Potential side effects - justify your interventions!

I remember a patient in the clinic with a very rare genetic disorder, that affected his collagen fibers, that was known to cause aneurysms of the big vessels already after a harmless trauma.

There are different types, but an aneurysm is basically a pathologic widening of a vessel, usually of an artery, as if in one place a tube suddenly blew up like a balloon. Of course this is bad for the current in this vessel, the aneurysm leads to turbulences that themselves oftenly increase the size of the aneurysm. It's a vicious circle that can remain somehow stable for a long time, even for one's whole life, but that can as well suddenly lead to an uncontrollable growth and rupture of the lesion with major, eventually lethal bleeding.

This patient I remember was hospitalized for some obscure belly pain. He knew about other persons in his family with the genetic disorder, but he didn't know that he had it himself and he didn't mention it, when he was admitted. He was in his thirties or forties, had children, and didn't remember to have ever suffered from serious medical problems.

Maybe he had been asked routinely by the admitting resident, whether there were some noteworthy family events, and he did not remember, or maybe he was not even asked, because to this question patients sometimes tend to give lengthy reports about family events and names of involved doctors and preferrably professors that often are of little useful information, so it is a question that tends to be neglected, when there is not enough time (which is almost always the case) for the initial exam. Though in some cases the informations from the family history can be absolutely essential!

Diagnosis and treatment were difficult, the patient obviously suffered from a serious problem but reasons were not easily identified. At one point he was operated. Then, during his stay, there were more and more problems and finally and sadly he died. By then it was known that he probably suffered from his family's disease and precautionary measures were set in place, he was treated like a raw egg, but too late, important time, days, had been lost. It has to be said that he probably died from the consequences of the aneurysm that caused already his initial problems and had led to his admittance. And yet!

As tragical as this case was, what fascinates me until today is the following: when, after his death, his body was examined by a team of pathologists, they found multiple aneurysms in different parts of his body. They were all over!

Basically it could be reconstructed that every invasive procedure to his vessels had left an aneurysm at the spot where the intervention had been performed. And most shocking: not only simple intravenous punctions, as usually done to obtain a blood sample, had left him with an additional aneurysm, but even at the site of his upperarm where his blood pressure had been taken (before his disease had been known), there were aneurysms as well.

Imagine: even taking your blood pressure can once have (serious) side effects. To me, this is a very noteworthy illustration of the fact that no useful intervention in medicine is without potentially harmful side effects! Every intervention has to be justified!