Leo Ezerins, a former Tiger-Cat, stands in Tim Hortons Field in Hamilton, Ontario

Feature

Inside the Controversial Concussion Lab That Could Save Football

Why Toronto researchers are questioning the link between the sport and long-term brain damage

Photography by Jalani Morgan

Five days before he died, Rod Woodward sat in a restricted mental health pavilion at a hospital in White Rock, British Columbia. He was happy as he dined on cake and admired the clusters of balloons that dotted the room. It was September 22, 2016, and after his wife and nurses sang “Happy Birthday” to him, he posed for a photo in the uniform that had changed his life.

Woodward had once been a 200-pound football player who, on three different occasions, drank champagne out of the bell of the Grey Cup—first as a ballboy for the BC Lions, then twice as an all-star defensive back for the Ottawa Rough Riders. His career left him scarred and battered, with a shoulder so heavily reconstructed that doctors used it as a case study on rebuilding a joint. He’d retired at thirty-four with a basement full of trophies and a bank of memories from the field. Even near the end of his life, the game was foremost in his mind. He’d recount to patients and staff how, on a distant birthday, he’d once caught three interceptions at Lansdowne Park in a victory over the Edmonton Eskimos. Then, thirty seconds later, he’d repeat the story again.

Almost four decades had passed since Woodward left the game for good. He’d pursued a career as a coach before becoming a financial advisor. He’d been a success until he racked up gambling debts and, in his mid-fifties, stole $185,000 from two elderly clients. At sixty-five, he was sentenced to jail, though his family was never sure if he understood his crime. All they knew was that he’d grown paranoid with age. He believed the government was tracking his movements. He’d close the drapes, refuse to speak about certain topics on the phone, and wonder if the television was watching him.

Diagnosed with frontotemporal dementia in 2012, Woodward often forgot to eat. His athletic build diminished until, eventually, the Grey Cup ring he’d won on a brisk day in 1973 slipped off his finger and vanished. His former teammates had mailed him a replica of the jersey he’d worn in that game. Now, on his last birthday, he sat in that jersey, his old number twenty-six hanging from drooping shoulders.

Woodward finished his cake, then got to his feet and started to dance. At the end of the party, his wife, Kay, kissed him goodbye, then left him to rest.

The next day, he fell near the very place he’d danced. Because his brain was unable to send out signals warning him to brace himself, he smashed his shoulder on the ground, breaking it, and took one final hit to the head. Four days later, he was dead.

Among the condolences Kay received was an email from Leo Ezerins, a former Hamilton Tiger-Cat and the founder of the Canadian Football League Alumni Association. He wrote to say he was sorry to hear of Woodward’s passing and asked if the family would be willing to donate his brain to a team of doctors in Toronto who were studying the effects of concussions on CFL players.

The request left Woodward’s widow feeling conflicted. She wanted to learn the full extent of the damage inside her husband’s head, but was unsure whether to trust Ezerins and the Toronto doctors. She’d heard their research was being used by the CFL to deny any connection between concussions sustained on Canadian gridirons and chronic traumatic encephalopathy (CTE), a degenerative brain disease believed to be shortening the lifespans of players. To Kay, it seemed clear that her husband’s struggles were the result of the twenty-two years he’d spent colliding into other players. She’d already decided to sue the CFL for having encouraged and facilitated his suffering. Her lawyer placed a call to a competing American lab that runs one of the biggest brain banks in the world, and whose researchers have been instrumental in linking repeated head injuries in contact sports to CTE.

And so the most coveted possession Woodward had left was removed from his skull, lowered into a bucket of formaldehyde, and prepped for the long journey to a Boston refrigerator. It would sit in that refrigerator for months, part of a growing backlog of brains waiting to be analyzed.

It’s difficult to remember how football was viewed before a series of post-mortem discoveries linked the sport to neurological rot buried deep inside the skulls of deceased players. But despite fifteen years’ worth of headline-making reports, there remains controversy over what the science has actually proven.

Much of that science has come out of Boston University’s CTE Center, where neuropathologist Ann McKee and a team of seventeen researchers have spent the last decade slicing up the brains of athletes, injecting the shavings with dye, and placing them under a high-resolution microscope. While most of the more than 400 brains the Boston researchers have peered into come from football players, the bank’s specimens are also drawn from other sports: hockey, soccer, boxing, wrestling, rugby, and even baseball. The vast majority of those brains have revealed signs of irreparable damage that McKee’s team blames on concussions.

When you sustain a blow to the head, your brain—grey gelatinous matter suspended in fluid—jostles against the walls of the skull. Depending on the location of the damage, a concussion can lead to nausea. In some cases, the brain loses the ability to send signals to other parts of itself, triggering a physical collapse or a momentary inability to form sentences. Hit your head hard enough, and you’ll lose consciousness. Post-concussion syndrome can last months, even years, leaving victims sensitive to light, noise, and motion. A brain that hasn’t healed from a concussion is prone to second-impact syndrome, a more catastrophic injury that can be fatal.

