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Second Opinion: It's Probably Nothing

Leap, Edwin MD

doi: 10.1097/01.EEM.0000394582.80871.60
Second Opinion
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It's probably nothing. That's what we heard over and over. My wife, Jan, had a swollen lymph node on the left side of her neck, just under the angle of her mandible. That's what I told myself when she first complained of it a few months ago. A tender, swollen lymph node after all of us had colds, sore throats, and fever. Probably nothing.

In November, it was more painful. (Painful node; probably nothing, right?) So it was off to the ENT. A cautious, competent surgeon, he said it was probably nothing, but it needed to be evaluated. The CT scan showed an enlarged node. Nothing else was visible. No other adenopathy. We figured, “It's probably nothing.”

That was what the pathologist said when he did the fine-needle aspirate. “Some squamous cells. They don't look malignant. Can't say it's cancer; can't say it isn't. It needs to be taken out.” The pathology report read, “Squamous cells with cystic changes, consistent with branchial cleft cyst.” I liked that. It meant it was probably nothing.

The day she was scheduled for surgery, her surgeon blocked out four hours for a modified radical neck. “Well, I doubt we'll need it [probably nothing, in essence], but if we find anything, we'll need to explore.”

An hour into the surgery, “probably nothing” collapsed with immense gravity into “definitely something.” He called from the OR. “Ed, I talked to the pathologist. It's metastatic squamous cell cancer. We'll need to do a modified radical neck.”

At that point, all of my composure, all of my medical knowledge and skill, all of my years of experience dissolved. I simply and utterly fell to pieces. My bride, my partner for 20 years whom I have known for 27, was in peril. I ceased to be physician, and became nothing more than terrified husband, horrified father. I haven't cried like that in years.

My friend Steve had already visited us. My pastor Ken stood with me for seven hours. My dear friends Susan and Amy and my partner Doug, all ER family, came to my side. Our entire Sunday School class rallied immediately, worrying, reassuring, praying. All before she ever emerged from the OR.

When I next saw my dear, she was sweating and confused. “That was fast,” she said with a smile. “Not really,” I told her. As the time passed, she became more aware, and we discussed what happened. “I have cancer?” Two large incisions graced her lovely neck, and two long drains drew off the bloody fluid resulting from the surgery.

The children were worried. My daughter, 9, texted: “Is it cancer?” My oldest son knew something was up because the procedure took so long and I was so vague with my answers. Finally, I left for home, my sister-in-law at Jan's bedside. I talked to the kids, grabbed Jan's toothbrush, Bible, book, and phone, and went back to her room.

I am still surprised I found my way back and forth, in a daze as I was. My mother-in-law tells me I gave a stirring speech to the children, about pulling together, faith, love, and struggle. I really just wanted to hold them all and scream. Since then, I have screamed, always in my truck and alone. I have continued to cry. And I have held the children, and done my best not to frighten them.

The next day she was home, in pain, but in good spirits. “I don't have time for this. I have children to raise,” she told me. She is a ball of courage, that wife of mine. Still, we were ignorant. We had no idea what all of this meant. We simply kept falling down the rabbit hole.

Over the next week, it was a visit for drain removal, the discovery that what was felt to be a primary tumor was not. Then a CT scan of the chest and abdomen (no evidence of anything bad there). Then a visit to the oncologist. As I write, that's where we are. We have a plan.

It turns out, these cancers are pretty treatable, often curable, in fact. You will read this two months from now, as Jan is undergoing radiation and chemotherapy. The future is, as always, unknowable. But it is hopeful, especially for folks like her, who have old man diseases without old man habits.

As always, though, there have been lessons. For Jan and me, it has been a lesson in leaning. We have leaned, as never before, on God, on church family, on physical family, on friends, and on one another. We are very independent Appalachians. Leaning isn't easy.

We have learned compassion and empathy. I suspect, on the other side of this nightmare, we will rush to the side of those we love when they have times of terror, loss, sickness, and struggle.

I have been reminded of the way I cherish my wife. It is profound; the threat to her was like a threat to my own life. We are one, and that's how it feels when half of you is in danger.

But I have also learned how very little I know, and by extension how very little my patients know. I did not know that “metastatic squamous cell cancer” was not a death sentence. (Most of my medical knowledge has to do with chest pain, work excuses, or Lortab prescriptions.)

Similarly, my patients don't know that “angina” or “pneumonia” or “seizure” aren't always terrible things either. I see how easily I dismiss their fears because I don't fear the same thing. I know now how important reassurance is. How vital that we explain things, that we touch, that we hold, that we love these patients the way we want to be touched, held, loved, and educated ourselves.

We have learned, yet again, how wonderful it is to love and be loved, as people all over the country have written us their stories of survival, their words of encouragement, their sincere prayers for our family. And as people locally have fed us. It's what Baptists do. Casseroles are a kind of modern-day manna: always nourishing and in plentiful supply when you need them.

I have been afraid. But never as much as I have been over the past month. I feel as if I am emerging from it. Jan and I are laughing, rolling our eyes, amazed at the blessings in this storm, cataloging our lessons. The children are smiling and doing well. (Using this all as an excuse to avoid schoolwork, of course.)

But I can safely say that I will never, ever view my patients' fears, vulnerabilities, or disasters in the same way again.

Because you, dear readers, are also my family, I ask that you please pray for my wife's complete healing, and for our family, as we pass through this valley.

Comments about this article? Write to EMN atemn@lww.com.

Dr. Leap

Dr. Leap

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