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Jonathan L. Ventigan/08-87008/FCH250.1 S.B. was our patient in the afternoon of July 27.

We so far handled three patients yesterday and that morning and we were getting used to the task, though far from mastering it. Her case was special for us because we were going to use it for our case presentation. The presentation was supposed to be on a case of dysuria but we were not able to get any case like that so we settled for S.B. She came to the OPD with a chief complaint of abdominal pain but we soon found out that she had been bleeding from her vagina for the past three years. I think we all suspected cervical cancer right then but none of us showed it. We proceeded to get all her histories and the physical examination and our initial suspicion only increased; substantial weight loss in just a year, difficulties with urination, and five previous sexual partners. The internal examination revealed multiple nodules all over her vaginal canal, an unpalpable cervix and a foul-smelling discharge. She bled so much from the internal exam that we had to ask our supervising doctor for assistance. The doctor took over from us and gave her referral to the ER in the hopes that an OB-Gyne will be able to see her immediately. Then, he gave her the bad news that she very likely has cancer. Our patient took the news wordlessly without any distress showing on her face. We gave her the referral and she went to the nurse for instructions, then she left. I didn’t expect to see a cancer case so early in my rotation. For most people, the word cancer is a death sentence, regardless of how good the prognosis might be. In her case, it most likely was. She had been bleeding for three years and sought consult only because a doctor from a medical mission wrote her an ultrasound request. The cancer had advanced to stage III which had a 30% 5-year survival rate. She had no regular job and only worked as a laundry woman occasionally. I do not know what she would do now. She had no money for private chemoradiotherapy and the PGH cobalt machine has a long line of patients. I will learn a lot more about medicine this year as we go through our rotations; differentials, work-ups, diagnosis, management. But to deliver terrible news and to deal with it ourselves as much was a bit too much of a shock for me too soon. I hope I would learn to deal with these things faster. I hope.