A Medical Note On The Death Of Leonard Cohen

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Leonard Cohen’s Death

Nine months after the event, I continue to receive questions about the cause of Leonard Cohen’s death. I am posting about two pertinent medical issues in hopes of resolving some of the confusion. Please be aware that this post reveals no facts about Leonard’s death that haven’t been previously published. Instead, I offer a physician’s take on the available information.

1. Leukemia, Coagulation Defects, and Falls

Prior to Leonard’s death, it was well known that he suffered from cancer (a fact most famously reported by David Remnick in the New Yorker), and since then, reports have been published that specified the diagnosis as leukemia.1

On Nov 16, 2017, Leonard’s manager, Robert Kory, issued a widely published statement2 about the cause of death:

Leonard Cohen died during his sleep following a fall in the middle of the night on Nov. 7. The death was sudden, unexpected and peaceful.

Much of the uncertainty in the queries sent my way arises from the misperception that a fall and leukemia are mutually exclusive causes of death. This is the viewpoint implicit in the opening lines of Leonard Cohen’s Cause of Death Revealed by Dave Lifton (Diffuser: November 17, 2016):

Although Leonard Cohen had been suffering from cancer, it was not the cause of his death last week. According to his manager, Robert B. Kory, it was the result of a fall he had recently suffered.

In reality, however, the explanation of Leonard’s death may well involve the combined effects of the fall and leukemia.

First, treatment for leukemia, as well as for pain or other symptoms of leukemia, may increase the risk of a fall.

More significantly, a common symptom of certain types of leukemia is faulty blood clotting, typically due to low levels of platelets although other issues can also be involved. Consequently, a fall could cause an internal hemorrhage that would ordinarily be stopped by normal coagulation before reaching dangerous levels, but in an individual with impaired clotting, bleeding from the same closed wound could continue relentlessly, leading to death, especially in the case of head trauma. In fact, Intracranial hemorrhage is the second leading cause of mortality in patients with one type of leukemia (acute myeloid leukemia).3

In summary, the most likely clinical interpretation of the presented data is that Leonard’s death was the consequence of bleeding which was immediately triggered by his fall and which continued unabated because of a coagulation defect, which was itself caused by leukemia.

2. No Heroic Measures

Some writers have questioned why no medical intervention was mentioned in the announcements of Leonard’s death.

It is not unusual for patients diagnosed with a terminal illness, especially those suffering physical deterioration, to stipulate in living wills or similar documents that no heroic measures or extraordinary life-sustaining treatment be implemented to avoid the coming of death. A typical provision of this sort follows:

If at any time I should have a terminal condition and my attending physician has determined that there can be no recovery from such condition and my death is imminent, where the application of life-prolonging procedures and “heroic measures” would serve only to artificially prolong the dying process, I direct that such procedures be withheld or withdrawn, and that I be permitted to die naturally.4

Given Leonard’s well-publicized statement, “I am ready to die. I hope it’s not too uncomfortable. That’s about it for me,”5 he may well have made similar arrangements. If so, a no heroic measures provision might have precluded a call for medical assistance.

Conclusion

Again, I want to emphasize that this post is a medical perspective on rather than an investigation of the events surrounding Leonard’s death. The key conclusion is simply that, while I have no definitive proof that the scenarios I’ve outlined are indeed what took place, they do represent reasonable, unstrained clinical explanations of the available information. If this seems anticlimactic, it’s because my personal belief is that the loss of Leonard Cohen was a tragedy, not a mystery.
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  1. For example, in  I already knew Leonard Cohen was dead on Election Day (Slate: Nov 19, 2016), notes “The cause of his [Leonard Cohen’s] death was leukemia.” []
  2. E.g., in The New York Times []
  3. Prediction of fatal intracranial hemorrhage in patients with acute myeloid leukemia by C.-Y. Chen C.-H. Tai W. Tsay P.-Y. Chen H.-F. Tien (Annals of Oncology, Volume 20, Issue 6, 1 June 2009) []
  4. Source: Living Will []
  5. Leonard Cohen Makes It Darker, by David Remnick (New Yorker: Oct 17, 2016) []

Leonard Cohen Describes His Home On Hydra

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My house [in Hydra] looked beautiful, and it looks exactly the same as it always did. It doesn’t have a great view. It’s a big house full of little rooms. Rooms about half the size of this kitchen. And just with old tables and chairs that people gave me, most things in that house were given to me by people who were moving up and could afford a better table, like the Johnsons, gave me the kitchen table because they made a little money and they bought a better table. And that’s what we would do for the new generations coming in. At first all my pots and pans were second generation, you know, and then you made a little money and you could buy your own pot and pan and you’d give your pot and pan to the next kid who was moving in. At that stage when I was living with Marianne, we didn’t have any money… Well, Axel had made a little money, so there were some things from his house that found their way into my house.quotedown2

