Sunday, March 1, 2009

Disinformation: The Presley Report - The Sutured Thoracotomy

The Presley Commission took great offense at the Shelby County Medical Examiner’s reference to a “sutured thoracotomy” on page one of the 2-page Report of Investigation by County Medical Examiner. Their position was two-fold: 1) Since the thoracotomy was “sutured,” it could not have been a procedure performed on Elvis Presley’s body in the Emergency Room (they believe an opening in the chest wall on a cadaver would not be sewn up after the person had been declared dead), and, 2) The reason for this incision could not have been to access the interior chest (heart, lungs, etc.) because the incision was located at the ribs and thus would not allow for that type of access.

I believe this position clearly illustrates that the Presley Report was not the objective, truth-seeking operation is claimed to be, and that its sole purpose was/is to spread any and all information, rumors, conjecture, and/or theories that support only a faked death. It also proves that the Presley Commission did not objectively research the thoracotomy issue. What other conclusion can be reached? Five minutes of objective research on the thoracotomy procedure would have resolved the Commission’s questions pertaining to the procedure as outlined in the Medical Examiner’s report; instead, the Presley Commission, in typical conspiratorial mind-set, concluded that the procedure had sinister implications, and decided then and there that the body in the ER was not that of Elvis Presley.

Five minutes of research…that’s all it took. But the Presley Commission didn’t even do that. We must assume, then, that nothing in the Presley Report has been adequately researched or analyzed, if the thoracotomy analysis in any way exemplifies their approach to these topics and questions.

Let’s take a look at the Commission’s claims regarding the “sutured thoracotomy” that is mentioned in the 2-page Medical Examiner’s report:

“The next mark indicated on the drawing, is a ‘sutured thoracotomy.’ This is a small incision made in the space normally between the second and third rib. This technique is primarily used to drain fluids from the [thoracic] (chest) cavity, caused from excess fluid around the lungs, as in a case of pneumonia, for example. This is not a procedure used to insert a gloved hand, to perform cardiac massage. The spacing between the ribs measures in the centimeter range, and is [too] small to fit a hand into as indicated in some statements.”

Now, let’s compare the Presley Commission’s claims to the following information on a procedure called anterolateral thoracotomy:

“Anterolateral thoracotomy [the incision made to the front, and side] is performed upon the anterior [front] chest wall; left anterolateral thoracotomy is the incision of choice for open chest massage, a critical maneuver in the management of traumatic cardiac arrest. Anterolateral thoracotomy, like most surgical incisions, requires the use of tissue retractors - in this case, a ‘rib spreader' such as the Tuffier retractor." [This retractor is pictured above.]

So, simply stated, an anterolateral thoracotomy is an incision on the front left of the chest...exactly what was done in the E.R. during the resuscitation efforts. Based on this definition, we find two key pieces of information that counter and prove false the Presley Commission's claims: 1) the procedure is used for open chest massage (of the heart), and 2) the procedure may require a rib spreader, which allows access to the heart (meaning the small space between the ribs mentioned by the Commission is not relevant).
Why didn’t the Presley Commission locate this same information, since they claim to have researched and investigated these issues? The Presley Commission specifically states:

“This is not a procedure used to insert a gloved hand, to perform cardiac massage.”


“The spacing between the ribs measures in the centimeter range, and is [too] small to fit a hand into…”

In fact, contrary to what the Presley Commissions states here, it is the exact procedure used to “insert a gloved hand…to perform cardiac massage.”

Further, consider the following, from

“A resuscitative or emergency thoracotomy may be performed to resuscitate a patient who is near death as a result of a chest injury. An emergency thoracotomy provides access to the chest cavity to control injury-related bleeding from the heart, cardiac compressions to restore a normal heart rhythm, or to relieve pressure on the heart caused by cardiac tamponade (accumulation of fluid in the space between the heart's muscle and outer lining).

