Eileen

Well, the "free" version is hardly 282 pages. On Brook's blogsite on the far right are a series of hyperlinks, the first saying Home and the second: Read my Book.
When you click on that, you get the whole story so I can't hyperlink it to you, but I have been a "speed reader" since 8th grade (actually won contests) so I just clicked on it, sped read it again and cut and pasted it out for you to read. While we may differ sometimes on issues, I have always found you both fair and fun so enjoy
[quote]Dr. Cooper began, �I would like to discuss with you the results of the pathological examinations. I have some good and some bad news. The good news is that there are no signs of cancer spreading into the lymph glands on the left side of the neck. The bad news is that the tumor is still in your hypopharynx. We have not yet removed it. The endoscopic examination done today confirmed that it is still where it was before.�
Words cannot express the extent of my feelings when I heard the news. I was stunned. How can this be possible? The surgeons didn�t remove the whole tumor last week? They had assured me they did, and the margins that were left around it were all negative. My first response was utter surprise and disbelief. Anger and loss of trust came later. Accepting my situation and making decisions for the best course of action came last.
The surgeon proceeded to explain that the tissue they removed with the endoscope was not the tumor, but rather scar tissue that looked abnormal. That abnormal area was only half an inch away from the cancer, but was higher up in my airway, so that when they inserted the endoscope, they observed it right away. Because that area looked very suspicious, they assumed that this was the tumor. They removed it and sent it to the pathological laboratory without confirming that what they took out was indeed cancerous. They then proceeded to take biopsies around the resected area. These biopsies were immediately frozen and inspected in the operating room and were found to be cancer-free. When the pathology laboratory read the resected tissue suspected to be cancerous several days later, to the surprise of everyone, there were no cancer cells to be seen, and the tissue contained only scar tissue. To my question why they did not do perform frozen sections of the tissue suspected to be cancerous in the operating room, Dr. Copper responded �We were convinced that what he had removed was the cancer.�
Obviously, the surgeons erroneously assumed that they had removed the cancer. However, if they would have requested that the pathologist who was present in the operating room confirm this by looking at the frozen sections of the suspected cancerous lesion, the error would have been discovered right away and they would have proceeded to search and ultimately remove the cancer, which was so close by.
It was no surprise that the biopsies around the scar tissues were all negative. The surgeons discovered their mistake only when the pathological report came back and showed only scar tissue in the specimen. What was left now to do was to go back and attempt to remove the actual tumor. The surgeons informed me that they were planning to do just that in two days.
I was puzzled and upset by the incompetence of the surgeons. I had so many disturbing questions for them: �Why is this not the standard of care to immediately study by frozen section the removed tumor right in the operating room? This could have prevented me from needing another surgical procedure. Furthermore, this failure has delayed the removal of the cancer for nine additional days. How could you have missed finding the tumor you observed several times before?�
What was even more upsetting was that a few days prior to the surgery, my surgeon reassured me that he was going to take biopsies of the cancer before removing it and confirm the presence of cancer at the site. His email just prior to my surgery said, �I feel confident that an initial endoscopic approach is reasonable in your case. We will, of course, take multiple mapping biopsies, from both your new primary site and old site.�
Later, I learned from the otolaryngologist that another adverse consequence of the failure to remove the cancer on the first surgery was that each surgery induces extensive local swelling and inflammation, rendering immediate surgery in the affected area more difficult. This was especially significant in my case because my tumor was located at a very narrow and difficult to access and visualize area. In other words, the best chance for successfully removal of the cancer by laser had been in the first surgery. After the initial surgery, the narrow passage where the tumor was situated became inflamed, irritated and swollen, and its diameter was therefore reduced. This made any follow-up interventions more difficult because insertion of an endoscope and visualization of the area were harder.
It was very difficult for me to contain my feelings of extreme anger and my loss of trust; but I knew it was inappropriate for me to express these emotions freely and in a non-inhibited way as I wished I could. I was very vulnerable and depended on these surgeons who were still taking care of me. I had close professional relationships with many of them for over twenty-seven years and liked them very much as individuals. I only wished I could tell them how angry I was and walk away to get treatment elsewhere. I regretted not having the laser surgery done by surgeons who had more experience with this procedure.
I realized then that experience is very important in this kind of surgery, and since throat cancer frequency is diminishing in this country, there are fewer patients with this type of cancer[/quote]
Charm