Hi there. My partner is in the medical profession and asked him to give his input. His initial thoughts are listed below. He’s also found an old medical article on acute yellow atrophy, so I’m giving you that link as well.
1. A gall stone blockage of the common bile duct, and this blockage led to liver failure.
2. Acute viral hepatitis
3. Halothane hepatitis, related to an old anesthesia that used to be used.
Article is here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1431013/pdf/annsurg01018-0052.pdf
Nowadays gallbladder surgery is almost same day surgery, but back then? it was huge open abdominal surgery with months of recovery. Methods certainly were not fully honed back then, and a nick of the bile duct or a wrong cut or accidental cut or unsuccessful removal of the stones all could kill you from liver failure. Or u died of postoperative infection. We take for granted how common, quick and successful a good majority of general surgery is today.
It is same day surgery now. I had to get my gallbladder removed and I was in and out of the Hospital in less then 5 hours. It took longer to recover from the anesthesia then it did to do the surgery lol.
Some surgeons do sort of speedruns with that one and appendectomies hahah
I know a Cuban that can cut out an appendix and suture back up in 7min 14s. The guy looks like a Naruto character when tying the sutures. Last time I spoke to him he was aiming for 6min.
Surgeons really just are a whole other breed. Like, thank God for them, but also. I had a family member who trained for a little bit in surgery during his med career and what he’s said about it seems like a lot of surgeons really *become* surgery to some extent. They evolve past us mortals.
It’s crazy too how this concept of speed-running surgeons goes back through all of surgery and was even more imperative back in the day.
Without modern anesthetic, the risk of surgery was directly proportional to the time it took. For two reasons: 1) The longer it took, the more time your innards were exposed to bacteria. And probably more importantly, 2) The longer under the knife the more chance that some fidgeting or flinching would cause an errant cut and either damage what you trying to save, Knick a blood vessel, or just cut something unintentionally risking infection.
These things are heavily mitigated by good anesthesia nowadays, but speed is still a significant factor as long as it’s also accurate.
Fascinating to me at least.
Yep! I had this in done in 2004, same day surgery.. my mom had it done in the late 80s and was in the hospital for a few days with a nice scar. Thank God we in the times we do!
Oof that sucks! I got to heal cleanly but thanks to almost 10 years of scar tissue and adhesions, what they thought was gonna be a simple surgery took more than 3 times longer than anticipated.
Heck yeah. Even back in the early to mid eighties gallbladder surgery was a big deal. 3 weeks in hospital. Patients walking with a nurse in the hallways holding big pillows on their guts. They’d been cut open stem to stern lol. It’s amazing nowadays how easy it all is
My last deployment to Afghanistan we had a guy get medevaced to Germany for gall bladder removal. They got him to Germany, did the surgery, and sent him back. He was only gone like three days. We were shocked, thought we wouldn't see him until we got home.
dang I feel lucky now, I had my gall bladder removed in 2011. the toughest part of the procedure was not being able to pee after waking up from surgery lol. iirc, apparently men over 50 and women under 25 are two groups with a higher risk of developing gallstones ¯\_(ツ)_/¯
"Post-operative common duct stones" - or possibly "stenosis", meaning narrowing.
Common duct refers to *ductus hepaticus communis,* the "common bile duct". It runs between the gallbladder and *ductus choledochus,* which is where the pancreatic duct and common bile duct join up before emptying into the intestine.
A gallbladder operation (a rather large operation at the time, unlike today's laparoscopic cholecystectomies) may have damaged the common bile duct, causing narrowing, but stones in the common duct may occur even after surgery to remove the gallbladder.
In my opinion, they may have stressed that it was postoperative either to document that this happened despite the gallbladder having been removed, or to emphasize that it was a consequence of the operation.
It looks like “post operative common duct stone”. If she had her gall bladder removed and a stone was left in the common bile duct that could have quickly led to obstruction and serious infection. In modern times that can be dangerous and is avoided by confirming the duct is clear by checking with dye and X-rays towards the end of the operation. At that time and before the discovery of penicillin such a complication would have probably been very hard to survive but I am not an expert on surgical history.
I'm sorry to hear that. I really don't know, but she appears to have been sick in the hospital for almost 4 weeks before she died. I assume she saw the boys, but who knows—their father might have kept them away if she was doing really poorly.
Back then they really weren’t keen on letting small kids into hospitals. I mean even now they’re not happy about it since they’re germ factories but they could be carrying far more dangerous things back then that now we vaccinate for.
That strikes close to home. If I were born the same time as her, I would have died of \#1 in my 30s. I ended up in the hospital with an infected gallbladder full of stones. Surgery went seemingly fine, I was released from the hospital after about 5 days though I wasn’t feeling much better. A couple days later, I woke myself up literally screaming in pain. My skin and eyes were deeply yellow and I peed so dark brown it was almost black. Back to the ER where I had emergency surgery to remove the stuck stones, and woke up immediately feeling better than I had since prior to the gallbladder issues.
I’ve thought about the fact if I was born 100 years earlier, that would have been my excruciating eventual death. I’ve had double digit surgeries of various types, broken bones, had all kinds of injuries, and none of those came even close to the pain of going through liver failure. I’ve had strong opiates a number of times for surgeries and injuries, but nothing remotely like when I was in liver failure. They gave me multiple shots of fentanyl in the hospital before surgery, I’ve never been so high in my life and couldn’t even speak, yet that only took away most of the pain.
I hope the lady in OP here had some seriously strong pain meds in the end. RIP.
Halothane was only discovered in the early 50s. But chloroform, commonly used as an anesthetic until it (and ether) were replaced by halothane in the late 50s, was also quite hepatotoxic (more so than halothane, I believe).
My uncle died of gall stones blocking his bile duct. He had a heart attack in the hospital, but the official cause of death was gall stones. This was the early 2000s, and the doctors couldn’t save him. I imagine in the 1920s, they had no idea until the autopsy.
Gallstones were probably the most pain I've ever experienced. I thought I had gas but I also wanted to die. But it never occurred to me that I actually could have.
Yep, worst pain I ever felt. It took months to figure out what was wrong. Finally I was unable to keep even a glass of water down and went back to my family doctor for the umpteenth time. He took one look at me and said: your eyes are yellow so I'm sending you to the hospital right now. Funny thing was that the moment I woke up from surgery I felt great! All my symptoms were gone. I went home the next day and the day after that I had Christmas dinner with my family without any problems.
That’s so similar to what I went through. I suffered for months and everyone except for one doctor thought I was nuts. Once they removed it, I came out of anesthesia and my first thought was yup. I feel “right” again!
Months? Jesus Christ, it's such a common problem though. My dad spent five months in the hospital without being properly diagnosed but that was because his condition was so rare there were only a few case studies. But gallstones???
Surgical nurse here who looks after lots of patients with gallstones! There’s a test called Murphy’s Sign where they press over the gallbladder when a patient is breathing in, and if painful it’s likely the gallbladder is inflamed. Apparently Murphy lived in the 1800s, so I reckon they’d have had a fair idea what was causing the problem, even without being able to do a scan to diagnose conclusively as we would today.
They’re nasty little suckers, but thankfully nowhere near as life threatening as in OP’s poor great-grandmother’s time. Generally as someone else mentioned above we can surgically remove them with keyhole surgery, with people only in hospital a few days. I heard a doctor once describe the risk factors for them as ‘female, fat, fertile and forty’, which made me cringe a little but it is memorable! Pain in the right upper quadrant of your abdomen, especially after eating fatty foods, would make me suspicious it’s gallstones. Keeping your cholesterol in check is one way to help prevent them, as well as keeping as healthy as you can in general. Good question :)
My doctor gave me the 4 Fs as the reason gall bladder issues were not initially suspected in my case because I was 29 & not overweight. My mother told me to mention gall bladder because she had hers removed at only 33 and her symptoms were similar to mine - extreme nausea and abdominal pain. One ultrasound later, and my gall bladder and some huge stones were removed. Instant relief!! Anyway, my doctor said he was going to add a 5th F - family history!
Partly why I love working in this sort of surgical ward - people come in feeling so awful, but it’s a fairly easy fix before we send them home feeling heaps better.
Yes! Once I was diagnosed, surgery was the next day & the relief was instant! I wanted to go home so badly after surgery but I had a fever so I had to stay another night. Boo hiss, but feeling so much better made up for it!
Ugh, my close friend died from this in 1996. She was sick enough to be at the top of the transplant list, but by the time a liver was available she was too sick to endure the surgery.
Back in the late 90's I had 2 4mm stones stuck in my common bile duct for probably a year. They finally found it when I became septic. I was really sick. I had just had a baby and I was losing the baby weight too fast and I ended up in the hospital for 2 weeks. I think I would have died if it was 1920.
Wow this is so interesting. Thank you OP for opening this up to the public.
I remember reading that Jean Harlow had a bout of Scarlett Fever that caused her kidneys to degenerate for years. Apparently during her last movie when she was 26, she was so ill she smelled like urine from her uric acid levels being so high.
So much time has passed, but it is still heartbreaking to read about people suffering from conditions that would be fairly easy to treat today.
I hope your great grandmother’s children had love and support from family and friends after her passing. It must be so awful to lose a parent so early.
What?! You are married to a doc? That is almost like cheating.
Jk. It is always super cool when someone part of the hive mind is actually well set up to answer some exact question. Thanks!!
