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Post John Paul I from a Cardiologist's Perspective
Created by John Eipper on 07/21/19 4:52 AM

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John Paul I from a Cardiologist's Perspective (Paul Pitlick, USA, 07/21/19 4:52 am)

In response to Enrique Torner's post of July 19th, I'll start with one caveat, which is that I am a Pediatric Cardiologist, and children with cardiac problems only rarely die of a "heart attack." Thus, my personal experience is limited and one would probably benefit more from a Google search than from what I have to say. I also don't know Pope John Paul I's medical history, but if he was indeed taking a digitalis preparation, he was almost certainly being treated for congestive heart failure and/or an arrhythmia, either one of which can be lethal. I'm not familiar with the other drug.

So I agree with Rodolfo Neirotti (July 20) that the clinical diagnosis of a myocardial infarction without some other evidence is problematic. And to establish the exact cause of death (cardiac dysfunction, myocardial rupture, acute mitral regurgitation, etc.), one certainly needs more than a clinical impression. Or for that matter, did the pope have a stroke instead?

Having said that, there is also consideration of the law. In the US, state and local laws come into play. If a patient dies at home, and a treating physician is comfortable enough about the patient's clinical status, then he/she can just sign a death certificate with a (speculative, I'd have to call it) cause of death, and that might be enough. Or, they might not be comfortable signing it, and an autopsy would be performed. And if a physician signs the certificate but there is something suspicious, the local coroner can overturn that, and mandate an autopsy.

Finally, in answer to JE's question to Rodolfo about "reluctance of physicians and psychologists to render 'historical' or long-distance diagnoses," I'm reluctant to say much about something for which I have no inside information about the specific case. My analysis of Serena Williams' serve wouldn't be of much use to anyone. Further, to answer Enrique's 4th question, there is a fairly broad differential diagnosis for the cause of swollen ankles, as a Google search for "pedal edema" would reveal, and there are certainly a number of non-cardiac causes. These references are usually much more comprehensive than something I would be able write (see https://nursingandhealth.asu.edu/sites/default/files/pedal-edema.pdf , among many others), so I would defer to that.

JE comments:  Many thanks for weighing in, Paul.  Regarding the John Paul I assassination theories, I always find myself faced with the fundamental question:  if the "conspirators" were powerful enough to murder a pope, why couldn't they keep him from becoming pope in the first place--just 33 days earlier?

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  • John Paul I Conspiracy Theories (David Duggan, USA 07/22/19 6:08 AM)
    Regarding the possibility of Pope John Paul I's death being an assassination, John E asked, "if the 'conspirators' were powerful enough to murder a pope, why couldn't they keep him from becoming pope in the first place--just 33 days earlier?"

    Probably because it's easier to bump off one person than buy off more than 50.

    JE comments:  You have a point.  I'd like to hear Enrique Torner's thoughts on the following:  There is a common belief that John Paul I was prepared to introduce massive reforms ("modernization" if you will) to the Church, continuing the efforts of John XXIII half a generation earlier.  JP's successor and namesake, John Paul II, was anything but a reformer, and a passionate Cold Warrior to boot.  The "dark" forces involved in any assassination conspiracy saw their interests threatened by JP I.

    Enrique, is this an accurate summary of the assassination theory?

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  • Death of Pope John Paul I: Theories and Conspiracies (Enrique Torner, USA 07/29/19 4:19 AM)
    I want to thank Paul Pitlick for his response (July 21st) to my request for medical expertise regarding the cause of death of Pope John Paul I.

    I was glad to read Paul's statement that "to establish the exact cause of death... one certainly needs more than a clinical impression." That's exactly what Dr. Buzzonetti did: he established the cause and time of his death from a brief physical examination of the body. The only "test" he performed was an elettrocardiotanatogramma, a curious and hardly ever used medical term. Upon Googling it, I only obtained 70 results, and they are all articles devoted to its use on popes Paul VI and John Paul I and II: nothing exclusively medical. From what I read, and from what our friend Eugenio Battaglia told me offline, this test checks the cerebral death of a person, but the fact that I haven't found any references to this test outside of the ones on these popes, and that Buzzonetti performed all these tests, has me completely baffled. I wonder if our cardiologists can comment on this unique procedure.

