The long journey toward a career in medicine

I developed a passion for medicine as a child, after my diagnosis of ventricular septal defect, prompting frequent visits to the cardiologist. As a child, I received a toy model heart and would sit in my basement for hours, dreaming of becoming a cardiologist.

I didn’t take a direct path to become a physician assistant. I obtained an undergraduate degree in Business Management, but my first job out of school made me realize that I would only be satisfied in helping people through a career in medicine.

Shortly after business school, I married my husband as he was completing his courses to become a Green Beret. We were stationed in Fort Bragg (now Fort Liberty) and while he trained, I worked on my prerequisites for PA school. The plan had been to transfer them to a school in Colorado where we expected to be stationed, but 2 weeks before our move, we learned we would be stationed in West Virginia — where my credits wouldn’t transfer.

I was devastated and thought my dreams of medicine were over.

Following the birth of my son and a military deployment, I couldn’t shake the feeling that I was meant to work in medicine, so I re-did my prerequisites and required volunteer hours for application to PA school. I applied to only one school — the University of Kentucky. I was currently a stay-at-home Mom with a pie-in-the-sky dream. I put all my eggs into one basket and said a prayer. I was accepted.

I graduated as an Honor Grad in 2013. I was 36 weeks pregnant at this time, studying for my boards while in labor at the hospital, and took the boards 10 days after giving birth to my daughter.

My first job as a PA was in a pediatric clinic in rural Appalachia. The poverty was heartbreaking. Having two young children proved difficult for me to separate being a PA from being a mother. I began to have trouble managing my emotions and maintaining a professional attitude during clinic hours. I wanted to save all the children but recognized that I could not.

We moved home the following year to New York, and securing a job in Gastroenterology was a great transition. I found success in working with adults. I transitioned to Dermatology in 2019 to get hands-on experience through procedures and a surgical schedule.

From physician assistant to patient

Fast forward to spring 2023 which was an insane period. Though I was still working full-time at my Dermatology office, I had also returned to work in GI at a former office to help cover patients while one of the NPs was on maternity leave. My husband was away for military requirements. I was in survival mode managing my three kids and everything that school life and sports bring that way.

At first, I felt my scrubs getting tight. I chalked it up to eating out too much and indulging in fast food because of our hectic schedule. As the weight gain continued, I admonished myself and began making dietary changes. Constipation and abdominal bloating were frustrating, and despite Miralax, Colace, and increasing water and fiber, I could not have a bowel movement unless I administered an enema or passed liquid stool.

At this point, I was questioning my entire life. How am I treating patients for constipation and GI symptoms, but can’t fix my problems? I was frustrated and ended up calling in an antibiotic suspecting SIBO (small intestinal bacterial overgrowth). I never once thought it could be something more sinister. Then came the drastic change in appetite. I was unable to eat more than two bites of any meal without feeling immediately full. I love and enjoy food, so this was a serious change for me. I had some abdominal discomfort in the weeks before the diagnosis, but not pain per se.

On the morning of April 19th, I was lying in bed and started palpating my abdomen. I felt a hard mass the size of my fist. I immediately woke my husband and had him feel it. He whispered in the dark that he felt it too and that I was scaring him. As soon as I got to work that morning, I had another PA do an abdominal exam, all the while hoping that I was crazy and that all I needed was reassurance that it was nothing.

I immediately called my GYN and was scheduled for an ultrasound later that morning. I felt awful canceling my schedule that day, as it is always on my mind that my patients request time off from their work or schedule child care to come see me. I do not cancel my patients lightly but at this time, I was terrified.

Cancer until proven otherwise

Everything moved quickly from there - the ultrasound showed an 8 cm tumor on my left ovary. An MRI of my abdomen demonstrated a 16.5 x 14.5 x 8.5 cm tumor. The mass I had felt was my uterus shifted to the right due to the size of the tumor. The tumor marker associated with ovarian cancer was elevated. My GYN said “it is cancer until proven otherwise” and I was scheduled for a consultation with an oncologist.

My oncologist is phenomenal and scheduled me for surgery the following day. On my intake sheet, I had noted right leg pain for the past 10 days. We didn't discuss it during the visit, but her office phoned the hospital while I was there for pre-op testing. She wanted to add a Doppler test before surgery. I had taken the kids kayaking the weekend before — I thought the leg pain was a pulled hamstring from carrying the two kayaks back to our warehouse. Even after limping around my office and taking Motrin for the discomfort, it never occurred to me that it could be something more serious.

The Doppler demonstrated two blood clots in my right calf, and I had an IVC filter placed the next morning immediately before my hysterectomy. My tumor never hurt. That fact still resonates with me today. The side effects of the tumor were uncomfortable, but the cancer was not painful.