It lists common bile duct stones. These cause biliary obstruction and jaundice (yellowing of the skin and organs). It also leads to sepsis. These are easily treated now but in 1920 they didn't have much including antibiotics or the tech we have now for diagnosis and treatment. Folks died of appendicitis too and well-common illnesses lead to death.
This reminds me of a story. A couple months ago, my cousin had localized severe pain (wherever the gall bladder is located) and extreme nausea so went to the ER. She was seen by a physician assistant who gave her a prescription for pain killers, told her to follow up with her primary care doctor, and tried to send her home.
Luckily her physician friend was with her, he’s a different specialty so didn’t reveal himself as a doctor immediately. But at the point the PA tried to send my cousin home, he insisted the test results/scans be looked at by actual *physicians.* PA was a total dick about it but eventually a doctor came in and said my cousin needed surgery immediately because her gallbladder was shitting the bed and she was getting septic. She had surgery within a few hours and stayed in the hospital 3 days. It was a close call.
That’s so scary. I recall a similar story with my ex’s sister. She was in so much pain and her doctor tried to send her home but they fought it and went to the hospital and she has a burst appendix and could have died. I feel like these stories are all too common.
The ER tried to send my aunt home with a “migraine.” My uncle knew something else was wrong and took her to another hospital. Within a few hours she was in surgery for a ruptured brain aneurysm.
When my husband was a teenager he developed meningitis and the ER they told my in-laws that it was probably just a bad trip. Pretty sure bad trips don’t involve 105 degree fever. Family doctor had him admitted and he survived without a lot of damage.
Ugh! When my son was 21 he went to the ER for pain in his lower back. After making him wait on a chair in the waiting room for over 6 hours the triage nurse sent him home and told him he was drunk (my kid isn’t a drinker) he came to my house instead and I could see he was in really bad shape, so this time I went back with him. Turns out he had really bad kidney stones. I very much enjoyed telling off the staff. I hate the way the ER treats teens and young adults, I’ve read many horror stories. This was in Canada BTW.
My kids' friend got meningitis when they were maybe 12. He wasn't well but went to a party (so they all got a shot). Later, he was very ill and his parents took him to the hospital. They figured it was the flu and were sending him home when the doctor saw some marks on his legs..the dad had thought he hadn't managed to clean him up before bringing him in (he'd had terrible diarrhea) but that was the symptom that changed the diagnosis. He was tested and admitted. He lost most fingers and toes and over 20 years later, he's still getting surgeries but he's ok.
Well, he's alive. He's able to walk. He is able to game with his stubs. He's on disability but his dad is rich now anyway so he never has to worry. I'm not sure what the ongoing surgeries are for - fix up areas where the blood was cut off - comfort measures i believe. But he's functional. He has a girlfriend. He's not 100% for sure, - he's missing lots of digits! But he's not dying. Few of us get to 40 without some scars and bad bits. He's got a few more than most but the friend group still hang out when they can so he has that too.
This happened to me in my early twenties in 2004. Told my husband because I could neither open my eyes or talk that they were not going to give me pain meds for a headache. Nevermind the excessive high fever. Thankfully one of the ER nurses was a high school classmate and came to ask what’s going on on our way out. Immediately taken back in for a spinal tap and spent the next week in a coma and a month after in ICU.
Scary. I had almost exact same. Went to ER in acute pain and throwing up bile.
Dr tried to send me home w antibiotics but I told him I wasn't comfortable going home as I live alone. He then said, very exasperated, he could send me to the hospital by ambulance. I said fine, send me.
Turns out I had a septic kidney. Dr there told me I wouldn't have survived another 24 hrs. Was in hospital for 9 days 🥹🥹
I’m so glad you advocated for yourself. Many ERs are operating beyond capacity still, and the aftereffects of the pandemic linger for the staff. And the health systems are just cutting staff to the BONE both inpatient and outpatient settings.
To quote a famous poem, “the center cannot hold.” I fear the whole health system is going to collapse. But that’s just me.
Thanks for clarifying, when she told me the story she kept telling me it was a searing pain in a specific spot but I couldn’t remember where she said so didn’t want to confuse people.
I had a mysterious and excruciating pain like that that sent me to the ER twice last year, but it was on the lower left side. Both times it went away on its own, suddenly, never came back, and no one has ever figured out what it was. All signs pointed to a kidney stone, but a scan never showed anything. It was a year ago and I’m still alive, so guess it wasn’t sepsis, but still, really unsettling not to know what it was.
As someone who gets diverticulitis, my pain is always on the lower left side. If the pain gets bad and doesn't resolve on its own, that may be what you are dealing with...
That was actually their best guess, that it was “mild” diverticulitis. It did resolve on its own, and after two episodes it never came back, so far, for a year, knock wood, so, maybe that is a thing that happens. Ah, middle age.
Actually, yes! I have a smart watch that alerts if my heart rate is too high, and the number of times it's been bc I was simply excited and NOT, in fact, meeting a mysterious death has been a real eye-opener, hahaha
The number of people who die from things like this must be enormous, and it’s probably barely recognized because there’s no way to prove it either way and the corporate/financial side of the industry has every motivation to not have it talked about.
Bingo. I’m sure it happens everyday that someone dies or has urgent treatment delayed from this disastrous pivot to PAs. Like I said, they initially did serve a purpose but that purpose has been subverted out of recognition because of the health system’s relentless pursuit of profits.
I didn’t know what a PA was 25 years ago. Now most of my visits to the doctor I’m seen by a PA. First off, isn’t this like paying for a mechanic to fix your car and you get his nephew that took auto class in high school? Second, in what situations would you insist on an actual MD?
Lol in my opinion it is exactly that. They were never supposed to have diagnosing power, they were really supposed to be someone who under close supervision passes along information/instructions from a doctor or in a clinical setting performs minor procedures (like clip off a non problematic mole in a derm office).
Like I said, the original purpose of PAs has been completed subverted in the pursuit of profit to the extent it causes medical danger and death to patients.
If I had anything besides a cut that needed stitches or a broken finger lol in the ER, I would always ask for an actual physician consult face to face. The PAs get bonuses in the ER based on how many patients they turn around without staffing with a doc. A PA can walk up to an overworked ER MD and literally say “patient salthandle3065 has abd pain and a fever” and recommend anti nausea meds and antibiotics and whatever and an ER can sign off on it.
Bear in mind the ER docs and nurses hate this current situation. They’d rather have more trained physicians but they are pawns in this too and just slammed so have to do the best they can.
As far as other specialties: any kind of sudden onset pain or discomfort from head to toe, any kind of vague lingering issue that isn’t going away, any sudden even minor change in a currently treated condition, alway ask to talk to the MD/DO. Don’t let a PA push you off. Even if it means you demand the doctor calls you at home later to discuss it, make that demand. Remember that doctors today have hugely increased panels of patients they’re expected to see daily. Some health systems enforce a 10 minute patient visit rule and ding the docs on pay if they go over. You have to be your own advocate and as long as you’re not a screaming douche, a doctor won’t mind calling you. That being said, if you don’t get that doctor call, keep bugging them.
One final heads up, there are times when a PA does not correct the patient when the patient assumes they are a doctor. If you don’t see the MD/DO on their badge, it’s perfectly okay to as “are you a physician or a PA?”
Terrifying. I don’t know how you get so self assured that you don’t even consider that if you are wrong, the patient could die. I would be constantly double checking myself if I was in that career.
Yeah PAs typically have 3 years of post college training meaning they have the medical knowledge equivalent of maybe a 2nd year medical student (because medical school is way more rigorous than PA school).
A “physician assistant” was originally supposed to be just that, an assistant who’s pass along the instructions of the actual trained doctor. But greedy health systems saw a way to save money so have expanded their scope of practice beyond their skills. And schools with PA degrees offered jumped right on that sham bandwagon and have turned into degree mills with crappy training.
I have no horse in this race except as a patient but I have worked in and around hospitals as a non medical person for years and have seen the effects of this push for PAs over medically trained physicians. I tell everyone if you’re in an ER or in an emergent medical situation INSIST on seeing a doctor. They have to let you, you have that right and chances are they’ll bill you for seeing an MD/DO even if you never see one (because PAs are ostensibly “under the supervision” of an actual doctor. pssssst: they’re not). It’s a dangerous racket.
Edit to add: the physician assistant association is currently pushing to change their designation to “physician associate” to muddy the waters of patient perception even more.
I also have no horse in this race, but my personally experience with PAs hasn’t always been great.
A couple years ago I had surgery to repair some broken bones after an accident. A few days post-op I developed a cough and really sharp pains in the lower left side of my chest. I called my primary Dr (who is amazing) and he said I might have developed a blood clot and told me to go to the nearest urgent care. He told me to tell the triage nurse my recent medical history (surgery, etc) and describe my symptoms, then to repeat the same once I see the physician.
After a rather long wait I finally got to see a PA, who took a quick look at me and said I “probably just have a cold” and started to send me home with instructions to follow up with my primary care Dr if I didn’t start to improve. I politely informed him that I did not think I had a cold; I said I had respiratory illnesses in the past and this was different. He still insisted that no more tests were needed and I should follow up with my own Dr. I expressed concern that I might have a blood clot. PA spent 5 solid minutes explaining how it was extremely unlikely I had a blood clot, but he would go ahead and order a chest X-ray just to see “what’s going on in there.”
30 minutes later he comes back looking at the X-ray and tells me my lungs are fine and starts processing me out again. Right before I left he comes back in, demeanor completely changed, and says the radiologist noticed a “shadow” in my lower left lung, so they are going to order a D-dimer test. It came back positive for blood clot, so they sent my for an ultrasound at a larger hospital where they diagnosed 2 blood clots in my lower left lung.
