Most people have probably at least heard of cirrhosis, but I suspect very few actually understand its gravity. In short, it's a chronic and incurable disease where the liver is scarred beyond any ability to heal, typically from either long-term alcohol abuse or hepatitis C. After the liver has endured more than it can handle, it eventually loses its ability to perform its many functions, including producing clotting factors and other proteins, and filtering the blood. The only treatment for cirrhosis is treating the symptoms, and the only cure is liver transplantation. To put it mildly, I think of cirrhotics as walking Jenga games, and if at any time one even not-so-critical piece is pulled out, the whole thing will fall down into a bleeding, jaundiced, encephalopathic mess.
Graphic enough for you? Good, then I'll move on.
Cirrhosis patients are some of the most brittle any doctor will ever come across. Their overall health needs to be closely monitored and their medication just as closely adjusted to account for any disturbance. Bleeding is a huge potential risk because of the lack of clotting factors, so risky behaviour (skydiving, martial arts, cutting bagels) should be avoided. Alcohol should also be strictly avoided to prevent the situation from acutely worsening. Obviously. Acetaminophen (Paracetamol/Tylenol) should also be avoided the way I avoid painting. I hate painting.
Gary (not his real name™) had absolutely no idea how bad a disease cirrhosis is, because despite the risks he continued making it worse. And worse. And worse.
I can't really say that Gary was a smart guy, because he wasn't. I can't even say Gary was of average intelligence or even slowly below average, because anyone with more than 8 working synapses would know that being diagnosed with chronic Hepatitis C is a very bad thing. Gary, on the other hand, took it as an opportunity to start drinking heavily. He also used it as an excuse to do other really stupid things, like buying a motorcycle. Completing the decathlon of stupidity was, of course, the combination of all these activities.
On this particularly fateful day, Gary decided that he wasn't content with just throwing gasoline onto his Personal Risk Fire, so he threw some dynamite on there as well. He got slobberingly drunk, got onto his motorcycle, and then barreled down the motorway at twice the posted limit. It doesn't take a genius to predict how this ended.
Cirrhosis + alcohol + motorcycle + speed + stupidity = an painfully obvious dénouement
Surprisingly when Gary rear-ended a car that had stopped for a traffic light (neither of which Gary saw), he didn't die immediately. When he arrived in my trauma bay he smelled like the men's restroom in a rather seedy pub (ladies, if you've never had the pleasure of experiencing that aroma, just use your imagination. And it's just a bit worse than that). He was too drunk to even tell me where it hurt, so I ended up scanning him from head to toe. What I found was not a huge surprise:
- nearly every rib on the left side was fractured
- left lung was collapsed
- left acetabulum (hip socket) was shattered
- sternum (breast bone) was broken
- left scapula fracture