League of Denial

by Mark Fainaru-Wada

  Omalu wore impeccably tailored suits and tooled around Pittsburgh in a silver Mercedes-Benz E-Class sedan. He ordered his custom-made shirts without pockets to avoid collecting lint. He later designed his own $6,000 cuff links, which he was planning to sell in Dubai. Omalu sometimes spoke of himself in the third person, especially when provoked to outrage or anger (“He did not even acknowledge there was anybody like Omalu!”). He could seem indiscreet to the point of obliviousness. Once, while conducting an interview for this book, Omalu pulled out his laptop on the patio of a tony restaurant called Wine & Roses and showed images of disemboweled corpses while all around him diners brunched on quiche and eggs Florentine. To people who annoyed him, Omalu would sometimes remark: “I may do your autopsy some day. Remember that.”

  Omalu’s indiscretions and eccentricities sometimes got him written off as a kook. But once you stripped away the mysticism and theatrics, the strange ghost stories and confessions, what was left was an inordinately well-educated immigrant with a razor-sharp mind, soaring ambition, and a keenly honed sense of moral outrage. All this would prepare Omalu well for what was about to occur. Julian Bailes, the neurosurgeon who later would become Omalu’s biggest champion, noted that it’s often the least conventional people who shake up the world. “Most discoveries of great things are not done by shrinking violets,” Bailes said. “They’re done by people who want to be noticed or provocative, want to be recognized for discovering things.”

  Never was Omalu more of an outsider than when it came to pro football. It would have been almost impossible to locate a human being within a 200-mile radius of Pittsburgh who was more ignorant about the sport. Omalu hadn’t the slightest clue how football worked. He hadn’t watched a game, much less attended one. “I didn’t know what a Super Bowl was,” he later said. He found the city’s fevered obsession with the Steelers baffling and pointless, “part of the American stupidity. You know, in Africa, we believe, yes, the white man is smart but the white man can be foolish.” Omalu looked at the game through the lens of a Martian, if that Martian happened to practice neuropathology. Everything about it he found worrisome and dangerous. Why, for example, were the players sheathed in armor? He looked at the helmet and thought: “Why do they have to wear that big casing?”

  Omalu was just 32, the junior pathologist on staff. Because of this, he often was scheduled to work weekends. “Guess who was on duty that Saturday?” said Omalu. “Omalu.” As he prepared for work, he watched the news accounts of the sad demise of a local football hero, the stories about his Ritalin arrest, the rambling Hall of Fame speech, how Webster had slept in bus and train stations—a man broken mentally and physically. Omalu felt for the poor man. He wondered idly if he might have had some kind of brain disorder. Omalu recently had conducted an autopsy on a woman in her mid-forties. She had died after being beaten into a vegetative state by her husband. Omalu ran tests on the woman’s brain and was struck when they revealed an unusual Alzheimer’s-like pathology. He didn’t do anything with his surprising finding, but the case was still fresh in his mind.

  When Omalu arrived at the coroner’s office and was told that Mike Webster was his first case, he didn’t immediately make the connection.

  “Who’s Mike Webster?” he said.

  “That’s the greatest center who ever played,” he was told.

  “What’s a center?” Omalu asked.

  Then suddenly he got it: The body on the table belonged to the same broken man they had been talking about on TV.

  “Fuck, man!” Omalu recalled thinking. “Thank you, Lord!”

  Omalu looked down at Webster’s battered corpse—the cracked feet, scarred knees, mangled fingers—and got to work. He always played music during autopsies; it helped calm him and break the monotony of carving up so many bodies. A hopeless romantic, he was going through a Teddy Pendergrass phase of love ballads. Omalu worked with such swiftness and precision that it could seem almost as if he were on autopilot. But with each incision, with each organ he removed, weighed, and sliced, he was looking for clues.

  Omalu’s belief in spirits extended to his autopsies. He believed he could communicate with the dead and that the dead in turn could tell him how they became dead. Omalu saw himself as their champion, a person who could give them voice. As he worked his way around Webster’s body, he conducted an ongoing dialogue, trying to engage Webster’s spirit: “Mike, in my heart, I think there’s something wrong with you. I can’t do this alone, you need to help me. Let’s prove them wrong; let’s go get them.”

