Truth Doesn't Have a Side

by Bennet Omalu

  I ignored him, but his attorney was noticeably embarrassed. “Don’t mind him,” the attorney said to me. “Thomas is an idiot. That’s how he ended up in this mess.”

  I drew the blood. Tests confirmed that he did indeed have a form of hemophilia. This was the final piece of the puzzle. I typed up my findings in a seventeen-page report and sent it to his legal team in late February 2002. Two months later, I appeared in court and testified on behalf of the defense. My appearance in court that day was re-created in the opening scene of the movie Concussion.

  After my testimony, the jury found Thomas Kimbell not guilty and set him free. He came over to me in the courtroom, tears flowing from his eyes. He threw his arms around me (with the judge’s permission), and whispered in my ear, “Thank you, thank you, thank you.” It was a very different scene from the first time we met.

  I left the courtroom that day very happy that I was a forensic pathologist. I do not feel like this every day. While writing this book, I accompanied sheriff’s deputies into an overgrown field, trudging through mud and deep brush in my tailored suit and Johnston & Murphy Aristocraft shoes, until we came upon a partially decomposed body of a woman who had been allegedly murdered and dumped by a rural river in the delta. I drove home that day wondering if it was too late to change careers.

  But on the day of the Thomas Kimbell verdict, I had no doubt that God had led me into this place. It is funny, looking back, to realize how I got here. All the life decisions I had made as an adult prior to coming to Pittsburgh were all based on what I did not want to do or be rather than on what I did. Yet God used those decisions to put me in the place where He wanted me. His will was done, not mine, and as a result, my life was changed.

  Looking back at the Kimbell case, I do have one regret. We were able to show who did not kill Bonnie Dryfuse, her two daughters, and her niece, but the real killer was never found. Bonnie and her children and her niece did not receive justice. After Kimbell’s acquittal, local police did not reopen their investigation. I believed the husband, Thomas Dryfuse, should have been investigated closely, but he was not. Neither he nor anyone else ever became a suspect. The real killer was never caught. Thomas Dryfuse died in a motor vehicle crash in 2011. Apparently he had become an alcoholic, drove while he was intoxicated, and collided head-on with another vehicle while driving in the wrong lane.

  By the time I finished the Kimbell case, I did not have to fake who I was any longer. I had figured out who the best version of me was, whether I was in the autopsy room, courtroom, or in what little private life I had. The timing for my finding myself was truly an act of God. Now that I had found myself, God had a divine appointment awaiting me, one that I never could have kept if I were still in the wilderness searching for me.

  Chapter Eleven

  A Divine Appointment

  On the afternoon of September 28, 2002, autopsy case A02–5214 was no different from any other case on which I had worked in the Allegheny County medical examiner’s office. The body of a white male, fifty years old, lay on the same table near the exit where I’d performed my first autopsy in this office during my externship. Three years, more than a thousand autopsies,1 and two completed fellowships later, I was a different doctor, a different pathologist, and a different man from the one who drove into Pittsburgh in October 1998. When I was handed autopsy case A02–5214, people within the Allegheny County medical examiner’s office had already begun calling me Mini-Cyril. I took it as a compliment.

  I had gone out to a club the night before autopsy case A02–5214. I found it to be the one way I could relax. When I went out, I’d nurse a drink for a couple of hours while standing next to a speaker, nodding my head to the music. Around 3:00 a.m., I went home and slept for a few hours before reporting for work. Since I was the youngest pathologist in the office—and the only single one—I pulled many of the weekend and holiday duties, except Christmas and Easter, which were covered by the one Muslim pathologist in our office.

  My late night caught up with me the day of autopsy A02–5214, and I overslept. Hurrying to get dressed for work, I turned on the television and listened to the news headlines while dashing around my condo. Everybody, it seemed, was talking about the same thing on all the morning news shows. A famous football player had just died. That didn’t strike me as remarkable, since people die every day, a fact I knew all too well. However, something about the tone of the newscasts caught my attention. While reporters gushed about this man’s life on the field, they vilified him for his post-football life. Apparently he had thrown all his money away and become bankrupt. He was living in his truck and on drugs, they said. “What a shame!” one said. “What a waste!” said another.

