The patient, an elderly Vietnamese man, complained of poor vision. I was trying to establish the nature, severity and progression of his symptoms when the interpreter cut in: "Doctor, I will tell you a story his granddaughter told me in the waiting room. The patient went to the grocery store this week to buy a birthday cake for his granddaughter. He walked up and down the aisles until he found a large cake display."

She went on to describe how the patient selected a small, rectangular cake. It was light brown, and he assumed it was chocolate-flavoured, his granddaughter's favourite. As he was having some difficulty seeing the product clearly, he patted it gently with his hands. Through the plastic wrap the cake felt firm, cool and moist. Pleased with his find, he made the purchase and carried it home.

He set it on the centre of the table in the dining room and went in search of birthday candles. As he rummaged in the kitchen drawer, his daughter entered the room and asked, "What's that slab of pork doing on the dining room table?"

I decided his visual problems warranted further workup.