A 56-year-old white woman with a long history of smoking, coronary artery disease, gastroesophageal reflux disease, and osteoporosis presented to the emergency department with increased shortness of breath and severe productive cough that started a week earlier. A COPD exacerbation was diagnosed, and she received nebulized breathing treatment. The patient reported having one episode of hematemesis the day prior to hospital admission. While in the emergency department, she started complaining of epigastric and left upper quadrant pain. On physical examination, she was pale, with a systolic BP of 80 mm Hg, respiratory rate of 30 breaths/min, and an oxygen saturation of 96%. Her chest examination was significant for diffuse wheezing, and her abdomen was soft with normal bowel sounds. There was slight tenderness in the left upper quadrant. There was no mass or bruit, and rectal examination was normal. Subsequently, nasogastric aspiration revealed coffee ground drainage that cleared after 500 mL of nasogastric lavage. Her initial hemoglobin concentration was 15.2 g/dL with a normochromic normocytic picture, WBC count was 6,600/μL, platelet count was 202,000/μL, and electrolytes, BUN, creatinine, liver function tests, clotting studies, d-dimer, and cardiac markers were within normal limits. Urinalysis, ECG, and chest radiographic findings were also normal.