oral surgery

oral medicine
oral pathology
With sections OFI oral and maxiiiofacial radiology
and endodontics

oral surgery
Editor:
ROBERT B. SHIRA, DDS
School of Dental Medicine, Tufts University
1 Kneeland Street
Boston, Massachusetts 02111

Dying of cancer: A patient’s recollection of

her illness and of her doctors
David J. Krutchkoff, DDS. MS,” and Ellen Eisenberg, DMD,b Farmington, Corm.

UNIVERSITY OF CONNECTICUT, FARMINGTON

A personal account of a patient’s long ordeal with cancer of the tongue is presented. The explicit journal
begins at the time that a lesion was first detected and ends approximately 4% years later, just 8% months
before the patient’s death from local disease. Important principles of clinical diagnosis and patient
management, vividly underscored by this case, are reviewed and discussed.
(ORAL SURG ORAL MED ORAL PATHOL 1991;71:401-6)

E ither through personal experience, professional

interactions, or both, diseaseswe know collectively as
cancer have touched virtually all of us in one way or
another. We are all too familiar with the dry, didac-
tic dogma pertinent to oral cancer in general, tongue
cancer specifically, but, perhaps through subcon-
scious’avoidance,we rarely encounter the true horror
of the afflicted patient in the course of their progres-
sive demise. In this context the eloquent words of Dr.
A. W. S. Hay’ are worth repeating and remembering:
Of all the painful deaths by which men leave this world,
there are few more miserable and agonizing than that
which results from carcinoma of the tongue. From the
beginning to the dreadful end, one distressing event fol-
lows another in rapid succession.Pain is followed by the
unspeakable vile fetor of ulcerating infected carcinoma,
*Professor,Departmentof Oral Diagnosis,Division of Oral Pa-
thology,Schoolof Dental Medicine.
bAssoeiateProfessor,Departmentof Oral Diagnosis,Division of
Oral Pathology,Schoolof Dental Medicine.
7/12/27100
by the dribbling of foul saliva, and then slow starvation
day by day until the final climax is reached in a gush of
blood or some equally terrible catastrophe.
As vivid as this quotation is, nothing is more
emphatic than a specific illustrative caseto bring this
point to life. We thus offer the following chronologic
account of a patient’s personal ordeal with cancer of
the tongue. The journal, written by Mrs. “T.“, a
woman who coincidentally happened to be a nurse,
begins when she was 49 years of age, at the time a
tongue lesion was first noted by her general dentist,
and extends through the various stages of diagnosis,
management, mismanagement, treatment, and at-
tempts at palliation. It ends approximately 5 years
later, before her death, when she was so ravaged by
local diseaseand side effectsof treatment that shewas
no longer able to record her thoughts.
Although several tragic errors were made during
the course of this illness, our aim in publishing this
account is not to point an accusatory finger. Rather we
wish to relate to members of the healing arts profes-
401
402 Krutchkof and Eisenberg
sion a patient’s perception of her affliction with can-
cer, including how sheviewed her doctors and profes-
sional staff. We also wish to convey a sense of the
cancer patient’s inner feelings of hope, anger, despair,
and futility, which are too often ignored by those of
us involved in various aspects of treating human
illness. We do this becausewe believe it can make a
positive difference; perhaps through an account of
suffering, we can gain somemeasure of improved un-
derstanding of those involved in the desperate strug-
gle with cancer, thereby leading to better quality of
patient care.
One further pertinent remark: the following journal
represents direct transcription of the patient’s own
words, edited only for context, brevity, and conceal-
ment of names,places,and dates that might otherwise
identify those actually involved. The account is oth-
erwise explicit and to our knowledge completely
accurate.
Initial oral surgeon (OMFS 1): Dr. “A.”
Family internist: Dr. “B.”
ENT surgeon (ENT 1): Dr. “C.”
ENT consultant (ENT 2): Dr. “D.”
Oncologic surgeon (tumor surgeon): Dr. “E.”
Second oral surgeon (OMFS 2): Dr. “F.”
Day 1. My dentist noticed a lesion of the right side of my
tongue and left cheek. He advised me to go to an oral SUP
geon for a qualified opinion.
Day 22. I arrived for my IO:00 AM appointment with Dr.
“A.” [OMFS 11.After examining my tongue and cheek, he
said, “I think it’s a case of lichen planus, but I will take a
biopsy of the cheek since that’s the sameas the tongue.” He
said that the tongue would require some type of sedation.
