Why Grania died

Every day I feel keenly the loss of Grania from my life—and from this site. She wasn’t quite 50 when she collapsed in front of the clinic in Ireland and died; CPR didn’t help. Several days before that, she had passed out in her apartment after vomiting, but didn’t remember the vomiting. Then, for several days thereafter, she was in terrific pain, but wouldn’t go to the doctor. When she finally did, it was too late. I was in communication with her right until she took the cab to the clinic.

The initial autopsy yielded no definite cause of death, but now Grania’s sister Gisela reports the final diagnosis:

“haemopericardium, rupture of a dissecting thoracic aneurysm”.

You can read the medical explanation of this condition here; it is, my doctor tells me, consistent with her symptoms. The dissection must have began several days before when she got ill, and the aorta must have ruptured when she was at the clinic, filling her pericardium (the membrane around her heart) with blood. She bled to death internally, and the only mercy is that it was quick.

Could she have been saved had she gone to the doctor when she first had pain? It’s not clear: arterial dissections are hard to diagnose, and even so, can persist for months or even years without progressing. She might have been scheduled for surgery, but that might have required a long waiting period, and she would have died anyway.

There’s no use pondering the “what ifs” now, as what happened was fated to happen. But I suppose the diagnosis does help give us some closure, though for me there will never be “closure” (whatever that may be) with respect to Grania.

70 Comments

  1. ThyroidPlanet
    Posted September 14, 2019 at 11:04 am | Permalink

    thank you for reporting this. it is painful to think about this. I am so sorry for her family. it is so sad.

  2. Michael Fisher
    Posted September 14, 2019 at 11:09 am | Permalink

    Thank you for the update Jerry. That particular diagnosis is some comfort for both you & Grania’s family I think.

  3. Laurance
    Posted September 14, 2019 at 11:11 am | Permalink

    Thank you, Jerry, for telling us this. Although we were not as close to Grania as you were, she was a big part of this website and these posts. We were grieved to hear of her death, and although it will not bring her back, it helps, somehow, to learn what happened.

    • Sastra
      Posted September 14, 2019 at 5:05 pm | Permalink

      Yes, well put.

      • Jenny Haniver
        Posted September 14, 2019 at 9:22 pm | Permalink

        I echo that sentiment.

  4. Sian Evans
    Posted September 14, 2019 at 11:14 am | Permalink

    Very sad.
    There is no point second guessing an aortic aneurysm. I have known a couple of young people that have died suddenly and aneurysm was only detected at post-mortem. Closure is an alien concept to me as well.

    • Ken Kukec
      Posted September 14, 2019 at 4:35 pm | Permalink

      My bestie’s kid brother — a year younger than the two of us — died of an aneurysm when he was just 37. His wife said he jumped up out of his easy chair as though to say something, then collapsed like a marionette whose strings had been cut. The doctors later told her he was probably dead before he hit the floor.

      • Posted September 16, 2019 at 10:37 am | Permalink

        This happened to the father of one of my wife’s student a few years ago. He knew something really bad was happening (I won’t recount his description, ugh!) and he had just time to grab his phone and press 9-1-1. He was away from home in a hotel room.

        The paramedics found him, rushed him to the hospital, the doctors induced a coma and he had surgery and was slowly brought back out the coma.

        He’s pretty much OK; but he says his balance and motor abilities are still impacted.

  5. Diana MacPherson
    Posted September 14, 2019 at 11:23 am | Permalink

    Sad of course and vexing in how it all unfolded. We are so fragile.

  6. Randall Schenck
    Posted September 14, 2019 at 11:25 am | Permalink

    This is the same thing that killed John Ritter back in 2003. An undiagnosed aortic dissection. He was 54. I, on the other hand, had a type A aortic aneurysm, discovered in 2009. Very luck because there are no symptoms for this one. I had the big time surgery roughly 10 years ago for this.

    • Laurance
      Posted September 14, 2019 at 11:42 am | Permalink

      You, too? And John Ritter? Me, too. I have an aortic aneurysm which the cardiology guy is watching. Mine actually decreased in size by two centimeters. Don’t ask me why. That was some time ago. Last time I saw him the aneurysm had stayed the same.

      I’m due to pay the cardiology fellow a visit soon, and we’ll see if anything has changed.

      I feel lucky that the aneurysm was noticed early on. IIRC I’d had a CAT scan or something for something, and somebody noticed this thing.

