At the time of this writing, the jury is set to decide the fate of Derek Chauvin on Monday 19th, April, 2021. The medical nature of this case has preoccupied my attention for a while now, so I’m going to produce a quick synopsis of what I understand happened to Saint Floyd, may the angels of Heaven bring him many banana mayonnaise sandwiches. I am currently certified as an Advanced EMT; I am not a paramedic, pulmonologist, cardiologist, ER doctor, medical examiner or veterinarian. Consider this entire run-down as a matter of opinion and speculation made by someone with some degree of practical knowledge and experience in similar matters, and nothing more.
The central issue at stake concerns how George Floyd died while being restrained by police officers and Derek Chauvin in particular.
In my view, this entire scenario was distorted by one signature image, and that was the photo of Officer Chauvin seemingly “kneeling on George Floyd’s neck”.
This picture became visual propaganda itself, a symbol containing an entire narrative about a seemingly callous, arrogant cop crushing a black man’s neck and forcing his face into the pavement. That freeze-frame was part of a video, which itself only shows a brief snippet of an entire police encounter and strips it of all context. It circulated around the planet and single-handedly upended the concept of policing in the western world, but objectively, what actually happened?
We have to take George Floyd’s medical history into account. This was a 46 year old black male with an extensive past history of polydrug use (meaning he used multiple types of drugs), a tobacco habit, and significant cardiovascular disease. Specifically, he had hypertension that required medical intervention (216/160 BP) and cardiomegaly, meaning his heart was enlarged. Despite what certain prosecution witnesses allege, George Floyd did NOT have the type of left ventricular hypertrophy associated with athletes. People engaged in heavy endurance exercise like yours truly can develop a mostly benign form of heart enlargement in which the left ventricle (the biggest, most important chamber of the heart) becomes thicker and more muscular in response to frequent training. According to the autopsy report, Floyd’s heart enlargement was from constantly pushing against peripheral high blood pressure which was effectively stretching and thinning both ventricles of his heart exactly like a balloon. This is the Bad Type of cardiomegaly and puts the patient at risk for all sorts of problems such as sudden cardiac dysrhythmias. Stretched out cardiac muscle doesn’t conduct electrical impulses the way it’s supposed to. The primary coronary arteries of his heart had multifocal atherosclerosis with narrowing of 75 to 90 %, meaning that the most crucial blood supply for his cardiac muscle had multiple sites of extremely compromised function.
Let me also remind you that despite its name, heart disease is not necessarily limited merely to the heart. Those same blood vessels run through your brain and there is a significant risk of stroke for an individual with a history of high blood pressure and atherosclerosis.
As for his drug use, one look at the autopsy report will show that he had a veritable cocktail of multiple drugs in his system, with fentanyl in particular exceeding the lethal limits for an opiate naïve person. This doesn’t mean that level of fentanyl was deadly for George Floyd per se, merely that it would certainly kill someone with no opiate tolerance. Based on what was heard during the trial, Floyd’s drug tolerance on any given day was something of a moving target given his inconsistent usage patterns and periods of “sobriety”. Also, his tobacco use worsened his chances for stroke and heart attack significantly.
His medical condition on May 25th, 2020
On the day of Floyd’s attempted arrest, he apparently ingested a combination of methamphetamines and fentanyl, some or all of which he may have spit out into the back of the police car when officers tried to place him in the back of their vehicle. One speculation is that Floyd realized he had a lethal dose in his mouth and was attempting to avoid overdose. I would add that the oral mucosa is actually an excellent route of drug administration meaning that George Floyd certainly would’ve absorbed some additional amount of drugs into his system by merely having them in his mouth, in addition to whatever amount he had taken earlier in the day.
Just prior to Floyd’s police encounter he was observed in an agitated state that could’ve easily met the definition of “altered mental status” and was for a period of time either fully or partially unresponsive in the vehicle he was found in by police officers. That sure sounds an awful lot like an opiate overdose to me and could’ve very easily ended up as a trip to the hospital in an ambulance under different circumstances. He was of course admitted to the hospital for multiple days regarding exactly such an overdose a year prior.
During his encounter with police officers George Floyd was extremely agitated, resisted arrest, and was eventually restrained on the pavement in a prone position by 3 cops. While on the ground, he went into apparent full cardiac arrest, and by the time EMS arrived he was pulseless, unresponsive, and displayed asystole on their cardiac monitor. This means that he was graveyard dead when they arrived with a total flatline. He was worked according to the ACLS protocols for Cardiac Arrest PEA and Asystole and received epinephrine en route to the hospital. To put this in layman’s terms, George Floyd’s heart didn’t have an electrical rhythm and would not have responded to defibrillation (shocking him), so the attending medic gave him a dose of adrenalin in a last ditch effort to restart his heart. Epinephrine has a VERY poor track record of successful “saves” under these circumstances. I can tell you from my very own personal experience that administering it in such situations may restore some degree of heart function, but this merely delays the inevitable and the patient will almost certainly be declared dead by the Emergency Room physician or another doctor within a matter of hours. Epinephrine in out-of-hospital arrest remains controversial as a treatment, is ultimately ineffective over 95 % of the time, and seems completely useless for producing a salvageable patient with intact neurological function.
