeback against Green Bay when Reggie Wayne stretched his orange gloves across the goal line in the final minute. Orange is the color designated for leukemia awareness.
Arians called the award "such a fitting honor for Chuck and what he accomplished last year,"
"I've seen some impressive things in my career but nothing compares to what he did beating cancer and coming back to energize our team leading into the playoffs," Arians said. "I was proud to have a front row seat to witness it."
Pagano credited moments like Wayne's TD with the orange gloves and the team's overall performance for keeping him upbeat throughout the grueling and draining treatments that continued late into the fall.
The mutual admiration was never clearer than Pagano's postgame locker room speech following a Week 9 victory against Miami. It nearly brought Arians, Colts players and team owner Jim Irsay to tears.
"I've got circumstances," Pagano said, at times sounding out of breath. "You guys understand it, I understand it. It's already beat. It's already beat. My vision that I'm living is to see two more daughters get married, dance at their weddings and then hoist that Lombardi Trophy several times."
Indianapolis didn't stop there.
It kept winning. Pagano watched another victory over Buffalo from owner Jim Irsay's suite and saluted the crowd, leading to a rousing ovation from the fans.
Pagano returned to coach the final regular-season game, a victory over Houston that cost the Texans a first-round bye and sent Pagano back to Baltimore for the playoffs. But the former Ravens defensive coordinator couldn't figure out a way to upset his old team, which went on to win the Super Bowl.
Arians won the AP's Coach of the Year award for his work while Pagano was sidelined, and now is head coach in Arizona. And along the way, many in the league joined a bandwagon that went far deeper than football.
The Colts began a campaign to raise money for leukemia research and called it CHUCKSTRONG. Many Colts players, including No. 1 draft pick Andrew Luck, shaved their heads in support of Pagano. Two Colts cheerleaders raised $10,000 for leukemia research by shaving their heads during that Nov. 25 win against Buffalo.
Packers center Jeff Saturday, a longtime Indy player, wore a CHUCKSTRONG shirt during warm-ups for a game against his old team in October. After scoring a touchdown in the season finale at Indy, Texans running back Arian Foster tapped a sign in the back of the end zone as a tribute to Pagano before taking his traditional celebratory bow.
Many of Pagano's coaching friends and old players, including Ray Lewis and Ed Reed, hugged him before and after the playoff game.
AP sports writer Bob Baum in Phoenix contributed to this report.