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can—often—provide better care than doctors who treat the rich.Also, any care provided at Grady has to be based on solid evidence.I am not suggesting that Grady is perfect.It has many flaws that come with underfunding, and many challenges that come from caring for the uninsured.Yet, at Grady, an effort to disregard science will be shot down fast.
    The technical term for millions of people like Edna Riggs is the underserved. Edna didn’t receive medical care until the manifestations of her disease became catastrophic.Another of my breast cancer patients—Helen Williams—started out on the opposite end of this scale.She had the most advanced care Atlanta had to offer.
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    IN 1990, Helen, then fifty, finds a lump in her breast.Without delay, she goes to her gynecologist, who sends her to get a mammogram.The tumor can’t be seen on the image, but the gynecologist does the right thing.He refers Helen to Luther Smith, one of the best-known breast-cancer surgeons in the Southeast.
    Smith performs a needle biopsy, which leads to the diagnosis of breast cancer.The tumor looks aggressive under the microscope.Though scared, Helen reminds herself of her good fortune.She is married, her kids are grown, her job benefits at a financial-services company include excellent health insurance, and she is discerning enough to demand the best treatment modern medicine can provide.
    The tumor turns out to be four centimeters in its maximum size—quite large.Altogether, twenty-one lymph nodes are resected, and all prove negative.This means that the disease may not have spread.The biology of the tumor is worrisome.It’s estrogen-and progesterone-receptor negative, meaning hormonal therapies cannot be used.Hers is the sort of high-grade, aggressive disease that is more likely to occur in black women than in white women.This mixed bag of good and bad characteristics translates into the diagnosis of Stage II disease.
    Helen is offered a choice of surgical procedures: a lumpectomy and radiation or a mastectomy.She chooses mastectomy.The insurance company doesn’t object.The company also pays a plastic surgeon to rebuild the breast.She is offered postsurgical chemotherapy.Insurance agrees to pay for this, too.
    This scary time has a special meaning for Helen, who had witnessed the civil rights movement and integration transform Atlanta in the sixties, seventies, and eighties.Here she is, a black woman in the South, getting Cadillac care.She feels fortunate.
    Smith, the surgeon, refers Helen to his favorite medical oncologist, Norman Kuhn, who is known for an especially aggressive approach to treating breast cancer.The oncologist explains that a stronger dose of chemo is better than a weaker dose.“More is better” has been a hallmark of the oncology profession since the 1950s: the more chemotherapy you administer to the patient, the more effective it is in terms of killing the disease.
    Kuhn has treated a lot of breast cancer, and he favors a take-no-prisoners technique for “adjuvant”—postsurgical—therapy.This is a procedure in which we give chemotherapy drugs after surgery to eradicate cancer that was too small to be seen by the naked eye in the surgical area, or too small to be seen with radiological imaging if it has spread to the distant organs, including the liver, the lungs, and the brain.
    The oncologist’s plan for Helen’s treatment seems logically compelling: a high dose of drugs will be used to kill all the cancer cells that might be hiding in her body.The doses will be so high that the bone marrow—an innocent bystander—will be destroyed.It used to be that this much chemo would kill the patient, but no longer.Doctors had recently developed an ingenious technique that enabled them to take the patient to the brink of death from chemotherapy, then—at the last moment—rescue her.To save Helen from succumbing to the toxic effects of chemotherapy, her own bone marrow will be harvested and stored before chemotherapy and