The Boston researchers say that even sub-concussive blows—repeated hits that aren’t diagnosed as concussions—can damage neurons, causing a protein called tau to cluster and clot inside cells, slowly killing them. These tau deposits assume misfolded shapes called neurofibrillary tangles; as they spread, the brain deteriorates and loses mass. A similar process occurs in other neurodegenerative diseases, such as Alzheimer’s, but in the case of CTE, the tangles are found wrapped around blood vessels. While the wreckage this brings about is often concealed within the brain’s deep folds, its symptoms eventually become visible: mood swings, cognitive impairment, impulsive behaviour, depression, memory loss, addiction, and suicidal thoughts.

A group of Toronto researchers, however, has started to push back on the narrative coming out of Boston. Led by Charles Tator, a highly decorated eighty-one-year-old neurosurgeon, the Toronto lab, which was founded in 2010, has become the world’s second-largest devoted to concussion research. Compared to the Boston researchers, Tator’s team has found fewer incidents of CTE in the brains it has examined. In fact, says Tator, “We’ve seen examples of people who’ve had multiple concussions but who don’t have any evidence of the disease. Like, none.” While research suggests that concussions can cause CTE, why, they wonder, aren’t all players affected equally? What’s the threshold for how many concussions you have to sustain or how hard you have to be hit to develop CTE? Is it possible that certain players are prone to the disease for other reasons? Are there genetic factors? Integral to the Toronto team’s research: the brains of CFL players.

The CFL reported that thirty-two concussions occurred during the regular season of 2016—an average of 3.6 per team, representing a drop of 29 percent from the previous season. Yet that statistic doesn’t reflect the countless sub-concussive blows that may occur on any play and that go undocumented. For its part, the CFL continues to assert that there is “no conclusive evidence” linking concussions to CTE, a position that appears to find some backing in the science highlighted by Tator’s team. The CFL’s current stance is similar to one the National Football League abandoned in March 2016, two years after agreeing to pay an estimated $1 billion in damages to more than 4,500 ex-players.

Despite the reluctance of both leagues to admit a direct relationship between CTE and the game, the concussion crisis has already altered the way football is played on both sides of the border: rule changes, fines, and penalties related to reckless play have been implemented. But many say the changes are inadequate. Helmets equipped with telemetry systems designed to monitor impacts to the head have been available for years, but they’re not mandated for use in the CFL. Instead, the CFL has introduced an “injury spotter,” an individual who monitors impacts via video from the CFL Command Centre, on the third floor of league headquarters on Wellington Street East in downtown Toronto. Before they are allowed to return to the game, players suspected to have suffered a concussion are examined on the sidelines with the use of an app that evaluates the fine movements of the eyes.

In the meantime, the CFL is facing two related concussion lawsuits. The first, filed in Vancouver in 2014 by Arland Bruce, a former all-star, is expected to set a precedent that will dictate how the court treats the second case, a class-action lawsuit that was filed in 2015 in the Ontario Superior Court of Justice. The class action involves Woodward and more than 200 other alumni, some of whom have experienced suicidal thoughts as a result of what they believe is going on inside their heads. Alleging that the CFL has tried to create an impression that concussions in the game don’t cause long-term brain damage, these players are seeking $200 million in damages—estimated to be the league’s entire revenue in 2016.

The lawsuit, some believe, could ultimately finish off the CFL, historically one of the more precariously financed leagues in professional sport.

On a rainy Friday in early March 2017, Arland Bruce, a thirty-nine-year-old Kansas-born former wide receiver, sat in a Vancouver courtroom. With tattoos peeking out of the sleeves of his black suit, he kept his eyes fixed on the panel of judges while his lawyer argued that it was the court’s duty to hear the case. But Bruce’s counsel was getting nowhere.

For three years, the CFL and its battery of high-priced attorneys have fought Bruce’s litigation, arguing that the courts are the wrong place to deal with the case of an otherwise healthy looking two-time Grey Cup winner who alleges he has CTE—a legal claim, the first of its kind against the CFL, that can’t be proven so long as his brain remains inside his head. A BC judge ruled in the CFL’s favour back in 2016. But Bruce appealed, and now he was back in the courtroom for a second attempt to push his case to a trial.

A ten-year CFL vet, Bruce had been a marquee player who’d explode off the snap, dart across the line of scrimmage, and seek out open ground on a crowded field. It was after one such snap on a September night in 2012 at Regina’s Mosaic Stadium that Bruce took off into the Saskatchewan zone looking for a pass, only to collide with a Roughrider. Bruce somersaulted into the air and then came down hard, his head striking the turf. For several minutes, he lay unconscious. In his affidavit, he says that he has since been terrified to go to sleep. After that hit, he competed in just one more game for the Lions. He was traded to Montreal, but he was no longer the player he’d once been.

Released from his contract, Bruce soon found himself unemployable and sleeping in a truck parked underground at the Fairmont Hotel Vancouver. As a star of the game, he’d earned more than $1.5 million over a career that saw a top salary of $190,000. But he’d saved hardly any of it. One day, he walked, unannounced, into the office of Robyn Wishart, a Vancouver-based brain and spinal lawyer who’d made a name for herself representing Gabrielle Carteris, one of the stars of the original Beverly Hills, 90210, in an on-set injury case. Bruce was paranoid, delusional, and dealing with escalating headaches. He told Wishart that the pain in his head made him feel as though he’d just been in a car accident. He wondered if his years in the game had left him with CTE.

