I was feeling well with no symptoms when I followed up with Dr. Ildiko Lingvay, my physician at the University of Texas Southwestern Medical Center in March 2017 for thyroid cancer. Dr. Lingvay is a professor in internal medicine and leads an active clinical research program in the Division of Endocrinology at the University of Texas Southwestern Medical Center in Dallas. She has been managing well in the control my thyroid cancer for about 12 years.
I had a follow up ultrasound of my neck to check for any recurrence of thyroid cancer before that appointment. She told me there was a recurrence of the mass in the same place they removed one close to my esophagus 4 years before this visit. She then referred me back to the same surgeon who did my previous surgery.
The surgeon schedule me for outpatient surgery. I came to the hospital on the morning of surgery. I was examined by the anesthesiologist and looked at my previous records and said, “I notice after your last surgery you had urinary retention and had to have a urinary catheter. I think that was the side effect of the medicine they gave you to recover quicker from anesthesia. I would not use that drug and I expect you would be alright.”
After the anesthesiologist left, I was reminded of the incident he was refering to. After coming out of surgery 4 years before, when I woke up, I told my attending nurse that my urinary bladder was full. She hand me a urinal, but I just could not urinate. My nurse told me, “They did an in and out catheter to drain your bladder before you woke up from surgery. I think you have just a feeling of urgency, but your bladder is empty.” I felt like by bladder would burst due to amount of discomfort. I told her, “Ma’am, could you please do an urinary bladder ultrasound to check for content.” Fortunately, they had one in the recovery room. After she did the ultrasound, she told me, “Your bladder is full of urine and I will call your doctor if he wants you to have a Foley catheter.”
After she inserted the catheter, she reported, “You had almost a liter of urine that came out.” I answered, “Thank you, I knew that from the way I felt.” It was a big relief, in spite of having tubes, one in my nose going to my stomach and another to my bladder. Thank God I was a doctor and was able to suggest doing an ultrasound.
The surgery this time was uneventful. When I woke in the recovery room, my wife was at my bed side. The surgeon came in, talked to me and told they took the mass everything went well in surgery. With a laryngoscope, he checked my throat and said my vocal cords were intact. That was the last time I saw the surgeon.
Before I was discharged, the nurse made sure I was able to urinate on my own, which I did with ease. I was sent home with instructions and a prescription for pain medication. Next morning when I woke up, I was hardly able to talk. I noted I could not speak loudly, with hoarseness, unable to control my vocal pitch, need to take frequent breaths while talking and a breathy vocal quality. The sound of my voice was just a little above a whisper. I also had to be careful swallowing liquids to keep from choking. On my follow up appointment with the surgeon, I was only seen by his physician assistant. I told her about the problem with my voice after surgery. She with a laryngoscope she looked in to my throat and told me that I had left vocal cord paralysis. I was advised to see an ENT (ear nose and throat) specialist. After that visit, I never talked or saw the operating surgeon again.
I went to see the ENT specialist who said that she could inject a filler substance to the paralyzed left vocal to narrow the distance between the good right cord which may help my problem. This she did this under local anesthesia in her office. I was then referred me to a speech therapist for further therapy. After the injection, my speech improved about 40%. In fact, I was able to give a short lecture to a nursing alumni group who had a retreat in Cancun, Mexico.
The speech therapist taught me some exercises and told me to utilize a more nasal vocalization. Now, I am about 80% back to my usual talking voice. Singing is still a challenge though and I could do it only in the lower register. I still work one to two shifts a week in a specialty hospital emergency room. Initially I found out it was difficult for the attending physicians to hear me well on the phone. Soon I found using text messages, sending photos of x-rays and patients’ lesions was a more effective method of communicating with them. Having to work provided me an incentive to improve my speech to the point that now I am able to communicate better through the phone.
One thing I have learned is we often don’t appreciate things God has given us till we lose them. As a physician, I have learned the importance of showing personal concern to patients, especially when there are complications that develop. I was fortunate that I was a physician who had an insight into the complications I had. That would have been more difficult for the patients with limited medical background. They would not know what the treatment options, possibility of recovery, and have the reassurance that the surgeon is doing his/her best in helping them with the problem.
For us physicians, interpersonal skills and communication are vital in dealing with patients as well as their relatives. This is important, especially when breaking bad news or complications to those who are affected. Unfortunately, there is no formal training in school given to us physicians in this matter. Most of what we learn is from observing how our mentors did it. Lately, however, physician groups and hospital monitor patient satisfaction through post visit follow up. Physicians are grade on satisfaction scores and inform what areas they need to improve. I had to take the role of a patient to fully realize there is a lot of room for improvement in the way we doctors communicate with their patients.