  The contradiction in the way in which reporters described the man’s life piqued my curiosity. How could a man go from a hero to a bum so quickly? I found their description of him very offensive. To me, his behavior indicated some sort of psychological disorder or illness. To speak ill of such a person struck me as the worst sort of insult. As a child of God, he deserved dignity and respect, especially now.

  However, once I was out the door and on my way to my office I did not give the matter a great deal more thought. Like I said, I deal with death every day. On the drive from my condo to the office, I turned up the music in my car and prepared myself mentally for what I might face this day.

  When I arrived at the office, I found news crews around the office. My technician, Mr. Robinson, ran up to me as soon as I walked into the lobby. “Hey, Bennet, Mike Webster is here.”

  “Why is there so much commotion around here?” I asked, ignoring his statement.

  “I told you. Mike Webster is here.”

  “Who is Mike Webster?” I asked.

  The lobby got quiet. I looked around. Everyone was staring at me. I had no idea why. Then it hit me. “Was he the guy on television this morning?” I said.

  “Yes, now you’re talking. Mike Webster was one of the greatest football players to ever play the game,” Mr. Robinson replied.

  “Okay,” I said in a way that made it clear I had no idea who or what he was talking about. All I knew was that this man had some sort of problems that ended his life early. It was my job to discover why.

  When I am assigned a patient on whom to perform an autopsy, I do my best not to assume anything going in. I once had a case where a teenage boy escaped from the county juvenile justice center, only to be found dead in the bushes, not far from where he climbed over the fence. The family cried out, alleging he had been killed by the police or someone else around the facility. When I examined the body, I found no evidence of blunt force trauma or any other signs of foul play. To me, it was clear that no one killed the boy, but that he had died of natural causes. But what were they? I requested some very sophisticated chemical analyses of his blood, which identified biochemical evidence of anaphylactic shock. That wasn’t enough for me. Digging deeper, I found that the anaphylaxis was triggered by exposure to a certain type of pollen. I went back to his escape route and found that he had run through some bushes with plants that contained the particular type of pollen to which the boy was allergic. His exposure to the pollen triggered a severe hypersensitivity reaction, which precipitated the boy’s sudden death. The case just confirmed that one cannot assume or settle for easy answers. The boy’s family deserved the truth, as did the officers of the juvenile detention center who had been falsely accused. That’s why I dug deeper. I always dig deeper. Doing so is not out of the ordinary for me. It is how I do my job.

  Once I finally got to my office, I was handed a file on Mike Webster. In it I found his medical records and the preliminary report on his death from the hospital. His cause of death was listed as coronary atherosclerosis, or heart attack. Verifying that diagnosis is not a difficult process. However, based on all I heard on the television before going to the office, I suspected that more than heart disease was at play here.

  After reading through Mike’s file, I walked over to his body in the autopsy room.
Looking at his face, I whispered to him, “Hi, Mike. I am Dr. Omalu. Bennet.” I patted him on his shoulder. “Mike, I heard about your life and what people have said about you. I think they are wrong. You are not the loser people are making you out to be. I think something has hurt you. Something did this to you. But I need your help, Mike. I’m going to use all of my skills and all of my knowledge and all of my education to find out what has happened to you, but I cannot do this alone. Come with me. Walk with me. Guide me to the light of the truth.”

  The technician working with me didn’t say a word. By this point, he was used to me doing things my “weird” way. I was different, and everyone knew it. I talked to Mike and my other patients many times in my heart and mind for a very simple reason: when I look into their faces, I do not see a dead body; I see myself. As I wrote about my very first autopsy, I know that could be me lying there. Someday it will be me. All of us will die. That is why I treat those who come into my autopsy room with the same dignity and respect that I hope is shown to me someday. Every human being is created in the image of God and therefore deserves respect and honor, even in death. The Golden Rule says to do to others as you would have them do to you. Death does not invalidate the Golden Rule. Mike Webster and I—we share a common humanity and a common spirit. That is why I spoke to him and asked for his help. Because of our shared humanity, I could not do a simple examination and call it a day. He might have died of a heart attack, but I knew something more had happened to him that ultimately took his life at the age of fifty. As a child of God, I owed it to him to keep looking until I found his answers.

