The NFL responded by slamming Omalu in the newspapers and on television. NFL doctors attacked the science, and then the scientist. They said he was too young and too inexperienced, just a rookie pathologist in his mid-thirties who was out of his depth. They insinuated, he’d later recall with a shake of his head, that he was practicing “voodoo medicine.” They questioned his motives and his ethics, denigrating him as some foreigner—a Nigerian—out to destroy America’s game and, by extension, the American way of life.
Omalu was stunned by the personal attacks. He had written his papers to share what he’d learned with the world, not as an assault on the sport. He understood the appeal of sports, even if he wasn’t a fan of football. While growing up in Nigeria, where he’d been born a refugee in the jungles of secessionist Biafra during a civil war air raid, he’d played the popular sport that most of the world calls football: soccer. His only exposure to American football then was through highlights glimpsed on CNN. He didn’t see the appeal of American football, and didn’t understand the game. He thought the players looked like extraterrestrials in their helmets and shoulder pads, and he found the tackling too ferocious. That opinion didn’t change when he immigrated to the United States in his mid-twenties to attend college and then medical school. He was sure he was the only man in Pittsburgh who didn’t spend Sunday afternoons rooting religiously for the Steelers.
Omalu, who hadn’t heard of either Mike Webster or Terry Long until the day of their autopsies, would eventually come to wish he had never heard their names or looked at their brains. He hated picking up the newspaper and seeing his own name dragged through the mud by the NFL doctors trying to discredit and dismiss his findings. He felt threatened by the NFL; he was just a little doctor going up against a multibillion-dollar goliath. Next time an ex-player died, he wouldn’t be so anxious to perform the autopsy.
On a cold winter night late in 2006, Omalu had just settled onto his living room couch to watch the evening news when the phone rang. Annoyed that the phone was intruding at dinnertime, he decided to ignore it. His wife quietly got up from the couch and answered it. She didn’t recognize the name of the caller and was about to hang up on him. Then she paused and decided to ask her husband if he knew someone named Chris Nowinski. The name rang a bell with Omalu. Mildly curious what it was about, Omalu nodded to his wife and took the phone.
• • •
Chris Nowinski had called Omalu with an unusual, albeit simple, proposition: If Nowinski could get another football player’s brain, would Omalu be willing to perform the autopsy? Nowinski had seen an obituary of a former NFL player as he was reading his morning newspaper and something had sparked in his brain. He wondered if Philadelphia Eagles star Andre Waters might have been suffering from the same concussion-related problems as Mike Webster and Terry Long. Now, Nowinski was offering to call Waters’s family to ask if they would allow Omalu to examine the player’s brain; Nowinski would tell the family that an autopsy might help not only answer their questions surrounding Waters’s odd behavior and suicide, but also shed more light on the possible connection between football and dementia.
Nowinski had a personal stake in the answer to that question. Over the years, he’d experienced many hits to the head as a college football player and a pro wrestler, and he was currently suffering from post-concussion syndrome. He wanted to know if he was at greater risk of developing early-onset dementia.
A big, athletic kid, Nowinski had always been drawn to football, but his mom had vetoed his participation until high school. She was aware of all the injuries in younger kids and she didn’t want her son hurt. Once he reached high school and went out for the team, it was clear that he was made for the sport. He had the hundred-page playbook memorized in a single afternoon and was voted captain the third day of practice. Nowinski played hard, and by the time he was a sophomore, he’d injured both his shoulders. That didn’t slow the enterprising linebacker down a bit. He just switched from battering with his shoulders to hammering with his head. He quickly realized that this was actually an improvement since it was an even more effective means of thrusting opposing players out of the way. It never once occurred to him that the technique could hurt his brain—he figured that he was big and tough and that his head was protected by a helmet.
