[HMS: Medical Human Story–Episode 72]-Part I: When Did the Abdominal Pain Begin?
Part I: When Did the Abdominal Pain Begin?
The Illness First Noticed by a Wife
"Honey, is your stomach hurting again?"
It was a summer afternoon when the sunlight felt almost too bright, and
Kim Jeong-sook first noticed something was wrong with her husband.
After meals, he had developed a habit of pressing gently against his lower
left abdomen—almost absentmindedly, as if trying to silence something only he
could feel.
"I’m fine. It’s just indigestion."
Sixty-eight-year-old Park Jun-ho, a retired Korean literature teacher, had
spent more than three decades teaching students the beauty of language. In
retirement, he tended a small vegetable garden and lived what appeared to be a
peaceful, uneventful life.
Having rarely been ill, he always found hospitals uncomfortable, almost
unfamiliar. Even when he caught a cold, he relied on medication from the local
pharmacy. Health screening reports, if he ever bothered to open them, often
ended up untouched in the back of a drawer.
But that summer, something in his routine began to fracture—quietly,
almost imperceptibly.
What It Means to Grow Old
The abdominal discomfort became more frequent. Constipation followed. His
appetite diminished without explanation.
One day, his belt needed an extra notch. His trousers hung looser than
before.
"You’ve lost too much weight," his wife said.
"That’s what happens when you get older. Better than gaining
weight."
He smiled as he said it, trying to sound light.
But she could not smile back.
After nearly fifty years of sharing a home, they had learned to read what
others would miss: a slight tremor in the hand, the delayed placement of a
spoon, the shortened breath released during sleep. Illness, for them, was not
first identified in a hospital report—it was first recognized in the quiet
language of daily life.
Often, it is not medicine that notices disease first, but family.
A Dinner Table and the Return of a Forgotten Memory
"You don’t look well. You should go to the hospital."
"I’ll get better in a few days. You worry too much."
"Your father said the same thing… until it was too late."
At her trembling words, he slowly set down his chopsticks.
The memory returned with painful clarity.
He was twenty-eight again, the winter he lost his father to stomach
cancer. His father had always said, “It’ll pass if I just endure a little
longer.”
It did not pass.
By the time they finally went to the hospital, it was too late.
Forty years had not dulled that memory. It resurfaced in an instant,
summoned by his wife’s voice.
That night, he could not sleep, staring into the dark beyond the living
room window.
The First Clinic Visit and an Uneasy Hint
"When did the pain begin?"
"A few months ago. It’s been a dull, persistent discomfort."
"Left lower abdominal heaviness, and some weight loss."
Blood tests were performed.
Hemoglobin: 11.0 g/dL—mild anemia.
But inflammatory markers, including CRP and white blood cell count, were
normal.
The physician tilted his head slightly.
"Nothing striking on the labs. Let’s proceed with an abdominal CT
scan."
The patient assumed it was gastritis or enteritis.
His wife wanted to believe the same.
At least, for now.
[Medical Insight] Early Symptoms of Colonic MALT Lymphoma
The CT Room
"Breathe in… hold your breath."
The scanner whirred with a mechanical, alien rhythm.
It was a brief examination.
Yet it is often only a few minutes that determine the course of an entire
life.
As contrast material coursed through his bloodstream, a warm sensation
spread through his body. He closed his eyes.
A vague unease lingered.
Sometimes, the human mind senses something before it can be explained.
As if fate itself were scanning him.
The Radiology Reading Room
I was seated in front of the monitor when the images appeared.
A circumferential wall thickening in the descending colon.
Long-segment involvement.
Homogeneous contrast enhancement.
And, most strikingly, almost no evidence of obstruction.
My diagnostic pathways activated instinctively.
Colorectal cancer? Unlikely.
Inflammatory bowel disease? Less likely.
Ischemic colitis? The pattern did not fit.
Then, a single diagnosis surfaced in my mind.
Colonic MALT lymphoma.
Rare—but increasingly plausible.
What a Radiologist Sees
Most people look at a CT scan and notice size first.
A radiologist looks at behavior.
Uniformity. Length of involvement. The response of the surrounding fat.
This lesion was unusually quiet.
Large, yes—but not aggressive.
It behaved as if it had grown slowly over time, quietly preserving the surrounding structure, like roots spreading through soil without
disruption.
Key CT Features Suggestive of Colonic MALT Lymphoma
These findings help distinguish it from colonic adenocarcinoma.
Making the Call
After some hesitation, I called the gastroenterology professor.
"Professor, could you take a look at a CT with me?"
"Anything unusual?"
"It looks like lymphoma."
A pause.
Then—
"Colonic lymphoma?"
"Yes. Possibly MALT type."
A faint, audible breath came through the receiver.
Even for experienced clinicians, rare diseases bring a subtle tension—like
standing at the edge of something unfamiliar.
The Consultation Room
The next day, the couple entered the room.
The husband remained calm. The wife’s hands trembled slightly.
"There is something unusual on the CT scan."
"Is it cancer?"
The most difficult question in medicine.
And the most common.
"We don’t have a definitive diagnosis yet. We need a tissue
biopsy."
Her face turned pale.
The husband asked quietly:
"Is it serious? Am I going to die?"
Silence filled the room.
I looked at him carefully.
There was fear in his eyes—but also something else.
Preparation.
A quiet acceptance shaped by decades of teaching literature to students,
of understanding the fragility of human stories.
But his fingers trembled slightly.
"It’s too early to say that. Let’s first find out what it is."
He smiled faintly.
But his wife began to cry.
Humans Fear Before Disease Arrives
Before cancer, there is fear.
The waiting period is often more unbearable than the diagnosis itself.
The “what if.”
The sleepless nights.
The silence was kept from family members.
Disease begins in the body.
But suffering often begins in the mind.
The Night Before Colonoscopy
At 2 a.m., the living room light was still on.
"Why aren’t you sleeping?"
"You’re not sleeping either."
After a long silence, she said softly:
"You can’t be sick."
"I’m okay."
"No, you’re not. You’re not okay."
Her restraint finally broke.
"I can’t live without you."
Forty-four years of marriage.
Youth spent loving each other.
Middle age spent raising children.
Old age finally arrived—only to find illness sitting quietly between them.
The Morning of Fate
In the endoscopy suite, the mucosa of the descending colon appeared
thickened.
Slightly elevated.
Irregular, but not typical of adenocarcinoma.
Forceps grasped the lesion.
A small fragment of tissue separated.
That fragment would determine the course of an entire family.
A Specimen on Its Way
Disease always begins small.
A handful of abnormal cells.
A single mutation.
A single lymphocyte gone astray.
And yet that microscopic change is enough to alter the trajectory of an
entire life.
The specimen was sent to pathology.
All that remained was waiting.
Medical Recommendation – Part II
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The above content is a web novel adapted from the article
published on https://leesangbock.blogspot.com/2026/06/colonic-malt-lymphoma-ct-imaging-ai-healthcare.html. |
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