The fine art of choosing between medical options
“Good news, Mr. Roy. There is no cancer!”
“And, what is the bad news?”, I asked my otolaryngologist, mildly worried
“Well, we still have to go in and take it out”, he said sympathetically.
I kept on staring at the small outgrowth in my voice box showing up brilliantly in the big monitor. A few minutes back, I had to go thru the uncomfortable procedure of cameras going down my nose and diving deep in the voice box and then video recording all the muscle movements as Joey (doctor’s assistant) instructed me to make all sorts of weird noises.
All this came about when I reported to my general physician about breathing shortness while talking. I thought he would take me thru all sorts of lung and heart tests to look at abnormalities. Instead, he asked a few questions and did the initial diagnosis. The logic of which was pure and I was struck by how quickly he narrowed it down.
“Are you still running?” he had asked.
“Yes. Although miles have gone down and so has speed. Also, I have started biking.”
“Good. Good. Good. Are you feeling any shortness of breath while running or biking – more than what it used to be a year back?”
It suddenly occurred to me. I have had no discomfort doing any exercise. Only when talking – especially in the morning, on Zoom calls or phone calls.
“Actually no.” I said, a bit perplexed myself.
He was clear in his mind though. “Well, there you go. Your lungs and heart are fine. There seems to be a problem in the voice box and you are having to take more effort to push the air thru. I would ask you to immediately see my friend Dr. Law”.
And there I was as Dr. Law, laid down the law for me on a surgery.
I was too busy staring at the video and in complete awe of how the whole thing works. I guess I had asked one too many question. The doctor asked his assistant to instruct the scheduler to give him ten minutes. She stepped out. He took off his gloves and manipulating the video frame by frame, patiently explained to me the different muscles that come together to make noise. He showed me how my flaps were closing asymmetrically compared to another video he had. And all this because of the outgrowth. I could have sat there for another hour and learnt how the whole laryngitis area works.
But I was struck with another question.
“Without biopsy, how did you know it is not cancer?” I asked getting a bit worried that I was taking too much of his valuable time.
I guess doctors do live by the maxim “Treat the patient, not the disease.” Because he doubled down on showing me pictures of what a cancer in that area would look like. The surface dryness, the shape of the outgrowth and all that.
“You match none of the three mandatory symptoms. I will return my degree if proven wrong.”
Somewhat assured by his confidence, I returned to our question in hand…
“So, what are our options?”
“Well, Option 1 is surgery. We will go thru your mouth and take it out. 100% chance of recovery.”
“What are the risks?”
“Negligible. No more and no less than other options.”
“Can it come back after the surgery?”
“Very rare. We might see one case in three to four years. Usually always benign.”
“Post surgery, will there be any restrictions – like eating and all that?”
I suddenly remembered that Dr. Vine in Dallas had told me I had to stop drinking wine for the medicine (Methotrexate) that he was going to put me on to combat the onset of psoriatic arthritis. I landed up getting him to refer me to another doctor who would do a deal with me – half a glass of wine every evening, half the dose of medicine, twice the time of recovery and every Monday drawing of blood to keep a watch on the liver.
“Well, we do not want any scars in that area immediately after surgery. So, you cannot talk for 5 days.”
“Come again?”
“No talking for 5 days. Absolute silence.”
“Well, Option 2 it is then, doctor!” I declared without even hearing what that option was!!! So much for my intellectual curiosity.
This had nothing to do with learning. I was in no mood to make Sharmila THAT happy.
Or my office friends, for that matter!!!