You gulp down the last sip of your lukewarm coffee just as the charge nurse hands you a chart.

“Room 3,” she says. “She looks miserable.” You walk in to find Maria, a 56-year-old woman, clutching her right side and wincing. “It hurts so much, Doctor,” she groans, her skin pale and clammy. You gently examine her, palpating a firm, vague mass in her right upper quadrant that makes her gasp in pain.

Her history notes type 2 diabetes mellitus, recurrent urinary tract infections, and nephrolithiasis. She mentions a 10-pound unintentional weight loss and feeling utterly exhausted for the past three months.