January 24, 2026 - Softspoken

I've been home from Johns Hopkins Hospital for a couple of days now. It's a slow recovery from surgery, but that's what we expected. I was discharged with a surgical drain still in, so Claire and I are dealing with that at home. So far, so good with keeping it emptied and logging how much fluid it produces.

Once the drain is no longer draining, the plan is for us to stop by Dr. Leila Mady's office so a nurse can remove it. With a big multi-day snowstorm on the horizon, and with that office being closed over the weekend, that could be delayed a bit.

I've got an appointment to see Dr. Alexander Hillel, a Johns Hopkins laryngologist, in early February, and to have a follow-up visit with Dr. Mady a few days after that.

I didn't even know there was such a thing as a laryngologist until now. Dr. Mady is an otolaryngologist (what they used to call an ear, nose and throat surgeon), and Dr. Hillel is even more specialized than that. The Johns Hopkins Medicine website says he focuses on "the medical and surgical management of patients who have scar tissue blocking their larynx and/or trachea, a condition called laryngotracheal stenosis." There's going to be a three-way conversation among those two specialists and Dr. Douglas Ball, my endocrinologist, about interventions to prevent the further spread of thyroid cancer, while preserving what's left of my ability to speak.

Before I was discharged from the hospital, Dr. Mady stopped by my room to share a post-game analysis. She told me she removed three small thyroid cancer tumors, including the one that evidently crushed my recurrent laryngeal nerve -- the tiny nerve that controls my paralyzed vocal cord. She wasn't able to get to all the thyroid-cancer tissue because the most troublesome tumor was located right up against the larynx (the "voicebox" that contains the vocal cords), not far from the trachea (windpipe). She's not sure whether the thyroid cancer has actually invaded either of those vital structures, but she couldn't remove any marginal tissue for biopsy, to rule that out.

It remains to be seen whether the damaged nerve can recover any of its function. At the moment, my voice is a little worse than it was pre-surgery. It's got a whispery quality, as before, but now I have the sensation that, after speaking a few words, I'm running out of air. I'm not actually running out of air (my breathing isn't any worse than before). It has to do with the way my vocal cords modify the airflow for speech. I've lost my "outdoor voice," the ability to project -- ironic, for someone like myself who used to teach public speaking to seminary students.

It's looking more and more like my decision to focus my professional efforts on writing -- sharing preaching material with colleagues on my new Substack, Curated Sermon Illustrations -- has been the right call. (Does that make me a holy ghostwriter?)

Possible future medical interventions, Dr. Mady tells me, include (1) an injection of collagen or similar material to bulk up my paralyzed vocal cord so it can mirror the vibrations of my healthy vocal cord, (2) targeted radiation therapy, (3) a possible repeat of the radioactive iodine pill I swallowed back in 2011, not long after my thyroid was removed, or (4) a relatively new chemotherapy medication. Speech therapy may also be worth a try.

But at the moment, job one is recovery from surgery, which starts with waiting out the imminent snowmageddon. I've been binge-watching old episodes of The West Wing on Netflix and wishing Martin Sheen could really be President.