Authors: Mark Fainaru-Wada
Omalu had no idea what he wanted to do next. Then, one night, he was watching TV and stumbled upon a documentary about the assassination of JFK. There he saw Wecht, pathologist to the stars, making the case that Lee Harvey Oswald could not have acted alone. In his thirties, Wecht had challenged the conclusions of the Warren Commission before Congress; he called the lone gunman theory “
an asinine, pseudoscientific sham.” His conspiracy theories launched him into the public eye. Omalu was mesmerized. Wecht was a master of the medium: articulate, passionate, compelling—filled with the kinds of juicy details that later would turn forensic pathology into the basis for hit TV shows. Omalu fired off a letter to Wecht, asking if he could come to Pittsburgh for a one-month internship.
The one-month internship became
a one-year fellowship, which was followed by two years studying neuropathology at UPMC, which was followed by two years studying for a master’s degree in public health at the University of Pittsburgh, which was followed by three more years studying for an MBA at Carnegie Mellon.
Omalu continued to work in the coroner’s office; his one-month internship had effectively turned into a full-time job working for Wecht, who seemed to see a younger version of himself in the flamboyant
Nigerian intellectual. “
Bennet, you remind me of myself when I was your age,” Wecht would tell him. Forensic pathology requires a bit of salesmanship and panache. As Dominick put it: “You gotta have giant balls to be a pathologist, especially a forensic pathologist.” In addition to the scientific sleuthing, it requires an ability to get in front of a jury or a phalanx of TV cameras and come off as persuasive. Wecht taught Omalu how to dress and how to talk. The two men often had breakfast together. “He trained me,” said Omalu. “He taught me things I wouldn’t read in books. For Wecht, how much I respected him, whatever he wanted me to do I would have done.”
Omalu went from wearing jeans to wearing $600 suits. Some people in the office referred to him as “
Junior Wecht.”
“We have
a saying in Arabic: ‘He knows where to look for the best piece of meat in the pink lamb,’ ” said Abdulrezak Shakir, a pathologist from Iraq who worked alongside Omalu and saw the relationship with Wecht develop. “What it means is if I go under this guy, that will be better for my future. I wish I have this capability. Not many people have it.”
Omalu’s close relationship with Wecht drew him into his boss’s side business:
private medical consultations. The famous forensic pathologist would get requests to perform autopsies and consultations from all over the country. It was a lucrative business. According to Omalu, Wecht charged as much as $10,000 for his services. He paid Omalu $300. “I would do all the work,” Omalu said.
When Omalu asked for more money, Wecht told him he was getting “intangible benefits” from the work, Omalu said.
That turned out to be true. One of the private cases Omalu worked on for Wecht was the autopsy of the battered middle-aged woman. It was that case that led Omalu to save Mike Webster’s brain.
Omalu placed the 3½-pound brain in a bucket of formaldehyde and water. The process, called fixing, hardens the brain, which in its natural state is the consistency of a soft-boiled egg and can be difficult to cut. Webster’s brain soaked for two weeks. Omalu then sliced four 2-millimeter sections, each about the width of a dime, from the primary lobes (frontal, parietal, occipital, and temporal). Each of the sections was placed in a small container.
Omalu then drove Webster’s brain tissue over to UPMC in his Mercedes. He handed off the tissue to Jonette Werley, a lab technician with more than 20 years of experience working with autopsied brains. Werley bathed the containers in alcohol to flush out the water, then in xylene to flush out the alcohol. She used a microtome—essentially a tiny meat slicer—to shave the 2-millimeter sections into 200 slivers of brain tissue, which were transferred onto glass slides. She stained the tissue with an array of antibodies selected by Omalu, each designed to highlight abnormalities associated with specific types of neurodegenerative disease.
Then
Omalu forgot about it. He had a busy life. His decision to save Webster’s brain was only a hunch, and he had other things to do. In addition to his work at the coroner’s office, he was studying for a master’s degree in public health (with a specialization in epidemiology), making regular court appearances, and conducting private autopsies for Wecht. Whatever time he had left he devoted to his girlfriend, Prema Mutiso, a Kenyan whom he later married. The couple had met in church, where Omalu spent most of his time away from work.
