While I’m #storytelling, let me tell you about another patient who left her mark on my heart.

Raina is a 41 y/o Black woman with a PMH of left-sided breast cancer, diagnosed 2 years ago when it was discovered on her very first mammogram at age 39.

For her 39th birthday, she decided to make an appointment with her doctor for a comprehensive physical exam, including a pap and mammogram. She diligently performed her BSE (breast self-exams) as recommended and never felt any lumps. She has no 1st degree relatives with breast cancer, but her grandmother and her grandmother’s sister both died of breast cancer at young ages.

When she tried to obtain a mammogram at age 35, she was told ‘no’ by her primary doctor. “It is not indicated. . . dense breast tissue in young women. . . false positive. . . yadda yadda yadda.”

When she argued that she was ‘high-risk’ based on her family history, she was informed that she, in fact, was *not* high risk since she has no *first-degree* relatives with breast cancer (mother, sister, daughter), nor did she have a personal history of breast cancer. She did not receive genetic testing for the same reasons. Since her HMO wouldn’t allow mammograms, unhassled, as screening for women such as herself – and since her PMD didn’t continue to actively advocate for this exam – nothing happened. . . and the cancer grew.

So after her very first mammogram, weeks before her 40th birthday, there it was, “an abnormal density” in her left breast.

Ultrasound. Biopsy. Biopsy is “inconclusive.” Weeks pass. Finally, another (larger core) biopsy reveals the cancer. She is *then* rapidly scheduled for a lumpectomy, XRT (radiation), and chemo.

She goes into remission.

Then, 2 years later, like clockwork, she goes to her PMD for a “check-up.” She is told, “Everything is fine.” She is told she doesn’t need to come back as frequently. She is scheduled for a mammogram in 6 months.

6 months pass. The mammogram is abnormal. There is a density in the right breast. It is not calcified, so the “suspicion for cancer is low.” She is scheduled for an ultrasound and a repeat mammogram in 3 months.

In the meantime, she develops a cough. Then a fever. Then the cough becomes productive of yellow sputum. Then weakness and fatigue set in. She sees her doctor. They do a CXR and see “an infiltrate.” It is diagnosed as pneumonia and treated with antibiotics. The HMO calls her to schedule her ultrasound, but she explains that she is too sick with ‘pneumonia.’ A note was made, but nothing was done.

She returns to the PMD when the ‘pneumonia’ persists despite a course of strong antibiotics. She is given another prescription for a different antibiotic and sent home. This 2nd antibiotic causes her to have diarrhea, abdominal cramping, and eventually dehydration.

This is when she presents to me in our emergency department.

Chief complaint: nausea, vomiting, productive cough, shortness of breath, abdominal pain, and diarrhea for 1 week. Her husband is at the bedside holding her hand. Both look at me as I enter the room, and through their tears, they both start talking at once. . .

“Dr. Taylor, please help us!” is how it begins. . .

[like before, I gotta run. I have a thing tonight. But I’ll be back with the conclusion soon!]

Oh. And while this story is shared with permission, her name is obviously not really Raina.

To read “Part Two” of Dr. MyeishaTaylor’s patient story, please visit http://www.PhysicianOutlook.com