Melanoma

The Portrait

/ Dr. Lee Bryant / 4 Comments

As we left off, my medical diagnosis forced me to take a deep breath, slow down, and redirect how I spend my time. As I mentioned before, despite the medical treatment and the inability to work, I somehow developed a lot of joy and peace in my life.

As I continued to recover from the flu-like symptoms of my first infusion of Keytruda and as my thumb and axilla continued to heal, all before I had the ability to return to my medical office, I began a new daily routine. I found that exercise helped me to combat the fatigue from the Keytruda infusions, and I started my day with an hour long “prayer walk.” With my crazy schedule prior to my cancer diagnosis, I did not have this kind of time! I spent an hour a day, early in the morning, walking and intentionally praying for others, not for myself. Pastor Tom Gholson and Pastor Jack Foster had always talked about the power of prayer, but I never really slowed down enough to really spend many hours a week in prayer. As a matter of fact, on one of my walks, I stopped in front of Jack Foster’s house (August 22, 2021, to be exact) and bent down on one knee to pray for Jack and his beautiful wife, Jenny. It was a powerful moment, and there was a walker going by who must have thought I was a little off, and suddenly found a second wind and took off running away from me!

Secondly, I would then spend some time on our front porch with a daily devotional, and my relationship with God seemed to grow powerfully and more deeply. My quiet time in the Word would sometimes turn into 2-3 hours of reflecting on Scripture more deeply than ever. Many scriptures became more deeply imprinted in my mind, with some of my favorites including Luke 9:23-24, all of Romans 8, Psalm 119:65-72, and James 4:13-17.

Third, in addition to my spiritual well-being, I began to focus on some of the physical aspects that I could control- diet and exercise. As a physician and surgeon, I know what a difference that these activities can make not only in the healing process but also as a preventative measure. I will expound on these topics in a future blog.

As I recovered, I began to miss seeing my horses. My father, Grady Sr., and cousin, John Ricks, had kept up the daily work of feeding the horses and making sure they had a good supply of hay. John is a dear blessing in my life, and without him, we could not keep the farm running. So, the first day back on the farm was uplifting. As an ENT surgeon, we use a lot of technology and work with many companies that supply that technology in the OR. Many of the representatives for those companies spend countless hours in the operating room suite with us, and we get to know each other well. Michelle Miller works for a company that provides all types of stents designed to keep surgically created openings from stenosing back down. We both share a passion for horses and riding, and she has her own horse. Because I was unable to do any farm work, she volunteered to come out one day and help with the horses. She cleaned all my stalls, a term called “mucking,” and groomed all my horses. All I could do was watch, but she tacked up two of my horses and breezed them in the riding ring. She got to experience smooth gaited Tennessee walking horses for the first time and returning to the farm was another little victory for me!

  • Kellee, grandson Bradley, and myself
  • Michelle Miller
  • Reunited with Duke

Kellee and I were developing a new life plan. This plan involved slowing down, allowing me time to do all the things I could control physically to give me my best shot at surviving and thriving despite my diagnosis, achieving financial freedom by downsizing our home and becoming debt free (got both home closings behind us), spending more time with our families, reconnecting with our friends, and doing more Kingdom work. This time was truly transformative, and I genuinely felt God’s presence more in my life. Although it is a continual struggle because I am human, my thoughts turned away from material things that really do not matter, and more toward thoughts of grace, kindness, forgiveness, and many other fruits of the Spirit. Pastor Jack communicated to me regularly that this transformation was palpable.

The Portrait

Pastor Jack sent me an article by Tim Keller, an American theologian and pastor of Redeemer Presbyterian Church. In the article, titled “Growing My Faith in the Face of Death,” Keller discusses how he intellectualized God for most of his pastoral career, but that a cancer diagnosis had taken him to a greater and deeper relationship with God, and enabled the process of sanctification in his life. His metaphor about how he and his wife now experience vacation really mirrored my current life circumstances. Keller’s wife loved going to the beach. He stated that prior to his cancer diagnosis, when on vacation, that his wife’s joy at the beach was stolen because each day she would lament that it was one more day closer to going back home. In addition, while he was there, he would be planning the whole time his next set of teachings or sermon series. After his cancer diagnosis, he and his wife experienced a change, and could just sit, hand in hand, and enjoy a beautiful sunset together…in that very moment…in God’s presence…without worrying about tomorrow. I have experienced the same transformation. My metaphor relates to a family photo taken at the beach from many years ago that has been on our dining room for years. I walked by it daily for over almost 20 years, yet I never really looked at it closely or acknowledged it. However, after reading Pastor Keller’s article on the front porch, after I walked inside, I actually looked at it for the first time in years. I stared at Kellee in the photo, and for the first time, I realized how beautiful she was in that picture. I experienced not just her outward beauty but also how she radiates her unconditional love for me and our family. I stood there for 10-15 minutes or so, weeping the whole time, with tears of joy for that moment, with tears of gratefulness for her putting up with me over the years, and finally with some tears of sadness that maybe I had missed other moments because I was too focused my earthly future, and not truly focused on Heavenly thoughts and what really matters. Please remember to take a deep breath today and feel God’s presence…today…right now…in the moment.

Peace of Christ to you this week! Next up…my second infusion.

Slow Down

/ Dr. Lee Bryant / 4 Comments

As I left off in the last blog, I described the day of my first IV infusion of Keytruda. After surgery for my right thumb malignant melanoma with sentinel node dissection, I would need a full year of these infusions to reduce the risk of recurrence. After the first infusion, I developed flu-like symptoms including fatigue, brain fog, muscle aches, and bone aches. My right arm continued to remain very tight and painful, and my thumb was continuing to heal. Over the next few weeks, I would have time to rest and to recover physically, emotionally, and spiritually. I would have time to reflect on my life prior to my diagnosis of cancer and to redirect my life with more balance. When I reflected on my life schedule prior to my diagnosis, it was absolutely mind boggling to me. I thought it was just a normal routine for a surgeon, but I was caught up in the busyness of life and neglecting my wellness.

