For decades, researchers going back to Martland had suggested that dementia pugilistica was most likely to strike second-rate fighters, sluggers who lacked the technical skills of scientific boxers, and heavyweights whose heads were pounded with the most force. Sugar Ray Robinson, all 155 sculpted pounds of him stretched over a five-foot-eleven frame, broke the mold. Of all the practitioners of the sport long known as “The Sweet Science,” Sugar Ray was the sweetest. In that mano a mano subculture prizing the knockout punch as the pinnacle of accomplishment, Robinson had brought the manly art of self-defense to a new level. He boasted an unrivaled blend of speed, power, and the creativity of a Picasso, his skills so sublime that a precocious teen named Cassius Clay resolved to model his style on the mentor he called “the king, the master, my idol.” If Robinson wasn’t immune to the ravages of brain damage, could any boxer be safe?
It seemed as if no amount of artful, scientific skill could protect a boxer from paying the price of glory. Willie Pep, nicknamed Will o’ the Wisp for his elusiveness and fleet-footed agility, and hard-punching Sandy Saddler traded the world featherweight title through four classic confrontations at mid-century, then lived out their final years in nursing homes suffering from dementia pugilistica. Wilfred Benítez, a stylish prodigy whose skills and speed made him the youngest world champion in ring history when he won the welterweight title at seventeen in 1976, kept finding places to fight long after the government of his native Puerto Rico banned him from boxing on medical grounds. Stumbling, slurring incoherently, flying into rages, Benítez would be living in a nursing home by the age of thirty-eight.
The list of demented champions goes on and on. Paradoxically, the best boxers were often the ones at highest risk because they had longer careers, faced more quality opponents, and showed the most ability to take a punch. Not surprisingly, the heavyweight ranks, where researchers measured punches equivalent to a thirteen-pound weight swinging into the face at twenty miles an hour with a force exceeding a thousand pounds, were even more decimated by dementia than the lower weight classes. For too many, the reward for achieving the most coveted title in sports—heavyweight champion of the world—turned out to be a requiem for the brain. For the public at large, brain damage became as much a part of boxing lore as the championship belt itself.
In the opening scene of the 1962 film Requiem for a Heavyweight, the washed-up fighter Mountain Rivera, played by an aging Anthony Quinn, has been brutally knocked out in the seventh round. After examining him in the dingy locker room, the doctor tells Rivera’s manager that the battered boxer’s career is over because he’s just a couple of punches away from needing a tin cup and some pencils. As Rivera staggers off to the shower, the manager, played with sleazy desperation by Jackie Gleason, reflects for a moment and tells the cutman with a shrug, “Maybe he’s lucky at that. At least he walks away with his brains. That’s better than most.” The fighter who ends Mountain Rivera’s career was portrayed by a brash young up-and-comer who played himself in the film: Cassius Clay.
• • •
Two decades after winning that fictional movie fight in a dreary New York City armory and then capturing the real-life heavyweight title to turn Cassius Clay into a household name he’d soon change, Muhammad Ali returned to the same upper Manhattan neighborhood where Requiem for a Heavyweight was filmed. In September 1984, Ali checked himself into Columbia-Presbyterian Medical Center, right across 168th Street from the armory, hoping doctors there would tell him that he was one of the lucky ones who, in the words of Mountain Rivera’s manager, “walks away with his brains.” The bravado that defined his celebrated persona had given way to a subdued anxiousness. “I’ve been in the boxing ring for thirty years and I’ve taken about a hundred and seventy-five thousand hard punches,” he mused, “so there is a great possibility something could be wrong.”
For years, that prospect had hung over his head like a sword of Damocles. Despite his unmarked face and his elusively agile boxing style, Ali had endured a lot more punishment than it appeared on the surface, especially later in his career. Upon his 1970 return from his forced ring exile, three and a half years slower than the dazzling young champion whose tap dancer’s footwork had made him hard to catch and harder to hit, he needed to compensate by adding another tool to his repertoire: the ability to take a punch. He would demonstrate this toughness in training sessions, laying on the ropes and letting sparring partners pound his body and head as a show of machismo, and in bouts against champions who punched with malice and left damaged brains in their wake. When his aura of invincibility was shattered in “The Fight of the Century”—the 1971 showdown of unbeaten heavyweights that somehow exceeded its hype and confirmed Joe Frazier as the undisputed champion by unanimous decision—so was his veneer of invulnerability.
