The door to Ann McKee's office is a shrine to the human brain: artistic, scientific, and comic. An iridescent Andy Warhol carrying a Campbell's Soup can keeps company with a newspaper photograph of the anatomist and neurologist who created the Wilder Brain Collection at Cornell University. A teenage boy slouches across a 2006 cover of The New Yorker, the lobes of his not-yet-adult brain depicted under a baseball cap. "MySpace" dominates his prefrontal cortex, an illustration of just how much has changed in social media, sports, and brain science. A bumper sticker asks, "Got brains?"
Brains she's got. Brains in glass jars in the storage room across the hall from her office. Brains blown up in digital images taken from autopsies she has done on some of America's most famously deceased athletes. Brains stored in a deli case in white plastic tubs that might otherwise accommodate 10 pounds of potato salad. Brains in baggies, slices of tissue that, she says, remind some people of the pickled ginger served with sushi.
This is the Brain Bank at the Bedford Veterans Administration Medical Center in Bedford, Massachusetts. Here, in a small room dominated by stainless steel, McKee performs autopsies. She examines the brains of athletes — men and women — who, without really knowing it, put themselves in harm's way. She sees the brains of soldiers who knew the risk. In all of them, she sees what happens when the brain is assaulted.
Among other things, Ann McKee is chief neuropathologist for the VA, Boston University's Alzheimer's Disease Center, the Framingham Heart Study, the New England Centenarian Study, and the Center for the Study of Traumatic Encephalopathy, which was created in 2008 to examine the impact of collisions between oversize human beings in pursuit of balls, yards, pucks, wins.
She is a mother, a painter, and a frustrated jock who says she can't keep up with her family. She is exhausted and inexhaustible. "I think it shows, but I can't stop."
Only she thinks she looks her age — 59. "Most neuropathologists look and sound like they've spent time in formaldehyde," says David Hovda, director of the UCLA Brain Injury Research Center. "Ann, well … "
"She's a brilliant scientist who happens to be a little blonde bombshell," says Eleanor Perfetto, widow of former offensive lineman Ralph Wenzel, whose brain tissue is currently being studied in McKee's lab. Like McKee, Perfetto, a pharmacist who has a Ph.D. in public health and a senior position at Pfizer, knows the challenges of being a woman in a male-dominated world. "That's why people look at her and think, This is a woman who cuts up brains? There's such a dichotomy. Her work is something a lot of people would not want to do, and certainly not a lot of women. She's so unexpected."
"I'm a Cheesehead," McKee says.
This explains the framed 1968 Green Bay Packers yearbook and the January 22, 1969, cover of Sports Illustrated with Jerry Kramer cradling Vince Lombardi in his arms. Her pooches at home wear Green Bay Packers dog tags. Within reach of her desk, she has a roster of empty-headed bobbleheads — Brett Favre in green-and-gold, in white-and-green, in purple-and-white; and Aaron Rodgers, Favre's estimable successor in the huddle and in her affections. And a hero of another kind of artistry — a ringer in street clothes named Vincent van Gogh.
Every football Sunday, she parks herself in front of the TV in her authentic Packers foam Cheesehead ($17.95 at packersproshop.com) and Rodgers's no. 12 jersey and prays that none of the men on the field end up on a dissection table. To date, she has found ravages of CTE, the neurodegenerative brain disease that has become her life's work, in over 70 athletes, nearly 80 percent of those she has examined. Among them: 18 of the 19 NFL players she has autopsied; three NHL enforcers; and a boy just 17 years old. McKee, who received $1 million in funding from the VA as well as a home for her lab, has also documented evidence of CTE in combat veterans exposed to roadside bombs.1
"The coolest thing about Ann is she spends all day doing autopsies on NFL players and can't wait for the weekend to put on her Packer sweatshirt and climb into bed with a big bag of popcorn and a beer," says Gay Culverhouse, former president of the Tampa Bay Buccaneers, who now advocates on behalf of former players.
"Well, I don't usually do it in my bed," McKee says.
