Say you have one big database. You have 300 engineers and 30-50 product managers shipping new features every day accountable to the C-Suite. They are all writing queries to retrieve the data they want. One more join, one more N+1 query. Tons of indexes to support all the different queries, to the point where your indexes exceed the size of your tables in many cases. Database maintenance is always someone else's problem, because hey, it's one big shared database. You keep scaling up the instance size cause "hardware is cheap". Eventually you hit the m6g.16xlarge. You add read replicas. Congratulations, Now you have an eventually consistent system. You have to start figuring out which queries can hit the replica and which ones always need the fresh data. You start getting long replication lag, but it varies and you don't know why. If you decide to try to optimize a single table, you find dozens or 100+ queries that access it. You didn't write them. The engineers who did don't work here anymore....
I could go on, and all these problems are certainly solvable and could have been avoided with a little foresight, but you don't always have good engineers at a startup doing the "right thing" before you show up.