I am a Professor of Economics at Vanderbilt University, VU. I teach and do research. My life is my work and my family. Inside me there is Myrna Holtz, a kid from very humble beginnings on a small farm in rural Alberta, a nerd who loved math puzzles and books but had few of either. Through my own research and through helping others with theirs, I want to contribute to our ability to understand social and economic interaction. I want to be close to my family and now to increase awareness of thyroid cancer and its potential effects.
It should not be assumed that a few days after thyroid surgery a thyroid cancer patient is back to normal. Surgery may be the easy part compared to the effects of loss of trust.
In 2008 and 2009 I felt fatigued. My home treadmill rested, unused. In September 2009, my VUMC (VU Med Center) physician palpated my thyroid and detected no problem. Two months later, after a quick swipe of my throat, my gynecologist found that my thyroid was enlarged. We both notified my VUMC physician. He responded (recorded on a VUMC web interface for patients) with, effectively, “See you when you next come in.” I thought, “Oh, that’s good, no problem then. Maybe I had a cold.” But as time progressed, I pressed and pressed again for an appointment with my physician. Finally, in mid-May 2010, after five and a half months, I had an appointment. When my VUMC physician palpated my thyroid, he immediately detected the enlargement and ordered an ultrasound, which I had the same day.
A few days later, some unknown person phoned to schedule an appointment for me with an endocrinologist and to advise me that I would probably need surgery. What! How could something treated so casually by my VUMC physician be serious? Was it really? If so, why had my physician not seen me sooner? Why had he himself not called? Maybe it was only another surgery opportunity.
My former VU physician always called me “Myrna”. I called him “Dr. Hock”. A trusting patient is like a small child who places her hand in the hand of a benevolent, caring adult. The asymmetry in use of titles reflects this relationship of trust and confidence; the patient wants to be confident that the physician is competent, knowledgeable, and will take care of her. But maybe the asymmetry is designed to keep the physician in a position of unquestioned superiority, above the patient. I started to call my former VUMC physician “Rich”. And he switched, immediately, to “Professor Wooders”. It was almost funny.
With all confidence in VUMC gone – this was the most disturbing but not my first negative experience – I searched for a specialist on the internet and in September 2010 saw Dr. Erik Alexander, at Brigham and Women’s (B&W) in Boston. Erik advised me to have a thyroidectomy and also recommended a surgeon, Dr. Francis Moore, also of B&W. Dr. Moore interviewed me on November 10th, 2010, and I had a total thyroidectomy on November 11th. 2010
B&W Pathology reported a tall cell papillary thyroid cancer with extrathyroidal extension (minimal). Not good. Tall cell thyroid cancer has an estimated mortality rate 16 times that of papillary cancer generally. At least one study proposes that tall cell thyroid cancer can become anaplastic cancer, which is extremely aggressive. “Extrathyrodial extension” means that the cancer has extended beyond the thyroid capsule. With extrathyroidal extension, thyroid cancer becomes Stage III. Whether the extrathyroidal extension occurred during VUMC’s delay is unknown, but I believe it is likely; my VUMC physician was unable to detect the enlargement of my thyroid in September 2009, but detected it immediately in May 2010.
My treatment involved thyroid hormone withdrawal and a low-iodine diet lasting some weeks followed by ablation with radioactive iodine (RAI). “Glowies” are not allowed to fly so I had the RAI at VUMC. The instructions for my procedure were somewhat garbled. I sought and obtained clarification, but still it was anxiety-provoking.
In January 2011, three men in hospital garb brought my RAI pill into a small, cold room at VUMC where I had been waiting on a small, cold hard chair. Might they be like three co-authors, each of whom relies on the other two to catch any mistakes? Might something else have been garbled? But I was at VUMC to swallow the pill so I swallowed the pill.
A few days after swallowing the pill, standard procedure is to have a whole body scan to see where the RAI was soaked up. I lay in a cold machine in a cold room, while in the adjoining small room with a glass window and open door several hospital personal watched monitors, laughed and giggled. Was it funny? Most important, though, the RAI was soaked up where it was supposed to be – in the thyroid bed.
After my RAI, exhausted, anticipating there may be effects of surgery and subsequent treatment, in late 2010 I had asked the Dean of the College of Arts and Science and the Head of the Economics Department for some teaching relief. I offered to pay a person available who could easily have taught my assigned undergraduate course. But my request was denied.
In September 2010, I had started to experience a clutching in my throat and heaviness in my chest, along with extreme fatigue. Was I worried! For some weeks after my RAI, my distress started to alleviate, but I had made the mistake of complaining to VUMC about the “alleged delay”. What, you might ask, as I did, would have been the common, expected care of a physician when notified that a patient had an enlarged thyroid? According to email correspondence with Dr. Kenneth Ain, when notified of any enlargement or lump, a physician should see the patient “soon” and, at the latest, within two weeks. No one disagrees.
