Deadly aftershocks

BEDFORD, Mass. - What Lisa McHale would like you to know is the way it once was, not the way it ended. Because it is vital to her that you know her husband Tom as she will always remember him - the intelligent, principled, fun-loving man she fell for so long ago back in college. Away from the violence that unfolded each Sunday on the football field, where he played on the offensive line for 9 years in the NFL for the Eagles and two other teams, the 6-4, 290-pound Tom McHale could fill up a room with his presence. Good guy: Loved his wife, doted on his three boys, and remained loyal to his old pals from childhood. Lisa remembers she was "instantaneously crazy about him" and that would never change, even as she now catches herself saying: "I just wish you could have known Tom when he was Tom."

Gradually, he became a stranger to her. In the years that followed his departure from the league in 1995, during which he opened some restaurants and worked in real estate in the Tampa area, McHale began taking OxyContin and other drugs to quell the pain that had settled in his joints. "Physically, he had the body of a far older man," says Lisa, who by 2005 became aware that "something was terribly, terribly wrong." Tom had lapsed into a depression. The man who once embraced life with such energy and enthusiasm became withdrawn socially, what Lisa would later describe as a shell of his old self. He told Lisa he was hooked and entered rehab but he relapsed, again and yet again before Lisa asked him to leave in May 2008; Tom had begun using while the children were in the house. Within a week Tom had died in his sleep from an accidental drug overdose at the apartment of a friend. He was 45.

Chances are it would have ended there as just another sad casualty of addiction were it not for a telephone call Lisa received from Chris Nowinski, the founder of the Sports Legacy Institute and co-director of the Center for the Study of Traumatic Encephalopathy at the Boston University School of Medicine. From what he understood of how McHale died, Nowinski suspected that years of repetitive head trauma had left him with Chronic Traumatic Encephalopathy (CTE), a brain abnormality that renders one susceptible to memory impairment, emotional instability, erratic behavior and problems with impulse control. Nowinski asked Lisa if she would allow the brain of her deceased husband to be analyzed.

She agreed.

And the findings she was later presented with seemed to explain everything.

Tom had an acute case of CTE. According to Dr. Ann McKee, a CSTE co-director and neuropathologist who specializes in degenerative brain disease, McHale exhibited significant pathology in areas of the brain that control inhibitions, impulsivity, insight, judgment, memory, emotional liability and aggressive behavior. While McKee says there is "no direct link" between the damage she discovered and drug dependence, she speculated that McHale was probably experiencing "these weird connections," that he could well have been using drugs not just to feel better physically but also to ease the psychological turbulence that forms in concert with dying brain cells. Lisa remembers that Tom had written in a diary that he was overwhelmed by the continual feeling that he was having a nervous breakdown.

"I had come to grips with the fact that he had died of addiction, but it seemed to me as if something else was going on with him," Lisa says. "He had worked hard in recovery but just did not get any better. The poor man was confused. And then I looked at the slides of his brain tissue and I understood why.

"He was losing his mind. And our minds are who we are."

The delivery usually comes to the lab, though McKee says sometimes it will come to her home if the hour is late. The brain is placed in two layers of plastic bags filled with wet ice and secured in a bucket. The bucket is sealed with tape and placed in an even larger plastic bag of wet ice, which is then packed inside a styrofoam container and shipped in a cardboard box preferably no later than 14 hours after death. McKee and her small staff then photograph the brain, weigh it and cut it in two: One part is frozen at 80 degrees below zero for use by ensuing generations of scientists; the other part is placed in a fixative and used to harvest tissue that can be placed on slides for examination under a microscope. All of this takes place in an austere brick building at the Veterans Administration Hospital in suburban Boston, where McKee has affixed a sign to her door that asks ironically: "Got Brains?"

"Once a delivery was inadvertently dropped off at the wrong address, so it ended up with a neighbor," McKee says as she slips on a pair of surgical gloves in the morgue. "I can only imagine what they were thinking when they got it."

A wry chuckle, then unnecessarily: "By the way, I would not touch anything."

