NEWS STING BEEPS Good evening. Elvis Presley died today. He was 42. He was found at his home in Memphis not breathing. His road manager tried to revive him ` he failed. A hospital tried to revive him ` it failed. His doctor pronounced him dead at 3 o'clock this afternoon. CRIES: Elvis! Elvis Presley was the king of rock 'n' roll. His meteoric rise to fame in the mid-'50s made him one of the world's first international superstars. He sold an estimated one billion records. But at 3pm on the 16th of August 1977, Elvis Presley's pronounced dead, having been found lying unconscious on the bathroom floor of his Memphis home ` Graceland. He is just 42. The sudden and unexplained death of one of the most famous men on the planet immediately sparks speculation. And his death is still shrouded in mystery. Elvis was not a well man, and I'm staggered at the number of possible causes of death. Most of his organs were about twice the size they should have been. He was severely constipated, and he was taking numerous prescription drugs. The challenge here is to try and understand which of these ultimately killed Elvis Presley. Copyright Able 2015 UNSETTLING MUSIC World-renowned forensic pathologist Dr Richard Shepherd has been conducting high-profile autopsies for more than 25 years. He was the expert witness at the inquest into the deaths of Princess Diana, victims of the 9/11 attacks and the Bloody Sunday enquiry. These are the medical papers relating to Elvis' autopsy, and together with other information I've gathered, they provide numerous clues as to how Elvis lived his life. And they also unlock the reason for his untimely death. Just a few hours after Elvis was pronounced dead, an autopsy was carried out on his body. But with the world's media waiting for an answer, the results were announced before the post-mortem had even finished. Basically, it is a natural death and due to the cardiac arrhythmia, which is an irregular beating of the heart. Almost everyone dies as a result of a cardiac arrhythmia that precedes the ultimate stopping of the heart. The key question is ` what causes the arrhythmia? Nearly 40 years on, myths and legends still surround the death of Elvis Presley. But what really happened during the final hours of his life? UNSETTLING MUSIC Elvis wakes up next to his 21-year-old fiancee, Memphis beauty queen Ginger Alden. He's now entering the last 24 hours of his life. Beginning his day late in the afternoon is typical of Elvis' upside-down lifestyle. The following day, he is due to start a gruelling 12-day tour. His record sales are dwindling, and despite earning millions, Elvis is in financial trouble. 50% of his earnings go to his manager, Colonel Tom Parker. Touring is now the only way for Elvis to remain solvent. For someone who needed to be physically fit for a demanding stage performance, he wasn't in the best of shape. Although we have no record of the post-mortem weight, he was estimated to weigh at least 220 pounds ` 15 and a half stone. And at 5'11", that gave a BMI of 31, which is in the obese category. The other thing shown at the autopsy was that he had a high cholesterol, which is associated with obesity. In the last few years, Elvis has battled with his weight. When he start putting that weight on, I start worrying about him a whole lot. Elvis, he wasn't a food connoisseur-type of guy. You know, he liked normal Southern-type foods. Elvis loved low-fibre, high-cholesterol, high-fat dishes. He reportedly ate everything from fried chicken and cheeseburgers to giant 'peanut butter jam and bacon' sandwiches. He had a full staff to make him this stuff 24 hours a day. So he could indulge himself food-wise whenever he wanted. Elvis Aaron Presley was born in the Deep South of America in 1935. His parents brought him up on Southern home cooking and the traditional gospel music he grew up to love. Well, when I first met him, he was` we were 12 years old, and he was at high school in his music class. I didn't know what it was, but I said, 'This guy's a little different'. In 1954, rock and roll was born when a 19-year-old Elvis Presley took the world by storm with his first hit, That's All Right, Mama. Music would never be the same again. Elvis' persona did change once he stepped on that stage. He was sort of a different guy. And he shocked me a little bit because I didn't know he had it in him like that. Elvis went on to have 18 number-one singles and sold an estimated one billion records. If Elvis Presley sang on the stage in front of you, you thought he was singing to just you. That is a gift. He was a beautiful man. I` I never have seen a picture that did justice to the way he really looked. But by the time he got into his 40s, Elvis was showing clear signs of physical and mental decline. The iconic images of Elvis always show the quiff of jet-black