The Packers' loss to the Giants in the playoffs was a blow, but also an opportunity to work. By Super Bowl Sunday, she had recovered sufficient equilibrium to host a family party. She wore her Cheesehead — and even volunteered to send me a photograph. "I love it — I love football," she says, her face falling like the pocket collapsing around her favorite quarterback. "I'd like to put everything I know about it in another room when I'm watching it. But it's hard to do it through the whole game. I have enormous admiration for the physical athleticism and ability. It's strategic but requires skill that most people don't have. I get extremely caught up in it. At the end of the game I think, How could I watch this?"
The day America gave itself to Super Bowl XLVI feels as long ago as the Roman Empire. Since then?
- March 2: NFL commissioner Roger Goodell announces the findings of an investigation into bounty hunting by the New Orleans Saints, a system — football's favorite word — organized by defensive coordinator Gregg Williams.
- March 21: Goodell suspends Williams as well as Saints general manager Mickey Loomis and head coach Sean Payton.
- April 4: A tape recording of Williams's pregame exhortation is released: "Kill the head, the body will die." (Those pregame, pep talk fighting words sicken Perfetto. "I've seen what happens when the brain is killed," she told me a month before her husband's death. "It is a long, agonizing journey for that body to die.")
- April 19: Ray Easterling, former Falcons safety, commits suicide. He and his wife were lead plaintiffs in the first class action suit filed against the NFL, in August 2011, seeking damages for seven former players. A year later, there are approximately 113 suits pending, involving more than 3,000 players, which have been consolidated into a master complaint in federal district court in Philadelphia. This class action suit charges the NFL and official helmet maker Riddell with negligence and hiding information linking football-related head trauma to permanent brain injuries.2
- April 30: Headstrong, an Off-Broadway play about a former NFL player living with post-concussion syndrome, premieres.
- May 2: Goodell suspends four Saints players, including Jonathan Vilma and Scott Fujita, a member of the NFL Players Association executive committee who has advocated for independent neurologists to be on the sidelines. That same day, Junior Seau, a future Hall of Famer who did not have a diagnosed history of concussions, was found dead with a self-inflicted gunshot wound to the chest — the same awful methodology Dave Duerson chose when he killed himself, leaving a suicide note asking that his brain be left in care of Ann McKee and her team. The findings of CTE in Duerson's brain were released on May 2, 2011.
- June 13: Pop Warner football, which registered more than 285,000 children ages 5-15 to play in 2011, bans head-to-head hits and limits contact in practice to 40 minutes a day.
That night, Terry Bradshaw, the former Steelers quarterback who now receives treatment for short-term memory loss at the Amen Clinic in Newport Beach, California, told Jay Leno: "In the next decade, we will not see football as it is."
It is a measure of the sea change in public perception that Junior Seau was immediately popularly diagnosed with CTE, despite the existence of personal problems that might have played a role in the suicide. On July 12, his family announced that part of his brain tissue had been donated to the National Institutes of Health's National Institute of Neurological Disorders and Stroke for study. Two weeks later, Goodell announced the creation of NFL Total Wellness, a new program of mental health benefits, including Life Line, a free telephone service staffed by mental health professionals and suicide prevention experts. The next day the medical examiner in Richmond, Virginia, confirmed a diagnosis of CTE in Easterling's brain.
The potential cost of employment in McKee's favorite sport is never far from her mind. She reaches for Green Bay Brett and flicks his molded-plastic noggin with her finger. The oversize head bobbles and wags, lurching back and forth on its spring like a kid trying out a pogo stick. Only the smirk on his prefab mug remains fixed.
"Get the irony?" she says.
Over the last four years, McKee has become the most visible member of a cohort of research scientists and family members — wives, mothers, daughters, and sisters of the dead, dying, and demented — who have forced the issue of chronic brain trauma into the forefront of American consciousness. The process has engendered enormous publicity as well as criticism and jealousy in the scientific community, which is every bit as competitive as the NFL. Her work has brought "a great deal of acclaim, exposure, and recognition," says neurosurgeon Robert Cantu, clinical professor of neurosurgery at Boston University and co-director of CSTE. "But at the same time it's brought a great deal of pressure. Not everybody greets her findings with the same degree of enthusiasm."
War-painted denizens of the upper deck may view her as The Woman Trying To Destroy Football. In fact, she is The Woman Trying To Save Football From Itself. The process has engendered a particular intimacy with those who entrust their loved ones to her posthumous care. Virginia Grimsley, whose husband, John, was the first NFL player diagnosed by McKee, says, "He's in good hands with her. They're all in good hands with her.
