Office of Education
Yale University
School of Medicine
367 Cedar Street
300 ESH
New Haven, CT
06519 USA

Case author: Frederick D. Haeseler, M.D.

Donna Taylor: Introduction

Donna Taylor placed two Greek salads and two seltzers on the tray and carried them to the corner table where a pair of stylish women in their 30s sat talking intensely. They nodded to Donna as she set the plates and glasses on the table. One woman was wearing a beautiful turquoise silk blouse. "Maybe I should get something nice like that for the New Year's Eve party with Ron." Donna thought.

There was Vincent, a regular. "Hello, Vincent," said Donna. "What will it be today?"

"I need to cut back a little," he said, glancing quickly at his paunch and then melodramatically rolling his eyes. "Choose something for me."

"You're asking me?" asked Donna with a laugh. "Right. I'm a fashion model."

Vincent smiled briefly. "Please suggest something not too depressing."

"Broiled salmon with salad, oil and vinegar on the side, broccoli instead of the rice? Diet Coke?" Vincent nodded, looking glum.

As Donna walked back toward her computer, she made a deal with herself: If she lost about 5 pounds before the middle of December, got down to, say, 150, she would buy herself a silk blouse to wear to the party.

She wanted to look good for Ron. He was the most attractive, most promising man she'd dated in years. She typed in her code and entered Vincent's order on the touch screen. She went into the bar, not too smoky at lunch, to pour the soda.

There was that ache again. It was coming a couple of times a day now, like a pressure from within, first in one shoulder, then the other, and then across the back of her neck. For a week or so Donna had thought it was soreness from raking leaves. Then she'd thought maybe she'd slept funny on her neck. Or that she had heartburn from eating after the late shift and going right to bed. But she couldn't think of a reason for this ache right now, or for why her chest had hurt last night when she was sacked out watching a movie.

She aimed the club soda nozzle into a glass, then stood behind the dimly lit bar, sipping the drink slowly, hoping no one would notice her, hoping that the tiny bubbles would make the pressure go away. After a couple of minutes, the ache was nearly gone. Donna delivered Vincent's Coke and noticed Dr. Grey sitting at one of the window tables with an alert-looking young woman about her son Jeffrey's age. Charlene had that table, had probably taken the order, but Donna went over to say hello.

"Donna. Nice to see you," said Dr. Grey. He was wearing the usual tweed jacket with those worn leather elbow patches. "Let me introduce Suma Patel. Suma is a fourth-year medical student who has just started her Primary Care Clerkship at our office. We're celebrating." Donna had to laugh; the Salty Dog Cafe was hardly elegant. But what it lacked in atmosphere, it did make up for in convenience, and friendly as he was, Dr. Grey always seemed to be in a rush.

He asked how her sister Patty was doing. "She's doing great," said Donna. He had been the first to notice her sister's lump, at a checkup, thank God. "How long has it been? Five years at least?" he asked. "Ten years. Ten years next month," said Donna. "That's a good number to hear," said Dr. Grey. Donna headed toward the kitchen to check on Vincent's salmon. "Face it," she told herself. "It's a sign that Dr. Grey came in here today. I'd better go see him about the pains. There goes my blouse money."

Next: Patient interview