My Battle With Squamous Cell Carcinoma

By Jeff Goldsmith

On Christmas Eve 2014, I received a present of some profoundly unwelcome news: a 64 slice CT scan confirming not only the presence of a malignant tumor in my neck but also a fluid-filled mass the size of a man’s finger in my chest cavity outside the lungs.

Two days earlier, my ENT surgeon in Charlottesville, Paige Powers, had performed a fine needle aspiration of a suspicious almond-shaped enlarged lymph node. The lab returned a verdict of “metastatic squamous cell carcinoma of the head and neck with an occult primary tumor”. As someone who had worked in healthcare for nearly forty years, I considered myself an “expert” in how the health system worked. However, this experience fundamentally changed my view of health care delivery from a patient’s point of view.

When cancer struck, my experience did not feel like a battle, but more like a chess match where the deadly opponent had been playing many months before I was aware that he was my adversary, much like the remarkable image from Ingmar Bergman’s Seventh Seal. The CT scan was the second step in determining how many moves had been made, and in narrowing the uncertainty about my possible counter moves.

The scan’s results were the darkest moment – if the mysterious fluid-filled mass was the primary tumor, my options had already dangerously narrowed. A PET/CT scan later dismissed the chest mass as a benign fluid-filled cyst. Further tests were required to locate the still-hidden primary tumor somewhere in my throat.

I decided to seek a second opinion at my alma mater, the University of Chicago. Their superb head and neck cancer team had a rich and powerful repertoire of non-surgical therapies that caught my attention.

Dr. Everett Vokes, Chair of Medicine at the University of Chicago, who headed the head and neck cancer team, initially diagnosed mine as a surgical case and was proved accurate. Dr. Alex Langerman, in an initial consultation, spotted a potential primary tumor nestled up against my larynx and a full-blown exploration under general anesthesia was performed a week later. The possible threat to my voice convinced me to return to Chicago for therapy.

The surgery, performed on February 2, 2015, required nearly six hours: resections of both sides of my neck, including a host of neighboring lymph nodes, and the removal of a nearly golf ball-sized piece of the base of my tongue and throat. Recovery was far from smooth but was made worse due to the inadequacy of the hospital staff.

I received thoughtful and attentive nursing care throughout my stay, but there were some issues in the standard of care I received, particularly with pain management and resident doctor response rates.

No thought was given to rethinking my pain control, resulting in a painful and long drawn-out recovery from surgery. The failure of on-call residents to respond expeditiously to pages from the nurses caring for me led to substandard care.

Despite these challenges, the University of Chicago and their team provided outstanding patient-centered care. They proved to be a guiding light through my fight against cancer, and I’m forever grateful for their role in my recovery.