Elvis Presley’s Organs Had Swelled to Twice Their Size: Inside The King’s Tragic Final Hours

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 but failed. A hospital tried to revive him and that failed too. His doctor pronounced him dead at three o’clock this afternoon.

Elvis Presley was the King of Rock and Roll. His meteoric rise to fame in the mid-1950s made him one of the world’s first international superstars. He sold an estimated one billion records.

But at 3 p.m. on the 16th of August 1977, Elvis Presley is pronounced dead. He had 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 sparked speculation. His death is still shrouded in mystery. Elvis was not a well man.

I’m staggered by 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. 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 inquiry.

These are the medical papers relating to Elvis’s autopsy. Together with other information gathered, they provide numerous clues as to how Elvis lived his life. 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? 4 p.m., 15th of August 1977, Graceland in Memphis. Elvis wakes up next to his 21-year-old fiancée, 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’s 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. Fifty percent of his earnings go to his manager, Colonel Tom Parker. Touring is now the only way for Elvis to remain solvent.

For someone who needs to be physically fit for demanding stage performances, 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. 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 high cholesterol, which is associated with obesity. In the last few years Elvis has battled with his weight. When he started putting that weight on, people started worrying about him a whole lot.

Elvis wasn’t a food connoisseur type of guy. He liked the normal Southern type foods. Elvis loved low-fiber, 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 making 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. When his future wife first met him, they were 12 years old at Hume’s High School in music class. She didn’t know what it was but she 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’s persona did change once he stepped on that stage.

He was sort of a different guy and he shocked people a little bit because they 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 just to you. That is a gift.

He was a beautiful man. No picture ever 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 the chief medical investigator examined Elvis Presley’s scalp, the first quarter inch of his hair was white. His hair was being dyed jet black—what they called Elvis black.

Now if he let his hair grow out unattended, it would have been white as snow. At 42 you may have expected Elvis to have had a few gray 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 graying. The second is stress. It’s likely that it’s a combination of the two.

Memphis, around 8 p.m., 15th of August 1977. Elvis’s 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 nine-year-old daughter Lisa Marie from his marriage to Priscilla Presley, along with his father Vernon. Elvis had large responsibilities. He 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. Elvis’s checking account when he died was a little bit over one million dollars. People say “wow, he’s only got a million dollars—where’d all that money go?”

He gave away Cadillacs. He gave friends two Cadillacs and paid for two operations. He was a very giving person, very generous to a fault.

If he knew that you needed something but you were afraid to ask him, he would volunteer to give it to you. 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, it’s not sure that Elvis was fit enough to go back on the road. In particular the internal examination throws up some interesting findings.

His 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’s liver may not have been actually diseased but it was spectacularly large—at 3,500 grams it is twice the normal weight of a human liver. It’s been a long time since anyone has seen a liver that’s so large.

The commonest cause of such a large liver is someone who is chronically abusing alcohol and drinking a liter or more of spirits a day. Elvis had kind of a mental stigma when it came to alcohol. He just thought it was not something he wanted to get into.

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 alcohol is excluded, there are a number of other possible causes for a fatty liver. 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 prescribed medication. There was a suspicion that Elvis had been heavily involved in drugs. Some 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 and Roll? On the 16th of August 1977, the King of Rock and 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 there is 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. 10:30 p.m., 15th of August 1977.

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 just gets started at night and then they gotta wind down, so it was his style. It was easier for Elvis to get around because in daytime there could be riots and crowds would gather real quickly and he’d get trapped having to sign a million autographs. But avoiding being mobbed by fans was not the only reason for his nocturnal lifestyle.

Elvis suffered from chronic insomnia. The toxicology report shows there are staggering nine different prescription drugs in Elvis’s body at the time of his death, and four of them were 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. 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 two o’clock when he called a friend just a few days before he died and asked her to come out to the house, she went in and said “what’s the matter honey?” and he said “I can’t sleep.” She put her hand on his arm and finally about 6:30 he said “I think I’m okay 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. He doted on his mother. He adored his mother and it was evident in every conversation.

He felt like he almost couldn’t go on without her. Elvis’s mom—if she had not passed on early—there was a very very good chance that others would be alive today. You’ve got an intense loss and an intense gap in somebody’s life and he would have been struggling with how to fill it.

He would have used any vice he could that was around that he felt would feed that loss. Sleeping pills weren’t the only pharmaceuticals that Elvis was taking. In the toxicology report there is 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. The presence of the combination of these two suggests a man who is suffering from severe anxiety and depression. Studies have shown that when you have disrupted sleep it can lead to all kinds of physiological and psychological problems such as anxiety.

In people who have suffered from depression, when they don’t get enough sleep it would have completely affected his mood. At 12:28 a.m. Elvis returns to Graceland from the dentist, possibly with painkillers. Fan Robert Cole takes the last photo of Elvis alive.

Elvis has around nine hours to live. When looking at the toxicology report, codeine is present in his bloodstream at dangerously high levels. 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, Elvis was suffering from an agonizing 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 toothache might be the reason why he’s taking so much codeine. 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. 2:15 a.m. 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 writes out a prescription. Two of them are amphetamine-type drugs—Dexedrine and Biphetamine—essentially legal forms of speed. Neither of these drugs was present in Elvis’s body when he died.

However, the presence of these drugs leads to the belief 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 started taking too many of them. When he woke up the next day he’d have to take pills to wake up, 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. Elvis may have been using multiple prescription medications to regulate his lifestyle, but other than codeine they are present in fairly small amounts.

None of them on their own are life-threatening. However, there was one drug in Elvis’s 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.

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.

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 an 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’s death.

