“Huh,” Hamilton said, having finally figured the puzzle out. “So how did you end up with a boxer down at that morgue?”
“It’s not a boxer,” Bennet said.
“It’s not a boxer?” Hamilton said.
Nope.
Hamilton returned to the slides. “Where else do you find tau tangles like this?”
“It’s a football player,” Bennet said. “Mike Webster.”
Hamilton looked at him, his eyebrows popping up in disbelief.
“A professional football player,” Bennet said. “Mike Webster was a professional football player who played football for the Pittsburgh Steelers.”
“Bennet, I know who Mike Webster was,” Hamilton said. “But this is crazy.”
“Mike Webster was crazy,” Bennet said.
“I know—”
“And this is why.”
Hamilton went back to the microscope.
“I’ve been looking at it for a long time, and this is why,” Bennet said. Now he spoke like a confident man. He knew this stuff.
Hamilton sat back in his chair. The simplest, most elegant discovery. Football players getting dementia pugilistica.
Bennet explained the major difference between dementia pugilistica and his finding. In this case, the brain doesn’t look battered at all on gross examination. It looks perfectly normal. It wouldn’t be something a pathologist would have cause to go looking for. There would be no signs of it in a normal autopsy. You would have to know the clinical history. You would have to know the guy went crazy. You would have to then go cut the brain, stain it with these particular stains, and then look at it under the microscope. You would have to go through all the steps Bennet went through, following no protocol, following the call of only his own blind curiosity.
“Good lord.”
“Same pathology, different presentation.”
“This is crazy.”
“Mike Webster was crazy,” Bennet said.
“Dementia footballistica,” Hamilton joked. He kept going back to the slides. “This is crazy. This has never been identified before.”
“I’ve been sitting with it,” Bennet said. “I have no other way of understanding it.”
“We need to take this upstairs,” Hamilton said.
And so that day Bennet and his former professor paid a visit to the chair of the University of Pittsburgh Department of Neurology, Steve DeKosky, director of the Alzheimer’s Disease Research Center, who was preeminent in the field of neurodegenerative diseases. Bennet had met him maybe twice before, and only in passing. He was the grand pooh-bah. He was fancy and political. He was just the type of guy Bennet never wanted to become.
But DeKosky knew brains. And he’d had his own questions about the NFL and brain trauma. Alzheimer’s researchers in his circle of colleagues had been talking about retired NFL players reportedly having memory problems. He had decided to follow up. He reached out to the NFL Hall of Fame and suggested a design for a large longitudinal study that would track Hall of Famers over time. The suggestion was never acknowledged—no one from the association had even written back to him—and the slight had made DeKosky ever more curious.
And now Hamilton was appearing in his office with a former fellow—that odd man who chose to work at the morgue instead of pursuing an academic career—with something to say about the brain of an NFL player.
DeKosky respected Hamilton. That was about the only reason he agreed to entertain Bennet’s seemingly random presentation. The three sat and repeated the guessing game, only this time DeKosky was the one looking in the microscope.
Mike Webster’s brain.
This is Mike Webster’s brain.
“You have my attention,” DeKosky said, and he got up to close the door.
And so Bennet explained what he had done and what he had seen, and under the buzz of a fluorescent light in an office in a hospital on a sunny hillside in Pittsburgh, the three scientists agreed that they were looking at something no one had ever found before, let alone gone looking for. They decided to write a scientific paper about it and present it the way they would present the results of any important scientific study.
Later, Bennet told Wecht about what he had found in Mike Webster’s brain, and Wecht said, “What? What the hell are you talking about, Bennet?”
He had Wecht’s attention, and soon he would have America’s.
