Health disparities secondary to social factors including socioeconomic status, race, gender and ethnicity are well known to the health community and are a troubling issue in the United States. Social determinants are defined by the WHO as the structural “conditions people are born, live, grow, work and age in…determined by wealth distribution and available resources…that are mostly responsible for health inequalities.” We present here the case of TL, a 49 year old African American female who presented to the emergency department three times with atypical coronary disease symptoms in the setting of recent NSTEMI with subsequent 3 vessel CABG. At the time of her third presentation she was admitted for emergent stenting. This case is a good illustration of the effects of social determinants of health. Not only is TL an African American of low socioeconomic status, she is also deaf and communicates only via lip reading and written word. She does not use American sign language. Her communication difficulties and socioeconomic status likely greatly contributed to the delay in her care.