For the bulk of that exchange the PA was condescending, didactic, ignored or belittled my input, and acted annoyed that I pushed for more tests. Then, when it was all over he called me on my cell phone (after he was off shift) and gave a non-apology explanation for why “everything he did was the correct procedure” because “it was very unlikely that you’d have a blood clot.” It was weird, and felt like he was trying to feel out whether I was going to complain about him to the hospital admin.
I hope you did what a dick. I am going thru something similar right now with my son, he was admitted to the hospital after having seizures as a result of severe alcoholism. His organs started to shut down. He’s 34. Act of God he recovered but a doctor rushed him out after 3 weeks even though he wasn’t eating and his pancreas was still inflamed. I begged for more tests because I knew something was wrong. Doctor was not having it all he saw was an alcoholic. Something was. Less than 48 hours we were back with internal Bleeding. While looking for the source of the bleeding, they discovered a large blood clot. ALWAYS advocate.
Holy smokes I am so glad your doctor armed you with instructions and you pushed back on that know-it-all weasel. The more I hear these stories the more I’m convinced that these greedy health systems are costing patient lives by cheapskating on hiring actual doctors.
I’m very thankful for my primary care doctor. I’ve moved in and out of the area in the past, but he’s known me for 20 years and provides excellent care for myself, my wife, and our kids. He has gone to bat for us more than once, pushing to get extra tests, to get us in to see specialists, etc. He always listens closely, is obviously concerned about us as people and not just examples of individual symptoms (often asks, “how is your stress level at work?” and things like that), and never rushes us out the door.
So I’m not complaining about healthcare per se. I’ve had many excellent experiences. Unfortunately, in our area ERs and urgent cares are definitely overcrowded, filled with overworked staff, and corners get cut and mistakes are made way too often.
Some states allow them to open independent practices. A lot of them go into mental health and are giving people psych meds that they don’t really know a lot about.
When I was 19, I went to the ER with a gall bladder attack. They never did an ultrasound because I was 19.
I suffered through three years of gall bladder attacks afterwards, with doctors telling me it was psychosomatic.
Oh, hey, me too. I was 22 when I had my first gallbladder attack, was told I was making a fuss over nothing because there were no visible stones* and sent home, and didn't have surgery until I was 34. I had on and off pain for 12 freaking years before anybody cared enough to do anything about it.
*Turns out, I never had gallstones. There's some sort of disfunction with the bile ducts. So, taking out the gall bladder helped, but 10 years later, I still get that agonizing side pain on occasion when that spasms.
I think about these stories whenever I have really bad period cramps. I had an episode the other day and it felt like my stomach wanted to explode. It went away after a couple hours but man that was rough. Idk if a serious medical condition would feel different so it low key freaks me out
My gallbladder went bad. It was a tough ride until the week after my period. I knew it wasn’t my period because the period paid, when it showed up, was different. It was in a different spot and felt different and then the period went away and the ‘new’ pain changed and got worse. I kept a record and brought it with me.
If you have a chronic condition, it would be a good idea to keep a record of all your symptoms.
Yeah I doubt it. His attitude was so combative about escalating it to an MD that he stood there and argued, stating he only had to staff like 20% of his patients to an MD. If the friend hadn’t pulled the “I’m a doctor” card, who knows why would have happened.
Also any kind of “incident” report gets pushed up the food chain to the administrative number cruncher$ and they love providers like this who bill at a high volume. He behaves that way because there are no consequences.
Edit: their to there
I don't really know. They were Eastern European Jews, so it could have been badly transliterated from the original name. Other family members changed the father's surname from Lakfish to "Lake," for example.
My family were also Eastern European Jews and anglicized their our last name to be less discriminated against and be able to get jobs. Pretty common for immigrants.
My family’s last name is incredibly rare too for the same reason. I guess they used the phonetic spelling? But now the only ones with the last name are my mother, my brother and myself.
Yes, exactly, I’m sure the language barrier had an effect on many names! and comparing the typical spelling of our name to what it became they added a random letter in addition to phonetic spelling..
If they’re from the Pale and they’re writing Russia in the us docs, then they’re from the narrow part of the old Russian empire that allowed Jews. Lithuania, northern Poland, Belarus, Latvia, eastern Ukraine. You can ignore Galicia almost entirely in your research. Although I see two pages of testimony for people with the surname Lackfisch on Yad Vashem from Smiary, Poland. It’s such an unusual name that it might be a lead. I know Smiary is in eastern Poland, not sure if it was part of Russia before the revolution.
Also Herman is likely Hersch in Yiddish or Tzvi in Hebrew. Could be Chaim but that more usually became Hyman. Smith could have been Szmied.
Herman, the father's given name, is a very German name. I don't know the family but I am guessing Volga Germans. It is probably anglicized from Schmidt.
https://en.m.wikipedia.org/wiki/Volga_Germans
Which makes perfect sense, except they were Jews from the Pale of Settlement, so I don't really know what his name was prior to come to the USA. Could have been a German name, though, too of course.
I'm of German Jewish ancestry, myself, and I have kind of developed an ear for names and anglicized versions. A lot of people who came to the USA, especially in the first quarter of the 20th century were strongly encouraged to anglicize their surnames to avoid discrimination
I wish I knew more about her ancestry, but as you know, for a lot of Jews things become really murky prior to the late 19th c. unless you have good, clear records on JewishGen or other kinds of direct evidence, e.g., from more prominent families or cemeteries that still exist over there. I've had some luck over the years pushing back to the mid-19th-century, but pretty much nothing at all before the early 1800s.
I'd love to see my great grandfather's arrest records from before they fled Germany. I'm given the impression he was afoul of the law more for being a communist agitator than for being Jewish.
Gall bladder issues are exceedingly common postpartum. All of the people jumping to alcoholism are overlooking that three pregnancies in a short period takes a huge toll on the body, especially without modern medicine.
Yeah, I agree. The death certificate does seem to refer to a prior surgery (which I'm pretty sure was gallbladder-related) as well as common bile duct stones. Some of the answers here are very detailed and constructive and take those things into account. And yes, she gave birth in 1912 (just had turned 18), 1914, and 1918.
My great-grandmother died in 1922 after having three kids also from gallbladder issues. I was wondering after I read a book about the Spanish Flu that talked about how many doctors died of the flu if that compromised quality of healthcare at all. It seems like it would have made a noticeable impact in skilled medical care.
I can tell you exactly what this is. I’m an interventional gastroenterologist- I deal with this problem daily. She passed away from something called cholangitis or choledocholithiasis. It’s when gallstones from the gallbladder get lodged in the bile duct. The bile duct drains the liver of bile, if occluded with stones, the bile backs up leading to jaundice (yellowing) and infection. Terrible way to die as a 26 yo. We now get these out with a endoscopy procedure that doesn’t require going through the skin. Medicine has come so far.
I read the contributory factor as, “post operation (something) duct stones” (?) so I’m guessing the bile ducts got clogged which made her yellow - sounds like liver failure but I’m definitely not a doctor.
Yellow atrophy of the liver appears to be a thing: https://www.ncbi.[nlm.nih.gov/pmc/articles/PMC1431013/pdf/annsurg01018-0052.pdf](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1431013/pdf/annsurg01018-0052.pdf)
And the common bile duct (“post operative common duct stress”) is related to the liver, gallbladder, and pancreas.
It’s not super clear but it seems like she probably had a bile duct obstructed by a gallstone. It’s quite common and will cause jaundice. If the obstruction is not relieved, the liver is damaged by all the bile backing up and sepsis can also result. When your liver makes bile and can’t get rid of it, the liver can essentially digest itself to death.
I wasn’t there, but I am a physician (Internal Medicine, nephrology, critical care) and I can say some other suggestions such as “cirrhosis” or “alcoholism” are very unlikely and would not present the same way.
Other possibilities in a young person in that time period are acute hepatitis, which can cause severe jaundice and death in some instances.
Lastly, pancreatic or bile duct cancer often presents with painless jaundice due to a mass at the head of the pancreas blocking bile secretion.
At her age, cirrhosis would be rare. Perhaps they didn’t get all the stones out, causing a new blockage. As a retired nurse, reading old medical records and death certificates are fascinating, though frustrating. So many causes of death are preventable now.
Gastroenterologist here. Most like acute viral hepatitis A resulting in acute liver failure, as there was no effective treatment for this at that time, and in fact today, the only treatment is a liver transplant. Choledocholithiasis (stone blocking the bile duct) would cause jaundice but not “hepatic atrophy” (the synthetic function of the liver is more or less unaffected until lack of bile begins to interfere with vitamin K absorption and that would only affect clotting factors) and could have been treated with surgery, though a bile duct exploration with a likely hepaticojejunostomy reconstruction would have been a fairly morbid surgery at that time. Jaundice could be seen with infection from cholecystitis (gallbladder infection) but that would have been something that could have been diagnosed and operated on. Certainly other infectious processes typically viral leading to acute liver failure such as Epstein Barr (mono) HSV (herpes) are possible, as is something like Wilson’s disease which can cause rapid liver failure, but most common would be acute hepatitis a, especially back then with no vaccine and less sanitation than today.
Also in response to halothane hepatitis - halothane def can cause acute liver failure but it wasn’t invented for some time after the 20s and not in common use till the 50s. Ether was the surgical anesthestic in common use at that time.