In my speculative opinion, administration of epinephrine may have restored some sort of cardiac rhythm to George Floyd, but was obviously futile and ultimately served to further muddy the waters during the trial. (We see a similar pattern with discussions of Floyd’s oximetry, or how much oxygen was present in his bloodstream. The efforts of the medical providers to resuscitate him would’ve restored some level of oxygenation.)
Further complicating matters is the issue of possible carbon monoxide exposure raised by the defense. Whether this actually happened is entirely speculation, but it does highlight some significant problems with the prosecution. During the course of his cardiac arrest, George Floyd would’ve only been subjected to pulse oximetry, end-tidal CO2 monitoring, and Arterial Blood Gas testing. None of these tests would be able to definitely indicate or rule out carbon monoxide poisoning. You need a very specific blood gas test for carboxyhemoglobin, which would almost certainly NOT be ordered by a doctor unless the patient was a burn victim or had a known carbon monoxide exposure. Clinically the problem with carbon monoxide is that like oxygen, it binds to hemoglobin. Pulse oximeters cannot distinguish between oxygen or carbon monoxide bound to hemoglobin, and basic ABG testing also cannot make a determination because historically most lab-testing uses an algorithm to calculate the oxygen bound to hemoglobin based on how much oxygen is freely circulating in blood plasma. Blood plasma levels of oxygen will tell you nothing about carbon monoxide attached to hemoglobin.
The prosecution claims there is indeed such data and it was merely “buried in the medical examiner’s report”, but of course bringing up this rebuttal in the 11th hour is highly suspicious. I find it particularly odd since the ER doctor and the medical examiner neglected to mention any pertinent negatives about carbon monoxide exposure.
Finally, much was made of hypoxia and the prosecution played fast and loose with the clinical definition. Hypoxia is merely lack of oxygenation to tissues, which could result from ANY NUMBER of causes. It could happen on a cellular level as with cyanide poisoning, or from being thrown out of an airlock into space. It is the clinical equivalent of Karl Childers declaring a tiller “ain’t got no gas in it”. It does not necessarily mean you were choked to death.
Putting it all together
The prosecution alleges Floyd was killed via mechanical asphyxiation from the position he was placed in by officers. That is indeed a possibility, but it doesn’t necessarily indicate any criminal wrong-doing and we need to keep one rather obvious fact in mind: George Floyd was medically speaking, a ticking timebomb on a lethal cocktail of drugs. Despite all claims by the prosecution, this is certainly NOT a healthy 46 year old man and he was engaged in a lifestyle pattern that put him at risk for sudden death from any number of causes including drug overdose, heart attack, stroke, and a variety of lethal dysrhythmias. He could’ve very well had a heart attack and died right under officer Chauvin. The prosecution and their witnesses are seemingly unaware that fentanyl is a potent opioid analgesic routinely given to patients complaining of chest pain. If Floyd was having a heart attack, he likely wouldn’t have even known it!
The question to me is, would a normal, healthy man have died under similar circumstances if restrained by police officers, and I find that extremely unlikely based on the fragile, unstable nature of George Floyd’s underlying health status. He could’ve conceivably had a deadly stroke merely walking up a set of stairs. The combination of stimulants and physical stress could’ve certainly generated a lethal arrhythmia as posited by the defense counsel’s expert witness, but ultimately, he had so many comorbidities and was in cardiac arrest for so long that we may never truly know what killed him.
There was no conclusive evidence in the medical examiner’s report to support the idea that Derek Chauvin physically crushed Floyd’s neck closed and asphyxiated him. Nor was there any clinical smoking gun to show that Floyd experienced a lethal arrhythmia. His exact cause of death was ambiguous and unclear. The prosecution essentially had to argue that it was a combination of pressures on different parts of George Floyd’s body that aligned in just the right manner via the efforts of multiple officers that stopped Floyd from breathing, which constitutes a rather complex explanation for a death that could be more easily explained as the inevitable conclusion to decades of living a very dangerous lifestyle.
George Floyd was a 46 year old man still abusing lethal amounts of fentanyl; all the speculation in the world about how he died in this particular circumstance doesn’t change the fact he almost certainly wouldn’t have lived much past the age of 50.
Floyd was in the end just a sudden death waiting to happen.
One thing doesn’t remain unclear. We know all too well what happened in the wake of George Floyd’s death; we were subjected to over a year of riots, murders and wide, structural reductions in policing. One 46 year old addict with an unhealthy heart has the misfortune of dying during the course of an arrest and in return apocalyptic violence was visited on the United States. Ironically, Floyd’s death lead to the murder of more blacks by their own kin than any year in decades. The trial of Derek Chauvin itself was elevated into a hyper-real public spectacle fit to make Jean Baudrillard himself crawl out of his grave and write another book.
All of this chaos done in the name of a 46 year old drug addict with a lengthy criminal record who finally succumbed to consequences of his own making.