by Bennet Omalu
But my findings were not welcomed by the NFL, nor were they embraced by American society as a whole. As you will read more about later, the NFL tried to destroy my career. By the time they were finished with me, I had lost nearly everything I held dear. Their attacks were swift and severe, as they demanded an immediate retraction after my first paper on Chronic Traumatic Encephalopathy (CTE) was published in Neurosurgery (the official journal of the Congress of Neurological Surgeons) in 2005. Much of the latter half of this book will chronicle my ensuing battle with the NFL—a battle that in some ways continues to this day.
Looking back, I now know I should not have been surprised at the NFL’s response. After all, claiming that football caused life-altering, and ultimately life-shortening, brain damage threatens the football industry’s long-term viability. As one of the doctors connected to the NFL said to me in a private meeting, if just 10 percent of the mothers in America stopped allowing their sons to play the game, the sport is finished. He said this to me more than a decade ago. I believe his words to be prophetic.
The doctor may be correct in the long term, but what has surprised me in the fifteen years since I discovered CTE is how football’s popularity as a spectator sport remains, in spite of negative headlines concerning football and brain disease. Not even the suicide of one of the most popular players to ever play the game, Junior Seau—a suicide prompted by the depression and behavior changes caused by CTE—has dented football’s popularity. The American public holds up football stars as heroes. Yet when one of those heroes dies as a direct result of playing the game, the public simply shrugs and keeps watching. For proof you need look no further than the ratings for the Super Bowl, an event that has become an American holiday. The last nine Super Bowls account for nine of the ten highest-rated television broadcasts of all time.
That leads me to wonder: How can Americans idolize football players, yet seem to care so little about the toll the game takes upon their heroes? It seems like such a contradiction. Yet as I learned after moving to Harlem in June 1995, America is a land of contradictions. I am truly an American, because my time in Harlem revealed the contradictions deep inside of me as well.
• • • •
When I landed at LaGuardia Airport after moving from Seattle to New York, everything I owned in this world fit into one suitcase. Even though I had lived in America for a year, I still knew very little about how to conduct myself in my new country. I stepped out of the airport as the sun started to set and tried to hail a cab. One or two cabbies asked me where I wanted to go. “Harlem,” I said. I did not understand how odd it looked to these cabbies that a young black man wanted to go to Harlem after dark. No one volunteered to take me.
Every cab passed me by and picked up the next person in line until finally a cab driven by an older man with a thick Indian accent agreed to take me. I handed him the address, and we took off. I stared out the window at my new hometown as we sped down the freeway and zipped across bridges. The huge buildings mesmerized me. I had never seen anything like them in my life. The city changed when we exited the freeway and wound through the neighborhoods leading to Harlem. I noticed that the closer we got to Harlem, the more the cab had to dodge holes in the streets. The buildings appeared more dilapidated. At first I thought this might be because the streets were darker, with fewer working streetlights, but in the weeks that followed, I discovered the buildings were just run-down.
Finally, the cab pulled up in front of a two-story brick building. “This is it,” he said.
I looked out at an old building behind the hospital on a poorly lit street filled with all types of debris. It looked like the building had seen better days and was likely in need of some serious renovation and retouching of the brick. “This?” I asked.
“Yes, this is the address you gave me,” the cabbie said, more than a little annoyed.
“Okay, thank you,” I said. “How much is the fare?”
He told me the amount. I paid him exactly what he told me. The cabbie looked at the money and glared at me. “Why, you cheap . . .” he said, unleashing a string of names and curses as he put the car in gear and sped away. I had no idea why he was angry. A few months passed before I discovered that you are supposed to tip taxi drivers and waiters and waitresses.
In spite of my rocky introduction to the city, I soon fell in love with New York. Never before in my life had I encountered such an amazing mix of people from all types of backgrounds, religions, ethnicities, and creeds. In Nigeria, people were divided by tribe, with distinct tribal dialects and languages. However, no matter the tribe, everyone looked very similar to one another. But New York was a melting pot of people from all over the world. I had never seen such a mix in my life. And the languages! The first time I heard someone speaking Spanish I thought they were singing as they spoke. It was beautiful, as were the Hispanic women I met at the hospital.
I so loved the blend of people and cultures in New York that I used to go out on Sundays to a busy part of Manhattan just to people-watch. I found a restaurant with an outside patio, ordered something to eat and drink, and soaked in everything around me. The diversity gave me great joy and reaffirmed to me our common humanity. Black and white, Hispanic, Asian, Native American, Jew and Gentile—we are all a very beautiful people, and all were here in New York, in America. I could hear the words of the Declaration of Independence ringing in my ears. Surely this was the place where the truth that all people are created equal had finally come to light.
