The other mode of defecation-associated sudden death is pulmonary embolism. The surge of blood when the person relaxes can dislodge a clot in a large blood vessel. When the clot reaches the lungs it can get stuck, causing a fatal blockage, or embolism. A 1991 study found that over a three-year period, 25 percent of the deaths from pulmonary embolism at one Colorado hospital were “defecation-associated.” This study’s authors took issue with Sikirov over squatting, claiming that descending and rising from a squat raises the risk of dislodging clots in the deep veins of the thighs.
Presley was given laxatives and enemas on an almost daily basis. “I carried around three or four boxes of Fleets,” Nichopoulos says, referring to the enema brand and recalling his days on tour with Presley. Getting the timing right was, he says, “a difficult balancing act.” Presley sometimes did two shows a day, and Nichopoulos had to schedule the administration such that the treatments didn’t kick in while the singer was on stage. This was the low point of Presley’s career: the bulky jumpsuit and isosceles sideburns era. His colon had expanded so dramatically that it crowded his diaphragm and had begun to compromise his breathing and singing. Beneath the polyester and girth, it was hard to see the man who had performed on the stage of the Ed Sullivan Theater, his moves so loose and frankly sexual that the producers had ordered him filmed from the waist up. Now there was a different reason to do so. “Sometimes right in the middle of the performance, he’d think, ‘I’m passing a little gas,’ and it wouldn’t be gas,” Nichopoulos says quietly. “And he’d have to get off stage and change clothes.”
People who saw the Graceland master bathroom would remark on its extravagance—a TV set! Telephones! A cushioned seat!—but the décor was in equal part a reflection of how much time was spent there. “He would be thirty minutes, an hour, in there at a time,” Nichopoulos says. “He had a lot of books in there.” Constipation ran Presley’s life. Even his famous motto TCB—“Taking Care of Business”—sounds like a reference to bathroom matters. (The TCB oath touched on self-respect, respect for fellow men, body conditioning, mental conditioning, meditation, and, according to a group tell-all by Elvis’s entourage, “freedom from constipation.”)
When Nichopoulos’s book came out, a colorectal surgeon named Chris Lahr contacted him. Lahr’s specialty is the paralytic colon.* He has excised, in part or in whole, more than two hundred of them, and he surmised that Presley had had one too. When I spoke to Lahr by phone he told me Johnny Cash, Kurt Cobain, and Tammy Wynette had also struggled with obstinate constipation, and he was convinced that they too had stretches of paralyzed colon. But these were also people who struggled with obstinate drug addictions. Opiates, whether they’re in the form of heroin or prescription painkillers, drastically slow colon motility (as do, by varying degrees, antidepressants and other psychiatric drugs).
To know which is right—whether it was drugs or genetics behind the King’s condition—you’d need some information about his childhood. Most people with Hirschsprung’s—the main cause of megacolon—are diagnosed as infants or young children. As Mike Jones put it, “They come out of the box that way.” If there were truth to the story Adrianne Noe had heard, about Presley’s mother having to use her finger on him, that would suggest a hereditary condition like Hirschsprung’s. I ask Nichopoulos whether he’d heard the business about manual disimpaction. Edna volunteers that she’d read that in one of the many Elvis biographies.
Nichopoulos says he looked into it himself. “We were trying to figure out if it was there from birth or whether it was something that came on later. But his mother was gone.” Gladys Presley died when Elvis was twenty-two. Presley’s father wasn’t around the house much when Elvis was a child.
“I wanted to talk to Priscilla about it,” he says. Presumably Elvis would have discussed his medical issues with his wife. Nichopoulos shifts his weight. The hip still causes him pain. “She didn’t want to discuss it.”
It surprises me that Presley’s condition didn’t dampen his enthusiasm for food. He so appreciated Edna Nichopoulos’s Greek hamburgers that he gave her a ring he’d commissioned, with each of the recipe’s ingredients represented by a different-color diamond. “Green for parsley,” says Nichopoulos when I ask about it, “white for the onion, brown is the hamburger, and yella . . .” Some words are born for the Memphis accent. Yellow is one.
“Yella is the onion,” says Edna.
Nichopoulos considers this. “Wasn’t that the white?”
“No, white’s the bread.”
“Elaine!” Nichopoulos shouts toward the upstairs. “Can you get the hamburger ring!” Elaine Nichopoulos has been living with her parents, helping out since her father broke his hip.