  • • • •

  The Mike Webster autopsy was very routine. I knew his cause of death. It was already written out for me in black and white. “White male. Fifty years old. Suffered a massive heart attack.” But the words in his file did not explain how a hero beloved and admired by the entire city of Pittsburgh had become a bankrupt, divorced, homeless man living in his truck. I suspected the answer to that mystery could be found in his brain.

  The brain is such a complex and beautiful organ. If the body is a family, the brain is the spoiled youngest child. She is the most pampered organ, yet she finds a way to always get her way. I had recently completed a second fellowship at the University of Pittsburgh, this one in neuropathology. I pursued this fellowship because I wanted to understand this spoiled child that is the brain.

  I ticked off all the boxes with Mike Webster to confirm the original diagnosis of his cause of death. Then I began searching for the causes of his mental illness. When I opened his skull, I expected to find a bruised, shriveled, and beaten-up brain. But everything appeared normal. There was no evidence of blunt force trauma that I could see with the naked eye. Disappointed not to find an easy explanation, I removed the brain and carried it over to my work station. I grabbed a knife and was just about to cut into the brain to look further when something stopped me. I dropped the knife in exasperation, doubt, and frustration. For a moment I just stood there, thinking. Then I turned to the second autopsy technician in the room and said, “Would you please fix the brain for me?” To fix the brain, we have to submerge it in a chemical called formalin for at least two weeks. The brain is about 60 to 80 percent water, and in the natural state, it is as soft as Jell-O. To be able to study the brain microscopically, we first need to submerge it in formalin so that it hardens and can be processed.

  I gave the order to fix Mike’s brain, even though I knew the county would not cover the cost of the tests, since these tests went beyond the parameters of what was necessary to complete his autopsy and determine his cause of death. If I wanted to fix the brain and study it further, I was going to have to pay for it myself. This was not the first time I covered the expenses for extra tests, nor would it be the last.

  “Why?” she asked in a tone that conveyed far more than her one-word answer. The two of us did not work well together. She often treated me with disrespect, regularly questioning my instructions and even raising her voice at me. Since I was the only physician in the office she treated like this, and since I was the only black doctor in the office, I wondered if race or the fact that I was born abroad might play a factor.

  Her disrespectful tone was more than I wanted to hear at that moment. “Fix that brain!” I said firmly, somewhat putting her in her place. She did as I said, but I suspected she would report me to the office manager and to Dr. Wecht. However, if I had to choose between having a technician report me as insensitive or intolerant and failing to exhaust every path to find the cause of Mike Webster’s demise, I gladly chose the former. I owed Mike that. I hope he would have done the same for me.

  • • • •

  Because I knew the technician would not only report me but also question my order to fix the brain, I called Dr. Wecht as soon as I finished the autopsy to explain my actions. He was very interested in my results. Like everyone else in the office, Dr. Wecht was a huge Pittsburgh Steelers fan. I remained very much on the outside looking in when it came to football. Even after living in Pittsburgh for three years, I knew no more about the game than I did the day I moved into the city. There were, I now know, football teams in Seattle and New York, but at the time, neither city matched Pittsburgh in its rabid love of the game or in its devotion to the home team in particular.

  “So what did you find, Bennet?” Dr. Wecht asked on the phone.

  “He died from a heart attack, just as the hospital said,” I said.

  “So that’s it then?” he replied.

  “I think there’s more,” I said.

  “Oh,” he said, surprised. “And what might that be?”

  “I do not yet know, but I fixed his brain so I can study it further.”

  “And what do you think you might find?” His curiosity was piqued as well.

