In 2004, Donda West left Chicago for L.A., where Kanye lived, apparently to be closer to her son. A longtime colleague, College of Arts and Sciences dean Rachel Lindsey, says that West was conflicted about moving, but wanted her son to have someone he could rely on nearby. At Kanye’s request, Donda became chief executive of West Brands LLC, the umbrella company for his business endeavors, and oversaw his philanthropic efforts. "She wasn’t trying to glom off Kanye," Lindsey says. "She was very much her own person."

Once in California, West seemed to take a more active interest in her appearance; in TV interviews for her book, she looked polished and telegenic, with new reddish hair extensions. She had much to look forward to: her son’s planned wedding to girlfriend Alexis Phifer and the Grammy Awards in February 2008— Graduation had sold nearly a million copies its first week in release and would win four Grammys. Donda West was starting a new chapter in her life, and may have wanted a new look to go with it.

But at the time of her surgery, West was in less than perfect health. According to the coroner’s report, she was borderline diabetic, clinically obese—at 5’2”, she weighed 188 pounds—and had a family history of heart disease; her right coronary artery was 50- to 70-percent blocked. Before the operation, which lasted more than five hours, Adams apparently advised West to go to an aftercare center. Instead, she chose to go home in the company of her nephew, a trained nurse named Stephan Scoggins, and two women of unknown expertise identified in the coroner’s report only as “Diana” and “Nubia.” (Scoggins declined to speak to 02138, saying, “We’re just trying to get back to living.”)

Donda West surely could have afforded the best medical care, and surely knew that such care was readily available for the wealthy and famous. On the other hand, why would Donda West have questioned the credentials of a doctor who had a Harvard resumé, appeared on Oprah, and hosted a TV show?

Some in the world of Los Angeles plastic surgery have suggested that West may have chosen Adams partly because she felt particularly comfortable with a black doctor who emphasized his treatment of black patients. Adams’ book detailed differences in scarring patterns for women with dark skin, and provided case studies demystifying tummy tucks, liposuction, breast reductions, and narrowing noses. Adams wrote that black women’s faces age differently than white women’s, tending toward sagging in the forehead rather than in the jowls.

The idea that ethnic differences matter in plastic surgery isn’t just marketing hype, according to Dr. Anthony Griffin, a plastic surgeon who’s known Adams for years. Black patients, he says, tend to have “thicker skin layers” than whites, requiring different sutures. He adds that people with “ethnic skin” are prone to keloid scars, which can grow beyond the initial wound.

But other doctors say that any experienced surgeon could have performed West’s surgery. “There’s nothing ethnic to a breast lift or a tummy tuck or a liposuction,” says Dr. Larry Koplin, a well-known (and white) Beverly Hills surgeon. But, Koplin adds, with some types of cosmetic procedures, such as rhinoplasty or eye surgery, it might make sense for patients to find doctors familiar with their own ethnic groups.

So what went wrong? It’s likely that no one will ever know. But complications are common in plastic surgery and can be especially problematic when a patient has preexisting health issues. Every doctor interviewed for this article sooner or later said, “It could have been me.”

By all accounts, Adams’ professional future looks grim. Even if he can avoid further legal quagmires and attract new patients—he admits to losing numerous old ones—his celebrity status has been reduced to sordid tabloid headlines.

Although the Wests haven’t filed any lawsuits against Adams, the threat seemed to weigh heavily on him when he returned to Larry King’s set on January 23, 13 days after the autopsy was released. He told King that his practice was “almost destroyed” by the negative publicity, and avoided any topic likely to irritate the West family.

“Did the autopsy clear you of any involvement, do you think, in [Donda West’s] death?” King asked.

“I think the autopsy speaks for itself, period,” Adams responded.

For someone used to being on television, Adams seemed strangely agitated. He bit his lip, looked at the ceiling, and spoke in contorted sentences. Malpractice suits, he insisted, are “a symbol of the foulness that has sort of contaminated our entire society.” But Adams reserved his strongest words for those whom he felt had criticized him, implying that such critics, perhaps, were racist. "When people attack you like that—and I’m talking [about] the press—you have to say, 'Why do they fear you?' Because generally people attack someone whom they fear,” Adams said. “The real question isn’t … this particular patient. The real question out there is … 'Why is this attack going on?'"

Larry King asked Adams to come back another time, but that seemed an unlikely, unpleasant possibility for both. After the commercial break, King had already moved on to investigate a brand-new celebrity tragedy: Heath Ledger, the Australian actor, who had been found dead in his Manhattan apartment the previous day. Jan Adams’ time in the spotlight was almost up.

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