The Parable of the Quality Pie

Until it was closed in 1992 the Quality Pie was a cafe known for its always-open hours, its decent coffee, excellent pies, doughnuts, hamburgers and breakfasts.  It was across NW 23^rd Avenue from the emergency entrance of my home-hospital, Good Samaritan.  When you walked from the Hospital door the air was redolent of doughnuts.

When I came to Good Sam in 1980, NW 23^rd Avenue was a street of seedy taverns and diverse enterprises, from doctors’ offices and banks to music and paraphernalia shops attractive to a dwindling population of aficionados of the1960’s counter-culture. 

The Quality Pie welcomed all of these businesses and their customers.   From the outside the QP resembled the scene of Edward Hopper’s Night Hawks.     Day or night it was the place, for coffee breaks.

Some time within memory, a QP waitress developed ongoing bloody diarrhea, and her physician referred her to a Good Sam specialist.  After a thorough evaluation she was diagnosed as having idiopathic ulcerative colitis.  In this case, idiopathic meant that no cause was found or the ulcers in her colon even after biopsies and laboratory studies.

Her diarrhea did not get better with standard treatments, but she was able to continue to work serving patrons from Good Sam and NW 23^rd Ave.  After weeks, the diarrhea worsened and she was given corticosteroids.  Her pain worsened.  She was sick.  The gastroenterologist had had cases like this before, and he called a Good Sam surgeon.  Her colon was removed. 

The colon was inflamed and ridden with ulcers.  It was put under the pathologist’s microscope.  The walls of the ulcers and rest of the colon were found to be infested with Entamoeba histolytica.  She had chronic amebic dysentery.  Her colon and her stool had been alive with this parasite. 

Amebic infections can be contagious.  

Good hand washing makes this unlikely.  The waitress must have heeded the warning on the bathroom walls, for no other cases of amebic dysenteric were recognized on NW 23^rd.

The removal of her colon might have been avoided.  There is a simple and inexpensive test for invasive Entamoeba histolytica infection.  It is very accurate.  Her test most certainly would have been positive, and she would have been successfully treated without surgery.  She would still have her colon. 

The message of the Parable of the Quality Pie:  even rare and unusual diseases deserve diagnosis, and sometimes hoof-beats are zebras and not just horses.