hair. But the autopsy reveals that it had in fact been dyed. When I examined Elvis Presley's scalp, the first quarter inch of his hair was white. Chief medical investigator Dan Warlick played a key part in Elvis Presley's autopsy. Not only was he one of the first people to attend the death scene, he also helped the pathologist to examine and dissect the singer's body. His hair was being dyed jet black, or what I call Elvis-black now, but if he'd let his hair grow out unattended, it would've been white. White as snow. I love you, Elvis! > Thank you, dear. I love you too. Thank you. At 42, you may have expected Elvis to have had a few grey hairs. But the fact that he is completely white is quite extraordinary. There are two possible reasons for this ` firstly, there may have been a genetic predisposition to early grey; and the second is stress. And it's likely that it's a combination of the two. Elvis' friends and employees, known as the Memphis Mafia, are gathering at his house, Graceland. The next evening, they will all hit the road for the upcoming tour. But Elvis will never make it on stage. Also staying that night is his 9-year-old daughter, Lisa Marie, from his marriage to Priscilla Presley, along with his father, Vernon. I remember his comment, 'Ya see all of this and what we have to do? I gotta` 'I gotta take care of this so everybody can keep doing what they're doing.' He had large responsibilities. Elvis financially supported many of his extended family and friends, some of whom lived with him at Graceland. On top of that, he also employed five maids, a physician, nurses, cooks, security guards, personal hairdressers and a pilot. PATRICK: Elvis' checking account when he died was a little bit over $1 million. People say, 'Wow, he's only got $1 million. Where did all that money go?' GEORGE: He gave away Cadillacs and` Ya know, he gave me two Cadillacs and paid for two operations. He was a very giving person, very generous to a fault, and if he knew that you needed something but you were afraid to ask him, he would volunteer to give it to ya. He truly did enjoy giving these gifts and watching the reactions. When it comes to the money, though, he had a lot of people going out on tour with him. And so, he was singularly responsible for bringing in the money. This financial burden weighed heavily on Elvis, and to keep Graceland and his entourage going, he had to keep working. Looking at the reports, I'm not sure that Elvis was fit enough to go back on the road. In particular, the internal examination throws up some interesting findings. Elvis' liver was fatty, sometimes known as fatty metamorphosis. A fatty liver is a marker that it's not working correctly. The fat that should be processed by the liver is becoming stuck within the cells. His liver looked really big, but it did not look diseased. And it did not turn out to be diseased, under microscopic inspection. Elvis' liver may not have been actually diseased, but it was spectacularly large. At 3500g, it's twice the normal weight of a human liver. And it's been a long time since I've seen a liver that's so large. Commonest cause of such a large liver is someone who is chronically abusing alcohol and drinking a litre or more of spirits a day. Elvis had kind of a mental stigma when it` when it came to alcohol. He just thought it was not something he wanted to get into. And one of the reasons that Elvis didn't drink was that he saw how people behaved on alcohol, and there was a lot of alcoholism in his family. If I exclude alcohol, there are a number of other possible causes for a fatty liver, and the next most common is drug abuse. He didn't do cocaine. He didn't do marijuana. He didn't do all the hard drugs, but he was addicted to, uh, prescribed medication. Well, I think there was a suspicion that Elvis had been heavily involved in drugs. I think some of them thought he might in fact overdose at some point and die from it. So could the abuse of prescription drugs have led to the death of the King of Rock 'n' Roll? 1 On the 16th of August 1977, the King of Rock 'n' Roll, Elvis Presley, was found dead on the floor of his Graceland bathroom in Memphis, Tennessee. The world was shocked by the sudden passing of this icon. He was just 42 years old. Now leading forensic pathologist Dr Richard Shepherd is investigating Elvis Presley's autopsy, piecing together the last hours of his life to reveal the real reason for his mysterious death. Based on the medical documentation, Elvis was clearly not a well man, but I can see no immediate cause for his death. He was obese, probably as a result of his poor diet. He also had an extraordinarily large liver that may have been contributed to by his poor diet. But that change in the liver may also have been caused by drug abuse. Elvis has painful toothache, and despite it