Even in the fights Ali won, he absorbed some vicious beatings. In the 1974 “Rumble in the Jungle” against George Foreman, the massive puncher who’d wrenched the title from Frazier with six knockdowns inside two rounds, Ali lay on the ropes, his forearms raised to shield his face like a turtle in a shell, and let the younger, stronger champ bang away with sledgehammers to the body and head. Only after Foreman had punched himself into exhaustion did Ali spring from his “rope-a-dope” shell to shock everyone with an eighth-round knockout and reclaim the championship.
Defending that title the next year against Frazier in the epic “Thrilla in Manila,” Ali would have to survive a grueling war of attrition that tested each man’s will, courage, and resilience. With Frazier relentlessly and remorselessly pounding thunderous hooks to the body and head, Ali slumped on his stool after the tenth round and gasped, “I think this is what dying is like.” Just when all hope seemed lost, Ali summoned strength from somewhere deep down inside and rallied like a wounded lion ferociously fighting off a fierce enemy. He punched Frazier’s legs to rubber and eyes to slits, but spent the last of his own reserve and resolve doing so. At the end of a fourteenth round savage enough to make even bloodthirsty fight fans feel guilt over their voyeuristic bloodlust, Ali dragged himself to his corner, wearily held out his gloves, and told his trainer, “Cut ’em off.” Before Ali had a chance to quit, Frazier’s trainer, Eddie Futch, beat him to it, placing his hands firmly on his own protesting fighter’s shoulders and commanding, “Sit down, son. It’s over.” By not letting his defenseless charge answer the bell for the fifteenth and final round, Futch had mercifully stopped history’s best and most brutal bout because he “didn’t want Joe’s brains scrambled.”
Given all the damage that Ali and Frazier inflicted on one another through the forty-one rounds of their three-fight blood feud, their heroic rubber match should have put an exclamation point on both of their storied careers. “What you saw,” Ali said slowly an hour afterward when he’d finally summoned enough strength to face the press, “was next to death. Closest thing to dyin’ that I know of.” His eyes vacant and his voice a halting raspy whisper, he would later confide to a reporter, “Why I do this? It was insane in there. Couple of times, [it felt] like I was leaving my body. I must be crazy. For what? This is it for me. It’s over.”
If only Ali had indeed walked away then. If only he’d had an Eddie Futch in his corner to save him from himself. The closest thing to that in his own entourage was Dr. Ferdie Pacheco, the physician who’d been in his corner since the night a young Cassius Clay shockingly beat the fearsome ex-con Sonny Liston into submission to win the title in 1964. Now, eleven years later, as Pacheco performed his customary postfight checkup back at the Manila Hilton, he examined Ali’s puffy face—forehead ridged with bony lumps, eyes swollen half shut above angry purple welts, lips scraped raw as if sandpapered—and envisioned a brain that must likewise have become “a swollen, scar-filled mess.” Pacheco, haunted by the specter of someday seeing “the most joyful, talented guy in the world stumbling around and mumbling to himself,” decided the time had come to advise Ali to retire. Ali nodded knowingly, then ignored doctor’s orders.
A year lat
er, minutes after barely retaining the title with a controversial decision over Ken Norton, Ali lay flat on his back, exhausted and strangely silent, in an eerily quiet Yankee Stadium dressing room as Pacheco examined him. “I don’t have it anymore, Doc,” Ali said softly, breaking the silence. “I see the things to do, but I can’t do them. I’ve got to get out of this before I get hurt. Am I through, Doc? Should I quit?”
“Yeah, Champ, I wish you would,” Pacheco sighed, “but you won’t.”
Pacheco knew better. Pacheco knew all about the ego that had stoked Ali’s competitive fire and the vanity that now threatened his well-being. Pacheco knew all about Ali’s mounting financial worries due to lavish spending, alimony payments, and the responsibility of providing for eight children. More than that, Pacheco knew all about what he diagnosed as Ali’s susceptibility to “the most virulent infection in the human race: the standing ovation.” For the self-proclaimed “People’s Champion,” his own personal siren call became the rhythmic chants that echoed loudly through arenas the world over: “Ah-lee! Ah-lee! Ah-lee!”