Omalu belonged to
St. Benedict the Moor, a church founded in 1889 shortly after the National Congress of Black Catholics met in Washington, D.C., to demand greater representation in the Roman Catholic Church. By the time Omalu entered St. Benedict more than a century later, it was almost entirely black, with 80 to 90 percent of the parishioners being African American. The rest were African immigrants—Nigerians, Kenyans, Liberians, Sudanese, Ugandans, Congolese—who had settled in Pittsburgh.
Away from work, where his naked ambition sometimes engendered resentment, Omalu was beloved. He directed his energies into helping others. The church was located in the Hill District, for decades the center of African American life in Pittsburgh, whose rich history includes the Underground Railroad, the glory years of Negro League baseball, and the country’s most widely circulated black newspaper, the
Pittsburgh Courier
. The influx of Africans into St. Benedict the Moor had created tensions, but Omalu served as a bridge between cultures. “What was remarkable about Bennet, he was able to, in our church, kind of dispel or dissipate that thinking that some African Americans
had about Africans as coming over here as privileged,” said Father D’Amico.
Omalu quickly became one of the church’s most prominent and valued members. It was obvious to others in the congregation that he had money—from his tailored suits, expensive car, and fine jewelry—but he didn’t flaunt it. “He didn’t tell anyone his background,” said Father D’Amico. “None of us really knew what his work was. We knew he was from Nigeria, but you would never know from meeting him what a brilliant person this man was, the number of degrees he had, and the kind of groundbreaking work that he was doing.” Father D’Amico frequently asked him to provide other members with money, clothes, whatever help was needed. Before Mass, rather than having members quietly pray, the priest encouraged them to openly express their gratitude to God about specific blessings in their lives. Omalu became one of the leaders of this “gathering rite,” his melodic voice even more spellbinding in prayer.
“It was almost like preaching, you know?” said Father D’Amico. “I said to him, ‘Bennet, you’re one of the best prayers I know.’ It would be so, so beautiful to listen to.”
Omalu was so preoccupied by his nonstop life that when
slides of Webster’s brain came back from the neuropathology research lab, they sat on his desk for weeks. Eventually he brought them home to his apartment, where he kept a microscope on the dining room table. Omalu found that he often did his best work in the middle of the night. He would go to bed early, wake up around 2
A.M.
, and then work until he had to go to the office.
There, in his apartment, Omalu examined the Webster slides, trying to figure out what they meant. What he was seeing was not normal for a 50-year-old man. But what was it? He was so new to neuropathology that he didn’t trust his own eyes. Omalu followed this routine for weeks, waking up at 2
A.M.
and examining the slides closely, convinced that they were telling him something extraordinary but wanting to eliminate any doubt before he uttered a word to anyone and risked embarrassing himself.
What Omalu was seeing under the microscope was
the buildup of tau, a protein that enables the brain’s ability to function but can also strangle it. Without tau, neurons would collapse, cutting off the flow
of nutrients and molecules to the cells. But sometimes, especially later in life, tau congeals into clumps called neurofibrillary tangles. These tangles slowly strangle the neurons from the inside. In neuropathology, they are one of the two defining markers in Alzheimer’s disease. The other marker is the buildup of beta-amyloid plaques: hardened proteins that surround the cells and poison them.
The staining of the slides is what brings the tau to life; otherwise, you can’t see it. Under a microscope, tau appears as tiny brown splotches interspersed among a pattern of normal cells represented as dots, as if someone had dripped dark brown paint on a flecked marble tile. As Omalu examined the slides of Webster’s brain, he saw lots of brown splotches. He also saw signs of amyloid plaque, but the pattern didn’t look like Alzheimer’s as he had been trained to identify it. There was very little beta-amyloid, and it had taken on a slightly different form. Even stranger, the tangles of tau seemed to be distributed haphazardly throughout different parts of the brain, almost without rhyme or reason. In Alzheimer’s disease, numerous tangles are present in the hippocampus (an area of the brain involved with memory) before they are seen in the cortex (the outer part of the brain that is critical to cognition). But in Webster’s brain it was the opposite: Omalu saw many tangles in the cortex but none in the hippocampus. And besides, Webster was 50: He wouldn’t be expected to
have
Alzheimer’s disease.
