“Sometimes one creates a dynamic impression by saying something, and sometimes one creates as significant an impression by remaining silent.”
My patient returns for her annual follow-up clinic appointment dressed to the nines and offering hugs and kisses to everyone. She has been cancer-free for a long time – many years, in fact – but makes a point to tell me how much she enjoys these visits, especially the part when I tell her that everything looks great. I walk into the examination room and she smiles.
“How are you doing?” I ask. “You look beautiful, as always! A vision of loveliness…that’s what you are!”
She drops her eyes demurely and flutters her fingers at me, scolding me for flirting and attempting to deflect the compliment just a little. She is well past 80 and has been listening to my banter for a long time.
“Have you noticed anything that worries you?” I ask.
She shakes her head. She knows that “nothing new” is good news. I run through the physical exam. No new masses. The tongue is soft. The throat is well healed and open. The neck has no enlarged lymph nodes and the scars are all stable. The stoma – the opening where her windpipe had been sewn directly to the lower neck skin when her voice box was removed – is open and clean. No changes since the last visit. I jot down a few notes.
“What else is going on in your life?” I ask. “Any trips? Has your family been up from the South for a visit?”
She gestures and tries to coax out some words. As always, I can only pick up a fraction of what she is trying to say. “Did you bring your electrolarynx today?” She shrugs and smiles sheepishly. She never brings along her speech device; the batteries are always dead or she has misplaced it again. She has never liked the buzzing sound.
She digs in her purse for a pencil stub and a small spiral notebook. She concentrates as she writes out her responses in large capital letters. Writing has been her only means of communicating since her voice box was removed. It has been over twenty years since she has spoken a word out loud to anyone. The hospital where the surgery was performed has closed and most of her original caregivers have retired. Yet, here she is: silent and unchanged. A cancer survivor.
I remember skimming through her old, faded records from her cancer treatment and realize that things have changed. If she had developed her voice box cancer today instead of two decades ago, her treatment would likely not have included surgery, at all. A few years after her surgery, a large research study demonstrated that treatment with chemotherapy and radiation was just as likely to cure her stage of larynx cancer as an operation. Her physicians, acting on the best information available at the time, though, had removed her voice box, changing her world forever.
She continues to carefully write messages on the lined paper. Despite my offers, she has refused other opportunities for restoring her voice. She writes a bit about spending time with family. She writes to tell me that she looks forward to these yearly visits. She writes that she is doing okay.
The appointment is over and she prepares one last message in her notebook in large block letters. “MERRY CHRISTMAS!” it reads. She holds it up and smiles.
“Merry Christmas to you, too,” I say. “Have a wonderful year!”
Silent Night is playing over the speaker system as she enthusiastically gives me a hug. Then she slips on her coat and moves down the hall, waving one more time before she disappears around the corner.
A previous version of this essay was originally published in 2007. Happy Holidays to everyone!