I have been asked a cardiologic medical opinion about the death of the pop star Michael Jackson. Above all, we have to judge by the data we have, broadcasted by official sources.
M.J. suffered from drug dependency, understood as the maximum expression of its meaning, since he usually made use and abuse of narco-drugs, major analgesics and hypnotic anesthesia induction drugs.
Many sources mention Demeron, Oxycontin and even Diprivan. While the first two are used for pain therapy, above all in oncology, since they are derived from morphine, Diprivan (Propofol in U.S.A.) is a powerful drug specifically pertaining to anesthesiology, used to induce anesthesia. It acts rapidly, in some minutes, and lasts shortly; it is often used in cardiology to anesthetize the patient during the “electrical cardioversion” (DC-cardioversion).
"Electrical cardioversion (DC-cardioversion): it is a procedure whereby a synchronized electrical current (shock) is delivered through the chest wall to the heart , to restore the heart’s normal rhythm in case of supraventricular arrhythmias, such as atrial flutter or fibrillation. In such circumstances, considered suitable, the patient is conscious and, being the procedure very painful, it is necessary to administer sedation, rapidly and for a short time. In case of serious hyperkinetic arrhythmia without cardiac output (volume of blood conveyed in one minute) or in cardiac arrest, the patient is already unconscious, lacking the minimum cerebral blood flow, and the anesthesia is not needed.
It is not difficult to guess which devastating effects these substances may cause in the body, especially if taken over and over again. It seems that Jacko frequented willingly dentist’s surgeries to be given various anesthetic substances, and that he was injected Diprivan to induce sleep.
From Jacko’s hard and complex sanitary history some important indiscretions come out: that he suffered from a congenital Alpha-1 antitrypsin enzyme deficiency, whose absence causes mucoviscidosis (cystic fibrosis), a serious disease involves the respiratory system with chronic bronchopneumopathies, the pancreas with recurrent pancreatic disturbances, sight problems up to blindness, etc.
If this anomaly was confirmed, it could be a decisive factor in the cause of death. It could also explain why Jacko regularly slept in a oxygen saturated room and why he often wore a mask in public, or even a kind of transparent diving suit in which oxygen was pumped in: it is probable that he protected himself from potential infections, more frequent and with a more serious course in a person suffering from mucoviscidosis.
It is also reported that he had only a frugal meal a day, inadequate in quantity, and this would explain his anorexic and skinny appearance, as well as explaining the serious weakening of his body."
Let’s come to the fact: Jacko is found unconscious in his bed, the body is warm, the pulse is present, on the contrary the spontaneous breathing is lacking. Because of this he is immediately administered CPR (Cardio Pulmonary Resuscitation): about this point there are many controversies: the cardiac massage has been done on his bed, while the standard procedures prescribe to carry it out on a hard surface to efficaciously restore a minimum cardiac output. While the doctor tried to revive him, 911 was called, coming with a reanimating team that went on with CPR procedures for approximately 45-60 minutes, also during Jacko’s transportation to the Medical Centre, where, a little after, the death was officially declared.
Let’s come now to the official data we possess of the first autopsy: the body looked remarkably undernourished, anorexic, nearly skeletal, practically without hair; the stomach contained only some pills, partly digested. Elbows, arms and shoulders were mangled by the numerous injections of analgesics and anesthetics administered three times a day for years. Scars on the face have been noticed, related to the 13 aesthetic surgery operations. Large abrasions on knees and a wound on the back, probably indicating a recent fall. On the chest, in the heart area, 4 injection sites, corresponding to the intracardiac adrenaline injections during the attempt to restore an adequate cardiac activity. Three injections joined the heart, damaging it, one stuck into a rib.
Adrenaline injection: in case of cardiac arrest an intracardiac adrenaline injection is recommended; this drug is a powerful heart and vessels stimulator, able to increase the cardiac rate, the strength of contraction of the cardiac muscle, to increase the peripheral resistance of the blood vessels and to increase or support blood pressure. But it is an extreme procedure and burdened with serious risks: it is made on the patient lying on his back, with a long needle placed perpendicular to the chest, in the IVth intercostal space, 1-2 cm to the left of the sternum. The long needle must penetrate deeply in the chest for some centimeters, to the free wall of the right ventricle that, in its normal position, is placed in front of the left ventricle. The needle must completely pierce into the wall of the cardiac muscle and has to be pushed into the chamber of the right ventricle: this can be recognized by a skilled reanimator cardiologist, because he sucks desaturated blood, that is to say cyanotic, with a syringe fitted with the needle.