“In the case of an emergency thoracotomy, the procedure performed depends on the type and extent of injury. The heart may be exposed so that direct cardiac compressions can be performed; the physician may use one hand or both hands to manually pump blood through the heart.”

Based on the information above, it’s pretty clear that a thoracotomy is used to access the heart in a cardiac emergency. Does the Presley Commission tell us this? No. They tell us the exact opposite, even though the information above was and is readily available to any researcher.

The Presley Commission then writes:

“Once again, this invalidates the accuracy of this document. Another very significant term used, is ‘sutured.’ A cadaver is not sutured after a thoracotomy has been done. The tubing used is normally left in the body, and in some obscure cases, may be removed. In either case, there would not be a suture.”

Now, the Presley Commission in this passage is trying to convince the reader that they did the research on this subject, and thus have some authority to comment on how a thoracotomy is performed, and what steps are taken at the conclusion of the procedure. However, if they researched how a thoracotomy is performed, in terms of the removal of tubing and such (they reference only the draining of fluid as the reason for this procedure), then how did they miss the fact that this procedure is used for open cardiac massage (which they implicitly deny it is used for)? Interesting that they supposedly researched and analyzed this information, but only those facts that they believe support their conclusions actually made it into the Presley Report. The fact that a thoracotomy is used to access the heart apparently was not part of the research materials they consulted.

Since they are mistaken on what the procedure can be used for, their contention that the thoracotomy "invalidates the accuracy" of the Medical Examiner's report is without merit.

Also, on the question of whether a cadaver is sutured, we might consider the following, from the same source cited above:
“Once the procedure that required the incision is completed, the chest wall is closed. The layers of skin, muscle, and other tissues are closed with stitches or staples. If the breastbone was cut (as in the case of a median sternotomy), it is stitched back together with wire.”

This most likely refers to the closing of the wound after the patient has been successfully resuscitated. However, it is certainly possible that out of deference to a patient, who instead of being successfully resuscitated, has just died, the doctor would close the open wound. There is also the possibility that a wound like this would be sutured due to the chance of leakage during transport (when the body is removed from the ER).

To suggest that a thoracotomy incision is not (or is rarely) closed/sutured on a dead body, as the Commission contends, and then to conclude that such a closure has sinister implications, is absurd. Is a thoracotomy incision on a cadaver typically sutured? No, it's not. But, is a thoracotomy incision ever sutured? Of course it is. So, why is this such a puzzling question for the Presley Commission, that the thoracotomy incision in this case was sutured?

We continue with the Presley Commission’s analysis of the thoracotomy:

“This [the suturing, mentioned above] would indicate that this procedure had been done days prior to death, to still have the stitches in place, and noted. The various statements indicated that Elvis was very active, playing with Lisa, playing racquetball, and also singing; having sutures in that area of the chest would cause great risk of pulling and/or tearing the stitches out during any of the activities noted. If for argument sake, this was a sutured thoracotomy that had healed, it should have shown a ‘thoracotomy scar.’”

The chest wall had been accessed during resuscitation efforts, so the sutured incision noted at the autopsy was not referring to an opening in the chest made prior to August 16, 1977.

And, obviously, if Elvis had a sutured incision on the morning of the 16th, while he was still alive, he would have been taking things easy, in bed resting, or in the hospital. No one close to Elvis, including his own physician, has ever mentioned such a wound, nor that Elvis had undergone any recent surgical procedure in the days, weeks, or months prior to August 16, 1977.

To close, the facts from August 16, 1977, pertaining to the question of the sutured thoracotomy, are as follows:

3:00pm – 3:30pm: Elvis’s chest was accessed (for a specific reason) using the resuscitative thoracotomy procedure described above.

3:30pm (+): The opening in the chest was sutured after resuscitation efforts were ceased.

7:00pm (+): The sutured opening was noted during the autopsy and included in the Medical Examiner’s report.

Conclusion: There is nothing suspicious about the sutured thoracotomy as noted in the Medical Examiner's report, and the Presley Commission once again exhibits its suspicious inability to understand the facts.