When a clinician gets cancer

An oral surgeon reflects on her own experience of cancer

It began last August when Hilary Mitchell felt a small lump in her neck. She told herself to ignore it, but when it was still there a few days later, she thought she better get it looked at.

Dr. Mitchell is an Oral Surgeon at Musgrove Park hospital in Taunton, so she was booking an appointment with colleagues  in the Maxillofacial department where she had worked for 20 years.

Hilary’s subsequent experience as clinician-turned-patient is highly instructive for all of us, on both sides of the clinic door, and she has bravely agreed to share her story here.

Hilary Picture

Of course, doctors get cancer like other people. But it is exceedingly rare for a specialist to be struck by cancer in precisely the part of the body that their department deals with on a daily basis.

“To have cancer of the head and neck seemed to me to be completely ridiculous,” she reflects as she is coming to the end of six months recuperation and prepares to go back to work this summer.

At first, she thought the swelling might be caused by a tooth infection, but a colleague (and friend) arranged an investigation to put her mind at rest.

Another colleague did the investigation and it was when he went very quiet she realised the serious nature of the lump. He said little, but told her to come back the next day for a more detailed procedure.

She remembered her training back in the 1990s when cancer of the mouth, tongue and throat led to extensive and disfiguring surgery with a very poor long term outcome. She also recalled assisting at long neck dissection surgery to remove lymph nodes in the neck; an operation she might now be facing.

“If I ever get anything like that,” she had told herself when a trainee, “I’m going to top myself.”

Hilary knew all the likely scenarios from years of clinical experience

It was a stunning realization that she had probably got this excruciatingly nasty form of cancer. While most of us would scare ourselves silly by looking up dreadful diseases on the Internet, Hilary knew all the likely scenarios from years of clinical experience.

“I was completely wide awake for two nights in a row,” she recalls.

There followed a PET scan and then tonsillectomy and biopsies of tongue and throat. The nurses she’d worked with for years were traumatized as Hilary came to the hospital for these tests, not as a senior clinician but as a vulnerable human being, a terrified but unusually well informed patient.

Eventually she was diagnosed with squamous cell carcinoma of the tonsil caused by the Human Papilloma Virus (HPV), an increasingly prevalent form of cancer. It had started in her tonsils and spread to the lymph nodes in her neck.

Unlike the Head & Neck cancers she’d seen during her training, the outlook for HPV tonsil cancer is good, although still serious. It would require an intensive course of chemotherapy and radiotherapy.

Like the proverbial rabbit in the headlights

Like anyone finding herself in this position, Hilary felt like the proverbial rabbit in the headlights. She sat there stunned as she listened to what she was told by the team of oncologists and surgeons.

The Chemoradiotherapy was carried out with great efficiency and compassion with excellent support from a fantastic team. On the downside she has suffered hearing loss and tinnitus, recurrent oral thrush and lymphoedema – a persistent swelling under the chin. Since her saliva glands were zapped by the radiotherapy, she has a permanently dry mouth which has lead to problems with speaking, eating and sleeping.

And, the least of her worries perhaps, wine now tastes disgusting, whether red or white, vintage or plonk.

As she recovers and prepares to go back to work, there are a number of lessons Hilary draws from her experience. These will be the subject of a forthcoming article.



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