By the time he was a junior, a host of colleges, including Harvard and Princeton, were courting the student with exceptional SAT scores, an excellent grade point average, and prodigious football talent. Nowinski chose Harvard on the advice of his high school coach and was soon using the head-as-battering-ram technique to bowl over players in college games as an All–Ivy League defensive lineman. He still wasn’t worried about his brain, even after one concussion left him calling friends by the wrong names at dinner and another turned the sky a strange orange hue.
When graduation time rolled around in the spring of 2000, Nowinski was at a loss to figure out what to do with his life. In college, he’d developed an interest in acting and he was hoping to find some sort of career that would allow him to explore that further. He had also become a big fan of professional wrestling, often crowding around the TV with his roommates and hailing each rousing bodyslam with a shout and a high-five. He thought it looked like fun, and as a lark, he checked to see what was involved in becoming a pro wrestler. The more he learned, the more it sounded like a real option to him. Here was a chance to have a job that would be an outlet for both his love of theater and his penchant for the physical. The promoters at World Wrestling Entertainment welcomed his acting talents, his sculpted six-foot-five physique, and the cachet of having a Harvard-educated star to hype.
Always with a flair for the dramatic, he enjoyed strutting out into the ring with his varsity letterman jacket and assuming the character of “Chris Harvard” before huge crowds of screaming fans. Though the beginning and ending moves were choreographed ahead of time, much of the rest was improvised. It reminded him of plays and drama classes he’d enjoyed in college. He had a lot of fun playing the vilified Ivy League snob—until the concussions started piling up.
Over the course of three years, he had four major concussions, each one worse than the last. Still, he managed to bounce back from the headaches, the blackouts, and the temporary blindness after the first three concussions without giving a thought to long-term consequences. Then, during a tag-team match in 2003, Nowinski got kicked in the chin by an opponent. As the boot made contact, it seemed as if everything around him exploded. He lay on his back staring up at the lights wondering why they were so fuzzy, wondering where he was and what he was doing there. Then he turned his head to the side, saw the screaming crowd and the referee, and suddenly remembered the match. He thought about getting up, but his head felt like it was in a vise. Before he could even register what was happening, another wrestler appeared seemingly out of nowhere and leapt through the air, landing his full three hundred pounds on Nowinski. The pain in Nowinski’s head was now excruciating. Somehow he made it through the rest of the match, but when it was over, he went to the locker room and stretched out on the cold cement floor without pausing to put on a shirt. His head hurt too much for him to move.
This time the concussion symptoms hung on tenaciously, even after weeks of rest. His head would throb for days on end. Each night he’d lay his head on the pillow, hoping that the ache would be gone in the morning. His memory, which had been almost photographic, was now spotty at best. He couldn’t recall anyone’s names; he’d forget important appointments; he couldn’t even summon his password when he sat down at the computer.
Nowinski went to doctor after doctor only to receive the same response every time: Just be patient, you’ll be better in a couple of weeks. After several months had passed, he realized that his doctors didn’t understand what had happened to him any better than he did. Resolving to find out more on his own, he became a regular at Harvard’s medical school library, pulling and photocopying every study that said anything about concussions, and about brain injury in general. The rese
arch came naturally to him. Since college he’d been working part-time as an analyst for a Boston-area biotech firm that did consulting work for pharmaceutical companies. It didn’t take long to dig up all the studies—there just wasn’t that much information out there.
Some of what he read made him shake his head in disbelief. Study after study found concussions to be relatively rare in athletes. Nowinski knew from personal experience that that couldn’t be right, but he understood how the researchers might have gotten it so wrong. He thought, “OK, I’ve had six concussions that I know of. I told zero people about them. That must be what everyone else is doing, too.” Nowinski dug deeper and eventually found studies showing that up to half of football players were being concussed every season. That made a lot more sense. So did the studies showing that concussions seemed to add up, with increasing numbers of jolts to the head leading to longer recovery times and a heightened risk of sustaining more concussions. Nowinski saw references to something called post-concussion syndrome and figured that might explain the symptoms that had been dogging him for the past year. What worried him was that nobody seemed to be able to predict how long the syndrome might last. It was at about this time that a friend referred Nowinski to Dr. Robert Cantu, one of the nation’s leading concussion experts.
