"Had an old coot (best possible description of the man) who was sweet but had spent his adult years drinking away whatever brain cells he had when he started. He presented with the chief complaint, 'I can't drink brewskies anymore. Every time I drink one, I just throw it back up a few minutes later.' Well, it turns out he hadn't been able to eat actual food in months, was subsisting on pretty much just liquid, and hadn't gone number 2 in over two weeks. That didn't bother him a bit - until he couldn't drink. Then it was an emergency! He had a big ol' tumor blocking the distal part of his left colon (so near the end of the road, intestinally speaking), and everything gradually got backed up all the way to his stomach. That's why he couldn't keep a drink down - there was just no more room at the inn. I fixed him with a colostomy, and he got better and left. He refused chemo, and I figured he'd just go home and die of cancer. However, almost exactly one year later, he came back to me with just about the same complaint - obstructed to the point of not being able to drink. Except for this time, it was that his ostomy had essentially retracted into his abdomen and the skin had nearly grown shut over it. He was pooping out of a teeny-tiny hole in his skin. WHAT? Even my oldest partners had never seen anything like it, but once again Cooter wasn't remotely fazed. He just wanted us to fix it so he could go home and keep drinking. I did. Haven't seen Cooter since.
I kind of hope he's still out there, treating his cancer with suds and just blissfully ignoring the Grim Reaper. As the dumb general surgeon, I did the standard-of-care thing and sent him to an Oncologist, who talked to him about the likely curable cancer he had and that chemo would help keep it from coming back again. After the discussion, Cooter told him to stuff the chemo up his butt. And I don't necessarily disagree with him. Chemo sucks and isn't without complications. But with it, Cooter might've gone on another 20 years to die of liver failure from his drinking instead. Maybe the cancer will/has come back to kill him, but whatever. Cooter made the call for himself, and that's totally fine by me.