      I’m so sad that Grania’s condition had not been caught in time. I miss hearing from her in these posts.

      • Randall Schenck
        Posted September 14, 2019 at 11:51 am | Permalink

        Couple of questions for you. Is your aneurysm ascending or descending? Mine was ascending or type A. Discovering this type of aneurysm is just luck as in your case. There is really no symptom for this one. What I experienced was a slight funny feeling in the chest when I coughed or sneezed. It was nothing really but I went to the doctor and after some checking, they finally did a scan and there is was. Another thing that is often associated with this aneurysm is a bicuspid aortic value. Birth defect. I had that as well.

        • Laurance
          Posted September 14, 2019 at 2:28 pm | Permalink

          Yipes! Ascending or descending…? I don’t know, but I’m sure going to ask the Cardio fellow! I do know that it’s not abdominal, it’s up in my chest, not too far from my heart. Thanks for telling me about ascending and descending. I would not have known to ask.

          • Randall Schenck
            Posted September 14, 2019 at 2:46 pm | Permalink

            I know you said it had decrease in size. That is good I would think. They usually want the aneurysm to be a certain size before they need to operate. If I remember correctly, mine was 5 centimeters and that is when they operate. So they did mine right away. However, they will want to do some pre-operation things as well. They will likely want to do the procedure checking arteries around the heart. You don’t want to do open heart surgery without checking that. Not a good idea to do open heart surgery and then find out later you had a blockage.

    • ThyroidPlanet
      Posted September 14, 2019 at 11:45 am | Permalink

      Thank you for sharing your personal story.

      I wonder about this notion of symptoms. Symptoms are uncomfortable, reproducible phenomena the patient reports to a doctor.

      What about background health indicators- for example,,if the doctor gives an exam or reads an x-ray where there is no *evidence* of a disease – is that the case here? There are no symptoms but also no *evidence*, and furthermore, symptoms or evidence *that we know of*? Because new research could in principle show certain observations to be evidence of certain problems.

      • Randall Schenck
        Posted September 14, 2019 at 12:14 pm | Permalink

        I think I kind of covered your questions in my comments to Laurance but it should be noted, there is a difference between dissection and just aneurysm. With the dissection I think there is some symptoms such as what Grania experienced. I believe there is some symptoms with the descending aortic aneurysm sometimes. But the ascending aneurysm, no. At least that is what doctors told me. First question I got from the surgeon was – How did they discover this? So I went through the whole story about the funny feeling I had when coughing. He had never heard of it before. My regular doctor thought I had bronchitis and I told him no, that’s not it. It was nothing like that. But he made me take antibiotics anyway. Waste of time. Then they did something like an upper GI. Still nothing. Then the Scan and that was it.

        • Diana MacPherson
          Posted September 14, 2019 at 12:24 pm | Permalink

          That is so lucky. Whoever spotted it was a life saver. You easily could have been sent down a rat hole of treating a non existent breathing issue as often is the case when a doctor fixated on a diagnosis and can’t come up with anything else.

          • Randall Schenck
            Posted September 14, 2019 at 12:59 pm | Permalink

            Yes, I was lucky twice. First was discovering the aneurysm before it killed me. Then later, new technology of replacing the aortic value via TAVR and that is much preferred over open heart surgery.

  7. Posted September 14, 2019 at 11:29 am | Permalink

    Respecting first sympathy for the loss of so close a friend, I send condolences.

    In the world, millions die from ruptured aorta. There are no symptoms leading up to it bursting. When you see a report of a person dying in their 50s or early 60s, there is a high likelihood it is from a burst aorta.

    Your sentence “Could she have been saved had she gone to the doctor when she first had pain?” can be extended to “Could she have been saved had the aneurysm been detected years ago when it began?

    I have AAA, which is the abdominal form of aortic aneurysm, and far more common than the thoracic variety. It was luckily detected by a scan for a different condition. Now I get yearly ultrasound on it, and when it reaches a certain point, repair will be needed.

    We don’t do enough preventative medicine on this. A relatively inexpensive ultrasound on the aorta would prevent hundreds of thousands of premature deaths.

    • infiniteimprobabilit
      Posted September 14, 2019 at 7:41 pm | Permalink

      “We don’t do enough preventative medicine on this. A relatively inexpensive ultrasound on the aorta would prevent hundreds of thousands of premature deaths.”

      Umm, yes, but…

      You could say the same for many forms of cancer, I think, and brain tumors, and probably many other conditions. How many are you going to screen for, and how often?

