A Piece of My Mind Section Editor: Roxanne K. Young, Associate Senior Editor.
I love to teach. As an infectious disease physician for more than 35 years, I have spent many hours with medical students and physicians, making rounds, discussing patients, and reviewing diagnoses. It has been so gratifying to see new and future physicians learn the art and science of medicine.
When I gave my first lecture 30 years ago, I recall being self-conscious of my Israeli-inflected accent. Would I be able to hold the audience's attention and clearly explain my research? But after delivering scores of lectures, I grew to love the back-and-forth exchange with my colleagues. I became a better physician and researcher by responding to their challenging questions. Most important, I felt like I made a difference in the lives of thousands of patients by discussing my research in ear, sinus, and tonsillar infections. Now, I view lecturing as a critical component of my career, and I try to accept every opportunity I can to share my work.
Three years ago, when a bothersome sore throat led to my diagnosis of hypopharyngeal squamous cell carcinoma, I was shaken to my core. After all, I neither smoked nor drank alcohol, two major causes of this disease. But my physicians anticipated that treatment would have no lasting adverse effects and, indeed, I was able to function—and to speak—normally after removal of the tumor and radiation therapy. Unfortunately, a recurrence two years later necessitated more drastic measures. After several unsuccessful operations to remove the cancer while endeavoring to salvage my voice, my surgeon told me that my best chance for a cure was a total laryngopharyngectomy: complete removal of the larynx, including the vocal cords. Speaking—let alone respiration, swallowing, and coughing—would be forever changed. At the time, I didn't think of what it would mean to breathe through a hole in my neck forever. Even though I might never teach, lecture, or speak in public again, I didn't hesitate. For me saving my life was more important than saving my voice.
Weeks of convalescence without being able to utter a word were, at best, supremely frustrating. And yet, like many others who have undergone this radical procedure, I attempted to fashion a new “voice” with the help of dedicated speech pathologists and supportive fellow patients who had also undergone laryngectomy. I learned how to force air into a small prosthesis that connected my upper airway to my reconstructed throat, thus enabling it to vibrate, imitating the functions of vocal cords. But the result was disappointing—a rusty whisper that barely resembled my former voice. Speaking became a physical challenge: I had to use my chest muscles and diaphragm to intensely force air into the prosthesis; sudden coughing was an impediment to conversation; and the speaking device easily clogged and became useless. It was difficult to express emotions or alter the intensity of my speech. My lifestyle also changed: I avoided noisy restaurants, large gatherings, and many other social situations. People often hung up when I used the telephone; one person later apologized for thinking I was a prank caller.
I badly wanted to use my voice as I did before, but I had serious doubts. I wasn't sure I would ever be able to speak in public again, let alone return to teaching and lecturing.
I was both elated and terrified when I gave my first talk on respiratory tract infections some ten weeks after surgery. While having a microphone helped, I understood that my lecturing abilities would be forever limited by the quality of my voice, the need to express myself with fewer words, and the ever-present fear that a technical glitch with the prosthesis would render me speechless. I was well aware that, given the choice, organizers will usually select someone else without speaking difficulties. As depressing as this was, I felt unable to change the situation.
Recently, as it happened, I discovered an expertise in an area where my impaired speech is an asset rather than a handicap. Several months ago I was asked to give a lecture about my personal experience with throat cancer. In the audience were the surgeons of tomorrow as well as my fellow patients who had had their larynx removed. No longer the detached researcher, I spoke as a patient with a potentially fatal illness and described the challenges I face every day. I talked about how my impairment made me extremely vulnerable and how the compassion, empathy, and concern of treating nurses, speech therapists, and physicians could make a positive contribution to their patients' recovery.
The applause I received at the end of my talk was not for the quality of my voice but for the content of my words. The surgeons were grateful to hear what issues are important to those under their care. They told me they felt inspired to meet a patient who has recovered to the extent of being able to present a lecture again. The patients who had undergone my procedure not only benefited from hearing my story, but realized that their own experiences and feelings are shared by others.
Since that time, I have been asked to give similar talks to local and national conferences of medical practitioners and to individuals who have undergone laryngectomy. My new audiences are eager to hear from a physician who has been “on the other side.” Most of all, I feel invigorated by the positive responses to my presentations. I have finally found a new mission that turned my weakness into strength and where a whisper has the impact of a shout.
Brook I. Rediscovering My Voice. JAMA. 2009;302(3):236. doi:10.1001/jama.2009.981