Behind every seedy celebrity death stands a seedy celebrity doctor. Or so it surely seems now that Michael Jackson has died under a pharmaceutical cloud of uncertainty. Though we don't know yet just what the autopsy (and inevitable re-autopsy) will show, rumors suggest that investigators searching his residence found painkillers of various shapes and sizes as well as Diprivan (propofol), a powerful anesthetic rarely found outside of ICUs or operating rooms. It's a story we've heard before with Elvis and with the not-really-famous Anna Nicole Smith, whose postmortems both turned up lots and lots of prescription drugs (14 for Elvis, nine for Anna Nicole). Enough drugs, as it turns out, to kill either horse or human.
In these sordid events, the doctor usually starts out in the corner of the story then moves center stage as more and more evidence points to his involvement. Elvis' stay-at-home doctor, George Nichopoulos, M.D., aka Dr. Nick, claimed to have written 10,000 prescriptions in the last seven months of Elvis' life. (Dr. Nick's explanation was that he just "cared too much.") That's not 10,000 pills but rather 10,000 sheets of paper handed or called in to a pharmacist. At an average of, let's say, 20 pills per script, this comes in at about 200,000 pills (or injections), for a chill mean of 1,000 pills a day.*
The story for Anna Nicole Smith, whose autopsy is here and here under her real name of Vickie Lynn Marshall, is more or less the same. First came the downers for sleep, then the uppers to counteract the downers, then the pain meds and the anxiety meds; before you know it, you're talking real pill counts. The problem of dying because of too many, rather than too much, drugs in situ has become so common that it even has gained its own Wikipedia entry under the rubric of "combined drug intoxication."
Of course, not every patient of Dr. Feelgood dies as a result of the easy prescription access. Max Jacobson first copped the nickname for his fine work injecting and medicating JFK as well as Alan Jay Lerner, Marlene Dietrich, and Eddie Fisher. Jacobson had fled Hitler in 1936 and crawled to the top of the heap of celebrity practitioners because of his creative pharmacopeia. One might flatteringly consider him a father of the field of stem cell research: His famous "miracle tissue regenerator" injection contained, among other tidbits, solubilized human placenta as well as amphetamines and pain meds, which left recipients feeling dandy. Despite his extremely happy clientele and fine work ethic (he, too, was said to be a heavy amphetamine user), he eventually lost his license for his shenanigans.
So now are we awaiting the news on poor Michael. His version of Dr. Nick, a physician named Conrad Murray, had, by report, been a member of the retinue for just a few months. Murray's entry into the news was characterized by his apparent attempt to exit the news; he is said to have high-tailed it from the scene of the dead or dying Michael even as police and others descended on the house. His exact contribution to the death will be revealed in the weeks, months, and probably years ahead but is likely to resemble that of his predecessor Dr. Feelgoods—whose pen and syringes and customer-is-always-right attitude ended up creating a corpse where once an icon stood.
In a strange way, I actually stand in awe of these guys. I have taken care of a few celebs in my career, and for me it was an awful experience. If you fuck it up, you're toast. Once I took care of a very important person, a person you have heard of and are very interested in, someone you would be shocked to know had the problem—asthma—that I treated him for. Well, almost treated him for. His complaints and his recollection of near death last time he had the identical symptoms so unnerved me that I asked a colleague to assume his care.
But the Dr. Feelgood experiences no such hesitancy. He isn't like the rest of us in the groveling pack. He steps up when others falter, seizes glory where others panic, moves forward where others second-guess. This is his blessing and his curse. He is everywhere, too—in my own Oklahoma youth, there was a drunken, friendly, not-stupid doctor who worked his way up in local society by giving his special "love potion" injections to the upscale neighborhood's idle doyennes. Though not as accomplished as Drs. Jacobson, Nick, and now Murray, he shared their affliction—a near fatal, groupie-like susceptibility to the powerful seductions of fame. Perhaps it all starts innocently—a rich, famous guy with a tiny problem walks into the office. He can't sleep at night. He's so friendly, sincere, not stuck up like some celebs. Then he comes back a week later because of a sore ankle, wanting a little codeine and bearing an autographed photo or a CD. Other patients notice and figure you must be a pretty good doctor if Mr. Showbiz is coming in. And when his migraines come, followed by the back pain and the sleepiness from the back-pain medicine, you're at the ready to call in a script.