"If Joe Six-Pack was as educated as the wives that have gone through this and as Dr. McKee, Joe Six-Pack would sit down, shut up, and continue to drink his six-pack," Grimsley says. "She's not trying to destroy football."
McKee says: "I'm just trying to tell football what I see."
What she sees through her microscope is mediated by a painterly sensibility that suffuses how she talks about her work, how she approaches it, and how she presents it. She was an art major freshman year at the University of Wisconsin. She gave it up in favor of making a living, but she never quit making art. "I think you have to be creative to make a difference in science," she says. "So being artistic, it's not always going with what is accepted. I'm not your run-of-the-mill scientist."
It took an artist to see beyond Joe Theismann's splintered tibia, Johnny U's gnarled fingers, and Bo Jackson's necrotic hip to the head-banging obvious and to grasp the importance of aesthetics in changing public opinion. "Actually, I do think that makes a big difference," she says. "I think that laying out something in a visually pleasing way is very important. I look at Mad Men and how you advertise to get your point across. In order to swing public perception and gain acceptance for your work, you have to be your own advertising firm."
She photographs every brain before autopsy and memorializes slivers of tissue in irrefutable portraits of disease that line the hallways of her lab. Exhibit A: a montage she created from sections of 27 damaged brains, white matter arranged like so many Marilyn Monroes by Andy Warhol. "This is Eric Scoggins," she says. "This is Wally Hilgenberg. This is Mike Borich, a college player. We got it from the coroner, so it's not a complete section. This is John Grimsley. This is Dave Duerson. Up here we have Derek Boogaard, the hockey player."
Some painters revisit a single image again and again — a billowing sail or perhaps a lily pond — finding the particular in the generic. Tau, a protein in brain cells that turns rogue with repeated trauma, is McKee's subject; the brain is her canvas. "If you look at the paintings of Van Gogh, he saw things other people didn't see," Hovda says. "Good neuropathologists see things through a microscope that you and I don't see clearly, and I have spent a lot of time looking through a microscope. It's because they have an artistic appreciation for what they are seeing and the ability to recognize it as pathology. She has demonstrated pathology in a way that is beautiful and irrefutable."
To gaze upon McKee's montage is to see the unseen. Daniel Perl, professor of pathology/neuropathology at the Uniformed Services University in Bethesda, Maryland, who has known and worked with McKee for two decades, says: "I think she has completely changed the way we see the experience of playing football."
Can I see a brain?" I ask.
"Sure, we can go to the morgue," she says.
She leads the way down the hall to an unprepossessing room in an unprepossessing brick building on the campus of the Edith Nourse Rogers Memorial Veterans Hospital. Currently, there are 125 brains registered to the Brain Bank, among them 21 veterans who experienced mild traumatic brain injury. Chris Nowinski, co-director of CSTE and founder of the Sports Legacy Institute, a nonprofit organization dedicated to concussion awareness, secures the donations. Five hundred athletes — including him — have promised their brains to McKee.
They arrive in buckets packed in Styrofoam boxes, inside plastic bags on wet ice. Sometimes, after hours, deliveries are made to her home. Once, inadvertently, a box was left with a neighbor. "I can only imagine what they were thinking," she told Mark Kram of the Philadelphia Daily News in 2009. It hasn't happened since.
The contents are precious, so on-time deliveries are essential. "Our greatest fear is that something will get lost," she says. "We have to go from hand-to-hand-to-hand."
At the lab, the brain is weighed, photographed, and preserved in fixative, a Formalin derivative that firms the tissue and makes it easier to cut. Half will be frozen at 80 degrees below zero Celsius for future investigators; the other half becomes McKee's raw material.
McKee regards each as a charge, a challenge, a privilege, a person. "It's actually the person of the body," she says. "If you don't have a brain, you have no identity."
She sees beauty in the infinite handiwork of the human brain and the complexity of its structure. "I do love the way the brain looks. I love the way it's shaped. When I see a brain that's been damaged, it hits you like — "
"You see tearing of certain structures. You see holes where they shouldn't be. You see shrinkage."
