I saw a 32 year old woman in clinic yesterday, J.B. She gave a rather wandering history that started with a mass in her right breast that she noticed in January of 2016. She presented to our clinic in April 2016 and was referred to a hospital for biopsy and possible mastectomy. That hospital decided she should go to a different hospital and referred her there. She presented to the second hospital and had a biopsy performed. She was eventually told that she had cancer. Then she stopped talking.

Me: “What happened next?”

Patient stares at me.

Me: “What treatment did you have?”

Patient: “I didn’t have any treatment. They offered me nothing.”

Me: “Ok, did they give you a follow up appointment”

Patient: “Yes.”

Me: “Did you go?”

Patient: “Yes, but they lost my chart, so they did the biopsy again. They aren’t doing anything for me, so I am coming back to you.” She looks at me with expectation.

At this point I decide a physical exam is the next best step. Well, her right breast was distorted by multiple or 1 big mass that was hard, immobile and not painful. Her nipple was detached by a white mass rising up beneath it. I feel a sickening feeling. This was not promising. There is a hospital in Port au Prince that is supposedly working with a U.S. hospital to provide treatment for breast cancer. Though, at best, this would only include surgery and chemotherapy- radiation therapy is not available in Haiti. So, I told the patient I want to refer her to this hospital, but it would be best if she could bring a copy of the pathology report from the last biopsy. She tells me she doesn’t have it yet. I asked her how long ago it was done- it was done in July of this year. I prepared the referral and told her to go as soon as she could. Stupid cancer. This lady needs a miracle. Pray for J.B.