How surviving cancer changed my life and my practice

From the October 1999 ACP-ASIM Observer, copyright © 1999 by the American College of Physicians-American Society of Internal Medicine.

By Joshua Grossman, FACP

It happened 14 years ago, the night before Thanksgiving. I had gone downstairs to the kitchen to tackle a mountain of dishes and clean up before the family descended for the holiday. Dishes done, I started up the stairs.

The stairway was dark, but some light from our middle child's bedroom threw my neck into bold relief against the shadows. My wife, watching me from the top of the stairs, suddenly exclaimed, "You have a mass in your neck!"

My immediate response was to dismiss her observation with a flippant "Nah!" Then I proceeded to sit down on the stairs for 15 minutes in what my wife later referred to as a state of "total denial." Finally, I got up and looked in the mirror. She was right: There was a mass in my neck.

I called our internist, who wasted no time: "My office, Friday morning, 9 a.m.!" Hanging up the phone, I felt numb. No fear. Nothing. Just numb. I sat down with our children then and there and told them what was happening. Somehow I got through Thanksgiving.

Strange journey

On Friday morning, I began a strange journey through the health care system from a new perspective. It began when I visited my internist. "Who would believe you've never come in for a complete physical examination?" he exclaimed, when I reported to his office that morning. As a physician used to diagnosing and treating other people's problems, I guess I had thought that I was invincible.

The next step was a visit to a head and neck surgeon who inserted a large-bore needle into the mass to check for fluid. There was none.

The surgeon who did my initial neck surgery—a two-hour mass excision—was a personal friend and colleague, but it didn't help. In fact, it made matters worse, as he simply could not tell me my diagnosis.

After he'd sat in front of me for several minutes muttering incomprehensibly, I decided to help him out: "Will the slides be out today?" I asked. "Yes," he said, and dashed gratefully from my hospital room, relieved to be off the hook.

When I got home, I called the pathologist and received my diagnosis—papillary-follicular carcinoma of the thyroid gland—over the phone. Though the diagnosis was there to see, plain as day, I still felt numb. On a gut level, I just could not believe it.

Despite my years of experience working in the health care system, I felt like I was on my own, like any other patient. I didn't know what to do or where to go. Personal computers were in their infancy back then, so surfing the Internet for information wasn't an option. With the helpless feeling of someone who has just been diagnosed with cancer, I dialed 800-4-CANCER and got a stack of literature in the mail detailing the surgical options.

Ultimately, I opted for an examination with an oncologist who was also a friend, and I decided to follow his recommendations. After a second four-hour operation on my neck, I was pronounced "cured" and put on a course of daily levothyroxine sodium, but no radioactive iodine. As my oncologist now notes, "It was not in vogue at the time."

Lessons learned

One important lesson I learned was to trust people. I trusted and continue to trust the judgment of my oncologist, and I refrained from flitting here and there seeking alternate opinions. I trusted folks I knew were well-trained and board certified in internal medicine, just as I myself was. I knew I wouldn't second-guess my oncologist because I respected him as a friend and colleague. And that was important.

My diagnosis, surgical treatment and follow-up care have all helped put me in touch with my spirituality. In the hospital, on the eve of my major neck dissection, I prayed for strength. Immediately afterwards, I experienced a great sense of calm and felt in touch with my higher power. I asked for strength for my family and for myself to deal with whatever the future held in store.

Since the experience, much in my life has changed. First and foremost, I now make it a priority to celebrate life every day. Two things I'd always wanted to do—but somehow never found the time—were to act in community theater and take up western square dancing. Three months after my second neck dissection, I was in rehearsal for Irving Berlin's "Annie Get Your Gun," in the role of Chief Sitting Bull! Western square dancing (on the local, state and national level) began a year or so later.

My experience has also changed my view of illness. I learned a lot, for example, about the power of denial. I remember one meeting of a cancer support group where I confided that prior to the first of my two neck dissections, I had convinced myself that the mass was due to my having wrenched my neck sneezing. The group facilitator chimed in at that point: "Anyone who hasn't had thoughts like that, I want to see you raise your hand." Not a single hand went up.

My battle with cancer continues to affect—and improve—my work as a physician. Throughout my career, my patients have been my best teachers. Today, my patients who are cancer survivors are the very best of all. I participate in cancer support groups, walkathons and cancer-survivor days, and I am an active member of our hospital's tumor board.

In my initial history and physical examinations, I now ask new patients, "Do you have cancer, like me?" Perhaps most important, I have become more positive in the way that I give patients and their loved ones a cancer diagnosis. After all, I'm a cancer survivor!

Dr. Grossman is a general internist in Johnson City, Tenn.