I had heard that Presley died on the toilet, but I’d assumed the location was happenstance, as it was with Judy Garland and Lenny Bruce: an embarrassing setting for a standard celebrity overdose. But the straining-at-stool theory made some sense. With all three autopsies—that of J.W., Mr. K., and E., as Presley’s intimates called him—the collapse was abrupt and the autopsy revealed no obvious cause of death. (Though Presley had traces of several prescription drugs in his blood, none was present at a lethal level.) What Elvis’s autopsy did unambiguously reveal was a colon two to three times normal size.
At the time it happened, no one pinned Presley’s death on his colon or efforts to empty it. It wasn’t until years later that Dan Warlick, the coroner on the case, came forward with the megacolon/straining-at-stool theory. Presley’s longtime doctor, George “Nick” Nichopoulos, was an eager adopter of Warlick’s theory. Nichopoulos had been vilified for overprescribing prescription drugs, and many fans blamed him for Presley’s death. He wrote a memoir and made himself available to talk to the press. Few seemed inclined to listen. The reference I came across was on a website hawking herbal constipation remedies. A short piece headlined “Elvis Died of Constipation” had run as the site’s lead story (and its middle and last story) under the category Constipation News.
Why didn’t the colonic inertia theory come up earlier? Nichopoulos says that at the time, he had never heard of it. Nor had the gastroenterologist who treated Presley in the 1970s. “Nobody knew about it back then,” Nichopoulos says.
I recall reading in one of Charles Tyrrell’s books that advances in medical knowledge about the colon had, historically, been hobbled by the organ’s repulsiveness. Eighteenth-and nineteenth-century dissectors and anatomy instructors would, he claimed, promptly cut the lower bowel out of the cadaver and throw it away, “on account of its scent-bag propensities and nastiness.” Michael Sappol, a historian with the National Library of Medicine who has written extensively on the history of anatomy, said he’d heard this too. Leading me to wonder: Does distaste slow progress in treating diseases of the bowel? Does the excretion taboo discourage research, discussion, media attention?
I recall riding a bus in San Francisco, years ago, and seeing a public service ad about anal cancer, “the cancer no one talks about.” I had never heard of it, and in the decade and a half since then, I haven’t come upon another reference. Until I looked it up, while writing this paragraph, I didn’t realize Farrah Fawcett had died of anal cancer. There were references to her ailment as cancer “below the colon.” It was like my mother, when I was a kid, calling the vagina “your bottom in front.” Up through 2010, anal cancer had no nonprofit society, no one to organize fund-raisers and outreach, no colored awareness ribbon. (Even appendix cancer has a ribbon.)* Like cervical cancer, anal cancer is caused by the human papillomavirus; people get it via sex with an infected person, and that seems like something they ought to know when making decisions about using a condom.
Colonic inertia has an even lower profile than anal cancer. And I doubt you’ll be seeing bus posters about defecation-associated sudden death any time soon. I imagine the stigma discourages open talk among doctors and patients and people at risk. As Nichopoulos wrote in The King and Dr. Nick, “Nothing could have been more embarrassing than having people whispering about his bowel difficulties.”
But I have questions. At what point does constipation cross over from unpleasant to life-threatening? How hard would you have to be pushing? How exactly does it kill you? Should certain people be taking stool softeners the way others take baby aspirin?
I know one person who doesn’t mind talking about it.
GEORGE NICHOPOULOS LIVES in a leafy Memphis neighborhood of widely spaced homes, on a bend in the road where once or twice a year a drunk fails to notice the curve and crashes his car in the yard of the house across the street. Elvis Presley had the house designed and built as a present for Nichopoulos and his family in the 1970s. You can see that in its day it was modish and luxe: the peaked ceiling with exposed rafters, the massive stone fireplace that divides the open floor plan of the downstairs, the backyard swimming pool.
Nichopoulos escorts me to the sofa. He and his wife, Edna, sit in armchairs to my left and right. The furniture is positioned far enough apart that I hand the doctor my tape recorder, for fear it won’t otherwise pick up his words. The coffee table is just out of reach, so that each time I pick up or set down my cup, I have to rise partway from my seat. It’s as though the family had been at a loss to fill the expanses of a home designed by someone with far more extravagant taste.