Part I: The Life and Contributions of Bennet Omalu MD

The following is a short, fictional beginning to this month’s feature article on Bennet Omalu MD, the pathologist who first recognized Chronic Traumatic Encephalopathy in NFL football players.  The fictional beginning is meant as an introduction to soften the topic before telling Dr. Omalu’s story. Following the fictional introduction, is Dr. Omalu’s tragic, yet ultimately triumphant, story.   I interviewed Dr. Omalu at his office in Northern California during the summer of 2024.  John Joseph Pack MD

“What do you think, Bill?  Have we got a chance?”

“We’ve got more than a chance, Frank,” stated the color commentary announcer.   “We’ve watched the Mustangs all season long and they’ve had several dramatic comebacks.  One more win, and they clinch their fifth division title in a row.  This 1985 season has been one for the record books, I’ll tell ya.   An incredible achievement for the General Manager, Jim Dutton, and their future Hall of Fame coach, Mel McCarthy.”

“And how about Colt McQueen’s performance up until now.  Have you ever seen such a remarkable display of poise from a rookie quarterback?”

“Frank, McQueen is simply on his way to becoming the best quarterback in the league.  A little more than midway through the fourth quarter, he’s 15 for 20 for 243 yards and has scrambled for an additional 57 yards on 6 carries trying to escape the torrid Predator blitz.”

“That’s incredibly accurate passing considering he’s been terrorized nearly all game long,” stated long-time Mustangs announcer Bill Dalrymple.  “They’ve delivered some brutal hits to McQueen after some of those throws, and, quite frankly, I don’t know how he’s still upright and in the game.  It tells you something about the man, don’t you think?”

“Indeed, Frank.  Indeed.  And don’t forget the outstanding play of Jimmy Jackson at running back.  He’s got 86 yards on 17 carries, each of them hard-fought, plus 54 yards receiving out of the backfield on 7 catches.  Jackson and McQueen are the Batman and Robin of this team.  The dynamic duo!” 

“Let’s turn our attention back to the field now as it looks like Smith is up and back on his feet.  He’s getting quite an ovation from the crowd.  You can see from the replay again the devastating hit he took from Jack Carr.  Carr’s nickname is the Wolfman, and he did not disappoint Predator fans on that play.  As many of you know, he’s considered the most feared linebacker in the sport, and you can see why after he launches his body in the air and spears Smith right to the head.  Smith’s hits the ground like a ragdoll and remains motionless for what seems like an eternity to me from up here in the booth, Bill.  Add another highlight-reel hit to Carr’s dossier.  I hope Smith’s family isn’t watching, however. On the positive side, he is up and moving on his own, albeit a little wobbly. I see the team doctor, Dr. Catalano, steering him towards the Mustang bench now.  Remarkably, they don’t appear headed towards the tunnel.  We’ll have to see if Catalano clears him to return.  The Mustangs sure could use him.  It’s not like Catalano needs any more business after all the injuries accrued in this game.  It’s been one to remember for football fans.  It’ what they all pay to see; a very physical football game.   They sure are getting their money’s worth today.” 

Colt McQueen watched Sammy Smith hobble off the field.  He tried to clear his mind of the brutal hit that was running through his mind, frame by frame, in slow motion.  The loud clack of the two helmets connecting was …chilling.   He shook his head and brought his attention around to the team's predicament and crouched down into the huddle.  The Mustangs were on the 50-yard line with 4:59 left in the game and they were down by 4 points.  “It’s 3rd and ten, boys.  We need to maintain this drive.   The way the Preds have been running the ball and burning clock, this may be our last chance to score.  It’s now or never!” 

McQueen used the dirty towel that hung from his belt to swipe at the blood on his skinned elbow, then stuffed his hands back into the insulated pocket of his uniform.  The temperature on the score board read 15 degrees Fahrenheit.  His breath was visible when he spoke.  “They’re looking pass boys. I’m sure of it.   Instead, were gonna shock ‘em.   28 Student Body right everybody pull, on three.  Break!” 