  The autopsy lasted about an hour, building toward the moment Omalu had been waiting for: the removal of Webster’s brain. To understand definitively what had gone wrong with Webster would require months of study. But when he was able to hold the brain in his hands, Omalu felt certain he would see some obvious signs of deterioration. Perhaps it would be shrunken and atrophied like a brain with Alzheimer’s disease. But when Omalu removed Webster’s brain, he was disappointed. It showed no outward signs of injury or disease. Omalu weighed it: 3½ pounds. It was perfectly normal.

  Omalu shrugged.

  Sorry, Mike. I couldn’t help you after all.

  But Omalu found himself thinking back to the case of the battered woman. And so, almost as an afterthought, he ordered his technician to preserve the brain for further study.

  He recorded his intentions in the autopsy report: “The brain weighs 1575 grams and has been fixed in formalin for comprehensive neuropathologic examination. A report will be issued on a later date.”

  Omalu cleaned up and returned to his office. He called his boss, Allegheny County Coroner Cyril Wecht, a Pittsburgh legend. Wecht, among other things, had an uncanny ability to insinuate himself into every major crime and fatality of the day: O. J. Simpson, JonBenét Ramsey, even the Kennedy assassinations. He was an odd breed. People called Wecht a “celebrity pathologist.”

  “Sir, I’ve finished the autopsy,” Omalu told Wecht. “I’ve saved the brain and, please, I’m asking for your permission to study it.”

  “What are you studying the brain for?” Wecht asked.

  “Well, they said he had some neuropsychiatric problems. I want to see if he has some evidence of brain damage.”

  “Do whatever you want to do, Bennet,” Wecht told him. “Just make sure you make me fucking famous.”

  Omalu’s full name was Bennet Ifeakandu Onyemalukwube.

  His middle name meant: “Life is the greatest gift of all.” His parents chose it for a reason: Omalu was born in the middle of a bloody civil war. Nigeria’s Igbo tribe, of which his family was part, had annexed the southeastern part of the country to form the state of Biafra. When Omalu’s mother went into labor, his father lay in a hospital bed, having nearly been killed when the Nigerian Air Force bombed their village. The two-and-a-half-year civil war ended in 1970, when Biafra was absorbed back into Nigeria. The conflict claimed at least 1 million lives, many from starvation and disease. In the United States, the war would be remembered for its disturbing images of skeletal children. Omalu recalled almost nothing beyond his village receiving rations of dried fish from the World Health Organization.

  Omalu’s last name, fully realized, meant: “If you know, come forth and speak.” This too was fitting, for the Igbo had a reputation for being the most outspoken of Nigeria’s three main tribes (the others are the Hausa and the Yoruba). “I’m an Igbo man,” said Omalu. “I think we are bold people. That thing that you tell me I can’t do is what I want to do.” The Igbo are predominantly Christian, with many practicing a mix of Roman Catholicism and native rituals. The Igbo have complicated views on death and burial. Most believe in reincarnation and the interaction between the living and the spirit world. The Igbo are also known as businessmen and traders. Omalu’s father, John, was orphaned at three and raised as a house servant by a local parish catechist. When he finished high school, according to Omalu, his “colonial master” paid his father’s way to England, where he studied mining engineering and shortened t
he family name to Omalu. He returned to Nigeria and spent most of his life as a civil servant, eventually retiring as director of the Federal Ministry of Mines and Power.

  Omalu was the product of an arranged marriage, the sixth of seven children. He attended the finest schools in Enugu, a city of about half a million people in southeastern Nigeria, living comfortably in a gated community, protected by armed guards, going to school in chauffeur-driven cars. Math and English tutors came by the house twice a week to teach Omalu and his siblings. Bennet was quiet and introverted as a child. He excelled in class but had few friends and was something of a mama’s boy. He was tidy and meticulous, voted the “neatest” kid in his class. By his late teens he yearned to break away, dreaming of becoming a jet-setting pilot.

  “My childhood dream was to have a girlfriend in every major city of the world,” he said. “I fly into Paris. I spend the night with my Paris girlfriend. I fly to Sydney, Australia. I spend the night with my Australian girlfriend. Then I fly to New York.…”

  His parents nixed that idea and instead sent him to medical school at the University of Nigeria. After getting his degree, he worked four years as an emergency room physician and then, at 26, applied to a one-year visiting scholar program at the University of Washington’s School of Public Health. After a year in Seattle, he went to New York to do his residency at Harlem Hospital.

  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, s
o 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.