A Swollen Arm, Radical Mastectomy, And Becoming A Doctor: How To Overcome Failure

Holly, a 68-year-old woman, came in with a red, hot, and swollen left arm. On presentation, her left arm was at least twice the size of her right arm. She’s a thin lady, so the contrast was remarkable. She told me that the arm blew up 2 days ago. Her left arm felt extremely hot. She chronically gets arm swelling because she had a mastectomy of her left breast about 5 years ago. This type of swelling is a common side effect of the surgery. Lymphatic ducts in the arm cannot drain the fluid correctly, thus congesting and blowing up the arm like a water balloon. Ever since the surgery, Holly tells me that her arm keeps on swelling up, but never this big. Normally she goes through her physical therapy very religiously; she never misses a session. She’s frustrated that her arm is infected, but she states she’s not going to let this stop her.

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Holly did well in the hospital overnight. I diagnosed Holly with cellulitis superimposed on a lymphedematous arm. Basically an infection of the arm swelling. We figured out the correct dose and type of antibiotics, and I discharged her the following day.

Battling Cancer With A Sword

In the late 1800s, doctors were frustrated with breast cancer. Surgeons would make attempts of cutting lumps out, bits and pieces of the cancer, and eventually the whole breast. Before the advent of diagnostic imaging, surgeons would just cut whatever they saw, like butchers at a meat market.

In the 1890s, William Halsted at Johns Hopkins University pioneered the radical mastectomy. In the procedure, Dr. Halsted would duel with breast cancer by slicing the breast and pectoralis major off. The pectoralis major is the muscle most responsible for moving the shoulder and the arm. This was permanently disfiguring to the patient, as you can imagine, but often was the only cure at the time.

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Illustration of the Halsted incision and final cut. In 1882, the American surgeon William Halsted first performed what would become known as the Halsted Mastectomy, which involves removal of the entire breast, area lymphatic tissue, and the pectoralis muscle. Image From Science Source.

These days, cancer is battled with a multimodal approach. We have a wide variety of armamentarium ranging from surgery to radiation to chemo to even the more advanced biological immunotherapy. Even then, just like cancer, medicine is ever-growing to keep up with this immortal foe. There are plenty of setbacks such as cancer mutations to become resistant to outright being non treatable. But medicine as a whole continues to move on, progress, and I feel that in my lifetime we will catch up to cancer. At the very least, cancer will become like hypertension. It can kill you, but you can live with it.

My Journey To Medical School

My dentist whom I’ve been going to since I was little always tells me these days that they knew I was going to be doctor. She would remind me every time I come in about how chubby I was and how cute I was when I said I wanted to be a doctor. Well, I’m not so chubby anymore and now I’m a doctor. But it wasn’t easy.

After undergrad, I was preparing for my MCAT, or the medical school admission test. The first time I took it, I studied haphazardly for it. I didn’t take it seriously enough, and ended up scoring below average on the test. Reading on how this likely won’t be good enough for med school admissions, I refocused my goals and planned for a retest 6 months after graduation. I did well on the practice tests, scoring well above the average in the 80th percentile. I took the test with high hopes.

Whether it be poor test taking skills, choking under pressure, or the false confidence I had from the practice tests, I scored just barely above my previous score 6 months prior. Frustrated, and thinking it was a fluke, I quickly rescheduled my exam to be taken in 3 months. I studied even harder, put away extra time, and low and behold, I scored slightly above my previous two exams, but still below average.

Even with the low score, my confidence was not deterred. I was doing research and volunteer work in between study sessions for the MCAT. I tried bolstering my application with post-graduate courses as well. I broadly applied to numerous medical schools in almost every state on the west and east coast. I was wait listed to interview at one school and rejected by almost 20 others. On a whim, I applied to the Caribbean medical schools as well.

Life In Paradise

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St. George’s University, School of Medicine in Grenada, West Indies. I was here from 2011-2013 for my first two years of medical school. Beautiful campus, great experience, wouldn’t trade it for the world.

After the long hard application process, I finally got accepted – St. George’s University, School of Medicine in Grenada, West Indies. I didn’t know it then, but the decision to go there has changed my life; for the better.

A little note on the Caribbean medical schools. In the regular world, technically these schools are equivalent to the US medical schools. Same curriculum, same tests, and we get to apply to the same residencies. Unfortunately, there is still a stigma with medical students and the Caribbean.

Going to a Caribbean medical school automatically placed a chip on your shoulder. The whole time I was there on that island, I worked harder than I ever had in my life. I felt like I needed to prove something. Prove to all the US medical schools for not accepting me. Prove to my friends and family back at home that I can make it out there. And most importantly, prove to myself that I can become a doctor.

My hard work paid off. After two long years on the island, I scheduled to take the USMLE step 1. This is the same licensing test that all medical students (US and foreign) take to get a residency in the US. I was nervous about this test. But I was well prepared. I was motivated. I would not let another test deny my dream. I took the test and scored two standard deviations above the mean. Basically I killed it. I was so happy and even more so relieved.