Personal Life

Prior to the Covid pandemic, my days consisted of early to rise at 5 am for a workout, get dressed, eat breakfast, and out the door as early as 6:15 am when I had 7 am operating room starts. I typically would have a 45 minute – 1 hour commute home, and often would review imaging studies and finish notes in the evening. I was on call frequently on Monday nights and every few weekends, some busier than others. Wednesdays were always a long day in the operating room and then a rush across town to make supper at church around 5:30 – 5:45 pm followed by choir practice.

Other weeknights, Kellee and I often met at Nashville Predator hockey games, something we enjoyed together, but there were a lot of games, and it made for long clinic days the next day. We also attended every single Tennessee Titan home NFL game. After attending Brook Hollow Baptist Church, we would hustle down to Nissan Stadium on Titans home game days. On Sunday nights, Kels and I started hosting a young adult ministry in our homes, called “The Back Porch.”  We hosted these young adults for a fantastic meal, courtesy of Kels, and then we would worship together both in song and with a video series and discussion moderated by me. We remain very close to most of this group, many of whom have graduated from college, started families, and are doing great in their careers. In addition, I had a lot of hobbies (horseback riding, fishing, target shooting). I helped my Dad and Mom run a working farm, with several horses and lots of donkeys.  I spent most Friday afternoons working at the farm mucking stalls and grooming/caring for the horses. I have been riding horses for over 50 years, and it has always been a passion (so I have enclosed several farm pictures!) So, everyday life was crazy busy, not counting all the time Kels and I spent with our extended families on both sides. We both have big families and would gather frequently for birthdays and holidays. And that was just our personal life!

Me with some of our donkeys, and riding with my daughter, Alex.
My good buddy, Highland.

Life as a Surgeon

Professionally, I had a passion for performing sinus surgery in the office, and over a 10-year period, along my practice partner and close friend of 33 years, Dr. Scott Fortune, helped to develop techniques and anesthesia protocols to allow us to perform many procedures in the office that would have typically been performed in the OR in the past. I began working with a company called Entellus, which was later bought out by Stryker. Our office became a designated Center for Excellence by Entellus and later by Stryker. Along with Dr. Fortune, I became a Physician Trainer for Entellus and later Stryker. We both began to lecture and teach all around the country. Both Dr. Fortune and I hosted physicians on Fridays to watch us operate in the office and learn our protocols. This grew into a situation that was at least 3 Fridays a month. Often, we would entertain the physicians and company representatives on Thursday nights before the cases on Friday, taking an evening away from spending time with Kellee. I was nominated to be on the election ballot to be on a Board of Director At Large for of the American Academy of Otolaryngology/Head and Neck Surgery. I gave several national presentations at the American Academy of Otolaryngology/Head and Neck Surgery. I had served as Chief of Surgery at Summit Medical Center for 5 years and was later asked to be on the Board of Trustees, where I served for 6 years, 3 of which were serving as Chairman. I also served as a Clinical Instructor for Trevecca Nazarene University PA program, hosting students for 6-week rotations with me. I continued to serve on the Deacons Committee at church, with 2 stints as Chairman (the last one being during the Covid pandemic). Finally, I served for over 2 decades as President of Allergy & ENT Associates of Middle Tennessee, our company that had 40-50 employees. I somehow found time to do consulting work, including peer review work and expert witness work for malpractice cases.

Dr. Fortune and myself before a lecture in New Orleans.

So, the busyness of life had slowly crept into my life, taking away sincere and daily lengthy meaningful time in prayer and in the Word. One would think that having multiple hand surgeries for trigger fingers in 5 years would alert me that I was going too hard and needed to slow down. But it took losing a part of my finger to slow me down! Brook Hollow Baptist Church Pastor Tom Gholson was preaching a series of sermons from James and read the following scripture. James 4:13-16 says, “Now listen, you who say, ‘Today or tomorrow we will go to this or that city, spend a year there, carry on business and make money.’ Why, you do not even know what will happen tomorrow. What is your life? You are a mist that appears for a little while and then vanishes. Instead, you ought to say, ‘If it is the Lord’s will, we will live and do this or that.’ “  

My medical diagnosis forced me to take a deep breath, slow down, listen for those providential moments I have described previously, and redirect how I spend my time. Life is just a mist! What are we doing? Are we focusing on heavenly things? Despite the medical treatment and the inability to work…I began to experience a lot of joy in my life…

My First Infusion

/ Dr. Lee Bryant / 10 Comments

As we left off, I was recovering from my partial right thumb amputation and sentinel node biopsy. And Kellee and I got the great news, in a providential type of moment, that my sentinel lymph nodes were negative for any cancer cells. I was found to have Stage II disease. Considering that my original lesion presented 5 years earlier, it seemed almost miraculous that my metastatic workup was negative. I took the liberty to assume that my age, lack of any other medical problems, healthy diet (no red meat or dairy), and exercise level (training for triathlon) maybe was keeping my immune system strong enough to battle. And now I did not regret my crazy decision to biopsy my own nailbed!

Almost 2 weeks after my surgery, I sought a second Oncology opinion, which is often a wise idea. As a matter of fact, for every single patient to whom I recommend an operation, I offer a second opinion because I want them to feel completely comfortable both with me and their decision. I got the exact same treatment recommendations, so I kept my original team of physicians where my care would be under the same umbrella. Because of the depth of my melanoma and some other histologic factors, such as ulceration and high mitotic activity, it was felt that I would need further therapy to reduce the risk of recurrence. There are new promising drugs, that are called PD-1 receptor blockers, which help restore the T cells of our own immune system, prevent deactivation of our T cells by tumor cells, and thus restore our body’s ability to combat and destroy tumor cells. These drugs are in a class called biologics, and the treatment is a form of chemotherapy called immunotherapy, administered by intravenous infusion.

My First Infusion:

Exactly 3 weeks after my surgery, I was scheduled for my first IV infusion. I would be scheduled for a full year of treatment, with the first 5 treatments being 3 weeks apart, and then the last 5 treatments being 6 weeks apart, as long as I could tolerate the therapy. This type of drug has common side of effects of nausea, fatigue, muscle pain, bone pain, brain fog, and others. More serious side effects include conditions such has liver toxicity, pneumonitis (pulmonary toxicity), renal toxicity, and others. The drug is intended to enhance one’s immune system against tumor cells, but also can cause the body to attack itself. Naturally, there was some anxiety about how well I would tolerate the treatments. A typical infusion day involves a check-in process, going to a lab to have an IV inserted, and having extensive labs drawn. I decided to try being infused with peripheral IVs to avoid a portacath placement if my veins would hold up. After the labs are returned and evaluated, there is an appointment with my Oncologist, after which I head to the IV infusion center for IV saline fluid, followed by my cancer drug infusion, followed my more saline fluids. It is quite the process and somewhat exhausting at times.