being late at night, he decides to visit the dentist. Being Elvis Presley means that everyone is at his beck and call 24-7. Elvis did have an unusual lifestyle in that he would stay up all night and sleep all day. In the music and entertainment world, it'd just get started at night, and then they gotta wind down. So it was his style. It was easier for Elvis to get around, because in day time he would start riots and stuff, and crowds would gather real quickly, and he'd get trapped and have to sign and be giving autographs. But avoiding being mobbed by fans was not the only reason for his nocturnal lifestyle. Elvis suffered from chronic insomnia. I have here the toxicology report, which shows there are a staggering nine different prescription drugs in Elvis' body at the time of his death, and four of them are commonly used to treat insomnia. It wasn't unusual in the 1970s for someone to be taking one sleeping pill at night. However, to be taking four was unusual. But the problem is they're all highly addictive. But Elvis thought that because it was prescribed medication, that it wouldn't hurt him. And he did have a hard time sleeping, so he'd take sleeping pills. One morning, at 2 o'clock, when he called me, just a few days before he died, and asked me to come out to the house. And I went in and I said, 'What's the matter, honey?' And he said, 'I can't sleep.' And then I just reached over, and I put my hand on his arm, and I said, 'OK.' And finally, about 6.30, he said, 'I think I'm OK now.' Sleeping pills work by depressing the central nervous system, causing you to become drowsy and possibly fall asleep. Normally, any one of these pills would send a person to sleep. But over time, Elvis had built up tolerance that meant that he had to take more to go to sleep. Elvis had a history of disrupted sleep going back to his childhood. But at the tender age of 23, his insomnia intensified when his world was shattered. He was really seriously destroyed because his mother passed away. In fact, he went and got an article of her clothing, and he held it close to his heart. He cried for two days ` continuously crying ` but I never seen a guy that tore up about his mother passing away. He doted on his mother. He adored his mother. And that was evident in every conversation we had. And I think that he felt like he almost couldn't go on without her. Elvis' mom, if she had not passed on early, there was a very very good chance that Elvis would be alive today. You've got an intense loss and an intense gap in somebody's life. And he would've been struggling with how to fill it. And he would have used any vice he could, that was around, that he felt would feed that loss. But sleeping pills weren't the only pharmaceuticals that Elvis was taking. RICHARD: In the toxicology report, I can see that he is taking a drug called diazepam, also known as Valium, which is a very common anti-anxiety drug. He's also taking amitriptyline which is a drug used to treat depression. And the presence of the combination of these two suggests a man who is suffering from severe anxiety and depression. Studies have shown that, you know, when you have disrupted sleep, it can lead to all kinds of physiological and psychological problems such as anxiety, and people have suffered from depression when they don't get enough sleep. And if he was experiencing insomnia, and then having this lifestyle that meant he was up all night, it would have completely affected his mood. 1 At 12.28am, Elvis returns to Graceland from the dentist, possibly with painkillers. Fan Robert Call takes the last photo of Elvis alive. Elvis has around nine hours to live. TENSE MUSIC When I look at the toxicology report, I can see that Elvis has the painkiller codeine in his bloodstream. Normally, I wouldn't be too concerned, but it's present at dangerously high levels. And this drug present at such high levels indicates that he must have been in considerable pain. But toothache wasn't the only painful ailment Elvis was suffering from. He was hiding an excruciating secret behind his legendary dark glasses. Looking at the medical reports, I can see that Elvis was suffering from an agonising eye condition known as glaucoma. Glaucoma occurs when the drainage tubes within the eye become blocked and the pressure rises, and it causes very severe pain. The severe pain in his eyes, and he's got toothache, might be the reason why he's taking so much codeine. So here's a man taking a large number of medications, from sleeping pills to painkillers ` all of them with a sedative effect ` and all of them depressing the central nervous system. It's really a wonder that he even managed to get out of bed. Elvis calls his personal physician, George Nichopoulos, known as Dr Nick. Mumbling and incoherent, he manages to ask Dr Nick for more medication, including