JUNE 25TH, 2009, what a night it was, what a day it transpired to be, what an unbelievable catastrophe. A monumental disaster.
Ever since I came to Los Angeles to take care of Michael Jackson, things had changed. I came here thinking I’ll be with Michael and the three children during the day, but at nights I’ll go home to rest and be with family.
Instead the opposite happened. Michael did not only want me to be with him during the day, but he also wanted me to be with him every night.
The nights became sleepless for me, but not for Michael. Michael for the first time on my watch could be artificially sedated minimally with propofol for sleep, an agent he stated he had been using for years, especially when under pressure brought on during tours as an artist.
I, however, over weeks and months managed to convince him to let go of propofol, and we were successful in completely weaning the medicine as early as three days prior to June 25th. I thought it was a remarkable achievement, no more propofol for Michael!
A photograph of Michael Jackson's bedroom is presented during Conrad Murray's involuntary manslaughter trial on 11 Oct 2011. Picture: Robyn BeckSource:AP
Dr. Conrad Murray waits to leave the courtroom during his involuntary manslaughter trial. Picture: Kevork DjansezianSource:Supplied
The 50-year-old singer Michael Jackson before his death in his trademark hat and surgeon's mask.Source:Supplied
It is important for me to repeat a few salient points about propofol.
Propofol is not an addictive substance. It is also not known to cause addiction, dependence, nor withdrawal symptoms in patients. Not one single case has been reported in the medical literature that confirms withdrawal from propofol, the reason being it does not cause drug addiction, as would be the case with opiates.
Propofol is not a street drug, you could not sell it for pennies on the street, no one would buy it and if someone wanted it for a hit or to get a high they’d be wasting time and money because it does not do any of that.
Michael was not addicted to propofol, he could not be. But it was still a drug that damaged his life in insidious ways.
What Michael was addicted to was Demerol, an opioid, an addictive agent on which he actually wrote a song.
If Michael had shared information of this perilous habit with me I would have made the effort to personally enrol him in a drug rehab program, but he never told me about it.
My mind was made up that night.
“I’m not going to see Michael, he’ll be fine and able to sleep on his own by the time he is through with rehearsals and takes the long drive home. It will be very late and he will also be exhausted.”
The flickering of lights on the ceiling faded away until I realised I had fallen asleep when suddenly I was awakened by the ringtone of my cellphone. It showed the number of brother Michael Amir, the personal assistant of Michael Jackson. It was 12:25AM on June 25th. I cringed, then answered, “yes, what do you want?”
He said, “Mr. Jackson will finish rehearsals in the next 10 minutes and he wanted to know if you’ll be at the house when he arrives.”
I said to him, “I was not planning to be there tonight, it’s already past midnight, this is ridiculous, I’m not a machine, l too need my rest, just like he does. I didn’t come to Los Angeles for this.”
The drugs found at Michael Jackson’s house were presented to the court at Dr. Conrad Murray’s trial. Picture: Mario Anzuoni/APSource:AP
Michael Jackson's bedroom is shown during Conrad Murray's involuntary manslaughter trial. Picture: Al SeibSource:AP
Then after thinking of Michael and his tenuous state of affairs, his future hanging by a thread, I fretfully got up from bed to go to work.
I should have followed my intuition for once. I found tonight’s request very unreasonable because of the time, after midnight, I did not sign up for this. Not to help Michael Jackson go to sleep artificially every night.
I did not need this job, I was doing well on my own until both he and AEG duped me into closing the doors to my practices for this piece of shit. I’d rather have awakened to a call from Michael that night saying, “I’m tired, I got home late, I’m going to sleep, see you in the morning”, but that would be hoping for a miracle.
He was not yet at home, when I arrived, the time was around 1:00am.
I took a one litre bag of normal saline solution, spiked the bag of fluid with a single IV line then hung the bag of fluid on the IV pole. The bag of normal saline was prepared for IV hydration of Michael tonight following his rehearsals at the Staples Center.
When Michael danced in rehearsals or a show he could drop more than five pounds in a single session from sweating, hence the reason for mild rehydration.
After preparing the normal saline, I sat on a chair towards the left lower foot of his bed, awaiting his arrival. On the inside of the house, it was very still, the three children were asleep soundly in their rooms. Shortly after that, the tall lanky figure dressed in an orange trousers, black jacket and a black hat suddenly walked through the door. It was Michael!
