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A photo of Robert F. Kennedy from a 1968 campaign handout for the Indiana primary. (Credit: Kennedy for President Committee via Wikimedia Commons)

The senator was shaking hands with a busboy in the kitchen of a hotel when the assassin charged forward, firing a .22-caliber pistol rapidly. The attacker got off eight shots, three of which hit his target: Robert F. Kennedy, a contender for the office of President of the United States.

The assassination was one that altered the course of history, 50 years ago this month. It happened in full view of dozens of people, but conspiracy theories doggedly maintain there was a second shooter in the kitchen of the Ambassador Hotel at 12:15 a.m. on June 5, 1968. (The latest to promote this theory of an unseen and unheard second killer is the senator’s own son, Robert F. Kennedy, Jr.)

The first full medical review of the murder, published today in the Journal of Neurosurgery, reviews what has been called “the perfect autopsy.” The new review concludes that Kennedy received the best medical treatment available at the time—and though there were some delays in getting him to surgery, he would have died as surely in 2018 with the best trauma care as he did in 1968.

It also concludes that a second shooter is extremely unlikely.

“Although this story has been repeated in the press and recounted in numerous books, this is the first analysis of the senator’s injuries and subsequent surgical care to be reported in the medical literature,” write the four doctors, from Duke University School of Medicine.

This representation was created based on data from the autopsy report and testimony, as no imaging studies are available for review. (Credit: Illustrated by Megan Llewellyn, MSMI; Copyright Duke University; with permission under a CC BY-ND 4.0 license, https://creativecommons.org/licenses/by-nd/4.0/.)

Kennedy was shaking hands with a busboy Juan Romero when Sirhan Sirhan, a 25-year-old immigrant from Palestine, rushed forward and fire eight shots out of his Iver Johnson Cadet revolver.

Five shots missed Kennedy, but hit people behind him—all of whom survived.

Three bullets hit their mark. Two were nonfatal, one in the armpit and another in the back.

But the third was behind the senator’s right ear. That shot sent bullet and bone fragments through the brain, and ultimately caused the death, according to the paper.

Kennedy lay on the floor of the hotel kitchen for 17 minutes while campaign staffers and onlookers waited for an ambulance.

Among the crowd were five doctors who had listened to the senator’s speech in the hotel ballroom minutes before, and who tried to help. The senator was able to move all four limbs still, but he started to lose consciousness. One of the doctors noted a blood clot at the head entrance wound. By inserting his finger in the bullethole, the doctor dislodged the clot, which allowed blood flow and drained the pressure within the cranium. The senator returned to consciousness. (This intervention is “eerily similar” to a doctor who inserted his finger in the entrance wound of Abraham Lincoln’s fatal gunshot 103 years earlier, which temporarily allowed improvement, but ended with the same ultimate result, the Duke doctors note in the study.)

The police dispatched originally sent the ambulance to Central Receiving Hospital just 2.1 miles away, but which was unequipped for the complex neurosurgery required. The senator was transferred after just a few minutes to Good Samaritan Hospital, about 0.4 miles down the road. (The Duke authors conclude 45 minutes could have been saved if the “correct” hospital had been picked.)

X-rays showed doctors that the head wound was the real problem. A tracheostomy improved some dangerous hypertension. At one point, staff transferring Kennedy from the fifth-floor ICU had to take a back elevator to avoid a crowd of well-wishers and press while making their way up to the ninth floor surgery room.

The operation took almost four hours to remove as many of the fragments as possible, and to limit the bleeding. The craniotomy improved the senator’s breathing and vital signs. The dead parts of the occipital lobe and right cerebellum were also debrided, and a steroid and respiratory drug were administered. Kennedy was then placed on a cooling blanket to reduce fever, and then multiple neurosurgeons from across the country were consulted. One even flew from Boston to assist with the potential treatment options.

Twelve hours after the surgery, Kennedy went downhill, and he was pronounced dead in the early hours of June 6.

The technology at the time did not include computer tomography, or CT, scans. But the medical literature indicates that the ragged kind of head trauma caused by a bullet and bone fragments behind the ear, even with a relatively-small .22-caliber round, results in an approximately 54 percent mortality rate.

“This high rate of mortality unfortunately holds true in modern series of of cranial gunshot wounds,” write the Duke doctors.

The autopsy was conducted by Thomas Noguchi, the noted Los Angeles County chief medical examiner, who headed the office for 15 years and conducted the autopsies of celebrities from Natalie Wood, to Marilyn Monroe, to Sharon Tate.

For its attention to detail, the RFK death probe was called “the perfect autopsy” by at least one independent author.

The fatal wound, based on powder burns on the skin, was fired within 3 inches of Kennedy’s head, according to Noguchi’s findings.

Further look into the firearms evidence indicated that there was a discrepancy of the eyewitness reports saying Sirhan had approached from the front, and had come no closer than within 12 to 18 inches of Kennedy.

“Noguchi, in his later writings, makes it clear that his report did not imply that Sirhan was the lone shooter, leaving the door open for conspiracy theorists,” the Duke team writes.

Overall, there is not enough evidence to bolster the second-shooter theory, the authors add.

“Much has been made of the fact that the assassin approached Kennedy from the front, but the gunshot wounds were in the back,” they conclude. “Severael witnesses documented that Kennedy’s head was turned to his left as he was shot, which explains the trajectory of the bullets.

“The same witnesses did not see another shooter,” they add. “Despite concern over the trajectory of the bullet and controversy about gunpowder on the skin, there was never clear evidence of conspiracy and Sirhan was ruled the lone gunman.”

Sirhan Sirhan, now 74, remains behind bars in California.

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