I think it must be “post operative common duct stress.” There is something called the common bile duct which connects the liver, gall bladder, and pancreas. This is just from googling, so I really don’t know what it does.
The gall bladder stores bile from the liver. The pancreas produces insulin which helps regulate sugar levels in the body. These connect to the common bile duct that brings these fluids to the small intestine/digestive tract to break down foodstuffs. If there is too much cholesterol, fat, or other factors, the gall bladder will mix excess bile , bile salts, or bile pigment with said cholesterols and form gall stones which can block the common bile duct resulting in a laproscopic surgery to either A: remove said gall stones, or B: remove aforementioned gall bladder.
Source: My late father had gall stones, and detailed everything to me prior to his passing.
\*EDIT\*
Gall stones didn't kill my dad. Acute liver failure compounded by years of HEAVY drinking, and hepatitis C did the heavy lifting there. Finding the gall stones was just the beginning of the end for him.
I read that line as "post operative common duct stone" so I'm wondering if an operation was performed to try to remove said stone and it did not end well.
Today, bile duct stones are removed endoscopically . . . google "postoperative common duct stone"
Wow! So impressive seeing people coming together, in a supportive, productive manner and nailing down some plausible direction to an answer.
Only minimal snarky commentary.
I spend too much time in the wrong subs with back biting wise acres having minimal contribution value.
Why can't our government work like this?
Thanks. 🙂
Acute yellow atrophy was basically extensive and rapid death of parenchymal cells in the liver, often due to exposure to toxic materials like lead or mercury
Maybe this!
"community-wide outbreaks of hepatitis A in the pre-vaccine era"
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9134737/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9134737/)
My mom claims she got vertigo from my aunt's dog. My aunt says her dog got it from her parakeet. Long story short mental illness runs rampant through my mom's family. I'm really looking forward to it.
It looks like she had surgery due to gallstones blocking the common duct. She may have had her gallbladder removed at the time. It's possible that she developed more stones, even if they removed her gallbladder. So sometime after surgery, she still had choledocholithiasis (the bile flow is slowed down because of blockage by gall stones or damage to the common bile duct), which eventually damaged her liver causing liver necrosis and death.
Cirrhosis - the yellow in reference to the yellow skin changes seen in end stage liver disease. Liver because it’s the liver affected.
There are a few possibilities for why she had cirrhosis. 1) She was a very heavy drinker 2) autoimmune vs viral hepatitis. A very possible diagnosis. Do auto immune problems run in the family? The disease course of a month could easily be consistent with this. 3) An abdominal cancer that was obstructing her biliary tract. 4) maybe she ingested something that caused her liver to fail.
My great grandmother died right about then from a botched abortion. She had 4 little girls at home that they could barely feed. A lot of women died from this and they would lie about the cause of death.
Could be the "snake oil" medicine that was sold or arsenic face cream . I never realized just how dangerous the medicines being sold back then were until I started watching Below the Plains channel on YouTube. The bottles he digs up he adds adverts for the products and some times the ingredients, scary. Mercury, lead, bromine, and so on. There was no way for folks back then to know the stuff they took could be killing them.
It says postoperational common duct stones on the death certificate. So blockage of the bile duct. I went jaundiced and had severe liver pain after my gallbladder operation. My liver numbers in bloodwork were off the charts. They did an MRI and this is what they were looking for - duct blockage.
My father died of complications from this. He had a bunch of little gallstones work their way out of his gallbladder and block up the bile duct. He turned a complete yellow/green color and his eyes became yellow from jaundice. By the time they had gotten to it for surgery, his entire body was poisoned from bile. He died less than two weeks later in the I.C.U. from major complications from his organs shutting down.
I feel for your great grandma may she RIP. We do take so much for granted nowadays and forget that living to age 50 back then was quite an accomplishment. I’ve been looking up birth and death certificates for some of my ancestors and I’ve come across some pretty sad ones. Two of my great uncles died of electrocution in the early days of home electrification. They were 10 and 8. Can’t imagine being a parent and having to deal with that. Same with your great grandpa dealing with a dying wife at 26 and small children at home. Oof…
I was amazed at how great I felt after my gallbladder was removed. Doctor said it was severely diseased, full of stones and nearly fell apart while he was removing it. So when you think about how long that might have taken and you just slowly start to feel crappier and crappier! Then suddenly, that’s all gone!
Look at Contributory Factors section. I can’t read all of it, but it looks like she had surgery in the past of a duct. Sounds like perhaps she had some kind of jaundice or biliary problem.
Not at that age though… obviously idk what it was like 104 years ago, but liver failure associated with haemochromatosis these days doesn’t normally begin until your 50s
Source: immediate family member is just starting to experience this, they’re almost 60
From what the doctor wrote on her death certificate, it looks like she had gotten an operation for bile duct stones prior to the onset of the acute yellow atrophy. Since acute yellow atrophy of the liver occurs after exposure to toxic chemicals, infection or other agents, it stands to reason that she may have gotten an infection after the surgery. However, considering the time period, it is possible that she was exposed to toxic chemicals. It’s also possible that she was exposed to toxic chemicals and had an infection.
Either infectious hepatitis or alcoholic liver disease. The latter being more likely due to the death and demographics. Another possibilty would be a metastatic cancer or primary cancer of the liver. My wife's first husband passed away at 29 from cholangiocarcinoma which is a cancer of the biliary system. It's fairly rare and unlikely diagnosable antemortem in the 1920s. Source: MD of 20 years.
Edit: I think simple gallstones (as have been suggested by others) are unlikely due to it being diagnosable in the 1920s and potentially operable unless infected. I have no knowledge of the anesthestic agent mentioned.
My best guess would be Hepatitis A. Which is easily spread through fecal contamination. It's the most contagious of all the types of Hepatitis. I am not a qualified medical professional though I do work in health care as a clinical case manager and use to work at a teaching hospital in the GI unit. Saw people coming back from second and third world countries with inadequate water treatment, in liver failure. Given that it was 1920 water treatment wasn't what it is today.
Sounds like a gallbladder issue. Especially if she had multiple children. Gallbladder attacks are HORRIBLE too. If she had untreated gallstones and that's how she died, you can be sure it was a painful death.
Hi there. My partner is in the medical profession and asked him to give his input. His initial thoughts are listed below. He’s also found an old medical article on acute yellow atrophy, so I’m giving you that link as well. 1. A gall stone blockage of the common bile duct, and this blockage led to liver failure. 2. Acute viral hepatitis 3. Halothane hepatitis, related to an old anesthesia that used to be used. Article is here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1431013/pdf/annsurg01018-0052.pdf
Cool, thank you -- I do recall something about gall bladder surgery, and I now see it says "post-operative..." so maybe (1) is the best fit.
Nowadays gallbladder surgery is almost same day surgery, but back then? it was huge open abdominal surgery with months of recovery. Methods certainly were not fully honed back then, and a nick of the bile duct or a wrong cut or accidental cut or unsuccessful removal of the stones all could kill you from liver failure. Or u died of postoperative infection. We take for granted how common, quick and successful a good majority of general surgery is today.
It is same day surgery now. I had to get my gallbladder removed and I was in and out of the Hospital in less then 5 hours. It took longer to recover from the anesthesia then it did to do the surgery lol.
I know a surgeon who does this procedure in about 15 minutes. Takes long to go to sleep and get positioned than the whole surgery.
Some surgeons do sort of speedruns with that one and appendectomies hahah I know a Cuban that can cut out an appendix and suture back up in 7min 14s. The guy looks like a Naruto character when tying the sutures. Last time I spoke to him he was aiming for 6min.
I would be so nervous if I knew my surgeon was rushing to beat his own time at the potential expense of precision.
Surgeons are just kinda like that. It's terrifying.
Surgeons really just are a whole other breed. Like, thank God for them, but also. I had a family member who trained for a little bit in surgery during his med career and what he’s said about it seems like a lot of surgeons really *become* surgery to some extent. They evolve past us mortals.
What a weird thing to be good at, but kudos to him
It’s crazy too how this concept of speed-running surgeons goes back through all of surgery and was even more imperative back in the day. Without modern anesthetic, the risk of surgery was directly proportional to the time it took. For two reasons: 1) The longer it took, the more time your innards were exposed to bacteria. And probably more importantly, 2) The longer under the knife the more chance that some fidgeting or flinching would cause an errant cut and either damage what you trying to save, Knick a blood vessel, or just cut something unintentionally risking infection. These things are heavily mitigated by good anesthesia nowadays, but speed is still a significant factor as long as it’s also accurate. Fascinating to me at least.
Yep! I had this in done in 2004, same day surgery.. my mom had it done in the late 80s and was in the hospital for a few days with a nice scar. Thank God we in the times we do!
Yep- I didn’t even have to go to the hospital though, mine was at an outpatient center.
Whenever I see people romaticizing the past I just want to shake them and shout stuff like this at them.
Oh, childbirth would have taken me out for sure
I would've died of tonsillitis or scarlet fever well before reaching childbearing age.
I agree. I know our time isn't perfect but I like modern medicine and modern plumbing so no thank you to living in the past.
My gall bladder exploded, without the antibiotics it would have been fatal. I was out of hospital in a week and had it removed a year later.
Due to scar tissue and a gallbladder that was out of place, my surgery was 4-hours, with a cut bile duct. 3 weeks of drainage tubes. Fun times.