My Mistake:

That first infusion day, I had a gap between my Oncology appt and my infusion. Therefore, Kellee and I decided to grab some lunch at the hospital cafeteria, with the IV already in my arm and all covered up by coban wrap. I also happened to be a patient at the academic medical center where I trained as a medical student and resident physician. As we entered the cafeteria, it brought back memories of late dinners alone before a long night on call in the hospital, and memories of early morning coffee and breakfast after operating all night long. It also brought back memories of my nervous stomach and GI distress, memories that were soon to become reality again! I apologize but this is about to get personal! I had been eating so healthy (anti-cancer diet to be explained in another blog), and I thought I may want some comfort food. So, I skipped all the healthy stuff and went straight for the stir fry Asian food…spicy chicken over some fried rice and maybe a fried roll also. After I consumed all of my own plate, I proceeded to eat about half of Kellee’s plate as it was just too much for her. We then checked in at the infusion center. As we entered the private room, one of the nurses asked if I had eaten a light lunch because the infusions can make one very nauseated…bahahahahahaha. I did not have the heart to tell her I was already nauseated, bloated, and flatulent….well before the infusion ever started. Lesson learned! Thank goodness for nausea medication.

My Nurse:

In all seriousness, I want to close this episode sharing about the most wonderful nurse I had. I want to share with you how nurses make such a difference in the lives of patients. I also want to thank all the nurses that have ever worked for me in my office or with me in the hospital, operating room, ER, or surgery centers. I am just going to use her initial “M.” Although we had seen a lot of care providers, it had all been about my workup, diagnosis, prognosis, percentages, and treatment. As a physician turned patient, I soon realized that sometimes we have so much schedule pressure that we do not always embrace the emotional needs of our patients: their anxiety, their fears, their worries about their jobs, their concern for finances and medical bills, their concern about their families, their spiritual health and search for truth, etc. Here I was, a right handed surgeon with an amputated right thumb, currently unable to work, and worried if I would ever work again or when, worried about my family, worried about innumerable issues. So when M came out and called me and Kellee back, she made eye contact, the kind of eye contact that says “I see you and I know you are scared.” She asked, “How are you doing?” as she reached out and tenderly touched my shoulder, in a comforting manner. As we arrived in the infusion room, she asked if this was our first time, and we said yes. She asked a little bit about my story, and heard some of the craziness of my diagnosis, how I biopsied my own thumb, and my career as a surgeon. She connected with me and Kellee, and the first thing she did was to comfort us and tell us everything to expect. I shared some of my faith journey and the wooden cross that I kept in my pocket that had not left my side since it was gifted to me by some of my OR nurses. We talked about God and faith. And then, the most amazing moment happened. She dropped down on her knees between me and Kels. She took Kellee’s hand in her left hand and she placed her right hand on top my bandaged thumb and then proceeded to pray over us, asking God to comfort us and give us peace and strength, and to trust in Him. Tears were being shed! We greatly needed that emotional connection. My infusion then went flawlessly, with the exception of the GI distress which more than likely was related to my overindulgence of stir fry at lunch!!!

Moving forward, I plan to share how I spent my time recovering from surgery, regaining strength, preparing to return to work, and most importantly, how I embraced a new lifestyle with more balance and a deeper relationship with God.

“4:05”

/ Dr. Lee Bryant / 15 Comments

As I rested and recovered from surgery involving partial amputation of my right thumb and sentinel node biopsy for my malignant melanoma, we began the process of waiting for the pathology on the lymph nodes to be resulted. Whether or not they were positive or not would determine my final stage. The status of the two sentinel nodes would affect my staging, prognosis, and treatment. What I am about to reveal is what happened exactly as it unfolded. I have used the term “providential” with others, and you can make your own conclusions. I still get chills down my spine every time I tell this story.

My surgery was on a Wednesday, so we really did not expect any results until the following week. However, 5 days later, on Monday, I began to get very anxious and started checking my email more frequently. As a few days turned into a week, both Kellee and l were getting more anxious for the results by the hour. I began to have difficulty concentrating on anything else and developed some insomnia.  A complete week went by and still nothing. However, on Thursday morning, 8 days after my procedure, Kellee sat straight up in bed, just before 5 am, and woke me from a deep sleep (I believe I had just finally gotten to sleep in the wee hours of the morning with a sore armpit and elevated right upper extremity). She conveyed to me that she had a vivid dream or communication that my test results were revealed at “4:05.”  She never ever mentioned or discussed remembering dreams with me in the past.  Anyway, it was so clear to her that she woke me up and asked me to check my email on my phone, which I did, and there was nothing there. We went back to sleep. Later that day, my son Gray’s fiancée, Molly, called at lunchtime, and asked if “Dr. B’s path results were back.”  Gray and Molly are both fourth year medical students, and Molly called during a lunch break on one of her clerkships. Kellee and I were both in the kitchen, and I heard Kellee specifically tell Molly, “No,” but then explain how she had a vivid dream that morning that my test results came back at “4:05.”  She explained to Molly how she even woke me up to check my phone. Kels and I really did not think anymore about that conversation for a while…..

 Later in the day, at approximately 4:01 or 4:02 pm,  I checked my email (as I has been doing all day), and finally there was an email from the medical center time stamped at  “3:58 pm “ (and still there on my phone today) that I had a new test result on my patient portal.   My heart began to beat faster, and I knew that this likely represented my path results. Kels and I were in the den together, and I asked her to sit down beside me to pray with me.  Next, after our prayer, I opened the portal (not realizing at the time it was 4:05 pm) and clicked on my path results, revealing “sentinel lymph node 1 was negative for tumor and sentinel lymph node 2 was negative for tumor.”  We stopped right there and began crying and praising Jesus. I will be honest with you: I began jumping up and down all over the den and fist pumping liked I had just scored a touchdown! Another answered prayer!