Leonard Cohen

Also see

From Leonard Looks Back On The Past, an interview with Leonard Cohen by Kari Hesthamar, Los Angeles, 2005 (Unedited interview for the Norwegian Radio). Found at LeonardCohenFiles. Photo by Rauli Arjatsalo of The Leonard Cohen Files. Originally posted May 11, 2011 at DrHGuy.com, a predecessor of Cohencentric

Photo: Leonard Cohen’s Home In Montreal

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lc-house-montreal-scaled1000This impressively clear and detailed photo of Leonard Cohen’s home in Montreal (click on image to enlarge) was taken by and posted with the permission of Lilian Graziani.

Also see

Note: Originally posted August 3, 2012 at DrHGuy.com, a predecessor of Cohencentric

“Don’t” & “Are You Lonesome Tonight” By Elvis Presley Are On Leonard Cohen’s Jukebox

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The Original Leonard Cohen’s Jukebox

Biggest Influence on My Music – The jukebox. I lived beside jukeboxes all through the fifties. … I never knew who was singing. I never followed things that way. I still don’t. I wasn’t a student of music; I was a student of the restaurant I was in — and the waitresses. The music was a part of it. I knew what number the song was.

– Leonard Cohen (Yakety Yak by Scott Cohen, 1994)

Leonard Cohen’s Jukebox: Over the years, Leonard Cohen has mentioned a number of specific songs he favors. Leonard Cohen’s Jukebox is a Cohencentric feature that began collecting these tunes for the edification and entertainment of viewers on April 4, 2009. All posts in the Leonard Cohen’s Jukebox series can be found at The Original Leonard Cohen’s Jukebox Page.

Leonard Cohen – “I was a huge fan of Elvis”

Elvis_Presley_1970

From Bård Oses intervju med Leonard Cohen by Linn Gjerstad (BA: March 26, 2012)  in Google Translation:

I have plans to sing an Elvis song on stage soon. … – I was a huge fan of Elvis! I was in town until today and bought a compilation LP of the man. Soon you will hear me sing “Don’t” and “Are You Lonesome Tonight” – but not at the plate. My voice is too deep. 20,000 cigarettes have led my tone of voice three to four notches down too far.

Elvis Presley – Don’t

Elvis Presley – Are You Lonesome Tonight

DrHGuy Note: While I am unaware of any recordings of Leonard Cohen singing “Don’t” or  “Are You Lonesome Tonight,” he did cover “Can’t Help Falling in Love” by Elvis Presley.  He sings a bit of it, in fact, during this 1988 BBC interview.

A full version of Leonard Cohen singing “Can’t Help Falling In Love” is available on The Other Leonard Cohen Album.

For another Leonard Cohen-Elvis Presley connection, see Elvis’s Rolls Royce

Credit Due Department: Thanks to Roman Gavrilin aka Hermitage Prisoner for his help in ascertaining that the first Elvis Presley song mentioned by Leonard Cohen was “Don’t” rather than “Don’t Be Cruel” as I initially thought. Photo of Elvis Presley “Elvis Presley 1970” taken by Ollie Atkins, chief White House photographer, when President Nixon & Elvis Presley met.

Note: Originally posted April 6, 2012 at 1HeckOfAGuy.com, a predecessor of Cohencentric

In 1959, Leonard Cohen moved into Stella Pullman’s boardinghouse at 19b Hampstead High Street, London

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This Is How 19b Hampstead High Street Looks In 2015

In December 1959, Leonard Cohen moved into a London boarding house at 19b Hampstead High Street. His long-time friend, Morty Rosengarten, had lived there previously. Another childhood friend, Nancy Bacal, was a resident there at the same time as Cohen.  The house was presided over by Jake and Stella Pullman (along with the Pullmans’ cat, David).1

I lived at the corner of Gayton Road and Hampstead High Street in 1959. I lived with my landlady, Mrs Stella Pullman. I had a bed in the sitting room and I had some jobs to do, like bringing up the coal to start the fire every morning. She said to me, ‘What do you do in life?’ and I said ‘I’m a writer.’ She said, ‘How much do you write?’ and I said, ‘Three pages a day.’ She said, ‘I’m going to check at the end of every day. If you haven’t written your three pages and you don’t bring up the coal, you can’t stay here.’ She did that, Stella Pullman, and it was under her fierce and compassionate surveillance that I wrote my first novel, The Favourite Game.