My obstacles didn’t stop there. My journey still continues. I matched into an amazing residency program back here in California and I still continue to think big. I am aiming for a hematology oncology fellowship after residency. This blog is also part of my ultimate plan. We will just have to see where the journey goes.

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To Succeed Is To Continue

Holly battled cancer and beat it. Even after the cancer is gone, she is still battling through the repercussions of the war. Medicine has evolved so much in such a short time and continues to evolve. From primitive butcher style treatments to medicines in clinical trials with promise of curing metastatic brain cancer. I am still battling through residency to match at a competitive fellowship. Trying to take each obstacle as an opportunity to do bigger and greater things.

In what I’ve seen in Holly, in the history of medicine, and in the reflection of my journey, I can confidently say that the only enemy in life is ourselves. Our own minds whispering negative thoughts in our ears. Our negativity is what slows us down. It wants to keep us from realizing our true potential. We just need to shut it off. How to shut it off? First is be aware of it. Listen. Observe. Once you know that it’s there, it’s easy to melt that negative energy away. Why is this important? Because that’s how we maximize our life. Really live to the fullest. Once we overcome the limitation of ourselves, anything is possible. Holly knows it. I know it. You know it. Believe in yourself, think big, and accomplish great things.

24 thoughts on “A Swollen Arm, Radical Mastectomy, And Becoming A Doctor: How To Overcome Failure

  1. lupietrish says:

    Love reading your posts. I enjoy hearing about your life and the work you have chosen. I wish you were closer and I could have you for a doctor. The fact that you have this blog and listen to others is going to make you a great physician. We need more Dr’s that actually listen to us & not automatically think they know everything because they are Dr’s. God bless you on your life’s journey.

    Liked by 1 person

    • doctormikesblog says:

      Thanks for the wonderful comment. I’m sorry you had such a tough time with your healthcare providers. We are definitely overworked and sometimes even the best of us can’t be 100% there for every patient. Hopefully you’ll find a provider who can give you the care you need. Just keep searching and I’m sure you’ll find the treatment you deserve.

      Liked by 1 person

  2. clearskies2016 says:

    Very well written and got me thinking about my sister. She is in the hospital in Corpus Christi this weekend. She’s scheduled for a pericardium window tomorrow at 7a. She’s in the ICU. Can’t walk nothing without feeling like she’s run a marathon. She has cardiac Tamponade from a pericardium effusion. Very common in Hodgkins survivors. She’s 49 and has been suffering the effects of the treatments for the cancer when she was 19. She’s tapped out on Radiation (lifetime dose). Back then it was full mantle vice pin point like today. She had both breasts removed over the years. Her heart is at 20% along with her lungs. Being in the nuclear industry I’m very familiar with radiation effects.

    Your story brought back many thoughts regarding my sister, time and treatment. I applaud you for getting into this field.

    That’s all for now-
    Roger

    Liked by 1 person

  3. redheadedhousewife says:

    You got this Dr. Mike!!! You have the knowledge, the perseverance, determination & the immensely kind heart to care medically for people. It shows here with the words you write that you have the patience, kindness to care properly and professionally for your patients. I hope all your dreams come true and you never let anything stand in your way. ❤ Wishing You All the Best ❤

    Liked by 1 person

  4. Chelsea Hetzel (@ChelseaHetzel) says:

    I loved reading your journey and hearing how your hard work paid off. Way to persevere. My best friend in college was the smartest person I knew, and got denied to so many med schools because her MCAT score was slightly below average. I kept thinking, wow, it’s that school’s loss; not only was she extremely intelligent, but she was amazing working with people, and just struggled with test anxiety. She eventually got into a school in Virginia.

    Liked by 1 person

  5. greenteaandcotton says:

    This is my first time reading one of your posts, and I love it! I’ve always had a fascination with medicine so finding this to read was awesome! I, too, have a hard time with some tests. Partially, I think some of the anxiety comes from what is going on in life, and it affects you negatively. On the flip side, when hard work is put in, success happens. High five on killing that test and best of luck on this amazing journey ahead of you!

    Liked by 1 person

    • doctormikesblog says:

      I’m glad you took the time to read the post. Test taking is really a skill. Took me a while to get the hang of it, but it is something to learn. At this point though, tests are really an archaic relic of the past. At least for medicine, rote memorization has no place in today’s clinic and hospitals! It’ll take some time, but I think education needs to catch up with the times. It’s more about how you put knowledge together to solve a puzzle rather than memorizing what the textbook says. That’s just my two cents anyways. High five!!

      Like

  6. Sparkyjen says:

    Failure is not a bad thing, unless you stop. Einstein failed mega times…and then there was light. When you know you are on the Path you stick to it, adjust, and just do it until you get it right.

    Like

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