The broad smile, lighting up his face, as on every other occasion he had seen me.
A slide of the bed where Michael Jackson died is shown during the prosecution's opening arguments in the Conrad Murray involuntary manslaughter trial.Source:AP
“Conrad, how are you?”
“I’m well.”
“Good to see you and thanks for coming.”
“You’re welcome Mike.”
“Hey Conrad, I’ll get a quick shower and come back to you, ok.”
“That will be fine.”
“Hey Conrad, have you had dinner, don’t forget I have the cook prepare a meal for you every day, and keep it in the warmer for you.”
“Yes Mike I’m aware of it, but you know I don’t like to eat so late at night.”
“I’ll have them prepare it anyway.”
“No problem Mike. So tell me Michael, how was rehearsal today?”
“I’d say it was ok, only got to about 50 per cent of my capacity. Fifty to sixty per cent seems to be all I can do.”
“What limits your performance? Are you having chest pains, shortness of breath, pains in your hip knees or feet during rehearsals?”
“No nothing like that. Conrad you think I’ll have a heart attack.”
“I can’t make that prediction Michael, but your risk for a heart attack is quite low. However, we all know nothing is impossible.”
“Yeah, I guess so! Ok, let me go and shower I’ll be right back.”
Michael Jackson pictured in 2009 at a rehearsal for his ‘This is It’ tour.Source:Supplied
In a little while following the shower he came back in the room, dressed in his cotton pyjamas and imbued in his favourite cologne.
After Michael climbed into bed then I searched over his arms and legs to see where I could find a vein to attach his IV fluid tonight. Looks like the vein tonight will be on his left leg just below his left knee.
Next a condom catheter was placed over his penis and the catheter bag was strapped to his right leg and thigh. The condom catheter was used primarily for urinary incontinence and enuresis, which had become a long standing problem for him, secondary to benign prostatic hypertrophy.
Before starting pills for the problem, he would complain that he had to stand for hours to completely empty his bladder. Of course during road trips he carried plastic urinals, which he used for voiding when inside his vehicle. As you’d expect because of his celebrity status he could not use public restrooms, especially those at public rest stops.
The next thing I did was ask him to take one 10 milligram Valium tablet orally. We started talking more by then, because he kept very quiet whenever an IV catheter was being placed in him. Hopefully the Valium will soon take effect the conversation will slow and he’ll fall asleep.
This night though Michael appeared revved up, he was restless not anywhere close to sleep nor being himself. Something was different about him tonight, and I didn’t know what it was. I’m puzzled by his behaviour; but I can’t place my finger on the enigma.
Valium seems to have had zero effect on him, so I gave him two milligrams of Ativan intravenously (IV) and allowed it to circulate in his system for some time. But after waiting for a least an hour, there was no appreciable change noted in Michael, especially after which time those medicines should have shown their therapeutic effects.
2009: Authorities leave the scene after executing a search warrant at the Red Rock Canyon Country Club residence of Dr. Conrad Murray, in Las Vegas. Picture: Daniel GluskoterSource:News Limited
Michael remained wide awake, restless, walking about the house, going in and out of the bedroom, talking and mumbling to himself and at times complaining to me that he had to get some sleep tonight, and telling me excitedly why sleep for him was necessary.
He thumbed through magazines to pass time and occasionally he asked for my input on some of the pictures of the women. We half chuckled at times, but I was waiting patiently to see the sleep effect of Valium and Ativan.
But, there was no effect seen from the medication. By this time Michael was growing more impatient and restless, his facial expression was grimacing and twisting, his eyes red and wide open, fully alert.
Where was the sleep he anticipated this night? I could see his racing thoughts turning in his mind. Then he got up, he wanted to go to his exclusive master bedroom, said he’ll be back soon.
I had some time to think about the next step while he was gone, “how do I help him to sleep tonight? Propofol use is now a thing of the past. He has been off it for three nights, we are not going to re-enter that road once travelled ... no more propofol”.
The room this night was the usual, when he would go to sleep with all the lights blazing every night. I would dim the lights only after he fell asleep.
This night however, there were no affirmations played, the loud music had to be toned down, but the lights were all lit and bright as usual since he was so restless and perpetually walking around.