CHAPTER 8
BELONGING
Uche came to visit and then Mie-Mie did and then Uche again; in those first years in Pittsburgh while Bennet studied brains, the two sisters circled in and out of Pittsburgh on business travels and vacations. For Mie-Mie it was a chance to visit the big brother she had always called her best friend. She was now a newly minted PhD, working for Shell Oil in the United Kingdom; she had a fancy life, fancy friends, a boyfriend of considerable wealth who drove a Rolls-Royce. Hanging out in Pittsburgh with Bennet in his little condo grounded her, was a respite from all that, her quirky brother with the brains in his fridge, doing experiments, writing papers—she thought it was awesome, and kind of adorable, and she was proud of him. She loved spending time with Prema, this quiet, iron-willed nurse from Nairobi whom Bennet was seeing—or maybe not seeing. That still was not clear. But Mie-Mie and Prema felt they were becoming sisters and Bennet got to feel like the man of the family; it was his apartment, his car, his world they had entered. On Saturdays they all went to the Grove City outlet mall together, on Sundays to St. Benedict’s together. Bennet was proud to introduce Mie-Mie to the congregation; the people had gotten to know Uche, and now here was Mie-Mie. It was like he had a growing family here, he had sisters, Prema, Wecht like a father, and Father Carmen like a brother. He had work he cared about, and all of it together was like a cradle rocking him in 2003 and 2004, slowly rocking him, as the depression that had strangled his youth was gradually losing its grip.
Out of the cradle and into the real world. That’s what it felt like. Or maybe: out of the loony bin and back into the real world. Maybe that was more like it. He would drive his Mercedes through the streets of Pittsburgh with Bob Marley blasting through the speakers and he would think how good and mysterious it felt to be emerging, finally, from the hell that had been holding him. He thought back to secondary school. The track team. You’re watching everyone running, for so long just watching, thinking, marveling at the kids whizzing by you. But then something happens—what happens?—and you decide to stand up and push your foot off the soft ground and you find out you can do it, you can participate, and oh my gosh you have a lot to offer! He thought about his sister Winny, her telling him about that strange howling noise that came out of his mouth that day he went back to grab the baton from that fallen boy, that great howl of determination that came out of him! Winny couldn’t stop marveling at that sound he had made, and he had no idea what she was talking about. I made a sound?
You belong. That was probably the biggest thing he felt in 2003 and 2004. In those days of discovery, when the depression lifted, he felt he was finally able to belong to something, to somewhere, to someone.
That was the spirit and that was the strength he brought to the scientific paper he was writing about Mike Webster’s brain. He was doing what a respectable scientist does, and he felt comfortable in those shoes. He did not think his research on Mike Webster’s brain was any more brilliant than any of his other studies; all of them were the results of logic, so all of them were beautiful. He had at least a half-dozen works in progress. He never stopped being interested in suicide. Why do some depressed people kill themselves and others do not? He would talk to Prema about it. “Could there be something in the brain itself?” he’d say. “We should do a study.” She said she would help. Together they worked on a ten-year retrospective survey of suicides in Allegheny County, tracking patterns of brain pathology.
Also, he was working on “Fatal Constriction of an 8-Year-Old Child by Her Parents’ Pet Python: A Call for Amendment to Existing Laws on the Ownership of Exotic Wildlife to Protect Children fr
om Avoidable Injury and Death,” with Wecht. That was a doozy. A Wecht-branded doozy. He was working on “Fatal Fulminant Pan-Meningo-Polioencephalitis Due to West Nile Virus” with some other pathologists at the morgue, and he was working on “Postbariatric Surgery Deaths, Which Fall Under the Jurisdiction of the Coroner” with Todd Luckasevic, his new sidekick at the morgue. Todd was a medical student doing a rotation there, and Bennet was his supervisor. Todd was a delight, and so was his little brother Jason, a law student. Two brilliant guys who welcomed Bennet into their family, too, for Thanksgiving, for a beer after work, to hockey games; the community Bennet was creating in Pittsburgh was growing wide and deep, like roots under a sapling suddenly standing strong.
If he thought his paper about Webster’s brain was special at all, it had little to do with the league Webster played for or the politics of big-money football. It was a personal thing for Mike. It was, Bennet thought, Mike Webster needing to tell us something.
