Demystifying the Death of Elvis

by Daniel Brookoff, MD, PhD

Medical Director
Center for Medical Pain Management
Presbyterian/St. Luke's Medical Center
Denver, Colorado
The opinions contained within this commentary are solely those of Daniel Brookoff, MD, PhD
and are not supported or endorsed by Medical Learning Solutions or Cephalon, Inc. and its
affiliates.
Dr. Daniel Brookoff received his medical degree as well as his doctor of philosophy degree from
the University of Pennsylvania in Philadelphia. He also completed his residency in medicine and
a fellowship in medical oncology at the University of Pennsylvania. Dr. Brookoff has held faculty
positions at both the University of Pennsylvania and the University of Tennessee medical
schools, and is currently the medical director of the Center for Medical Pain Management at
Presbyterian, St. Lukes Medical Center in Denver, Colorado. In addition, Dr. Brookoff is the
founding associate director of the Methodist Comprehensive Pain Clinic in Memphis.
Dr. Brookoff has authored numerous papers and textbook chapters on pain management, most
recently "Chronic Pain as a Disease: the Pathophysiology of Disordered Pain" for the textbook
Expert Guide to Pain Management, published by the American College of Physicians in 2005.

In order to comfort many of my patients with chronic pain, for years I have told them the story of
Job from the Bible. These days not only do I tell my patients the story of Job, I also tell them the
story of Elvis.
Elvis was born in 1935. He was a twin, his twin died at birth. Elvis had problems right from the
start and it turned out he had a form of Hirschsprungs disease, and Hirschsprungs disease is a
disease of the colon that really kept him from having normal bowel movements and things that
he really didnt want to talk about. There are a lot of people with Hirschsprungs disease that
survive into adulthood, and later on in adulthood they start to develop severe bowel problems,
and thats exactly what happened to Elvis. He started seeking treatment because he didnt know
what he had. In the 60s he was seeing a variety of doctors, some of them in California, some of
them in Las Vegas. They were giving him all kinds of treatments, and one of the treatments that
he got were anti-inflammatory steroids for the colitis he was developing. So people who survive
into adulthood with Hirschsprungs disease will stretch out their bowel, will develop twists in
their bowel, and develop a symptom like colitis. And this is what was plaguing Elvis when he
met Dr. George Nicopolis. And its kind of interesting because if you asked people what
happened, they said that Dr. Nicopolis caused Elvis to be addicted and thats what he died of,
and that is absolutely not true. And it just kind of mirrors a lot of what we go through either as
pain patients, or as doctors taking care of pain patients, that its hard enough taking care of the
physical suffering that the stigma and humiliation really are not deserved, and they become an
enormous burden.

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The first time Elvis met Dr. Nick was in February of 1967. Elvis had suffered an attack of
vertigo and had fallen in the bathroom and broken his rib. He came to see Dr. Nicopolis and one
of the interesting things is from then on they developed this relationship that was kind of a
father-son relationship. A lot of pain physicians develop very close relationships with their pain
patients, and often thats the most important part of our treatment is having somebody they can
trust and somebody who believes in them.
Elvis actually got better under Dr. Nicks care. When Elvis met Dr. Nick in 1967, he wasnt
touring. He hadnt played a concert since 1958, which is when he went into the military service.
He started playing concerts again in 1969. Despite that, he started to suffer worse and worse
bowel problems. Because of a problem with the Hirschsprungs disease, which is a neurologic
problem with your bowel, he developed a very distended and stretched out colon, and at one
point developed something called a volvulus, which is real crisis where his colon actually twisted
and he started bleeding and was nearly dead. And it was kind of interesting, Ive seen the
medical notes for that. What you do with somebody who has a volvulus is you take them to the
hospital. Elvis went to the doctors office and saw Dr. Nick and a gastroenterologist and they
said, we need to take you to the hospital. Elvis was just absolutely terrified that they were going
to do a colostomy on him, which is probably what they would have done, and to be Elvis Presley
and to have a colostomy, I could see being kind of intolerable. When Elvis refused, the
gastroenterologist said, well we can stick a scope, you know, a rigid scope, in your colon and,
because your colon is twisted, and if we twist it the right way, youll be okay, and if we twist it
the wrong way, itll be catastrophic. Elvis told him to go ahead and do that, because his identity
as Elvis was so important to him.
I remember looking at the medical chart for that visit and its kind of sweat-stained and the note
for thats really long. Usually when you write a note for a procedure its a page or two. That note
is 16 pages. And luckily they twisted the right way. So he made it through that crisis. Its kind of
interesting, everybody makes their judgment of Elvis, who was a good person, loved his mom, a
good Southern Baptist who didnt drink alcohol, much less abuse drugs. And they made all these
kind of presuppositions about him. And really what he was trying to do was, to get treatment and
still stay Elvis and maintain his real iconic image, and its kind of interesting because his image
continues to grow.
He started to develop terrible constipation and something called overflow diarrhea. So he had
trouble moving his bowels and at the same time some of the liquid stool would overflow. There
was an incident at a concert in Baltimore where he actually had what we call an accident, and
that terrified him. And you can imagine Elvis having a bowel accident would be terrifying.
Because of his accident, Elvis became very, very concerned about his bowels and started taking
medicines that actually caused the blockages and the constipation to get worse. He took a
medication called Lomotil, and he insisted that medication be given to him at his own
discretion. All his other medications, as it turns out, were very carefully controlled. So it wasnt
like he was going out on the street buying drugs or asking for drugs. He was actually taking very
little medication, but he did take a lot of Lomotil. Lomotil has two drugs in it. Lomotil was
developed in the 50s when they were trying to look for a pain-relieving narcotic and its a drug
called diphenoxylate. Diphenoxylate didnt relieve any pain, it caused constipation. But when it

