Monday, May 10, 2004

healthy pink mucosa

For the past month or so, Joe has been complaining of stomach pains on and off. When reasonable, he realizes this is a simple gastritis, but at his most paranoid, I think he suspects he has stomach cancer. (I guess he knows someone our age with Barrett's esophagus, so it's not such a long shot in his mind.) I tried to convince him that he probably didn't have stomach cancer because 1.) he's young, and 2.) he's not Japanese (funny how some things from med school will just stick to your brain, like gum under a diner counter), but I think part of him continued to think that he had linitus plastica, especially when the trial of antacids I recommended didn't work.

I offered to write him for triple therapy (not that I necessarily think he had H. pylori, I just wanted to help him out), but he upped me by actually going to a gastroenterologist today and getting scoped. Just like that. Called up to the attending's office, didn't eat anything past 9am, and got scoped that afternoon. This may be one of the very few perks in being a doctor: access to care. They even gave him a whole shitload of free Nexium samples and the videotape recording of his scope to watch at home; a tape that he promptly popped into the VCR and showed me as soon as I walked in the door.

Never has healthy pink mucosa looked so good. I mean, not like I really thought he had stomach cancer either, but it's hard not to worry sometimes. The biopsy results will probably be back next week so we'll know about the H. pylori part of it (couldn't they just do a blood test for the antibody?), but in the meantime, the attending gave him a few suggestions. "Try a proton-pump inhibitor. And don't drink coffee."


This was the advice given to a man who has had at least two cups of coffee a day for the past 12 years. Whose devotion to Peet's verges on idol worship. Who gets caffeine headaches at 10am if denied a cuppa joe (heh) in the morning. Who just got a $150 coffee maker for his birthday, for Chrissake. (It's a great coffee maker, I'm told. Among its many high-tech features, it can grind beans, keep coffee hot for hours on end with active heating plate, and travel through time.)

Given the choice between gastritis and no coffee, I'm still not sure what he'll choose. But my feeling is, someone's stomach is going to be bothering him at work tomorrow morning.

Currently reading: "Walk On Water". Help, I'm becoming one of those doctors who only read books about medicine! Somebody stop me! Though I have to say, "The Spirit Catches You and You Fall Down" was one of the finest books I've read in a very long time. I would recommend it to anyone.

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