As Bryan says in a comment on my previous post, “you do get better care from such big institutions precisely because so many different people with such specialized expertise can be involved, but the more of those resources you have the harder it is coordinate and monitor them to ensure that they work properly.” With that point in mind, my own story, told at some length for a particular purpose:Six or seven months of increasingly regular abdominal pain eventually led to the removal of my gall bladder — my “huge, completely dead gall bladder,” as the surgeon so neatly described it — in February. I thought my troubles were over, but after a few weeks my symptoms started to return. The days before Palm Sunday were increasingly bad. I called my excellent gastroenterologist, Stephen Chang, on Monday and he had me get some blood work done. By Wednesday morning jaundice was showing, which my bilirubin levels predicted. It was an obvious diagnosis: a stone from the gall bladder had worked its way into the common bile duct, something my surgeon had warned was possible, and was creating havoc. Dr. Chang asked me to come in to CDH the next day for an endoscopic procedure to have it out — then, an hour later, called back to ask if I could come in that afternoon. I did.He said that 90% of the time ERCP is successful; he also said that in a very small number of cases the procedure itself can prompt an attack of pancreatitis. If the latter happened, he said, I would know: pancreatitis is “not subtle.” In my case the procedure was unsuccessful, so Dr. Chang immediately got on the phone with a major specialist at the University of Chicago, Irving Waxman — who, as should be obvious from his name, turns out to be from Mexico — to see when he could take over. Unfortunately, just a few hours later I discovered that I was among the lucky few to pick up the pancreatitis.Rarely has there been an understatement to match the observation that pancreatitis is “not subtle.” My entire abdominal cavity throbbed as though Saruman had set up a supplemental Uruk-Hai-making facility within it; every muscle in my back went into spasm. My wife Teri drove me to the ER, where they rolled me into a wheelchair; when I finally got in to see the triage nurse, the convulsive vomiting began. I would have been white as a sheet had it not been for the bilirubin, but, Teri tells me, the absence of normal skin tone made my brilliant yellow stand out all the more.On the other hand, to be a doubled-over, groaning, violently shivering, bright-yellow vomiting guy is an excellent way to get moved up in the triage rankings. So I got medicated and got into a room before too long.I spent Thursday receiving antibiotics, saline solution, anti-nausea meds, and pain meds. I slept through much of that. On Good Friday an ambulance arrived to take me to the University of Chicago Medical Center for a more advanced form of ERCP with Dr. Waxman — which now seems to have been fully successful. About noon on Easter Sunday I was released, and I have been resting (mostly) since then. I am still pretty weak, but I’m not very yellow any more and a blood test done yesterday confirms that the various chemical levels are all moving in the right direction, though none of them are what they should be. Teri has been incredibly kind and attentive to me. I got great care from everyone involved.But remember what I said in my last post about the absolute necessity, in this absurdly complicated system, of having an advocate? And remember what commenter Brian said about the difficulty of coordinating and monitoring such high-level services? Well, I had in Dr. Chang just such an advocate who did all the coordinating for me. Just look through the previous narrative and think about how things might have turned out had he not been assertive, persistent, and knowledgeable. So while I owe debts of gratitude to many right now, I think I owe my greatest debt to him. Thanks, Dr. Chang!