Quotes of the Day

The initial autopsy report on Michael Jackson came at 3:30 p.m. on Friday, June 26, 2009, from Craig Harvey, spokesman for the Los Angeles County coroner's office: "The coroner has concluded the autopsy for Mr. Michael Jackson. The cause of death has been deferred."

It will be several more weeks until details of the full autopsy will be released to the public. For now, said Harvey, the coroner had not found "indication of any external trauma or indication of foul play on the body." The cause of death, however, could not be determined. Results from further testing on the brain and Jackson's pulmonary system, as well as a toxicology analysis of what substances may have been present in the singer's body at the time of death, will take an additional four to six weeks to complete.

The preliminary results came just over a day after an unidentified man placed a call to 911 from Jackson's rented Holmby Hills mansion on Thursday: "He's not breathing ... he's not conscious ... he's not responding to anything. He's not responding to CPR, anything," the man said.

When the 911 operator asked how Jackson had collapsed or whether anyone had witnessed it, the caller replied, "The doctor has been the only one here."

That physician — presumably Jackson's personal doctor, cardiologist Dr. Conrad Murray, who was called on Wednesday night when his patient complained of not feeling well — has disappeared. He left the car that he drove to Jackson's home, a silver BMW registered to an associate, in the driveway. Dr. Tohme Tohme, a Jackson associate who has served as a spokesman for him in the past, told the Los Angeles Times that Murray, who has filed for bankruptcy in the past and has financial problems, was hired by Jackson's concert promoter, AEG Live, to live with Jackson and care for him during his upcoming shows. Los Angeles law-enforcement authorities towed Murray's vehicle on Thursday night, saying the car could contain "medications pertinent to the investigation" into Jackson's death.

As the Jackson family awaits results of the autopsy performed Friday on the 50-year-old King of Pop, some family and close friends have raised the possibility that Jackson's alleged drug use played a role in his sudden death.

Brian Oxman, a former attorney for the family, believes that Jackson's use of medications was "extensive" and that the people who surrounded him were "enabling him," encouraging his reported drug dependence. A family member told the celebrity gossip website TMZ.com that Jackson had been receiving daily injections of Demerol, a narcotic painkiller.

In high enough doses, Demerol can slow respiration almost to the point of suffocation, which can lead to sudden death by depriving the heart of oxygen, according to Dr. Douglas Zipes, a cardiologist at Indiana University and past president of the American College of Cardiology. Demerol can also cause a sudden stoppage of the heart in patients who are dehydrated. The drug causes blood vessels to dilate, or expand, and dehydration would impede this stretching, leading to a dangerous drop in blood pressure and blackout, which can cause sudden death.

Before his death, Jackson had apparently been rehearsing intensely for his 50-concert comeback, which was to launch in mid-July at London's O₂ Arena, but there are no reports yet of whether the physical strain had left him dehydrated Wednesday evening.

When EMTs arrived at the Holmby Hills mansion where Jackson had collapsed, they would have had a series of quick-fire decisions to make, based on little information. Had Jackson suffered a heart attack? A drug overdose? A stress-related event? Did his condition require paddles or a syringe of epinephrine?

In the case of either a heart attack or cardiac arrest — a heart attack can also cause cardiac arrest — EMTs' initial response is to begin cardiopulmonary resuscitation (CPR) in order to keep blood flowing. According to the 911 tapes from Jackson's case, his physician was "pumping his chest." That physician and the EMT team that brought Jackson to the Ronald Reagan UCLA Medical Center attempted to resuscitate him for more than an hour, according to a statement issued by the hospital. Typically, however, there is only a four- to six-minute window of opportunity to revive a patient in cardiac arrest; the chances of survival drop 7% to 10% with each minute that passes without CPR or defibrillation.

A heart in cardiac arrest, says Zipes, "looks like a bag of squiggly worms, totally uncoordinated, disorganized, with no effective pumping." In a normal heart, the pumping chambers beat 70 times a minute or so, while an organ in cardiac arrest can spasm anywhere from 400 to 600 times per minute. Unless a regular rhythm can be restored, brain death and ultimately death can result.

It is not known what measures the emergency workers took to save Jackson, but if they had determined that he suffered from cardiac arrest triggered by an overdose of narcotics, they would have likely used a shot of naloxone, a drug that counteracts opioid overdose, to get the brain back online and the heart beating again, says Connie Meyer, an EMS captain in Johnson County, Kans. In cases where it's not clear whether narcotics are involved — cardiac arrest may be caused by a wide range of factors, including stress — some EMTs will use epinephrine, a shot of adrenaline that jump-starts the heart back into action.

Jackson's autopsy will include a toxicology report that will identify any substances present in his body at the time of death, but even still, it may not yield a definitive cause of death. "A toxicology screen can only tell you the drugs were or were not there," notes Zipes. "It cannot tell you if the drugs caused the event."

The autopsy could, however, rule out a heart attack. If Jackson's cardiac arrest had been triggered by a heart attack — caused by a ruptured plaque blocking blood flow to his heart — then pathologists should be able to see the occluded vessel and the fresh evidence of the clogged-up heart.

After all the speculation and rumors and bizarre events that have peppered Jackson's medical history, it may be the case that ultimately he died from the same condition that claims 440,000 other middle-aged Americans each year: heart disease. A longtime friend, Patti Austin, who duetted with the singer on "It's the Falling in Love," told CNN that Jackson rarely ate right and didn't exercise. "When you live like a hummingbird, you don't have a long life span," she said.

• Alice Park