painkillers. The loyal physician duly writes out a prescription. I have here a copy of the prescription that was given by Dr Nick to Elvis the night before he died. It's a strange mixture of medications, but what's particularly interesting, that two of them are amphetamine-type drugs ` Dexedrine and Biphetamine ` essentially, legal forms of speed. Neither of these drugs was present in Elvis' body when he died. However, the presence of these drugs leads me to believe that Elvis needed these stimulants to counteract the effects of all the sedative drugs that he was taking. He'd take sleeping pills. But then he'd start taking to many of 'em. And then when he woke up the next day, he'd have to take pills to wake up, ya know. And that took a toll on him. Looking at the medical evidence, it's clear that Elvis was using these drugs to be able to function. Downers to go to sleep and uppers to wake up again. We now know that it's incredibly dangerous to use drugs in this way, and it causes long-term psychological and physical damage. I think it went from, 'I need these to control my life,' to, 'These are in control of me.' But he may not have recognised when that happened to him. Elvis may have been using multiple prescription medications to regulate his lifestyle, but other than codeine, they're present in fairly small amounts. None of them on their own are life-threatening. However, there was one drug in Elvis' system which was potentially lethal. The report shows that the strongest, most dangerous drug that Elvis was taking was Demerol, also known as meperidine or pethidine, and this has an opiate effect similar to heroin. And this is a drug that directly affects the brain to control pain. Demerol is extremely potent and is usually only prescribed in hospitals to people suffering from serious injuries. So why was Elvis taking it? After the death of his mother 16 years before, the second great tragedy of his life was the divorce from Priscilla in 1973. As a result, he became depressed and rapidly put on weight. It may have been another sense of loss in his life, you know, after his mother and these various things. But I think what may have hurt him more was the fact that another man came in and took Priscilla away from him. I think it was a male pride and a male ego thing, where people were looking and saying, 'Wow, Elvis Presley lost his wife.' But the divorce is also thought to be linked to his addiction to the powerful sedative Demerol. Demerol is an incredibly powerful drug, and by taking it, it might have made Elvis feel disorientated and dizzy. It's a drug that's associated with addiction, and in overdose, even with death. However, the drug isn't present in his bloodstream. It's only present in his liver and kidneys. So he's not taken it in the last 24 hours in his life. So Demerol has not played a direct part in Elvis' death. 3am ` Elvis calls his stepbrother, Rick Stanley, and asks him to pick up a prescription. Elvis was hiding yet another secret. He was obtaining prescription drugs from multiple sources. GEORGE: Dr Nick was the good doctor. The two bad doctors, they would send stuff to Graceland, and the people at Graceland would give it to Elvis. But Dr Nick found out about it. So he would call us, and we would go out late at night, we'd take the stuff out of the pills, and we'd put sugar in there. But Elvis caught on to that because it wasn't taking care of him. If Elvis didn't get what he wanted from Dr Nichopoulos, he would just get it from somewhere else. And so Dr Nichopoulos said, 'I'm gonna stay around, and I'm gonna try to control this.' People find it extremely hard to say no to Elvis Presley. He controls his physicians and told them exactly what to prescribe for him. The exclusive focus is 'getting what I need to help me to keep going', and a state of denial that, you know, you're actually abusing the drugs and you will do anything to get hold of it. He would have a bad show because he was slurring his words or` or had movement problems. He would forget lyrics, which he handled well, because he would laugh it off, and the` the crowd would think, 'OK. We're in on the joke. We get it.' But it really wasn't a joke, and he was in bad shape for those last few years. Elvis has just hours left to live. Most people in Elvis' home, Graceland, are probably fast asleep, including his father, Vernon, and daughter, Lisa Marie. Elvis, however, is wide awake. Bizarrely, he has decided to play a game of racquetball. His cousin Billy Smith and wife, Jo, are woken up to play. Elvis has decided playing racquetball would keep his weight down and get him fit. The pressure is on. He's due on stage in Portland, Maine, the next night to start his tour. I think going back on stage gave him incentive and desire to lose the weight and get back in shape. But he was a little