Part II: The Life and Contributions of Bennet Omalu MD

“I’m Dr. Omalu.  I’m going to do your autopsy.  Guide me.  Please, help me.  Show me what killed you.”  Bennet Omalu MD

Omalu positioned himself at the head of the autopsy table, picked up a scalpel, and, with firm steady pressure, precisely traced the sharp blade across the crown of the scalp from one ear to the other, tugging and separating the thick tissue from the skull, pulling half down towards the back of the head and the other half anteriorly until the tissue flopped in front of the dead man’s face.  The crisp sound emitted was like that of masking tape being torn from a fresh roll.  He asked for his trusty Stryker bone saw and it buzzed to life, misting a fine white dust as it sawed through the skull cavity.  A skull key, or T-chisel, was used to remove the skull cap in one piece, which he set aside close by.  He would place it back on the empty cavity once the brain was removed.  With skilled hands, he carefully lifted the brain and severed the spinal cord and the cranial nerves that were keeping it tethered down, freeing the brain from its casing.  Visually, the brain seemed in order.  No obvious trauma or blood.  Next, Omalu ordered the technician to fix Webster’s brain in formalin for eventual microscopic analysis.  The process would take two weeks….

Bennet Omalu’s father was orphaned at three years old.  A fisherman and a member of the Igbo tribe in Nigeria, he died under unclear circumstances.  They said he drowned, but his body was never recovered.  Bennet’s grandmother grieved and suspected he had been murdered.  Unable to cope, she abandoned her children and disappeared from their lives, only to reappear as fast as she had gone, decades later.  Amaechi, whose name implies in the Igbo language, “I may be down today, but no one knows what tomorrow may bring,” now without a mother or father, found luck in a local Roman Catholic priest, a missionary, who found him wandering the streets with his one and half year-old sister, Nwanedo.  He took them in and eventually found separate homes for them.  Amaechi was adopted by a local church leader, where he became more of a servant then a foster son and was often physically and emotionally abused.  Through intelligence and luck, as his name implies, he became a favored personal assistant to a colonial administrator from England. 

“When the administrator departed back to England, he asked my father what he could do for him,” said Doctor Bennet Omalu.  “My father replied that he wanted to go to college in England, but he had no money.  Six months passed without a word and one day my father received a telegram.  He had been accepted to the Cornwall Institute of Mining in England, with a full scholarship.  With hard work, he was awarded an engineering degree, but he never recovered from his childhood trauma, becoming a worried man who chain-smoked and had several failed marriages.  He was a functioning alcoholic, drinking only at night, and he eventually developed diabetes.”  With the prospect of a future condemned to poor health and suffering, he was able to clean himself up and start afresh.  He lived to age 93.  “My mother was a seamstress and started her own business.  She was successful and had thirteen employees’ before she married my father.  I was the next to last born and I was born during the war. (in Biafra).”

“Most of the boundaries in Africa have nothing to do with traditional tribal areas.  The vast majority were created by European powers who colonized them, except for Ethiopia, the only African nation that was never colonized.  As a result, tribes and religions found themselves thrown together because of treaties negotiated between governments thousands of miles away (Truth doesn’t have a side, Dr. Bennet Omalu with Mark Tabb, pg 22, Harper Collins, 2017).

The Nigerian Civil War, or the War in Biafra, raged from 1967 to 1970, largely the result of ethnic and religious differences, with the Muslim Hausa people in the North and the Christian Igbo tribes and Yoruba tribes in the south and east, respectively.  The two sides could unite against their British colonizers, but once Britain pulled out and Nigeria achieved independence on October 1st, 1960, their differences became magnified.  Through a series of violent events, including anti-Igbo pogroms, many Igbos migrated south and declared independence from the rest of Nigeria.  They renamed their country Biafra, a Portuguese word used to detail a recessed portion of the Nigerian coast on the Atlantic Ocean called the Bight of Biafra. 

