A Tale of Two Surgeons

2Surgeons_HeaderI believe enough time has passed that I may tell the following story with impunity. Nevertheless, I will disguise the names so that no reputations will suffer in the telling. And while certainly there were more than two surgeons involved in this saga, the focus is on two in particular, along with the very different manner in which each took ownership of the doctor/patient relationship.

During the summer of 2001, I noticed a lump in the roof of my mouth, directly in the center where the hard palate and soft palate come together. I had not been aware of it before and was uncertain whether or not it had always been there. I was marginally aware of it for the next two years, and finally asked my dentist to look at it when I was in for a cleaning. Dr. K did not like the look of it, but it not being his area of expertise he referred me to an oral surgeon who performed a biopsy on the mass. When the pathology report came back, we were all delighted to learn that the tumor was not malignant.

Regarding the biopsy, I have found over the years that I possess a reasonably high tolerance for pain. Still, nothing prepared me for the agony and inconvenience of having a chunk of flesh removed from the roof of my mouth. No dressing could be applied so the wound was horribly in the way while I ate, and the ache for much of the first week of healing made dining an excruciatingly unpleasant activity. Further, a rank pong pervaded during the first days of healing that diminished any olfactory or gustatory pleasure I might have experienced despite the pain. In subsequent paragraphs, I will refer to this special combination of pain and olfactory foulness as “The Sandwich Horror,” with apologies to H.P. Lovecraft.

The oral surgeon advised me to share the pathology report with my primary care physician at KP, which I did. He, in turn, referred me to Dr. T in the ENT department downtown. I liked Dr. T. In addition to being personable and easy on the eyes, she felt that because the tumor was benign and did not appear to be growing, surgery was not warranted. Instead, I should visit annually and we would watch it over time to verify that the condition was not changing. I wholeheartedly approved of this approach. Alas, Dr. T wanted to confirm the original pathology report and performed a biopsy, triggering my second dread encounter with “The Sandwich Horror.”

That was the spring of 2004, and all went well until early 2007 when I tried to schedule my annual checkup appointment with Dr. T. She had recently married (and was now Dr. something else) and transferred to another medical center. My case had been given to Dr. L, the first of our two title surgeons. Dr. L. was in almost every respect the absolute antithesis of Dr. T. Aside from any bedside (or aesthetic) qualities they failed to share, Dr. L.’s plan was to jump immediately to surgery. In much the same way that to a hammer everything looks like a nail, his philosophy seem to be that surgery was the sole solution. “Benign or malignant, a tumor is a foreign object that does not belong there and consequently should be removed.” There were no other considerations. In the end, Dr. L. possessed one and only one quality that mirrored Dr. T. He did not wish to proceed without a biopsy, resulting in a third visitation from “The Sandwich Horror.”

The procedure to remove a tumor such as this is performed routinely as outpatient surgery. KP does an outstanding job of preparing patients for surgery from the standpoint of explaining about what to expect and helping to understand any risks. I arrived early on the morning and everything went pretty much as expected until I awoke from the anesthetic. The nurse was tapping my hand and calling my name, and as I regained consciousness, she handed me a glass of water to drink. Thirsty from the anesthetic, I took a large sip. The water never made it to my throat. Instead, it gushed from my nose. The look on the RN’s face must have reflected my own. Dr. L. had had to cut so deeply to remove the tumor that it had left a hole in the roof of my mouth about the size of a dime.

Dr. L. was still in surgery and could not be consulted, so the nurse suggested a couple of techniques to get fluid past the hole but to no avail. She also had me try some solid food – blueberry yogurt, to be specific – which also ended badly. Anatomically, we use our tongue to move food from our lips to our throat. With the tongue being on the bottom of the mouth, it works against the roof in this process. If there is a hole in the way, the tongue pushes it right through. Ergo, blueberry yogurt went into my mouth on a spoon but then right out through the hole into my nose. It was not pretty.

At a loss for any other course of action, the nurse sent me home with the promise to have the surgeon call as soon as he was out of surgery around noon. When we had heard nothing by 2:00 PM, my wife started calling KP. Dr. L. was nowhere to be found. It had already been six hours since the surgery and I still couldn’t get anything past the hole in my mouth. I was frantic. I was in pain, hungry, and my thirst was extreme. The extremity of my wife’s frustration exceeded my own. Someone finally took pity on us and gave us Dr. L.’s cell phone number. My wife reached him on the golf course. I will not repeat the angry exchange of words that ensued, but Dr. L.’s dismissive response was to plug the hole with chewing gum. Then he hung up.

I thought my wife’s head was going to separate from her body, but she busted a mission to the corner drug store for a load of sugarless gum. I had to admit that the solution worked. It took a little practice to get a piece of gum into the right shape and pushed with my tongue into the hole in a way that would form a dependable seal, but I was finally able to take a drink and eat something.

