March 21, 2021

I don’t remember whether I have previously offered my observations on the death of George Floyd, but now that the trial of officer Derek Chauvin is empaneling a jury and will soon get under way I will add my opinion to the others regarding what happened, my view largely being drawn from observation of the body-cam videos that had “disappeared” from American press coverage until they were published by The Guardian in Britain.

Though unsolicited and unofficial, my narrative is one I have not seen presented in any other place, not that I have followed the case in any complete or systematic way.

The bare facts of the infamous case hardly need repeating.  Minneapolis officers attempted to detain or arrest Mr. Floyd, who had been accused by a shopkeeper of attempting to pass a counterfeit bill.  They had difficulty in getting Mr. Floyd out of the driver’s seat of his Mercedes SUV and into the back seat of a police car, a process he resisted both vocally and physically. Bystander video showed Mr. Floyd prone on the ground being held down by two or three of the officers, one of whom, Officer Chauvin, has his knee on the back and right side of Mr. Floyd’s neck.  Mr. Floyd is heard repeatedly, almost continuously, protesting in plaintive tones that he cannot breathe.

What I had not seen until about a month ago was the police body cam footage that recorded the approximately 25 minutes of the encounter prior to the officers restraining Mr. Floyd on the ground.

As the officers open the driver’s door of his vehicle and order him to get out, one officer assisting with his service pistol drawn, Mr. Floys begins to plead with them not to shoot him.  This seems a little incongruous, but there is a drawn gun and to an urban black male, even in broad daylight with bystanders present, that alone could have been a source of fear.

Still, it is unclear at that point.  Is this guy playing to the camera or is he really in fear of his life?

Gradually the officers move Mr. Floyd to the read door of the police car and this is where things escalate.  At this point, Mr. Floyd, seated momentarily in the back seat of the police car becomes visibly more agitated.  His constant stream of talk has changed to: “I’ll die if I go in there! and I can’t breathe”.  And he struggles physically to get out of the car’s back seat.

He is saying, “I can’t breathe”, while visibly breathing deeply and rapidly. To the average witness, this appears incongruous at best, fake at worst, unless one is familiar with so-called hyperventilation syndrome, or panic disorder, something I have seen and treated several times.  In which case this incongruity is absolutely classic.

To the patient, taking in huge breaths,  it feels subjectively like someone has removed the oxygen from the air, and the breaths are  simply “not working”.  What the breathless patient almost always says is, “I can’t breathe”, while to the average observer it appears he is breathing quite well.

Meanwhile, the patient really thinks he will die in the next few seconds for lack of air, and if constrained he will almost surely struggle to be free to get more air.

If he is feeling claustrophobic, as Mr. Floyd demonstrated by struggling to get out of the police car, an attempts to restrain him will only increase his panic and he will struggle the more frantically.  He cannot “just quiet down first” as others may be telling him to do. 

To the police at the scene, if they are unfamiliar with what hyperventilation syndrome or a panic attack looks like, the individual appears to be over-breathing if anything.  In fact in the later stages of hyperventilating, the patient, who has plenty of oxygen in his system frequently has blown off too much carbon dioxide.  This makes the blood alkaline, causing blood calcium to precipitate out of solution, which in turn causes severe tingling around the lips and mouth, and next, severe tetanic contraction of hand and arms muscles.  These bizarre symptoms further convince the patient something is terribly wrong and he is going to die.

As many people do know, the emergency treatment for the hyperventilation syndrome is to have people breathe in and out of a paper bag, returning the expired carbon dioxide to the lungs, and thus preventing the emergence of the frightening neurologic symptoms.

Not surprisingly, however, the police, in the middle of trying to force a man accused of a serious, though not violent crime, to allow himself to be arrested, might not be in a position to use the reassurance and paper bag trick to end the panic attack — that is if they even knew what was going on with Floyd.  Moreover Floyd was being arrested for being a trickster, passing phony money, so their safety might require that they not give him the benefit of assuming he was credible in the midst of a physical struggle.

