This is going to be an important medical experience that may save your life. It is the story of my patient, Mr. S.
When we or a loved one receives a diagnosis of a serious, life-altering or life-threatening condition, what we do next can be the most important decision we make.
Mr. S., my patient of several years, had been referred back to my practice to remove a tooth that was infected which the dentist had deemed as nontreatable. The tooth was to be removed and implants to be placed at a later time as had been done on the other side of his mouth two years prior.
The patient, an otherwise healthy individual, had related that he had been under the care of his Ear, Nose & Throat doctor for a year for a chronic sinus infection. Otherwise, he had no other symptoms.
Upon the removing the infected tooth, I noted that the tissue around it did not have a normal appearance or consistency. After removing the tooth, I submitted this tissue to a laboratory for biopsy which we often do in order to obtain an analysis. At that time, I was suspicious that the infection presented by the patient was other than of dental origin. A call three days later confirmed my fear; the diagnosis was a squamous cell carcinoma which in laymen’s terms means a malignant growth of the upper jaw communicating with the sinus cavity which is the space above the teeth.
Before the patient returned to my office for me to present this news and realizing the patient was unprepared for such a diagnosis and expecting only to hear about his dental condition, I made arrangements with a major medical institution in New York City that specialized in cancer care to see the patient the next day. I forwarded all the materials that I had received from the laboratory so they would be prepared to examine the patient and present him with some treatment options.
When I saw the patient late the next day, I presented the patient with the diagnosis and also told him that we had already arranged for an appointment for the next day so he could be seen at the medical center in Manhattan.
The patient was seen the next day at the medical center and after being examined by the head and neck cancer staff, was advised that he would undergo a surgical procedure to remove the remaining portion of the tumor and a dental prosthesis would then be fabricated for him to replace that part of the tissue that was removed and he could expect an uneventful recovery. They did however take a CT scan of his head at the time of his visit.
Three days later, the patient received a call from the medical center informing him that the tumor was much more extensive than they anticipated from just the oral examination and that he would undergo a very radical procedure that would result in much of his oral cavity being removed, involve the removal of much of his oral tissue, his upper jaw and would require him to be on a feeding tube for the rest of his life.
The patient was devastated by this news since he had anticipated only a procedure to remove the localized tumor. When the patient called me with the information that he had received, I quickly contacted another major cancer center in New York and he was promptly seen within a few days. The second major medical center, also with an excellent reputation, saw an entirely different outcome for this patient. They presented him with palliative radiation and felt that any surgical procedure would severely disable him and not prolong his life. Their humane approach however was interpreted correctly by the patient as a noncure that could ultimately lead to his death.
Two medical centers; two totally different approaches. The patient at that point having received two devastating diagnoses, the second of which he saw as "throwing in the towel", sought a third consultation at a third major medical center with a more respected head and neck surgeon. Here, he was received with a completely different approach. They indicated they could do radiation, unlimited chemotherapy and then remove the tumor with a team of surgeons
that would render him intact. Whatever deficit occurred in his mouth from the removal of the tumor, they could repair with a skin graft and he would speak, eat and function normally. And they felt this outlook was favorable.
Needless to say, the patient embraced the third approach. He underwent treatment for about a year with multiple procedures and treatment performed; some of which with at times a rocky and difficult road.
However, I can report to you now, five years later, the patient is completely free of cancer and in every way intact and functioning almost as if he never had the original diagnosis. He’s grateful that he’s here and that he can continue to enjoy his family, his career and a second opportunity to hopefully live out a long, fruitful life.
There are many take-aways from this story. All three of the institutions he saw have excellent reputations and doctors. It is clear that a serious diagnosis can have different approaches based upon the institution’s and practitioner’s training and their protocols. This does not denigrate or in any way make any of the institutions or the individuals involved less capable then they are. However, it does indicate that the art and science of medicine are not identical and there are many situations for which there are alternative approaches that can vastly different outcomes. Hopefully, you will never need to deal with issues such as those encountered by Patient S but if you do, try to keep this in the back of your mind as a helpful story that may make a big difference for yourself and those you love.
Dr. Victor Sternberg