    In addition to the fact that Buzzonetti based his diagnosis of death by heart attack only on his physical exam, it is important to mention that Buzzonetti was not his family physician, and that he had not had him as a patient before. To reinforce his initial diagnosis (he had arrived at the pope's bedside at 6:00 am), at 8:00 Dr. Mario Fontana--director of the Vatican Health Services--arrived at the scene, and, after consulting with Buzzonetti and examining the body, adds his signature to that of Buzzonetti on Luciani's death certificate. The death certificate (not revealed to the public for ten more years, and set in print for the first time in Falasca's Papa Luciani, Cronaca di una morte in November of 2017) expressed the cause of the pope's death as sudden death from acute myocardial infarction, without any terms that might express any doubts regarding the diagnosis.

    Jesús López Sáez, a Spanish priest who has published two books (note 1) and many articles on Luciani's death, is, in my opinion, the best and most expert on this controversial subject. He keeps a website in which he regularly uploads just about everything he can that deals with Luciani, offering extensive critical reviews of them. In this website, in February of this year, he offered a 66-page analysis and rebuttal of Falasca's two recent books: her biography of Luciani published in July of 2018 (note 2), and the aforementioned Cronaca di una morte. Using many bibliographical sources and the fruit of his own research--including his consultation with several medical specialists--he demonstrates the fallacy of Falasca's conclusion that Luciani died of a heart attack and that anybody still thinking that John Paul I was murdered is just contributing to the already large literature of conspiracy theories. The truth is that there are lots of contradictions among the statements given by the different eyewitnesses of the initial finding of Luciani's dead body, and Falasca, though acknowledging a few of them, chooses to ignore even more.

    Unlike other authors on John Paul I who had financial gain as an incentive to write their books, López Sáez risked his position, reputation, and finances to do so. He has been on top of all publications for about 30 years, and done so for the sake of doing justice to the life and figure of Pope John Paul I. He has openly expressed his opinion that his beatification should not take place until the mystery of his death has been solved. He contends that proving he was good enough to be beatified is not sufficient, and states that it is necessary to clarify how and why he died. Instead, he should be recognized as a martyr of the purification and renewal of the Church. This, he says, "hará un gran bien a la Iglesia, se quitará un peso de encima, un peso que ante el mundo hipoteca su credibilidad, contribuirá a la difusión del Evangelio y será una señal de la transparencia que reclama su pontificado". (3) López Sáez's conclusión is strong: "En conclusión, no basta una crónica, ¡basta ya de crónicas! Se requiere una autopsia, si no se hizo. Incluso, más fácil, podría resolverse con una resonancia magnética nuclear realizada al cadáver."(4)


    This last "if" can only be understood by knowing that Father Giovanni Gennari--professor of the Diocesan Seminary in Rome and a close friend of Luciani's--had claimed that an autopsy was performed: "por ella se supo que había muerto por la ingestión de una dosis fortísima de un vasodilatador recetado por teléfono por su ex medico personal de Venecia" (López Sáez; note 5). There are several reliable sources that mention this autopsy, but the Vatican--and Falasca--denies that ever happened. López Sáez and others (including myself) believe it was done in secret. Regardless, according to López Sáez, a vasodilator is contraindicated for anybody with low blood pressure, and its ingestion would produce the kind of death Luciani suffered, and explain "la forma en que se encuentra el cadáver: no ha habido lucha con la muerte, como corresponde a una muerte provocada por sustancia depresora y acaecida en profundo sueño" (6). The problem with this theory is that it doesn't match Dr. Da Ros's statement (many years after Luciani's death) that he did not prescribe any medication for the pope on that last night while he was talking to him on the phone. On the contrary, he affirmed that Luciani had claimed to be in excellent health when he called him the night before he died, and denied categorically having prescribed him anything. In addition, several sources state that the Vatican pharmacy's files were checked for that date--and the day of his death--and there is no record of any prescription being given or sent to Luciani. However, Yallop's theory that somebody may have intentionally slipped some liquid medicine in any of the pope's drinks the day or night before his death (supported by López Sáez, Bassotto, and others) would explain the results of the autopsy and the Vatican's refusal to accept it ever happened. An accidental overdose of the vasodilator has been offered as another explanation, but Vincenza and other people close to him reject this theory, alleging that Luciani was extremely careful when taking his medications. Yallop's theory seems the most plausible.

