The Killing of Albert Einstein and King George: Aortic Dissections and… how to save a life
Like many people, I guess, the question of how Albert Einstein died has never been particularly important to me. We know from media folklore, that he lived to a good age, and that at some point (a while ago) he passed away. And so what actually caused his death has never seemed particularly important. Recently, however, I find myself dwelling on the fact that I now have this in common with him. Thankfully, I am living in 2019 and not 1955, when Einstein’s life sadly ended.
In 1948 he was diagnosed with a problem in his aorta — the main vessel that takes blood from the heart to the rest of the body — for which he received the leading medical treatment of the time. That is, he had surgery that year for the swelling in his aorta (known as an aortic aneurysm) which involved wrapping it in cellophane, to prevent it bursting.
However, a few years later in 1955 he found himself again in a lot of pain, and on being admitted to Princeton Hospital his doctor recommended further surgery to replace the resurfaced aneurysm with a graft. Without this surgery, the aneurysm would rupture and the internal haemorrhaging from that would be fatal.
This is where my story differs from Einstein. At the age of 76, he felt his time had come and he declined the surgery. Within a matter of days the rupture occurred, and most likely with the help of morphine he endured the intense pain, passing away on 18 April.
In January this year (2019), I also had a rupture of an aortic aneurysm — these ruptures are called aortic dissections, they involve the internal lining of the aorta coming away from the outer wall. This was my first experience of the intense pain of this medical emergency, and I did not want it to finish me off. I got myself to the local hospital emergency department in Perth, and within hours I was undergoing surgery — which is now far safer and far more effective than back in Einstein’s time. Rather than merely wrapping up my aorta, I had the damaged section replaced with an artificial tube which should (fingers crossed) last me a lifetime. Although by the time of Einsten’s death in 1955, the surgeons were able to offer more than celleophane to repair him, it was not until 1990 that the much more successful use of such a stent to fix an aortic dissection was first done, by pioneering surgeons in Argentina.
Not only had I not heard of the cause of Einstein’s death, the news of my aortic dissection initially also left me clueless. I had not heard of this condition, nor its implications. I was not aware that it is usually linked with poor cardiac health — that is, high blood pressure, cholesterol, type 2 diabetes, obesity — and that people (such as myself) who have a bicuspid cardiac valve (regulating the flow of blood into the aorta) also have a greater chance of being effected. I did know that these were all things that should encourage me to regulate my own health, but there I was.
I had gone to the hospital thinking I was in the middle of a heart attack, or something similar. Indeed, there are serious concerns by medical specialists that aortic dissections can be misdiagnosed as heart attacks. Without surgery to repair the dissection, they are usually fatal within a matter of days, and the aorta literally bursts. Of course, the initial treatment for most heart attacks does not involve surgery. So if an aortic dissection is treated in the same way as a heart attack should be, then the patient (in this case myself) is almost certain to die.
This indeed is what happened with another famous occurrence of aortic dissection, that is the sad passing of the American actor John Ritter in 2003. Like myself, Ritter developed chest pains and vomiting quite suddenly one day and went to his nearby health centre in Burbank, California. The doctors initially misdiagnosed the problem as a cardiac arrest, and although they eventually diagnosed an aortic dissection, by the time they were operating it was too late, and Ritter died. He was only 54 years old, the same age as myself.
One result from Ritter’s death was the creation of the John Ritter Foundation to work for public education and research on acute aortic dissections. A part of this is the dissemination of what they describe as the Ritter Rules, a series of statements giving advice on the challenges of aortic dissections, which aim to give greater prominence to the causes, risks, and symptoms of the life-threatening condition and also to help prevent a repeat of the delay of misdiagnosis that led to Ritter’s own death.
This obviously does make a difference. The condition is not well known, and has the potential for being mistaken for a heart attack even by experienced trauma medics. It is not a very common form of heart/thoracic ailment (occurring at a rate of 3 per 100,000 people), and so it is important for those who treat patients in pain to be aware that the symptoms of a heart attack may potentially require a quite different treatment to prevent death.
And so, not only have I the good fortune of living (and continuing to live) in a time when the surgical intervention is possible, the work of the Ritter Foundation (in particular, awareness of the Ritter Rules) may also have helped to save my life. I don’t know why the medical staff treating me that evening decided I needed a CT scan to check for an aortic dissection, but for whatever reason, it is why I am still here. It is because of this that my children still have a father. For this, I consider myself very fortunate.
And as I look into this, it seems that there have been many cases of very well-known people who have died from aortic dissections, as well as Einstein and Ritter. People such as: Richard Holbrooke, George C Scott, Lucille Ball, Betty Garrett, Walter Huston, Humphrey Lyttleton, Marilyn Chambers, and Michael Rennie. Of course, these are high-profile personalities, and to a certain extent distract from the many less known victims of the affliction. However, given that there is so little public knowledge of aortic dissections, it is useful to think about some of the detail.
The first known incident of aortic dissection was in October 1760, with the death of the British King George II. Following his death, his grandson took the throne, becoming King George III — the monarch under whom the American colonies seceded from British colonial rule. The reign of George II from 1727 to 1760 was marked by the brutal suppression of the Jacobite rebellion of 1745 (including a large-scale suppression of Scotland), the long war with France that led Britain to taking over colonial power in northern north America (i.e., Canada), and a significant development of Britain’s wealth and international power through the transatlantic slave trade.
