anonymous

My Cancer Has Brought Prosperity

"My Cancer has brought Prosperity !"   

Dr. R.S. Rao

The human voice is one of the greatest gifts of God to mankind : It is the medium of communication and social discourse. It can convey all human emotions ranging from excitement, joy, sorrow, compassion, comfort, friendship to hatred, jealousy and anger. A cultivated human voice can reach great heights. Bhimsen Joshi and Lata Mangeshkar have brought immense joy and happiness to millions of their listeners. Yet this voice is occasionally in danger of being snuffed out. The human voice is produced in the voice box or larynx, by the vibration of two strings called the vocal cords. These vibrations are modulated by the pharynx (throat), tongue, palate and the lips to produce the spoken word.

Occasionally the vocal cords are the seat of cancer. Even a small cancer, the size of 1 mm, can produce a change in voice, readily noticed by the patient. At this stage if the cancer is detected (which is not difficult), a person can be cured with restoration of the voice to normal.

Unfortunately, people neglect a persistent hoarseness of voice and reach the doctor at a late stage. When the vocal cord has lost its ability to vibrate, it is immovable and there is some narrowing of the air passage. resulting in breathing difficulty and of course, hoarseness of voice.

Even at this stage, a person can be cured and his life saved, but there is a price to pay. To secure his life, a person has to permit the surgeon to remove the voice box, an operation called Laryngectomy. This results in permanent loss of voice and an opening in the neck which communicates with the trachea or windpipe. He breathes through this hole or tracheostoma, instead of through his nose.

When a patient is given this treatment option, the first reaction is one of horror or dismay. Imagine not being able to utter a single word to your near and dear ones! If the patient is illiterate, his isolation is complete and he wonders whether life is worth living.

Unfortunately, the patient has no alternative. Untreated, the disease will progress in a few weeks or months to a stage when the patient can hardly whisper; the cancer causes narrowing of the air passage to such a degree that he gasps for breath. At this stage, he will end up with a tracheostomy which will give him relief from voice is gone and there is no chance of saving. 

Would you refuse all forms of treatment and go home or would you accept the surgical option and be a silent spectator in this world? Most people accept the second option as it saves their life, and then cope with the handicap of loss of voice. In fact, we are able to persuade majority of patients to accept surgery.

It is an inherent quality in man to accept challenges, overcome difficulties and try to achieve the impossible. This is not the prerogative only of the Wright brothers, or a Tensing or a Winston Churchill. It is dormant in every human being, and circumstances bring this out in a cancer patient, helped to some extent by the surgeon and the speech therapist.

 

How has this challenge of loss of voice been faced? One of the most natural method is the cultivation of esophageal speech. In esophageal speech, the person learns to aspirate or suck the air into the oesophagus (gullet or food pipe).There is a sphincter at the mouth of the oesophagus, at its junction with the throat or pharynx. Normally the opening of the oesophagus is kept closed by the sphincter but during swallowing, the sphincter relaxes to permit food or even air to pass down the gullet and again closes after the act of swallowing. The patient learns to expel the swallowed air in the oesophagus through this opening in a controlled manner. Instead of expelling air in a fraction of a second as we do when we belch, the air is expelled slowly over a few seconds. This causes vibration of the sphincter. These vibrations are similar to vocal cord vibrations, but more coarse. These vibrations are picked by the muscles of the tongue, palate, pharynx and lips and produce an audible voice.

By training and constant practice over a few weeks, it is possible for a patient to master this technique of aspirating air and produce sounds which can be understood as spoken words. About two thirds of patients are able to achieve this level of perfection and are able to speak again.

The success of this endeavour depends to a large extent on the patient himself, his personality and his compulsions. A carefully-planned and executed surgical operation is absolutely essential. A patient and understanding speech therapist is a great help but the patient has to help himself and surprisingly many overcome this handicap. Over the last three decades, I have come across several such patients and have come to admire their guts and determination.

At one time I thought illiteracy and ignorance will be a great handicap. In fact, we find that illiterate persons pick up oesophageal Speech equally well. It is possible that their need is greater, hence their determination to learn is stronger. The first case I came across was a young man called Totharam. Following the operation following the operation, he developed several complications and was in the ward for several weeks. He was a bright cheerful person, but one day he ran away from the hospital. We lost track of him. Ten years after, he came to the hospital with another patient and he spotted me and asked in a clear voice whether I recognised him After a couple of minutes, I hesitantly asked him if he was Totharam. 

We were both very happy; he felt happy that I remembered his name and I felt happy that he could speak so well. He had learnt to speak without the help of any speech therapist. I asked Totharam why he ran away he had learnt to speak. He said that he got tired of daily hospital routine and the liquid diet we had put him on. So he ran away from the hospital his village. The operation wound somehow healed on its own and he was able to eat normally. The villagers found that he could not work in the field as he had a tracheostomy and dust would enter into the trachea. So they gave him the job of a scarecrow: to stand upright in the field and keep the birds away! It was an unfair task because, unless he made some kind of noise, he could not possibly keep out the birds. So he tried to shout and kept on trying till one day he produced some sound. He quickly learnt the trick and learnt to speak fluently and became a kind of social worker, helping the villagers. It was his struggle for survival that prompted him to discover oesophageal speech untaught and without any help or guidance whatsoever!

Another case was that of a salesman who underwent laryngectomy for cancer of the vocal cords. As a result of the operation he could not speak and the employer gave him notice to quit. He begged his employer to give him one year's grace period. In case he could not speak at the end of one year, he said he would himself quit. The patient was well past fifty, with a large family. The employer, out of compassion, agreed and kept him on the same salary for a year. The patient made a determined effort and with the guidance of a speech therapist learnt to speak, retained his job and is still well and alive, fifteen years after the operation!

The third and the last case I wish to recount is that of a Marwari gentleman who was working as manager in a mill. He underwent larnygectomy around 1975. After the operation he had to quit the job as he could not work in a polluted atmosphere. However, he was a strong-willed man and quickly learnt to speak. He started taking interest in stocks and shares and prospered well. One day, his wife came along with him on his annual check-up to the hospital. I examined him and opined that he was doing well and there was no evidence of any disease and complimented him on his excellent voice. But his wife had a grouse against him! "Doctor" she said, "please ask my husband to speak less”! I got a little annoyed with her and said! "You should be lucky that your husband has learnt to speak so well”. To that she replied: "Doctor, it is not that I object to his speaking, but he keeps on speaking for half an hour at a stretch on trunk calls to Madras and Calcutta, buying and selling shares. I am afraid he will strain his voice by shouting on the telephone”.

This was before STD was available. The husband, however, was quick with his own explanation. "Doctor” he said, "during the last three years I have made more money on the stock market than what I made in twenty years as manager in the mill. This cancer has brought prosperity to me and now I shall be leaving my family financially in a sound position. I thank the Almighty for His blessings!”

Compilation of professional reminiscences of specialists - edited by M.V.Kamath and Dr.Rekha Karmarkar