“Twenty years from now you will be more
disappointed by the things you didn't do
than by the ones you did do. So throw off
the bowlines. Sail away from the safe har-
bor. Catch the trade winds in your sails.”
Cancer physicians know when “The Questions” are
coming. A casual conversation at a party or in the grocery
store eventually turns to careers. The pleasant exchange is
replaced with talk of life-changing illnesses and impossibly
difficult decisions. The other person’s brow furrows, the
head shakes, the face darkens. “How can you deal with
that day after day?” they ask. “Isn’t it depressing? Why
didn’t you pick something happier for a career?”
These are legitimate questions. As a medical student many years
ago, I enjoyed every rotation and wondered how I would ever be able
to narrow down my choices and pick a specialty. Eventually, I decided
that I was most content when I was in an operating room. Even though
I knew that I was going to be a surgeon, there were still dozens of
directions where my career might head.
One day in 1980, I was in a small conference room in Chicago
packed with medical students,
residents, and surgeons who
had gathered to hear a presentation by a visiting out-of-town
surgeon. He ran through his
slide show, describing a procedure he had devised to restore
voice for patients who had
undergone removal of their
voice boxes. It was a complex operation that involved the creation of
tubes of lining tissues that shunted air from the trachea to the back of
the throat allowing the person to speak.
It was interesting, but at my level of training, I was confused by the
details and diagrams. I was years away from doing any type of surgery
on my own. At some point during his talk, I probably checked my
watch, wondering when the conference would be over.
Then, the visiting surgeon flipped the controls and adjusted the volume on a 16-mm movie projector. The light flickered as the film
moved past the bulb.
There, on the screen, was a man who had undergone a total removal of his voice box. The surgeon
asked him a question and the patient responded by
holding a vibrating device against his neck to create
an artificial, machine-like sound that he shaped into
words. He was understandable but his voice sounded
The next scene was filmed after the same patient
had undergone the voice restoring procedure. This
time when he responded to the surgeon’s question, he
brought his hand up to his neck and covered his stoma
to redirect air from his lungs through the shunt and into
his throat. He was able to talk! The sound was natural
and fluent. I was enthralled by the patient’s outcome
and can still remember the man’s big smile at the end of
the movie. The experienced physicians asked questions about wheth-
er the procedure was practical or might cause more problems than it
solved. I, on the other hand, thought that the procedure was amazing.
I left the conference thinking, “I want to do something like that!”
Although the procedure described by the visiting surgeon never
caught on (there are much simpler techniques widely used today),
that meeting steered me toward a career devoted to patients with
head and neck cancer. I can
trace my interest to that par-
Later, during residency
training, I had the oppor-
tunity to spend time in the
office and at the bedside of
many patients as they were
being treated for cancer, and
I was gratified whenever a family welcomed me into their intimate
circle as a relative lay dying. Being present in those moments has
always been a rare privilege. I haven’t looked back.
I love my work even on the days when I find my practice overwhelming. When someone outside of medicine scratches their
head when I tell them what I do for a living, I explain how I felt
when I heard that lecture many years ago. I describe the movie and
the man’s huge grin. Over the years, I have seen more than a few
of those grins on my own patients. It has, indeed, all been worthwhile.
Answering ‘The Questions’
Cancer physicians know when “The Questions” are coming. Here's how one answers them.
Bruce Campbell, MD,
How can you deal with that day after
day?” they ask. “Isn’t it depressing?
Why didn’t you pick something happier for
a career?” These are legitimate questions.