    Regarding the debate about Luciani's cause of death, the experts are divided in two groups: those who claim that Luciani was in weak health when he died; and those who defended that he was in good health. Falasca and her followers base their heart attack diagnosis on the fact that Luciani was already in bad shape; Yallop, López Sáez, Bassotto, Sister Vincenza, and the pope's family--among others--claimed that he was in excellent health. A clerical friend of Luciani's from Venice even states that he was in great health, and even climbed a mountain with him not too long ago!

    Buzzonetti and Falasca--and others on her side--base their diagnosis on several facts: that the day before of his death, Luciani had a sharp pain on his chest that lasted for about 5-10 minutes (and Luciani dismissed its importance, telling his secretaries not to bother calling a doctor); that his ankles looked swollen; and that in 1975 he had suffered a retina thrombosis. The other side, including several doctors that López Sáez consulted, claim that a sharp pain on the chest can be due to several reasons, a heart problem being just one of them; swollen ankles can be the result of many different "non-cardiac causes" (as Paul Pitlick mentioned), like simply sitting or standing up for long periods of time, and Luciani had been standing up for a long period of time the day before he died; and, finally, that retina thrombosis not only is unrelated to heart issues, but, in Luciani's case, it had been treated and resolved successfully. The day Luciani had his chest pain, he had told Father Magee, his secretary, that it was of a rheumatic nature, that it had happened before, and that Sister Vincenza--her assistant and nurse--had wonderful medicines to treat that. Later in the evening, when Magee asked him how he was doing, he responded: "Benissimo! That medicine worked wonders." I have had many similar chest pain episodes that were later diagnosed as esophagitis in the ER, where they treated it with a mix of something like Maalox and an anesthetic called Hurricaine, and that always did the trick. Regarding the retina thrombosis, that happened as a result of a plane trip Luciani took to Brazil in 1975, three years before his death. The altitude and the accompanying high pressure in the plane affected his left eye and caused the retinal thrombosis. Not because of ignorance, Falasca and others neglect to mention this slight detail.

    Regarding the medications that Luciani was on, they are the following: Trieffortil, for orthostatic arterial hypotension, Gratusminal (a sedative), mild heart prescriptions, and multivitamins. (Falasca) He was not on Digitalis: that's what Yallop thinks somebody slipped into Luciani's drink to poison him. I would like to know Drs. Pitlick and Neirotti's opinion on these medications.

    Many more details are forthcoming in my essay, which I hope to post soon at WAIS. For now, I will end this already long post by answering John Eipper's question: yes, Luciani was murdered because he was a threat to the traditional Catholic Church. He planned to terminate financial corruption he had found, support birth control to help the many who needed it, eliminate dangerous elements that infiltrated the Vatican (masons, intelligence agents, communists, and others), and modernize the Church. That's why he had to be stopped. The murder theory will be hard to prove without an autopsy or an MRI. It might be wrong. However, the Vatican has stated so many lies regarding John Paul I's life and death through all these years, and has covered up so many misdoings, in addition to refusing to disclose so many documents and pieces of evidence that could shed some light on the mystery of the pope's death, as well as to perform an autopsy or an MRI on Luciani's body--if it hasn't been done, which I think it has--that it wouldn't make any sense to believe in their innocence. Sister Vincenza saw camerlengo Villot take, with his own hands, quickly and "sneakily," upon entering the pope's private chambers, the papers he was holding, the medicine and glass that were lying on Luciani's bedside table, his slippers, and other private items. The papers and the medicine have never been brought out to light, not even during Luciani's beatification process. What could be in those papers that have never resurfaced? Homilies? Sermon notes? I don't think so! It could only be damning evidence, like the list of all the Vatican members that he was planning to dismiss: Villot, Marcinkus (the president of the Vatican Bank), Cardinal Baggio, and many others. The Vatican has been deflating all the accusations on their guilt by counter accusing their authors of inventing conspiracy theories, as John Eipper calls them. Some authors of books on John Paul I's death have helped and contributed to the Church playing this card by writing non-fiction narratives that border (or go beyond) into science-fiction. However, there are quite a few serious books out there that point in the direction of the Vatican's guilt. It's time they start listening.