  “I’m not sure, but something is not right. I saw the reports about him on the news this morning. From the description of his behavior and from his file, I suspected he’d suffered brain trauma. I expected his brain to appear abnormal. But it did not. Something did not match. Something just does not fit.”

  “Okay, Bennet. Good work. Let’s talk about this Monday,” Dr. Wecht replied.

  I hung up the phone, returned to my desk, and wrote out the preliminary autopsy report. I filed it and went back into the autopsy room to do my work on one of the other bodies awaiting me. I walked over to the next person on whom I was to perform an autopsy and introduced myself. “Hello. I am Dr. Omalu. Bennet.”

  • • • •

  Two weeks after Mike Webster’s brain was fixed in formalin, I took it back over to my work station and resumed my examination of him. No one assisted me, because the office was not going to pay for unjustifiable testing. The cause of death was already determined, and all the proper documents had been signed. This was my quest for answers into what led to Mike Webster’s death, not Allegheny County’s quest.

  I knew that Mike’s heart gave out, but there was a very long pattern of behavior that defied explanation—behavior that ultimately led to the heart attack that took his life. The pattern actually started, but in a subtle manner, toward the end of his seventeen-year career in the National Football League. The symptoms progressed after his retirement. At first, he had trouble holding down a job. A series of poor business decisions and investments caused him to lose his house in foreclosure. He appeared both mentally and cognitively perturbed. Then he began to disappear for days at a time. He had memory losses, personality changes, disorientation, and spontaneous anger episodes.

  Doctors prescribed medicines to help Mike. At different times, he took Prozac, Zoloft, or Paxil for depression; Ritalin or Dexedrine to keep him mentally alert; narcotic and nonnarcotic painkillers in various combinations (Tramadol, Propoxyphene, Hydrocodone) to ward off pain; Benzodiazepines to prevent panic attacks and anxiety; Selegiline to minimize movement disorders; and many others. But the drugs didn’t help. It wasn’t just the cognitive problems with which he had to deal; a lifetime of football left h
im in pain from the top of his head to the soles of his feet. Mentally, he became more and more lost. He sometimes forgot it was winter and went out in the freezing Pittsburgh weather without even a light jacket. He sank into paranoia and sleeplessness. At one point, he started using a Taser to shock himself to sleep.

  As Mike sank deeper and deeper into mental illness, he visited some of the best neurologists and neurosurgeons in some of the best hospitals in the country. They ran all the latest, most thorough tests available, but no one could say exactly why Mike was the way he was. One of his doctors diagnosed him with post-concussion syndrome, among the many other diagnoses. That’s the diagnosis that caught my attention, especially because Mike Webster had never officially sustained a diagnosed concussion. I also noted that Mike suffered from depression. That made him a kindred spirit to me. I did not know the cause of my depression. Perhaps I could give Mike the answers I never found for myself.

  • • • •

  Alone in the autopsy room, I cut into Mike’s brain, not sure of what I might find. I took pictures with my own camera to document everything. To be honest, part of me just wanted to move on, but I had made a promise to Mike. I didn’t want to go back on it.

  To my surprise, everything in Mike Webster’s brain looked completely normal. I became more confused. From everything I read about his long list of symptoms, he should have had visible signs of trauma or brain damage. But there were none. The more I looked, the more frustrated I became. In my subconscious, I just wanted out. Before I could, I needed to take one more step. I prepared brain sections that could be viewed under a microscope after they had been properly prepared. I took the sections to a lab at the hospital to a wonderful woman named Jonette Werley. She was the tissue histotechnologist who ran the brain tissue laboratory at the University of Pittsburgh Medical Center. We got to know one another during my neuropathology fellowship at the hospital.

  Jonette took the sections of Mike Webster’s brain and processed them for me. When she was finished, she placed them in my mailbox at the Presbyterian Hospital where I was an adjunct, or volunteer, clinical faculty member. And that’s where the slides remained for the next several weeks. As I said at the beginning of the chapter, case A02–5214 did not stand out as anything unusual.