As you know, I am currently receiving infusions of Keytruda for malignant melanoma of my dominant right thumb, for which I underwent partial amputation of the thumb and sentinel node biopsy of my axilla. I have been writing this blog to give my perspective of a surgeon becoming a patient, to give some perspective to other cancer patients, to share my faith, and to allow my friends and patients to keep track of my progress. Once everyone is up to date, I plan to write some blogs about healthy living and healthy habits that strengthen our bodies, decreasing overall inflammation and promoting immune system health to decrease one’s risk of cancer. But first, here is my firsthand account of the past 2 weeks, a story that is completely true, but one that could be hard to make up. 

Wednesday, November 17- The Bike Wreck

Although I have started to operate again on Wednesdays, there was no time available in the operating room on this particular day. Also, my son Gray and his fiancée Molly were coming in town for a few days, so I decided to take a day off work, and plan a fun day with them knowing that I was scheduled for my 5^th infusion of Keytruda the very next day. Gray’s friend, Jared Clements, was also in town with them.  Gray, Molly, and Jared are all in their last year of medical school at the University of Tennessee Health Sciences Center in Memphis, and all will be fine physicians in their respective careers.

Our day started off with beautiful weather and a 3-mile hike in the trails of Percy Warner Park. Gray, Molly, Jared, and me hiked together along with the dogs, Baylor and Bentley. Next, I had planned a road bike ride from our home in Nashville, through the beautiful West Meade area, onto the Richland Creek Greenway, and then over to Star Bagel for lunch. I rode with Gray and Molly. My wife Kellee, Jared, grandson Bradley, and grandson Jack met us there and we had a great lunch together. I kept commenting on “what a perfect day it had been so far” considering the weather, the hiking, the cycling, and the time with family. Oh was that about to change!

After lunch, we had planned to cycle back home on the same route, and we walked are bikes across the street, clipped into our pedals, and just started to head out. Somehow, while on the sidewalk, I must have become careless and allowed my front wheel to slip off the edge of the sidewalk at low speed. It slipped off right at the intersection with another sidewalk, leaving my front wheel in a low spot, abruptly stopping my bike at which time my rear wheel pitched upward, launching me over the handlebars in a complete 360, and landing on my side on the concrete with a hard “thud” and my bike on top of me. Immediately, I heard (and felt) my rib crack, knocking the breath out of me. Considering my severe pain, and inability to breathe, my family called “911” and an ambulance was summoned. I was transported to Vanderbilt University Medical Center with shortness of breath. I quickly became a patient on the Trauma Service there, with scans revealing a fractured 7^th rib, a right pneumothorax (collapsed lung), bilateral pulmonary contusions (bruised lungs on both sides), and a mediastinal hematoma (bleeding into my chest near the heart area). If a pneumothorax (collapsed lung) becomes severe enough that the lung continues to collapse more, then a chest tube is placed. Initially, there was just a small amount of air outside my lung but inside the chest cavity. But I progressively developed more pain and shortness of breath, and my repeat chest x-ray revealed further collapse of my lung, so my team of physicians consented me for a chest tube. An incision was made on the right side of my chest after some local anesthesia, and the tube was inserted through the soft tissues, over a rib, and into my chest cavity with a rush of air.  It was connected to a container that allows air to escape out and over time the goal is for the lung to re-expand and seal the leak.  I spent the next two days in the hospital with the chest tube. It was able to be removed on Friday night, November 19, and I was discharged home. The situation at that time was pain with hardly any movement, worsening pain with a deep breath, and severe pain with a cough or sneeze. I was unable to lay flat for the next 2-3 weeks. Obviously, the bike injuries caused my Keytruda infusion to be postponed.