He did the biopsy, and I think I had 2 stitches in my left
cheek. Neither my tongue or my cheek bothered me at the
time.
Day 29. Came back to have stitches removedand was told
about results of the biopsy. The diagnosis from the left
cheek was “chronic inflammation with subepithelial vesicle
formation suggestiveof lichen planus.” He [Dr. A.] told me
there is nothing to be done about it. “It is there to stay, won’t
go away, and you have to live with it.” He was extremely
confident, knew what he was talking about.
During the ensuing year, my tongue started to bother me
now and then depending on what I ate.
One year, 3 months. My son had to have his wisdom teeth
pulled by Dr. A. When I took him to the office for surgery,
I made an appointment for myself one week later when his
stitches had to come out. My tongue had started to bother
me, so I wanted him to take a look.
One year, 3 months, 7 days. They fit me in while my son
was taken care of. Dr. A. told me: “As I told you before,
there is nothing you can do about it. It is there to stay, and
it may or may not bother you at times. It is chronic.”
ORAL SURG ORAL MED ORAL PATHOI.
April 1991
When I askedhim if this could becomecancer, he told me
that a lot of things could turn into cancer such as moles and
the like, but he didn’t think this would. He did not tell me
to come back or suggestanother opinion. He was very con-
vincing.
One year, 3 months, to 2 years, 2 months. As time went
on, I becamemore and more aware of the side of my tongue.
I started to compensateby swallowing my food faster, less
rotation for the tongue. Discomfort in the tongue sometimes
bothered my speech. Whenever I looked at the tongue, it
looked the same. It never bled.
Two years, 2 months (approximately). All of a sudden,
the tongue seemedmuch worse. In spite of this, I left for
Europe with my husband since we had planned this trip for
some time. During our vacation, the tongue became even
worse-why? I can’t say. The lesion seemedthe same size
but thicker, more granulated at the edges. It really inter-
fered with eating, swallowing and speaking. I made up my
mind to seeanother doctor when I returned since I couldn’t
take it much longer.
Two years, 3 months. I saw my internist, Dr. B. I wanted
to see if he could recommend or refer me to a specialist.
When he looked at my tongue, he looked worried. He called
Dr. A. and then called an ENT specialist, Dr. C., and sent
me right over to him.
One hour later, Dr. C. examined me, and after he was
through, he sat me down and told me he was sure it was
cancer. However, since it seemedwell defined and didn’t
seem to have spread elsewhere in the neck, he was quite
confident he would get all of it out with “microsurgery.” A
hospital date was set as soon as possible.
Two years, 3 months, to 2 years, 3 months, 1 week. I was
admitted and the surgery was performed the next day. My
face, neck and tongue were extremely swollen. I could
hardly swallow and consequently had very few liquids
orally. I was on IV’s til half an hour before I checked out.
Dr. C. [ENT surgeon l] was very happy with my progress
and gave me a prescription for Keflex suspensionand Ty-
lenol plus codeine. I was also to gargle often with Cepacol
mouthwash.
Before I checked out, I had a CAT scan which I found
to be unpleasant psychologically. I kept praying throughout
the test-hoping they would not find anything. As it turned
out, it was negative. What a relief!
Two years, 3 months, 2 weeks. My first checkup after the
operation. Dr. C. was very satisfied with what he saw. Still,
I had this terrible pulling on my stitches when I talked be-
fore lubricating my tongue. It was quite unpleasant, and I
had to take Tylenol and codeine.
Two years, 3 months, 3 weeks. Next checkup. Looking
back, I found myself thinking how strange it was that a
person like me, who never smoked and drinks only a half
drink twice a year, and doesnot like pepper in things or any
real spicy foods-gets this lesion on the tongue. Somehow,
I can’t find peacewith that. I’ve been eating food the con-
sistency of mashedpotatoes,cream-of-wheat, Enfamil, etc.
Anything coarse like toast, meat, chunky stuff, I can’t eat.
I asked Dr. C. after my examination if this lesion could
have been cancer 2 years ago when it was first noticed. He
Volume71
Number 4
said theoretically, it was possible, but the biopsy told us
otherwise. When I pointed out that the biopsy had been
taken out of the cheek, nor the tongue, he was momentarily
taken aback, but said there are many types of cancer. It
could have been a slow growing type that stayed dormant
until something triggered a sudden growing spurt. “Yes, it
could have been,” he said, “but the bottom line is, we got
it all out, and the CAT Scan was negative.” I am to seehim
again in 1 month.