Later in the afternoon, after we had called Molly and Gray with the good news of my path results, Molly remembered her conversation with Kellee, and asked her what time she dreamed the path was revealed.  Chills went up and down both of our spines as we retraced the sequence of events and realized we opened the patient portal likely exactly at “4:05.”  I assure you that this sequence of events unfolded exactly as I have shared them. Please interpret this encounter as you see fit. But through this journey, I have genuinely felt God’s presence in my life, and I assure you that it is 100 percent genuine and not a self-serving, hyper-religious coping mechanism. There will be more providential moments to share, and maybe we all have them…but are just not slowing down enough to listen to them.

Now that my tumor was staged, I could get on with a more definitive treatment plan. We already knew that based on the depth of my tumor and the presence of other features, such as ulceration and high mitotic activity, that I would likely need some more systemic therapy called immunotherapy, but the fact that my tumor was more localized was great news.

That weekend, I reached out to a longtime friend and former head and neck cancer patient of mine who now lives in Texas, Matt Lee.  My words to him by text were exactly as follows: “I felt compelled to reach out to you when I got the news. We are very similar in our world views. And I walked you through your fight with cancer. You and God beat it. He had more Kingdom work for you on earth.”  Matt, formerly a professional golfer and still a scratch golfer, spent a large part of his adult life educating others on the dangers of tobacco use and risk factors for head and neck cancer. He texted back these exact words: “And now it’s my honor to be here for you and you should know I will do what I say. Support, prayers, friendship, whatever you need to win the war.”  And we came up with this plan for cancer: “1. Surviving and thriving for others to be brought closer to Christ (through my victory over cancer) or 2. Battling with such a spiritual demeanor that I am a witness through the battles until I get to go home = my job well done.”

I have pledged to stay the course with this plan. You will soon be caught up to present with my story, which is still being written. It is my hope and prayer that it helps some others battling cancer or other adversity in their lives.

Surgery Day

/ Dr. Lee Bryant / 8 Comments

As we left off, my pre-operative workup was complete for the malignant melanoma under my right thumbnail; Kels and I had contracts on our new home, which would be a downsize, and our current home; and I took a day of rest in preparation for my surgery, pleasantly surprised by a visit from my 3 life-long relatives/friends, Lee Randolph, James Sutton, and Ronnie Carter, who prayed over me in my living room the night before.

My surgery date was exactly 2 weeks after I was operating on my own patients and received the call from my Pathologist between operations, revealing the diagnosis of malignant melanoma. I will say that I am extremely grateful that had I have access to such stellar and speedy healthcare. In under two weeks, I had seen 4 physicians in consultation, undergone plain x-rays, undergone MRI scans of my brain and upper extremity, undergone a whole-body PET/CT scan, and was on the operating room table! Once the diagnosis of malignant melanoma was made, it was hard to keep it out of my mind since it was so readily visible right there on my right hand. I was extremely grateful for my health care providers and was ready to move on with what we surgeons call surgical extirpation of the tumor.

For my surgery day, the plan involved partial amputation of my right thumb, clearing the margins of the tumor, reconstruction of the thumb, and sentinel node biopsy of my lymph nodes, likely being in the region of my right axilla. I was to report to the medical center around 6:30 am to be checked in by 7:00 am in the Nuclear Medicine Department. For the sentinel node biopsy, the Surgical Oncologist would identify and sample the lymph node (or two) that was the most likely to receive any tumor cells if they had spread beyond my primary tumor. The nodes would be removed and evaluated by the Pathologist to see if there had been any microscopic spread of tumor cells that would not have yet been identified on imaging studies. Localization of the sentinel node or nodes involved two aspects: 1. Lymphoscintigraphy in which a radioactive tracer, Technetium-99m, would be injected in and around the tumor prior to surgery so that it would be taken up by the sentinel nodes and could be detected with a gamma counter probe during surgery, and 2. Injection of lymphazurin blue dye around the tumor during surgery which will stain the lymph vessels and lymph nodes blue to help with visualization and mapping.

I did have some topical anesthetic cream to be placed on my thumb to help tolerate the injections of the radiotracer in the Nuclear Medicine department. Either it did not work very well, or I erred in the timing of the placement of it, but those 4 injections in and around my fingernail were painful!  After that, I checked into the pre-operative area for surgery, was prepared for the procedure, kissed Kellee, and was on my way to the operating room. For obvious reasons, I had very little recall of the rest of the day. All the surgeons told Kellee that everything went well, and the Surgical Oncologist felt confident that they were able localize the sentinel lymph nodes, the first representing most of the radioactivity, followed by a second one that had the remainder of the activity. The team felt good about the surgical margins and had to amputate the thumb back to the first joint or knuckle, but preserving enough of it that I would have the ability to use it and oppose other fingers to it.

Over the next few days, I had a large bandage on my right thumb and a healing incision in my right armpit. Basically, I had to adapt to performing activities of daily living all left-handed. I had to eat left-handed, brush my teeth left-handed, and try to bathe myself left-handed. Fortunately, although I am right-hand dominant, I am also ambidextrous to some degree. I naturally have much more upper body strength on my left side, so in my youth I taught myself to play ball with either hand. I played baseball left-handed, but I could hit both ways. I can shoot a basketball with either hand. In my adult life as a surgeon, I typically remove the right tonsil with my right hand and the left tonsil with my left hand. So, I did not find this immediate situation to be very inconvenient.

As I rested and recovered from surgery, we were anxiously awaiting the pathology on the lymph nodes. Whether or not they were positive for cancer cells would determine my final stage. How this information was revealed to us is quite the story, and I will tell it in my next blog.

More Answered Prayer and Ready for Surgery

/ Dr. Lee Bryant / 7 Comments

As we left off, Kellee and I had received some good news about the MRI of my brain that was clear and about the whole-body PET/CT scan which also came back clear. The very next day after the PET scan, I met with yet another surgeon, a Surgical Oncologist, who prepared me for additional surgery that would be needed. In addition to the partial amputation and reconstruction of my right thumb to clear the margins of the malignant melanoma, I would need to undergo a sentinel node biopsy. I will explain more about the details of this part of the procedure later, but the procedure allows the surgeon to determine the lymph nodes to which tumor cells most likely would travel if it spread via the lymphatic system.  Next the most representative of those nodes is removed and sampled to assess for the presence of tumor and to help with staging. I also met with my Medical Oncologist that same day, who was encouraged about my imaging results, but also said that my staging and thus prognosis would be determined more once the pathology of the sentinel node or nodes is back. The very next day I reached back out to my Orthopedic Oncologist, and my surgery was set to be performed the following week, with a team of 3 surgeons. Everyone was ready to go.