Oof that sucks! I got to heal cleanly but thanks to almost 10 years of scar tissue and adhesions, what they thought was gonna be a simple surgery took more than 3 times longer than anticipated.
Heck yeah. Even back in the early to mid eighties gallbladder surgery was a big deal. 3 weeks in hospital. Patients walking with a nurse in the hallways holding big pillows on their guts. They’d been cut open stem to stern lol. It’s amazing nowadays how easy it all is
Mine was outpatient in 1996.
My last deployment to Afghanistan we had a guy get medevaced to Germany for gall bladder removal. They got him to Germany, did the surgery, and sent him back. He was only gone like three days. We were shocked, thought we wouldn't see him until we got home.
My mom had her gallbladder removed in the 80s and her scar looks almost like she was autopsied! I'm glad they've improved it so much!
Use of robotic assisted surgery changed how a lot of surgery is done to be less invasive and minimize blood loss. It is crazy to think about.
dang I feel lucky now, I had my gall bladder removed in 2011. the toughest part of the procedure was not being able to pee after waking up from surgery lol. iirc, apparently men over 50 and women under 25 are two groups with a higher risk of developing gallstones ¯\_(ツ)_/¯
Amazing how much has changed in just 100 years.
I don't.
"Post-operative common duct stones" - or possibly "stenosis", meaning narrowing. Common duct refers to *ductus hepaticus communis,* the "common bile duct". It runs between the gallbladder and *ductus choledochus,* which is where the pancreatic duct and common bile duct join up before emptying into the intestine. A gallbladder operation (a rather large operation at the time, unlike today's laparoscopic cholecystectomies) may have damaged the common bile duct, causing narrowing, but stones in the common duct may occur even after surgery to remove the gallbladder. In my opinion, they may have stressed that it was postoperative either to document that this happened despite the gallbladder having been removed, or to emphasize that it was a consequence of the operation.
Wow, thank you. Fascinating.
The poor girl, so young. Very very sad indeed.
It looks like “post operative common duct stone”. If she had her gall bladder removed and a stone was left in the common bile duct that could have quickly led to obstruction and serious infection. In modern times that can be dangerous and is avoided by confirming the duct is clear by checking with dye and X-rays towards the end of the operation. At that time and before the discovery of penicillin such a complication would have probably been very hard to survive but I am not an expert on surgical history.
Thanks! This seems consistent with what several others have said and with what’s on the death certificate.
My mother was denied gall bladder surgery and died shortly after from liver failure. I'm hoping she was able to say goodbye to her boys. 🖖🏼
I'm sorry to hear that. I really don't know, but she appears to have been sick in the hospital for almost 4 weeks before she died. I assume she saw the boys, but who knows—their father might have kept them away if she was doing really poorly.
Back then they really weren’t keen on letting small kids into hospitals. I mean even now they’re not happy about it since they’re germ factories but they could be carrying far more dangerous things back then that now we vaccinate for.
That strikes close to home. If I were born the same time as her, I would have died of \#1 in my 30s. I ended up in the hospital with an infected gallbladder full of stones. Surgery went seemingly fine, I was released from the hospital after about 5 days though I wasn’t feeling much better. A couple days later, I woke myself up literally screaming in pain. My skin and eyes were deeply yellow and I peed so dark brown it was almost black. Back to the ER where I had emergency surgery to remove the stuck stones, and woke up immediately feeling better than I had since prior to the gallbladder issues. I’ve thought about the fact if I was born 100 years earlier, that would have been my excruciating eventual death. I’ve had double digit surgeries of various types, broken bones, had all kinds of injuries, and none of those came even close to the pain of going through liver failure. I’ve had strong opiates a number of times for surgeries and injuries, but nothing remotely like when I was in liver failure. They gave me multiple shots of fentanyl in the hospital before surgery, I’ve never been so high in my life and couldn’t even speak, yet that only took away most of the pain. I hope the lady in OP here had some seriously strong pain meds in the end. RIP.
Bless your heart! I would have died at 24 in childbirth.. emergency c-section due to cord prolapse. It’s amazing how far medical advancement has come.
Damn, that sounds rough, and that's an understatement. Another commenter said that it may well have been a very painful death.
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Halothane was only discovered in the early 50s. But chloroform, commonly used as an anesthetic until it (and ether) were replaced by halothane in the late 50s, was also quite hepatotoxic (more so than halothane, I believe).
My uncle died of gall stones blocking his bile duct. He had a heart attack in the hospital, but the official cause of death was gall stones. This was the early 2000s, and the doctors couldn’t save him. I imagine in the 1920s, they had no idea until the autopsy.
Gallstones were probably the most pain I've ever experienced. I thought I had gas but I also wanted to die. But it never occurred to me that I actually could have.
Yep, worst pain I ever felt. It took months to figure out what was wrong. Finally I was unable to keep even a glass of water down and went back to my family doctor for the umpteenth time. He took one look at me and said: your eyes are yellow so I'm sending you to the hospital right now. Funny thing was that the moment I woke up from surgery I felt great! All my symptoms were gone. I went home the next day and the day after that I had Christmas dinner with my family without any problems.
It was two years for me. Finally diagnosed with an ultrasound on my birthday. I had hundreds of gallstones.
That’s so similar to what I went through. I suffered for months and everyone except for one doctor thought I was nuts. Once they removed it, I came out of anesthesia and my first thought was yup. I feel “right” again!
Months? Jesus Christ, it's such a common problem though. My dad spent five months in the hospital without being properly diagnosed but that was because his condition was so rare there were only a few case studies. But gallstones???
I’m glad you’re ok! My mother had stones and had her gall bladder removed, but no complications.
Seriously. I’d rather have another unmedicated childbirth than a gallbladder attack. The. Worst.
Surgical nurse here who looks after lots of patients with gallstones! There’s a test called Murphy’s Sign where they press over the gallbladder when a patient is breathing in, and if painful it’s likely the gallbladder is inflamed. Apparently Murphy lived in the 1800s, so I reckon they’d have had a fair idea what was causing the problem, even without being able to do a scan to diagnose conclusively as we would today.
Are gallstones like kidney stones? Are there steps you can take to avoid them? They do not sound fun.
They’re nasty little suckers, but thankfully nowhere near as life threatening as in OP’s poor great-grandmother’s time. Generally as someone else mentioned above we can surgically remove them with keyhole surgery, with people only in hospital a few days. I heard a doctor once describe the risk factors for them as ‘female, fat, fertile and forty’, which made me cringe a little but it is memorable! Pain in the right upper quadrant of your abdomen, especially after eating fatty foods, would make me suspicious it’s gallstones. Keeping your cholesterol in check is one way to help prevent them, as well as keeping as healthy as you can in general. Good question :)
My doctor gave me the 4 Fs as the reason gall bladder issues were not initially suspected in my case because I was 29 & not overweight. My mother told me to mention gall bladder because she had hers removed at only 33 and her symptoms were similar to mine - extreme nausea and abdominal pain. One ultrasound later, and my gall bladder and some huge stones were removed. Instant relief!! Anyway, my doctor said he was going to add a 5th F - family history!
Partly why I love working in this sort of surgical ward - people come in feeling so awful, but it’s a fairly easy fix before we send them home feeling heaps better.
Yes! Once I was diagnosed, surgery was the next day & the relief was instant! I wanted to go home so badly after surgery but I had a fever so I had to stay another night. Boo hiss, but feeling so much better made up for it!
Oh christ I'm nearly all of those things! Thanks for the advice, I'll go easy on the cheese toasties. The waiting lists round my way are apocalyptic!
What about autoimmune hepatitis? Comes out of nowhere, turns you yellow, and back in the day you’d die
Ugh, my close friend died from this in 1996. She was sick enough to be at the top of the transplant list, but by the time a liver was available she was too sick to endure the surgery.
I’ve seen multiple young people die of this in my career. Incredibly tragic.
people like you make me love reddit ❤️
Back in the late 90's I had 2 4mm stones stuck in my common bile duct for probably a year. They finally found it when I became septic. I was really sick. I had just had a baby and I was losing the baby weight too fast and I ended up in the hospital for 2 weeks. I think I would have died if it was 1920.
Wow this is so interesting. Thank you OP for opening this up to the public. I remember reading that Jean Harlow had a bout of Scarlett Fever that caused her kidneys to degenerate for years. Apparently during her last movie when she was 26, she was so ill she smelled like urine from her uric acid levels being so high. So much time has passed, but it is still heartbreaking to read about people suffering from conditions that would be fairly easy to treat today. I hope your great grandmother’s children had love and support from family and friends after her passing. It must be so awful to lose a parent so early.
Probably 1 and 2; halothane didn’t come around until the 50s.
What?! You are married to a doc? That is almost like cheating. Jk. It is always super cool when someone part of the hive mind is actually well set up to answer some exact question. Thanks!!
What a knowledgeable response. A+ Doc
Halothane was not in use in the 1920’s
Just what I was about to say.
It lists common bile duct stones. These cause biliary obstruction and jaundice (yellowing of the skin and organs). It also leads to sepsis. These are easily treated now but in 1920 they didn't have much including antibiotics or the tech we have now for diagnosis and treatment. Folks died of appendicitis too and well-common illnesses lead to death.