After watching the videos my working conclusion was that there had been an unfortunate misunderstanding that prolonged the struggle to constrain Mr. Floyd.

Since viewing the videos I have learned two more things that are relevant and helpful in analyzing the sad outcome of this arrest:  

  1. It is the standard training in the Minneapolis police department to place a knee on the back of the neck of a prone man in order to control his movements.
  2. George Floyd had taken what for a person hot habituated to the drug, more than a lethal dose of fentanyl, as well as a lesser amount of methamphetamine and cannabis.

These facts resolved two puzzles for me, why Mr. Floyd had experienced the panic attack in the first place, and why the officer kept his knee on the back of Mr. Floyd’s neck, despite being told by the young officers he was training that the man “couldn’t breathe”.

First, when he was trained, Officer Chauvin would have been told by his instructors, as I myself observed while watching the Chauvin/Floyd video, that with the individual prone, a knee on the back or back “corner” of the neck could in no way interfere with the person’s airway, nor could it possibly cut off blood flow to the brain.  I do seem to remember that the training and policy of the department was to not maintain the neck pressure for more than a certain number of minutes — like four, or six.  And I concur that is a good rule of safety.

But second, I had been puzzled as to the origin of Mr. Floyd’s panic attack, which, it now seems to me, could well have been related to the fentanyl, which is a fast-acting anesthetic.  In the amount found in his bloodstream, fentanyl could easily have interfered with Mr. Floyd’s ability to think clearly, and with the decisions and conclusions that caused him to be so afraid.  The amphetamine was present in a low dose, but combined with fear generated by fentanyl-induced confusion and impaired cognition, could have contributed to panic, an outpouring of adrenalin from his adrenals, and a fatal arrhythmia.  

This is an important possibility because a sudden cardiac arrhythmia is one cause of sudden death that leaves no trace.

The public and the lay press, on the other hand, have always indicated a belief that Officer Chauvin’s actions “strangled” Mr. Floyd by cutting off his air.  Of which, as I understand it, the autopsy has found no indication.  And the video and witnesses, I understand, have indicated Mr. Floyd was talking almost continuously right up to the time when he became unresponsive, indicating his death was not likely to have been caused by, “not breathing”. 

Addendum: March 25, 2021

In a video produced on the basis of his investigation of the incident, by George Perry, a former federal and state prosecutor, further autopsy information suggested a slightly different view of what led to the fatal arrhythmia.  


The level of fentanyl in Mr. Floyd’s  system, 11 ng/ml, was described by the medical examiner as being capable of causing pulmonary edema, fluid collecting in the lungs that would interfere with the patient absorbing oxygen from the air. That this did occur was evidenced by the fact that Mr. Floyd’s lungs were two to three times their normal weigh at autopsy. 

At three times the lethal dose, the fentanyl was also sufficient to have caused the agitated and combative delirium exhibited by Mr. Floyd, which, by causing an outpouring of adrenalin in his body could easily have triggered a fatal heart arrhythmia.  This would only have been made more likely by the residual from the methamphetamine Mr. Floyd had taken earlier.

My observations are based upon the few items of evidence that have become public, and I will yield to the opinions of the judge and jury when they have seen all the admissible facts, but I fear that the image and symbolism of the white oppressor with this knee on the neck of the black man will, for the public and the press, outweigh any actual facts that survive the courtroom fight.

If Officer Chauvin is not drawn and quartered despite any amount of evidence of reasonable doubt, I predict that the mob will exact punishment of its own from whomever they assign to be his surrogates.

On the other hand, if he is found guilty, I predict that there will be no rioting by his supporters and that he will win on appeal after a long and financially ruinous legal battle.  And that thousands of more police officers will find other employment rather than face the same risks.

I hope I am wrong.  In a few weeks we will know.