A woman came to the emergency department (ED) with abdominal pain. She was in her mid-fifties and was not well. The pain had been getting worse for days and by the time she arrived with us, she was tachycardic and hypotensive, the pain was unbearable – she was dying. We didn’t know the exact cause, but at this stage it had become a combination of multiple pathologies and we soon knew that she was unlikely to survive.