Cantu did a series of tests and confirmed that Nowinski did indeed have post-concussion syndrome. The neurosurgeon explained that concussions could signal actual damage to the brain and that the damage could result in permanent deficits. Cantu couldn’t tell Nowinski exactly when—or if—all the concussion symptoms would resolve. What Cantu could say was that another concussion would lead to worse symptoms, a longer recovery time, and maybe permanent brain damage. That was enough to convince Nowinski to retire, at twenty-four.
Though he now had his diagnosis, Nowinski continued to scour the scientific literature for information on concussions. Some of what he found was downright scary. He read the studies showing that traumatic brain injury increased the risk of developing Alzheimer’s disease. Then he saw population studies suggesting that the risks of depression and dementia were higher among pro football players than the general population. Each time Nowinski found some new and startling result, he’d e-mail the researchers to get more information.
All the while, he was thinking about the significance of what he was learning. He started to wonder about all the other players who assumed, just as he had, that concussions were benign and transient. More important, he started thinking about the millions of kids playing football. In the back of his mind were the words his mother spoke as he was heading off to college. “You were born with gifts,” she’d said, “and you have an obligation to use those gifts to help people.” He decided it was his responsibility to sound an alarm. When he talked things over with Cantu, the neurosurgeon suggested that Nowinski write a book that would expose football’s threat to the brain.
As Nowinski continued to dig through the scientific literature, he stumbled upon Omalu’s first paper. He was stunned, and a little frightened, to see that a pathologist had found concrete evidence of chronic traumatic encephalopathy in a football player. After reading the paper, Nowinski wanted to know more. He shot off an e-mail to Omalu explaining his interest in long-term damage from concussions and asking if the neuropathologist would consent to an interview for a book. During the hour they spoke, Omalu told Nowinski about the Webster and Long cases, about the symptoms the players had exhibited after their retirements, and about the pathology he had found in their brains. He explained what was known about CTE from studies of boxers. Nowinski put it all down in a chapter in his book and then moved on to other topics.
He didn’t think about Omalu again until the day he opened the newspaper and saw Andre Waters’s obituary. Nowinski remembered Waters as an aggressive defensive back for the Eagles, one of the hardest hitters in the NFL. The safety’s fierce tackles and ferocious hits had earned him the nickname Dirty Waters and had led to a rule banning defensive players from hitting quarterbacks below the waist while still in the pocket. That hard-hitting reputation got Nowinski wondering about Waters’s concussion history. Sure enough, the more Nowinski searched the web for clues, the more concussions he uncovered. He found one newspaper clip in which Waters was asked in the midst of his twelve-year career how many concussions he’d sustained. Waters had replied simply, “I think I lost count at fifteen.” Another clip told about the time Waters was hospitalized following a seizure on the team plane after a game in which he’d suffered a concussion.
What happened to Waters after his 1995 retirement reminded Nowinski of Webster and Long. As Waters drifted from job to job as an assistant college football coach, he fell into a frighteningly familiar pattern of mental deterioration: memory loss, paranoia, depression, suicide attempts. A few days before Thanksgiving of 2006, Waters shot himself in the head at his Florida home. The report of his death at the age of forty-four made Nowinski think immediately of Long’s descent into suicidal depression. Nowinski thought that two former NFL players committing suicide in their mid-forties couldn’t just be a coincidence. So he called the pathologist who had examined Long’s brain as well as Webster’s.
Omalu listened to Nowinski’s proposition and then said he’d be willing to examine Waters’s brain. But Nowinski would have to be the one to convince Waters’s family that the autopsy could answer important questions—both for them and for others. Once Omalu was on board, Nowinski realized the enormity of what he’d volunteered to do. He was nervous about making what he recognized would be the hardest cold call he’d ever made. He sat down and typed out a script so he’d get the words right on the first try. He would explain that he, too, had suffered damage from repeated concussions and that he believed that Waters’s brain might help prove dementia could result from them.