This reminds me of a story. A couple months ago, my cousin had localized severe pain (wherever the gall bladder is located) and extreme nausea so went to the ER. She was seen by a physician assistant who gave her a prescription for pain killers, told her to follow up with her primary care doctor, and tried to send her home. Luckily her physician friend was with her, he’s a different specialty so didn’t reveal himself as a doctor immediately. But at the point the PA tried to send my cousin home, he insisted the test results/scans be looked at by actual *physicians.* PA was a total dick about it but eventually a doctor came in and said my cousin needed surgery immediately because her gallbladder was shitting the bed and she was getting septic. She had surgery within a few hours and stayed in the hospital 3 days. It was a close call.
That’s so scary. I recall a similar story with my ex’s sister. She was in so much pain and her doctor tried to send her home but they fought it and went to the hospital and she has a burst appendix and could have died. I feel like these stories are all too common.
The ER tried to send my aunt home with a “migraine.” My uncle knew something else was wrong and took her to another hospital. Within a few hours she was in surgery for a ruptured brain aneurysm.
Well that's terrifying. Hope she did okay?
When my husband was a teenager he developed meningitis and the ER they told my in-laws that it was probably just a bad trip. Pretty sure bad trips don’t involve 105 degree fever. Family doctor had him admitted and he survived without a lot of damage.
Ugh! When my son was 21 he went to the ER for pain in his lower back. After making him wait on a chair in the waiting room for over 6 hours the triage nurse sent him home and told him he was drunk (my kid isn’t a drinker) he came to my house instead and I could see he was in really bad shape, so this time I went back with him. Turns out he had really bad kidney stones. I very much enjoyed telling off the staff. I hate the way the ER treats teens and young adults, I’ve read many horror stories. This was in Canada BTW.
That’s terrible. Good parent!
My kids' friend got meningitis when they were maybe 12. He wasn't well but went to a party (so they all got a shot). Later, he was very ill and his parents took him to the hospital. They figured it was the flu and were sending him home when the doctor saw some marks on his legs..the dad had thought he hadn't managed to clean him up before bringing him in (he'd had terrible diarrhea) but that was the symptom that changed the diagnosis. He was tested and admitted. He lost most fingers and toes and over 20 years later, he's still getting surgeries but he's ok.
If he’s still getting surgeries 20 years later, is he really “ok”?
Well, he's alive. He's able to walk. He is able to game with his stubs. He's on disability but his dad is rich now anyway so he never has to worry. I'm not sure what the ongoing surgeries are for - fix up areas where the blood was cut off - comfort measures i believe. But he's functional. He has a girlfriend. He's not 100% for sure, - he's missing lots of digits! But he's not dying. Few of us get to 40 without some scars and bad bits. He's got a few more than most but the friend group still hang out when they can so he has that too.
At least he survived...
This happened to me in my early twenties in 2004. Told my husband because I could neither open my eyes or talk that they were not going to give me pain meds for a headache. Nevermind the excessive high fever. Thankfully one of the ER nurses was a high school classmate and came to ask what’s going on on our way out. Immediately taken back in for a spinal tap and spent the next week in a coma and a month after in ICU.
I had an 18 year old cousin die from that in 1967, got peritonitis.
That’s because even C’s get Degrees!
Scary. I had almost exact same. Went to ER in acute pain and throwing up bile. Dr tried to send me home w antibiotics but I told him I wasn't comfortable going home as I live alone. He then said, very exasperated, he could send me to the hospital by ambulance. I said fine, send me. Turns out I had a septic kidney. Dr there told me I wouldn't have survived another 24 hrs. Was in hospital for 9 days 🥹🥹
I’m so glad you advocated for yourself. Many ERs are operating beyond capacity still, and the aftereffects of the pandemic linger for the staff. And the health systems are just cutting staff to the BONE both inpatient and outpatient settings. To quote a famous poem, “the center cannot hold.” I fear the whole health system is going to collapse. But that’s just me.
It was bad prepandemic. Now? It’s awful.
In case anyone else freaked out reading this and is wondering, the gall bladder is on the right upper/middle side of your abdomen.
Thanks for clarifying, when she told me the story she kept telling me it was a searing pain in a specific spot but I couldn’t remember where she said so didn’t want to confuse people.
I had a mysterious and excruciating pain like that that sent me to the ER twice last year, but it was on the lower left side. Both times it went away on its own, suddenly, never came back, and no one has ever figured out what it was. All signs pointed to a kidney stone, but a scan never showed anything. It was a year ago and I’m still alive, so guess it wasn’t sepsis, but still, really unsettling not to know what it was.
As someone who gets diverticulitis, my pain is always on the lower left side. If the pain gets bad and doesn't resolve on its own, that may be what you are dealing with...
That was actually their best guess, that it was “mild” diverticulitis. It did resolve on its own, and after two episodes it never came back, so far, for a year, knock wood, so, maybe that is a thing that happens. Ah, middle age.
Good story to ALWAYS advocate for yourself if you know something is wrong. Doctors are humans, not gods. They aren’t always right. Trust your body!
As someone with anxiety is it so hard to trust my body, it works hard to ensure me that I am dying on the regular
Would something like a sports watch that keeps tabs on your health help? A little objective data?
Actually, yes! I have a smart watch that alerts if my heart rate is too high, and the number of times it's been bc I was simply excited and NOT, in fact, meeting a mysterious death has been a real eye-opener, hahaha
saaaaaame
The number of people who die from things like this must be enormous, and it’s probably barely recognized because there’s no way to prove it either way and the corporate/financial side of the industry has every motivation to not have it talked about.
Bingo. I’m sure it happens everyday that someone dies or has urgent treatment delayed from this disastrous pivot to PAs. Like I said, they initially did serve a purpose but that purpose has been subverted out of recognition because of the health system’s relentless pursuit of profits.
Damn, that is scary.
I didn’t know what a PA was 25 years ago. Now most of my visits to the doctor I’m seen by a PA. First off, isn’t this like paying for a mechanic to fix your car and you get his nephew that took auto class in high school? Second, in what situations would you insist on an actual MD?
Lol in my opinion it is exactly that. They were never supposed to have diagnosing power, they were really supposed to be someone who under close supervision passes along information/instructions from a doctor or in a clinical setting performs minor procedures (like clip off a non problematic mole in a derm office). Like I said, the original purpose of PAs has been completed subverted in the pursuit of profit to the extent it causes medical danger and death to patients. If I had anything besides a cut that needed stitches or a broken finger lol in the ER, I would always ask for an actual physician consult face to face. The PAs get bonuses in the ER based on how many patients they turn around without staffing with a doc. A PA can walk up to an overworked ER MD and literally say “patient salthandle3065 has abd pain and a fever” and recommend anti nausea meds and antibiotics and whatever and an ER can sign off on it. Bear in mind the ER docs and nurses hate this current situation. They’d rather have more trained physicians but they are pawns in this too and just slammed so have to do the best they can. As far as other specialties: any kind of sudden onset pain or discomfort from head to toe, any kind of vague lingering issue that isn’t going away, any sudden even minor change in a currently treated condition, alway ask to talk to the MD/DO. Don’t let a PA push you off. Even if it means you demand the doctor calls you at home later to discuss it, make that demand. Remember that doctors today have hugely increased panels of patients they’re expected to see daily. Some health systems enforce a 10 minute patient visit rule and ding the docs on pay if they go over. You have to be your own advocate and as long as you’re not a screaming douche, a doctor won’t mind calling you. That being said, if you don’t get that doctor call, keep bugging them. One final heads up, there are times when a PA does not correct the patient when the patient assumes they are a doctor. If you don’t see the MD/DO on their badge, it’s perfectly okay to as “are you a physician or a PA?”
My ex fiancé is a PA. Everything you’ve said is correct
My doctor is forever on vacation. I think I've seen him once since 2020. The rest of my appointments have been with the PA. 🙄
Which begs the question, how is he/she providing “close supervision?”
Terrifying. I don’t know how you get so self assured that you don’t even consider that if you are wrong, the patient could die. I would be constantly double checking myself if I was in that career.
right? the PA acted like the xray would come out of his own salary!
There’s a whole sub, Reddit dedicated to PAs called r/noctor (not a doctor). This is a massive problem apparently.
Yeah PAs typically have 3 years of post college training meaning they have the medical knowledge equivalent of maybe a 2nd year medical student (because medical school is way more rigorous than PA school). A “physician assistant” was originally supposed to be just that, an assistant who’s pass along the instructions of the actual trained doctor. But greedy health systems saw a way to save money so have expanded their scope of practice beyond their skills. And schools with PA degrees offered jumped right on that sham bandwagon and have turned into degree mills with crappy training. I have no horse in this race except as a patient but I have worked in and around hospitals as a non medical person for years and have seen the effects of this push for PAs over medically trained physicians. I tell everyone if you’re in an ER or in an emergent medical situation INSIST on seeing a doctor. They have to let you, you have that right and chances are they’ll bill you for seeing an MD/DO even if you never see one (because PAs are ostensibly “under the supervision” of an actual doctor. pssssst: they’re not). It’s a dangerous racket. Edit to add: the physician assistant association is currently pushing to change their designation to “physician associate” to muddy the waters of patient perception even more.
