Mrs. Sandra Jackson knew that she was no Warren Buffet. She knew that she was no Bill Gates. Instead, Mrs. Jackson knew that she worked two jobs, 7 days a week to support her family. So, she hid her breast condition for a better time, another day. She would ask herself, which was more important: going to a doctor or buying her children dinner? For a true mother, the answer was easy, but the consequences were not.

Months passed and Mrs. Jackson worked harder. She was working against a clock which was hidden from her view and yet, somehow instinctively, she knew the time.  She came to the ER at the end of the last shift she ever worked.

She lifted her blouse and turned her head away, in shame. But I did not cringe, instead I delicately examined the breast which had the appearance of melted wax, disfigured by a flame. “Do you hurt?” I asked, knowing that pain may take many forms.

“Only my bones,” she said as a few tears escaped her proud eyes, cast upward trying to look beyond the room — trying to look back in time or into an alternate reality, anywhere but here, anywhere but now.

I had hoped that her bones were aching from the back-breaking labors she performed day in and day out for her family. I hoped that her pain was that of a worker-warrior, those who push themselves in ways that make the rest of us appear weak and flaccid. I hoped that her pain was anything other than what it was: metastatic breast cancer.

After I confirmed the diagnosis, we sat in silence. I had not told her anything that she hadn’t already known. But, what I said was much less important that what she had to say — the story leading up to that day. Mrs. Jackson told me of her struggles, her fears and her choices: big doctor’s offices with big bills to match, bad news that she could not afford to fight, and children whose own health and well-being depended on what she did or did not do in any given moment.

As she spoke, I entered her story with her and could feel her life as my own. I took off my white coat, and for a while, we were just two mothers, sitting together sharing a very difficult journey. In the end, I did not fault Mrs. Jackson for her choices — instead, I understood her plight. Some may have called her choices “poor” but, I called them “heroic” in a system that proved “poor” for someone whose financial status carried the same name. You see, Mrs. Jackson knew that she was no Warren Buffett. She knew that she was no Bill Gates.

However, Mrs. Jackson did know the cost of her illness … that it was far beyond her means. So, it costed her life.

This patient’s name and some minor details were changed to protect the privacy and identity of the patient.

Monica Williams-Murphy is an emergency physician and author of It’s OK to Die.

This post originally appeared on the Costs of Care Blog. Costs of Care is a 501c3 nonprofit that is transforming American health care delivery by empowering patients and their caregivers to deflate medical bills. Follow us on Twitter @costsofcare.