As an emergency medicine resident in the early 2000s, I cared for a patient in her early 60s with back pain. Prior to the passage of the Affordable Care Act (ACA), approximately 16% opens in a new tab or window of emergency department patients were uninsured. Often their issues were of low acuity, again because they had no other place to see a physician. I assumed that to be the case with this patient, that I would treat her presumably musculoskeletal back pain, and discharge her. However, while treating her, I noticed she struggled to walk and clutched her gown across her chest. It was the clutching that really struck me as unusual.

When I examined her chest, I saw something unexpected, right out of the medical history books. Her entire left breast was as hard as a rock, consumed by cancer that likely developed over months, if not years. She had severe hypercalcemia and was on the verge of going into cardiac arrest as a result.

After I stabilized her, I gently inquired why she […]