However, the wonder I felt in Manhattan eventually gave way to a stark reality. For nine months I lived in a dormitory maintained by the hospital for single residents like me. Life in the dorm got old fast. I started looking for an apartment in Midtown Manhattan near the areas where I liked to go to people-watch. I walked up and down the streets and took note of apartments with vacancies. I called several, but for some reason, whenever they heard my accent, they said they no longer had a vacancy. Undeterred, I started going to the apartments to inquire in person. After all, I was a doctor, albeit still a resident. I thought if I talked to the apartment managers, I could dispel any fears they might have about my ability to pay. But going to the apartments in person was even worse. I hardly had a chance to open my mouth before being told there were no vacancies.
After having door after door closed to me, I decided to conduct an experiment. I told a Jewish friend what had happened, and he went with me the next time I went apartment hunting. First, I went into the rental office and asked about their advertised vacancies. “We don’t have any vacancies,” the office manager said bluntly. Ten minutes later, my friend went into the same office and asked the same question. “Of course, we have several. In fact, you can move in this week if you like,” he was told. On our way back to Harlem, my friend told me I should file a complaint with the housing commission, but I brushed his suggestion aside. If I filed a complaint every time a taxi driver refused to pick me up or a bank teller questioned the legitimacy of one of my checks, I would go crazy. New York may have been a melting pot, but it was still a city with deep racial divides.
Eventually, I moved to the nearby town of Lodi, New Jersey, and commuted to the hospital in a new Volkswagen Jetta I leased. This was my first major purchase in America. However, the toll fees nearly left me broke, along with the cost of parking and insurance. I didn’t make much as a resident physician, and a significant amount of what I made went back to Nigeria to help support my family. So I returned my car and moved to a studio apartment in the heart of Harlem on 149th Street. For four years I walked back and forth from my apartment to the hospital. That’s when I came face-to-face with the immense hopelessness, deprivation, and apathy that came with the extreme poverty I saw every day. I talked with very strong people who had been bruised and battered by a system they felt locked them out of any meaningful opportunity. The neighborhood reaffirmed the same message. Unlike the bright, clean, well-lit neighborhoods of Midtown, these streets were dirty and dark. Even though the two places were
separated by only a few miles, traveling from one to the other made me feel like I had stepped onto a different continent.
Still, I held out hope in the American dream. I believed that by hard work and determination, anyone could find their way here. One day while working at the hospital, I tried to encourage one of the young black men working in the department to further his education and not to limit himself in his expectations. He looked at me with tears in his eyes and said, “You don’t get it, man. You’re lucky because you weren’t born here.”
His words took me aback. “What do you mean?” I asked.
“If you had been born here in this neighborhood, you never would have become a doctor. From day one, people would have had you pegged. You never would have had the chance to become a doctor. Never.”
Twenty years later as I write these words, I can still see the look in his eyes. This wasn’t just about racism. He spoke of a reality, where your slot in society is already set from the day of your birth before you do anything. I know there are exceptions and that opportunities can be found, but the core of what he said to me has not changed. That’s one of the great contradictions of America. All people are created equal, yet without even realizing it, we prejudge some as less, all because of the color of their skin or the neighborhood where they grow up or both. This is a great land, the freest nation on earth and in history, yet it is still a land of contradictions. The problem does not lie in America but in the human heart, as I learned in a very personal way.
• • • •
In a way I am surprised that I had any time to observe anything outside of the Harlem Hospital Center. My residency training filled nearly every waking hour of my life. Like all residency programs in every field of medicine, mine consisted of multiple four- to twelve-week rotations where I focused on different areas of both anatomic pathology (AP) and clinical pathology (CP). Pathology itself is the specialty that deals with the causes and nature of disease. Anatomic pathologists investigate the effects of disease on the human body through autopsies and microscopic examination of tissues, cells, and other specimens. My AP rotations included autopsy pathology, forensic pathology, cytopathology, surgical pathology, and a couple more.
Clinical pathology focuses more on the diagnostic interpretation of laboratory tests. These rotations included clinical chemistry, immunology, medical microbiology, and molecular diagnostics, as well as several more areas. Both specialties meant I spent a lot of time peering through a microscope searching for answers hidden in the cells in front of me. When some of my friends back in Nigeria heard what I was doing, they told me I was wasting my time and talents. But I disagreed. Pathology fed my natural curiosity. I found I could spend hours doing research, and the time passed quickly without my even noticing it.
I faced a challenge, however, right out of the gate. My very first rotation of my first week of my first year of residency was autopsy pathology. Back in medical school, I had worked with cadavers, but this was very different. Now my task was not to learn and understand human anatomy. No, I had to discover the reason the person in front of me had died.
My first autopsy began before I even saw my first “patient.” One of the technical support staff brought a file of medical records to my desk for me to study before the actual autopsy began. This was in 1995—in the dark days when the AIDS epidemic still ran through New York City and all the major cities in the United States. According to his records, the man I was to examine had full-blown AIDS, which had taken his life. However, the question I had to answer was how.
The autopsy suite was located in the basement of the hospital adjacent to the morgue. When I arrived shortly after 11:00 a.m., the body was lying on an examination table, waiting for me. I changed into my green scrubs and suited up in all the protective gear to protect me from the infectious diseases that had taken this man’s life. Returning to the autopsy room, I found the chief resident was there to guide me through the autopsy protocol and assist me if I needed any help.