“He was in really bad shape,” recalls Wishart, who agreed to represent him on a contingency fee basis. A month into the 2014 CFL season, she launched a lawsuit against the league on Bruce’s behalf. In it, Wishart contends that the league misrepresented the dangers of concussions throughout Bruce’s career and failed to provide him with adequate care—especially after the hit in Saskatchewan that left him with signs of post-concussion syndrome: fogginess, memory loss, anxiety, personality changes, and a sensitivity to light and sound.

But the league’s handling of Bruce’s post-concussion syndrome was just one part of Wishart’s initial case. She also dragged Charles Tator into the lawsuit, naming him as a defendant. Arguably the most famous Canadian neurosurgeon alive, Tator is a professor at the University of Toronto and an internationally acclaimed concussion expert. But to Wishart, Tator is a leading advocate for the type of science the CFL has relied on to dictate its policies on concussions.

In Bruce’s statement of claim, Wishart alleges that, after having accepted funding from the CFL and teaming up with Leo Ezerins and the alumni association to gain access to the brains of retired players, Tator began “downplaying and obfuscating” the research of independent scientists and neurologists. (Tator denies ever having received funding from the CFL.)

At the heart of her allegations is a controversial academic study of six deceased CFL players that was co-authored by Tator, Ezerins, and four others. The study, published in the May 2013 issue of The Frontiers in Human Neuroscience, found that CTE was present in 50 percent of the brains analyzed. However, the paper was published under the title “Absence of Chronic Traumatic Encephalopathy in Retired Football Players with Multiple Concussions and Neurological Symptomatology.” The authors go on to challenge the established link between concussions and CTE, stating that existing post-mortem research was “limited by biased samples.” In other words, people donated their brains for autopsy because they already had reason to suspect they had CTE.

Wishart recalls how angry that study made her. The title alone, she says, was “horribly misleading.” In the statement of claim, she alleges Ezerins’s author credit was proof that the study, if not the entire project, had been tainted by a conflict of interest.

Also in the statement of claim, Wishart draws attention to comments from Ezerins that, she alleges, show he put the league’s survival ahead of player safety. He once told a reporter that the Boston CTE researchers were on a “feed bag” and suggested that the long-term impact of concussions might be “psychosomatic.” Wishart further alleges that Ezerins tried to shut down a cognitive test being run out of McMaster University on twenty-five retired Tiger-Cats. Ezerins says he didn’t support the McMaster study, because he was led to understand that it wouldn’t be able to effectively determine cognitive decline. But, in the claim, Wishart quotes Ezerins as having made the following statement: “It is a very important issue and we want to make sure it does not reflect poorly on the game of football.”

For nearly three years, Ezerins and Tator stood accused of negligence in the Bruce case because of their work on the “absence of CTE” study. The allegations against both men were never proven, and were ultimately dropped by Wishart. Speaking after the fact, Tator says he found his involvement in the Bruce case utterly perplexing; Ezerins—whose name was attached to the study because he procured the brains that were used—says it kept him up at night. It never made any sense to either of them that they should be prosecuted for publishing work in a peer-reviewed journal.

Bruce’s case, however, soon devolved into a dispute that has nothing to do with football, league negligence, or the competing science about degenerative brain damage. To stave off a trial, the league argued that the court has no jurisdiction to resolve disputes between employers and unionized workers. It presented Bruce’s appeal as a simple case of “health and safety,” meaning it should be handled by arbitrators under the CFL’s collective bargaining agreement. It was a smart play: a judge sided with the CFL in 2016 and then again during the March 2017 appeal, which Wishart lost in a unanimous ruling. But Wishart intends to keep pressing for a trial. “I want to take this all the way to the Supreme Court,” she says.

Tator argues that, by tarnishing the motives of his team, Wishart’s actions are hampering the progress of science. The real villains, he says, are the holdouts who refuse to acknowledge the dangers of aggression and violence in contact sports. But in the eyes of many ex-CFLers, Wishart’s a crusader. “Once Bruce’s case was out there,” she says, “I started hearing from former players spread all over the place.” She became a kind of legal shepherd, herding those players into the class-action lawsuit now targeting the CFL, travelling everywhere from Boston and Los Angeles to Edmonton and Calgary to interview broken-down legends who made small sums of cash in return for risking their minds and bodies in pursuit of a storied chalice.

Wishart believes she’s fighting a long war on behalf of the forsaken and the vulnerable. She describes a frantic call she once received from the mother of a former player who had locked himself in a room. Terrified that her son was planning to end his life, his mother had pulled Wishart’s name off the internet. “She called me screaming,” Wishart says. “That’s when I told her to call out the names of the players on the class-action suit. Let him know he’s not alone.”

The man ultimately came out of the room. “That was just one phone call. I get them often. I get wives. I get children. I don’t get players as often as I get a loved one.” She says clients fall into three categories: those who have lost motor control, those who have lost impulse control, and those who have lost both. “My goal is that no CFL player will kill themselves,” she says.