Evaluation of the specimens always begins with a blind analysis, a search for abnormalities that could lend clues to how a person lived - and died. In the case of McHale, McKee knew he had played football at Cornell and in the NFL but no more. However, the evidence she found of CTE led her to certain assumptions, which were only confirmed when she spoke with Lisa McHale and became aware of the issues that faced Tom in his final days. McKee says: "In a way you come to feel as if you know the person you are working on." At that point the object she is probing is no longer an inert entity but a piece in an elaborate puzzle that could explain sometimes odd behavioral patterns that preceded or even contributed to death. "It becomes a question of: Can you connect the dots?" McKee says. "You try to correlate their clinical symptoms with your pathologic findings."

Autopsies conducted by Mc-Kee and others in her field have shown that "the dots" lead back to CTE, which for years had been considered a form of dementia suffered largely by boxers. CTE has been found in 10 of the 11 deceased football players whose brains have been examined in the laboratory. Dr. Bennet Omalu, the chief medical examiner for San Joaquin (Calif.) County and author of the book, "Play Hard, Die Young: Football Dementia, Depression and Death," discovered the presence of CTE in three Steelers: center Mike Webster (heart attack); guard Terry Long (suicide) and tackle Justin Strzelczyk (high-speed car crash); and Eagles safety Andre Waters (suicide). McKee has discovered it in McHale, who played 21 games at guard and tackle for the Eagles in 1993 and '94; former Houston Oilers linebacker John Grimsley (self-inflicted gunshot wound); two NFL players who have not yet been publicly identified; and two non-NFL football players who also have not been publicly identified. None of the former players found with it was younger than 36, but McKee did encounter evidence of the abnormal tau protein deposition that is the precursor of CTE in a deceased 18-year-old football player. Says McKee: "And that is extraordinary. Someone that age should not have that."

Head blows that were once shrugged off as just having your "bell rung" have become an increasing concern for ex-players who participate in contact sports. Nowinski, a former Harvard football player and pro wrestler who suffered some serious head trauma, has signed up 116 former athletes to donate their brains for study as part of the CSTE Brain Bank Registry - including former Flyers star Keith Primeau, who had to quit playing because of a series of concussions. While there is not yet enough data accumulated to draw any firm conclusions, that day is not far off - perhaps just 3 years. "Ideally, we would like to have 50 brains or so," says Mc-Kee, who says the study has been receiving an average of "around a brain per month." Nowinski says that as the word of his program has spread he has been hearing from concerned spouses of former players who have shown signs of declining cognitive ability. Such accounts are supported by a 2007 survey of 2,552 former NFL players by Center for the Study of Retired Athletes at the University of North Carolina: 37 percent had a higher risk of Alzheimer's disease than other men their age.

So what does the NFL have to say? For years, the league has argued that there is "no conclusive proof" of a link between playing football and the development of cognitive impairment. But unlike the head-in-the-sand position it took under former commissioner Paul Tagliabue, the NFL has adopted a proactive stance toward concussions under successor Roger Goodell. In the wake of a concussion conference the league held in Chicago in June 2007, the league has embraced more enlightened guidelines on the supervision of concussions, which has included the enactment of rules to prevent "unnecessary helmet impacts." NFL spokesman Greg Aiello said "the injury has been treated more carefully than it has ever been and the players are more aware of it." A formal statement issued by the league stressed in part "there continues to be considerable debate within the medical community on the precise long-term effects of concussions and how they relate to other risk factors, including preexisting conditions or family history."

Elsewhere, the statement argued: "Hundreds of thousands of people have played football and other sports without experiencing any problem of this type."

CSTE co-director Dr. Robert Cantu replies: "That is bosh!"

"There is no statistical study of those people," says Cantu, a clinical professor of neurosurgery at Boston University. "There is no way of knowing that unless an autopsy has been conducted."

As part of its own study into concussions, the NFL committee on Mild-Traumatic Brain Injuries invited Nowinski and Mc-Kee to appear before them May 19. Neither side would comment specifically what was discussed, but McKee says: "They seemed interested in hearing what we had to say." Cantu applauds the league for bringing them in but hopes that it ends up being more than just "lip service," that it is instead the beginning of a probe that addresses the central unanswered question has engaged CSTE: "Can we connect with a black line between playing football in the NFL to these abnormal tau protein depositions?" Cantu concedes that a prior condition or a genetic predisposition could play a part, but says there is no existing data that points to drug use as a contributing factor. Says McKee: "Of the six players I have looked at, there is no evidence that two of them had ever used anabolic steroids. [Skeptics] love to point to anabolic steroids as explanation."