Next, Kellee and I were discussing all the possibilities of how to move forward, receiving healthcare, and how to manage our finances if I would be limited in my ability to work or not be able to return to work at all. In our mid-50s, our only debt was really the mortgage on our house. Everyone says not to make major life decisions under duress, but we had talked about downsizing in the past. We had 3 bedrooms and 3 baths upstairs with an additional bonus room….and we hardly ever went up there. So, we were considering a change, but we love our neighborhood with lots of yard space. We went to an open house that night less than 2 miles from our house, but smaller than our house, more of a ranch style. We loved the house and decided to make an offer. The very next day on a Friday, the sellers countered, and we accepted. We had a deal! Another answered prayer! After we got the contract, Kels and I worked until the wee hours of the morning cleaning out our den in preparation to put our house on the market. There was so much uncertainty at this time regarding my health status, work status, and now we had a contract on a house before selling ours. Kels and I were both anxious but trusting in God.

On Saturday morning, we frantically worked on the house all day to get ready to place it on the market. I placed new pine straw in the beds out front and sold several items on Facebook Marketplace. Kellee worked tirelessly cleaning out and staging the house. My daughter Alex, our realtor, and our son-in-law, Brad, came over that evening to help us start the process of listing our house. Time was of the essence, since we had a contract on the new house, and needed to sell ours to make it all work. We had planned to do a lot of painting, book a professional photographer, do professional staging, and have an open house. On a whim, I took a few pictures, and we listed the house that night. Within 24 hours, we had several showings, an offer on the spot, and a contract! Another answered prayer! Over the next few weeks, we began to reflect on how so many things were working out for us. And we began to anticipate a future with less financial liability, less dependency on material things, and more happiness and joy in glorifying God and spending more time with Him rather than the everyday business of life.

So, by this time, I had one day to rest on a Tuesday before my anticipated surgery date on Wednesday, August 4. I had continued my training for my triathlon, even though I knew I would not be able to compete in it.  I needed some rest after a hard cycle workout that morning and a hard swim workout just 2 days before.  But I had a pleasant surprise coming…….

I got a surprise visit from my cousin, Lee Randolph, and two of my closest friends since childhood: Ronnie Carter and James Sutton. Kellee knew they were coming, but I had no idea. I want to share just a little bit about the days of our youth in Goodlettsville, TN, and then share a little bit about that evening. Lee Randolph, along with another Lee with the last name Harris, grew up with me almost like brothers. Our parents took us to Goodlettsville First Baptist Church, taught us to love God, and taught us right from wrong. Now I know that the community in which we grew up in the 70s and 80s was a much different time and place than now, but we grew up with little to no rules, at least for me personally, and freedom to learn from our mistakes (lots of them). Lee Randolph and I spent many hours together working and playing on my parent’s farm. We imagined ourselves as cowboys around 9 and 10 years old, except that we rode real horses and shot real pellet guns. We rode 4 wheelers, mopeds, motorcycles, and bicycles and never had a helmet. One favorite activity was to head our bicycles down the steep road, Draper Drive, in front of Randolph’s house, take a sharp turn onto his gravel driveway, then hit a homemade ramp in his front yard and see how far we could fly. We did not always stick the landing, and I remember when Randolph broke his femur. I had to help carry him in the house when he came home from the hospital in a full body cast in the back of my parent’s station wagon. We had to turn him sideways to get him in the door and almost dropped him! He will not find this funny! Later, I competed in horse shows, learned to start horses, and learned to always get back on when bucked off. I was driving tractors by age 10 and had an actual driver’s license at age 14, the age at which I got my first two speeding tickets! I never had a curfew growing up and took full advantage of that! The 3 “Lees,” Ronnie, and James all played a lot of ball together, and James’ father was one of our coaches for years. One of our favorite pastimes was to put on actual boxing gloves and fight each other; yes, there were technical knockouts and real knockouts. We were all a little crazy. People could call us a lot of things, but one thing they could not say is that we were not tough (apology for the double negative). My toughness and my ability to fight this cancer come from those days, from working with horses, and from all the team sports in which I participated in high school.

So Lee Randolph, Ronnie, and James all showed up at my house, the evening before surgery, and spent time. We had been “brothers” since we were in diapers in the Goodlettsville First Baptist Church nursery. We always show up for each other in time of need or crisis, and there is no doubt that we would take a bullet for each other. As a matter of fact, Ronnie is an Ivy league educated long standing officer in the Marines and is one of those guys who would sacrifice for all of our freedoms. The boys just sat around and reminisced about the “good ole days.”  James always keeps us laughing, and continued to command the room like he always does, our ring leader. And then I got in the middle of the room as they all gathered around me. They laid their hands on me and we all hugged as they prayed over me. They asked for Father God to give me peace and strength and prayed for my healing if it be God’s will. I love those guys, and they know it. I was ready for surgery, which will be the next episode.

Answered Prayer

/ Dr. Lee Bryant / 18 Comments

When I left off, I had spent the weekend with my immediate family after learning that the lesion under my right thumbnail that had been present for a while was malignant melanoma. As a surgeon, I had performed the biopsy on myself. During that weekend, I came to peace with that diagnosis, accepted the Lord’s will to be done no matter what the outcome, experienced old hymns from childhood that would continue to comfort me, and was finally able to eat and sleep again.

Monday was to be a big day. My wife Kellee and I had spent the past couple of business days working on our affairs and planning for “worse case” scenarios. So, the first meeting of the day was with our personal attorney downtown to sign and finalize our updated will. Then, the rest of the day was dedicated to the first series of medical consultations and to starting the workup and staging process for my cancer.

I found myself back at the large academic medical center in town, where I had trained for 10 years (4 years of medical school and 6 years as a resident physician). But now, instead of being a caregiver, I was the patient. Becoming the patient was a somewhat humbling experience! After answering the medical questionnaires and filling out all the demographic information, I was asked to remove my clothing and put on a hospital gown. Before meeting with the first surgeon, I was escorted down the hall by a nurse to get a plain film (x-ray) of my thumb. I sat in a little waiting area with two other patients who also were wearing the same attire: hospital gown, underwear, and socks. It seemed surreal that just a few days ago I had been treating my own patients.