The details of the cause of George II’s death in 1760 are recorded in a report written by Frank Nicolls, the physician attending to him, who performed the post-mortem examination of the king’s body. This report was subsequently published the following year in the Philosophy Transactions of the Royal Society of London. A part of this reads as follows:
‘… we found the two great arteries (the aorta and pulmonary artery, as far as they are contained within the pericardium) and the right ventricle of the heart stretched beyond their natural state; and in the trunk of the aorta, we found a trasverse fissure on its inner side, about an inch and a half long, through which some blood had recently passed, under its external coat, and formed an elevated echymosis. This appearance shewed the true state of an incipient aneurism of the aorta…’ [p269]
‘… it is not doubted, but that this distension of the aorta had been of long standing, at least to some degree; and, as the pulmonary artery was thereby necessarily compressed, and a resistance, greater than natural, thereby opposed to the blood’s discharge out of the right ventricle [of the heart]…’ [p270]
George II was not born in Britain, as his father was brought in to become the British monarch in 1714 to prevent the line of succession going to a Catholic heir (particularly one of the Jacobites, such as James Stuart). Thus George II spent the first half of his life outside of Britain, in northern Germany, in the city of Hannover. What is strange to me about this story is that the family home of this Hanoverian dynasty, was Herrenhausen Palace, just to the north west of the city of Hannover — which was a very short distance from the guest house where I stayed during my visit to the city in December 2018 as a visiting scholar in the Institute for Religionswissenschaft at the Leibniz Hannover University. This was just one month before my own aortic dissection. I have some very happy memories of cycling around the gardens of Herrenhausen on cold December mornings.
As I learn more about those who lost their lives to the ruthless destruction of an aortic dissection, one story in particular stands out for me. This was the death of the actor Suzanne Krull on 27 July 2013. She was 47 when she died, and so several years younger than I am now, but we were roughly the same age. The details of her experience are not very clear, but as with many cases of younger people who did not have the chance to recover from an aortic dissection, the impression is very much of a life cut short, of unfinished business, and (as with John Ritter) of so much more that could have been.
One way in which this can be clearly seen is her twitter page, still up and running with posts dated just two days before her passing. Her timeline literally ended too soon. One day she was within the daily things of her life as an actor with a public profile, and then it ends. Full stop.
Here I think back to the things I did and didn’t do in the days running up to my own aortic dissection. It is a strange question to ask, but how would I feel now for that to have been the end of my own timeline? Not only on twitter, but in all aspects of my life? I feel that this extra time is a very precious gift for me to use well.
One final name that I was very saddened to learn about was the academic Vine Deloria, Jr, who died from an aortic dissection in November 2005, at the age of 72. He belonged to the Standing Rock Sioux (Lakota) Nation, and was a leading activist for Indigenous nations across Turtle Island (what is now known as north America). Professor Deloria also worked within the same academic field to which I belong, that is the study of religion. His highly influential works include Custer Died for your Sins: an Indian manifesto (1969) and God is Red: a Native View of Religion (1973). Through these, and through his further prolific writing and teaching, he was a hugely inspirational figure within the study of Indigenous nations, cultures, and religions of Turtle Island. I did not know him, but I knew of his work, and I remember hearing the news of his sad passing.
Again, I do not know the circumstances of his death, but that it was quite recent is a clear sign that even with the surgical treatment that I was to benefit from just over a decade later, there is still no guarantee of survival when an aortic dissection strikes.
I feel some sort of affinity with each of these people — the aortic dissection is a quite particular affliction, and as the list above indicates it often is very deadly. Hopefully, there are also a growing number of people (from all aspects of life) who — like me — have come out the other side. It is not something that can be predicted, but like other forms of illness related to the heart, things like high blood pressure, cholesterol, and diabetes (all of which I have) are major contributors. There is also a growing body of knowledge about genetic factors that create a risk of aortic dissection, a clinical science that I have been told will become more prominent in its treatment and prevention in the years to come.
In the meantime, though, the best advice appears to be: 1) stay heathy, live well, get exercise (reduce blood pressure and body weight), and 2) act quickly if the pain of an aortic dissection (or heart attack) does occur. If you are not familiar with the Ritter Rules, have a look at them — if only in tribute to the man who did not survive this brutal affliction. And finally, I know I am still alive because I have the fortune and privilege of living in Scotland, with its National Health Service — a system that offers universal health care for all. If my visit to the emergency department had been contingent on my lack of health insurance (which I would not have had), then I would not be alive today.
Malory Nye normally writes about religion, race, and culture, particularly on his Religion Bites blog. In the past few years he has held short term and precarious posts at the Universities of Glasgow and Stirling, but he is currently in recovery mode — without any position or salary.
He can be found on Twitter (@malorynye) and on his website, malorynye.com. He produces two podcasts: Religion Bites and History’s Ink.
Malory Nye is also the author of the books Religion the Basics (2008) and There Shall be an Independent Scotland (2015). He is currently working on a new edition of the Religion the Basics book, together with a new book on Race and Religion, which will be published by Bloomsbury Academic.
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