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Physicians speculate Game of Thrones’ King Joffrey would have lived had he received proper medical care when poisoned at his wedding

Toronto, February 15, 2018

By Leslie Shepherd

King Joffrey I Baratheon, moments before dying of poisoning
Games of Thrones’ King Joffrey I Baratheon (right), moments before dying of poisoning at his wedding to Queen Margaery (left)

What would the world of Game of Thrones look like if King Joffrey I Baratheon had not died of poisoning at his wedding?

The question arises because a medical student and physicians at St. Michael’s Hospital, writing on an emergency medicine website, say the twisted little king would have lived if he had received proper medical care at the time.

In the fantasy drama books and TV series, King Joffrey developed dry mouth, a severe cough and shortness of breath after eating pigeon pie at his wedding and drinking from a glass of wine poured by his uncle, Tyrion Lannister. He fell to the ground, gasping, choking and convulsing before going into cardiorespiratory arrest. Although many guests and bystanders were present, no one tried to resuscitate him and he died in less than three minutes.

“We believe the resuscitative attempt (or lack thereof) for Joffrey demonstrated in this case was poor, even for a peasant, let alone the King of the Seven Kingdoms,” wrote third-year medical student Will Wu, staff physician Dr. Emily Austin and Emergency Department physician Dr. Steve Lin, on the CanadiEM website.

The three speculate the king’s odds of survival would have been much higher had someone performed CPR, used an automated external defibrillator, and consulted a toxicologist. Extracorporeal Membrane Oxygenation, or ECMO, a mechanical system that temporarily takes over the function of the lungs, or intravenous lipid emulsion therapy “are also promising therapies” that could have boosted his chances of survival.

“As authors of this report, we can only speculate about the fate of King Joffrey had he received appropriate and timely medical care, and the difference his survival could have made to the chain of events that lead to the [continent of] Westeros we know today,” said Wu, a University of Toronto student, Dr. Austin, a toxicology expert, and Dr. Lin, whose research work focuses on resuscitation.

“We created this case report on Game of Thrones as a fun way to engage fellow health-care practitioners and to reach out to a broad audience on important topics in emergency medicine. It was enjoyable trying to apply what we know in research and medicine to the fictional world of Westeros, and speculating about how modern medicine could have changed everything.”

If he had lived, the authors speculate, it's likely that Tyrion Lannister (the presumed though actually innocent poisoner in the TV series) would not have been forced to flee, killing his own father on the way out of the Seven Kingdoms.

Sansa Stark, another suspect by virtue of the fact she had been forced to marry Tyrion and to watch as Joffrey executed her father, also would not have been forced to flee. Therefore she would not have been rescued by the devious Littlefinger who later wed her to the sadistic Ramsay Bolton who raped and tortured her.

Margaery Tyrell, the king’s bride, would not then have married Joffrey’s younger brother Tommen, leading to further conflict with their mother Cersei Lannister, which led to Cersei killing Margarey and most of her family, along with much of the people of King’s Landing, the capital. All of that led to Tommen’s suicide and Cersei claiming the Iron Throne, setting the stage for the show’s final season pitting Cersei against Daenerys Targaryen, the heir of the former rulers of Westeros and now the arch-enemy of the Lannisters.

It was Margaery's mother who poisoned Joffrey, by the way, in the TV series.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 29 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.