I currently working with a

I currently working with a ENT (ear nose and throat) doc once a week. He is actually a surgeon, who specializes in head and neck cancer, so I have gotten to see some pretty cool things. Actually, I hung out with him in surgery a few weeks ago, and saw a sub-sternal goiter removal, a laryngectomy, and the beginning of a thymectomy (where they used this weird little crane to hoist up the sternum of a 15 year old girl in order to gain access to her thymus, located just above her heart). Surgery was a really rewarding experience, and my pervious night's review of neck anatomy definitely paid off- I was able to make myself look good by correctly naming a couple of muscles and nerves. Though I think I need to learn to be a bit more assertive with what I know - "Is that the omohyoid?" Doesn't sound as good as just saying it confidently, even if I was wrong. "Omohyoid." I also did not know which animal was famed for having the largest omohyoid muscle of all animals (Dr. Andersen was either trying to be funny or look smart). Turns out, its the badger.

A lot of the folks I see in clinic are there for post-op visits, after Dr. Andersen has removed part of their head or neck. Yesterday I saw I guy whose ear had been replaced by a flap of thigh skin (he had had a skin cancer in his ear canal). I see tons and tons of people with tongue, mouth, and throat cancer, the vast majority of whom were long time smokers, and some of whom, in some inexplicable feat of either masochism or stupidy, are still smoking. I think all kids who are caught smoking should be required to do volunteer work in an ENT clinic or a VA hospital, where practically everyone is dying of lung cancer or emphysema.

Some of these patients, though, are the exception. Yesterday I also saw a guy, a young guy, maybe he was 29 or 30, who got a throat cancer in his early teens. He wasn't a smoker, he didn't do anything wrong, he just got cancer. He eventually ended up with a laryngectomy, where the entire larynx (voicebox) is removed, and the trachea is reconnected to the skin at the base of the neck. He is now like one of those old guys you occasionally see with the horrible growling voices who breathe out of a hole in their necks. He talks by way of a small voice prosthesis that funnels air into his esophagus, allowing him to use the flappy walls of his esophagus as vocal cords. But because there is no muscular control over this tube, his voice has no tone, no inflection, and no variation in volume. In addition, every time he wants to say anything, he has to lift is hand to the gaping hole in his neck to cover the opening of the prosthesis.

He also must undergo frequent painful dilations of his esophagus, and the changing of his voice prosthesis every 8 weeks or so. I was there for that yesterday, and it looked very unpleasant. He recently had to get a feeding tube reinserted because he couldn't get enough food down his damaged esophagus to keep him going.

It seems so cruel, such an incredibly harsh blow to this man's life, especially his social life. He told me that because of multiple treatments and difficulties, he went a period of three years without talking - as a teenager. Imagine how that would change your life. He is in architecture school now, and says that people treat him really weirdly because his voice is so, well, grotesque. He told me of a time when he was working on a small group project, and one of the girls in his group was literally scared of him. Looked terrified and grossed out every time he said anything. How awful. It weird, but it seems like this kind of outcome is easier for us to accept if it happens to someone whose actions have caused it (aka by smoking). Not that their suffering is any less, or they deserve it more, especially considering how difficult it is to master a nicotine addiction. But somehow we think, reasoning with our child-like sense of fairness, they brought in on themselves. Seeing it in an "innocent" person is much harder, especially if they are just at the beginning of their life. Nothing about it is fair.

It was really cool to get to talk to this guy. We ended up walking out of the clinic at the same time and i got to chat with him a little more. He told me how he was getting ready to climb mount St. Helen's, which he does every year. He told me that biking up the hill to OHSU wasn't that hard and I should just do it. He was just this cool guy. I couldn't help but wonder about how difficult it must be to meet people and to make new friends, much less go on dates or find someone to love him. I hope he does.
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