    1 Se pedirá cuenta (Muerte y figura de Juan Pablo I) (1991) and Juan Pablo I, caso abierto (2009).

    2 Stefania Falasca, Davide Fiocco, Mauro Velati. Albino Luciani, Giovanni Paolo I. Biografia "ex documentis" - Dagli atti del processo canonico.

    3 [This] will benefit the Church greatly, it will relieve Her from a heavy burden--a burden that is "mortgaging" Her credibility before the world.  It will contribute to the spread of the Gospel, and will be a sign of the transparency that his [Luciani's] papacy demands. (66) (All translations are my own.)

    4 In conclusion, chronicles must stop! An autopsy is what's required, if it hasn't been done. An even easier solution to the problem would be to perform a magnetic resonance image of the body.

    5  It was thanks to it that it was found out that he had died from the ingestion of a very strong dose of a vasodilator that was prescribed on the phone by his former personal physician from Venice.

    6 ... the position of the body: there has been no struggle with death, as would correspond to a death caused by a depressant that happened during sleep.

    JE comments:  With my rudimentary Greek, I decipher elettrocardiotanatogramma as an electric heart examination performed after death (Thanatos).  But if the patient is dead, wouldn't there always be a "zero" reading, electricity-wise?

    Enrique, I'm starting to agree with you on the likelihood of an assassination, although the papers disappearing from the Pope's cold hands seem like a reach.  If there was a conspiracy, how could the plotters have known that John Paul that very evening would be working on a list of people to be sacked?

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    • Death of Pope John Paul I: I Don't Buy the Conspiracy Theories (Edward Jajko, USA 08/04/19 4:32 AM)
      In partial response to Enrique Torner's posting on his preliminary analysis of the cause of death of John Paul I (July 29th), I don't buy the conspiracy theories.

      Enrique says Albino Luciani was murdered, and this because he was a threat to the traditional Catholic Church; he planned to terminate financial corruption, allow birth control, eliminate various dangerous elements that had infiltrated the Vatican, and modernize the Church. He references damning evidence, a list that must exist but who knows if it does, of Curia officials the Pope intended to dismiss.

      Where is the evidence for any of this?

      I have an acquaintance, a religious scholar and former Protestant minister, who has taught that Luciani intended to downgrade the meaning and importance of the Bible in Roman Catholicism, to literally put a warning label on it telling the faithful to take it with a large grain of salt. This is nonsense.  The Roman Catholic Church is not a "Bible" church, but even so Sacred Scripture plays an important part in its liturgies and Catholic Biblical scholarship is first rate.

      As for other theories, somewhere among my books I have a work by, I believe, an Italian journalist (not cited by Enrique) who has another far-fetched theory. I'll have to look for it. The problem with all of these, including Enrique's, is that they are conjecture. There is no evidence for motive, as there is none for the cause of death.

      Some added comments:

      Gratusminal is phenobarbital in the European Pharmacopoeia. Enrique mentions this and another medication by name, but then adds only that the pope took "mild heart prescriptions." From personal experience, I can say that "mild heart prescriptions" is equivalent to physicians saying "I'm comfortable with that" or, as one is facing a deadly looking needle, "You will feel a little stick." Non credo.