The temperature in the bedroom was warm to his liking. The room was also very cavernous, his bed was an irregularly large king size, with an extra firm mattress that sat very low on the firm base board which was only a few inches off the floor.
Oh what a night it was! Hell night, a definite thriller night. After Michael came back to the bedroom he appeared to be getting even more revved up. I managed to convince him to lay once more in bed, after which I administered two milligrams of Versed IV and waited to see the effect if any, but after 20 minutes or so he was up and gone again boiling with frustration.
He just couldn’t keep still, then he came back and temporarily got back in bed. I asked him to dim the lights to about half the brightness. I applied a foot rub while to each other we tried speaking in softer tones, but he did not have that control tonight, even though he was generally soft spoken.
He just couldn’t lay still, could not relax, nor were there any signs of sleep in him tonight. He was like a hamster running on a wheel. He was in constant motion.
As the night progressed he gradually grew to look much like his image in his Thriller video. Michael was weird tonight, literally a zombie.
I said Michael, I don’t understand what is wrong with you tonight because after 10 milligrams of Valium, two milligrams of Ativan, and two milligrams of Versed you should be fast asleep. I know that I would be, you’re not acting normal, you’re wired and I can’t explain the source of your caffeine or the electricity.
Over the next four to five hours Michael’s desire for sleep gradually intensified. He became more and more restless, agitated, and looked as torn up as someone with a most scary and bizarre Halloween make over. He was Thriller in appearance for sure.
During those hours and up to the first couple of hours after daybreak he still could not sleep except for a 10-minute period when he appeared to doze off briefly, which was hours ago. But he was up again and immediately in motion.
During the latter hours of the night and into the early hours of the morning, say about 7:40am he received another two milligrams of Ativan and two milligrams of Versed alternating and separated by hours, but that too had no obvious effect on him.
He left again, took a longer than usual time to come back but he did. This time he was basically begging then came the tears; he begged and pleaded with me to give him some “milk”. Milk was the name he used for propofol.
“Conrad,” he said “if I don’t get to sleep, I can’t rehearse for the show. I won’t be able to go to England and perform, everything I have will be lost, you know that AEG has a tab that’s piling up against me. Even when I don’t go to rehearsals I’m charged for it. Help me Conrad, please help me! Just give me some milk so I could sleep, only after some sleep I would be able to function.”
We were now soundly into daylight,.
As Michael continued to beg and plead his case for sleep, I wished to myself that propofol had been a clear substance, because if it was, I would have given him a normal saline injection as a placebo and hope the placebo effect would mentally help him to relax and eventually get some sleep.
That was however impossible since normal saline is a clear liquid substance while propofol is not. Propofol is a whitish or milky appearing solution. The pressure was even greater at that point, last night was painfully long and challenging.
Nothing given him thus far was able to induce sleep, so taking his entire situation under consideration I relented and agreed to give him a very small amount of propofol “milk.” It was 25 milligrams of propofol pushed slowly intravenously over three to five minutes into the J-port of his normal saline IV line.
I prepared the propofol mixed with a small amount of lidocaine to avoid the burning sensation that is usually felt when propofol is infused into a small peripheral vein. I made sure that Michael was able to see the whitish mixture in the syringe because a dose that small from my perspective and clinical experience would not be expected to produce any sedation, or very little, if any at all.
I thought it would be almost like giving him a placebo, since it was so small a dose, but when he saw that he was getting the “milk” he might relax and drift into sleep, kind of a placebo effect.
By the time the five-minute slow infusion of propofol was completed, he surprisingly drifted slowly into sleep, but he was not snoring today which was something he usually did shortly after closing his eyes and falling asleep when propofol was administered by an infusion. It was an innocuous dose of propofol.
I was very surprised that he had fallen asleep, but at the same time very relieved from the pressure of last night, as well as being happy for him to eventually get some sleep.
A photograph of Michael Jackson's bedroom presented at Dr Conrad Murray’s trial.Source:AFP
Because Michael was not snoring after administering the small dose of propofol between 10:40 and 10:50am I monitored him for a longer period than would reasonably be expected of me. Time is its own antidote because of its very short half life. It is metabolised rapidly in the body. One would not expect to have a risk for a complication or apnoea after 10 minutes following propofol administration because of its rapid metabolism.