Two years, 5 months. I saw Dr. C. at 10:00 AM. He was
very happy with my progress.The tongue was healing well,
and looked almost normal. A CT Scan was planned in 2
months.
Two years, 7 months. Saw Dr. C. again. Everything looks
good. CT Scan scheduled in 3 weeks.
Two years, 8 months. Results of CT Scan negative!
Whoopee!!
Two years, 9 months. Saw Dr. C. again, and all is well
so far. CT Scan planned in 3 months.
Three years, I month. Another CT Scan. Dr. C. noted a
lump in my chin and said it was scar tissue forming. There
was some tendernessso I was placed on antibiotics for the
infected gland. Another CT Scan was ordered next month
to see if it disappeared.
Three years, 3 months. Special type of scan attempted on
ducts in the floor of mouth. Dye was supposedto be intro-
duced into ducts. Duct on right side [side of surgery] could
not be found. It was overgrown with scar tissue. Two doc-
tors tried to probe but couldn’t find it. CT Scan rescheduled
after consultation with Dr. C.
Three years, 3 months, 1 week. Regular CT Scan done.
Results negative. Meanwhile, my husband and I, after a lot
of discussion, decided to sue Dr. A. We neededan unbiased
opinion from a doctor not previously involved and made ap-
pointment with Dr. D. [ENT 21.
Three years, 4 months. Saw our consultant, Dr. D. who
took lots of notes but didn’t offer any opinion.
Three years, 6 months. Saw Dr. D. again. He favored
surgery in order to obtain tissue to seephysically why this
thickness was present in the floor of the mouth. He didn’t
trust the CT Scan exclusively.
Saw Dr. C. three days later. He felt there was nothing
unusual about the situation. Don’t know who to believe. In
the meantime, I have a double chin due to the enlarged
gland, and I have stabbing pains in the area. Will see Dr.
C. again in 6 weeks.
Three years, 7 months. Saw Dr. C. at 11:OOAM. Despite
my complaints about the thickness next to my tongue and
glands in my chin, he feels everything is A-OK. “Don’t want
to cut for no reason and don’t want to CT Scan-you-
to-death. Will see you in 3 months.”
Three years, 8 months. Could not stand the pain with
chewing. Decreasedmobility of my tongue and increasing
slurring of words. Made an appointment for Dr. C. to see
me today, and my husband came with me. Dr. C. looked in
my mouth and felt the growth. He thought it was a fibroma
and advised another CT Scan.
Three years, 8 months 1 week. CT Scan done at 11:30.
Results were negative but Dr. C. wanted to do a biopsy in
Dying of cancer 403
9 days, but due to family circumstances and Christmas, I
askedfor it to be delayed. Biopsy was scheduled in 3 weeks
instead.
Three days later, saw Dr. C. again to discuss the biopsy.
He made all kinds of excuses that “this all of a sudden
developed. . .” I had been complaining all this time but he
wouldn’t listen.
Three years, 9 months. Saw Dr. D. again. He was very
thorough and felt the area definitely neededto be biopsied.
Three years, 9 months, 1 week. Biopsy and partial
removal of fibroma done by Dr. C. in l-day surgery clinic.
Stayed in bed with a lot of painkillers.
Three years, 9 months, 2 weeks (approximately). Results
from biopsy: CA near jawbone on right side. Advised by Dr.
C. to seeDr. E. [tumor surgeon] at university hospital (Dr.
E. was highly recommended). I asked him why was I being
sent to the university hospital, and he said merely that I am
the proverbial “hot potato.”
Three years, 9 months, 3 weeks. Seen by Dr. E. at the
university hospital who sprayed my mouth with novocaine.
His preliminary findings were that the tongue was still in-
volved and was connectedby tumor to the glands in the chin.
He sent me to the Dental Department for special x-rays of
the jawbone and teeth.
Two days later, Dr. E. called and wanted me to go to a
tumor conferenceon Monday so all disciplines could discuss
my case.
Three years, 10 months. Monday afternoon tumor con-
ference. There were 3 other patients besidesme to be eval-
uated. First, each casewas discussedwith 15 other doctors
and then the patient is called in to be questioned and exam-
ined. Then the patient is sent out again, and the team would
discuss a course of action. My new oral surgeon, Dr. F.