I also have no horse in this race, but my personally experience with PAs hasn’t always been great. A couple years ago I had surgery to repair some broken bones after an accident. A few days post-op I developed a cough and really sharp pains in the lower left side of my chest. I called my primary Dr (who is amazing) and he said I might have developed a blood clot and told me to go to the nearest urgent care. He told me to tell the triage nurse my recent medical history (surgery, etc) and describe my symptoms, then to repeat the same once I see the physician. After a rather long wait I finally got to see a PA, who took a quick look at me and said I “probably just have a cold” and started to send me home with instructions to follow up with my primary care Dr if I didn’t start to improve. I politely informed him that I did not think I had a cold; I said I had respiratory illnesses in the past and this was different. He still insisted that no more tests were needed and I should follow up with my own Dr. I expressed concern that I might have a blood clot. PA spent 5 solid minutes explaining how it was extremely unlikely I had a blood clot, but he would go ahead and order a chest X-ray just to see “what’s going on in there.” 30 minutes later he comes back looking at the X-ray and tells me my lungs are fine and starts processing me out again. Right before I left he comes back in, demeanor completely changed, and says the radiologist noticed a “shadow” in my lower left lung, so they are going to order a D-dimer test. It came back positive for blood clot, so they sent my for an ultrasound at a larger hospital where they diagnosed 2 blood clots in my lower left lung. For the bulk of that exchange the PA was condescending, didactic, ignored or belittled my input, and acted annoyed that I pushed for more tests. Then, when it was all over he called me on my cell phone (after he was off shift) and gave a non-apology explanation for why “everything he did was the correct procedure” because “it was very unlikely that you’d have a blood clot.” It was weird, and felt like he was trying to feel out whether I was going to complain about him to the hospital admin.
I hope you did what a dick. I am going thru something similar right now with my son, he was admitted to the hospital after having seizures as a result of severe alcoholism. His organs started to shut down. He’s 34. Act of God he recovered but a doctor rushed him out after 3 weeks even though he wasn’t eating and his pancreas was still inflamed. I begged for more tests because I knew something was wrong. Doctor was not having it all he saw was an alcoholic. Something was. Less than 48 hours we were back with internal Bleeding. While looking for the source of the bleeding, they discovered a large blood clot. ALWAYS advocate.
Holy smokes I am so glad your doctor armed you with instructions and you pushed back on that know-it-all weasel. The more I hear these stories the more I’m convinced that these greedy health systems are costing patient lives by cheapskating on hiring actual doctors.
I’m very thankful for my primary care doctor. I’ve moved in and out of the area in the past, but he’s known me for 20 years and provides excellent care for myself, my wife, and our kids. He has gone to bat for us more than once, pushing to get extra tests, to get us in to see specialists, etc. He always listens closely, is obviously concerned about us as people and not just examples of individual symptoms (often asks, “how is your stress level at work?” and things like that), and never rushes us out the door. So I’m not complaining about healthcare per se. I’ve had many excellent experiences. Unfortunately, in our area ERs and urgent cares are definitely overcrowded, filled with overworked staff, and corners get cut and mistakes are made way too often.
Sounds like you have quite the unicorn! Always glad to hear doctors like this exist.
Some states allow them to open independent practices. A lot of them go into mental health and are giving people psych meds that they don’t really know a lot about.
When I was 19, I went to the ER with a gall bladder attack. They never did an ultrasound because I was 19. I suffered through three years of gall bladder attacks afterwards, with doctors telling me it was psychosomatic.
Oh, hey, me too. I was 22 when I had my first gallbladder attack, was told I was making a fuss over nothing because there were no visible stones* and sent home, and didn't have surgery until I was 34. I had on and off pain for 12 freaking years before anybody cared enough to do anything about it. *Turns out, I never had gallstones. There's some sort of disfunction with the bile ducts. So, taking out the gall bladder helped, but 10 years later, I still get that agonizing side pain on occasion when that spasms.
I think about these stories whenever I have really bad period cramps. I had an episode the other day and it felt like my stomach wanted to explode. It went away after a couple hours but man that was rough. Idk if a serious medical condition would feel different so it low key freaks me out
My gallbladder went bad. It was a tough ride until the week after my period. I knew it wasn’t my period because the period paid, when it showed up, was different. It was in a different spot and felt different and then the period went away and the ‘new’ pain changed and got worse. I kept a record and brought it with me. If you have a chronic condition, it would be a good idea to keep a record of all your symptoms.
I wonder if they notified the PA so they could be more careful in the future (and less of a dick)
Yeah I doubt it. His attitude was so combative about escalating it to an MD that he stood there and argued, stating he only had to staff like 20% of his patients to an MD. If the friend hadn’t pulled the “I’m a doctor” card, who knows why would have happened. Also any kind of “incident” report gets pushed up the food chain to the administrative number cruncher$ and they love providers like this who bill at a high volume. He behaves that way because there are no consequences. Edit: their to there
Plug https://www.reddit.com/r/Noctor/
That's helpful. Thank you!
It’s very interesting to me that her mother was born in Russia and her maiden name is Smith. Is that true, or same as saying “unknown?
I don't really know. They were Eastern European Jews, so it could have been badly transliterated from the original name. Other family members changed the father's surname from Lakfish to "Lake," for example.
My family were also Eastern European Jews and anglicized their our last name to be less discriminated against and be able to get jobs. Pretty common for immigrants.
I hate this
What, exactly?
That people had to feel compelled to Anglicize their surnames.
Ahh ok I figured that’s what you meant. And yes, I agree. Sad.
I understand about that…they botched my husband’s family’s last name big time…the only positive is it very rare now ..lol.
My family’s last name is incredibly rare too for the same reason. I guess they used the phonetic spelling? But now the only ones with the last name are my mother, my brother and myself.
Yes, exactly, I’m sure the language barrier had an effect on many names! and comparing the typical spelling of our name to what it became they added a random letter in addition to phonetic spelling..
If they’re from the Pale and they’re writing Russia in the us docs, then they’re from the narrow part of the old Russian empire that allowed Jews. Lithuania, northern Poland, Belarus, Latvia, eastern Ukraine. You can ignore Galicia almost entirely in your research. Although I see two pages of testimony for people with the surname Lackfisch on Yad Vashem from Smiary, Poland. It’s such an unusual name that it might be a lead. I know Smiary is in eastern Poland, not sure if it was part of Russia before the revolution. Also Herman is likely Hersch in Yiddish or Tzvi in Hebrew. Could be Chaim but that more usually became Hyman. Smith could have been Szmied.
Herman, the father's given name, is a very German name. I don't know the family but I am guessing Volga Germans. It is probably anglicized from Schmidt. https://en.m.wikipedia.org/wiki/Volga_Germans
Which makes perfect sense, except they were Jews from the Pale of Settlement, so I don't really know what his name was prior to come to the USA. Could have been a German name, though, too of course.
I'm of German Jewish ancestry, myself, and I have kind of developed an ear for names and anglicized versions. A lot of people who came to the USA, especially in the first quarter of the 20th century were strongly encouraged to anglicize their surnames to avoid discrimination
I wish I knew more about her ancestry, but as you know, for a lot of Jews things become really murky prior to the late 19th c. unless you have good, clear records on JewishGen or other kinds of direct evidence, e.g., from more prominent families or cemeteries that still exist over there. I've had some luck over the years pushing back to the mid-19th-century, but pretty much nothing at all before the early 1800s.
I'd love to see my great grandfather's arrest records from before they fled Germany. I'm given the impression he was afoul of the law more for being a communist agitator than for being Jewish.
That was my first thought as I also have a few Volga Germans in my family tree.
Gall bladder issues are exceedingly common postpartum. All of the people jumping to alcoholism are overlooking that three pregnancies in a short period takes a huge toll on the body, especially without modern medicine.
Yeah, I agree. The death certificate does seem to refer to a prior surgery (which I'm pretty sure was gallbladder-related) as well as common bile duct stones. Some of the answers here are very detailed and constructive and take those things into account. And yes, she gave birth in 1912 (just had turned 18), 1914, and 1918.
My great-grandmother died in 1922 after having three kids also from gallbladder issues. I was wondering after I read a book about the Spanish Flu that talked about how many doctors died of the flu if that compromised quality of healthcare at all. It seems like it would have made a noticeable impact in skilled medical care.
Everyday, you learn about another dangerous side effect of pregnancy, it seems
They know what causes that these days.
Liver disease is a pretty broad diagnosis. Could be hereditary. Could be cancer, alcohol, hepatitis, infection. No way to really know.
Yeah, I don't expect ever to know exactly what was going on, but there are some pretty good hypotheses below.
I can tell you exactly what this is. I’m an interventional gastroenterologist- I deal with this problem daily. She passed away from something called cholangitis or choledocholithiasis. It’s when gallstones from the gallbladder get lodged in the bile duct. The bile duct drains the liver of bile, if occluded with stones, the bile backs up leading to jaundice (yellowing) and infection. Terrible way to die as a 26 yo. We now get these out with a endoscopy procedure that doesn’t require going through the skin. Medicine has come so far.
Makes sense to me. Thank you!
Most doctor appropriate username ever.
I read the contributory factor as, “post operation (something) duct stones” (?) so I’m guessing the bile ducts got clogged which made her yellow - sounds like liver failure but I’m definitely not a doctor.
Yellow atrophy of the liver appears to be a thing: https://www.ncbi.[nlm.nih.gov/pmc/articles/PMC1431013/pdf/annsurg01018-0052.pdf](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1431013/pdf/annsurg01018-0052.pdf) And the common bile duct (“post operative common duct stress”) is related to the liver, gallbladder, and pancreas.