too late. 4.30am ` whilst Elvis' intentions for playing racquetball were good, the effect on his body was not. Playing racquetball would certainly have helped Elvis lose weight and get fit, but the autopsy shows that his heart was somewhat enlarged, and the arteries to his heart were narrowed by over 50% by fat deposition in their walls. This is a disease known as atherosclerosis, and it's commonly associated with high cholesterol in the bloodstream. And we know that Elvis suffered from that cholesterol. This build-up of material in the walls of the blood vessels prevents blood getting through to the organ and stops it working so efficiently. And that's particularly the case with the heart. So Elvis was obese, he had raised cholesterol, and he had a bad heart, and this means that any exercise or fitness regime should have been very carefully planned. Ah, just a wee bit up. And to the right a little bit. Perfect! Oh, beauty, guys! Mmm. Maybe a touch left and down a bit. 1 Elvis heads to his piano room with his cousin Billy, wife Jo, and his fiancee, Ginger. Ever the showman, he can't resist entertaining the group on the piano. That was the last two songs he ever sang. Billy said that he sang Blue Eyes Crying in the Rain, the old Willie Nelson song, and he sang Unchained Melody. GENTLE PIANO MUSIC Around 5am, Elvis heads up to bed. On the way, he finds his daughter, Lisa Marie, is still awake. He tucks her into bed and kisses her goodnight. PIANO MUSIC CONTINUES UNSETTLING MUSIC Back in his room, Elvis calls Rick, demanding more sleeping pills. Rick delivers the first packet, and Elvis tries to fall asleep. GEORGE: The only regret that I have looking back on my time with Elvis was the fact that I wasn't able to step up and help him. You try to help a person and he don't want you to, you hit the road. The door slams in your face. PATRICK: And so when people went to him and said, you know, 'You're unhealthy. You need to do something about your health. Take some time off.' But Elvis lived his life largely with the notion that, 'It's my life. I'm in control. Thanks for your input, but no, thanks.' Still awake at 7am, Elvis calls Rick for a second packet of pills. But this too fails to send him to sleep. About an hour later, he asks for a third pack. (SLURPS) TENSE ELECTRONICA MUSIC Despite the number of pills Elvis may have taken, he still can't sleep. And it isn't just the insomnia that's keeping him awake. Reports suggest he was also suffering from severe abdominal pain. At 9am, he heads to the bathroom. Ginger goes back to sleep, unaware that the King of Rock 'n' Roll could be just moments away from dying. RICHARD: From the medical information, we already know that many of Elvis' internal organs were abnormal, and some were about twice their normal size. And the same is true of the colon, or the large bowel. When we look at it, the normal size should be about 3 inches. Elvis' was distended to about 5 inches. And it was full of grey, chalk-like material. He couldn't have had his bowel open for several days, and this would have been very uncomfortable or, frankly, painful. And this potentially dangerous problem had been known about. He had all that clay in there, and I don't think he could've passed` I think it would've taken some significant, significant medical intervention just to clear that out. GEORGE: Dr Nichopoulos tried to get the doctors in Memphis to operate on Elvis and reduce his colon. They said, 'We're scared to operate on Elvis. He's a superstar, man. 'If something happens, we could really be in trouble.' So, uh, they wouldn't operate. They tried to do it with medication, and it wasn't working. It got worse and worse. When you take opiate painkillers like codeine and some antidepressants, it can have an effect on the digestive system, causing it to slow down. In other words, the normal regular motion of the bowel becomes disturbed, and the bowel becomes distended with faeces, causing it to stretch. And we can see that that has happened to Elvis, and he's clearly suffering from an extreme case of constipation. 9.05am. By now Elvis is likely to be experiencing extreme discomfort and no movement in his bowels. TENSE MUSIC DAN: He was reading a book, and it was not the type of book that you would fall asleep while you were reading. It focused on sexual positions in relation to zodiac signs. (GROANS) At some point, Elvis collapses on the floor. MUSIC STOPS ABRUPTLY He way laying on his left side, with his knees pulled up ` not in a fetal position but right knee over the left knee on the floor ` and his head against the floor. UNSETTLING MUSIC At around 2pm in the afternoon, Ginger wakes up to find that Elvis hasn't returned from the bathroom. Elvis? Elvis? He has been alone for around five hours. TENSE MUSIC Oh my God, Elvis! Oh my God! Ginger finds him