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.
__________________________

  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’s Response Following The September 11 Attacks

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On Sept. 11,  Mr. Cohen was in India visiting another teacher, Ramesh Balsekar. He returned to the States as soon as he could. The level of suffering that he believes is always present in the world had been raised to unfathomable heights. And Mr. Cohen knew better than to try to comfort the comfortless.

quoteup2
You know, there’s an ancient Hebrew blessing that is said upon hearing bad news: ‘Blessed art thou, king of the universe, the true judge.’ It’s impossible for us to discern the pattern of events and the unfolding of a world which is not entirely our making. So I can only say that.quotedown2

Leonard Cohen

 

From Look Who’s Back at 67: Gentle Leonard Cohen by Frank DiGiacomo. New York Observer: Oct 15, 2001. Photo by Coast Guard News Originally posted May 2, 2014 at DrHGuy.com, a predecessor of Cohencentric

Leonard Cohen Reveals Death Camps As Origin Of “Dance Me To The End Of Love”

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quoteup2
‘Dance Me To The End Of Love’ … it’s curious how songs begin because the origin of the song, every song, has a kind of grain or seed that somebody hands you or the world hands you and that’s why the process is so mysterious about writing a song. But that came from just hearing or reading or knowing that in the death camps, beside the crematoria, in certain of the death camps, a string quartet was pressed into performance while this horror was going on, those were the people whose fate was this horror also. And they would be playing classical music while their fellow prisoners were being killed and burnt. So, that music, ‘Dance me to your beauty with a burning violin,’ meaning the beauty there of being the consummation of life, the end of this existence and of the passionate element in that consummation. But, it is the same language that we use for surrender to the beloved, so that the song — it’s not important that anybody knows the genesis of it, because if the language comes from that passionate resource, it will be able to embrace all passionate activity.quotedown2

Leonard Cohen

 

Leonard Cohen, CBC Radio Interview (August 26, 1995). Originally posted May 14, 2011 at DrHGuy.com, a predecessor of Cohencentric

Video: The “Best Glastonbury Performance Ever” – Leonard Cohen 2008: Goosebumps Version Of Hallelujah

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glastonnburyThere’s a blaze of light in every word
It doesn’t matter which you heard
The holy or the broken hallelujah

Leonard Cohen’s 2008 performance garnered the #1 ranking in The 100 best Glastonbury performances ever by Thomas H Green (Telegraph: 20 Jun 2014):

The gravel-voiced 73-year-old songsmith’s greatest hits set, performed with wonderful graciousness under a balmy Sunday evening sun – and including ’Hallelujah’ with crowd-sung choruses – was sheer, unadulterated bliss.

Leonard Cohen at Glastonbury Posts:

Leonard Cohen – Hallelujah
Glastonbury: June 28, 2008
Video by routeoz02

Note: Originally posted June 21, 2014 at DrHGuy.com, a predecessor of Cohencentric

Leonard Cohen Tribute: A Bunch of Lonesome Heroes + Alberto Manzano Poetry Reading – Zamora, Aug 19, 2017

From A Bunch of Lonesome Heroes Facebook Page:

“A Bunch of Lonesome Heroes” is a song by Leonard Cohen and also the name chosen by the band A Bunch of Lonesome Heroes to spread their music and poetry. If you want to enjoy with them and your tribute concert to Leonard Cohen do not miss them this Saturday, August 19, at 22 pm., in the cathedral square.

“I am interested in my internal landscape and just paint pictures of it” Leonard Cohen


Q: Do you think your lyrics and way of life add to the Cohen mystique?

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I think you do have to be in contact with yourself or be interested in establishing contact with yourself. A lot of people aren’t interested in their higher state. It just happens that I am interested in my internal landscape and just paint pictures of it.quotedown2

Leonard Cohen

From The Sounds Interview 1971 by Billy Walker. Sounds: October 23, 1971. Originally posted July 1, 2013 at DrHGuy.com, a predecessor of Cohencentric

Listen To “Best Glastonbury Performance Ever” – 2008 Leonard Cohen Glastonbury Show

skyLeonard Cohen’s June 28, 2008 Glastonbury show was ranked the “Best Glastonbury Performance Ever” by The Telegraph. Check out these posts about that concert:

Setlist

Dance Me to the End of Love
The Future
Ain’t No Cure for Love
Bird on the Wire
Everybody Knows
Who By Fire
Hey, That’s No Way To Say Goodbye
So Long, Marianne
Tower Of Song
Suzanne
Hallelujah
Democracy
I’m Your Man
Closing Time
Anthem
First We Take Manhattan

Credit Due Department: Photo by wobblyturkey

Listen To “Mpivahiny” – Leonard Cohen’s “The Stranger Song” In Malagasy

This cover is so beautiful and moving that
it can cause the fall of a few tears!!!

Dominique BOILE sends this enthusiastic recommendation for this Malagasy cover of Leonard Cohen’s The Stranger Song:

Band: Lôlô Sy Ny Tariny
Country: France
Year: 1982
Album: Madagascar
Song: Mpivahiny (in Malagasy) The Stranger Song

Dr. Chantal Ringuet To Lead Leonard Cohen Course At McGill School of Continuing Studies

Leonard Cohen: In Words and Music

Leonard Cohen: In Words and Music is a course led by Dr. Chantal Ringuet at the McGill School of Continuing Studies, beginning on Oct 16,  2017. The followiing is from the McGill website:

Join us for an overview of Leonard Cohen’s work and journey.

Gain an understanding of the greater cultural context of the writers of the beat generation, folk singers in the US, the turbulence of the 1960s, Québec’s Quiet Revolution, modernism and postmodernism, and the Cold War; all through Leonard Cohen’s work. You will learn all about the emergence of the young McGill poet and his position as an outsider in his community.

The focus will then shift from the writer to the acclaimed singer, composer, and songwriter that he became when he turned to performance and recording. As a cultural icon, Cohen will be studied starting with the emergence of his first album, 1969’s Songs of Leonard Cohen, which later became a cultural phenomenon. We will follow his resurgence after 1988’s I’m Your Man and his world fame after the tours of 2008-2012.

More information about the course and enrollment can be found at Leonard Cohen: In Words and Music

Thanks to Chantal Ringuet  and Francis Mus, who alerted me to this event.