I see now that my ignorance and arrogance could have killed me. From the time I felt the mass, to the OR was just 7 days. I recognize that is an incredible feat that my network helped me pull off. My appointment was secured by a sorority sister whom I hadn't seen in 20 years, who worked as a drug rep for my oncologist. They opened the MRI machine for me on a Friday when I called a friend for a favor.

Confronted with mortality

The surgical pathology confirmed Mucinous Adenocarcinoma, Stage 1C. I initially did not process the results well. So much had happened in the 7 days to diagnosis that I never once turned on the TV in the 5 days I spent in the hospital following surgery. I spent hours staring at the wall.

Each time my husband prepares to deploy, we have a checklist. We have his funeral arrangements documented, his final wishes, and I even know where he wants to be buried. In 19 years of marriage, I have discussed his mortality more times than I care to count, but we had never discussed mine. My children are 15, 10, and 7. Their lives and mine flashed before me. Would I be here for Christmas? How would life be without me, as I have been their constant during my husband’s career? While the prognosis for Stage 1 is good, the fear took over those first days and I would be lying to say it doesn’t still creep in at times.

I didn’t know what I didn’t know

I have learned more in these 4 months as a patient, than in the decade as a physician assistant. My journey has been tumultuous. I needed a transfusion following my hysterectomy. I had an allergic reaction to my first round of chemotherapy (Doxil) and was transported unresponsive to the ER. Multiple hospitalizations for dehydration, concerns for infection, and ischemic colitis. My port eroded through my chest and I finished my last two treatments with peripheral IVs.

Nothing about my treatment has been textbook. I now understand the power of the office staff.

I think I would have handled the rudeness better if it had come from the provider, as I know that I was at the appointment for their expertise, but the support staff creates the mood and the environment of the office.

I know now that bowel movements can certainly take up my entire brain space and become the most important thing to accomplish in a day. I understand that my 9:45 appointment is the focus of the week, when as a provider I would review my schedule daily and count down the patients until I needed to get to my son’s track meet. I did not understand the value that patients place on their medical appointments, and that illness becomes your whole world. I did not understand the mental burden of disease, or even scratch the surface of what my cancer survivor patients have endured.

It comes down to I didn’t know what I didn’t know.

My own lived experience as a patient with cancer will forever change the way I practice medicine

Right now I am working through this guilt that I have. I think back to all the young female GI patients I saw and wonder if I missed something in their complaints of abdominal bloating, constipation, and change in appetite. Should I have done imaging, or testing that I possibly did not pursue because I was looking for horses and not zebras? I don’t know if I will ever get closure on those thoughts. I hope that is not the case, but those thoughts haunt me at night. I consider myself an attentive, dedicated provider, but struggle with what I could have done differently. The shock of the diagnosis and now navigating through tumultuous treatment has revealed how important early detection is.

I am now immersed in a cancer community and time after time hear how diagnosis was delayed because the “patient seemed too young for cancer” so more conservative monitoring was taken instead of testing. As I keep watching my cancer friends die, it drives me to keep speaking about the need for early diagnosis and treatment. I know I am not ready to return to practice yet. I need to work through my illness and get to a place where I can work without the bias of fear and make good clinical judgments.

For as much bad, there has been good.

I have been vulnerably chronicling my journey on social media from the first time I felt the mass to learning it’s cancer to the chemo sagas to shaving my head to the deep, dark moments, and the warmth of the sun on my face.

The outpouring has been truly incredible. Friends from all seasons of my life have stepped up to actively support and encourage me and my family. Card warriors who send greeting cards weekly, to meal trains, people entertaining my children during chemo weeks, and my military friends organized “Sam’s Fight Club” for ongoing support.

The most impactful moments of sharing my journey have been the messages. Messages from people who saw my story and decided to get evaluated by their primary care provider for issues or scheduled screenings such as mammograms.

In this busy lifestyle we all lead, I find that there simply isn’t urgency for screening appointments or routine visits but that is absolutely where early detection or intervention can occur.

Sharing our stories can change the trajectory of someone else’s story — forever.

About Sam

Samantha Gomolka is a Physician Assistant, Military wife of 19 years, and Mother of three. Since her Ovarian Cancer diagnosis, she has become a passionate advocate for raising awareness of the symptoms of the disease and expediting treatment. Co-founder of Inspire UP Foundation, Samantha works to connect military and civilian communities through education, acts of service, and intentional acts of kindness.

To connect with Sam

LinkedIn | Instagram | InspireUp Foundation

For more of Sam’s journey

To learn more about Ovarian Cancer:

National Ovarian Cancer Coalition | Ovarian Cancer Research Alliance