She has seen brains that have defied aging and those that have aged prematurely; brains that have sustained damage from a concussive rocket blast 150 feet away and brains damaged from one too many head butts at the line of scrimmage. She has seen so many brains she has lost count. "Somewhere in the thousands," she says. "One hundred and fifty a year for 25 years — what's that?"
In the morgue there is a single autopsy table, and a drawer labeled FEET FIRST, HEAD BY DOOR. Her colleague Dr. Victor Alvarez opens the drawer, revealing the remains of an unidentified donor swaddled in a crisp white hospital sheet, a bundle as small as an Egyptian mummy. "Just like on TV," he says.
At McKee's behest, Alvarez retrieves the atrophied brain of an elderly veteran from a white bucket. Fixative had rendered it the color of a peeled potato too long exposed to the air. The weight was scribbled in Magic Marker — 1,017 grams.
"Should be 1,400," McKee says — the size of a small chicken. "The NFL guys should be 1,600. Some of them weigh half that much."
Alvarez placed the brain on a black cutting board atop the stainless steel table and took up his scalpel. He paused, almost imperceptibly, before making the practiced and decisive cut.
It felt like a sacred pause.
"That moment of awe lasts a long time, because you not only open the box but then you investigate, take photographs," McKee says. "There's a somberness that sometimes comes over the room because you're now starting to become involved."
There is excitement too. She doesn't want anyone to get the wrong idea of what she means by this. It is the exhilaration bred from intellectual rigor, the thrill of scientific discovery and the tantalizing prospect of finding a way to diagnose the disease in the living and intervene in the degenerative process before too much damage is done. The work is compelling and consuming. One morning, two new donations were delivered to the lab at the same hour a widow arrived to see where her husband had been diagnosed. McKee asked: "Do you mind if I just ?" The visitor understood: She just couldn't wait to take a look.
By definition, pathology begins with the denouement. "Now you're at the end, and then you're going to slowly unravel the mystery, the puzzle," McKee says. "You start with what the brain looked like at death, get an idea of how impaired it was, and then over the next few months you're going to unravel the rest of the story."
She may know if the donor on her table played football or hockey or launched one too many headers on goal. Scientific bias precludes any further familiarity. Googling will have to come later. "I have to know the name," she says. "A number of times it's come up they want me to just use numbers, and I can't do that. It's got to have a name because it is a person, a life."
She was born into a football family in a football town some 30 miles from Lambeau Field. As a young girl she was known as AC — as in the spark plug — because she was the fastest kid in school.
Growing up she loved Barbie as much as she did Bart Starr. Of course. "She got Ken and all those wigs," McKee says.
She was a cheerleader in high school — "The only sport they allowed me to do." Her brothers played college football — as did her father, whose 1930s team picture from Grinnell College hangs in the conference room where we met. "We would spend nearly the whole summer at Post Lake," she says. "Our best friend was the high school coach, and so Mr. Dillon would have us run the tires every morning and we did football practice. That is what we'd do all summer. My brothers would let me play."
McKee on McKee: "I had promise."
She was the youngest of five children, seven years younger than the next-oldest sibling, Chuck, a star high school and college quarterback. "I just admired him like crazy," she says. "I went to every game of his. One time when I was 8 I put a sign in the yard because people would go past our house to get to the stadium: 'Chuck McKee lives here.'"
The NFL was interested, but he wasn't. "He didn't think it was so good for him, actually," she says. "He didn't say it was about his brain, but I think he was looking at his longevity. He went to medical school instead. He's a huge reason why I'm in this business."
Last on the familial depth chart — "shorter, slower, dumber — last to the table, the last in everything," she learned to "fight and scratch for position." Good training for future tussles with the NFL. A twice-divorced mother of three, she presides over an almost empty nest — her 26-year-old daughter is a med student and a newlywed; her 22-year-old son played soccer, not football. He was a great goalie, his mom says, and would have been a great wide receiver. "I would have loved him to play, because it's what you do in my family. His dad didn't want him to play. And I thought my husband was the biggest wimp because of that. Turns out now it might have helped him."
Her 16-year-old daughter lives at home in Massachusetts. "I'm still dealing with driving carpool," Mckee says, rolling her eyes. "I've been a mother for a l-o-o-o-n-g time."