Over the course of the next several hours, I met with resident and attending physicians. I did receive the first bit of good news. The plain x-ray did not reveal that the distal phalanx, or bone of my thumb, was involved by any tumor as sometimes is the case when it has been present for so long. However, I did learn that I was going to need to undergo a partial amputation of my right thumb, likely back to the first joint if all the margins were clear. This was really no surprise to me, but the reality of being a right-handed surgeon was beginning to sink in, and my mind raced to all the possibilities and to whether I would be able to adapt very well or not.

That evening, I was scheduled for my first major round of imaging studies. I was to undergo an MRI scan of my right hand and of my brain. The imaging study of the brain would be used to evaluate for any distant metastases (distant spread) of tumor to my brain. Because of the multiple consultations and logistics, my imaging studies were delayed and rescheduled to be performed in the evening. It had already been a long day, but as the sun was setting, I walked with Kellee into an empty waiting room, late in the day, to embark on a 2-hour imaging session. I first underwent several series of imaging sequences, followed by intravenous access for contrast administration, and then had to finish up with more imaging sequences. The MRI technician was working late into the evening, and she was so compassionate, courteous, and professional. I shared with her how appreciative I was that she was willing to stay late and provide care for me. We were running late because of our appointments; however, the Radiologist, the receptionist, and this MRI technician all waited for me. I shared with her that I was a physician and surgeon, somewhat apprehensive about what the future might bring. I laid there and prayed for the solid two hours, wondering what the scanner was finding with all that loud knocking as it sliced through my brain. When it was all over, I got the fantastic news that my brain images were all clear…no evidence of brain lesions…answered prayer! I was moved to tears as I walked back to car with Kellee. We finally got a little good news. I saw the pronoun “we” because Kellee has been right there beside me every step of the way on this journey.

Dr. Bryant and wife Kellee

Next, two days later, I was scheduled for a whole-body PET/CT scan. This type of study is a complicated one. Certain types of human tissue have a high metabolic activity, and this can be measured by how much glucose is being taken up as fuel for cell division and growth. For this study, fluorodeoxyglucose, or FDG, is a radioactive tracer that is used. The radioactive isotope is attached to the glucose molecule so that it can be picked up on the imaging study. Tumors tend to have a high metabolic activity and can be identified by the PET scan. The activity on the PET scan is compared to any lesions that might be found on a standard CT scan, and this information can be very valuable in determining if there is distant spread from a primary tumor. First, an IV inserted into my arm, and then the FDG was administered. I then had a one hour wait to allow the radioactivity to spread throughout my whole body. After the waiting period, I then spent the next hour in the scanner, praying the whole time! Again, I just laid there wondering what the imaging study would find as it scanned my lungs, my liver, my bony skeleton, etc. Being a physician, I took the liberty of asking to speak to the interpreting Radiologist after the study, because the waiting is so tremendously difficult. The radiologist called me back into the reading room, and we reviewed the images together, which revealed that they were completely clear. Another answered prayer! I ran out through the waiting room, waving Kels to come with me, and began crying and praising Jesus loudly in the hallway of the hospital, a hallway I had walked so many times and for so many years as a medical student and later as a resident physician during my medical training. I was so emotional and filled with tears that I lost all my sense of direction, and simply asked for Kels to grab my hand and lead me to the car. Being on the other side, as a patient, has given me so much more of an emotional connection with my patients I now treat every day. And yes, as you follow along this journey with me, you will see how I have worked my way back to the medical office.

At this point, we had again received some great news, answer to our prayers, and we would continue to receive more good news. A peace began to fall over me and Kellee, a peace that only God could provide knowing that I was a surgeon who would soon undergo partial amputation of my thumb. We were learning how to live our lives just one day at a time and be happy in the present and in the presence of God.

Until the next post, I will leave you with some words by the pastor, theologian, and author, John Piper. He said, “No one ever said that they learned their deepest lessons of life, or had their sweetest encounters with God, on sunny days. People go deep with God when the drought comes. That is the way God designed it. Christ aims to be magnified in life most clearly by the way we experience Him in our losses. When everything in life is stripped away except God, and we trust him more because of it, this is gain, and He is glorified. “

Embracing My Diagnosis, My Family, My Faith

/ Dr. Lee Bryant / 8 Comments

As we left off, I had been notified by phone of my diagnosis of malignant melanoma, acral type, under my right thumbnail.   I received the call between operations and had to finish the last case.  When the documentation and family conference was finished, I headed straight home.  I called my wife Kellee on the way home, and we decided to determine a course of action together.

Lee and Kellee (with Baylor)
Alex, Brad, Bradley, Jack

We decided to tell our kids first. Let me tell you a little bit about my family. I have already mentioned my sweet wife Kellee, who is always there for everyone in our extended family; everyone who meets Kellee loves her! Our oldest child, Alex, just turned 30 years old. She married her high school sweetheart, Brad, in 2017, after they both graduated from Penn State University. Alex has a doctoral degree in physical therapy, is a practicing physical therapist, and is also a successful realtor. Brad started his professional career in the NFL for couple of years with the New York Giants, and is now a successful businessman and developer, who runs his own company. They have two little boys, my grandsons, Bradley and Jack. Our other child is Gray. He is currently in his 4th year of medical school and will soon be the next Dr. Bryant. He is a “gentle giant” with a great smile and compassionate heart, liked by everyone who meets him. His fiancée, Molly, is also in her last year of medical school, and she is as pretty on the inside as she is on the outside, with a passion to treat children. They will get married and graduate medical school together next Spring.

