For years, pain dictated nearly every aspect of young Nichole Lam's life.
The Dallas, Georgia, teenager woke many mornings with pain so severe it would make her vomit. Sometimes, she'd faint just from raising her arm to style her hair; the blood flow cut off by something doctors hadn't yet identified.
A hug from loved ones had to be gentle — anywhere too tight or even just a touch in the wrong place could cause her pain to flare. Most days, she'd sleep whenever she could because sleeping hurt less than being awake.
"Emotionally, I was losing hope in finding out what was even wrong with me," said Nichole, now 18 and a high school graduate. "I was very angry most of the time and in pain 24/7."
Since she was 13, Nichole endured many surgeries and specialist visits. It wasn't until she was referred to Dr. John W. Gouldman, a surgeon at Northside Thoracic Surgery, that she and her family found relief.
The answer? Severe thoracic outlet syndrome compounded by a rare condition called 12th rib syndrome, two conditions that cause nerve pain.
A cascade of diagnoses
Nichole's medical journey began when she dislocated her knee while playing volleyball. While multiple surgeries eventually resolved her knee problems, new health challenges continued to emerge.
Over the next few years, she was diagnosed with multiple complex conditions, including postural orthostatic tachycardia syndrome (POTS), nutcracker syndrome and median arcuate ligament syndrome (MALS). Despite numerous treatments and additional surgeries, her severe pain persisted.
She struggled to keep weight on, unable to climb above 96 pounds no matter how much she ate. She missed approximately 180 high school classes due to surgeries, medical appointments and pain. Even on days she made it to class, she'd often have to leave when her symptoms became unbearable.
"She’d come to me and break down crying sometimes because she just couldn’t handle the pain anymore," her mother, Stephney Lam, said. "She described the pain as someone stabbing her in her back with a knife and dragging it down her entire spine."
Nichole was eventually referred to a pediatric pain clinic, where specialists tried various pain management techniques, including compounded medications. But nothing fully worked, and the pain was taking a toll not only on her but her family.
"Her dad and I did our best to hide emotions," Stephney said. "I would typically wait until all the kids left for school and then I’d end up on the floor in my bedroom or the shower in tears, just begging God to heal her and to give me all the problems instead."
Finding the root cause
Finally, one of Nichole's doctors raised the possibility of thoracic outlet syndrome (TOS), which occurs when the nerves or blood vessels in the tiny space under the collarbone and above the first rib become compressed.
She was referred to Dr. Gouldman, and after a thorough evaluation and imaging, he diagnosed Nichole with both TOS and 12th rib syndrome, a condition that occurs when the lowest rib — the one that doesn't attach to the sternum or other ribs — moves too much and irritates the nerve that runs under the rib above it. In Nichole’s case, her 12th rib hooked beneath her 11th rib.
"He was extremely thorough, and we appreciated that as a surgeon, he didn’t jump to surgery as the first step. He went through everything step by step," Stephney said.
Nichole still needed surgery to remove her right first and 12th ribs. It was scheduled for January 2026 at Northside Hospital Atlanta. Dr. Gouldman removed her first rib using the da Vinci 5 robotic system, but her 12th rib removal needed an open surgery approach due to its anatomical location and it being hooked beneath the rib above it.
Life after chronic pain
As Nichole recovered and her post-surgical pain decreased, she kept forgetting to take her pain medication.
"She realized she didn’t need it anymore because she was no longer in pain," Stephney said.
It was a cathartic moment for the family, especially since they initially expected Nichole would need a second surgery to address the TOS on her left side. But after surgery and physical therapy, her left-side symptoms resolved, eliminating the need for a second operation.
Just two weeks after surgery, Nichole returned to work on light duty — well ahead of schedule. Four months later, she had gained a healthy weight and returned to the gym three days per week.
"The first thing I wanted to do was go back to the gym," Nichole said.
Her improvement went beyond the pain. Her blood pressure, chronically low for years, rose and stabilized.
"Dr. Gouldman may not want to take credit for her blood pressure going and staying up, and for her ability to gain weight and keep it on, but we don’t believe that it’s a coincidence that her health has significantly improved since he did her surgery," Stephney said. "Her life now compared to her life before Dr. Gouldman’s surgery is like day and night."
Despite the challenges, Nichole graduated from high school in May with honors, earning a 3.9 GPA while completing 30 college credit hours through Kennesaw State University’s dual enrollment program. She earned a 4.0 GPA in her KSU courses, landing herself a spot on the university’s spring 2026 President’s List.
This fall, she is continuing her studies at KSU, where she is majoring in pediatric nursing.
"My goals are to finish college and continue going to the gym three days a week," she said.
As for her family, they are just grateful to finally watch their girl enjoy life.
"I’m tearing up thinking about this," Stephney said. "It feels like someone was choking us to death or holding our heads under water and they finally let up. I don’t know how to describe the relief we feel knowing she’s not living life in chronic pain anymore. I keep thanking God because that's all I know what to do with my gratitude ... We’re getting the chance to enjoy her as the kind and silly person that she is."
LEARN MORE ABOUT THORACIC SURGERY AT NORTHSIDE.
*The health story shared here is for informational purposes only and is not medical advice. Patients should consult with their own physician before making medical decisions.
