Michael Jackson May Have Died From Fibromyalgia

Dr Kevin is reporting that Michael Jackson may have died after receiving a dose of Demerol (generic meperidine). Demerol has all but been banned from Happy's Hospital. If any patient comes in on it our pharmacists are on me like a hawk to change it to something else, especially in our elderly population. It has metabolites that hang around and can cause bad side effects. It is also used by many folks to get high (apparently to a different degree than other narcs).

As I mentioned in my post on Michael's death, I'm not convinced it was a "heart attack" as some news outlets are reporting. He just doesn't fit the profile for coronary artery disease. With that said narcotic drug overdose is certainly a plausible explanation for his death.

Let me give you a story. I was doing my normal daily rounds on a patient when I walked in and just stopped. I stopped and I listened. I looked for signs of life in my 67 year old man who was admitted with abdominal pain. I stood there. Watching. Calmly observing.

It struck me as odd. For a full thirty seconds I saw my patient breath exactly one time. I turned on the lights and noted a remarkable physical finding (another reason to always turn on the lights). Cyanosis. A physical finding in which the skin turns purple due to an increase in deoxyhemoglobin in the capillaries (I will never forget the cause of cyanosis due to my exposure to one of the greatest pimping attendings of all times).

So I calmly walked out of the room, walked to the nurses station and stated calmly:

"One of my patients is about to code. What would you like me to do?"

This is probably the quickest way to get a nurse to jump out of their chair and come bedside to your assistance. I think in retrospect I lost the golden opportunity of a lifetime to pull the code chord and watch every nurse on that floor flock to my room with me standing there saying

"What would you ladies and gentleman like to do about my dying patient?"

This patient, perhaps just like Michael Jackson, was heading to Heaven at the hands of IV morphine, being used to treat an abdominal pain which certainly would not take his life. It was nurse administered, not patient controlled analgesia (the pain pump or better known as the PCA). Not every patient will respond equally to the same dose of medication. No matter how many protocols or protections are in place, we can not prevent 100% of our patients from not experiencing an adverse event. This is one such example. The fact that only a handful of my patients a year experience a complication from IV narcotics is a pat on the back to Happy's Hospital for getting rigorous safety protocols in place.

A PCA is a pump filled with narcotic, set to only deliver a maximum amount of medicine every defined period of time, which is activated by a button the patient carries near them. If the machine is set to only allow one dose every eight minutes, pushing the button a hundred times in eight minutes will only deliver one dose in eight minutes. The beauty of the PCA is that as the patient gets sleepy, the patient stops pushing the button. This is why family should NEVER EVER EVER nor should nurses NEVER EVER EVER push the PCA button for the patient. If they cannot push their own button, they should not have a PCA and nurse administered narcotics should be the route of choice.

My patient had nurse administered narcotics. Several times a year, for just me, I will have patients who experience life threatening respiratory depression from intravenous (and sometimes even oral) doses of narcotics. They are not to be taken lightly. The antagonist for narcotic overdose is Narcan. Sometimes multiple doses must be administered as it gets "consumed". Most patients will wake up very quickly, often in a fit of rage and delirium and no long standing side effects are experienced.

However, sometimes if the respiratory depression consumes the patient, irreversible cardiac ischemia or deadly arrythmias may present themselves, leading to the patient's death. It's the same reason heroin addicts die. They suppress the breathing centers of their brain and they stop breathing. A heroin overdose, is in fact quite a peaceful way to die.

I think I've delved into my hospitalist experience with IV narcotics enough. I think the real question needs to be asked. Why is any doctor prescribing and administering daily Demerol to any one, Michael Jackson or otherwise. Happy's nurse coordinator believes he may have had fibromylagia.

How's that for the official cause of death. Michael Jackson, dead at the age of 50, from fibromyalgia.