[OMFS 21, wanted an x-ray called an occlusal, and based
on that x-ray which showed thinning of jawbone, both Drs.
E. [tumor surgeon] and F. felt 4 molars should be extracted
and the jawbone sampled. My husband and I were a little
shockedsince we were told a few days earlier that the bone
and teeth were not involved.
In the meantime, we made appointment at Sloan-Ketter-
ing Memorial Hospital in New York for another opinion.
Two days later, after the examination, we talked with the
doctor for almost an hour. He was very thorough but also
very depressing.He painted a very dark picture of what may
have to be done. More x-rays were taken, and we went home
very depressed.
Three years, 10 months, 1 week. 4 molars pulled by Dr.
F. He was extremely helpful in discussing all our fears and
questions.
Four days later, I was still uncomfortable, probably be-
cause of tongue movement and pulling of stitches. Drink
water all the time.
Three years, 10 months, 2 weeks. Out of the house by
8:30 to get to Dr. F. for my 10:00 AM appointment to get
stitches taken out. We were 1‘A hours late becauseof a flat
tire. I must say, I have never met a doctor more compas-
sionate, helpful and able as Dr. F. He took impressions of
my upper and lower teeth in preparation for making a pro-
tective gadget for my teeth which I wear when I have to go
404 Krutchkof and Eisenberg
for radiation. Stitches were taken out, and he cancelled an
appointment to talk to us. Even though you sort of expect
bad news, hope never leaves you. Well, it has now. I tried
to control myself while he told us the jawbone was invaded
by the tumor. Now, I’m worried about my ear or cheek-
bone-just don’t know where it will end. I literally could
strangle Dr. C. with his cool exterior and repeated assur-
ances that all cancer was removed from my tongue. The
tongue hurts me more than ever now. It has the feeling at
the tip as if I burned it, and there’s a swollen hard feeling
along towards the back. Naturally, it’s full of cancer.
Maybe I’ll lose my whole tongue and can never swallow or
speakagain thanks to Dr. C. I can kick myself that I didn’t
listen to Dr. D. as far back as 7 months ago when he told
mea biopsy would be beneficial. Anyway, it’s water over the
dam, and hindsight doesme no good. I feel like I could eas-
ily becomea drug addict with this constant pain. I take ASA
or tylenol around the clock but it doesn’t help.
Three days later. Operation set for 4 days from today.
Talked with another doctor who told me they would have to
take tissue from my right breast to closethe surgical wound.
Now I’m scared.
Three years, 10 months, 3 weeks. Surgery completed af-
ter 12% hours. My face was grotesquely disfigured and
stretched out. My husband said I looked like a Buddah in
the intensive care unit.
Two days later. Beginning to be aware of things. I still
have a tongue and I can swallow although difficult due to
the feeding tube. Have a trach in so I can’t talk at all. Write
everything down.
Big scar going all around my right breast and 2 other in-
cisions, one from right ear to almost the left ear plus another
from the shoulder to the neck. Pectoral muscle cut so I have
trouble lifting my right arm. No strength in it-right breast
much smaller than the other. Drs. E. and F. plus residents
and interns came to see me every AM and PM.
After 4 days post-op, the trach comesout. Hole is closed
up to heal. I can hear my voice or rather someother scratchy
voice.
Three years, II months. Incisions healing well, stitches
taken out. I am promised my feeding tube will be taken out
next week. Wiring cut that holds my jaws together.
Replaced by rubber bands.
Three years, I1 months, I week. The drain hole under my
chin became a fistula; not closed yet; being irrigated and
packed with iodoform gauze. As long as the hole is open, I
need a feeding tube since everything you put in your mouth
comesout through that hole. Healing retarded and risk of
infection high,
Discharged 3 days later. Home! With feeding tube but
still home! Lots of supplies and fistula still open. Problem
with sleeping; have to sit up straight due to collection of
mucous in the throat. Can’t sleepmuch in one stretch. A lot
of pain in right arm. Arrangements made for physical ther-
apy at home.
Three years, I1 months, I week. Physical therapist here
to work with my arm. Blood pressurequite good due to los-
ing 17 pounds. No strength in arm. Very depressedand
ORAL SCRG ORAL MED ORAL PATHOI.