Football’s ties to Canada are about as old as the country itself. The first game generally recognized as a precursor to North American football was played on Canadian soil in 1861—a full fourteen years before the first organized indoor hockey game in Canada, and eight years before what is often cited as the first football game in the United States.

Even in those early years, the Canadian and American games were played differently—a fact that became apparent in 1874, when a team from McGill University travelled to Cambridge, Massachussetts, to square off against Harvard in a cross-border skirmish that would change the American game forever. It was that encounter that introduced Americans to the idea of “downs”—a set number of plays in which the offensive team carrying the ball has to either overrun the defenders and score or force its way far enough over an invisible line of battle to gain more downs and maintain possession of the ball.

Both the American and Canadian variations were codified in the years that followed. Both initially involved a three-down structure, though the Americans eventually added a fourth. This change ultimately made players more focused on trying to physically carry the ball past the defending line, while Canadians have become more intent on throwing the ball into enemy territory.

Performed on a field of mock battle, American football was initially popular among the sons of Civil War veterans. It’s easy to imagine they enjoyed outflanking opponents, charging the field, and flying their school colours over a vanquished foe. In Canada, the game took shape as a display of grit between the leading schools of Ontario and Quebec. By 1884, the predecessors of the Hamilton Tiger-Cats, Montreal Alouettes, and Toronto Argonauts were all vying for the precursor to the Grey Cup.

Early reports of concussions in the game date back to the late nineteenth century, though the term was used to describe everything from temporary confusion to comas or even deaths on the field. The sport’s risks attracted real scrutiny in Canada and the US after the Washington Post reported that forty-five football players had died from injuries sustained on American gridirons between 1900 and 1905. The mounting violence caused then president Theodore Roosevelt to urge a series of changes to the American game: the forward pass was eventually introduced, as was a new rule that called for play to be stopped when a player fell on the ball. But, for “reasons of tradition,” says Steve Daniel, the CFL’s head statistician and designated historian, those rules weren’t applied north of the border until 1929. Daniel has spent the last decade compiling and analyzing statistics from 5,400 games and more than 100 years of Canadian football. According to Daniel, the only player to die after suffering injuries on a CFL field was an American linebacker named Tom Pate. Pate was a twenty-three-year old University of Nebraska grad who’d gone undrafted by the NFL and signed with the Tiger-Cats in 1975.

Late in the fourth quarter of his twelfth game for Hamilton, Pate sprinted straight into two Calgary blockers while trying to give chase to a Stampeder who was en route to a touchdown. The front page of the next day’s Calgary Herald showed an image of Pate mid-air. One Stampeder had just taken out his knees while another blocked him high. Pate went into convulsions shortly after that photo was snapped, his head having smashed into the turf of McMahon Stadium. He was unconscious when they took him off the field and died three days later. The official cause of death was an aneurysm.

“American football has a lot of these stories, but this is the worst that I can find on a CFL field,” says Daniel. “It just so happens the player was an American.”

Of the more than 5,000 living CFL alumni, 75 percent are Americans who earned a fraction of what they would have made in the NFL. (In 2014, CFL salaries were roughly $80,000 per season.) At last count, more than seventy of those American players have alleged that they’ve suffered debilitating brain damage on Canadian gridirons. Yet a group of CFL alumni and scientists argue that Canadian football may not be the threat it’s often considered to be. It may even offer a solution to a bigger problem: American football.

Ezerins and others have taken the lower rate of CTE discovery in Toronto as a sign that the game might be safer up here. Those who make such an argument point out that CFL fields are twelve yards wider and ten yards longer than those in the US, a circumstance that may limit the force of collisions. Though the CFL resisted the forward pass for years, Canadian football is now more of an aerial game than anything else. The three downs in the Canadian game make the offensive team more inclined to try to throw the ball up the field than to attempt to gain yardage by running the ball across the line of scrimmage, which is where some of the most brutal hits still occur.

But perhaps the most fundamental difference is that in the NFL, opposing linemen are separated by just eleven inches. When play begins, they explode into one another from less than a foot apart. In the CFL, the distance is one yard. As a result, the linemen who serve as immovable objects are generally smaller in the CFL.

“Whether all of this makes Canadian football safer is a legitimate question,” says Tator. “I don’t think we have data that would back up such a claim right now, but ten years from now, we might.”

McKee scoffs at the very idea. “Head trauma is head trauma,” she says. “I find it frustrating that there’s so much discussion about whether this disease exists—the evidence is more than ample. Of course we need to do more research. But the conversation shouldn’t be whether football is associated with it, because it is, but how to prevent it. Our mission is to cure this disease, not to destroy the CFL or any other league.”

What we now call CTE was first identified eighty-nine years ago by a forensic pathologist named Harrison Martland. He analyzed the symptoms displayed by a generation of battered prize fighters—speech impairments, slowed movement, confusion, and tremors—and concluded that they’d been brought on by repeated blows to the head. He called the condition “punch-drunk syndrome,” or dementia pugilistica, and estimated that nearly half of all former boxers had it.