The telephone records showed that between 10:34 and 11:23am I did not use my cell phone, which also corresponds to the time that I told the police in my statement I was attending to Michael.
Michael was never abandoned by me and nothing that I gave him would have killed him or caused him harm.
After leaving Michael’s bedside following 35 minutes of direct monitoring I conducted multiple pieces of business in adjacent chambers within the master suite. I used my cell phone to call my offices in Las Vegas and Houston as well as to Stacey Howe, my office administrator of roughly 17 years.
I couldn’t wait to get out of the house, I said to myself. However, I intended to wait until around noon then I would wake up Michael, remove the IV normal saline from his leg, and encourage him to attend rehearsals that day.
Still having a little time to burn, I thought I’d call this girl, Sade Anding whom I befriended in Houston. She was a waitress at a pretty decent steak house. She had left me numerous messages over two weeks and I never called her back, this could be the opportunity for me to touch base with her. The call will be a short one, we never did have many extended conversations as I recalled.
I dialled Sade’s number, she came on the line within a couple of rings, we began to speak, I next wedged the phone between my right shoulder and neck, opened the strings to my beige linen trousers, pulled it down partially and started to pee. I didn’t think she would hear me taking a p*ss while she was on the phone.
After finishing I pulled up my pants tied up the strings and started my casual slow trek back towards Michael; I was still on the phone with Sade. As I walked back through the chambers and cleared the doorway between the dressing chamber and the master’s retreat, which was adjacent to the bedroom. I was getting closer to Michael now.
That is when I suddenly encountered the unexpected. Michael was laying differently on the bed, he also looked different, I picked up the pace towards him.
He was not in the same position as when I last saw him. His head was off the pillow, his body was shifted slightly down towards the foot of the bed and nearer the edge towards the right side of the bed.
He was still attached to a condom catheter, and on his right leg and slightly below the left knee he was attached to a clear bag of IV normal saline solution, that was hung from an IV pole.
The nasal prongs from his oxygen tank was off his face, and resting on the right side of his pillow on the bed, the pillow was no longer under his head as when last seen.
“Michael! Michael! Are you ok?”
Not a sound he was making, not a breath he was taking, not a single pulse, sustained or intermittent was truly discernible.
He was lifeless.
Shocked, in dismay, and disbelief, but with no timidity I began an assessment of him.
What the f**k happened here?
What did he do in my absence?
I therefore, immediately sprang into action and started cardiopulmonary resuscitation (CPR), immediately after confirming that he was pulseless. I started with chest compressions and an Ambu-Bag for minute ventilation.
I had to save him.
I had to save Michael.
I shortly thereafter changed from using the Ambu-Bag and attempted mouth to mouth ventilation because being a single operator it was easier to attempt resuscitation that way. Sade Anding might have heard the inaudible sounds she described as someone coughing during her sworn testimony, it could have been me, but once I found Michael in that lifeless state, my focus was all or none to help him, so I sprung into immediate action to do whatever it took to help him survive this crisis.
This battle he must win. Sade was the least of my concerns at that moment.
As I worked feverishly on Michael, I may have even placed myself in danger of having a heart attack, because I developed symptoms in the attempt to resuscitate him, but I did not quit, nor give in to my concern.
I however, kept hoping and looking towards the bedroom door that someone would show up especially after I spoke to Michael Amir and told him I had an emergency, please send security. I could have been screaming for help at the top of my voice, but from that deeply cavernous master bedroom, no one would hear me.
In the process of heroically attempting to resuscitate Michael I developed for the first time in my entire existence chest pains and shortness of breath that felt like cardiac at the time I was performing CPR. I remember thinking then that I was going to die myself.
I hopelessly stared in the vicinity of the doorway more times than I could count. Every time hoping for a miracle that someone would knock, someone would show up, but there were no knocks and no one showed up.
I also remembered staring at the black house phone on the night stand while I continued CPR, beading in perspiration, and recalling that not a single telephone land line was functional in that house. It was extremely difficult working relentlessly on Michael as a lone operator not knowing where to find help, nevertheless, I couldn’t give up on him, not unless I physiologically collapsed or my body quitted involuntarily against my volition.