April 1991
weepy in evening. Can’t sleep, no energy. I draw strength
from prayers and from all my good friends.
Two days later, I’m back to seeDr. E. Fistula still wide
open. Took some stitches out of my mouth. Keep up tube
feedings.
Three years, 11 months, 2 weeks. Saw Dr. F. who
adjusted someof my rubber bands and made a small pros-
thesis so my bite is more comfortable. Much easier to keep
my mouth or teeth from shifting. Later, I saw Dr. E. (tu-
mor surgeon) who examined my fistula. Not closedyet. Will
have to wait with radiation until it does. Happy with my
general recovery.
I do as much as I can around the house. Also, good for
my right arm. Other people shop for me since I have that
tube hanging out of my nose.Have to plan any absencefrom
home as far as my feedings go.
Three years, I I months, 3 weeks. Went to Dr. F. at 2:00
PM. He adjusted some braces & told me he thought hyper-
baric oxygen might be of somehelp and suggestedI give it
a try.
Later that day, after a very nice explanation, I began
treatment. People there were really pleasant. They put me
on a stretcher-like bed which was wheeled into a clear plas-
tic cylinder. The door was shut after I had two pillows un-
der my head. It wasn’t high enough since mucous formed in
my throat but there wasn’t any more room. The whole pro-
cedure took l’/z hours, and I prayed it would be over soon
so I wouldn’t choke. Tried not to think of the mucous; man-
aged to swallow by turning my head to the side, but towards
the end, it became harder. You have to remain in one po-
sition. Can’t sit up or move. I was close to distress but
couldn’t move or sit up. Even if they had to stop, you just
can’t open the cylinder door. First, the 02 has to be reduced
gradually. I was almost crying. If I hadn’t had the problem
with mucous, it would have been OK. I kept thinking that
the minimum number of treatments is ten, and was it worth
it? Got to the point where I just couldn’t take it; not the way
I am now. Didn’t get home till after 9:00 PM. Took two tube
feedings together.
Seven days later, I’m eating & swallowing much better
but at first, it was torture. Couldn’t get any more than 2 tsp.
of Jello which took % hour. Then, little by little, more each
time. I know I have to go through this if I ever want to eat
again. Don’t think my tongue knows what to do. Can’t put
my lips together. No feeling in lower lip and chin.
Four years. Saw Dr. F. who made mouth guards for flu-
oride that would protect my teeth from radiation therapy.
Later saw the radiation doctor and was very depressedbut
not sure why. Maybe fear of the unknown, side effects, how
I will feel, etc. Have to go 5 days a week for 6 weeks. Do
not look forward to any of this. Am always asked whether
I smoke or drink & answer emphatically, “No” to both.
From 4 years, to 4 years, I month, 2 weeks. Radiation
treatments. Mouth keeps getting drier which is a mixed
blessing. First, I had too much mucus, now not enough. I
wake up with dry tongue and throat and have to wet it with
water. At least I can sleep now on 2 pillows instead of sit-
ting up.
Volume71
Number 4
During therapy, we went to see a law firm that special-
izes in medical cases.I don’t like the idea of telling so many
people about petty little things, claiming injury, etc., but
looking at it objectively, it goes way beyond this sort of
thing. I simply want Dr. C. to be aware, to think twice be-
fore he treats someone beyond his capabilities. If he had
only shown some interest, some compassion. He never
looked me in the eye when he gave me the news. He never
called to seehow I was doing after the biopsy. He never in-
quired how I was getting along in the hospital. It would have
made a difference.
Past mid-point in radiation. The end is in sight! Eating
ability, swallowing is getting worse-It’s such an effort just
to get 1 cup of milkshake or blenderized food down. I do a
lot of coughing, burping; liquids get in my nose. I’m not fit
to sit at the table with people other than my family. Terri-
ble food restrictions. Nothing hot or cold. Dryness almost
unbearable. Lost 30 lbs. so far. Good thing I was over-
weight.
Four years, I month, 2 weeks. Last day of radiation!
Can’t believe it’s actually over. My mouth is terribly sore,
and everything is just as awful as it was a few days before.
Better days are coming. Can’t wait!
Four years, 1 month, 3 weeks. Saw Dr. E. and weighed
in. Lost a total of 44 lbs. Lots of instructions about report-
ing anything unusual. He seemedpleased with the way I
looked.