      There’s obviously an equation of cost-effectiveness, and the prevalence of the condition, the ease of detection, and the cost of testing for it all factor in.

      I’m not saying an aortic ultrasound would necessarily be ruled out, but I suspect it wouldn’t be at the top of the list of ‘things to test for’.

      (In my case I had a heart valve repair about then years ago. I’d had a damaged valve for decades, which got worse at one point – only symptom was slight shortness of breath when walking uphill. No pain or discomfort ever. I thought it was a lung problem. I don’t think ECG showed anything but the specialist I was sent to said “I bet I know what it is” and gave me an ultrasound which showed it immediately).

      cr

      • rickflick
        Posted September 14, 2019 at 10:06 pm | Permalink

        I too have experienced an unexplained shortness of breath. I guess I figured it was just age. Maybe I should discuss it with my doc.

        • infiniteimprobabilit
          Posted September 15, 2019 at 1:40 am | Permalink

          I think it might be a wise precaution.

          In my case the damage was (possibly) caused by rheumatic fever or something when I was a few years old – my mother told me I almost died of [something – can’t remember] when I was young. It (probably) damaged a heart valve, and five decades later, there’s a sort of string that stops the valve closing too far and leaking, and that broke, hence the reduction in pumping efficiency and the onset of shortness of breath. The valve would have continued to get steadily worse till it failed, fortunately they caught it in time while it was repairable (the surgeon sewed a reinforcing ring in place), this should last longer than I do, so actually better than a replacement valve.

          So I guess the moral (if there is one) is, it pays to check.

          cr

  8. Joanne Dallas
    Posted September 14, 2019 at 11:36 am | Permalink

    Sorry to all for your loss.

    Sent from my iPad

    >

  9. Posted September 14, 2019 at 11:39 am | Permalink

    This is incredibly sad.

    IF the aneurism had been discovered in time, it’s quite possible that Grania might not have had to wait a long time for corrective surgery. She likely would have been triaged to emergency surgery.

    • Posted September 14, 2019 at 11:53 am | Permalink

      I was thinking that. Surely this would be considered as something requiring immediate attention, assuming that it was discovered in time.

    • Nicolaas Stempels
      Posted September 14, 2019 at 4:10 pm | Permalink

      Exactly, a dissecting aorta is considered a red emergency.
      Emergencies are classified with a colour code:
      Red: immediate surgery , Orange: within 2 to 3 hours, Yellow 4 to five hours, Green: same day ,
      I have never heard of a descending dissecting aorta as other than red.

      • Nicolaas Stempels
        Posted September 18, 2019 at 11:24 am | Permalink

        And Ascending ones are even considered more urgent if anything.

  10. Geoff Toscano
    Posted September 14, 2019 at 11:54 am | Permalink

    Thanks for the update Jerry. I didn’t know Grania in any way other than her posts, but I have sensed her absence. My commiserations again to you as her friend, and of course to her family.

  11. Mark R.
    Posted September 14, 2019 at 12:00 pm | Permalink

    Thanks for letting us know Jerry. This deadly ailment seems very random, thus making it seem even more terrible…at least to me. Grania was way too young.

  12. Blue
    Posted September 14, 2019 at 12:19 pm | Permalink

    Let alone difficult, at all, to believe,
    the grieving itself is difficult.

    Blue

  13. rickflick
    Posted September 14, 2019 at 12:32 pm | Permalink

    Thanks for the update. I was just wondering if there would be an update and an explanation. Now, here it is. I can’t help wondering what’s going on in my own chest. Please accept my condolences.

  14. Ginger
    Posted September 14, 2019 at 12:35 pm | Permalink

    I miss Grania too. But I can’t imagine what you are experiencing, Jerry.

    I hate the word “closure.” There is no such thing as closure in reality.

    • GBJames
      Posted September 14, 2019 at 1:27 pm | Permalink

      Yeah. “Closure” is a word with little meaning. Maybe memory without sadness? That’s not right, either.

  15. Posted September 14, 2019 at 12:46 pm | Permalink

    Thank you for the update, Jerry.

  16. Eli Siegel
    Posted September 14, 2019 at 12:53 pm | Permalink

    When you feel really bad and you faint, go to the hospital.

    • JezGrove
      Posted September 14, 2019 at 1:04 pm | Permalink

      Absolutely!