Pacheco’s intensifying crisis of conscience reached a tipping point a year later after Ali barely retained his title by decision over the hardest puncher he ever faced, Earnie Shavers. At a press conference the next day, Madison Square Garden’s matchmaker, Teddy Brenner, privately urged Ali to announce his retirement and then publicly made a startling announcement of his own: the mecca of boxing would never again host an Ali fight, Brenner declared, because “I don’t want him to come over to me someday and say, ‘What’s your name?’ ” The very same day, a New York State Athletic Commission doctor handed Pacheco a lab report revealing that Ali had serious kidney damage as well as neurological deterioration. Pacheco immediately wrote Ali a letter begging him to retire and sent copies of it along with the lab report to his wife, trainer, and manager by certified mail. When the letter elicited no responses, Pacheco did what Ali wouldn’t—he quit. Pacheco, whose work in Ali’s corner had made him a celebrity in his own right known internationally as “The Fight Doctor,” left the famous entourage and the fight game itself.
Ali kept right on fighting for another year, losing the title to the inexperienced Leon Spinks and then regaining it for an unprecedented third time, before announcing his retirement at thirty-seven. As it turned out, though, Ali was no more immune than Sugar Ray Robinson, Joe Louis, and Jerry Quarry to the prizefighter’s curse. Ignoring the pleas of his wife and his mother, Ali decided two years later to challenge for the title he’d vacated by retiring.
Because of mounting controversy over his slurred speech and slowed reflexes, he had to pass a neurological exam at the Mayo Clinic as a precondition for a Nevada boxing license. Though medically cleared for a 1980 title challenge in Las Vegas, he proved no match for the unbeaten Larry Holmes, his onetime sparring partner who’d succeeded him as champion in his absence. Holmes pulled his punches throughout the first ten rounds, continually imploring the referee to mercifully stop the beating before his idol got seriously hurt or worse. The slaughter finally ended with Ali slumped on his stool, unable to answer the bell for the eleventh round. By then so impaired that no U.S. site would sanction a farewell fight, Ali ignominiously ended his career in the Bahamas a year later with a dismal, defenseless defeat against an artless, awkward trivia answer named Trevor Berbick.
When Ali finally hung up the gloves for good, he looked and felt much older than his thirty-nine years. Although the head blows had stopped once and for all, the troubling symptoms—slurred speech, slowed movement, crushing fatigue, sluggish reflexes, hand tremors—were getting progressively worse.
Just seven months into his hard-earned retirement, Ali was hospitalized at UCLA Medical Center with those telltale signs of parkinsonism. He complained to doctors there that he was “walking like an old man,” slurring his speech with low volume, drooling on occasion. A year later, he was back at the UCLA hospital, complaining that he was “moving like a mummy” and that his speech was becoming unintelligible. This time, CAT scans and neuropsychological tests revealed signs of brain damage significant enough for doctors to prescribe L-dopa, the drug of choice for treating parkinsonian symptoms. The meds helped ease the symptoms by replacing the dopamine his brain was no longer able to produce in sufficient amounts, but when the condition kept worsening over the next year, Ali became more worried. No longer in denial, he resolved to get to the bottom of whatever was causing these problems. Which is what brought him to Columbia-Presbyterian Medical Center in 1984 for eight days of extensive testing at its Neurological Institute.
The neurologist he had been referred to was Dr. Stanley Fahn, director of the hospital’s center for movement disorders, who’d built a reputation as the Muhammad Ali of Parkinson’s experts. During their intake consultation, Fahn could sense how much the tremors and sluggishness troubled the once-graceful athlete celebrated as the fastest and smoothest heavyweight of all time. More than that, Fahn could sense how much the slurred and mumbled speech distressed the voluble firebrand notorious for taunting his foes in verse and for sparring verbally with reporters. “People say to me, ‘What did you say? I can’t understand you,’ ” Ali reported. “I’m not scared, but my family and friends are scared to death.”
Upon examination, Fahn found such telltale signs of parkinsonism as stiffness, slowed movement, and decreased facial expression. A CAT scan showed atrophy of the cortex and a hole in the septum, and an MRI revealed damage to the brainstem. Neuropsychological testing uncovered slowed reflexes and response times, but there was no evidence of memory loss or declining intelligence.
