Guessing a person’s age can sometimes surprise you. Visual cues don’t always match reality, as I discovered when I saw an old man in the emergency room. I assumed he was around 70, but to my astonishment, he was actually 90 years old—yet he had remained physically fit throughout his life. I couldn’t help but envy his robust physique.

He was a country man who had spent his life farming, working the fields with his bare hands. He rarely trimmed his nails and only wore shoes on special occasions. A simple, innocent soul, he had likely never imagined ending up in a hospital. But over the past two months, he had grown progressively weaker. Fatigue weighed him down, and even short walks left him breathless. Going to the bathroom exhausted him. Yet, what troubled him most wasn’t his limited mobility—it was his loss of appetite. Food, even his favorites, held no appeal. Occasionally, he smoked a cigarette, but his stomach always felt like a full vessel, leaving him uncomfortably bloated.

What do you think was wrong with him?

The obvious guess? Severe anemia—his blood was critically low in hemoglobin. One day, after returning from the latrine, he was gasping for air. His ankles had swelling, and he developed bouts of cough at night—something entirely new for him. A man of few words, he would never seek medical help on his own. His son had to drag him to the hospital.

When he arrived, he was paper-white. The lab technician, stunned by how thin his blood sample was, ran the test twice before providing the report. Hemoglobin: 1.8 g/dL. Yet, shockingly, he sat on the bed with only mild distress. The hospital reconfirmed the result—no mistake.

But the surprises didn’t end there. His heart rate was just 74 bpm, far steadier than expected for someone in his state. The doctor double-checked, thinking he might be wrong—but no, the old man’s heart was indeed that calm. He was slowly transfused with five pints of blood. His chest X-ray showed mild effusion in the pleural cavity and an enlarged heart.

What’s your intelligent guess now?

On further questioning, it turned out he had been passing black, sticky stool (melena) for months—a sign of upper GI bleeding. He had not even noticed the color; he just flushed it away with extra water.

What was causing the blood loss? Most would suspect stomach cancer—given his age, anemia, appetite loss, and melena. A reasonable assumption. Many would expect an angry-looking gastric ulcer later confirmed as malignancy. If luck were truly cruel, the cancer might have already spread. At his age, surgery would be too risky, leaving his family to take him home for his final days.

But reality had one last shock in store. When the endoscope was inserted, instead of a tumor, hundreds of roundworms were found swirling in his stomach. The most astonishing part? Four tablets of albendazole (three over three days, one after two weeks) cured him completely.

He is still active in his work nowadays.

Learning point: Common things are always common.

Dr. Shambhu Khanal is a resident doctor at the Shahid Gangalal National Heart Center.