Omalu knew from his training that head trauma could cause tau to form tangles. The presence of a neurodegenerative disease had been chronicled in boxers since 1928, when Harrison Martland, the chief medical examiner for Essex County, New Jersey, published
a landmark paper in which he used the expression “punch-drunk” as a medical term. The phrase, he noted, was already part of the vernacular of fight aficionados, who also referred to the condition as “
slug-nutty” and “cutting paper dolls.” The condition was most pronounced among “poor boxers who take considerable head punishment, seeking only to land a knockout blow,” Martland wrote. In severe cases, Punch-Drunk Syndrome was characterized by “marked mental deterioration” that sometimes forced ex-fighters to be sent off to the asylum. Martland estimated that nearly half of all veteran fighters had some form of the syndrome.
Martland has since been lionized for what is now seen as the seminal
first study on head trauma and sport. But the reality was that his conclusions were not universally well received, especially by fight fans, who saw them as an unproven denunciation of the sport. It wasn’t until 1973 that dementia pugilistica, as it came to be known, was accepted as irrefutable science.
A British neuropathologist, J. A. N. “Nick” Corsellis, cut open the skulls of 15 former boxers who had died of natural causes. The autopsies showed cerebral atrophy in 14 of the 15 cases. Corsellis, who put together his own brain bank, the “Corsellis Collection,” had shown for the first time that the repetitive head trauma associated with boxing led to the “destruction of cerebral tissue.”
However, in Webster’s brain, Omalu didn’t see one of the hallmarks of dementia pugilistica: an opening in the septum pellucidum, the wall that separates the lateral ventricles in the brain. Plus, from what he had read, Webster didn’t seem to have any of the symptoms of Parkinson’s disease—slow gait, tremors, and slurred speech—that defined so many old boxers.
Omalu’s working theory was that Webster may have been suffering from something similar to Punch-Drunk Syndrome, the reason behind his irritability and erratic behavior. Even that would be groundbreaking as there had never been a diagnosed case of brain damage associated with football.
Omalu pressed on, still too reticent to come forward with his findings. He ordered additional stains of Webster’s brain tissue, paying for them out of his own pocket. He stacked up every piece of literature he could find on concussions, dementia pugilistica, head trauma, and football on his dining room table and went through it paper by paper. He read Martland, Corsellis, and numerous others on boxing as well as the recent work related to football by researchers such as Jeff Barth, Kevin Guskiewicz, and Micky Collins. He came across papers published by something called the NFL’s Mild Traumatic Brain Injury Committee, which was documenting the scientific effects of concussions in pro football.
Finally, in the spring of 2003,
Omalu was ready to seek a second opinion. He turned to his mentor, Ronald Hamilton, the neuropathologist who had helped train him during his two-year fellowship at UPMC. Hamilton was renowned as the first neuropathologist to show that Lewy bodies—abnormal masses of protein that develop in nerve cells and are
commonly associated with Parkinson’s disease—were twice as common in Alzheimer’s patients than previously had been known. He had a close and somewhat paternalistic relationship with Omalu. Hamilton viewed his protégé as bright and ambitious but also a bit flamboyant and given to hyperbole. In forensic pathology—particularly Cyril Wecht’s brand of forensic pathology—certainty and authority under the bright lights are valued. Not so in neuropathology, in which scientific debates are more measured and deliberate than the fierce advocacy required in the courtroom. Omalu spoke in pronouncements, an attitude that earned him a warning from the head of the neuropathology program that he might not make it in academia if he kept it up. “That’s everybody’s experience with him. Bennet has a powerful personality, and at first it’s just like,
What?
” said Hamilton. “And then you start listening to him more and more—if you have the patience. And you start to realize that he’s really right on the mark. It’s just that his personality really drives some people nuts.”
For his part, Omalu viewed Hamilton not only as a great scientist but as his introduction into a broader world. With characteristic bluntness, he announced one day: “Hamilton is gay. And Hamilton was the one who changed my attitudes toward gay people. I was very homophobic. I thought that gay people are bad people. Hamilton was the first gay person I had met. He was such a good guy; he was so good to me. For the first time in my life I realized that I had been fed lies by the church, by my family and society, that this guy is a good guy with a heart, who cared for me.”