“My father was a bombing victim.  He sustained multiple injuries and was in a refugee hospital for several months when I was born.  There was much violence in the North against the Christians.  Since Jos had a large Igbo population, the slaughter was fierce there.  My father had us moved from the predominantly Muslim Jos to the Christian South.”  Omalu’s father, who remained behind, became trapped in Jos however, and a British ex-patriate smuggled him through check points in the back of Land Rover to safety in the south.  The war ended in 1970 when the Republic of Biafra could not sustain the war economically and militarily.  The War in Biafra, along with Vietnam, became the first two wars to be broadcast to the world on television. 

Omalu was born on September 30, 1968.  “I was very shy growing up.  I didn’t go out or have friends.  I got into grade school at three years old and I was always the youngest in my class.  I wouldn’t go out to play.  I just read and did my homework.  I wasn’t smarter than the average kid, I think I just spent more time on it.” 

As Omalu grew up, he showed increasing signs of insecurity, loneliness, isolation, and low self-esteem.  Much later he was diagnosed with clinical depression, which had likely started at an early age, and unrecognized by his parents and teachers.  He was particularly troubled by his small stature and his own perceived physical weakness.  One day he asked his mother why he was so small.  “Bene,” she replied, “God is the one who makes you tall or short.  Your height is beyond your control.  But it is within your control as to what you choose to make of yourself.  You can become whatever you choose to be in your life… …You can become the tallest man in the world in whatever you choose to do. (Truth doesn’t have a side, by Dr. Bennet Omalu with Mark Tabb, Harper Collins Publishers, 2017.)”

“I wanted to become a pilot.  My parents said, “Oh, no, no, no.  You’re going to die in a plane crash.”  Then I said I wanted to become an engineer like father, and they said “No, no.  Engineers are dying in the mines.  So, they packaged me up and shipped me to medical school at 15 years old.  I look at my daughter, who is now fifteen, and at that age I was already in medical school?  It doesn’t seem right.  It’s a seven-year curriculum in Nigeria.  They start you early.  So, I became a doctor at twenty-one.”

With the increased stress, Omalu’s depression deteriorated in medical school.  He stopped going to class.  He developed a reputation as a loser, a failure.  Keep away from him, they said, something might rub off on you.  He became increasingly isolated.  Another student, Kenneth, took pity on him and forged his signature in class and left his clear and comprehensive notes for young Bennet to study.  Unable to get out of bed, he slept during the day and studied at night.  His world became upside down and remained so until he decided to leave medical school altogether.  Mentally, he had already checked out long before.  “One of my professors knew my sister, who was also a doctor. He called her and asked where I had gone.  She had no idea anything was happening.  They finally tracked me down living with a friend of my fathers in another region.  I had told my father’s friend I was on vacation.  Eventually, my depression lifted, and I decided to return to medical school, get my degree, and then decide to do something else after fulfilling the family requirements of my becoming a doctor.” 

“I eventually compensated for my depression by excelling in everything I did, namely academics.  I said to myself, I can’t be the best in this country.  I need to prove to the world that I’m somebody.  I am not a loser.” 

“One day, after graduation, I was working as an emergency room physician, and I saw a newsletter asking for applications for a World Health Organization scholarship to come to the University of Washington in Seattle to study cancer epidemiology.  At the airport, the airline asked me where I wanted to go.   I said “Cedl.”  Eventually, we figured out it was pronounced Seattle.  I really knew nothing.”

“When I came to America, I discovered there was racism.  In my country, we had something similar called tribalism, which means somebody from one tribe wants to promote and enhance people of his tribe over another’s.  It is not founded on the premise of the other tribe being inferior (like in America).  I started to read American history books.  I read about slavery.  In Africa, they tried to conceal the history of slavery.  I wasn’t aware of it.  They taught us about the great kings of Africa, the great queens, that they set up the complex trade routes across the Sahara Desert.  The British had established the curriculum.  Nobody taught me about slavery, though.”  Omalu was appalled he had left a country in ethnic conflict, and now willingly emigrated to another, this one with pre-conceived notions attached to the color of a person’s skin.   “So, in America, I set my goal to be a high achiever academically, so you’re untouchable (to mitigate against the specter of racism). It’s like a plane, when it hits turbulence.  It goes up further to rise above it.  As I read more books (on America), I noticed that, despite racism, the American culture will recognize you if you’re super talented in something.  So, I got a degree in public health and a master’s in business administration, in addition to my MD.”  Omalu was on a mission. 

