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12 October 2011

MJ's death: two main mysteries

Two aspects of Michael Jackson's death make CyberShrink feel very uneasy. The slashed drip bag, and the doctor's choice of medication for treating MJ's insomnia.

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Two aspects of Michael Jackson's death make CyberShrink feel very uneasy. The slashed drip bag, and the doctor's choice of medication for treating Jackson's insomnia.

The first one is the evidence of a plastic drip bag cut open, with a propofol bottle inside it. Firstly, nobody seems to have mentioned seeing a knife or scissors which would have been needed to do this, and surely nobody tore it open with their teeth! 

To administer propofol, normally one would use a syringe and needle to draw up the required dose, and then inject it into the bag through a specially designed bung, leaving the bag intact. Opening the bag would immediately contaminate its fluid contents and raise a major risk of infection within the bloodstream.

Simply placing a propofol bottle in the bag makes no sense. If the stopper had been removed, the drug could be poured in;  if it was in place, none of the drug would escape. It would be a frankly daft and ridiculous thing for any doctor to do, even someone of Murray's seemingly odd practices.

Maybe MJ might have done so if desperate, but Murray has described him as sophisticated and very well informed about the drug, having received it for a long period - even MJ wouldn't make such elementary mistakes. Who then, slashed the bag and inserted the bottle, and why?

 

A weird way to help anyone sleep

Years ago, while working as an expert witness in a major trial, I was shocked at the blatantly and extravagantly false statements the defence advocate was making, and asked one of the lawyers why this was not being challenged. He smiled, and asked me: "Have you ever seen any of the lawyers take an oath to tell the truth, the whole truth and nothing but the truth?" And of course I never have.

Hearing so many comments and claims from a defence attorney, we need to remember that nothing he says is evidence;  that needs to come from properly sworn-in witnesses, and it should be eventually disregarded unless supported by proper evidence.

Much of what has been described doesn't make sound sense. Even the defence version of events, as we hear it, describes a grotesque series of unprofessional, unethical, and at times frankly gormless actions by Murray.

And one particular example is that what he is said to have done, so far at least, would be a highly ineffective way to get an insomniac to sleep and enable him to have a refreshing eight hours of snoozing, Even if propofol were utterly safe, given intravenously it will put someone to sleep quickly. But, like the effective anaesthetic it is, it will wear off within 10 minutes or so, and the person will wake up again. Jackson was agitating for a long sleep, not a 10-minute nap. This is why propofol is used either to cover a brief surgical procedure (such as setting a broken bone or replacing a dislocated shoulder), or purely to induce initial sleep to then be replaced by a different agent to keep the person asleep.

 

An unusual set-up

Look at the set-up in Jackson's room. Judging by what we have heard so far, he was in bed, with a drip placed into a blood vessel in his leg. This is not usually the first choice for an infusion, but if there are daily drips being set up, veins get damaged and harder to find in the arms, and any available vein needs to be used.

One does not usually set up a drip to give a single injection over the course of a couple of minutes, and where this might be needed, it would not be left in place. Suggestions that he was so severely dehydrated by the exercise of the rehearsal as to need infusion are surely nonsense - so long as he kept drinking water or similar fluids, he would recover from any sweating easily, as presumably did every other dancer in the cast.

MJ was also wearing a condom-catheter, connected to bags, to collect his urine, something that would be entirely unnecessary unless he was going to be effectively under anaesthetic for hours on end, and unable to wake and pass urine in the natural way.

But we have also heard that MJ was being given benzodiazepine drugs (sedative tranquillisers such Valium, Lorazepam and Midazolam) and apparently usually by infusion, too, rather than by mouth. This too is highly unusual when treating insomnia, unless the person is too deeply asleep to swallow anything by mouth.

But suppose the usual routine was as follows:  set up the saline drip and catheter, give propofol to force him into deep sleep, and then keep him asleep for hours by topping him up with intravenous doses of benzos. This may explain the oddity of why there was apparently a supply of a special and unique drug, Flumazenil, used as a sort of antidote to benzodiazepines, which rapidly reverses their actions, and enables a patient to be woken up when deeply asleep after taking benzos.

A possible problem is that Flumazenil can potentiate and add to the effects of propofol, and doesn't reverse them, so it certainly wasn't there to reverse any propofol overdose. There is no antidote, but one can simply support the patient's breathing and heart-rate until that drug wears off within minutes. Propofol can be an irritant and painful to inject, and may then be mixed with some lidocaine (as has been mentioned in the evidence) to reduce or avoid this "burn".

This combination could be a logical way to force Jackson into hours of heavily drugged sleep, and could make some sense of the different threads of evidence we have heard so far, even if no sleep expert on earth would recommend doing it that way.

(Professor MA Simpson, aka CyberShrink,Health24, October 2011)

  

 
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