James Joyce
The middle-aged couple knocked at the door of the townhouse. When no one answered, the woman took her key and let them in. She called her daughter’s name as she hurried through the rooms. They had been trying to reach their 27-year-old daughter by phone all day, and she hadn’t answered.
They found her upstairs, lying in bed and mumbling incoherently. The mother rushed over, but her daughter showed no signs of recognition. She and her husband quickly carried her to the car.
Weight-Loss Surgery
Four months before, the mother told the emergency-room doctor at SSM Health St. Mary’s Hospital in St. Louis, her daughter had a procedure called gastric-sleeve surgery to help her lose weight. She came home after just a couple of days and felt great. She looked bright and eager.
Once she started to eat, though, nausea and vomiting set in. After almost every meal, she would throw up. It’s an unusual but well-known complication of this kind of surgery. The cause is not clearly understood, but the phenomenon is sometimes linked to reflux. The surgeon tried different medications to stop the nausea and vomiting and to reduce the acid in her stomach, but they didn’t help. She had the surgery in order to lose weight, but now she was losing weight too quickly.
After a month of vomiting, her doctors thought maybe she had developed gallstones — a common problem after rapid weight loss. But even after her gallbladder was removed, the young woman continued to vomit after eating.
That’s when the mother saw a change in the daughter’s behavior. She was quieter, slower. Recently she had even seemed confused at times. And she said she felt weak. Her mother also noticed that she walked strangely — her feet slapped the ground in an odd way.
Sicker Than She Looked
The emergency-room doctor then turned his attention to the patient. Her blood pressure was low, and her heart rate was nearly twice what it should have been. Worse, a test measuring the amount of lactic acid in her blood suggested that she was in serious trouble. Lactic acid, or lactate, is produced when there is not enough oxygen in the blood to feed the muscles and organs that need it. Exercisers know lactic acid as the compound that causes muscles to burn during extreme exertion. It is a reflection of muscles so hard at work that they use up all available oxygen.
In the emergency room, however, an elevated lactate level suggests a body too broken to deliver sufficient oxygen to the organs. This can be caused by extreme dehydration — and a patient who has been vomiting for weeks is at risk of that. But it can also be caused by other, more dangerous conditions, like an infection or a heart that isn’t beating properly. The patient was started on antibiotics and admitted to the hospital.
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