Yes.

What's worse, far worse, is finding out that you have a malignant tumor and not being admitted to the hospital then and there because the doctor is unwilling to play the elaborate intake game -- leaving you on your own to negotiate the Kafkaesque system to arrange diagnosis and treatment. Because even if you have a deadly cancer and great insurance coverage, the doctor must provide an airtight excuse to slip you in past the bean counters and case reviewers. Otherwise you can waste a couple of your last precious few months trying to force your way through a healthcare labyrinth that is blind and deaf to your suffering.

On a recent and relatively calm night in the emergency room, I picked up the chart of a 55-year-old woman complaining of a sore throat. According to the triage nurse's notes, the patient had just finished a course of the antibiotic Biaxin, but her throat remained swollen, which suggested a viral infection or a resistant strep.

I entered the examining room to find a diminutive Asian woman -- probably Cambodian, judging from her 14-letter, five-syllable last name -- accompanied by a slender daughter and the girl's boyfriend. I ran through a few perfunctory questions. The patient answered in broken English, with an occasional assist from the kids: Fever? Cough? Trouble breathing? No, no, no.

Smoker? No.

Open wide.

Most adults don't open their mouths properly. They bunch their tongue up toward the palate, blocking the view of the tonsils, and this woman was no exception. Even before I reached for my tongue depressor, I noticed a bulge where the woman's left tonsil should have been. My interest ticked up a notch: a possible peritonsillar abscess. Sometimes a strep infection can escape the antibiotic assault and grow into a pocket of pus in the lymph tissue behind the tonsil, creating a potential hazard to breathing.

The abscess can be drained easily enough with a sharp needle jab, as long as care is taken not to puncture the internal carotid artery, millimeters away. A tiny mistake can result in massive bleeding and a howlingly disastrous surgical emergency. This is the kind of fun procedure that ER doctors salivate over: a quick fix, an element of danger, topped off by the patient's admiration and heartfelt gratitude.

But as I positioned my stick and coaxed her tongue away from the roof of the mouth for a better look, I saw, instead, an angry red mass the size of a golf ball hovering over her larynx. No abscess, a tumor: Nothing else occurred to me. As I pulled back, trying to compose my face, I brought my hands up to feel the sides of her neck. There it was again on the left, just inside and underneath her jaw.

I launched into a new string of questions. You don't smoke? No, you told me that already. Fever? No, you answered that, too.

Have you had TB? The daughter and boyfriend looked at each other, then at the woman. She smiled, uncomprehending. Huh? TB? A quick huddle with the kids: didn't think so. I kept probing along her neck from the center of the bulk to the margins. The ball felt firm as wood.

Do you do a lot of gardening? Work as a florist? No.

Damn. She'd just ruled out a diagnosis of sporotrichosis, a definite long shot but the last soothingly benign explanation. I leaned back, sadly regarding her deferential smile.

How long have you noted the swelling? Two weeks.

No more than that? Are you sure? No, just two weeks.

Bad answer: This monster was growing rapidly.

No trouble breathing in all that time? No, none.