Pearls of Prevention


Jun 20 2014
Answering the Questions
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Twenty years from now you will be more disappointed by the things you didn't do than by the ones you did do. So throw off the bowlines. Sail away from the safe harbor. Catch the trade winds in your sails.
- Mark Twain 

Cancer physicians know when “The Questions” are coming. A casual conversation at a party or in the grocery store eventually turns to careers. The pleasant exchange is replaced with talk of life-changing illnesses and impossibly difficult decisions. The other person’s brow furrows, the head shakes, the face darkens. “How can you deal with that day after day?” they ask. “Isn’t it depressing? Why didn’t you pick something happier for a career?” 

These are legitimate questions. As a medical student many years ago, I enjoyed every rotation and wondered how I would ever be able to narrow down my choices and pick a specialty. Eventually, I decided that I was most content when I was in an operating room. Even though I knew that I was going to be a surgeon, there were still dozens of directions where my career might head. 

One day in 1980, I was in a small conference room in Chicago packed with medical students, residents, and surgeons who had gathered to hear a presentation by a visiting out-of-town surgeon. He ran through his slide show, describing a procedure he had devised to restore voice for patients who had undergone removal of their voice boxes. It was a complex operation that involved the creation of tubes of lining tissues that shunted air from the trachea to the back of the throat allowing the person to speak. 

It was interesting, but at my level of training, I was confused by the details and diagrams. I was years away from doing any type of surgery on my own. At some point during his talk, I probably checked my watch, wondering when the conference would be over. 

Then, the visiting surgeon flipped the controls and adjusted the volume on a 16-mm movie projector. The light flickered as the film moved past the bulb.  

There, on the screen, was a man who had undergone a total removal of his voice box. The surgeon asked him a question and the patient responded by holding a vibrating device against his neck to create an artificial, machine-like sound that he shaped into words. He was understandable but his voice sounded synthetic. 

The next scene was filmed after the same patient had undergone the voice restoring procedure. This time when he responded to the surgeon’s question, he brought his hand up to his neck and covered his stoma to redirect air from his lungs through the shunt and into his throat. He was able to talk! The sound was natural and fluent. I was enthralled by the patient’s outcome and can still remember his big smile at the end of the movie. The experienced physicians in the conference room asked questions about whether the procedure was practical or might cause more problems than it solved. I, on the other hand, thought that the procedure was amazing. 

 I left the conference thinking, “I want to do something like that!” Although the procedure described by the visiting surgeon never caught on (there are much simpler techniques widely used today), that meeting steered me toward a career devoted to patients with head and neck cancer. I can trace my interest to that particular day. 

 I love my work even on the days I when I find my practice overwhelming. When someone outside of medicine scratches their head when I tell them what I do for a living, I explain how I felt when I heard that lecture many years ago. I describe the movie and the man’s huge grin. Over the years, I have seen more than a few of those grins on my own patients. It has, indeed, all been worthwhile.


This essay will appear in the next issue of Surgical Products.


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