My distress worsened. Believing in “the ivory tower” I only complained through VUMC channels. No one suggested making a complaint outside of VU, to the Tennessee Board of Health, for example. A VU representative asked, in December 2010, what I had in mind for compensation. What I had in mind for my VU physician was “Horsewhipping on the steps of his club”. It suited my anger. But, since death is life-changing, I came up with a life- changing amount and gave a memo on this to the AVC. What did I expect? I do not know really but I did want to express and register my anger.
VUMC representatives expressed, in the privacy of offices, apologies. The only written response that I have from the VU Office of Risk Management claims that even tall cell papillary cancer is slow growing so the “alleged” delay was not important. It may be that the expert consulted by the VU representative was not knowledgeable about tall cell cancer; it is estimated that only about 2% of all cancers are thyroid cancers and only 10% of thyroid cancers are designated as tall cell. How fast they grow is unknown. My interactions with VUMC and then the VU Office of Risk Management were deeply depressing, anxiety-provoking, and worsened the situation.
After my surgery I had a sore throat. But the frequent sensation of clutching around my neck, the heaviness in my chest, my sometimes racing heart, and extreme fatigue seemed to only get worse. Last year, 2011, was a very bad year. I had MRIs, electrocardiograms, nuclear stress electrocardiograms, nuclear perfusion tests, CT scans with contrast, and blood tests for everything. But no explanations of my symptoms. They intensified.
It now seems that I was suffering effects of hyperthyroidism. To suppress the activity of any remaining thyroid cells, thyroid cancer patients are prescribed high levels of levothyroxine (thyroid hormone). Individuals react differently to hyperthyroidism. I had multiple symptoms – fatigue, anxiety, palpitations, and an atrial fibrillation. (At the time I was in Sydney. My wonderful daughter-in-law came to the hospital. I was so glad that she was there to keep watch. By the way, there everyone – doctors, paramedics, nurses – called each other by their first names. I was “Mrs. Wooders”.) See http://www.myrnacatharsis.com/what-it-is-like/ . It might have helped to know that my symptoms were those of hyperthyroidism, not of the return of cancer.
It would take too many pages to write in detail about my interactions with VU during the summer of 2011, when I wanted to move to Sydney to be near my family. Reading correspondence from that time, it is clear to me that I was stressed and anxious. I cannot know how my interactions with VU would have gone had I not been hyperthyroid, anxious, worried about cancer, worried about retaliation for consideration of a lawsuit against VUMC. I do not understand what was going on with VU. It may be simply that no one at VU understood that I was in a state of high anxiety and having physical and emotional symptoms of hyperthyroidism. Neither did I.
My first post-thyroidectomy exam was on August 20th, 2011 at B&W. There was no observable evidence of cancer. It was wonderful. The sun shone, the trees glistened, the streets of Boston were filled with happy, smiling people. Would I have pursued a lawsuit against VUMC had the outcome been different? I cannot know, but probably not. It sounds too tedious. I did not have the energy. VU is too powerful. Might I have bought a horsewhip? The idea makes me smile, but probably not. What most academics actually do is write.
Last March we reduced my levothyroxine. And, as time passes, it becomes less and less likely that I will have any recurrence. Back in rural Alberta, I had learned to “never let them see you cry” so I tried to keep my thyroid cancer private. This spring I decided to go public; I let my colleagues in VU Economics know in an email and via my website www.myrnacatharsis.com. I found Thyca and found that my experience while extremely hyperthyroid had been shared by others. (See http://www.myrnacatharsis.com/what-it-is-like/ )
Now my tests look very fine. My treadmill squawked a bit with its first use this summer, but now runs smoothly! Except for scarring, I am back to normal. I am no longer anxious about retaliation from VU (but expect no advancement either). If I have to increase my levothyroxine again, I will recognize symptoms of hyperthyroidism.
It may be useful for other thyroid cancer patients to know the symptoms that may occur as a result of their treatment, for persons in positions of power over others to better understand that thyroid cancer survivors may be hyper (or hypo) thyroid. And for physicians to recognize thatnot all thyroid cancers are slow growing so a patient with an enlarged thyroid should not be ignored.
 A specialist in thyroid cancer, author, with Sara Rosenthal, of The Complete Thyroid Handbook, which includes a discussion of various levels of care, including “standard community care” – what one might expect of their local GP. Another excellent, more technical and specialized book is Thyroid Cancer: A Patient’s Guide
By D. Van Nostrand, G. Bloom, L. Wartofsky
 According to the writer, P.G. Wodehouse, in prior times, this was the ultimate punishment for a male member of the British upper classes.