Number 28, Jimmy Jackson, lined up directly behind the big, fleet-footed quarterback, already under center.  He tried not to let his eyes and body language give away the play was coming to him or what path he would be taking.  One by one, the defensive linemen assumed 3-point stances, individual legs kicked out, taped fingers attached to scarred hands clenching an unclenching in nervous anticipation.   Steam rose up through open mouth with each rapid exhalation.  None of them could breathe through their flattened, congested noses, broken too many times. McQueen avoided making contact with their eyes and wasted no time in snapping the ball.  “Hut, hut….hut.”  The center delivered the ball smoothly and the quarterback dropped back as if to pass, then wheeled suddenly and pitched the ball to Jackson in one swift motion.  Jackson followed the block and swept right toward the sideline.  A hole opened and he cut straight for it, but in an instant, the Wolfman was filling it, delivering a vicious blow to the body.  Jackson, reacting on instinct, kept his legs moving and spun off the hit and slid past the bewildered linebacker.  He juked left and spun again, narrowly avoiding another tackle, before the weak side linebacker stood him up with a blow to his chest followed by a forceful slap from a tapped hand to the side of Jackson’s helmet, taking all the air out of the running backs sails in an instant.  Before he could collapse onto the turf, a defensive back finished the play with a spectacular roll tackle, cutting Jackson’s legs out from under him, and flipping him completely over.  His head hit with a sickening thud against the frozen, unyielding ground.  The crowd gasped but when the ref signaled first down, they erupted in celebration, pumping their fists in the air.

The announcers let the brutality of the play speak for itself and moved on to other thoughts.  “Frank, that was a completely unexpected play call by McQueen.   I don’t know if it came from the sideline or if it was an audible.  An old college play he had to have learned at  his Alma Mater, USC, which the old master, John McKay, popularized way back in the 60’s, if I remember correctly.”

“Bill, it looks like Jackson’s a little shaken up.  He’s getting up slowly and… oh, my, he appears headed toward the wrong huddle!  The Predators are wondering what’s going on and are pushing him back toward the line of scrimmage and now the Mustangs players are taking exception to that kind of behavior.  The refs have called time and are trying to get control of the situation.  Meanwhile, Catalano is back on the field and checking on Jackson.  He’s got his hand on the running backs arm and is guiding him back to the Mustang sideline, I imagine for concussion evaluation.  Oh, me-oh-my.  What a game!  There’s nothing like the drama of football, Bill.  Catalano’s got to wear a pair of sneakers to the next game as many times he’s jogged on and off the field.”

John Catalano stooped down in front of Jackson, who sat on the Mustangs bench, head in his hands.  He shooed the other players away with a wave of his arm and concentrated on his patient.  A player getting his bells rung was nothing new to Catalano.  Afterall, he had been involved with the Mustangs for 15 years now as the team physician. 

The orthopedist talked loudly to make his voice heard over the din of the crowd, which was reacting wildly to another exciting play.  Catalano guessed he would be missing another spectacular finish and tried to avoid the temptation of looking over at the field.  He blew into his hands to warm himself from the cold and shifted from foot to foot.

“Where are you?” he shouted at Jackson.

Jackson looked up and tried, with difficulty, to focus his eyes on the doctor.  “I’m in Billings, Montana.”  The doctor sighed and shook his head.

“What are you doing here?”

“I’m here with mom and dad.  We’re going fly fishin’.”

“Do you hear that noise?” 

“Yea.”

“What is that?”  asked the doctor.

“That’s crowd noise,” said Jackson. He looked around the stands.  Could see the collective exhaled breath of tens of thousands of people in their seats.  He looked down at his scuffed cleats, helmet resting between his feet. 

“If that’s a crowd, where must you be, son?”

He focused his eyes on the spectators, then turned his head back towards the field and craned his neck.

“I must have had a little dinger, doc.  I think I’m alright now, though.”

The crowd erupted again, and Jackson attempted to stand.  “I got to get back out there, doc.”

“Sit down,” Catalano commanded.  Jackson obeyed, but he was restless, fidgety, and began tugging on a hole in his torn jersey.

“Follow my finger with your eyes.  Don’t move your head.”  The doctor placed his finger in front of Jackson’s eyes and waved it back and forth, up and down, and diagonally.  Satisfied, he stooped lower, placing a hand on his black slacks for support, then shined his ophthalmoscope into Jackson’s eyes.  He followed this by testing the players strength and reflexes. 

The crowd gave a loud moan and then booed.  Jackson tried to stand again but was held down by Catalano’s firm hand upon his shoulder, at which point an assistant coach came running up to them, out of breath.

“Coach wants to know what the story is.  We need 28 back in there, pronto.  Can he go, doc?”