Saturday, November 20 – The Wedding

My niece, Katherine, was scheduled to get married to Andrew the day after I was discharged from the hospital. It had been twice postponed secondary to Covid restrictions, and the big day was finally here. My sister, Andrea, and her husband, Ray, live just down the street. Their kids, Katherine, Charles, and Caroline have grown up with my kids so closely that they are almost like siblings. Our family is so close to each other, and there was no way I was going to miss her wedding, even though I had been in the hospital less than 24 hours prior to the wedding. Despite the rib fracture and chest tube dressing, I donned a tuxedo, took some Ibuprofen, and went to the wedding and dinner reception afterwards!

Thursday, December 2- Infusion Time

Well, two weeks after it was scheduled, I finally received my 5^th infusion of Keytruda. I had f/u CT scans while I was admitted to the Trauma Service. Overall, the scans were good news.  For my right upper extremity, there was no evidence of any cancer in my arm and no enlarged lymph nodes. My chest and pelvis were notable only for the traumatic injuries.  The abdominal CT did reveal a few small liver lesions that look to be more chronic; but to be on the safe side, a repeat liver protocol CT is scheduled in 6 weeks to make sure they are stable…prayers accepted!

Saturday, December 4- The Race

As everyone knows, I was in training for a triathlon when I got the diagnosis of cancer.  I have continued to train as much as I can because the exercise seems to combat the fatigue that I get on Keytruda. Months ago, Gray and Molly had signed up for the St. Jude Half Marathon in Memphis, Tennessee, and I had signed up for the St. Jude 10K. This event is a huge fundraising event for pediatric cancer research at St. Jude Hospital in Memphis. Despite the Keytruda infusion 2 days earlier and the painful breathing from the fractured rib, I was determined to finish this race.

For some reason, I have always been able to tolerate pain very well. One of my hobbies is horses.  I have been riding horses for over 50 years. We sometimes take our horses on vacation with us and trail ride. A few years ago, while riding in rural Tennessee in the Big South Fork National Recreation Area, I was thrown when my horse Highland slipped on a wet, rocky trail, and I broke my distal radius.  I kept riding the rest of the week on vacation, seeking care later when I got home.

Kellee was our support team, and her sister, Kristin, and Kristin’s boyfriend, Robin, both made the trip to Memphis with us to do the 10k as well. So, I ran the 10K along with the support of Molly’s mother, Robin, who ran along with me and helped encourage me. I wound up finishing pretty high in my age group. Gray and Molly both ran strong and outstanding half marathon races as well.

Suffering

In conclusion, I think about the last two weeks and the last 6 months, and I do think “suffering” is a good description for some of my experiences.  And what does that mean to me? Through all my suffering this year, I have continued to experience God’s presence in my life.   Psalm 27 of David, verse 1 states, “The Lord is my light and my salvation- whom shall I fear? The Lord is the stronghold of my life- of whom shall I be afraid?”

Some of my earlier blogs have mentioned moments that I feel are providential. I have not experienced God in an academic and impersonal way; for me, I have experienced Him in a real, experiential type of way. The comfort of His presence has drawn me closer to Him, closer to my family, and closer to my friends. Kellee and I have had a major reset in our lives, have simplified our lives, and have focused on our personal relationships with God through our hope in Jesus Christ, not the empty hollow promises of all the secular, worldly, influences that claim to bring us happiness.

Thanks for being part of my journey!

As you know, I am currently receiving infusions of Keytruda for malignant melanoma of my dominant right thumb, for which I underwent partial amputation and sentinel node biopsy of my axilla. After much physical healing, it was now time to start the process of learning to adapt and perform my duties again as an ear, nose, and throat surgeon. I loved my job and my patients, and I was determined to rebound and resume the awesome privilege of caring for patients. Much of my time between my second and third infusions was spent adapting to work in the clinic. Next, between my third and fourth infusions, I focused on my surgical skills and a return to the operating room. By the way, my body continue to strengthen and heal with a vigorous exercise regimen; I seemed to be regaining energy; and I was tolerating the Keytruda infusions much better. I continued to remain free of the more serious side effects such as pericarditis, electrolyte abnormalities, low platelets, pneumonitis, colitis, pituitary abnormalities, skin rashes, or elevated liver enzymes.

