There was nothing unusual about the clinical history of the case that arrived at my microscope in the middle of a busy sign out day. As I examined the patterns on the microscope slide, I was reminded of a very rare tumor that I had read about when I was a resident. But no, it couldn’t be. There were less than twenty cases reported in the world medical literature. Still, the longer I examined the case, I was convinced that this was the diagnosis. The author of the definitive paper on this tumor was still actively publishing and I sent the case in consultation to him. Within a week, he confirmed the diagnosis. Thankfully for the patient, a complete excision was usually curative. I shared the case with my residents as an example of a tumor they will probably never see again for their entire careers.
Two weeks later, the entire scenario repeated. As I reviewed the slide, it looked nearly identical to the rare tumor I had earlier diagnosed. I checked the name of the patient, thinking this must be a re-excision, but no, this was a different patient from a different dermatologist. I was dumbfounded. I thought I would never see a case like this again and two weeks later, here was another one! I repeated my actions and sent this second case to the same consultant who again confirmed the diagnosis. In my nearly thirty years of practice, I have never again made this diagnosis.
When one encounters two cases of an extremely rare disease in a relatively short period of time, one conclusion may be to attribute it to chance. However, another possibility investigates whether the cases may have a common link. Perhaps the patients were related or worked in a similar occupation? Did they have a similar underlying medical condition that predisposed them to this rare tumor? An inquiry to both of the referring dermatologists yielded no additional clues but I have always kept these cases in the back of my mind and regularly review the medical literature to see if any epidemiological associations are ever discovered. I recalled the astute pathologists who found a connection with a heretofore rare disease, Kaposi’s sarcoma, and the AIDS epidemic in the 1980’s. It could happen again.
The disciples followed Jesus Christ for three years. In that time, they witnessed many miracles. However, there are two which were repeated almost exactly. Jesus fed over 5000 men and women with five loaves of bread. A short while later, he fed over 4000 with seven loaves of bread. Yet, the disciples completely missed the connection between these extraordinary events.
Later, after they crossed to the other side of the lake, the disciples discovered they had forgotten to bring any bread. “Watch out!” Jesus warned them. “Beware of the yeast of the Pharisees and Sadducees.” At this they began to argue with each other because they hadn’t brought any bread. Jesus knew what they were saying, so he said, “You have so little faith! Why are you arguing with each other about having no bread? Don’t you understand even yet? Don’t you remember the 5,000 I fed with five loaves, and the baskets of leftovers you picked up? Or the 4,000 I fed with seven loaves, and the large baskets of leftovers you picked up?
Matthew 16:5-10 (NLT)
It wasn’t until Jesus put together the association for them that they understood.
“Why can’t you understand that I’m not talking about bread? So again I say, ‘Beware of the yeast of the Pharisees and Sadducees.’” Then at last they understood that he wasn’t speaking about the yeast in bread, but about the deceptive teaching of the Pharisees and Sadducees.
Matthew 16:11-12 (NLT)
In life, we need to be aware that the occurrence of rare events may portend a very important association. Jesus reminds us that as we walk with Him, every event He leads us through is associated with eternal significance. It is our privilege to learn how it will strengthen and increase our faith in Him.
Love and trust the Lord; seek His will in your life.