How I ended up with a 4cm hole in my breast one month after delivery…

The title says it all.

I am in a dark mood now but I plan to write about my experiences of how mastitis turned my life upside down for the past week.

Among all the outcomes of lactational mastitis, having a 4cm by 1.5cm hole in the breast is not the worst outcome but does stand on the ‘bad’ end of the spectrum of all possible outcomes. From a very quick recovery and resuming breastfeeding, to a series of needle aspiration and eventual recovery without scars, to an emergent incision and drainage with a gaping wound on the breast. But anyway, I didn’t develop bacteremia/septic shock/death and still alive so thank goddess for that.

But this is the true reality of healthcare. A mixture of bad luck, rapidly progressing disease and subsequent clinical decision making behind the disease progression curve, you will find yourself end up in some place you never imagine would be.

Even now, I am still waiting to see where it goes since the wound is not healed.

I think it started on last Saturday when I found some area near my right nipple painful and bulging – thought it was some milk pouch since it was clogged duct there with hardened clots and it was difficult to see the redness as it was near areola. But I kept pumping – the next day pumping was so painful I even went to the hospital to borrow another hospital grade pump and the lactation consultant pointed out to me – isn’t that more red than usual?

Actually no, I think it all started when I was still staying in the hospital and son didn’t learn how to properly latch. Because he did not learn how to properly latch so I had to pump and nurse at the same time to increase my milk production (which never exceeded 3-5oz per day), and I had developed lots of clogged ducts which never went away and eventually developed into mastitis?

Chain of events.

How to choose your own physician?

Everyone has their own philosophy when it comes to choosing a physician.

For primary care, you need a responsive staff from the office, no matter how brilliant your primary care physician is. The utmost important thing about a primary care office is how responsive they are to the calls because you are going to call them a lot for basic stuff – physical exam form, lab test results, prescription refill, triage your symptoms at night. This usually relates to how the practice is managed, but less pertains to the capabilities of physicians who work there.

Secondly, you need some continuity in your care – do you want to see a different provider every time you go there and repeat again and again your own story? No one writes such a detailed note for the visit so all the information retains. Considering finding some physician who is not close to their retirement age so you can build a long-term relationship instead of being handed over to someone else in a short period. In addition, make copies of your medical records every a few years – some clinic purge records according to the statue limitations, which means once it is out of the legalized time period of keeping the medical records, “poof”, they are out of the window.

Thirdly, bedside manner vs. technical excellence vs. conscientiousness vs. experiences. This is really the field that everyone has a different taste for.

What can go wrong in a hospital?

What can go wrong in a hospital? The answer is anything. From Emergency Room provider doesn’t give treatment to a patient with potassium value of 6.5 thinking it is from a hemolyzed blood sample then patient coded on the floor (see here), to misinterpreted radiology reports, missing lab reports not reviewed by primary care physician, to a million things that could happen.

If you are a physician/medical student, you will benefit from reading horror stories happened in a hospital as 99% of our daily practice usually has some safety margin built-in, but that 1% of not-so-textbook clinical presentations/rare situations may sink you and you need to develop some sensitivity to that rarity.

There is a tendency among healthcare environment of underestimating the risks because those horror stories do have a low incidence rate. Nurses called you multiple times for false alarms on that telemetry patient and asked you to turn it off/discontinue the telemetry order, at that time can you imagine that specific patient was found a few hours later deadly cold and pulseless? You may brush it off as in your mind this event is so rare that it is almost impossible (see here).

Some good advice – stick to clinical routines, develop a wide differential diagnosis, build redundancy and double-check mechanism in your practice and be careful about those high-risk life-threatening potential diagnosis.

Reading stories on WebM&M provided by AHRQ.

Attend M&M conferences in your hospital.

Read books about medical mistakes such as

“Internal Bleeding: The Truth Behind America’s Terrifying Epidemic of Medical Mistakes“,

“Your Patient Safety Survival Guide: How to Protect Yourself and Others From Medical Errors“,

and “Bitter Medicine: What I’ve Learned and Teach about Malpractice Lawsuits (And How to Avoid Them)” (recommended for surgical specialities as the author is a surgeon and mostly talked about mistakes in the surgical world in the book).

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Healthcare for immigrant parents

When your parents come to the United States, what should you think about regarding their healthcare?

If they come here for a short-term visit, like a six-month stay, a short-term healthcare insurance for visitors could be your choice, but those usually don’t cover for existing conditions. If your parents have chronic conditions like diabetes, hypertension, heart diseases, etc, they may need medications and maybe some visit to the clinic or emergency room.

US healthcare insurance is largely based on employment and due to parents’ immigrant status (B1/2 visitor visa), there are very limited choices for healthcare insurance. A few options are as belows, but I suspect better knowledge is with local healthcare brokers.

-some employment-based healthcare insurances allow you to add parents as dependents, such as VA or Tricare

-some supplemental healthcare insurance offers some cost deduction by providing low out-of-pocket costs

-some visitor healthcare insurances offer choices for acute onset of pre-existing conditions

So what if an emergency happens and parents are not insured or under-insured?

-emergency rooms, according to law, all the ERs in the US have to accept patients no matter what, so they will be seen in the ER but you are going to expect to receive some bills with large numbers. Well, you can negotiate with their billing department later but it is always not pleasant to receive a bill that may make you broke. But if there is really any life emergencies, don’t hesitate to bring your parents to ER.

-free clinics or fee-scaled community health centers, usually different states and cities have some free clinics run by government or charity groups but they usually open on 9-to-5 regular hours. If they need hospitalization, the social workers at a hospital will help you apply for emergent Medicaid (depends on states), which will cover the costs of in-patient stay.

-private cash-only clinics, you can find some private clinics in lower Manhattan/Chinatown or Flushing, NY that accept cash for visits.

-call your own primary care physician and see if he/she can fit your parents into a schedule and charge a reasonable fee based on cash or fee-scale.

-some cash-based telemedicine services

How about medications?

They can bring enough medications to the United States for the duration of stay.

-some pharmacies provide low-cost common medications like CVS, Target, Walmart’s low-cost Rx program

-use GoodRx for wholesale prices for medications

-ship medications from home from mail but sometimes the Customs may be scrutinous about that since there are regulations to prevent smuggling cheaper medications to the US

If you have any experience exploring the US healthcare system with immigrant parents, share it in the comments section!