  17. BobTerrace
    Posted September 14, 2019 at 1:07 pm | Permalink

    Sad

  18. Posted September 14, 2019 at 1:10 pm | Permalink

    So sad. Grania and her family have a special place in my heart. I spent my high school years in Graaff-Reinet, South Africa. Graaff-Reinet was during my time there a peaceful rural community with good educational facilities. When I heard about the brutal murder of Grania’s father in my home town, it was hard for me to come to terms with the violence afflicting our beautiful country.

    • Gisela
      Posted September 14, 2019 at 4:23 pm | Permalink

      Thank you Stevie. Regards Gisela

  19. pieterdehaan6286
    Posted September 14, 2019 at 1:28 pm | Permalink

    Thank you for sharing Jerry. Six years I was diagnosed with an aneurysm of my ascending aorta. No symptoms at all but I realized that my grandfather and father died of dissection of the aorta. I told this my doctor and a MRI pointed this out. So in short there is a genetic component in this disorder. Grania’s family should go to a doctor and discuss this event.

  20. johnjfitzgerald
    Posted September 14, 2019 at 1:30 pm | Permalink

    Please accept my condolences on your loss. We have all lost a shared and sharing friend. Onward!

    John J. Fitzgerald

  21. Debbie Coplan
    Posted September 14, 2019 at 1:38 pm | Permalink

    Thank you so much for the update.
    It’s a very sad loss.
    Condolences.

  22. Posted September 14, 2019 at 1:55 pm | Permalink

    It’s so sad and all Grania’s friends and family have my sympathy. I feel it’s important to know what happened. Thank you for updating us.

  23. Pliny the in Between
    Posted September 14, 2019 at 1:58 pm | Permalink

    Aortic dissection, like myocardial infarct for which it can be mistaken (as in Ritter’s case) unfortunately often presents with very different symptoms in men vs women. Many of the ‘classic features’ seen in men may be completely absent in women.

  24. Posted September 14, 2019 at 2:08 pm | Permalink

    Grania is much missed.

  25. Posted September 14, 2019 at 2:12 pm | Permalink

    Thank you for sharing this information as to the cause of Grania’s death. I’m truly sorry for the immeasurable loss of a person so meaningful to you, and to those of us who read her on WEIT.

    My oldest brother had an abdominal aortic aneurysm and survived because when he went to the hospital, a team of doctors were there having finished a training session for just such a potential event. They were able to save him. How many of these unlikely “saves” there are. I experienced one when I had a Volvulus that a doctor new to the hospital I was at had received training in laparoscopic surgery and could unkink my intestine. This prevented further damage and didn’t require excision of the affected part in more traditional surgery. How lucky I was.

  26. Andrea Kenner
    Posted September 14, 2019 at 2:39 pm | Permalink

    I’m so sorry, Jerry.

  27. Azreal
    Posted September 14, 2019 at 3:01 pm | Permalink

    I can feel your grief and it saddens me.
    You will get better and be happy that you met her at all.

  28. scruffycookie
    Posted September 14, 2019 at 4:00 pm | Permalink

    Thank you for letting us know this. She was much too young, but she will be remembered with respect by the many people she reached through your site. My deepest sympathies to you and her family for the loss of your very dear friend.

  29. Josh Lincoln
    Posted September 14, 2019 at 4:13 pm | Permalink

    Not that it makes any difference in this tragic turn of events is that another sequelae to pericardial bleeding (from tumor, trauma or a dissection as in this case) is that the pressure from the fluid between the heart and the pericardium can cause a potentially fatal condition called cardiac tamponade which can easily cause pulmonary edema, shock and death if not rapidly diagnosed.

  30. Posted September 14, 2019 at 4:18 pm | Permalink

    A few years back I read a book on mortality that began with a metaphor. I don’t remember the exact words, but it went something like the following. “Nature wants to kill us. From the moment we are born, it throws deadly arrows at us. Arrows of disease, malnutrition, deterioration and more. As long as we fend off these arrows, we live. But, sooner or later, one of nature’s deadly arrows will find its mark, and we die.”

    In Grania’s case, nature’s arrow was an aneurysm, striking her down before she turned fifty. Ineffably sad.

  31. EdwardM
    Posted September 14, 2019 at 5:25 pm | Permalink

    My condolences to you Dr PCCe and to Grania’s family and friends (virtual and meat world). Far too young.

  32. Peter (Oz) Jones
    Posted September 14, 2019 at 5:51 pm | Permalink

    My sympathies to Grania’s family and our host. At time like this a physical hug is best. I miss her contributions, so sad.

