Head and neck cancer surgeons know when “the questions” are coming. A casual conversation eventually turns to, “What do you do for a career?” The pleasant exchange is replaced with talk of disfigurement and life-threatening illness. The person’s brow furrows. “How can you deal with that day after day? Isn’t it depressing? Why didn’t you pick something happier for a career?” These are legitimate questions. As a medical student many years ...

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"I don't want to get to the end of my life and find that I lived just the length of it. I want to have lived the width of it as well." - Diane Ackerman Nathan picks up a pen from the tray next to the dry erase boards. “OK,” he says. “Here’s what he showed us.” The rest of our small group watches. Nathan is one of the more intense medical students I ...

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"A moment’s insight is sometimes worth a life’s experience." — Oliver Wendell Holmes, Sr. Several years ago, an anxious senior medical student was preparing his application for The Match, the clearinghouse through which 37,000 candidates hope to secure one of the 33,000 available residency positions. It is a nerve-wracking time. Each student compiles documents, assembles records, creates lists of activities, summarizes research, catalogs volunteer projects, selects the perfect photo and solicits faculty ...

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"Those who suffer illness learn by hearing themselves tell their stories, absorbing others’ reactions, and experiencing their stories being shared." - Arthur Frank We stand together at the clinic room door, preparing to enter. “Tongue cancer. This is a 78-year-old man with an oral cavity mass and some memory loss. He had an ulcer on the side of his tongue for a few weeks which was biopsied by an outside doctor. No imaging ...

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"A teacher affects eternity; he can never tell where his influence stops." - Henry Adams Mrs. Jones (identifying information changed) is a vibrant woman in her eighties who has been admitted to the hospital with swallowing problems and a fever. The CT scans show some swelling next to one of the major blood vessels and our team has been asked to see her and decide if she would benefit from surgery. She ...

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"They may forget what you said, but they will never forget how you made them feel." - Carl W. Buechner I draw back the curtain and look within. My patient, Mr. Buchanan, is on the cart. His daughter, Jessica, whom I met during his office visit, sits in a chair with her preschool-aged daughter. He wears a hospital-issue gown and has an IV taped in place. The little girl looks intently at ...

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"You've got to jump off cliffs all the time and build your wings on the way down." - Annie Dillard Months ago, when my patient and his wife were in my office for the very first time, I could already tell that he would resist any display of sympathy from her and she would clearly be uncomfortable with ever being a caregiver for him. There was tension in the room. He “had not ...

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My new patient was having trouble breathing and had lost his ability to swallow; despite this, he had been too proud to call either friends or family for help. He had lost thirty pounds and his clothes hung loosely. His belt was far too long. The day I met him, I thought, “This man could walk through a harp.” People had tried. Over the previous months, his worried family members had ...

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"We are what we repeatedly do. Excellence, then, is not an act but a habit." - Will Durrant, historian For better or worse, all of my high school English teachers were memorable. Each held a precise but non-overlapping image of the perfectly crafted essay; therefore, every September I found myself adopting a brand new writing style. A paper that would have garnered an “A” at the end of one school year routinely received ...

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Cancer treatment delays are sometimes inevitable. Here is a story, though, that haunts me. Years ago, long before the Affordable Care Act, I was asked to evaluate a very pleasant man with hoarseness in a local free clinic. He struggled to make himself heard. "Things have been getting worse and worse," he said. "When did you start losing your voice?" I asked. "About six weeks ago," he responded. "When it started getting more ...

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"Medicine is a science of uncertainty and an art of probability." - Sir William Osler Two people presented to my clinic on the same day with classic symptoms of head and neck cancer. Each reported several weeks of unilateral throat discomfort, ear pain, and a neck mass. Each was having some trouble swallowing and had changed his diet to accommodate the soreness. When they opened their mouths, each had a mass with a ...

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"I like good strong words that mean something." - Louisa May Alcott My resident and I are removing a large, recurrent cancer from the neck. Dense scar tissue is everywhere from prior surgery and radiation therapy. The going is slow. Each move is arduous, and bleeding obscures the view of the anatomy. “Watch out,” I tell her. “The jugular vein is nearby, probably buried in that scar.” “Yeah,” she responds. “Look at this nerve! ...

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“An expert is a person who has made all the mistakes that can be made in a very narrow field.” - Niels Bohr Five experienced, well-published, and widely respected head and neck cancer surgeons are sharing the dais at the national medical meeting to explore the topic “Can We Be Better?” The panel represents a spectrum of experts from around North America, and they have served as program leaders, department chairs, and ...

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"It's strange how the worst day of your life often starts just like any other." - Joanna Cannon I prepare for each clinic by reviewing the tests and scans of the patients who will be seen that day. Today, I am dismayed as I read a report for a longstanding patient. The news is not good; his scan shows that his cancer has returned. Twenty years ago on a day like today, I ...

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We are in the middle of an all-day ENT screening clinic at Moi Teaching and Referral Hospital in Kenya. The local ENT physicians have scheduled about 100 patients to return to see our American team to be evaluated for surgery during our visit. We have already seen several people with baseball-sized tumors in their parotids, thyroids, or necks. The surgical schedule for the next few days is getting full. A thirteen-year-old ...

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“We do not remember days, we remember moments.” - Cesare Pavese “A plane! A plane just crashed into the World Trade Center.” The surgical case was moving along steadily. Another surgeon had removed a skin lesion from the patient’s neck, and the pathologist had not been certain if it was a cancer. I had recommended removing the scar and several of the nearby lymph nodes. The surgery had just started and was going ...

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"Knowledge is power. Information is power. The secreting or hoarding of knowledge or information may be an act of tyranny camouflaged as humility." - Robin Morgan Fifteen years into the future, in 2030, a patient returns home after a stay in the hospital. He powers up his mobile device and finds a file that was created during his surgery. “Let’s see,” he says. “I think I’ll turn off the ‘commentary’ for now. Maybe ...

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"To be trusted is a greater compliment than to be loved." - George MacDonald As we adjust her position on the surgical table, I spot some short, vertical scars on the front of her neck. The parallel slashes sit directly over her enlarged thyroid -- a goiter -- and appear to have been deliberately placed. There are two sets of scratches, one set on either side of the neck, nearly identical in length and evenly ...

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Old age is no place for sissies. -Bette Davis “I want the surgery today!” She started to cry. “I’m ninety-four years old. I’ll accept any risk. Just take this thing out!” She looked back and forth between the anesthesiologist and me. Her golf-ball sized tongue cancer had been growing over the past six months. It wasn’t changing from day-to-day, but it had increased over the course of the three weeks since we had ...

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Students undergo a conversion in the third year of medical school: not “pre-clinical” to “clinical,” but “pre-cynical” to “cynical.” — Abraham Verghese, MD The scalpel hovered over the swollen, red and inflamed mass peeking through the opening in the sterile drapes. The patient lay on her side facing away from us, clutching the stiff emergency room pillow against her face and moaning as she rocked back-and-forth. Whenever the surgeon manipulated the mass, ...

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