Ms. B. was a 70-year-old woman who presented with a chief complaint of “my belly got puffy.” She noted that her waistband got progressively tighter as her abdomen swelled up on the month prior to her admission. Although not painful, the swelling caused considerable discomfort and anorexia.

Ms. B. had come to the university hospital by referral from her primary care doctor. She was my first patient on my junior clerkship in internal medicine, a specialty I was particularly interested in going into. It is a rare opportunity for a medical student to pick up a mystery case. Ms. B. had come to us without a diagnosis.