The Lady Protested And Lived

Last week I welcomed a patient, who had not been in for her “annual” for many years. At her last visit, she volunteered that she had experienced left chest pain and consulted a Cardiologist. Apparently, he diagnosed musculoskeletal compression as the cause and she was confused about how the thoracic bony rib cage could be the culprit. We discussed her symptoms, I scribbled a diagram and we agreed that she would get a second opinion.

Lidia is an outgoing, attractive Latina who was eloquent in her brief, “I want to be well proportioned”. Her experience was truly harrowing but equally matched by her intelligence and resolve. She sought a second Cardiology opinion. A MRI demonstrated anomalous origin of the right coronary artery, which is a congenital malformation commonly associated with angina pectoris, myocardial infarction and sudden death, in younger individuals without atherosclerosis. The treatment is controversial because the frequency is low. In Japan, it is medically managed with Beta blockers. Lidia’s response was courageous. She chose the “safest” solution and underwent a one vessel coronary artery bypass. Peri­op, she suffered a TIA but in her own characteristically indomitable fashion, she made lemonade, becoming a spokesman for the American Heart Association.

Her story is inspirational on many levels. It’s well documented that the disparity in health care outcomes between white and non­white patients has not improved for over 50 years, despite significant advancements in medicine. Unconscious bias is normal human behavior and can possibly confound diagnostic potential. Consider heart disease, the most common stereotype is a middle­aged, white male who exhibits classic symptoms of left sided chest tightness on exertion and may have so­called “risk factors”, such as hypertension, hypercholesterolemia, family history and/or obesity. Lidia’s profile didn’t include any of these comorbidities and neither did she smoke or consume recreational drugs. Yet armed with the knowledge “pain is a vital sign it means something is amiss”, she had the tenacity and courage to challenge authority and in so doing chose life. Heart disease is the leading cause of death, among all age groups and genders in California. A clinician who resists unconscious bias and maintains a wide differential diagnosis, may make all the difference to a patient’s survivorship.

Lidia is proud of her chest scar, which she calls her “beauty mark”. She refuses to recognize it as “ugly”, preferring to acknowledge it as a sign of her becoming an empowered patient. It’s a privilege caring for individuals who recognize that life is a series of challenges, which require the investment of energy and the temporary abandonment of security. She recognizes that beauty is the product of the trifecta of physical attractiveness, strong intellect and boundless spirituality. Her creativity and self­assurance is manifest in her mission to share her experience so other women may benefit.