Mike Webster spoke to us through the patterns of disease in his tissues. I listened and translated what he said. He said it was not his fault. He said to us that he suffered from the effects of more than twenty thousand blows to his head while he played football. He told us to do something so that younger players who will come after him will not end up like him. He told us to be more compassionate, more understanding, and more patient with his peers who may already be suffering from what he endured.
—
Writing a scientific paper was like stepping into a loud and crowded room. There’s a whole bunch of blabbermouths in there already, going on and on, and you have to figure out what everyone is talking about before you can figure out how to join in.
The national conversation about football and concussions had started in earnest in 1992. That was the year Al Toon, a three-time Pro Bowler—once the highest-paid wide receiver in pro football—retired from the New York Jets at age twenty-nine because of brain injury. “It felt like a cannonball hit me in the back of the head,” he said of his final NFL play, in which he caught the ball, and got dinged. He had experienced many such hits. “I don’t recall all of the concussions. There were more than five and probably fewer than twenty. There was a serious blow my last year in the league, another in the middle of the season, and then little bangs that everybody gets in every game. It was the cumulative effect of previous concussions. I remember clearly to this day the doctor saying, ‘You have reached the point where we don’t know what’s going to happen next. You may never recover.’ ”
Two years later, the twenty-nine-year-old running back Merril Hoge—Mike Webster’s roommate when he played for the Steelers—retired abruptly from the Chicago Bears after getting kneed in the head while throwing a block against the Buffalo Bills. He had received a previous concussion a few weeks earlier during a road game against the Kansas City Chiefs and had been cleared to resume playing during a telephone call with his team doctor. Hoge made the decision to quit football as he lay in intensive care unable to recognize his wife or his brother, or even to remember that he had a fourteen-month-old daughter. “I don’t function, period,” he said. “There is no control. I’m at the mercy of time.”
At that point, people in the media started to question what was going on. Players had gotten so much bigger, so much faster, the hits so much harder. Guys were ending up in intensive care with head injuries, all these tragic stories playing out on TV. What was going on? And what was the NFL going to do about it? “The Season of the Concussion,” headlines read, when, in 1994, three quarterbacks—Troy Aikman, Chris Miller, and Vinny Testaverde—were knocked unconscious on one Sunday alone. “To this day, I don’t recall playing in the championship game at all,” Aikman would later say. “I don’t think I ever will.” He took the Cowboys to Super Bowl XXVIII, and they won it. “The Super Bowl isn’t real clear—what happened during the game isn’t clear to me.”
The PR was terrible for America’s game. Good clean fun. Family fun that began with peewee leagues in towns and farms and suburbs of America. High school dreams and letter jackets and cheerleaders bouncing. And then the NFL! Not just a league, but a whole entertainment industry. Bigger than any other sport. Way bigger. Bigger than TV. Bigger than music. Bigger than Hollywood. An $8 billion per year American success story. The hits were part of the fun. Fans loved them. The NFL sold “Greatest Hits” videotapes at Kmart for people who wanted to watch them again and again.
But…debilitating hits? Surely that was an exaggeration. Or that was when you cut to commercial.
“There is an enormous amount of pressure on the player, the owner, and the doctor to get that player back out there,’’ Hoge would later say, adding that the NFL had no guidelines at all for when a player should or should not return to play after a concussion. It was just: Get back in there.
And now America was saying: Well, now, wait a second. Are you sure these guys are okay?
NFL Commissioner Paul Tagliabue owed America a response. In truth, he thought this whole year-of-concussion business was a lot of hype—“a pack journalism issue,” as he told one reporter. But he had a public to answer to, customers to satisfy, and so he would be a man of action. In 1994, he announced that the NFL was going to address the problem of head injuries in its players by putting together a committee. A team of doctors and scientists would do research and determine if football was truly harmful to players and their brains, and if it was, the committee would figure out what could be done about it. They would mount a series of rigorous studies, Tagliabue said. The team he assembled was called the NFL’s Committee on Mild Traumatic Brain Injury. (The league had replaced the term “post-concussion syndrome” with “mild traumatic brain injury,” a term it deemed “more academically appropriate.”)