At the time of Ali’s discharge, Fahn issued a brief public statement explaining that his famous patient was exhibiting “some mild symptoms of Parkinson’s syndrome”—not punch-drunk syndrome, not dementia pugilistica—and that he didn’t appear to have a progressive degenerative condition. At Ali’s request, Fahn did not disclose what he believed to be the cause of the parkinsonism.
Not until several years later did Fahn, at Ali’s behest for an authorized biography, reveal that he had indeed linked Ali’s condition directly to boxing. His actual diagnosis, Fahn disclosed in the 1991 Ali biography, “was a post-traumatic Parkinsonism due to injuries from fighting.” In Parkinson’s disease, he explained, the cells that produce dopamine in the substantia nigra of the brainstem progressively degenerate and die, depriving the central nervous system of a neurotransmitter essential for motor control. “In Muhammad’s case, there’s damage to these cells from physical trauma,” Fahn told biographer Thomas Hauser in Muhammad Ali: His Life and Times. “Muhammad himself told me he thinks that most of the damage came from the third Frazier fight, the one in Manila. That may be where he started to get his damage, but it’s highly unlikely that it all came from one fight. My assumption is that his physical condition resulted from repeated blows to the head over time.”
The manifestation of that damage was evident even before Ali’s 1980 comeback fight against Holmes, when reporters accustomed to interviewing a loquacious loudmouth had to lean in close to hear his mumbled, slurred words. Noting how Ali had shown clear parkinsonian symptoms since that time, Fahn told Hauser, “One might argue that his Parkinsonism could and should have been recognized earlier from the changes in his speech. That’s speculative. But had that been the case, it would have kept him out of his last few fights and saved him from later damage. It was bad enough to have some damage, but getting hit in the head those last few years might have made his injuries worse. Also, since Parkinsonism causes, among other things, slowness of movement, one can question whether the beating Muhammad took in his last few fights was because he was suffering from Parkinsonism and couldn’t move as quickly as before in the ring, and thus was more susceptible to being hit.”
Certain symptoms led Fahn to diagnose what had long been described in the medical literature as “pugilistic parkinsonism.” Numbness in the face and lips, rendering Ali unaware of when food needed to be wiped away, indicated damage to the b
rainstem due to boxing. So did his sleep disturbances. The early onset of his speech problems, like that of the sleep problems, provided more evidence that the cause was brain trauma.
Over the decade following the diagnosis, Ali receded from the spotlight, becoming as conspicuous by his silence as he had been by his booming presence. Of all the names speculated as candidates to light the Olympic cauldron at the 1996 Summer Games in Atlanta, no one thought to mention the ailing legend who had stamped himself the world’s most famous athlete after bursting into the public consciousness as a brash eighteen-year-old gold medalist at the 1960 Games. But then suddenly there he was, at the climactic moment on the grandest stage in the world, materializing high on the platform at the far end of Atlanta’s Olympic Stadium, greeted by an astonished gasp that built into a reverential roar.
It was an unforgettable sight: Muhammad Ali, a six-foot-three specter dressed head to toe in white, standing larger than life on the pedestal, his left arm performing an involuntary dance at his side, his empty left hand trembling, while his right arm held the flaming Olympic torch aloft. It would remain an indelible image: Muhammad Ali, expressionless behind a parkinsonian mask, emerging as the public face of a disease many sufferers prefer to keep private and the public face of traumatic brain injury from the sport that had brought him to this Olympic peak before billions of viewers.
Paradoxically, the more Parkinson’s slowed his movements, the more mobile he became after his Olympic rebirth, traveling the globe in his role as cultural icon and goodwill ambassador. With Parkinson’s continuing its relentless march through his central nervous system, however, Ali became more and more a shadow of the glib and graceful figure remembered for promising to “shock the world” and then delivering on that boast time after time. The most recognizable face on the planet, once so animated and stunningly handsome that he never missed a chance to remind everyone how “pretty” he was, had become a lifemask. The familiar voice, once so strident that it inspired his original Louisville Lip nickname, was stilled. The fancy footwork, once so quick that the “Ali Shuffle” could be appreciated only in slow-motion replays, had given way to the Parkinson’s shuffle.
The Concussion Crisis Page 25