From The Wisdom Of Leonard Cohen by Kevin Perry. GQ: Jan 19, 2012

The King Of Bohemia and William IV welcomed Leonard Cohen to London on a dreary December day in 1959. The two pubs stood adjacent to 19B Hampstead High Street, a small, three-story boardinghouse which, despite its address, was actually tucked around the corner on Gayton Road.

From Various Positions A Life Of Leonard Cohen by Ira B. Nadel (1996)

Photos taken 2015 by Ruth Pietroni

20150807_130901Update 25 November 2016:  Daniel Saunders offers this photo of the same address, pointing out that “19b is round the back of the shop.”

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  1. Leonard Cohen: A Remarkable Life by Anthony Reynolds (2012) []

“I didn’t come to Coachella to fool you” Leonard Cohen’s Profound Performance Of Hallelujah – Coachella 2009

“Just because I wasn’t there doesn’t mean I can’t remember it.”

That line, lifted from Horseman by Richard Russo, characterizes the feelings generated when I view this video of Leonard Cohen performing Hallelujah at Coachella from from the Songs from the Road” DVD. When, for example, the youthful crowd shouts “Leonard, Leonard, Leonard, Leonard …” and then erupts following Leonard’s local reference, “I didn’t come to Coachella to fool you,” I’m not only in the desert with them but I’m about 25 years old.

The Apr 17, 2009 Leonard Cohen Coachella Show was special for many reasons. Read about it at “Here is Leonard Cohen! He is super old. I love him. He was so incredible.” The Kids, Cohen, & Coachella 2009.

Other Coachella Posts:

Leonard Cohen – Hallelujah
Coachella: April 17, 2009

“We’re in the middle of the Flood” Leonard Cohen On Why He Hasn’t Read Lorca’s Or His Own Biography (1992)

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People have time to sit around reading biographies? Haven’t they heard the bad news? We’re in the middle of the Flood. Well, maybe that’s the appropriate behavior in a flood: Get yourself a corner, slippers, tweed jacket with leather elbows; light the old pipe, and break open the bio and spend a pleasant evening.quotedown2

Leonard Cohen

For context, the paragraph preceding this quotation follows:

Lorca’s vision was of “a universe I understood thoroughly,” Cohen says, “and I began to pursue it, to follow it, and to live in it.” But he would not read the poet’s hefty biography published last year. He won’t even read his own, the recently published and scholarly “Prophet of the Heart,” written by Loranne S. Dorman and Clive L. Rawlins.

From Leonard Cohen, Pain Free by Sheldon Teitelbaum. Los Angeles Times: April 05, 1992. Originally posted June 7, 2014 at DrHGuy.com, a predecessor of Cohencentric

“Here is Leonard Cohen! He is super old. I love him. He was so incredible.” The Kids, Cohen, & Coachella 2009

“We’d played festivals in the past, and I’m not crazy about the setup.”

Leonard Cohen in anticipation of Coachella

In Leonard Cohen’s February 20, 2009 interview with the LA Times, he voiced concern about his April 17, 2009 show at the Coachella Valley Music and Arts Festival:

“We’d played festivals in the past, and I’m not crazy about the setup. You’re on a roster with a whole lot of other people. You don’t have the evening. I like to be in a room with people for three hours, have a beginning, middle and an end. We can’t do our whole set, it’s not our rhythm. But we have heard it’s a special hospitality there. We’ll play our best and look forward to it.”

In addition to the environment and the staging logistics listed by Cohen other potential hazards also loomed ominously.

Cohen would be trapped, for example, between the personification of pop music nostalgia, Paul McCartney, the headliner of the first night who would would be playing the evening’s grand finale, and the multitude of hip and trendy bands who were invited precisely because they were currently surfing on the waves of popularity. And, as can ascertained by the 2009 Coachella poster below, Leonard did not receive top billing.

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“What I was after was a significant high, so during the ’50’s and ’60s I tried everything I could get my hands on. But in time I found that this high became more available through other forms of activity…” Leonard Cohen

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What I was after was a significant high, so during the ’50’s and ’60’s I tried everything I could get my hands on. But in time I found that this high became more available through other forms of activity. And the mind that is produced by certain kinds of study, certain kinds of discipline, is so much more finely-attuned to those areas you want to get the news from that, in the end, even using hashish is like treating a pocket watch with a sledgehammer. I wouldn’t go near drugs nowadays. Cigarettes are the only drugs I’m combating now.quotedown2

Leonard Cohen

 

From Read Leonard Cohen’s exclusive interview with Hot Press from 1988 by Joe Jackson (Hot Press: 11 Nov 2016)