This is a true story as told to me by my patient.

She had been my patient for the past 30 years seeing me after I first started my clinic.

She brought her family and her children to see me for minor coughs and colds.

Of course as she aged, she also consulted me for minor aches and pains.

She had a history of high blood pressure which was being treated by the outpatient clinics or polyclinics as they are called in Singapore.

Once a year she would go for an annual blood test which invariably showed nothing significant in her blood except for slightly raised blood cholesterol

She also had a history of gastric problem since 50 years ago.

She had a history of a father who died of heart attack and a mother who died of diabetes.

There was no history of cancer on her side of the family.

However her husband died at the age of 52 from nasopharyngeal cancer.

I had been treating her for gastric problems on and off since 1974.

She usually gets gastric pain when she takes too much oily and spicy food.

Usually if an antacid (like Bismag or Actal) does not counter the acidity or pain, she would come to see me for treatment.

I would prescribe to her the usual anticholinergic librax, antacid gestid and cimetidine tablets (There were no Nexium or Losec at that time, only Tagamet) three times a day and my favorite antacid suspension every half hourly until there is no pain.

So for 24 years she has been taking the medicine I gave her without problem each time relieving her pain.

She also takes medicines for her hypertension and cholesterol daily from the polyclinics that are public outpatient clinics at a very subsidized price in Singapore especially when she is a Senior Citizen after the age of 65 years.

I had informed her to get the medicines at the polyclinics because these are long term medicines, which should be taken daily and it is very much cheaper at the polyclinics.

At the age of 78 years she suddenly had a severe abdominal pain in the middle of the night which was so painful that she had difficulty breathing and went into cold sweats.

Prior to this pain she has vague abdominal discomfort in her abdomen which she thought was due to her gastric problem.

Besides that she has been suffering from alternating diarrhea and constipation for the past 2 weeks.

As she had similar episodes before she did think much about these symptoms.

The daughter called me about her severe abdominal pain.

Fearing a heart attack that may cause pain in the epigastric (the abdominal area just below the heart) I called for an ambulance and asked her daughter to follow in the ambulance with all her medicines.

The journey to the Singapore General Hospital was arduous with abdominal pain striking her every time the ambulance went over bumps in the road.

Unknown to her and her daughter the lesion in the abdomen that turned to be cancer of the colon had already burst and was causing pain in the abdominal cavity.

She was taken to the emergency department of the hospital where a senior doctor diagnosed that she had peritonitis or inflammation of the abdominal cavity from a burst area of the small intestine or large intestine.

A senior general surgeon on duty was called and she was prepared for emergency operation.

A laparotomy (opening into the abdominal cavity) was done down the midline of the abdomen and the inside of the abdominal cavity examined.

Blood and pussy discharge were sucked out that the surgeon was able to see where the burst intestine was.

It was found in the first part of her transverse colon where the cancer had apparently eaten...