Midnight Mutterings | Lindsey

||| MIDNIGHT MUTTERINGS by JACKIE BATES |||

Tonight I’m muttering about Lindsey Graham. But not about his politics. Nor about his fickle bromance with Donald Trump. I’m muttering about his death on July 11, 2026 and the cause of his death. That is: aortic dissection.

Aortic dissection, particularly Type A, which involves the ascending portion of the aorta is a critical condition which develops rapidly and can result in a immediate death even if it is diagnosed and surgically treated quickly. It’s rare enough (one statistic I read is perhaps 3/100,000) that most people, even those medically trained and working in emergency departments don’t always recognize it, meaning the few unlucky peeps with the condition are likely to die even before diagnosis or even before they get to a hospital, or even before they think to perhaps head in the direction of emergency care.

I think Lindsey Graham’s fatal experience may serve to at least increase awareness of the possible diagnosis. Even with recognition and treatment (usually emergency open heart surgery by a cardiac-thoracic surgeon) doesn’t guarantee a good outcome, but it, at least, increases the odds a bit.

For one thing, most people, even with medical training, skip right from ‘dissection’ to aortic ‘aneurysm,’ which is a different condition in which there is a bulge in some part of the aorta. The aorta is largest vessel in your body and carries oxygenated blood from the heart to the rest of the body by way of branches of arteries. The ascending aorta goes from the heart to the aortic arch with branches going toward the neck and head, and the descending aorta which goes (with again ever smaller branches) to the rest of the body, providing oxygenated blood to all the organs and tissues of the body. In an aortic aneurysm there is a bulge in the artery which may or may not be a problem depending on size or if there is a rupture. A large aneurysm may require surgery to prevent rupture depending on where it is and how fast it bleeds if it ruptures and may cause a stroke or even death.

I realize this a garbled description by someone not medically trained and I accept your criticism even before you express it. And I will continue even as my limitations are obvious. And you, like many people, hate medical talk.
But back to aortic dissection. Instead of a bulge, the aorta (which consists of three distinct layers ’delaminates.’ The inner layer develops a tear which may be small or large. The tear means that blood, which should stay in the lumen, gets between the inner and middle layer, which means not all of the blood is getting where it should be going. Then depending on how much blood is diverted to between the layers, circulation is slowed, organs and tissues become depleted of oxygen, and the condition escalate as the tear enlarges under pressure, etc. Sometimes the tears can happen even in the middle and outer layers. If the outer layers are torn, then blood escapes the arteries and blood pressure can drop. Free blood in the abdomen can cause it’s own pain and and problems, the situation deteriorates.

Here are some symptoms, some of which are similar to cardiac arrest: blood loss from a number of conditions, stroke or shock. While an aortic aneurysm may have few symptoms, and even a small ruptured aneurysms may have only mild symptoms, a dissection is often fairly dramatic. In Type A, in the ascending aorta, there can be pain, sometimes described as ‘tearing’ in the chest or back, nausea and/or vomiting, intermittent loss of consciousness. If there is frank bleeding into the chest or abdomen, blood pressure can drop dramatically.

There is one condition that isn’t well known, but can help diagnosis by medical staff. That is when blood pressure is different bilaterally.That is, if pressure in the two arms is noticeably different, it can indicate a dissection in the chest and if the difference is in the legs, it can be an indication of dissection in the abdominal aorta. In reading up on aortic dissection again tonight, I found only one source on the almighty web that mentioned bilateral difference in blood pressure, even though I was looking for it because of something I had read years ago. Time for AI to catch up…

Who is likely to have an aortic dissection? Gender-identified male at birth, male smokers in their sixties and seventies, with cardiovascular disease, with high blood pressure or Marfan’s Syndrome, or Single X chromosome females, or people with one of several connective tissue abnormalities, or people of any gender involved in catastrophic automobile or other traumatic accidents. It is also more common in people who have had heart surgery or an aneurysm. It is also more common in peeps with a family history of aortic aneurysms. But still not very common at all.

The only person I know of who had a Type A or any other type of aortic dissection, is my daughter who died at age forty nine, eight years and three days before Lindsey Graham died on July 11, 2026. She was a gender-identified female at birth, who didn’t smoke (as far as I know). The only family history we know of is her father who got a stent for an AAA (abdominal aortic aneurysm) this year at age 85. She did have surgery for pericardial tamponade, when she was hospitalized with paraneoplastic syndrome before she was diagnosed with Chronic Meylomonocytic Leukemia. But that’s not really heart surgery. And it was when she was 37 years old.

Her aortic dissection was likely caused by ten years of high dose steroids (Prednisone) after her stem cell transplant for the CMML (She developed graft vs host disease after the successful stem cell (bone marrow) transplant. Now we fast forward ten years

Eight years ago her brother took her to the ER at 2:00 AM with the classic symptoms of aortic dissection (tearing back pain, nausea, very low blood pressure.) She was kept for observation. Given that she was the wrong age and gender for a dissection and no one in the ER had likely ever seen or maybe even heard of an aortic dissection, it was not suspected. She was scheduled for a CT next morning at 10:00 AM. She texted her brother to pick her up after the CT, but she coded in the CT room before the scan. They completed the scan which revealed the dissection.

But by that time the only available cardiac-thoracic surgeon was already in surgery. Her blood pressure had tanked and she was given copious transfusions and other blood products. ‘Too many to count,’ according to the cardiologist who phoned me to say she was being airlifted to Everett where there was an available surgeon. I jumped on the ferry and drove to Everett and met her brother there. She was already in surgery which lasted nine and half hours, with again ‘too many transfusions and other blood products’ to count.

Out of surgery by 11:30 PM, she never regained consciousness and died at 4:19 AM. No one had known to check her blood pressure bilaterally, and no one knows if she might have survived if she had the CT scan on admission when a surgeon was available. One interesting thing: The cardiologist said she had an aneurysm. I asked if it was aortic or abdominal (I knew the types of aneurysms even then.) The cardiologist said, ‘It’s everywhere.’ Which would have meant a dissection. But neither of us recognized the confusion.