What happened when my wife died

In the demographic of woman of child-bearing age the coexistence of more than one autoimmune diseases is not uncommon. Occasionally, there are even combinations of several of them [1]. As you've written, the manifestations you have reported may or may not be caused by one or more autoimmune diseases, but the ones that tipically keep autoimmune/rheumatologic origin in consideration even when labs are negative are the partial spinal fusion and the arthritis [3][2].

> According to every test they run on her, there appears to be nothing wrong

Does it? We have:

- clinical picture strongly suggesting some rheumatologic disesease: inflammation and rapid onset arthritis are typical, but DVT, random bleeding may also be linked.

- radiographic evidence of spinal fusion.

And that's exactly how (eg) Ankylosing Spondylitis has been diagnosed classically (i.e. when MRI was not an option) [4]. More generally speaking, as the name suggests, the diagnosis of most Seronegative Spondyloarthropathies is based more on clinical than laboratory criteria [3]. For how I understand it, ideally AS would be diagnosed before spinal fusion happens, but when it's present and there isn't a more likely explanation AS would be at the top of the differential diagnosis.

Another thing that came to my mind when reading DVT, bleeding, vision loss was that these are more typically seen together in of some kind of vasculitides, hence why I mentioned above an the possibiity of multiple autoimmune diseases, but these could also be explained by anything altering Virchow's triad.

> There's no explanation for the temporary blindness, the rapid onset arthritis, the partial spinal fusion, the diverticulitis, the random bleeding,

That sounds somewhat strange. While for temporary blindness, diverticulitis and DVT the cause may already be gone by the time the patient arrives at observation, at least for rapid onset arthritis, spinal fusion and random bleeding I think a diagnosis of the cause should be made.

The reason why rheumatologic diseases should be diagnosed is that if left untreated there will be periods of remission, when nothing happens, and periods of activity, when irreversible damage accumulates. Another reason to diagnose rheumatologic diseases is that they may themselves be manifestations of some other condition (e.g. rheumatologic paraneoplastic syndromes). We don't know if your wife actually has a disease, it may be not, but that's not a risk a doctor would leave to chance. It's just standard practice.

As I've already written I'm not a doctor, but if I may give you my advice anyway I would say your wife should go and see a rheumatologist.

> There's no one who either wants to or is qualified to look.

If I were in you, at this point I would go to some known research center with maybe a university department or ward.

[1] [Coexistence of Axial Spondyloarthritis, Systemic Lupus Erythematosus, Sjögren’s Syndrome and Secondary Antiphospholipid Syndrome: Case Report](https://dergipark.org.tr/en/download/article-file/1615538)

[2] [Approaching the Patient with "Joint Pain" - CRASH! Medical Review Series ](https://www.youtube.com/watch?v=sfKWNeAywak&t=195s)

[3] [Seronegative Spondyloarthropathies - CRASH! Medical Review Series](https://youtu.be/hvQkROf5rsQ?t=377)

[4] [Progression of Spinal Fusion in Ankylosing Spondylitis](https://clinicaltrials.gov/ct2/show/NCT00085995)

your friend is supporting his wife, and she shares her pain and grief with him, while he shares his pain and grief with you.

here is an interesting article that describes this support model as multiple rings around the person that is sick.

https://www.latimes.com/opinion/op-ed/la-xpm-2013-apr-07-la-...

your friends wife is at the center, your friend is the inner circle, next are his family and you. you are supporting those inside the circle, and you get help from outside the circle.

HN is the furthermost layer outside. maybe you have friends that you can turn to for your support, but if not, reaching out here on HN is the right direction. you are welcome to dump your pain here or in private to anyone who offers to listen.

i have been on that inner circle before, and on outer ones. feel free to reach out.

What I’m getting at is I’d assume the more of a community you can get around the situation, the better - and the greater the variety of needs that can be serviced (emotional or time-based) and the longer lasting that help can last. In a similar way to how constructing an org can be a lot more robust and capable than trying to solo a project

Sometimes just having someone(s) do some PM work to manage funeral arrangements, life insurance arrangements, closing down accounts, manage beneficiary distributions etc can be very helpful if motivation/discipline is hard or stressful to come by

Food for thought: after my sister and dad passed I had tons of people ask me how I was doing / “please you can talk to me anytime” and I’d say “I’m good” even though I was plagued with burnout, depression, anxiety for a few years etc. I’m in a much better spot now, but what I’m getting at is there can be a problem of that it may be near impossible to actually know how the person is doing, especially if they’re the type of person who doesn’t like sharing emotions or being a burden on others. Not exactly sure what you can do to fix it, just pointing it out