unresponsive. He's not breathing. SCREAMS: Elvis! (SPEAKS INDISTINCTLY) She immediately sounds the alarm and calls downstairs for help. An on-duty maid sends up Al Strada, one of Elvis' security guards, and his road manager, Joe Esposito. TENSE MUSIC CONTINUES They turn Elvis over, but his body feels stiff and cold. His face and neck have turned blue. They try to perform CPR, but Elvis' jaw is too stiff, and his mouth won't open. I think that Joe and Al were seeing the very early signs of rigor mortis. Rigor mortis is the stiffening of the muscles that occurs because of a chemical change within them, and it starts three or four hours after death. So, in retrospect, I think it's clear that Elvis was dead when they walked into the bathroom. However, they were quite right to commence CPR, because they couldn't be sure. Elvis' father, Vernon, also hears the commotion, and runs into the bathroom. Vernon was distraught. He saw what was going on. You know, he was saying, you know, 'Please don't die. Please don't die.' He saw the condition of Elvis, and he had to have known that this wasn't gonna end well. Lisa Marie had come up and was trying to look into the bathroom, saying, 'What's wrong with my daddy,' and Ginger stopped her. TENSE MUSIC 2.33pm ` paramedics arrive at Graceland. Despite the fact that Elvis has no pulse or blood pressure, the paramedics also attempt CPR. When that fails, they rush him to Baptist Memorial Hospital in Memphis, where they continue repeatedly to try to revive him. MACHINE BEEPS STEADILY And I walked into the emergency area. It was so evident to me that he had been gone for so long. They were doing CPR. I said, 'Please, stop. 'Don't do this to him.' How could they not tell he was dead by looking at him? I could when I walked in the door. At around 3pm on the 16th of August 1977, Elvis Presley is pronounced dead. The world mourns the shocking passing of the King of Rock 'n' Roll. Elvis Presley died today. He was 42. He was found at his home in Memphis not breathing. At that moment, I just felt like somebody just stabbed me with a red-hot knife in my heart. I never had a feeling like that in my life. I was just shaking all over, and everybody was crying. Mr Presley ran up to me and he hugged me. He said, 'George, we've lost him. 'I've lost my son. You've lost your best friend.' It was just the saddest scene I'd ever seen in my entire lifetime. I was stunned. I was totally stunned. Why didn't we see this ` how sick he really was? And when you see somebody all the time, you don't realise. He was such a strong influence in my life. And you always thought of him being bigger than life and that he would always be there for you. Um, it was a very sad day. 1 Elvis Presley's autopsy was performed on August the 16th 1977 at 7pm. But before it was even finished, with the world's media waiting for news, a statement was unusually released. There were 1000 people outside the, uh, hospital by then. All the news medias and news outlets, wanted to know what had happened. They announced that an autopsy had been performed. We were actually still performing it. And then Dr Francisco stepped forward and announced that, 'Well, we have determined that Elvis Presley died of a sudden cardiac arrhythmia.' Basically, it is a natural death and due to the cardiac arrhythmia, which is an irregular beating of the heart. And I know that that took the Baptist Hospital pathologist by surprise and that they were very unhappy with that. It may well be that Elvis suffered a cardiac arrhythmia before he died, but a cardiac arrhythmia can't, on its own, be a cause of death. And it's impossible to diagnose an arrhythmia once someone has died and their heart has stopped beating. So the key question here is ` what was it that caused Elvis' heart to stop beating? FRIGHTENING MUSIC Dr Richard Shepherd has been thoroughly investigating Elvis Presley's medical documents and key evidence from his autopsy. I've so far established that Elvis was abusing a number of prescription drugs, including antidepressants, strong painkillers and sedatives. He was suffering from bouts of insomnia. He had an enlarged liver and suffered from coronary artery disease. He had pain in his teeth and his eyes. And he was severely constipated. However, I still haven't managed to identify exactly what caused his death. In instances of sudden death that occur in the bathroom, one of the first things pathologists look for is a pulmonary embolus. A pulmonary embolus is a blood clot that travels up from the veins in the leg and becomes lodged in the arteries in the lungs and causes sudden death. It's known as an association between a pulmonary embolus and people having a desire to go to the toilet. So the fact that Elvis collapsed when he was` clearly been sitting on the toilet, made the pathologist suggest