Chapter 1: Derek's Arrival

There are some nights in the ER you can’t shake off, no matter how hard you try. Derek’s was one of them. His visit was quick, his condition shifting right under our noses, and by the end, there was no going back.

Even now, sitting at my cluttered desk—half-drunk coffee cooling in a Styrofoam cup, the muted TV in the corner reciting the evening news—I can still see that night so clearly. The bitter tang clung to my tongue, grounding me in the here and now even as my mind kept drifting back. The overhead lights buzzed, and exhaustion pressed behind my eyes. But some cases leave a scar. Derek’s did.

Derek was 29. He walked in because his throat just felt wrong. For a few months, swallowing food had become a struggle. Add a nagging cough, and he finally decided it was time to get checked out.

He showed up in a faded Nirvana T-shirt—the yellow smiley face was cracked and peeling, probably vintage, or at least thrifted—and jeans, looking every bit the guy you’d see at a record store. His face was tight with exhaustion and worry. He kept clearing his throat, eyes flicking to the wall clock like he had somewhere better to be. You just knew this wasn’t someone who came to the hospital unless he had no other choice.

Turns out, this wasn’t even his first stop. He’d already gone to urgent care. That doctor took his history and found out he’d been struggling to swallow anything—sandwiches, oatmeal, didn’t matter—for over two months. The doc told him he needed more tests at a real hospital, and, as gently as possible, warned him to watch out for the chance of esophageal cancer.

I could almost picture that urgent care: harsh fluorescent lighting, a stiff vinyl chair, a young doctor doing their best not to let their voice shake. No one wants to be the person who plants that kind of fear in someone’s mind.

“Esophageal cancer? How could I have esophageal cancer? No one in my family’s ever had cancer. And I’m still so young!” Derek’s voice broke, disbelief and anger crashing together.

He bit his lip, eyes darting up to meet mine, then away again. For a second, he looked like a kid about to get grounded. He stared at the linoleum, fiddling with his jacket zipper. I recognized that look—clinging to hope that this was all some mistake, a doctor being overly cautious.

Every med student knows the drill: trouble swallowing that keeps getting worse? You don’t mess around. Cancer’s always lurking on the list, no matter how young the patient.

Dysphagia that gets worse over time is a red flag you never ignore. Sure, you check for reflux or strictures, but cancer is always there, hovering at the edge of every differential diagnosis.

Think about it: the esophagus is just a tube. Food’s got to make the journey down to the stomach, but if a tumor starts squeezing it tight, the opening narrows. At first, bread and meat get stuck. Later, even water struggles to make it through.