Tagliabue named Elliot Pellman, a New York Jets team doctor, who had been Al Toon’s doctor, as the director of the fourteen-member MTBI committee.
—
The MTBI committee had been studying the problem of head injuries in football players for nearly a decade by the time Mike Webster died in 2002. They had been publishing their research in the scientific journal Neurosurgery. In 2003, Pellman compiled an overview of the committee’s work to date.
“Although published information existed,” he wrote in Neurosurgery, “most of what I—like other team physicians—knew about concussions was from on-field anecdotes passed on from other team physicians and athletic trainers who had been treating professional football players for many years. During my years of medical school, internal medicine training (including an extra year as chief medical resident), and fellowship, from 1975 to 1986, I had never received a single lecture on concussions. As I learned later, this was typical of physician training for what was then an often under diagnosed and little understood clinical condition.”
Gee, Bennet thought, reading Pellman’s account. He thought about his own dining room now littered with piles of books and papers about concussions dating back to Hippocrates. It is not difficult to locate information if you are interested in the science of concussion. Have these doctors not read the books? Should I tell them about the books?
“During my treatment of Mr. Toon,” Pellman went on, “I quickly realized how few experts and how little prospective, scientific medical information were available regarding concussions. I decided that a novel approach would be necessary to gather information, particular for a professional sports league.”
Gee whiz, Bennet thought. He had a library of scientific papers; researchers had been on this problem for a century or more. Perhaps he should call this Pellman and offer to share the materials he had accumulated on his dining room table? He felt increasingly excited about showing his own findings to this group that seemed to have a weak grasp on the basic science.
He wondered, too, what Pellman meant when he said his group needed to take “a novel approach” to studying brain injury. There were already plenty of research teams studying concussions. This was hardly some esoteric science. As early as 1982 brain injury in sports ap
peared as front page news in The Wall Street Journal. “A silent epidemic,” the story said. Teams of researchers in Pittsburgh, Boston, North Carolina, and other places around the country had been looking into the problem and publishing their findings. Jeff Barth, Robert Cantu, Julian Bailes, Kevin Guskiewicz, Micky Collins, Bill Barr—these were some of the established names in the field of concussion research, and none of them was on the MTBI committee.
Were doctors on the MTBI committee talking to these experts? And if not, why not? It seemed the committee was on a parallel track, blazing a new path, oblivious to—or ignoring—the work of experts working on the same question: Was there a measurable link between football and long-term brain damage?
Yes, concluded the American Academy of Neurology in 1997. In fact, the AAN had established guidelines for concussed athletes returning to play. “Repeated concussions can cause cumulative brain injury in an individual injured over months or years,” the AAN report stated bluntly. “The problem faced by the medical community has been developing a consensus on managing athletes with these injuries….Frequently, the loss of objectivity on the part of the athlete, coaches, sports media, and spectators is an unfortunate and potentially harmful bias.”
In the laboratory, scientists affiliated with the AAN were concussing rats to try to figure out how to manage the injury. The rat experiments confirmed the pattern they observed in people: Recovery varied from patient to patient. It depended on the severity of the blow, but also on how many previous concussions the person had had. Once you got one concussion, you were more likely to get another. After several concussions, it took less of a blow to cause the concussion and a longer period of time to recover. As a result of those findings, the AAN was able to define concussions in terms of three grades of severity: from transient confusion, Grade 1, to complete loss of consciousness, Grade 3. They recommended return-to-play rules based on the severity of the injury. Players who suffered a Grade 3 concussion should be withheld from play until asymptomatic for one week, they said, and if they got another Grade 3, they should be benched for at least a month.
Concussion Page 12