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came out on the market, regulators were really concerned that you just cant let a narcotic out on
the market even though it doesnt get absorbed. So they did something called the poison pill
theory of formulation. So Lomotil has two drugs in it. It has diphenoxylate and it has belladonna,
an atropine-like drug. The thought being that people who took low doses of it would never feel
the belladonna, whereas people who tried to abuse it, which are very, very few, would get
belladonna side effects.
Elvis took this drug and took it in large amounts because he was absolutely horrified about
having a bowel accident. And like I said, you just think of him living with that kind of terror and
still going out there and performing for people and going to Vegas and doing concerts, and the
poor fellow was terrified. If you look at the mode of death, he didnt die like a drug addict dies,
because on his last day he was having problems getting his days and nights mixed up so he did
sleep in kind of late. But then he ate breakfast and did several things during the day. He played
racquetball, which is not something a lot of my drug-addicted patients do, and then he had
friends come over and what did they do, they played gospel music into the night, which is
something he really loved doing.
Then Elvis tried to do the hardest thing that he had to do every day, because he tried to have a
bowel movement. And it looks like Elvis had not had a bowel movement for several weeks
before the time of his death. And one of the ways we know that is hed had a barium enema, in
those days we did that instead of colonoscopies, where they put barium in his bowel. And we
know that if you dont get the barium out of your bowel pretty quickly, it turns solid, like
cement. And hed had a barium enema more than eight weeks previously and had never gotten
the barium out of his bowel. So he had a very stretched out bowel with a lot of barium. And
hadnt had a bowel movement in at least two weeks, is on the toilet trying hard to have a bowel
movement. And unfortunately he had taken a lot of Lomotil right before that. The diphenoxylate
in Lomotil was stopping him from having a bowel movement. The belladonna in Lomotil caused
him to have an arrhythmia when he bore down. So as he bore down real hard to kind of push
things out of his bowel, his heart slowed down and he had an arrhythmia called ventricular
tachycardia which killed him. And he died on the toilet, which again, I take care of a lot of drug
addicts and thats not how they die. They either die with a needle in their arm or they die in bed.
He died on the toilet and he was taken to the hospital, and by the time he got to Baptist Hospital
hed passed on.
And its just kind of interesting because he died at a young age. He was trying to be Elvis
through his whole life and if youre Elvis Presley, thats what youve got to do. Its interesting,
thats what his doctor did for him was he kept him Elvis an extra 10 years. He would have
probably passed on sooner without Dr. Nicopoliss care. And Dr. Nicopolis kept his secrets.
Treating chronic pain is one of the most pro-life things we can do as physicians. And if were
being pro-life, were doing the right thing, were restoring people to their lives. So I just thought
it was interesting to share with you the story of Elvis and his doctor. Like I said, Dr. Nick has
told me that Elvis was his best friend and his worst patient. He was hard to deal with because he
kept wanting to be Elvis Presley. But in his case, that was legitimate. And because of Dr. Nicks
care, Elvis probably lived 10 years longer than he would have, despite a really terrible genetic
illness.

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One of the interesting features of that was, thats one of the secrets that never came out because
Elvis was humiliated by his illness, which is really unfortunate. And your doctors are the ones
who will keep your secrets when you pass on and everybody else is talking about you.

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