Introduction: I am republishing selected posts from Cohencentric (my former Leonard Cohen site), especially those offering information not available elsewhere, here on AllanShowalter.com (these posts can be found at Leonard Cohen). The following entry was originally posted Aug 16, 2017 on Cohencentric.com.
Leonard Cohen’s Death
Long 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.
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.
- 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.” [↩]
- E.g., in The New York Times [↩]
- 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) [↩]
- Source: Living Will [↩]
- Leonard Cohen Makes It Darker, by David Remnick (New Yorker: Oct 17, 2016) [↩]
25 thoughts on “A Medical Note On The Death Of Leonard Cohen”
This is interesting, and somewhat comforting, to read. A friend in her 70s with terminal leukemia died a few days after hitting her head in a fall at home. She was extremely weak and also had balance problems. She had made it clear that she was ready to go, and was texting friends up to the day before her death.
Didn’t his friend Eric Levine write in his book that Leonard emailed him that night, saying he’d fallen but was back in bed and having the most beautiful thoughts, or something to that effect. Eric replied to him but never got an answer.
That’s true. It doesn’t, however, conflict with any of the observations in this post.
No, of course not. In fact, it just confirms it.
I am reading Eric’s book for the for the 2nd time right now. I enjoy reading about their friendship, just 2 guys….. Makes me feel very sad but also happy that they seem to be such a good friends for a very long time.
The facts surrounding Leonard’s death are unimportant. What is important is that he was prepared for it within himself, and that he did not suffer at any great length. I myself would like to go the same way, quick and at peace with myself, and without any prolonging of life’s struggle to remain here.
I cried most of the day his death was announced, for despite never actually meeting him, I felt very close to him through his work. Even now, some four years later, I still miss him greatly. He became part of my life, for I found that I could often feel myself, deep within his work and spoken words. I admired his insight into the human conditions, portrayed as though he himself had designed the way we interact with each other, and the ways we should live together.
He was a gracious and calm person, blessed with this knowledge and insight into our very souls.
I am ever so grateful to have had the opportunity to be alive at the same time that he was, to have seen him personally, and to have been captivated by what he had to say.
I will always miss his ongoing presence in my life.
Beautiful words Andy, I feel the same, we were so lucky to have this wonderful man in our lives and to have seen him in concert. He calms me when I’m upset and lifts me up when I’m down. I feel blessed.
Wonderful words. I feel exactly the same. Thanks for your touching words.
Pat , I could not of said it better. He calms me when I am upset and lifts me up when I’m down. How many times have I reached for the stereo to play our dear darling Leonard . I say to myself I just have to hear Leonard. I feel so blessed
I concur … with all of you. What a wonderful human!
Can yourself Allan, or anyone else, please confirm where Leonard was living at the time of his death and with whom? Thanks, Jonathan.
He was living at his home in Los Angeles. He lived alone on the second floor of the duplex. His daughter, Lorca, lived on the first floor.
Thanks for the reply Allan. I was curious because at the beginning of his last interview, with David Remnick, Leonard says “sorry darling can you get my hearing aid”. So probably the voice of Lorca.
That is my thought as well. All the best.
One night as I was returning to my apartment, the voice of Cohen from his last album came on the car radio. Even though he was in my generation, I had never heard his music. The words were so gripping and incisive that I couldn’t get out of my car until all the pieces were over. His authenticity reminded me of what I have heard of Andrei Codrescu. There was something haunting in his voice and lyrics, and I was grateful to have heard his compositions, albeit later than most music aficianados and late in Cohen’s musical life.
I envy you the joy of discovering this rich vein at this time. For me, Leonard’s songs anticipated how I would feel and what life would be like as I followed him, lagging by 20 years, since I was 23.
I do not know why I loved Leonard Cohen, I just did. There is no need to understand why.
I had the great fortune of turning on to Leonard Cohen in the sixties, Woodstock days and never turned away. Concerts with Joan Baez,
Jennifer Warren and so many others. I traveled the world to see him in concert, have every album, book, clothing item, cufflinks,etc. I
think you know how much I loved him. AS a gift, my artistic son made me a wood carving portrait of Leonard, the only one of its kind
in the world. A beautiful addition to my home any all the good memories of Mr. Cohen. One of my very favorites, although there were
so many, cities across the globe ,etc. but number on e was The Coachella Music Festival in the desert. Amazing person. I hope to pass on
in my home, the shrine to Leonard Cohen.
I saw his show in Milwaukee several years ago and I could not have been more impressed. He put on a performance for some 2 plus hours. It was truly memorable. Such a unique person , no one with his voice and writing ability will come along in my generation. He will be missed.
I have been influenced by Leonard for many years and have tried mentally to accept people as they are and try to be more humble but it is not working. There is a crack in everything but the light is barely coming in. I was able to attend 3 of his concerts in Germany and it was peaceful and I have never seen such captivated audiences. He helps me as I hobble along in my life to reap the richness of his words. h eshould have lived longer as we were experiencing the wisdom of his words.
Leonard was with me as a student then travelled the world with My Leica ……. Loved him then Love him still breathe his air he left in will.
Leonard’s songs move me in a way unmatched by any other songwriter.
Leonard Cohen is my favourite.
I relate totally to his views on identity, love, luck… passion…rejection… loneliness and the ultimate loss and death of
Mutual and true lifelong ❤️
Some say cunical but he has captured both sides of love… the light and the dark. His insecurity touches the heart while his genius
Enthralls and seduces the mind. Vale great one. I live your music
And songs. Barbara Seccombe
I sustained a spiritually intimate relationship with Leonard. He and I were “classmates” studying with the same zen teacher for many years. I am blessed with many fond memories of our many silent, yet potent, connections through eye contact or simple proximity. In 2005 I wrote a little song and sent it to him. He replied to me in an email to say that it “touched [his] heart.” Soon after his passing, he began to visit me in my dreams. The visits continue, though not as frequently as before.
“May everyone live.
May everyone die.
Hello, my love
And my love goodbye!”