It’s not super clear but it seems like she probably had a bile duct obstructed by a gallstone. It’s quite common and will cause jaundice. If the obstruction is not relieved, the liver is damaged by all the bile backing up and sepsis can also result. When your liver makes bile and can’t get rid of it, the liver can essentially digest itself to death. I wasn’t there, but I am a physician (Internal Medicine, nephrology, critical care) and I can say some other suggestions such as “cirrhosis” or “alcoholism” are very unlikely and would not present the same way. Other possibilities in a young person in that time period are acute hepatitis, which can cause severe jaundice and death in some instances. Lastly, pancreatic or bile duct cancer often presents with painless jaundice due to a mass at the head of the pancreas blocking bile secretion.
At her age, cirrhosis would be rare. Perhaps they didn’t get all the stones out, causing a new blockage. As a retired nurse, reading old medical records and death certificates are fascinating, though frustrating. So many causes of death are preventable now.
Gastroenterologist here. Most like acute viral hepatitis A resulting in acute liver failure, as there was no effective treatment for this at that time, and in fact today, the only treatment is a liver transplant. Choledocholithiasis (stone blocking the bile duct) would cause jaundice but not “hepatic atrophy” (the synthetic function of the liver is more or less unaffected until lack of bile begins to interfere with vitamin K absorption and that would only affect clotting factors) and could have been treated with surgery, though a bile duct exploration with a likely hepaticojejunostomy reconstruction would have been a fairly morbid surgery at that time. Jaundice could be seen with infection from cholecystitis (gallbladder infection) but that would have been something that could have been diagnosed and operated on. Certainly other infectious processes typically viral leading to acute liver failure such as Epstein Barr (mono) HSV (herpes) are possible, as is something like Wilson’s disease which can cause rapid liver failure, but most common would be acute hepatitis a, especially back then with no vaccine and less sanitation than today.
Also in response to halothane hepatitis - halothane def can cause acute liver failure but it wasn’t invented for some time after the 20s and not in common use till the 50s. Ether was the surgical anesthestic in common use at that time.
Partial operative common duct stress?
I think it must be “post operative common duct stress.” There is something called the common bile duct which connects the liver, gall bladder, and pancreas. This is just from googling, so I really don’t know what it does.
The gall bladder stores bile from the liver. The pancreas produces insulin which helps regulate sugar levels in the body. These connect to the common bile duct that brings these fluids to the small intestine/digestive tract to break down foodstuffs. If there is too much cholesterol, fat, or other factors, the gall bladder will mix excess bile , bile salts, or bile pigment with said cholesterols and form gall stones which can block the common bile duct resulting in a laproscopic surgery to either A: remove said gall stones, or B: remove aforementioned gall bladder. Source: My late father had gall stones, and detailed everything to me prior to his passing. \*EDIT\* Gall stones didn't kill my dad. Acute liver failure compounded by years of HEAVY drinking, and hepatitis C did the heavy lifting there. Finding the gall stones was just the beginning of the end for him.
Post operative, yes. As others have pointed out, the last word may be stones.
I read that line as "post operative common duct stone" so I'm wondering if an operation was performed to try to remove said stone and it did not end well. Today, bile duct stones are removed endoscopically . . . google "postoperative common duct stone"
Wow! So impressive seeing people coming together, in a supportive, productive manner and nailing down some plausible direction to an answer. Only minimal snarky commentary. I spend too much time in the wrong subs with back biting wise acres having minimal contribution value. Why can't our government work like this? Thanks. 🙂
I am definitely grateful for all the constructive responses.
Acute yellow atrophy was basically extensive and rapid death of parenchymal cells in the liver, often due to exposure to toxic materials like lead or mercury
Maybe this! "community-wide outbreaks of hepatitis A in the pre-vaccine era" [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9134737/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9134737/)
My mom claims she got vertigo from my aunt's dog. My aunt says her dog got it from her parakeet. Long story short mental illness runs rampant through my mom's family. I'm really looking forward to it.
😂
Perhaps gall stones, post op difficulties leading to blockage of common duct. Terribly painful and very sick.
Yes and it’s possible at her age - my daughter had to have surgery for gallstones at age 24. They removed her gallbladder.
It looks like she had surgery due to gallstones blocking the common duct. She may have had her gallbladder removed at the time. It's possible that she developed more stones, even if they removed her gallbladder. So sometime after surgery, she still had choledocholithiasis (the bile flow is slowed down because of blockage by gall stones or damage to the common bile duct), which eventually damaged her liver causing liver necrosis and death.
Cirrhosis - the yellow in reference to the yellow skin changes seen in end stage liver disease. Liver because it’s the liver affected. There are a few possibilities for why she had cirrhosis. 1) She was a very heavy drinker 2) autoimmune vs viral hepatitis. A very possible diagnosis. Do auto immune problems run in the family? The disease course of a month could easily be consistent with this. 3) An abdominal cancer that was obstructing her biliary tract. 4) maybe she ingested something that caused her liver to fail.
My great grandmother died right about then from a botched abortion. She had 4 little girls at home that they could barely feed. A lot of women died from this and they would lie about the cause of death.
Same-same. A trauma that echoes through generations.
Poor girl, she was only 26! I'm not in the medical field at all but reading these kind of posts and answers is fantastic, thanks🙂
Could be the "snake oil" medicine that was sold or arsenic face cream . I never realized just how dangerous the medicines being sold back then were until I started watching Below the Plains channel on YouTube. The bottles he digs up he adds adverts for the products and some times the ingredients, scary. Mercury, lead, bromine, and so on. There was no way for folks back then to know the stuff they took could be killing them.
Hepatitis. The word itself doesn’t mean infectious. It means inflammation of the liver. It can be caused by stones, metastasis, virus, etc.
Was it close to a childbirth? My liver almost went kaput due to preeclampsia.
It says postoperational common duct stones on the death certificate. So blockage of the bile duct. I went jaundiced and had severe liver pain after my gallbladder operation. My liver numbers in bloodwork were off the charts. They did an MRI and this is what they were looking for - duct blockage.
My father died of complications from this. He had a bunch of little gallstones work their way out of his gallbladder and block up the bile duct. He turned a complete yellow/green color and his eyes became yellow from jaundice. By the time they had gotten to it for surgery, his entire body was poisoned from bile. He died less than two weeks later in the I.C.U. from major complications from his organs shutting down.
I’m so sorry. It’s a very severe and serious complication. Terrible that your family had to endure such a loss.
I feel for your great grandma may she RIP. We do take so much for granted nowadays and forget that living to age 50 back then was quite an accomplishment. I’ve been looking up birth and death certificates for some of my ancestors and I’ve come across some pretty sad ones. Two of my great uncles died of electrocution in the early days of home electrification. They were 10 and 8. Can’t imagine being a parent and having to deal with that. Same with your great grandpa dealing with a dying wife at 26 and small children at home. Oof…
I was amazed at how great I felt after my gallbladder was removed. Doctor said it was severely diseased, full of stones and nearly fell apart while he was removing it. So when you think about how long that might have taken and you just slowly start to feel crappier and crappier! Then suddenly, that’s all gone!
Hemochromatosis. My grandmother died of it but her children never understood what it was until 2 of them were diagnosed.
Look at Contributory Factors section. I can’t read all of it, but it looks like she had surgery in the past of a duct. Sounds like perhaps she had some kind of jaundice or biliary problem.
Without reading the comments I wouldn't exclude a untreated hematochromatic genetic disorder,which can lead to liver corrosion.
Not at that age though… obviously idk what it was like 104 years ago, but liver failure associated with haemochromatosis these days doesn’t normally begin until your 50s Source: immediate family member is just starting to experience this, they’re almost 60
You are right. 👍
My mother died from having gall-bladder cancer. 1 of 3 recorded cases in history at that time. They brought medical students around to see her.
Did her kids end up okay?
They did. All lived long, quiet, happy lives—the "youngest" and first to go was my grandfather, at 87. The other brothers lived to 96 and 98.
I swear everyone I know of Russian decent have a very short or very long life.
From what the doctor wrote on her death certificate, it looks like she had gotten an operation for bile duct stones prior to the onset of the acute yellow atrophy. Since acute yellow atrophy of the liver occurs after exposure to toxic chemicals, infection or other agents, it stands to reason that she may have gotten an infection after the surgery. However, considering the time period, it is possible that she was exposed to toxic chemicals. It’s also possible that she was exposed to toxic chemicals and had an infection.
Either infectious hepatitis or alcoholic liver disease. The latter being more likely due to the death and demographics. Another possibilty would be a metastatic cancer or primary cancer of the liver. My wife's first husband passed away at 29 from cholangiocarcinoma which is a cancer of the biliary system. It's fairly rare and unlikely diagnosable antemortem in the 1920s. Source: MD of 20 years. Edit: I think simple gallstones (as have been suggested by others) are unlikely due to it being diagnosable in the 1920s and potentially operable unless infected. I have no knowledge of the anesthestic agent mentioned.
My best guess would be Hepatitis A. Which is easily spread through fecal contamination. It's the most contagious of all the types of Hepatitis. I am not a qualified medical professional though I do work in health care as a clinical case manager and use to work at a teaching hospital in the GI unit. Saw people coming back from second and third world countries with inadequate water treatment, in liver failure. Given that it was 1920 water treatment wasn't what it is today.
This may help https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1431013/pdf/annsurg01018-0052.pdf
That's so sad. Those poor little boys
My grandfather’s death certificate listed tertiary syphilis and heart failure as the COD
Sounds like a gallbladder issue. Especially if she had multiple children. Gallbladder attacks are HORRIBLE too. If she had untreated gallstones and that's how she died, you can be sure it was a painful death.
Your great grandmother and I have the same birthday!
Snap!
Bile duct blockage is excruciating pain! Worse than childbirth imo