Pam was a 62-year-old female with pancreatic cancer who first came in due to abdominal pain and distension. She said she was diagnosed with pancreatic cancer this past January and was going through chemotherapy. She was admitted to the hospital because her abdomen was the size of a beach ball. Several family members were with her at bedside. Although Pam looked weak, she was laughing and making jokes with her family. In fact, she jokingly remarked “Doctor, I look like I’m pregnant!” I asked her if her husband knows. She asked me, “Know about what?” I pointed to her stomach and said, “the baby.” She broke a smile and the other family members in the room sheepishly chuckled. I told her we were going to run some tests and figure out what’s going on.
The nurse comes into my office with a grim look on her face. She tells me that my next patient threw up in the exam room. The nurse adds that the patient has severe abdominal pain. I save my note, get up from my desk, and briskly walk to see the patient. In the room, I see a light-skinned African-American 29-year-old female embracing her stomach and crouched over. Her name is Rae.
Rae’s afro was bobbing up and down due to the pain. She’s crying and wincing while clutching her stomach. I ask her what’s wrong. Rae tells me for the past month she’s noticed increasing amount of feces in the urine. I ask her how does she know it’s feces. She tells me that it’s brown and it smells.
I rush the history and physical. I tell the nurse to give her some pain medication and to straight catheterize her. When the nurse catheterized the patient, 100 millilitres of brown, fecal matter mixed with urine came out. I call the hospital and admit the patient. She had surgery the same day. The patient had an acute flare up of Crohn’s disease.
Over the past three weeks I have been traveling throughout Asia including Vietnam and Philippines. I don’t speak any of the languages, but it didn’t take much to see the culture of community and family.
On one particular day in Biên Hòa, a suburban area one hour away from Saigon, a storm flooded the street. As I stood at the doorstep of the place I was staying at, I watched cars and motorcycles trudging across the high water. I looked at the stores around my area and saw people helping each other put their belongings away, move their scooters inside, and even push cars through the torrent. There was hardly any hesitation in any of their actions – a firsthand example of working for the common good.