Things have been blessedly quiet on the cancer front for 5 years or so – hence, no blog posts.
Until now.
My non-Hodgkin lymphoma has been quiet for over 15 years, and my last couple of cystoscopies for bladder cancer have shown no recurrence. Not so with my thyroid cancer. After several years of no activity from a number of tiny nodules we’ve known about in my neck, chest and lungs — presumed to be metastasized thyroid cancer — my annual ultrasound and CT scans on November 3rd identified a couple of problematic lymph nodes in my neck that have grown in size. I went in for a needle biopsy on December 2nd. The results came back positive.
Let me back up for a moment and share a little history. I was diagnosed with papillary thyroid cancer (tall cell variant) in 2011, and had my thyroid gland removed shortly thereafter at Memorial Sloan-Kettering Cancer Center in New York City. It may have been a secondary cancer, possibly related to the numerous CT scans and radioactive PET scans I’d undergone as part of my non-Hodgkin lymphoma treatment. That was followed up by a radioactive iodine treatment. In 2018, scans revealed more cancer activity, so I had neck dissection surgery at Memorial Sloan-Kettering. The surgeon removed more than 50 lymph nodes from the left side of my neck.
Beginning in April, 2024 I started working as Bridge Pastor (essentially a part-time interim pastor) at the church Claire and I have been attending here in Baltimore City — Light Street Presbyterian Church. That work ended about a month ago, when the Light Street congregation welcomed their new pastor, the Rev. Kate Morrison. As negotiated beforehand with Baltimore Presbytery, rather than riding off into the sunset — as most interim pastors do — I returned to our accustomed place in the congregation on Sunday mornings.
For the last several months of my preaching as Bridge Pastor, I was troubled by a persistent hoarseness in my voice. I’d had a cold in early September, so I figured the hoarseness was left over from that. I mentioned it to my primary-care physician here at Johns Hopkins, Dr. Stephanie Nothelle, who prescribed some throat-soothing medicines. We both knew I was about to see Dr. Ball for my annual thyroid-cancer checkup, so we agreed that I would mention the problem to him.
A few days before I went in to see him, I’d read the radiology report on my scans that identified those enlarged lymph nodes. Dr. Ball explained that — considering the location of one of those enlarged nodes directly adjacent to my larynx — it was possible that the tumor was pressing on the nerve that controls one of my vocal cords, causing partial paralysis of that vocal cord.
Dr. Ball referred me to a head-and-neck surgeon, Dr. Leila Mady, in the Johns Hopkins Otolaryngology Department. I had my consultation with her today. She ran a tiny camera up my nostril and down into the interior of my neck (sounds unpleasant, but it was fine), and took a look at the problematic vocal cord. Moments later, she showed me a video of what she’d seen. Dr. Mady had asked me to speak some nonsense syllables during the test — and, sure enough, the video revealed that one of my vocal cords was vibrating normally, but the other was hardly moving at all. Right next to the problematic vocal cord was some swollen tissue that is the cancerous node.
It was an odd experience to look at my own vocal cords for the first time — and not only that, to see them moving.
Dr. Ball had called it exactly right. Paralysis of the vocal cord, caused by thyroid cancer.
The next thing is for Dr. Mady to bring my case before the tumor board at Johns Hopkins that oversees this kind of cancer. They’ll meet a week or two from now. She’ll get back to me with a recommendation about whether surgery or more watchful waiting is the best way to go.
Neck surgery of any kind is difficult, she explained (although I already knew that). There are many important structures in the human neck, all clustered together in a small space. Each time the neck is opened up, surgery becomes more difficult, due to the aftermath of former surgeries. So it’s not something you rush into.
I did ask Dr. Mady her whether she thought I could get my voice back, if the tumor were removed. She delivered the response I’d feared: “probably not.” The nerve that controls the vocal cord is tiny and easily damaged. It’s likely that it’s already damaged beyond recovery. But surgery could prevent further difficulties.
The tumor’s position is problematic. Further expansion could damage the larynx, the trachea, or other structures in the neck. So, there are risks either way — from surgery or from continued watchful waiting.
During this season of Advent, one of the lectionary scripture passages is the story of Zechariah, father of John the Baptist (Luke 1:5-25, 57-80). Zechariah was a priest of Israel. The angel Gabriel appears to Zechariah, announcing that his wife Elizabeth, who’d long been childless, was pregnant with John the Baptist. Zechariah asks Gabriel for a sign, which the angel interprets as an expression of doubt. So, he takes away Zechariah’s ability to speak.
Nine months later, at the newborn John the Baptist’s circumcision, Zechariah’s voice suddenly returns — just after he’d written down the name of their infant son. The Song of Zechariah, uttered by him at that moment, is equal parts joy at the birth and joy at his own unexpected recovery.
For a priest — or a preacher — to lose his voice is obviously not a good thing. Needless to say, I’ve been thinking a lot about Zechariah in recent days. My voice isn’t gone completely — just my ability to speak loudly and clearly — but it seems possible, even likely, that my preaching days are over.
Just a month ago, I started a substack, Curated Sermon Illustrations, through which I’ve been sharing a daily sermon illustration for my fellow preachers — not to mention promoting my new book, Illuminating Sermons. I didn’t know, when I started this little retirement project, that I was in the process of losing my preaching voice.
So maybe that’s the way I’ll be preaching in the future — through the voice of colleagues, who borrow what I write there and share it in their own sermons.
1 comment:
Holding you in my prayers, Zechariah, confident that the Holy One will speak through you in many ways. I'll listen to your words however they are imparted.
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