I finally had no choice but to run downstairs using the back stairwell searching for help from any adult I could find, because no one came to my rescue, that’s when I had to leave Michael alone and run downstairs screaming for help. After attempting CPR unsuccessfully I’d say for at least five to seven minutes, I’m not able to give an accurate account of the loss of time to get help during the crisis.
By the time security arrived, the first one on the scene was Alberto Alvarez. Trailing immediately behind and keeping up the pace with Alberto were both Paris and Prince who ran into the room almost simultaneously with him. Paris shouted “daddy, daddy”, and broke down in tears as she pushed her way deeper into the room barely passing Alberto.
Prince was running right behind Paris, he broke his stride as he entered the room, he appeared to be in total shock. He had tears in his eyes but I don’t recall him making a sound.
Michael Jackson’s children Paris and Prince stand together on stage during the memorial funeral service for their father.Source:News Limited
Before any of them could get close to me or Michael I shouted to Alberto Alvarez, please usher the children out of the room, and not have them see their father like this. He quickly grabbed them by their arms and escorted them out of the room.
I shouted to him, “Did you call 911?”
“Not yet. I’m going to call them now.”
He took out his cell phone from the inner pocket of his jacket, and placed the call to 911. When the operator answered the phone, Alvarez was like a cripple, and stammering, he did not know a thing about his boss. He could not answer simple questions based on what he was seeing on the scene.
I had to perform CPR alone during this time, then shout the answers to the 911 operator questions to Alberto across the room so that he could transfer the information to the 911 operator.
Before I give the details of what happened in the bedroom after paramedics arrived, let me preface it with the following statement. When someone calls 911 during an emergency, except for the blasting horns of sirens and flashing lights on emergency vehicles, you just don’t know what else you’re guaranteed to get. You hope for the best.
That was the same as in Michael’s case, but had he wished or prayed for a good, not an excellent group, just a good group to appear on the scene, his prayers were definitely not answered this summer day.
And let me also say that I’ve had the honour to work with excellent paramedics and other medical personnel as a physician, but in this particular case, this was a poor example of greatness, pardon my directness.
They had no difficulty intubating Michael. But beyond that task, absolutely nothing else was done successfully for that man by paramedics, especially during the next 25 to 30 minutes following intubation. And after doing nothing except milling around aimlessly and fumbling, they wanted to pronounce him dead at the scene, based on a Los Angeles “timed protocol.”
I was furious and foaming in rage.
“What do you mean call it? You guys have not done a single thing to impress upon me that you treated him effectively since you arrived. Your attempt sucked! You lost his IV access when moving him to the floor, and you took another 20 to 25 minutes before you could replace it, then you gave him an insufficient half ass amount of medicines after 25 minutes on the scene and decided to call it a day only because you have to follow protocol.
And finally you placed an IV line in his neck and want to use this to feign off your weak clinical skills, as if you did something for him. I save lives in critical states every day, and what you’ve done today is what I consider a pathetic effort. Get UCLA ER physicians on the line for me now! I’m assuming care and responsibility to take him to the nearest tertiary medical care centre with your help to transport him!”
The ER physician at UCLA agreed to relinquish and transferred care to me, I said to her prepare for us we are on our way to you.
The battle to keep him alive was far from over, to give him a fair chance of survival, and to save him just got more intense. I was not going to allow Michael to receive less than the maximum heroic measures, if it meant there was a chance for his survival, I was going to make sure, he got that chance. I was not ready to give up nonchalantly, nor to lose him, not this way. I wanted him to be around for his children.
After giving him more bicarbonate, epinephrine and atropine, chest compressions continued, he was still pulseless as when I first found him. He was transferred from his bedroom to the ambulance that was parked in the front yard. As we descended the stairs with him on the gurney, I followed last in line but immediately behind, keeping it all in sight.
I remembered on the last descent of stairs I looked towards my left side, towards the black grand piano and saw the children standing holding their nanny, their arms was bracing some part of her garment, and her arms holding them all.
The mood in the house was totally sombre. Anguish filled the air, a sight not to be forgotten.
I still couldn’t believe it might be the last time he would be leaving that residence and might not be coming back, the fate of which was also the same for me, I’ve never been back to that home, and have no desire to do so.
Conrad Murray’s self published book ‘This is It’.Source:Supplied
No comments:
Post a Comment