At this point, the story branches into two paths. One path was to set up the follow-up appointment with Dr. L. This was supposed to take place six weeks following the surgery. I was not looking forward to what would likely be an ugly confrontation, but I dutifully called KP to make the appointment. Oddly, Dr. L.’s calendar was not yet open to accept appointments for that time. I called again a couple of weeks later and his calendar was still not open. It was around the eighth week – well past when I should have had my follow-up – that an appointment agent informed me Dr. L. was no longer working for KP. It took several months for my case to be referred to another surgeon.

The second path was my personal journey with chewing gum. As I mentioned, the solution worked initially. But chewing gum is a digestible substance and a wad would only work effectively for a short period of time before it would begin to dissolve. In the beginning, I could squeeze a day to a day and a half from a plug. As soon as it began to show signs of failing, I would replace it. But the human body is a marvelous thing and mine quickly realized that a persistent foreign object was sitting in this hole. My body began producing new enzymes for dissolving chewing gum that worked faster and faster. Within two weeks, I would have no warning of imminent plug failure. If I was in the process of eating or drinking, whatever was in my mouth was at risk of being transported summarily to my nasal cavity. Beets, broccoli, borscht, and bourbon have all been there. I distinctly remember one business meeting in a Szechwan restaurant when a particularly spicy dish abruptly made the passage. I had neglected to put a spare pack of gum in my pocket and with pepper-induced tears running down my face had had to face the embarrassment of asking the waitress (who spoke minimal English) for some chewing gum, while explaining to my client my peculiar predicament. Their mixed expressions of horror, disgust, and hilarity pretty much said it all.

Oh, I tried pretty much everything. I tried rotating brands, which worked for almost a week. Then I tried randomly swapping brands. It was no better. The digestive enzymes just kept improving. The only redeeming factor during this time was my celebrity in the eyes of my daughter’s second grade friends. The image of an adult with broccoli in his nose is side-splittingly funny to a seven-year old, but as they gradually turned eight and approached the pending maturity of third grade, such merriment turned to “Eeeuwww, ick!” revulsion. Celebrity is fickle and fleeting.

Five months had passed by the time I was able to meet with the new surgeon, Dr. S., who enjoyed a more substantial celebrity. Well known in his field and head of the maxillofacial department at KP, he would sweep into the examination room with no fewer than two interns in tow. Unlike his predecessor, he was appalled at the shoddy work and even shoddier care I had received. He took immediate ownership of the situation, taking a mold of the top of my mouth and instructing one of his interns to have a plate fabricated in the lab at UCLA. He also looked at options for closing the hole. While it would be a couple of months before he could operate, he would need to perform a biopsy to determine whether or not any of the tumorous mass remained. Thus “The Sandwich Horror” descended upon me for the fifth and penultimate time.

Long story short, Dr. S. was able to close the hole successfully. The biopsy had revealed that microscopic elements of the mass had been missed during the first surgery, and these he removed as well. This final visit of “The Sandwich Horror” was the worst of all of them. The surgery was more extensive in order to take a slice of material from the roof of my mouth, fold it over the hole, and suture it in place. The result was considerably more painful and the recovery period longer. Also, this time there had to be a dressing and the cloud of putrid stench that emanated when removed was profound. Nevertheless, it was worth it to finally be able to put away the chewing gum for good and all.

I returned to Dr. S. annually for five years. Each year he would send a camera into my nose – a surrogate broccoli reunion? – to examine the graft site. Each year he would have a new entourage of interns. Each year he would take copious pictures. According to the pathology reports, the tumor itself was unusual and Dr. S.’s surgery was a masterpiece (in my mind and probably his as well) of using the body’s own healing ability to repair the damage. I have no doubt that Dr. S. has written this up in some medical journal somewhere. For me, that is perfectly fine. I consider it a win/win situation. Dr. S.’s ownership of the problem benefited me, it benefited him, and it will benefit other doctors and patients.

Ownership is the key. It is what turned this tale into a success story. During the process of writing this piece, I came to realize that ownership is my keyword for 2015. Unlike a set of resolutions, a keyword is a focal point against which I test my strategies and actions both immediate and long-term. I will undoubtedly muse on this concept in more depth in a subsequent post.

I have suffered no more visitations from “The Sandwich Horror.” In fact, I am living on a principle of total abstinence in that respect. On my final visit to Dr. S. in 2012, he declared me cured and that is good enough for me. The entire incident, apart from its lesson, is reduced now to an insane and revolting, but nevertheless outrageously entertaining party story. Would that all lessons ended so well.

How do you inspire personal ownership on your team? How might you apply this lesson to your customer service organization?



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