Dooley Noted: 11/10/2015
Today at Einstein Med, a lab group called me over to help remove their cadaver patient’s pericardium.
They showed me a left lung tumor that adhered to the pericardium, the covering of the heart.
My heart was shocked into stopping for a moment, and I brought it back with a long exhale.
It was the exact same location and type of tumor that tried to kill my father just two years ago.
I filtered through a fibrous mass of scarring. I was amazed at how the phrenic nerve and its arteries were compressed by the scarring.
I saw the mass encircling the hilum (entry point) of the lung, blocking air and blood flow in and out of the lung.
I observed the mass’s infiltration into the posterior mediastinum, where it was permitted to choke off the trachea and esophagus.
I saw the anatomical result of the pathology my dad was experiencing when he was at his sickest – when he couldn’t eat, breathe, or properly circulate blood.
And now I have a whole new appreciation – not only for anatomy, but for my father.
A tumor compressed his pericardium and choked off his airway and blood. And he fought the hell out of that tumor.
I told the students the story of me calling my parents in July 2013. A very hoarse voice replaced my father’s booming, joyful tone.
I asked how long he’d been hoarse. He said, “About a month or so.”
Dooley: “Dad, that’s not normal.”
Dad: “No, I’ve just had a cold.”
Dooley: “Dad, colds don’t last a month.”
I knew right away.
I knew the anatomy.
Something was compressing his recurrent laryngeal nerve, a structure supplying the muscles of vocal production.
I firmly told my mother to demand he get a chest X-ray.
Since my father will always see me as his baby girl, it took the forceful voice and influence of my big sister to influence dad to get the chest X-ray.
Extensive testing followed. Tests were positive for small cell carcinoma of the lung. This tumor was wrapping like a fist around his trachea, esophagus, and aorta. The tumor also compressed his anterior pericardium and his left recurrent laryngeal nerve – making his voice hoarse.
We watched dad battle the same cancer I dissected in my hands today.
I will never forget.
I will always share these anatomy gems.
Take a hoarse voice seriously. It’s called dysphonia – not laryngitis – when there’s no infection.
I know I have written about it many times, but I will never stop heeding this anatomical warning.
It’s important.
If you have been hoarse for longer than an infection typically persists, get a chest radiograph.
The X-ray exposure, in this case, may just save your life.
Take a hoarse voice seriously until proven otherwise.
As always, it’s your call.
– Dr. Kathy Dooley