Only when the needle position is certain it is possible to inject adrenaline that, entering the bloodstream, is often able to increase and to potentiate the heartbeat, otherwise unperceivable and insufficient. But if the drug is injected into the muscle instead of in the heart chamber full of venous blood, the opposite effect is obtained, because adrenaline is arrhythmogenic in itself and can therefore set off irreversible and deadly arrhythmias, not responding to any therapy."
Some ribs were broken, the probable result of a vigorous external cardiac massage during CPR. This is what the official postmortem describes and it is not sufficient for a certain and definite assessment. Many fundamental data are lacking, such as:
macroscopic examination of the heart: weight, volume, consistency to the touch, areas of hemorrhagic effusion of blood, data about coronary arteries, arterial calcifications, recent thrombus, atheromasic plaques, jarring at the cut (typical of the coronary sclerosis), other possible anomalies from the origin or of the course of the illness. The microscopic examination: the condition of the myofibrils? Edemas? Effusion of blood?
- And the lungs: their appearance, the weight, were they edematous? With effusion of blood or of transudative liquid?
- The liver? Shape, appearance, weight, volume, was it cirrhotic?
These questions are now without answers and could probably be clarified by a second autopsy, the one requested by the family. Let’s come now to the analysis of the data we possess so far: Jacko did not die for a sudden death. In cardiology this term defines a sudden absence of the cardiac function for a real cardiac arrest (asystolia) or for a serious ventricular arrhythmia, such as a ventricular fibrillation, incompatible with life. In these cases the subject loses consciousness in a few seconds and if aid does not come promptly, irreversible cerebral death takes place in a few minutes.
This is not the case, since the doctor who helped him first declared: “…The body was warm …the pulse was present …he did not breathe…” These data allow us to declare that it was not a sudden cardiac arrest. This term has been improperly used by the Medical Centre that declared the death. It is obvious that, in case of death, there is a cardiac arrest, for the Italian law this term cannot be used as cause of death because it is obvious, but in the official certificates and in ISTAT (Istituto Nazionale di Statistica – Statistics National Institute) forms the cause leading to death, therefore to the cardiac arrest, must be declared. But then, what caused Jacko’s comatose state and lack of breath?
An acceptable answer is that it was caused by a protracted respiratory insufficiency up to respiratory arrest, lack of oxygen to the brain and to vital organs, sopor and coma. We do not know how much time passed from the beginning of the lack of oxygenation and the moment in which Jacko has been aided. There are few doubts on which has been the cause of the respiratory insufficiency: probably not a specific drug, but a lethal cocktail of more than one neurotoxic substances. His cardiologist, Dr. Murray, denies having injected Demeron in his patient: “…never …not today…”!
Even if we admit this version, we must remember all the same that many sedative and hypnotic substances can cause a respiratory arrest, a more than likely hypothesis if we think that the body was remarkably debilitated and that maybe a condition of OCBP (Obstructive Chronic Bronchopneumopathy) preexisted, perhaps supported by the Alfa-1-antitrypsin deficiency.
Many narco-drugs, if taken excessively or in association can cause an alteration of the pressure in the pulmonary blood vessels, sudden increase in the permeability with consequent “flooding” of the alveoli or of the interstices, leading to an Acute Pulmonary Edema.
This is a very serious condition and, if not properly treated, can lead to death due to self-chocking. And if the patient is under deep sedation, he does not stay seated, he does not increase instinctively the respiratory frequency and so drifts in a serious state of hypoxia (reduced oxygenation), preventing him also from asking for help, and he passes from deep sopor to death.
I think this is what really happened, probably independently from the hypothetic injection of Demeron.
A narcotoxic chronic dependence, a debilitated body, a worn-out heart, compromised lungs: a destiny marked by the excess of the excesses. He will remain a myth, a genius for his artistic talents, bus, as a man, he was devoted to self-destruction.
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