    In grief,
    I found these 2 items helpful
    – a quote and then an 8min video
    from the UK BBC (after a 14sec advert).
    I will let WP do its worst with the URL.

    “We understand death for the first time
    when he puts his hand upon one whom we love.”

    Madame de Staël (18th Century, French)

    http://www.bbc.com/news/av/stories-43227108/why-grief-is-not-something-you-have-to-get-over

  33. Charles Sawicki
    Posted September 14, 2019 at 6:04 pm | Permalink

    Thanks for telling us about Grania. Very sad that she died so young.

  34. Posted September 14, 2019 at 6:39 pm | Permalink

    I am truly sorry for your loss, Dr. Coyne. Thank you for sharing your friend with us in these pages over the years.

  35. Ruthann L. Richards
    Posted September 14, 2019 at 6:40 pm | Permalink

    Thank you and her sister for sharing the cause of Grania’s death. Not a day goes by that I don’t think of her–especially when Prof. Ceiling Cat is away and I know she would be posting Hili and probably comments about other matters. Thank you for continuing to post photos, videos, etc. that she sent; I don’t care whether they’ve been posted before–it’s just nice to have a bit of her still present.
    I’ve always found the word “closure” a really stupid term and have never understood how people can feel that about someone they loved who has died.

    • Posted September 14, 2019 at 8:15 pm | Permalink

      “Closure” is probably better reserved for those with a relative/friend known to be missing in an accident and *presumed* dead.

      One does tend to hold out hope, no matter how unlikely.

  36. BJ
    Posted September 14, 2019 at 7:23 pm | Permalink

    I just want to once again add my voice to those who deeply lament the loss of Grania. She was funny, intelligent, and kind, as I knew her. We had many great conversations on here. She was one of my three favorite commenters.

    My condolences again to her family and friends.

    • Mark R.
      Posted September 14, 2019 at 7:42 pm | Permalink

      I’m not a gamer anymore, but I loved reading you and Grania’s banter regarding new games, her reviews of Fallout etc. I remember when you first found out she was a gamer and your exuberance. Fond remembrances, and now very sad.

      • BJ
        Posted September 14, 2019 at 11:01 pm | Permalink

        Yup, I had more fun in that conversation than any other I’ve ever had on this site (no offense to anyone!). And, considering this is the only site on which I have conversations, I guess that’s saying a lot. That review was fantastic too.

      • BJ
        Posted September 14, 2019 at 11:02 pm | Permalink

        I’m glad you remember it as fondly as I do 🙂

  37. pam
    Posted September 14, 2019 at 7:32 pm | Permalink

    Sounds as if you feel this loss deeply…I’m sorry and hope your happy memories will be a comfort.

  38. Matthew North
    Posted September 14, 2019 at 7:50 pm | Permalink

    Thank you. It was a bit of a shock to hear about her death at such a young age. I was frustrated and puzzled about her death because of how young she was.

    The contingencies of all of our lives are ever present.

    It’s so sad.

  39. Roo
    Posted September 14, 2019 at 8:20 pm | Permalink

    I’m so sorry. There are no words to express the awfulness of a person still in their prime suddenly and unexpectedly vanishing like this, so it’s hard to know what to say. Sometimes music helps, if there is a song that speaks to what you’re experiencing.

  40. Helen Hollis
    Posted September 14, 2019 at 9:19 pm | Permalink

    I am very sorry for your loss, and the loss many feel just knowing about her. The American Heart Association is working with Walgreen’s this month to draw attention to the need for heart health awareness. My husband had a six way by pass 7 years ago. I hope that more can give to the American Heart Association to be earmarked in her name, but I do not know how to. I will ask my district manager. If anyone knows how to push this up, let me know

  41. Posted September 15, 2019 at 12:59 am | Permalink

    So terribly, terribly sorry. 😔

  42. Posted September 15, 2019 at 7:57 am | Permalink

    Thank you for the news, Professor. We all miss her.

    -Ryan

  43. Dominic
    Posted September 16, 2019 at 4:10 am | Permalink

    Poor Grania – I wish we had had an opportunity to meet…
    x

  44. Posted September 16, 2019 at 10:33 am | Permalink

    This was my guess for the cause. No comfort whatsoever, Grania is still gone. 😦

  45. Beth Purkhiser
    Posted September 18, 2019 at 12:22 am | Permalink

    I’m so sorry.


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