3 a.m. Elvis calls his step-brother Rick Stanley and asks him to pick up a prescription. Elvis was hiding yet another secret. He was obtaining prescription drugs from multiple sources.

Dr. Nick found out about it so he would call and they would go out late at night, take the stuff out of the pills and 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. Nick, he would just get it from somewhere else.

People find it extremely hard to say no to Elvis Presley. He controlled 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.

4 a.m., 16th of August 1977. Elvis has just hours left to live. Most people in Elvis’s 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.

4:30 a.m. Whilst Elvis’s 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 percent 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 buildup 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.

This means that any exercise or fitness regime should have been very carefully planned. 4:35 a.m. Elvis heads to his piano room with his cousin Billy, wife Jo, and his fiancée 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.”

Around 5 a.m. Elvis heads up to bed. On the way he finds his daughter Lisa Marie is still awake, tucks her into bed, and kisses her good night.

Back in his room Elvis calls Rick demanding more sleeping pills. Rick delivers the first packet and Elvis tries to fall asleep. Still awake at 7 a.m., 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. Despite the number of pills Elvis may have taken, he still can’t sleep. It isn’t just the insomnia that’s keeping him awake.

Reports suggest he was also suffering from severe abdominal pain. At 9:00 a.m. he heads to the bathroom. Ginger goes back to sleep, unaware that the King of Rock and Roll could be just moments away from dying.

From the medical information we already know that many of Elvis’s internal organs are abnormal and some are about twice their normal size. The same is true of the colon or the large bowel. When they look at it, the normal size should be about three inches.

Elvis’s was distended to about five inches and it was full of gray, chalk-like material. He couldn’t have had his bowel open for several days and this would have been very uncomfortable or frankly painful. This potentially dangerous problem had been known about.

He had all that clay in there and they don’t think he could have passed it. It would have taken some significant medical intervention just to clear that out. Dr. Nichopoulos tried to get the doctors in Memphis to operate on Elvis and reduce his colon.

They said they were scared to operate on Elvis. He’s a superstar, man—if something happens we could really be in trouble. So 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 feces causing it to stretch, and we can see that that has happened to Elvis. He’s clearly suffering from an extreme case of constipation. 9:05 a.m.

By now Elvis is likely to be experiencing extreme discomfort and no movement in his bowels. 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.

At some point Elvis collapses on the floor. He was laying on his left side with his knees pulled up—not in the fetal position but right knee over the left knee on the floor and his head against the floor. At around 2 p.m. in the afternoon Ginger wakes up to find that Elvis hasn’t returned from the bathroom.

Elvis has been alone for around five hours. Ginger finds him unresponsive. He’s not breathing.

She immediately sounds the alarm and calls downstairs for help. An on-duty maid sends up Al Strada, one of Elvis’s security guards, and his road manager Joe Esposito. 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’s jaw is too stiff and his mouth won’t open. They 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. In retrospect 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’s father Vernon also hears the commotion and runs into the bathroom. Vernon was distraught. He saw what was going on. He was saying “please don’t die, please don’t die.”

He saw the condition of Elvis and he had to have known that this wasn’t going to 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. 2:33 p.m.

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.

When one person walked into the emergency area it was so evident to them that he had been gone for so long. They were doing CPR. They said “please stop, don’t do this to him.”

How could they not tell he was dead by looking at him? At around 3 p.m. on the 16th of August 1977 Elvis Presley is pronounced dead. The world mourns the shocking passing of the King of Rock and Roll.

Elvis Presley died today. He was 42. He was found at his home in Memphis not breathing.

At that moment one felt like somebody just stabbed them with a red-hot knife in their heart. They never had a feeling like that in their life. They were just shaking all over and everybody was crying.

Mr. Presley ran up and hugged them and said “George, we’ve lost him. I’ve lost my son. You’ve lost your best friend.” It was just the saddest scene they’d ever seen in their entire lifetime.

Elvis Presley’s autopsy was performed on August the 16th, 1977 at 7 p.m. But before it was even finished, with the world’s media waiting for news, a statement was unusually released. There were a thousand people outside the hospital by then.

All the news media and news outlets wanted to know what had happened. They announced that an autopsy had been performed. They 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.

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’s heart to stop beating. Dr. Richard Shepherd has been thoroughly investigating Elvis Presley’s medical documents and key evidence from his autopsy.

He has 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 he still hasn’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 there’s 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 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 him as suspicious. Where he was found, he was able to put himself in the same position that his body was based upon moisture on the floor where his mouth had lost some fluids onto the floor.

His feet were 40 inches away from the bottom of the commode which he was sitting on when he died. This position in which Mr. Presley was in was he had taken at least two full steps away from the commode before he collapsed. The fact that he’d stood up from the loo or knocked over the bottles and dropped his book, he’d staggered, fallen, suggests to the mind that he may have been going to seek help.

So he had an awareness of some disturbance or pain or abnormality and to the mind that suggests that this was a cardiac event. Dr. Shepherd has found further evidence to support the theory that Elvis’s death was not directly related to drugs. Elvis had a spectacularly enlarged liver.

It could have 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’s 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 higher pressure around the body.

Elvis’s heart was so big it was 520 grams when a normal man’s heart is only 350. It 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 have raised the pressure within his abdomen and within his chest. This would have resulted in a known physiological change called the Valsalva maneuver. The Valsalva maneuver is anything actually that increases the pressure in the abdomen and the chest.

It can be straining to defecate, it can 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 vein 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.

It obviously was Elvis’s time to leave. Was it a pretty picture? No. But 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.

They asked him one night, “Do you think people will remember me?” “Yeah baby, they’re going to remember you.” And he will always be remembered with love and giving, and he gave until he couldn’t give any more.