UPDATE – 11/13/14
The New York Department of Health and Human Services has now determined that Joan Rivers died from brain damage caused by lack of oxygen. The report states that her medical records contain discrepancies regarding the dose of propofol she was given before surgery, and that the clinic failed “to ensure that patient care services are provided in a manner that protects the health and safety of all patients.”

Propofol is a drug that is commonly used to put patients to sleep for a surgical procedure. On rare occasions, intravenous propofol can cause “propofol infusion syndrome” that stops the heart from beating (Anaesthesia, 2007 Jul;62(7):690-701).

What You Should Learn from This
• If your doctor recommends a procedure that requires a general anaesthetic that will put you to sleep, I recommend that you have it done in a hospital where resuscitation equipment and personnel are available immediately.
• If you have a choice between general and local anesthetic, ask for the local and stay awake during the procedure. Local anaesthetics are much safer than being put to sleep.
• If your doctor plans to give you propofol, ask if it is really necessary. He should discuss its side effects before he uses it.

Here is my original report from September 2014:
Joan Rivers, one of our best-known comedians who built her career on self-deprecating jokes and criticisms of the rich and famous, died at age 81 on September 4, 2014. Her death came a week after her heart stopped beating when she was given anesthetics so a tube could be put down her throat to check her vocal chords.

Rivers spent 50 years in show business, appeared on thousands of TV shows, made more than a dozen films, wrote 12 books and earned more than 300 million dollars. Her penthouse just off Fifth Avenue had a ballroom with 23-foot ceilings and was listed for sale at $29.5 million.

A Brilliant Lady Who Had a Brilliant Career
Joan Alexandra Molinsky was born in Brooklyn on June 8, 1933, to Meyer and Beatrice Grushman Molinsky, immigrants from Russia. Her father was a doctor who would come home and do funny impressions of his patients. Her mother put education first for her two daughters, starting them on piano lessons and sending them to private schools. Joan was graduated Phi Beta Kappa from Barnard College in 1954 with a degree in English.

She always wanted to be an actress but her parents did not approve, so she had to support herself by doing stand-up comedy in cafes and small clubs. She changed her name to Rivers and went to work for more money as a fashion coordinator for the Bond clothing stores. She married James Sanger, the son of a Bond stores executive, in 1955 and divorced him after six months. She married Edgar Rosenburg in 1965 and their daughter, Melissa, was born in 1968.

Tonight Show Regular
Her major breakthrough was a guest appearance on “The Tonight Show” with Johnny Carson in 1965. He liked her so much that he invited her back regularly over the next 20 years and she became a permanent guest host. In 1986, she received a $10 million contract to host the “The Late Show Starring Joan Rivers,” on the Fox network. Johnny Carson was furious because his protégé was competing against him, and never spoke to her again. After just one year, her ratings dropped and she was fired by Fox. Her husband and manager, Edgar Rosenberg, suffered a heart attack, became depressed and committed suicide. She dropped out of the public eye for a while to get over her grief.

In the late 1980s and early 1990s, she had her own daytime talk show, “The Joan Rivers Show”. She made a film about her estrangement from and reconciliation with her daughter, “Tears and Laughter: The Joan and Melissa Rivers Story” (1994). In 2011 they had their own reality show, “Joan & Melissa: Joan Knows Best?” on the WE cable channel. She marketed her own line of jewelry on the shopping channels.

A Routine Procedure Gone Horribly Wrong
We do not know why Joan Rivers’ heart stopped beating. Days before, she appeared on stage for more than an hour with no sign of discomfort or mental impairment. Members of the staff at the clinic report that Rivers stopped breathing just as they were putting her to sleep. Doctors resuscitated her and she was sent in an ambulance to Mount Sinai Hospital, a few blocks away. Other patients at the clinic confirmed that they were given propofol, a sedative often given intravenously before endoscopy procedures. It can cause a patient to stop breathing.

Most patients recover from cardiac arrest if their heartbeats resume in fewer than eight minutes. However, if the brain is deprived of oxygen for more than eight minutes, a patient can die or suffer permanent brain damage. Paramedics did put a tube down her throat and her heart resumed beating again after they administered CPR, but she never recovered. A week later, doctors turned off her life support machines.

What Can You Learn from Joan Rivers’ Medical History?
Her death was a shock since she appeared to be in good health at the time of the procedure. The only clue in her medical history is that her heart may have been weakened by anesthesia during numerous surgical procedures and by bouts of bulimia. Her dozens of plastic surgery procedures over the years also increased her risk for brain damage as every general anesthetic, in which a person is put to sleep, increases chances of brain damage. Michael Jackson also died after being given propofol, and he also had a history of numerous elective cosmetic surgeries.

The procedure that caused her death was considered routine and the surgical centers such as the one where she was treated claim that they have very high safety records. However, if you are 80 or older and your doctor recommends a procedure that requires a general anesthetic, I would ask to have it done in a hospital where resuscitation equipment and personnel are available immediately. If you have a choice between general and local anesthetic, opt for the local and stay awake during the procedure.

Joan Rivers
June 8, 1933 – September 4, 2014