this. They looked, and they found no evidence of a pulmonary embolus. So, can the medical and death-scene evidence combine to shed any light on what did happen in the fatal missing minutes and hours when Elvis was alone in the bathroom? The public perception is that he died of an overdose because Dr Nichopoulos just wrote him scads and scads of prescriptions for anything he wanted. The toxicology report does show that Elvis was taking multiple prescription drugs. But when chief medical investigator Dan Warlick went to the scene at Graceland, he found no trace of pills in the bathroom. That struck me as suspicious. I think some of 'em thought he might in fact overdose at some point and time, so there were contingent plans on how to handle that when and if he did overdose and kill himself. But whilst Dan Warlick failed to discover any sign of prescription drug abuse, he was able to make some startling observations from the place of death that help reveal why and how Elvis died. Where he was found, and I was able to put myself in the same position that his body was, uh, based upon moisture on the floor where his` his mouth had lost some fluids on to the floor, my feet were 40 inches away from the bottom of the commode, which he was sitting on when he died. But this position in which Mr Presley was in was, uh` he had taken at least two full steps away from the commode before he'd collapsed. I've seen many many cases of drug overdoses and also of people who have died from heart attacks, and I think the fact that Elvis got up and staggered away from the loo is very important. When people die from a drugs overdose, it commonly leads to respiratory depression, resulting in deprivation of oxygen to the brain, and so they may slip into unconsciousness. And if they're sat on the toilet, they may simply slump to the ground right next to it. But the fact that he'd stood up from the loo, knocked over the bottles and dropped his book, he'd staggered, fallen, suggests to me that he may have been going to seek help. And so he had an awareness of some disturbance or pain or abnormality. And to my mind, that suggests that this was a cardiac event. Dr Shepherd has found further evidence to support the theory that Elvis' death was not directly related to drugs. Elvis had a spectacularly enlarged liver. It could've been caused by the multiple prescription drugs that he was abusing. It could have been associated with his poor diet and his high level of cholesterol. But there's another reason for a liver being this enlarged, and that's if the heart is failing and there's a backlog of blood getting blocked and engorging the liver. Crucially, Elvis had severe narrowing of the arteries that supplied his heart. They were blocked off by fatty deposits known as atheroma. But there was another problem with Elvis' heart, and that was that it was greatly enlarged, most probably due to long-term high blood pressure, causing the muscle to get thicker to pump the blood at the high pressure round the body. And Elvis' heart was so big. It was 520g, when a normal man's heart is only 350. Shows how serious the situation was and how likely it was going to be that he suffered a cardiac event. Dr Shepherd has discovered that there were so many things wrong with Elvis that he was on the cusp of collapsing and dying at any moment. So as Elvis sat on the loo straining to defecate, naturally he would've raised the pressure within his abdomen and within his chest, and this would have resulted in a known physiological change called the Valsalva manoeuvre. The Valsalva manoeuvre is anything actually that increases the pressure in the abdomen and the chest. And it can be straining to defecate; it could be childbirth; it can be clearing your nose when diving. The point is the pressure increases, and it reduces the blood returning to the heart through the vena cava, the main artery from the lower part of the body. And the chance of an abnormal cardiac event are greatly increased. Straining to go to the toilet when he was constipated caused the change in blood flow, caused his heart to fail at that moment, and he collapsed, and he died. HAUNTING MUSIC It obviously was Elvis' time to leave. Was it a pretty picture? No. But I bet he's having a great time up in Heaven today. Elvis Presley will always be remembered as the greatest entertainer that ever lived. He sold one billion records. Nobody in the history of the record business has sold one billion records. He asked me one night, 'Do you think people will remember me?' I said, 'Yeah, baby. They gonna remember ya.' And, um, I think he will always be remembered with love. And giving. And he gave until he couldn't give any more. Captions by Kate Parkinson. Edited by Glenna Casalme. www.able.co.nz Captions were made possible with funding from NZ On Air. Copyright Able 2015