A Medical Note On The Death Of Leonard Cohen

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) []

10 Replies to “A Medical Note On The Death Of Leonard Cohen”

  1. Dianne Locke

    Thank you Allan. I understand now the complexity of illness, treatment side effect , and the mishap of a bad fall, which took Leonard away from us . He had pondered his own ‘ last act preliminaries of death ‘ in an interview on Q Radio . I am thankful he had a living Will, and that his was , death with dignity . Rest In Peace Leonard Cohen . We will ‘think about You long after you are gone’…..Forever you will be in our thoughts and Prayers .

    Sincerely and with Love
    Dianne Locke .

  2. Di

    What a beautiful explanation and confirmation that his death was indeed, a tragedy, not a mystery. Thanks Allan

  3. pat white

    THANKYOU FOR YOUR CONSIDERATIONS TO ALL OF WE LOVING SAD FRIENDS OF LEONARD COHEN.
    PERHAPS THIS IS OUR TIME TO EMBRACE IT ALL…..”LOOK, I DON’T UNDERSTAND A FUCKING THING AT ALL…….HALLELUJAH”
    What do you think???!!!!!!!

  4. Joan King

    This makes very interesting and believable reading….It is something we have all wondered about and what exactly did take place that night….Thank you Allan for your insight.

  5. abegnago

    Frankincense would likely have prevented it. It is a fairly common condition in our race. A great pity he is gone. A great blessing his life amongst us.

  6. Marc

    To pick up on what was said by Allan, maybe Leonard was suffered from multiple myeloma (also called myeloma or Kahler’s disease), a sort of blood cancer as leukemia which affects a variety of bone marrow cells named plasma cells, This form of cancer is characterized by osteolytic tumours (plasmocytomas) in various parts of the body. This diagnosis perfectly could explain the symptomatology of Leonard in his last years : multiple vertebral fractures, asthenia due to anemia, permanent back pain, and in the last phase of the disease, a low platelets count with a major risk of brain hemorrhage particularly after head trauma. The median survival in the absence of bone marrow transplant which is not realized after 65 is about 4 years. What an irony of fate to imagine that illness that caused the passing of Leonard may be of the same type as that which caused the death of two of his more beloved women : his mother Masha and his beautiful Marianne.
    On the other hand, any cancer may cause clotting disorders most often of the thrombotic type such as phlebitis, pulmonary embolism or even ischemic stroke.
    However, vhatever the cause of his death, Leonard misses us cruelly.

  7. Judith Ripp

    Though I understand the interest of LC fans
    in the circumstances surrounding his passing,
    I think his words on the ‘3rd act of life’ must be
    respected: “how it ends is nobody’s business.”