It wasn’t until September 28, 2002, that events were set in motion that would lead to the discovery of the syndrome in the brain of a football player. On that Saturday, a Nigerian-born forensic pathologist named Bennet Omalu walked into a Pittsburgh coroner’s office to examine the body of Mike Webster, a dead Pittsburgh Steeler. Webster had been a nearly 270-pound centre lineman in the NFL. Dubbed “the strongest man in football” by CBS, he’d hike the ball, then cross the line of scrimmage with more ferocity than any other player of his generation. It was said he hit like Rocky Marciano, though he used his head instead of his fists.

When his playing years were over, he descended into a sort of madness, sometimes using a stun gun to put himself to sleep. He died of a heart attack at the age of fifty, but those who saw his corpse remarked that the body looked like that of a man twenty years older. Omalu removed Webster’s brain and, over a series of months, waited for it to be sliced into thin sections, which were injected with dye. He then placed these samples under a microscope. What happened next has been the subject of films, documentaries, and more than a decade’s worth of literature, both journalistic and academic. The specialized staining allowed Omalu to tag the tau protein deposits that had accumulated in Webster’s brain, and prove the presence of CTE.

His controversial findings were published in the journal Neurosurgery. Omalu believed that the NFL’s doctors would want to know more in order to adjust the way football was played. Instead, the league’s doctors challenged his findings and called for the article to be retracted (it wasn’t). But the CTE diagnoses kept coming— in several cases, because of suicide. Andre Waters, a retired Philadelphia Eagle who’d shot himself in the head at forty-four. Justin Strzelczyk, another Steeler, who, after an almost forty-mile-long high-speed police chase, drove over a median and rammed his pickup truck into a tanker. His body was thrown eighty yards.

In June 2007, Omalu began working with the Sports Legacy Institute, an organization established by neurologists based in West Virginia and Massachusetts. One of the forces behind the institute’s founding was Chris Nowinski, a then twenty-eight-year-old Harvard grad who’d played college ball but made his name and reputation as a wrestler in the World Wrestling Entertainment (WWE). He’d suffered concussions during his football career, but it was the one he took from a boot to the chin in a wrestling ring that left him with post-concussion syndrome and unable to perform his job. In the middle of some matches, he’d forget the choreography and whether he was supposed to win or lose. He retired after one incident in which he leaped off his bed and slammed headfirst into the wall. He was asleep at the time, but later took it as a sign that something was wrong with his brain.

Nowinski wasn’t a doctor, but he was smart, outgoing, and persuasive. He began to view himself as both a survivor of post-concussion syndrome and a potential victim of CTE—a disease he felt desperately needed to be studied. Before the institute was even set up, he’d already convinced the families of Waters and Strzelczyk to send the players’ brains to Omalu. Nowinski became known as the “Brain Chaser.” He would monitor news for the suicides and deaths of any athlete he suspected had suffered from concussions. Then he’d cold call their families. “I don’t know what made me good at it,” he says.

After almost a year of working together, Nowinski and Omalu had a falling out over differing opinions on the direction of the institute. Omalu left to set up another centre in Davis, California. But Omalu’s work there has been overshadowed by the growing body of discoveries coming out of Ann McKee’s lab in Boston University’s CTE Center, which has become the largest hub in the world for the post-mortem study of contact-sport athletes; Nowinski and his arm’s-length organization, now called the Concussion Legacy Foundation, secure hundreds of brains for McKee. An average of two arrive each week.

During a tour of the brain bank in late March, McKee opened a refrigerator and pointed out the Tupperware containers filled with sliced-up remnants of the men they once defined. She noted that the specimens were all instantly recognizable to her. She didn’t need a nametag to identify them. “I’ve been doing this for a long time,” she said. “I’m constantly hearing that I’m making all this up, that it’s a construct of my imagination. Nobody wants this disease to be true. I wish it weren’t true.”

But McKee’s findings are only one part of the dispute. There are those who have a problem with the fact that so many brains in sport find their way to the same steel autopsy table in Boston. Which is why the University of Toronto got into the concussion business.

Bald, except for some white frizzled hair above his ears, Charles Tator wears a suit and tie under a white lab coat and sits in a small office overlooking the atrium of the Toronto Western Hospital on Bathurst Street. He’s surrounded by stacks of files, an autographed Canadian football, a sculpture of a spine, and numerous scientific and medical trophies collected over a fifty-six-year career as a leader in the study of the human brain. It has been about ten years since he conducted his last surgery, but he remains active in the field as the founder and director of the Canadian Concussion Project. It was Tator who, after reading the early research coming out of Omalu’s and McKee’s post-mortem studies, said, “We need to get into that.”

“Not long ago, concussions were viewed as a waste of time—barely worth studying,” he says. “As a result, they’ve been very neglected both on the clinical and research side. But a mythology has evolved in recent years, which is a whole other problem.” He agrees that concussions are significant injuries that need to be prevented, and has spent years urging the NHL to take head trauma more seriously. But he is uneasy about the narrative that he says originated in Boston and was then fed to the media and, by extension, the players—namely, that if you take enough hits to the head, you’re destined to develop CTE. That’s not what his team has been finding.