I must confess that I needed help right from the moment I walked into the room. The smell of death permeated everything. The smell only grew worse when the body’s thoracic and abdominal cavities were opened. “Let’s get started,” the chief resident said. He pointed to where I was to make the first incision with the scalpel. I hesitated for a moment as I stared at the body lying in front of me. I had never seen such an emaciated individual. He looked like a scary masquerade of a human body, like a skeleton that had slipped on a suit of skin. Lesions covered the body, including purple Kaposi sarcoma welts. At that moment I felt like throwing off my protective gear and running out of the room and off to nowhere, never to look back. A lump rose in my throat. The sides of my cheeks squeezed in. I knew I was going to throw up at any moment. The chief resident didn’t notice—or if he did, he didn’t care. He was too busy chatting away and laughing with one of the autopsy technicians. The shock at seeing this sight had long since worn off for him.
I stared down at the body. I knew I could not run away. My journey from Nigeria to Seattle had brought me here. If I were to quit, all I had worked for would be lost. Touching this body, cutting into it, and spending time with it was my only choice. Honestly, I felt like a condemned man.
Pushing back my nausea, I started the physical examination by ticking off the boxes on the autopsy worksheet. “Hair, black,” I said. “Eyes, brown. The body is in poor condition with multiple lesions. Subject appears to be malnourished.”
As I ticked off the boxes, a strange feeling came over me. I looked down at the body, but I did not see just a body in front of me; I saw an individual. This man was a human being just like me. He had been someone’s brother, someone’s cousin, a boyfriend or husband, a mother and father’s son. The emaciated condition of the body that had repulsed me now called to me. This man lying in front of me had been the victim of a disease that had caused him to die far too soon. I looked into his face. I saw myself there. He could have been me, and I could have been him. In that moment, the two of us became one.
Death strips away all dignity, just as this man had been stripped and laid bare before me. As I made my first incision into his body, I felt my job, my calling, was to restore his dignity by discovering the true reason for his death. In this way I felt I was preparing him for his transition into heaven. The autopsy then became a spiritual experience for me. I was treading on holy ground. The smell did not matter anymore. I methodically and systematically took sections of his organs and tissues, like I was painting a masterpiece. Before I knew it, the autopsy was finished. Two hours flew by as if only a few minutes had passed.
I removed my scrubs and went to my desk to record all my notes from the procedure. I meticulously described what I had observed into an autopsy narrative. The head of the program, the man who brought me to Harlem, Dr. Carlos Navarro, went through my work with me and asked me questions. At the end, he patted me on the shoulder. “Good job, Bennet,” he said. “Very good job.” Several weeks later the two of us examined the microscopic sections of the man’s tissues, which had now been stained and prepared for further examination. These slides were beautiful and different. Dr. Navarro guided me through the derivative thinking and analysis of each slide and led me through the process of differential diagnosis. We determined the man died of acute respiratory failure due to a type of pneumonia that only strikes immunosuppressed people like victims of AIDS.
When we finished our analysis, I finalized my autopsy report and enumerated all the pathologic findings. I signed the report, as did Dr. Navarro. This was his final stamp of approval of a job well done. My first autopsy was my first step into learning the language of the dead. I was learning to listen to them and to ask them the right questions. With time, I became so in tune with the dead that when I learned how someone died, I could tell you how he or she lived. It was truly a spiritual experience.
• • • •
Unfortunately, the deep spiritual moments were rare during my residency. My schedule was brutal, and I
felt very much alone. All my family was on the other side of the world, and calling them was very expensive. The depression I experienced in medical school reemerged. Rather than withdraw, I went in the other direction. While at the hospital, I poured myself into my duties and worked like a maniac. When I was off duty, I partied. I was wild and smoked and drank. Sex became something I looked for in women as I went to the clubs. It seemed like there was no end to my appetites. It was like I was addicted. I simply went crazy.
At the same time, I kept going to church and praying. I felt like a prodigal son. The contradiction of my life tore me up inside. On Saturday nights, I went out and partied as hard as I could. On Sundays, I went to church and pleaded for forgiveness, while promising God I was going to change my ways. One Sunday in particular, I kneeled at the Communion altar rail, making promises to God. When I looked up, the woman serving Communion winked at me. We had been together the night before in her apartment. That afternoon, we were back there, doing what men and women do in those settings. I was a mess.
Then one day, I began to feel weak. I had also begun to lose weight, and I had zero energy. Some days I barely had the strength to get out of bed. I felt for lymph nodes in my armpits, only to discover they were swollen. I recognized the symptoms. I’d read the same symptoms in medical charts at least once a week during my autopsy rotations when a victim of AIDS came across my table. I immediately made an appointment with a doctor in Manhattan, who confirmed my fears. “You may well have contracted HIV,” he told me. “We will have to do a blood test to tell for sure.”
