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November 2017

The End of the Road

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
JAMA Otolaryngol Head Neck Surg. 2017;143(11):1073-1074. doi:10.1001/jamaoto.2017.1573

“I wish it need not have happened in my time,” said Frodo.

“So do I,” said Gandalf, “and so do all who live to see such times. But that is not for them to decide. All we have to decide is what to do with the time that is given us.”

— J.R.R. Tolkien, The Fellowship of the Ring

He sat across from me, a large man dwarfed by the examination room chair, his body a shell of its former strength, swimming in clothing that was now too large, face scarred by the acneiform rash of cetuximab. In poor health for most of his adult life, he had known the prick of needles and the chill of hospital beds long before I met him. A diagnosis of head and neck cancer interrupted a relatively brief hospital-free period in his life. Backed by the tumor board, I had offered the promise of surgery. While the procedure was a success, adverse pathologic features screamed from the pages of his pathology report, marshaling a response from the troops of chemotherapy and the forces of radiation. His cancer retreated but, after a brief spell, returned with a vengeance. Salvage surgery, reirradiation, chemotherapy, and a variety of clinical trials had all been proposed. He was here to discuss his options.

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