Asking the right questions
IN THE DRUDGERY of an internist’s daily life, there are moments of surprises that come along the way. This happened to me two days ago. I checked on a fifty-something patient, someone my service and I were managing as a case of upper gastrointestinal bleeding secondary to a probable GI malignancy. I had told him during our first encounter that he should observe the color of his stool. It was to be his “assignment.” I wanted him to pay close attention as to whether it looks like asphalt or dinuguan—local descriptors of melena that I have found useful in my practice. Dark, tarry stools are a useful sign of acute or active bleeding anywhere in the GI tract.