Otolaryngology Clinic

My right thumb had been amputated back to the first joint, but I had still had the ability to oppose my thumb to my fingers. Therefore, with some retraining, I knew I could regain my dexterity. However, this is a process with a significant learning curve. My remaining thumb was still healing, very swollen, and very tender. I began wearing compression sleeves to decrease the swelling and help the skin be more formed around what was left. It was also very sensitive to touch, and I practiced all sorts of desensitization therapy, such as immersing my hand in rice and moving it around, applying all sorts of different textures, and even brushing it with a toothbrush! The good news is that I am somewhat ambidextrous. I had always been a switch hitter in baseball and preferred to play in the field left-handed. In my surgical career, I had always removed the right tonsil with my right hand and the left tonsil with my left hand.

During my first week back in the office, I started practicing donning and doffing gloves and simply played around with typical office instruments, noting which ones were more difficult and when I might want to go left-handed.

The next week, I began to work some reduced hours in the clinic in conjunction with my nurse Carrie Reich, RN, and one of our nurse practitioners, Kelly Strimaitis, FNP. I began seeing patients with them and learning to adapt in the clinic. Kelly worked with me as my nurse for years, and then I had mentored her as she progressed through NP school and specialized in Otolaryngology. She is trained in endoscopy, and together we performed both flexible and rigid endoscopy, where I realized that I could hold and control the scopes well with a variety of different grips.

By the third week, I began to see some patients on my own. It surprised me how quickly I was adapting and before long I hardly noticed anything different. What WAS different was my relationship with my patients. Many had heard I had been out on medical leave, expressed their love and concern, and were by this time reading my blog. There was a lot of genuine and sincere discourse, deeper than the usual more superficial conversations, and I was asked to share my testimony over and over. There were a lot of hugs, a lot of tears, and a lot of prayers. It was always so special when a patient would tell me they had been praying for me. Occasionally a few patients asked if they could pray for me…for the healing of their own physician… right there in the exam room!

Return to the Operating Room

Well, I began to have some anticipation, albeit somewhat nervous, about a return to the operating room. Was I ready? Would patients feel comfortable? Was I ready to undertake the awesome privilege of putting a patient to sleep, allowing me to make an incision on their body?

The process began again much like it did in medical school and residency. I began to practice injecting on the skins of oranges, to simulate human skin. Lindsay Reynolds, LPN, arranged with one of our suture reps to procure for me a tying board which allowed me to tie knots and practice sewing with all types of sutures. I practiced with the surgical instruments, and even simulated deploying some of the implants we use in sinus surgery.

Well, the day arrived, and I had only planned one operation. I gave full disclosure to the patient regarding my health condition and informed consent. She needed a revision sinus procedure, and she said she felt completely comfortable with me. In the holding room, she said she had read my blog, and she asked me to pray with her, so I did. As I prayed, both of us began to shed some tears, and we had a shared moment together. Her operation went flawlessly!!!

Over the next 2 weeks, I had more days in the operating room with multiple cases per day. It was very emotional for me to make the return to the operating room. There was an emotional reunion with many OR nurses…nurses with whom I have worked for many years and who had been texting words of encouragement and praying for me. One group had given me a wooden cross, which has been in my pocket for every infusion procedure, in every office clinic, and during every operation I have performed. My nurses and nurse anesthetists are all very experienced, supremely skilled, and have done thousands of cases with me. I have trusted them with my own procedures over the years and with my own family members. I have enclosed some pictures of many of them.

If you’re wondering how all those operations went, they again went flawlessly! It is hard to explain, but when I returned to the OR, my thumb was still a little tender, and I was extremely careful with each and every move that I made. I seemed to be even more delicate with the tissues, and seemed to concentrate even harder, with intense focus. I made sure not to overbook my time and had no schedule pressures. It was absolutely incredible how perfect these cases went, even with a few moves that needed some adaptation.

Next up…I am scheduled for my fifth infusion but suffer a setback.