Tator chooses his words carefully as he describes the growing rift between his pathologists and the ones in Boston. “There’s room for more than one school of thought on this,” he says. When asked about Wishart’s allegations that he and his lab have collaborated with the CFL to downplay the link between concussions and CTE, he says it’s absurd that anyone would accuse him of manipulating his science to serve the game of football. Tator explains that he relies on Ezerins and the CFL Alumni Association for one thing: brains. He stands behind his academic integrity.

Given the stakes, however, it seems inevitable that the two labs would find themselves at odds. There’s a story, which Nowinski initially hesitates to share, about a détente he tried to broker between his team in Boston and Tator’s team in Toronto. “When Toronto announced that they were starting up, I reached out to Tator and said, ‘Instead of us competing for the same brains, why don’t you collect and study the brains from Canada and we’ll do the same down here?’ But Tator refused.” (Tator doesn’t recall that specific request.)

Woodward wasn’t the first dead Canadian CFL player to have a brain that was coveted by both camps. Back in 2010, when Tator’s group was just getting started, Ezerins began reaching out to alumni while they were still alive. His rationale was simple: “We’re all part of the same fraternity. It’s tragic to see these men go down. I see it more than anybody. The biggest challenge to the science is getting donations. They need brains to study, and I’m the guy who knows where they can find them.”

Although Ezerins has helped bring fifteen brains to Tator’s researchers, he regrets having lost out on the brain of Doug MacIver, a personal friend and former nose tackle who spent nine seasons in the league. MacIver had told Ezerins that he’d been knocked out several times. He’d experienced mood swings in his later years. He eventually succumbed to a heart attack, but he’d become convinced before he died that something was wrong with his head. When Ezerins learned of his friend’s death, he followed up with the family about a discussion he’d had with MacIver about donating his brain. But it had already been committed to Boston. Ezerins says he tried to negotiate its return. Nowinski says that, by that point, the matter was out of his hands.

Still, the Toronto team quickly came into possession of other brains—Jay Roberts’s for one. A former Rough Rider who’d moved north from Iowa to play in 1964, he’d stayed in the town that made him a champion. He died, after suffering from lung cancer, on October 6, 2010, at the age of sixty-seven. His was the first CFL brain to be harvested for study. Next came the brain of Peter Ribbins, a Blue Bomber who’d suffered from amyotrophic lateral sclerosis (ALS) and Parkinson’s, and died in the Cayman Islands at sixty-three. Twelve days later, Tony Proudfoot, a sixty-one-year-old Alouette with the same ailments as Ribbins, passed away in Montreal. Bobby Kuntz—a seventy-nine-year-old Tiger-Cat who’d long suffered from Parkinson’s, died in Waterloo on February 7, 2011.

Their brains found their way to the office of Lili-Naz Hazrati, a member of Tator’s team who works at Toronto’s Hospital for Sick Children. By mid-2011, Hazrati had dissected all four specimens. She found no traces of CTE in the brains of Proudfoot or in Ribbins, but did identify them in those of Roberts and Kuntz. Hazrati says she has found some evidence suggesting that head trauma on CFL gridirons is leading to CTE, but cautions that it’s inconclusive. “We speculate that concussions cause CTE,” she says. “But I’m not 100 percent sure that’s the case. We lack proper controls to make that link.”

She tells the story of a Toronto lawyer in his early forties who suffered from ALS-like symptoms and died in his house four years ago. One of Hazrati’s colleagues called her and asked if she’d look at the lawyer’s brain. She put his tissue under the microscope and saw the obvious patterns of CTE. “I went back and I asked the man’s wife, ‘Did he have any history of concussions? Did he play any sports?’ And his wife said, ‘No, he did not suffer any concussions.’” Hazrati published her findings in the March 2017 issue of the International Journal of Pathology and Clinical Research, claiming to have identified the first case of CTE in a patient with no history of head trauma. Her methodology has been questioned by both McKee and Nowinski, who point out that there’s no real way for her to know whether the patient had suffered head trauma in earlier stages of his life.

But of all the brains Hazrati has examined, one that stands out is Todd Ewen’s. Ewen was a former NHL enforcer who got his name on the Stanley Cup with the Montreal Canadiens in 1993. He died in 2015 from a self-inflicted gunshot wound to the head. “Todd Ewen killed himself because he thought he had CTE. But the brain was clean—no CTE. His wife was completely upset with me. His kids were upset with me.” They wanted Hazrati to explain why he’d committed suicide, but she couldn’t.

Accurate suicide statistics about former CFL and NFL players are hard to come by. But when Edward Riley, a professor at Stanford University and an anesthesiologist, began looking at the data from a 2016 Centers for Disease Control and Prevention study on suicide mortality in retired NFL players, he noticed an alarming spike—twelve suicides in the last decade, more than in the previous sixty years combined. In a letter to World Neurosurgery, he posited that this spike may not be a result of CTE, but of contagion.

Suicides, Riley argues, may be feeding off one another. The loss of adulation that comes at the end of a career can plunge players into a deep and dark depression. And the publicity around CTE may be inadvertently validating suicide as an option for certain depressed players by suggesting a possible link between their emotional state and the disease.

