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The Jumbo Man in the Jumbo Mart

Years ago when I had newly moved to Sacramento, I lived in a house very close to a grocery store called the Jumbo Mart. It really wasn't that big, the selection of items to purchase wasn't that great, and things cost a bit more than at the bigger stores like Safeway or Raley's Bel Air. However, it was very convenient and had more open parking spaces and almost always had far fewer shoppers in the checkout line than these other supermarkets. So, most of the time, I shopped at the Jumbo Mart. One day I was looking for a tube of toothpaste and turned down the aisle with the sign for health and beauty products, which included antacids, antiseptics, ointments of all sorts, soaps, cough drops and syrups, tissues and toilet paper, cosmetics, vitamins, toothpaste, andnext to the toothpaste offeringsvarious deodorants. However, I couldn't get by to the toothpaste because there was already a man in that aisle blocking me as he filled his grocery cart. His back was toward me. The only things I could see about him was that he was very tall, had really big hands, and was scooping up multiple brands and types of deodorant. As I came a little closer, hoping to be noticed and allowed to pass, I immediately learned why he needed deodorant he smelled awful. I stepped back and tried to turn around. He evidently heard the squeak of the wheels of my grocery cart, because he turned toward me. His face was a diagnosis in vivo: the prominent brow; thick and greasy skin; bulbous nose; big, jutting jaw; and gaps between his teeth. In a coarse, deep voice, he said, Sorry, and pulled his cart out of my way. Forgetting about the toothpaste, I went by him as quickly as I could and wound up in a nearby aisle containing cookies, candies, and chewing gum. There I began to wonder: Did he know he had acromegaly? Had anyone told him? What, as a doctor, was my obligation here? Should I, a total stranger, inform him in a supermarket that he has a pituitary tumor? Several years earlier, I had cared for a man admitted in coma to the University of Michigan ICU. He was acromegalic and had pituitary apoplexy. He had been found comatose on the street. When his family was called in to see him, I asked them whether they had noticed the gradual change that must have occurred in his appearance over a number of years. The answer? No. He's always been kinda ugly. So, as was the case with the man in Michigan (and many, many others with this disease), the jumbo man might not have known what was happening to himhis brain, his heart, his lungsuntil it was too late. As I wrestled with my conundrum, I saw him pass by, heading to the checkout line. Still uncertain of my duty, I followed him and got in line just behind him. As he paid the teller and she turned to put the money in the cash register, I decided what to do: I leaned forward, fingers crossed, and when the cash register went cha-ching softly said one word: Acromegaly? He turned around to look at me and replied, again in a low-pitched, coarse voice, Yeah! Surgery coming up. Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "The Jumbo Man in the Jumbo Mart," by F.T. Fitzgerald.