Gray and Molly

The day after I got my diagnosis, I first got the haircut mentioned in the last blog!  Then began a process through which I am sure many of my own head and neck cancer patients have walked, but I now had the experience of walking in their shoes.  I began notifying some other close friends and family.   I reached out to three men to whom I refer as my spiritual mentors:  Pastor Tom Gholson, of Brook Hollow Baptist Church, where I attend; Pastor Jack Foster, of West End Community Church; and Pastor Barry Smith, of Generation Changers Church.  All 3 have continued to walk with me faithfully on this cancer treatment journey. I reached out to my 2 close friends and cousin since childhood (Lee, Ronnie, and James) with whom I have always communicated frequently.   I reached out to my closest adult friends, Worrick and Dwight.   I reached out to one of the senior officers of our large multispecialty organization about the logistics of medical leave, and he shared his own melanoma story with me.   I had to think clearly and embrace the thought of needing to make sure my own affairs were in order.  I reached out to my long time attorney to make arrangements to update my will.  I did some research on where I stood as it relates to my life insurance and long-term disability insurance.   I had scheduled an appointment to meet my new Oncologist, and he was kind enough to discuss my case over the phone before I had even met him. He arranged for testing to be performed the following week to start the process of staging, a process where they determine whether a tumor is more localized or if there is metastatic spread to distant organs.  Considering the long presence of my pigmented lesion and this type of melanoma, there was good reason to believe that I could easily have stage III or IV disease with an poor prognosis.  An MRI of my brain would be performed along with a whole-body PET/CT scan.

Over those few days between my diagnosis and the first day of medical appointments and scans, there was a lot of emotional and spiritual anxiety.  For my own patients, I know the most difficult time can be the period between a diagnosis and the definitive treatment plan.   This is the period to which physicians like me refer to as the “workup,” where tests are performed, tumors are staged, prognoses are determined, and treatment plans are finalized.  This was an emotionally tough time for me, and I was having difficulty both eating and sleeping.  Gray and Molly came in for the weekend, and along with Alex, Brad, and the boys, we spent a lot of time together.  We just ate together and loved on each other. I shed a lot of tears, as the thought of not being able to a part of their lives until I reached a ripe old age continued to haunt me.

HOWEVER, at some point in the weekend, through much prayer, I came to a place in my heart that I could accept any outcome.   I sincerely achieved peace with my situation and perhaps the Holy Spirit descended upon me.   Suddenly my head began to be filled with old hymns from childhood every minute that I was alone and continued to do so for weeks.   I could recite these hymns almost verbatim.   Examples included “Holy Spirit, Breathe on Me” and “Softly and Tenderly Jesus Is Calling.”  It was incredible how my thoughts were completely transformed, and that my head and heart became filled with thoughts of kindness, grace, forgiveness, mercy, and love as opposed to former selfish thoughts.  All the sudden, my large house, the pool, the boat, the status in my career, and the pursuit for increased productivity and income vanished from my mind.  I was truly set free in Christ.  These are the words I texted to many people who were reaching out to me.  “I am secure in my eternity.  If my time is short, then I will be in a better place with my heavenly Father.  If I have more time on earth, then I will try even harder to make all my decisions in life to be ones that honor Him.   I have been blessed on earth and have a strong family.  We are all good.  And I have never been one to back down from a fight, so I will fight cancer.”

I went on a spiritual journey the next few weeks. I was drawn even closer to all of our already big extended loving family (Kellee, Alex, Brad, Gray, Molly, my parents, Kellee’s parents, siblings, in laws, nieces, and nephews), and we all shared more verbally how much we loved each other. Pastor Jack Foster and I communicated daily, and he walked along beside me in this journey, along with many other people, including Pastor Tom Gholson. The hymns seemed to change each day, and I could vividly recall words that I had not heard in years. They gave me such peace every day when I was alone or could not sleep. Tests would follow the next week…and some answered prayer.

The Reveal…My Pathology

/ Dr. Lee Bryant / 11 Comments

As we left off, I had biopsied on own right thumb with the concern for melanoma on a Friday after clinic.  Although it was in the back of my mind, I still was not overly concerned because my medical providers were not overly concerned.  As I started the work week on the following Monday, I continued to see patients and operate with a very sore right thumb!   I also continued to train for my triathlon, starting the week off on Monday with a hard Peloton indoor cycle at 5:45 am.

The Reveal:

Later in the week, it was a typical OR day for me.  I was up at 5:15 am and out the door for a 30 minute almost 3-mile run.  I got dressed, ate breakfast, and headed to one of the surgery centers where I operate frequently.  The first case started at 7:30 am.  By late morning, I had already performed 3 operations, and things were going smoothly with a very competent and jovial OR team.   After speaking with the family following the third procedure, I received a call from one of my pathologists, and I recognized his name because he was in the contact list on my phone.  I ducked into a private office and answered.   Then, with some trepidation in his voice, he said he was sorry and had some difficult news for me.  I had malignant melanoma, the acral type, which is an aggressive type of melanoma, often with a poor prognosis.  The histopathology revealed that the entire specimen I submitted from my own hand was tumor, and there were some bad features such as a high mitotic activity…my heart sunk, and I became numb.

Dr. Bryant

I still had one operation to perform.  I had to check my emotions and be professional.  Surgeons like me have learned how to operate under duress and keep our emotions at bay, and we are almost robotic at times.  I trained back in the 1990s, when there were no restrictions on the hours for surgical residents.  During my internship year, I believe I spent every other night on call in the hospital for 9 or 10 months of that year.  During my second year, as a General Surgery resident, I was the “Trauma Dog” for two months on the Trauma Service, where I spent many sleepless hours leading the trauma team in the ED and taking care of victims of polytrauma who were brought in from all over the state on LifeFlight.  There were burn victims, patients involved in severe motor vehicle accidents, gunshot victims, and knife victims.   I watched countless victims die while I was trying to “crack the chest,” stop the bleeding, or rush them to the OR.   During those days, young surgeons learned to detach their emotions and focus on the task at hand.  So, without blinking an eye, I performed the next operation flawlessly and told the family how well it went.  So now what?

I really had no idea about what to do or where to go?  First, I called my wife Kellee and broke the news to her.  I continued to be basically almost numb, as if this were not really happening.  I told her that I would come straight home and we would go from there.   As a physician,  I am lucky to be able to call my colleagues directly, so I began the process of making medical appointments while driving home to see Kellee.    When I saw her, I broke down emotionally.  I knew that acral melanoma is the type with the worst prognosis and tends to be diagnosed late because it can live under a toenail or fingernail for a while and be misdiagnosed as other things, just like mine.   Considering the long-standing presence of my pigmented lesion, there was good reason to believe that I could easily have stage III or IV disease with an extremely poor prognosis.  I could not stop thinking about leaving this earthly world and leaving her behind.  How would she be emotionally?  How would she be financially? And then to the rest of our large extended families on both sides.  (You will here more about my family in the next blog.)

