The painful lessons to be learned from Jeff Adachi’s death

Today the San Francisco Police Department will be held to answer for the premature leaking of documents pertaining to Public Defender Jeff Adachi’s death.

And lurid details they were: Photographs of an unkempt pied-à-terre and a sheetless bed and all manner of speculation about Adachi’s home life were splayed about the Internet; details normally considered private and confidential were divulged to selected media sources. Adachi had a contentious relationship with the San Francisco Police Department, and it appears this was reciprocated by sullying him on the way out. Kicking a man when he’s dead, so to speak.

In any event, this morning’s hearing before the Board of Supervisors Government Audit and Oversight Committee, in which representatives of the SFPD will be on the hot seat, figures to be interesting, if not illuminating. We shall see.

Sadly, it won’t make a difference for Adachi either way. His autopsy was released late last month; his cause of death was pinned as “acute mixed drug (cocaine and ethanol) toxicity,” thereby ensuring “cocaine” was featured in every subsequent headline.

And cocaine is … a hell of a drug. You see that in a headline and you don’t even feel the need to read further. Don’t do cocaine, kids! Simple as that.

But it’s not. Of course it’s not. Jeff Adachi was a complicated man in life, and that carried on into death. And his autopsy is, ultimately, a wrenching document. Because the upshot of it is: Jeff Adachi did not have to die. Not on a gurney in a corner of the CPMC Davies ER. Not at 59. Not yet. Not like this.

But he did. Did Jeff Adachi kill himself when he used cocaine on or around Feb. 22? That’s what the report says. But it says more. It says that, in a way, he had been killing himself for years.

Jeff Adachi stood five-foot-ten and weighed 169 pounds. With his coiled energy and lithe build, colleagues likened him to a big cat; outwardly he seemed robustly healthy. He was not.

“Based on the autopsy, he was a ticking time bomb,” said Dr. David Farcy, the president of the American Academy of Emergency Medicine and one of several doctors who reviewed Adachi’s autopsy at Mission Local’s request (all of these doctors hail from elsewhere. They were not caught up in the politics of Adachi’s death. To them, he is merely a set of symptoms and a name on a report.).

“Even without the cocaine and the alcohol,” Farcy continued, “he could’ve had a sudden death due to a plaque rupture in an artery in his heart.”

Adachi had hyperlipidemia (high cholesterol). He had high blood pressure, revealed by the thickening of his heart muscles. His left anterior descending artery was 70 percent blocked.

This artery is referred to as the “widow-maker.” Adachi’s own widow, however, told investigators that he “had no known medical problems” and “to her knowledge was not taking any medications.”

Unlike illicit drug use, this didn’t make the headlines.

It’s not a seamy detail of the sort that drives interest in a story. But it is crucial. A 59-year-old man in Adachi’s condition should have been on medication.

For decades.

“That seems odd,” concurs Dr. William Durkin, a past president of the American Academy of Emergency Medicine. “He had high cholesterol. He had high blood pressure. He had coronary artery disease. He should have been on a statin.”

In life, Jeff Adachi was described in terms often more befitting a force of nature. Over the past 15 years, he remade the San Francisco Public Defender’s office into arguably the nation’s best. He famously slept four hours a night and wrote books and directed movies and participated in national justice campaigns and studiously returned reporters’ phone calls and turned up at God knows how many social or political events around town in addition to overseeing a major city department. He still took cases, too; he personally defended former attorney Carlos Argueta in December, winning a murder acquittal.  

That was a stressful case. But Adachi lived a stressful life. So did his co-workers. Adachi was a perfectionist and a micro-manager who was not necessarily easy to work for. His erstwhile colleagues tell me they’re adjusting to not getting calls and messages at all hours from their new boss, Mano Raju.  

Adachi’s level of devotion to his office’s clients was legion. His level of devotion to himself, however, was not. If Jeff Adachi had started taking medication in early middle age — as so many men do — and followed medical advice, he could be alive today. Should be alive today.

That was a huge missed opportunity. But his autopsy reveals so many missed opportunities.

On the night of his death, Adachi began acting “strange” and “unlike himself,” grinding his teeth in response to “upper abdominal” discomfort during his final dinner with his female companion. She asked him if he wanted to go to the hospital. He declined. Instead, they took a car to the North Beach flat Adachi had secured. There his condition worsened. She asked him, again, if he would go to the hospital. And, again, he declined, stating this “had happened a few times before and it had resolved on its own.” He took off his clothes, got into bed, and never rose.

And this leaped off the page for the doctors who reviewed the autopsy.

“If, when the friend made the suggestions to go to the hospital, he went, he would probably not have died,” says Farcy. Doctors “probably could have intervened at that moment through a percutaneous coronary intervention” or otherwise jolting his heart out of the lethal arrhythmia — irregular heartbeat — that killed him.

“He could’ve been given some nitroglycerin for his chest pain,” notes Durkin. This would have dilated his constricting arteries. “He would have had an EKG done.” If that didn’t reveal his serious coronary condition, “it certainly would’ve showed up in the blood tests.”

A 59-year-old man who copped to cocaine use and complained of chest pains “would not be sent home,” says Dr. Carl Chudnofsky, the chairman of the Department of Emergency Medicine at the Keck School of Medicine at USC, and chief of emergency services at Los Angeles County USC Medical center. “If he’d gone in and been honest about his history, they’d have kept him on a cardiac monitor.” 

They would, in all likelihood, have found his crisis and treated it.

But Adachi didn’t go to the hospital. He was taken there. And, by the time he arrived, these options weren’t on the table anymore.

But there’s more here. Remember, Adachi told his companion that this had happened a few times before. If a man of Adachi’s age and living his go-go-go lifestyle saw fit to mention these episodes to his doctors, it would have sent up a series of red flags, confirms Chudnofsky. 

Adachi, evidently, did not do this (or chose to disregard medical advice).

“If a male comes in at that age, or even younger, with complaints about exertional chest pain or shortness of breath, it would result in immediate investigation and intervention,” Chudnofsky continues. It would have led to a battery of tests and exams. These, all but certainly, would have revealed the condition of Adachi’s heart. He probably would have required a cardiac catheter and a stent.

And he probably would have been asked about drug use during his medical history. And explicitly advised that cocaine could cause lethal arrhythmia.  

There’s no getting around it. You shouldn’t do cocaine. Lots of go-go-go people, the kind of people who sleep four hours a night and work maniacally hard, do cocaine. They also take benzodiazepine and crash, and Adachi did have that drug in his system, too.

Cocaine was, sadly, just about the worst drug Adachi could have put into his body. Other than cocaine and alcohol, which magnifies cocaine’s effect. And Adachi and his companion drank champagne on his final night on earth. For a man with Adachi’s coronary condition, cocaine was akin to motoring a big rig over a rickety bridge. Cocaine itself doesn’t kill people via toxicity; rather, it induces lethal arrhythmia. “It can send the heart into an irregular heart rate,” explains Farcy. “It allows the heart to pump and no blood is going anywhere and the person dies.”  

So, don’t do cocaine. Don’t put off medical attention for decades. Don’t neglect to tell your doctor about severe medical incidents. Don’t blow off reasonable suggestions to go to a hospital. Self-care isn’t indulgent. Listen to your doctors. Go to one.

Jeff Adachi burned bright. He got a lot done in 59 years. But it didn’t have to be 59 years. He had many lessons to teach us. And, sadly, this was the last of them.