PRESENTER UINTERPRETER 1 SUBJECTIVE Current Complaint: I have a terrible squeezing pain in the lower part of my chest across the entire front, and now the pain goes up into my right shoulder. The pain has been pretty constant for the past 2 hours. History of Present Illness: Mary Smith is a 76 ylo white, obese female, who presented this evening to the ED with diaphoresis, chest pain radiating into right shoulder, and jaundice. She has a history of hypertension and poorly controlled diabetes mellitus, type 2. This patient is known to our service. She was referred to my office 2 weeks ago with RUQ pain radiating to the right scapula. She had experienced 4-5 episodes of this pain intermittently during the past year - associated with eating fried or fatty foods. The previous episode was accompanied by low grade fever, nausea and vomiting. Serum alkaline phosphatase and bilirubin were elevated as well as cholesterol and LDL. Cholecystogram and cholangiography demonstrated multiple choleliths. The patient declined surgery at that time