On Saturday, March 4, while his son was at a training camp with the Stampeders, Alondra Johnson hugged his wife, Marguerite, climbed into his Cadillac, and sped off into Los Angeles traffic. The then fifty-one-year-old Hall of Famer had decided to skip out on the interview scheduled for this story. He turned onto the freeway and pressed down on the throttle as he made for Mulholland and the canyon roads that cut through Malibu. He often thought of just ending it on those roads—of veering hard into a wall and letting the laws of physics do the rest. That day, he exited left toward the coast and drove until the impulse faded. It was dark when he returned home.

On Sunday, he apologized. “Yesterday was bad. I didn’t feel up to having this conversation.” He says he has felt ambivalent about the game ever since it cast him aside at the age of thirty-eight. He spent the last dozen years trying not to reflect on past glories or defeats. He pawned off much of his memorabilia, including his Grey Cup rings. And now, he’s suing the league—the most formidable all-star attached to the class-action lawsuit.

Johnson was one of the biggest names in the league during the 1990s and early 2000s. He spent thirteen years with the Calgary Stampeders and competed in six Grey Cup championships. When he retired, he did so with the second-highest number of tackles in CFL history. He was the hardest hitter in the game, the man quarterbacks feared most. He’d clench his teeth, fix his eyes on the man in the pocket, and smash his way through the offensive line with a ferocity few others could match.

But he says he played his entire career with headaches. His brain would start pounding every season at the start of training camp. Still, he outlasted almost every other Stampeder, holding onto his job for thirteen years in a market where players tend to last no more than two and a half seasons. After he was cut from the Stampeders, he managed to eke out another quarter of a season with the Roughriders, who needed a linebacker. Afterwards, with no money, a battery of injuries, and a dwindling sense of purpose, he drifted from couch to couch. He stayed in Canada for five years. When his father died in a car accident in 2009, he packed up what little he had left and headed home to help care for his mother in LA.

He soon got a job in construction and tried to move on with his life. But, gradually, his wife and others close to him started noticing that his behaviour was changing. She’d find him crying while reading about his past; sometimes, he’d disappear for hours on a drive heading nowhere. Since 2010, the couple had been paying increasing attention to the reports of CTE. Then, in May 2012, Junior Seau shot himself in the chest. Seau had been one of the game’s biggest stars, recording 1,846 tackles in a twenty-year NFL career. Johnson recalls shaking when he heard the news. He had been compared to Seau his entire CFL career. Both were California-born linebackers, both had played the game for longer than average, and both were known as the hardest hitters in their respective leagues. (Upon examination, Seau’s brain showed evidence of CTE).

Johnson was still trying to make sense of Seau’s suicide when he suffered a mysterious seizure during a barbecue with friends. Through her own research, Marguerite learned about the doctors in Toronto and Boston, and about Bruce’s case. “I know he has a brain injury,” she said. “I don’t need a diagnosis. I’m married to it.” She and Johnson decided to stay in the US to deal with their medical needs, but she reached out to Wishart.

Soon Johnson had signed on to the class-action suit. Doing so brought him a wave of unwanted attention from reporters, who latched onto his name. Many of them questioned how Johnson could sue the league for his own ailments while supporting his son’s attempt to get a contract north of the border. “It’s hard to explain,” he says. “My son loves the game—when I see him hit somebody, I cheer. It’s in our blood. I fear for him. But at least he knows what he’s getting into. We didn’t know anything.”

He didn’t receive much support from his old CFL friends for his decision to join the lawsuit. “It wasn’t easy to do this,” he says. “I don’t want to look like I’m trying to cash in. Football gave me everything I have. But we’re veterans, and we need looking after. Right now, I have things to live for. But I wake up every day wondering what’s going on inside my head.” In his wallet is a card that declares his last wish: that his brain find its way to Boston.

After she donated her husband’s brain, Kay Woodward would stand in her dining room and stare at his cremated remains, which she kept in an urn surrounded by flowers and photos from his career. Despite all the ways she believed the CFL hurt her husband, she had loved being the wife of a Grey Cup winner. She clung to her memories of watching Pierre Trudeau personally congratulate the members of the 1976 team. She loved thinking of her husband driving with the top down on his MG, cruising to the stadium, then strapping on his helmet and pads and doing what he did best. Each day since his death had been hard. “I know it’s not right,” she says. “But I want them to find it in his brain. I want them to tell me that he had it.”

She’d already told the Boston team about Woodward’s 125 concussions. She could recall at least two incidents when he’d been knocked unconscious. She hadn’t noticed many changes in him, then. He’d always been a neat freak, but in retirement he got obsessive about tidiness. He’d yell over spills and rant about the importance of keeping things clean.

He took that obsessive-compulsive behaviour with him to the Investors Group, where he was known as a diligent worker until he turned fifty, at which point his life went off the rails. He lost his job in 2001 and was eventually charged with fraud and theft. His defence lawyer struggled to get through to him. A reporter covering his sentencing described him as a “thoroughly beaten man, a galaxy away from his glory days.” To his wife and son, he seemed like a lost child while he was in prison. When he got out, he was changed. He’d wander away from home and return, confused, in the back of a police car. That’s when Kay took him to see the doctor, who told them Woodward’s frontal lobe was shrinking as a result of dementia.