Dr. Omalu had to negotiate with himself to continue a career in medicine.  He decided to pursue it, this time with zeal, but failed to match in a residency program.  He started to cry and worried that he couldn’t afford to buy even a plane ticket back to Nigeria. In his critical mind, he would return a failure.  At the last minute, Harlem Hospital had an unexpected opening, and he received the offer and the salvation that came with it.   After residency, and because of his natural introspection, aloofness, and sometimes off-putting mannerisms, he chose to avoid a specialty with high social interaction.  He settled on a fellowship in pathology in Pittsburgh, Pennsylvania.  After seeing a documentary on the JFK assassination in which high profile American forensic pathologist Cyril Wecht played a role, Omalu contacted Wecht and was offered the position.  Wecht was a nationally known figure who had consulted on many sensational crimes from a forensic standpoint, including testifying before a House subcommittee and becoming a leading opponent of the one bullet theory in the Kennedy assassination. 

After completing his fellowship, Omalu undertook a second fellowship in Neuropathology at the University of Pittsburgh Medical Center.  Meanwhile, Dr. Wecht offered Omalu a job on weekends and public holidays.  “One Saturday, I woke up and turned on the television, Fox News.  They were talking about Mike Webster, who was dead at age 50. I’m like, “Who is this guy?”  They were saying he played for 17 years but like many football players after they retire, problems began to emerge.  Mood swings, alcoholism, destitution, bankruptcy.  They were saying he couldn’t manage the transition from fame to obscurity, and (It got me to thinking) “Couldn’t they be suffering from brain damage, like boxers?”   Prior to this incident, Omalu had been kicking around the idea of Alzheimer’s Dementia being connected to brain trauma.  He had been turning the idea around in his head for quite some time and sparring with it intellectually.  The conversation he heard on TV that morning about Websters erratic behavior, led him to start an almost subconscious connection between the idea he had been playing with, brain trauma and Alzheimer’s dementia, and brain trauma and football.  Like most people, not every idea or connection Omalu’s brain generated turned out to be fruitful, but sometimes it could lead to other ideas that were, and so it was regarding Mike Webster.  He may have been wrong about his connection between trauma and Alzheimer’s, but, as it turns out, he was not mistaken about the link between the repetitive head trauma in football and subsequent brain disease.

“It was a rainy Saturday on September 28t in Pittsburgh and as I pulled up to the office, I saw a commotion.  I asked my technician what was going on.  He said Mike Webster is on the autopsy table!”  Omalu looked quizzical and then made the connection from the TV that morning.  “Oh, yeah, from the Pittsburgh Steelers.  Iron Mike.  I remember, I said, “I would like to examine his brain.”  The technician was like, “Oh, wow!””

“Now, I just don’t go right into an autopsy.  I introduce myself from my heart.  I say, “Hi, I’m Dr. Omalu.  I am going to do your autopsy.  Guide me.  Please, help me.  Show me what killed you”

After looking through the file of case number A02-5214, Omalu walked over to the autopsy table.  “I whispered to him, “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 to this alone.  Come with me.  Walk with me.  Guide me to the light of the truth.””  (Truth doesn’t have a side, Dr. Bennet Omalu with Mark Tabb, pg 121.). The technicians working at the morgue, at this point, were used to Omalu’s unorthodox mannerisms. 

