Summer in the playoffs: afamous utopsias (1/6). Friday June 26, 2009, 10 a.m. At the Los Angeles Forensic Institute, Doctor Christopher Rogers, head of the forensic medicine department, is preparing to perform the autopsy of case 2009-04415, the file of which is summarized in a few lines: “The deceased is a 50-year-old black man who suffered from respiratory arrest while at home in the hands of his attending physician. On the day of his death, the deceased complained of dehydration and not could not sleep. Hours later, he stopped breathing and could not be resuscitated. Rescue workers transported him to UCLA medical center, where he was pronounced dead. The deceased was taking several prescription drugs, including clonazepam , trazodone, diazepam, lorazepam [sédatifs], and flomax [traitement de l’adénome de la prostate]. It is not known whether he was taking these treatments regularly. The deceased suffered from vitiligo and had no history of heart problems. “
The identity card specifies that Michael Joseph Jackson, born August 29, 1958, 1.75 m, 61.7 kg, was declared dead on June 25, 2009 at 2:26 p.m., from a presumed accidental or natural cause.
The news of the sudden death of the pop star, in full preparation for a series of concerts after years of absence from the stage, has already circulated the world. The media evoke a “heart attack”. Then the hypothesis of a drug overdose becomes clear, especially since we know the singer long addicted to painkillers and tranquilizers.
THE VERDICT IS WITHOUT AMBIGUITY
But it was not until the end of August that the conclusions of the autopsy report were made public. The verdict is unambiguous. Death is due to acute poisoning with propofol, an anesthetic product. It’s homicide. At the request of the Los Angeles Police, the report itself remains confidential.
Four years and two trials later, the final secrets surrounding the end of “Bambi” ‘s life and death are at your fingertips. The autopsy report, which was one of the key elements in the conviction of his attending physician – cardiologist Conrad Murray – to four years in prison for manslaughter in November 2011, is now available. The entire document can be downloaded from the Autopsyfiles site. It’s just as easy to find post-death photos of the idol on the web, and even a staggering series of “crime scene” snapshots over the past few weeks. Bambi’s Louis XV-style room appears cluttered with infusion equipment, oxygen bottles, prescriptions, boxes of medicines including opened bottles of propofol …
These photos, which say a lot about the musician’s distress and his drug addiction, are published in the media while a new trial has been held since the end of April. The Jackson clan accuses AEG, producer of the singer’s last tour, of being negligent in hiring Doctor Murray to treat him and of putting him under pressure.
“THESE RESULTS ARE VERY ABNORMAL”
Reading the autopsy report held many surprises. In addition to the numerous scars (some due to cosmetic surgery) and areas of depigmentation, it appeared that Michael Jackson had “dark tattoos around the eyes and on the eyebrows” and “a rose tattoo in the lip area”. The reason ? He had been tattooed to hide his vitiligo, an autoimmune disease responsible for skin depigmentation that he had suffered from for years. The anterior half of his skull was also the site of a dark tattoo, and he wore a wig to conceal his baldness (presumably the sequel to a scalp burn that occurred during a shoot in 1984).
The king of pop also suffered from relatively banal pathologies in a fifty-year-old: colon polyp, osteoarthritis, prostate adenoma (treated). More surprisingly, the microscopic examination of his lungs revealed numerous lesions. “These results are very abnormal. In life, such a pathology can be responsible for shortness of breath and difficulty in breathing, and also for chronic cough”, analyzes the anesthesiologist Richard Levy in an article analyzing the autopsy of the star (published in Forensic Research, in 2011). The practitioner adds: “With this lung problem, it would have been difficult for Michael Jackson to exercise physically, and he would have quickly tired.”
This opinion is shared by Frédéric Maître, anatomopathologist at the Medico-Legal Institute of Paris, who confirms that this type of lesion causes respiratory problems on exertion: “Autopsy data shows singer was not in excellent condition. Pulmonary involvement and rheumatic lesions are compatible with chronic lupus disease. The diagnosis of this autoimmune pathology, which affects several organs, had been made a few years earlier in Michael Jackson, but it is not certain. “
“AN OVERDOSAGE OF PROPOFOL HAS BEEN BARELY BELIEVABLE”
Could the singer really have been able to choreograph his shows, which were supposed to begin in the days following his death? One thing is certain, he probably could have lived a long time if his addiction to propofol had not caused his death. The toxicological examinations made it possible to detect high levels of this anesthetic, and the presence of benzodiazepines (sleeping pills or sedatives) which could also have contributed to the death.
“When we found out it was a propofol overdose, it seemed barely believable”remembers Professor François Chast, head of the clinical pharmacy service at the Paris Center university hospitals. Because as the investigation proved, the product was administered to Michael Jackson completely outside its indications and the required conditions. “In the operating room, propofol is a drug of great safety, it is quickly eliminated, which makes it an ideal product for outpatient surgery. We sleep as soon as it is infused and we wake up very quickly after stopping, continues the pharmacologist. But it can only be used in a hospital environment, with cardio-respiratory monitoring and, if necessary, resuscitation equipment. “
In fact, propofol addictions – “my milk”, as Michael Jackson called it in reference to the color of this product – are extremely rare. In addition, since the marketing of this drug in the mid-1980s, the few dozen cases that have been the subject of publications are people from the medical world: doctors, in particular anesthetists, or operating room nurses. Apart from Michael Jackson, only one case of propofol abuse has been reported in a non-healthcare professional, writes Dr. Bruno Mégarbane in an article published in the journal Intensive care, in 2010.
Surveys of caregivers show that the drug is often taken initially to sleep or relax, and quickly induces dependence. The “craving” (repeated and irrepressible desire to administer the product) “is intense and persistent, which may explain the installation of an addiction in certain vulnerable subjects”, notes Bruno Mégarbane. Among healthcare professionals, misuse is often discovered at the time of death or a complication, such as a car accident.
Doctor Murray, who had been treating Michael Jackson’s insomnia problem for six weeks and giving him propofol “nightly”, as pointed out in his article Richard Levy, had all the elements to worry about this addiction, and prevent its high risk of fatal outcome.
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