Seven months after Woodward’s death, the doctors in Boston called to tell Kay that large portions of her husband’s brain were riddled with neurofibrillary tangles— a hallmark of CTE. “This was among the worst we’ve seen,” explained Thor Stein, the lead neuropathologist on Woodward’s case. Stein estimated that the disease had begun to spread through his brain in the early 1980s.

As Kay listened, she let her tears flow. Her husband’s condition had put her family through years of torment. “He would have been dealing with this for thirty years,” she says. “I know now it was the disease that changed him.”

There’s a statue outside the old Canadian Football Hall of Fame in Hamilton. Cast in stainless steel and aluminum, it depicts two football players at the moment of impact. One holds his arms outstretched, leaping for a catch, while the other sets in for the tackle, his head cocked to the side as he rams his shoulder into the leaping man’s torso. Forged as a lasting depiction of a touchdown pass, it looks eerily similar to the hit that triggered the photographer to snap Tom Pate in mid-air, the moment before he fell backwards. For forty-five years, the two men in that statue have done what no player really can: avoid the inevitable collapse. But now they stand in limbo on top of a cracked pedestal beside a parking lot—relics in need of attention.

To peak and then decline is the tragic arc that unites all athletes. But sports have a lifespan, too. A century ago, boxing and horse racing were the most popular pastimes in North America—a heavyweight title bout or a thoroughbred horse race was the athletic equivalent of a royal coronation. Now they’re just sideshows, richer in lore than in actual appeal.

Football has grown into a sport far bigger than almost any other in North American history. But the game’s significance seems to be declining, especially in Canada. Public apathy can be felt on schoolyard gridirons across the country: the number of high-school teams has dropped since 1977—the same year 69,083 fans set an attendance record as they crammed into Olympic Stadium for a September showdown between the Argos and the Alouettes. In Toronto, fan support has plummeted: last year’s Grey Cup struggled to sell out. Game attendance is dwindling throughout the league, even in the traditionally strong markets of Edmonton and Calgary. South of the border, the NFL still dominates the sports landscape. Yet TV ratings have fallen there, too, as has participation in tackle football by boys aged six to twelve.

Here in Hamilton, Ezerins spends his time liaising with veterans and also promoting the sport among youth. His rationale: if Canadian football is to have any future, it must prove that it is worth saving. Not just to the pathologists or the lawyers studying the case, or to the general public debating whether to tune in, but to the young men deciding whether competing for the Grey Cup is worth the risk.

Standing at the fifty-five-yard line inside Tim Hortons Field, home of the Tiger-Cats, Ezerins peers up past the empty grandstands to the banners that bear the names of his former teammates. He still feels pride when he steps onto this field, despite the physical toll the game took on him—that’s the price he had to pay for living out his dream and earning a Grey Cup ring. “Every day, I watch guys I played with deteriorate before my eyes. You don’t know how tragic it is to see these big men go down. In theory, I should be next.”

For the last six years, he has recruited alumni for an ongoing study aimed at detecting CTE in former players who are still alive. He directs them to Carmela Tartaglia, a Toronto-based neurologist and Tator’s colleague. Tartaglia is one of the first researchers in Canada to begin testing a revolutionary biomarker that can bind to the tau proteins associated with CTE in a living brain. A successful method of tracking the progress of brain damage in real time would help researchers figure out why some athletes get the disease and others don’t. It might also make it possible to distinguish the symptoms of concussions from those of other conditions—chronic pain, depression, or anxiety, for example. A big concern for Tator’s team is that players who suffer from treatable conditions may be forgoing help because they’ve been led to believe they have CTE.

By now, about a hundred participants, most of them between the ages of thirty and eighty-four, have entered Tartaglia’s lab in downtown Toronto. After they slip into hospital gowns, a doctor injects radioactive tracers into their arms. They’re then slid into a PET scanner, where they stay for about an hour while Tartaglia watches their brains on a screen.

Tartaglia has yet to finalize her results. There’s mounting pressure, she says, to find something. She operates under the rule of publish or perish, just like her rival clinicians in Boston, where alumni of the NFL have begun taking part in a similar study. Confirming CTE in vivo is the holy grail of concussion research. But there’s a risk involved, she says, in revealing your findings before you really know what they mean.

Tartaglia believes she sometimes sees the tau proteins that characterize the disease—they surface on her screen as red-dyed clusters in tissue that is otherwise green. Spotting them isn’t always emotionally easy for her, she says, since there’s nothing she can do to help these players. While her goal is to find a way to prevent the disease in the minds of the living, she has to know for certain what it is she’s looking at—and to establish certainty, she needs to get deeper inside their brains. Because the test to confirm CTE can only be done postmortem, the players will have to move on to the next stage of the study. Ultimately, she says, they will have to die.

Brett Popplewell (@b_popps) is co-author of The Escapist. His work also appears in The Best American Sports Writing 2016.

Jalani Morgan is a Toronto-based photographer, visual historian and photo editor who is known for his editorial, documentary and gallery work.

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