I have vivid memories as a little girl of taking my father’s otolaryngology textbooks from the shelf and looking for hours at the faces staring back at me. There were the black-and-white photos of people missing chins, cheekbones, and eyes. I saw pictures of forearms sewn to foreheads and great tubes of skin bridging a shoulder to a cheek. “Andy Gumps” shared their profiles, and patients with tracheostomes and pharyngostomes posed for the camera. Each description was more poetic than the other. The text referred to how tumors were resected, how long a forearm would stay in this less than natural position, and when the staged flap would be completed.

The procedures were heralded, with technical wonders and cures spoken of interchangeably. How to take things apart and put them back together again was the focus. Cure was the goal. I was comforted in knowing that the people on these pages were being treated by the best surgeons in the field. These steps were necessary in saving their lives. But at that tender age, the curiosity was one of peering in someone else’s window. I never asked the obvious questions. Did they go outside looking like this? Did they stay in the hospital away from family and friends? Did they know other people who looked just like they did? Did they ever get depressed and wonder whether it was all worth it?

This was an era in which the patient was not invited to be part of the decision-making process, and issues of quality of life took a back seat to getting the patient and tumor separated. I found the pictures fascinating in a macabre way and did not understand in my youth how those pictures would later affect my life as a head and neck surgeon.

Twenty years later, I began my career as most young, aggressive head and neck surgeons do. I considered the whole “world preop” and a personal failure if I could not find a protocol for each of my patients to fit into. I quite easily divorced the physical from the spiritual. After all, I could always call in the social worker or psychiatrist if a patient was having trouble coping or getting the blues. Rarely did we talk about the bigger psychosocial issues before scheduling a patient for surgery. There was this unspoken assumption that if the tumor could be resected, the patient would manage without his larynx or the ability to swallow the steak that had been a part of Friday night ritual for most of his adult life.

It is true that we celebrate our successes but we learn from our failures. One of my most striking failures came early in my career and smacked me in the face with the overriding issues of quality of life when taking care of the patient with a head and neck malignancy.

As a young staff surgeon, I performed a routine composite resection on a farmer with a squamous cell cancer of the retro-molar trigone. The operation went without a hitch, and he segued into postoperative life, able to swallow and talk. I considered him an early success. I thought I was listening, he seemed to trust me, and yet I slid into what I now call a doctor/patient disconnect. I lost the ability to really hear.

He started complaining of pain that radiated from the surgical site over his occiput. I scanned him, and scoped him, and assured him that there was no sign of tumor. I gave him one of my “buck up Bucky” pep talks and sent him on his way. The following Saturday night I got a call from the emergency room that my patient had just been brought in. He had put a shotgun in his mouth and blown his head off. He had been depressed, in pain, and very ashamed of the way he looked. I never got it. What I considered a cure, he considered a huge stone wall. I offered him a skilled surgical team and missed the mark.