Catalano felt like Atlas with the weight of the world on his shoulders. Gravity was nothing in comparison.  He weighed the consequences, both good and bad, both for himself and the player.  The player had suffered a dinger all right, but he was never unconscious and had come around and was now eager to get back into the action.  His neurologic exam was normal.  In a perfect world, he would like him to sit out the rest of the game and take it from there, but this was not a perfect world.  There were all sorts of invisible forces acting on him from all sorts of directions, not the least of which, was that the game, an important one, was on the line.  And Jackson was a star.  He stared up at the owner’s box, could not see through the reflection of the glass panels, but wondered if the owner was staring right back at him.  No, gravity was indeed a weak force compared to the pressure and expectations of a team physician at this level.  Where did he owe his allegiance?  To the team?  To the player?  To the patient, of course.  But the patient wants to play.   He said so himself.  He had taken some tough stands in the past, but how many times had he also compromised himself, he countered? Which battles were worth fighting?  Was this?  Sometimes, when it was a toss-up, it was best to live by the age-old adage:  you got to go along to get along.   He tried to suppress the thought.  It didn’t belong in medical decision making.  He took a deep breath.  Hell, they all get dingers.  Sometimes twice in one play.  That’s football.  It was an occupational hazard.  He’d have to bench half the team on any given Sunday.   He was overthinking the issue.  

“Well, doc?” asked the assistant coach with urgency, swiveling his head back and forth between the doctor and the head coach. 

Damn this job, he thought.  “I guess, for a play or two only, if you need him, and the player feels up to it.”  They both looked at Jackson. 

“Thank you, doc,” said Jackson, and grabbed for his helmet.  They both trotted off towards the head coach, who stared back at Catalano and gave him a thumbs up. 

 “Get the hell back in there,” said the coach.  “We need you.”  The crowd roared again as Jackson was shoved back onto the frozen tundra. 

The Mustangs had managed to run down the clock on their slow, deliberate march towards the end zone, but now they appeared stalled.  The ball lay at the opponents 2-yard line, where it had been for the last 3 plays.  It was fourth down and they were still four points shy of victory with only three seconds remaining on the game clock.

“Welcome back,” said the quarterback.  “You up to this?  I hope so. It’s been a heck of a show.”  McQueen thought he detected a subtle glaze in the running backs eyes, that made him think twice.  Leaning on his remarkable football acuity, he sized up the situation and began to speak.   “Listen, this is it.  It’s do or die.  They’ll be expecting Jackson to run the ball but I’m going to fake it to 28 and follow his block into the end zone off right tackle. 

“But that ain’t the play, Colt,” someone stated in a southern drawl.

“I know,” said the quarterback.  Colt McQueen was a maverick, and the front office knew that when they drafted him.  His expression held a devious smile coupled with a familiar twinkle in his eyes that his teammates recognized as he looked around the huddle at each of them.  “Are you with me, boys?”  His question was met with uncertainty.  He looked at Jackson, the captain, who smiled and shook his head confidently.  “We’re with you, big guy.”   The rest of the team relaxed and joined in.  “Smash-mouth football,” someone added.  McQueen said, “Jackson, I need you to take the Wolfman out at the knees to clear my path.  On 2.  Let’s do this!  Break!”

They broke huddle and the quarterback tried to quiet the crowd.  Then, thinking better of it, he strode behind the offensive line like a general, waving his hands up in the air, whipping the crowd up into a veritable frenzy.  A vortex of noise reached a crescendo and thundered through the frigid stadium air.  McQueen lowered his arms and surveyed the opposition. 

The announcers let the drama unfold in silence.

In the end, the young star quarterback, wise beyond his years, ran the play like a charm.  Jackson upended the hulking Wolfman, and McQueen followed right behind him with a game winning dive into the end zone.  The crowd, crazed, rushed over the barriers and onto the field in wild celebration, on a mission to topple each goal post.  McQueen, on the shoulders of his fellow teammates, was carried off the field, his fist raised high in the air.  Jackson sat on the ground, head between his knee’s, and did not join in the victory parade. Instead, he gripped the turf, trying to steady himself as the field began to spin.  He squeezed his eyes shut.  It was all he could do to keep from vomiting.  His head pounded, made worse by the fans pounding him on the helmet and shoulder pads as they ran past toward the goal post.   He comforted himself.  Tomorrow he would feel better.  He had been through this before.  He would rest all day and get ready for another big game next Sunday.  He tested his vision to see if the vertigo was still there and it was.  Before he closed his eyes again, he caught a glimpse of the Wolfman being carted off the field on a stretcher.