He went to his office at the consulting firm and shut the door so he wouldn’t be disturbed. He took a deep breath and picked up the phone and rang Waters’s mother. There was no answer and no message machine. Over the next few days, he tried a few more times. Then he found a phone number for Waters’s sister Tracy Lane. After several attempts, he was finally able to get her on the phone.
He looked down at his script and began: “Hi, I’m Chris Nowinski. I used to play football and I used to be a professional wrestler. I had a lot of concussions, and that’s why I care about this and why I’m calling.” Lane listened quietly as he went on. “I was hoping you might allow your brother’s brain to be examined by a pathologist to see if he had brain damage from all those concussions,” Nowinski said. “I think your brother’s brain could help future generations because it could help us confirm a link between concussions and depression and maybe dementia.”
Lane told Nowinski that the family did want to know what had gone wrong with Andre, why he had transformed from gregarious and giving to depressed and paranoid. Most of all, they wanted to understand why he had killed himself. Nowinski told Lane that a brain autopsy might give them the answers they needed. She said she’d talk to the rest of the family and get back to him.
Nowinski waited impatiently—until one day the phone rang with Waters’s niece on the other end. Kwana Pittman told him that the family had designated her as their representative. She asked him to again explain why he needed her Uncle Andre’s brain. Nowinski pulled out the script again and started at the top. When he was done, Pittman told him that the family had researched his background and checked out his just-published book, Head Games: Football’s Concussion Crisis. She told him that she trusted that his heart was in the right place and that she thought his experience with concussions would give him empathy. “OK,” she said finally, “let’s do this.” They talked for a few minutes longer, and as Pittman was about to hang up, she said, “You know, the only reason I’m doing this is because you were a victim.”
The next step was to get the brain from the Tampa coroner’s office. The medical examiner there told Nowinski that only a few scraps of brain tissue remained, adding up to less
than one-tenth of the original brain. When the package arrived in the mail, Omalu tore it open and was shocked to find how little of Waters’s brain remained. The five pieces fit easily in the palm of Omalu’s hand. He worried that there might not be enough brain tissue for an accurate analysis. As it turned out, there was more than enough to prove that Waters had developed CTE.
Once Omulu had the diagnosis, he arranged to meet Nowinski down in Tampa, where they could present their findings to Waters’s family and get a history of the former player’s symptoms. When Nowinski and Omalu arrived, the family couldn’t help but be struck by the appearance of this odd couple at the door: the trim, six-foot-five former lineman towering over the stubby, round-faced scientist. The family would come away from the meeting relieved to have an explanation for Waters’s tragic decline. Nowinski and Omalu came away with a partnership.
They were now in the business of brain hunting, Nowinski surfing the web each day to find brains for Omalu to slice up. Since the work had nothing to do with his day job, Omalu had to take it home. That’s how he had done it with Waters’s brain. He had set up an impromptu lab in his garage, where he could slice the brain into sections to be sent off for staining and mounting on slides.
When the Waters story broke on the front page of The New York Times, it focused public attention on the possibility that America’s most popular sport might be destroying the brains of its own stars. This was the third case of CTE that Omalu had documented in middle-aged NFL retirees. It was becoming harder and harder to argue that his findings were just anomalies. The partnership with Nowinski gave Omalu some much-needed moral support. He didn’t feel so alone anymore. He and Nowinski earned a reputation as muckrakers confronting the NFL’s concussion deniers. The story began to take on a life of its own. Nowinski became a go-to guy for interviews on the concussion controversy, popping up on national TV shows and all over talk radio. He was clean-cut, soft-spoken, and articulate, the voice of the odd couple both in public and in private. He was still the one who took on the responsibility of calling the grieving relatives to ask for the brain of a recently deceased loved one.
The Concussion Crisis Page 28
