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.