Protocols, metrics and collaborative practices look great on paper, but how do they work for a person who is pregnant and needing care? Kate R. is a nurse practitioner at one of Ascension Columbia St. Mary’s outpatient clinics in Milwaukee, Wisconsin. She is married with two young children. She learned she was pregnant with her third child just days before being diagnosed with breast cancer. Given the aggressive nature of her cancer, Kate chose a bilateral mastectomy as part of her treatment. Two weeks later, genetic testing found she had BRCA gene, which is associated with increased risk of several additional types of cancer. She successfully gave birth about two months ago and is in her last round of chemotherapy.