      Enrique says Luciani wanted to modernize the Church. But the Church has been in a process of modernization since the Second Vatican Council. But this is the Church, with 2,000 years of history and tradition, a rooting in a language and civilization that have both passed away, and now a worldwide compass of peoples and cultures. Modernization, even within the definitions or parameters of the Church, has been fitful. But it has to be within the definitions and parameters of the Church, not of secular society. And again, where is the evidence? You don't get named patriarch of Venice by being a revolutionary.

      Allowing birth control by artificial means? This was disallowed by Paul VI. His successor would not, possibly could not, change his law. In any event it is basically moot, except for abortion.

      There has indeed been corruption in the Curia for years. This has been a favorite topic of books and articles, also for years. Benedict XVI and Francis have each made some attempts at cleaning house but it hasn't worked well. If I were pope, I would get a few trusted people, old friends, and then, as absolute ruler, would fire the whole Curia. I would install nuns in positions of authority. Would I wind up dead in bed? But none of this "if I were king" business leads us any closer to answers about the demise of Zanipolo, John Paul I.

      Just one further note this time around: I think it unfortunate that my Church had seen fit to canonize recent popes or put them on the path to sainthood. Canonization of popes has become the Catholic equivalent of naming capital ships of the US Navy for presidents.

      JE comments:  Edward Jajko's strongest point against the assassination theories:  if John Paul I were so radical/revolutionary, how would he have been elected in the first place?

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    • Elettrocardiotanatogramma, and Other Mysteries of the Beating Heart (Paul Pitlick, USA 08/17/19 6:39 AM)
      I apologize for the lateness of my response to Enrique Torner's post of July 29th; I've been busy on another task, and as I've gotten older, multi-tasking isn't as easy as it once was.

      Again, I don't know enough about the specifics of the Pope's medical care to make an intelligent assessment on John Paul I, but if he had low blood pressure, and was being treated with a medicine to lower his blood pressure, it's pretty easy to see how that might not end well. I addition, if he had problems with his liver or kidneys such that he wasn't excreting that drug normally, then even small dose might end up accumulating into the toxic range. But this is all speculation without more information.

      I also don't know what an "elettrocardiotanatogramma" is. I Googled it, and saw only citations in Italian, and they all seemed related to the Pope. The test we call "electrocardiogram" in English is spelled pretty much the same in many languages (i.e. in German and Czech merely replace the "c" with a "k"; in Russian it's электрокардиограмма), and is a pretty standard test, but the "tanatos" here makes it something else. JE commented: "With my rudimentary Greek, I decipher elettrocardiotanatogramma as an electric heart examination performed after death (Thanatos). But if the patient is dead, wouldn't there always be a ‘zero' reading, electricity-wise?"

      That raises an interesting topic. Many years ago, the discussion could have stopped here, and probably with respect to the Pope, it still could. However, after 1968, with the ability to do transplants the definition of death needed to be clarified. Specifically, when is a donor dead enough to be "dead," but alive enough that their other organs can be transplanted into other people? There are many books about the early days of heart transplants, which, to be honest, I haven't read, but there is legend around Stanford that one of the early transplant donors had been shot, and his assailant had been captured. When it was felt medically that the victim was never going to recover, his heart was taken out to be used as a donor organ for another person in heart failure. At that point, the assailant's lawyer made the case that his client wasn't the murderer, Dr. Shumway was! After the court case, and some legal finagling, the concept of "brain death" has been codified, with clear criteria. So, to answer John's question--after the patient is "dead" (i.e. brain dead), there may indeed still be a heart beat, and the kidneys, liver, etc., may also still be viable as transplants.

      JE comments:  Dr Paul Pitlick has shared a number of fascinating anecdotes with me about his colleague Dr Norman Shumway (1923-2006), who was the first American to perform a heart transplant.  I note with pride that Dr S was born in Michigan (Kalamazoo) and studied at the U of Michigan before being drafted during WWII. 

      (Paul, I didn't know what to title this post.  "Mysteries of the Beating Heart" sounds like a romance novel or Bonnie Tyler song, but it's the best I could do on a sunny Saturday morning.)

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