Omalu began the examination with a visual inspection of the body, noting the height, weight, approximate age, race, hair and eye color.  He examined the skin, mouth, teeth, and nails for clues pointing to trauma, assault, or underlying disease processes, recording his findings as he went on a hands-free Dictaphone.   His steady, accented voice cut through the silence.  Omalu placed a large, rubber headblock under the neck of the corpse to lift the chest cavity upward towards the ceiling.  He picked up a scalpel and made a crisp “Y” type incision starting at each shoulder and extending down and towards the midline, connecting in the sternum, or breastbone.  With firm pressure, he continued the incision down the vertical axis of the body until the pubic bone was encountered, and placed the scalpel gingerly back on the cold, shiny, stainless-steel tray.  A prosector or bone cutter, similar to a pair of garden shears, was used to access the chest cavity.  This was done at the cartilaginous border that separates the bony ribs from the bony sternum.   Omalu carefully removed the sternum and set it aside to be replaced afterwards, like the lid of a shoebox.  Blood had already coagulated and settled with gravity to the lower aspects of the body, depending on how it was positioned at death.  After a visual inspection of the size and color of the heart, lungs, and aorta, each was dissected from its surrounding tissue with heavy scissors and examined for evidence of necrosis or infarction.  Omalu satisfied himself that there was no evidence of pulmonary embolism, or blood clot to the lungs, a common cause of sudden death.  After examining the heart grossly, he could see that myocardial infarction, or necrosis of the heart muscle, was evident.  Mike Webster had died of a massive heart attack, that was clear.  Omalu reflected the connective tissue of the abdomen and splayed the abdominal cavity open and used clamps to keep the field clear.  There was no steam rising from the cavity into the cold, morgue air, like in someone recently deceased.  No surprise, with time, the body had already cooled to room temperature. He carefully dissected out and examined, weighed, and took sections of the kidneys and the liver.  He ran the length of the aorta through his sensitive, skilled hands and determined there was no evidence of dissection or rupture, another common cause of sudden death. He examined the small and large bowels, using an enterotome to cut into them.  He returned the organs carefully and respectfully to the body cavity as if he were handling fine crystal, then passed a foley catheter into the urethra and took a urine specimen and blood specimens for routine labs and toxicology.  With a Hagedorn needle, forceps, and heavy suture, he sewed the body cavity back neatly and presentably. 

Omalu positioned himself at the head of the autopsy table, picked up a scalpel, and, with firm steady pressure, precisely traced the sharp blade across the crown of the scalp from one ear to the other, tugging and separating the thick tissue from the skull, pulling half down towards the back of the head and the other half anteriorly until the tissue flopped in front of the dead man’s face.  The crisp sound emitted was like that of masking tape being torn from a fresh roll.  He asked for his trusty Stryker bone saw and it buzzed to life, misting a fine white dust as it sawed through the skull cavity.  A skull key, or T-chisel, was used to remove the skull cap in one piece, which he set aside close by.  He would place it back on the empty cavity once the brain was removed.  With skilled hands, he carefully lifted the brain and severed the spinal cord and the cranial nerves that were keeping it tethered down, freeing the brain from its casing.  Visually, the brain seemed in order.  No obvious trauma or blood.  Next, Omalu ordered the technician to fix Webster’s brain in formalin for eventual microscopic analysis.  The process would take two weeks and incur some expense.   The technician was surprised and let it be known she thought it was a limited autopsy and thus unnecessary step.  Afterall, they had already confirmed the cause of death, hadn’t they?  Expense, at the county morgue, was always an issue.  To Omalu, though, they answered one question but not the most important question.  The one that lingered in his thoughts.  Why did Webster, Iron Mike, develop erratic behavior, have violent mood swings, become forgetful and hopelessly depressed.  Why had he become impulsive, destitute, divorced, and eventually homeless, living out of his truck and sleeping in train stations and greyhound bus stations around the country.  Webster, suffering from severe insomnia, would not sleep for days on end, and was said to have used a cattle prod to shock himself to sleep on some long, desperate nights. 

Omalu stiffened and could not hide his irritation.  Finally, he offered to pay for this part of the process himself.  After all, he had done it before in his quest for the absolute truth.  His curiosity was intense and so was his determination to get at the root causes of a person’s demise.  Omalu wanted to find the answer. No, Omalu needed to find the answer.  Suffering from depression himself, and always on a quest for his own answers, may have served as additional motivation.  After taking sections of the brain with his brain knife, the skull cap was replaced and the body released to the funeral home.  Mike Webster was subsequently interred, without his brain, the tissue of which was being prepared in a laboratory far from the gravesite. 

After several weeks, the brain tissue, fixed onto slides, returned to Omalu’s desk in a small, cushioned box.  “I took them home and stored them on a shelf.  Time passed, and one day I was eating a red apple, I remember, with nothing to do, and I took them down and slid the slide into my microscope,” said Omalu.