Just a few days later when journaling, it was very hard for me to recall the remainder of that day.  I do remember scheduling a haircut for the very next morning at 9:25 am.  My thought process was that I had no idea when I would be able to get back in the barber chair for a while.

The Haircut:

On the morning after I had received the results of my pathology, my barber, Dennis Redmon, welcomed me into his barber shop with a smile as always.  He is always smiling, and the whole team there likes to have a good time and laugh with the patrons.  I would always laugh and joke around with them; I hardly have any hair, but I just liked going in there!  One time, I was involved in a practical joke on one of the barbers.  Another time, they turned the music up loud, and I cut a rug with the mother of one of the barbers.  I was anxious, but just sat down in the chair and thought about what to say.  Should I tell him I had cancer?  Would I be emotional? 

Dennis has been always overtly Christian and shares his faith with everyone.  We often discuss matters of faith together, and he even hosts Bible Trivia on Wednesday nights in the shop.  As we were wrapping up, I shared my diagnosis with him.  I told him I was a right-handed surgeon who was about to undergo partial amputation of my right thumb, and that the situation might get much worse if the cancer had spread.

Let me tell you what he did.  He said, “Doc, I have a feeling that this cancer is localized.   I have a feeling (maybe the Holy Spirit) telling me that you are going to be OK.”  Then, he said, “Can I go out to your truck and pray with you?”  I said, “Sure!”  We walked out, and he jumped in the passenger side of my truck and put his hand my hand, the one with the cancer.  He prayed the sweetest prayer, asking God, the Great Physician, to put His healing hand upon me, and for me to accept His healing power.  He asked for the Holy Spirit to fill me with peace, strength, and comfort in the name of Jesus.   My eyes filled with tears, as I really needed that prayer! 

 More to come……less darkness and more light

When the Doctor Becomes the Patient

/ Dr. Lee Bryant / 25 Comments

Just two months ago, I was a 55-year-old ENT surgeon, in the peak of my career, on no prescription medications, and training for a Sprint Triathlon….and now I am a cancer patient.   Life can change so quickly!   I have malignant melanoma that developed under my right thumbnail.   I have had so many family members, friends, employees, and patients who have been supportive of me, walking along beside me in this new journey.  In addition, there have been so many providential moments and experiences for me I that felt compelled to journal my progress; now, I feel compelled to share some of this journey publicly for a variety of reasons.   I want to share my perspective as a physician becoming a patient, to share my progress with my friends and family, and to share my spiritual journey.  I will bridge some tender emotional moments as a physician/surgeon with similar moments that I have now experienced as a patient.  The experiences that I share will be completely transparent regarding my medical journey, and they also will be deeply personal.  If I can help one patient or person to feel comfort or feel God’s presence in their lives, then this endeavor will be worth it.  I plan to send a new episode out weekly, and it will take a few weeks to be caught up.    My story is still unfolding and still being written.  Feel free to follow along with me!  When I use names, I will either have gotten permission to use the name or changed the name for privacy reasons.

In December of 2016, I developed concern for my right thumbnail, which had an area of longitudinal redness (longitudinal erythronychia) and some splitting of the nail at the end.   I did some research and was concerned about the possibility of subungual melanoma, and so I sought a Dermatology opinion.  The Dermatology team agreed, and the Dermatologist removed part of my nail and performed a biopsy on 12/15/16.  It was negative for melanoma!  I remember getting the call while I was at work in the middle of busy clinic, and I immediately went into Exam Room 6 and wept like a baby.   I knew the serious nature the diagnosis of melanoma in the nail matrix or nailbed, which usually resulted in an amputation, and I had expressed that concern to Lindsay, my nurse of 23 years.  She also shared tears of joy with me.  I followed up several times, noting that my nail would never really grow back properly.   Over the next 5 years, I underwent several hand procedures to release trigger fingers, a hazard of the job as a surgeon.  The many years of performing surgery had taken its toll on me.   After attending Baylor University, I attended Vanderbilt University School of Medicine for 4 years followed by 2 years of General Surgery training at Vanderbilt, 4 years of training in Otolaryngology/Head and Neck Surgery at Vanderbilt, and then 23 years of private practice Otolaryngology where I had performed thousands of operations.  I also broke my left wrist while trail riding at Big South Fork and had to undergo a procedure on the wrist.  (Those of you who know me also know that I am an avid horseman and have been riding horses for over 50 years.)  So, during this 5-year period, I had 3 different hand surgeons work on me and from time to time I would ask about my thumb, because I always worried about it.   In July of 2020, one opinion was that I had a benign pyogenic granuloma from all the nail trauma and chronic inflammation, and I was instructed to cauterize it with silver nitrate intermittently.   I did that and it began to improve!   In March of 2021, I got another opinion.  Considering the benign biopsy in the past along with the chronicity of the issue, it was felt that if I had a melanoma, that it likely would have gotten much worse by now, demonstrated spread, or potentially even taken my life by now.  There continued to be a disconnect between me and the providers I had seen.

Was the call to biopsy my own thumb providential?  As you will see, there have been several moments in this journey where me and my wife Kellee felt that God had a hand of protection on us.  I had a previous biopsy in 2016.  I had seen several providers who had looked at it and were not overly concerned because it had been biopsied in the past. But on that Friday, July 16, 2021, after clinic, something in my head was telling me to follow my instinct or gestalt, and biopsy my own hand.  Only Dr. Justin Morgan, a practice partner and dear brother in Christ,  was in the office.  He was busy wrapping up.   Without any anesthesia, I basically used steel instruments to take a biopsy at the base of my nailbed on the thumb of my dominant hand, using my left hand.   I used silver nitrate to aggressively cauterize the area, as it bled profusely.   I placed the tissue specimen in a formalin filled specimen container, labeled it, and placed it beside Lindsay’s computer.  I called Lindsay, my long-time nurse who was now our Nurse Manager, and told her to send it off on Monday and have the pathologist call me directly.   So, this is how my journey started…thanks for your prayers and support.   To be continued…