The no-nonsense pantsuits and plain button-down shirts she favors in public appearances may be appropriate to her very particular workplace, but do not succeed in lowering her profile. Hip red reading glasses that magnify piercing blue eyes are accompanied by an unexpectedly girlish giggle and a mordant sense of humor. She has stared down congressmen and NFL officials with those baby blues. ("She's not exactly Jack Klugman," says Robert Stern, a co-director of CSTE.)
Initially McKee was greeted by the league as enthusiastically as Vikings fans at Lambeau Field. She first met with what was then called the "Mild Traumatic Brain Injury Committee" at NFL headquarters in New York on May 19, 2009. She remembers sitting at an "enormous boardroom table with a bunch of non-smiling men in suits. The atmosphere was cool and noticeably testosterone-filled," she says. "There were a total of two females in the room.
"The reception was one of complete dismissal. The men representing the NFL had made up their minds that anything I had to say was not accurate or not applicable. After I spoke, there was continued denial that the findings had any merit, and they proceeded to let me know that."
"If she sat in the corner and I showed the pictures, the response would have been the same," says Dan Perl, who also addressed the meeting. But over the years, McKee's heightened profile and accumulated results have engendered some not-so-subtle sexism. "Being marginalized by the NFL and a lot of our colleagues — that has a lot to do with being a woman," says Perl.
The October 28, 2009, hearings before the House Judiciary Committee represented another Rubicon. Before swearing an oath, she had to decide, "How much did I believe it?" The demented condition of a childhood hero — the Packers' splendid safety Willie Wood — was deeply affecting, as was her testimony and that of Culverhouse, and Perfetto, all of which left Congressman Lamar Smith fuming and Congressman Ted Poe grumping about "the end of football as we know it." Why, if Congress gets involved, Poe groused, "we would all be playing touch football out there."
"I love the scowl she gave the congressmen," Virginia Grimsley says. "I'd like to give them a scowl myself."
Within a month the NFL had accepted the resignations of the co-chairmen of its discredited brain injury committee and configured a new one: the Head, Neck and Spine Committee. Cantu serves as a senior adviser, as well as medical director of the National Center for Catastrophic Sport Injury Research. In April 2010 CSTE received $1 million in unrestricted funds from the NFL, part of which has funded McKee's research whether it's something the NFL agrees with or not.3
But giving voice to the dead on 60 Minutes, in the pages of the New York Times, and before Congress (four of 25 pages on her CV are devoted to media appearances) has also made her a target. Richard Ellenbogen, co-chairman of the NFL's Head, Neck and Spine Committee and chairman of the Department of Neurological Surgery at the University of Washington School of Medicine, says she needs to publish more in peer-reviewed journals and conduct studies with controls comparing incidence in collision sports with other athletes, such as rowers and female basketball players. He also says she has crossed the divide from hard science into advocacy. "She's possessed," says Ellenbogen. "She is no longer impartial."
This is a charge Cantu adamantly rejects: "She is a scientist first, not an activist first."
McKee sighs. "You get enemies in this business." She must tread a not-so-fine line between SLI's advocacy mission and the publishing protocols of medical research. "This was discussed from the day we started working together," Nowinski says. "She recognized she would be criticized in academic circles for talking about [some of] the work before academic publication. A lot of the blame — pushing for some of the information to get out comes from me."
Hovda, whose research into the neurobiology of concussions demonstrated the vulnerability of the brain to second insults, says McKee's science is rigorous, significant, and does not overinterpret the available data, which is inherently limited by the facts of neuropathology — you only get to diagnose people who are already dead.
The bull's-eye on her back is likely to remain there as long as postmortem exam remains the only way to diagnose CTE. Progress toward identifying the disease in the living has been rapid — compared to the agonizingly slow pace of Alzheimer's disease research. Blood tests for tau, diffusion tensor imaging, functional MRI, and biomarkers that will allow doctors to image the disease are all in development. Already, Hovda says, researchers at UCLA can image tau and beta-amyloid deposits in laboratory animals, and may be able to do so in humans within the year. "I'd love to put her out of this business," he says. "And I bet Ann would love me to put her out of business."
McKee says: "I'll keep this up as long as it takes."
Longevity runs in her family.