It’s good money

An avid reader of my blog, I have finally been able to convince my aunty to do a GUEST post. A neurologist with over 4 decades of experience both in US and India, Dr. Bindu writes here about the sport of boxing and its life-threatening consequences.

Driving one weekend in Louisville, Kentucky some years ago, I noticed that a major street was named Mohammed Ali Boulevard. “So this is where the great boxer grew up?” I thought. What a childhood it must have been, growing up in a state where the Presidents of rival sides in the US Civil War were born. Kentucky constantly changed allegiance during that bloody conflict. Louisville is on the banks of the Ohio, the river flowing west to join the Mississippi. It forms a boundary between the states of Indiana and Kentucky, between Midwestern and Southern accents. On the river bed lies his Olympic gold medal, flung into the river by the young rebel. Here Mohammed Ali grew up – a heroic arrogant figure of my youth, boxing champion, “I’m the greatest”, Cassius Clay converting to Muhammad Ali under Malcolm X’s influence. The man who refused to fight with the US Army in Vietnam saying and rightly too “No Viet Cong ever called me nigger”. The Champion, strong, muscular, proud, as he trod the earth like a colossus…

The fights won him fame, money and trophies galore. Underneath it all, a relentless and sinister process was at work. Call it “Punch Drunk Syndrome” or “Boxer’s or Pugilist’s Encephalopathy” the nerve cells in Muhammad Ali’s brain, damaged and scarred by repeated head injury began to slow him down. Gradually his walk became stiff, his voice low and slurred. In this fight he could not win – modern medicine could help ease some of his discomfort – it could not cure him. Seeing him on TV these days my shock is great. The words of Pete Seeger’s song echoes in my mind “Who killed Davey Moore? How come he died and what’s the reason for?”

Some years ago the American Medical Association took a strong stand against boxing – demanding that the sport be banned. Needless to say this has not happened. Boxing is not the only sport where the occurrences of what medical terminology describes as repeated “minor head trauma” ultimately results in the “Punch Drunk Syndrome”. Stunt jockeys are at risk too. Is Princess Anne heading that way? Increasingly American football (rugby) players have been found to suffer thus, the long-term consequence of repeated head injury.

When working for a Group Practice in Houston, Texas, I was ready to advise Andrew James Williams* age 34, height 6 feet 4 inches, weight 260 lbs., when he came to see me for headaches. I am a neurologist, then part of a Health Maintenance Organization (HMO). Mr. Williams had been referred to me because the Houston Independent School District, where he worked, had signed a contract with the HMO that employed me.

Andrew Williams trained boxers. He had won a few local championships. He loved boxing and could not imagine a life without it. I talked to him of Muhammad Ali and how the Punch Drunk Syndrome might claim him too in another decade. He listened carefully. He then asked me to call his friend Charles Robinson* into the room. Charles was waiting in the Lobby. 19 years old, Charles was one of Andrew’s students. Andrew wanted me to repeat all that I had said about boxing and its dangers to Charles since he had just started training with him. Charles had been boxing since he was 13. When I finished my spiel on Boxer’s Encephalopathy, he looked at me clearly, and said in calm, steady tone, “See Doc, I can’t live without boxing. It’s my life. Something’s gonna get me – may as well be boxing.” I did not know what to say. Then Andrew Williams, a faraway look on his face said softly “I wouldn’t do it Doc, but it’s good money”.

He sighed, stood up, collected his papers together and smiled “Can I give you a hug doc? You took so much time explaining all this to Charles and me.” I nodded; he hugged me and was gone. I thought of him all day – its good money – yes it is – often the only income for a poor young kid, more so a young black kid. “It’s good money” isn’t that why I was working in that Texas town listening to all kinds of aches and pains for which after spending several thousand dollars no cause could be found? My clinical judgement was never sufficient, unnecessary tests were needed to “reassure” the patients. Refusing to do a test frequently resulted in a complaint to a superior. They followed the maxim: the squeaky axle gets the grease, and would okay the test. So more often than not, I acceded to the patient’s request. “It’s good money” is that reason enough for so many of the harmful or useless things we do?

* Names changed.