Sometimes one creates a dynamic impression by saying something, and sometimes one creates as significant an impression by remaining silent.
Once each year, she gets dressed up and goes to her annual follow-up clinic appointment. She has been cancer free for a long time, but she indicates that still enjoys these visits, especially the part when the surgeon tells her that everything looks great. “How are you doing?”
he asks her. “You look beautiful, as always! A vision of loveliness … that’s what you are!”
She smiles demurely and flutters her fingers at him, attempting to deflect the compliment just a little. She is 81, and she has been listening to his banter for a long time. “Have you noticed anything that worries you?”
She smiles again and shakes her head. Nothing new. She looks at him happily. She knows that “nothing new”
is good news.
He runs through the physical exam. No new masses or ulcers. The tongue is soft. The pharynx 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 is sewn directly to the lower neck skin — is open and clean. No changes since the last visit. He jots down a few notes. “Tell me how you are doing,”
he says. “Any trips? Has your family been up from the South for a visit?”
She gestures and tries to coax out some words. As always, he 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 likely died years ago. 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 now been 24 years since she has spoken a word out loud to anyone. Over the intervening years, the hospital where the surgery was performed has closed. Many of her original caregivers are dead. Yet, here she is: silent and unchanged.
What if she had presented today instead of two decades ago? He skims her old, faded records and shakes his head. He knows that, today, her treatment would likely not include surgery at all. A few years after her voice box had already been removed, a large, randomized clinical trial
demonstrated that treatment with chemotherapy and radiation was just as likely to cure larynx cancer as was the type of surgery she had undergone. Her physicians, acting on the best information available at the time, had removed her voice box.
She continues to write him notes on the lined paper. Despite his offers, she has refused other opportunities for restoring voice (“No more surgery! I'm not interested!"
). She writes about spending time with family. She tells the surgeon she looks forward to the yearly visits. He tells her that he looks forward to seeing her, as well.
They finish their time together and she gestures toward her notebook where she has written in large block letters, “MERRY CHRISTMAS!” “Have a wonderful year,”
he tells her. She shakes his hand, smiles, and gestures enthusiastically. Then she slips on her coat and moves down the hall, silently disappearing around the corner.
The following is feedback received for this blog:
She sounds like a wonderful lady. I bet her doctor and his staff look forward to seeing her too. I know I would. - rl bates
Timing is everything (much anyway). Yes, if medical therapy had been a little more advanced when she was diagnosised, etc. But she is happy (or seems so from you post). I sometimes have to remind myself and patients not to judge treatment from 20 years ago by today's standards. We knew what we knew, and we did the best we could.