Four years, 3 months. Sorenesson left side of jaw, maybe
the gland. Feels swollen and painful. Am aware of it all the
time. Saw Dr. E. the next day who said there is definitely
a lump under the ear. Very painful.
Two days later, a needle biopsy was done & later was
negative for tumor and negative for new cell growth. My
prayers have been answered! Later, I was thinking that if
Dr. C. would just have done this needle biopsy when I com-
plained of pain and hardness in my chin 15 months ago, he
probably would have caught it in time. Instead he took a CT
Scan. How differently doctors treat you!
Four years, 6 months. Recent pain under chin. More pain
and tendernesson the left side again. Doctors feel it could
be due to radiation, but they really don’t know for sure. Dr.
F. feels I should resume hyperbaric oxygen which I do in
spite of the fact that I hate it. I am depressed,yet I feel I
should be happy that everything is OK. Still, I’m not. It’s
so hard to keep a “good” attitude and a smiling face.
Four years, 6 months, 2 weeks. My neck now is very red,
ready to burst. 9 hyperbaric oxygen treatments so far
including today, I becamedizzy & sweaty during treatment.
Still am very claustrophobic. I asked them to take me out
but they can’t just open the door and do it. It takes 10 min-
utes. Later that day, saw Dr. F. whojust touched my neck
and pus came out spontaneously. He took several specimens
and wanted to admit me that day. I went straight to the
hospital.
Several I t D procedures & biopsy specimensdone at the
hospital-two days later. Also, CT scans of head, neck &
chest.
Four years, dmonths, 3 weeks. Bad news!They found CA
Dying of cancer 405
again in the area under the chin. No more radiation since
I had had the maximum. Chemotherapy planned.
Back to Dr. F. for extraction of the rest of my bottom
teeth. They were loose, and the bone had deteriorated due
to radiation or cancer. We’ll know in 5 days. I felt awful.
Four years, 7 months. More bad news! CA all through
lower jaw, and all 3 doctors have to confer on what to do
now. If it’s surgery, it means taking out my lower jaw and
more. Why go through with all this? There is no quality of
life so I might just as well spare my family and myself all
kinds of unnecessary grief. We’ll know for sure soon.
Three days later, the big decision: No more surgery-
they decided against it. Only chemotherapy.
Four years, 7 months, 1 week. To the hospital for chemo.
First 2 days wasted with tests. Finally they started with
methotrexate followed by platinum 2 days later. The next
day, I feel nauseousand throw up. Next my mouth is full
of sores, swollen. Chemo is stopped. I can go home. I feel
rotten. If I go near food, I throw uvan’t even think about
it. Losing more & more weight.
Four years, 7 months, 2 weeks. Home but feeling 100
years old. If I have to go through this every month in order
to stay alive, I opt for death. What kind of life is this any-
way? If it wasn’t for my kids and my husband, I would never
make it. I can’t sleepin his arms, I can’t hug him, can’t kiss
him. What kind of wife is that? My jaw hurts, my left ear
hurts, can’t even put my lips together to kiss. Shit! . . .
Mrs. T. continued to deteriorate and died of local
disease 8% months from the last entry in her diary,
approximately 5 years 3% months from the onset of
her illness.
Legal actions were later taken by the patient’s
family. Dr. A. approved a settlement just before the
casewent to the jury; Dr. C. was found guilty of neg-
ligence.
How vivid the lessonshere are! They are here to be
learned by any doctor or, for that matter, any person
involved in various aspects of ancillary patient care.
The primary point that stands out is that proper di-
agnostic procedures must be followed. It is the
reasonable standard of care that persons responsible
for diagnosis and management of oral disease be
aware of cancer-prone areas of the mouth, and this
knowledge must be applied when determining site for
biopsy when multiple lesions exist. Second, it is not
acceptable to assume that a negative biopsy result
from one area guarantees or even implies the same
diagnosis for another site. Third, it is vitally important
to take steps to assure proper follow-up examination
and evaluation. If conditions fail to resolve with the
prescribed course of therapy, matters must be reeval-
uated. One should never be so blinded, stubborn, or
biased as to fail to consider that the initial impression
may not have been correct. Finally, and perhaps most
important, is the matter of compassion. How easy it
406 Krutchko$ and Eisenberg ORAL SLRG ORAL MED ORAI. PATHOI.
April 1991

is through long hours, crowded schedules, the multi- REFERENCE

ple aggravations with insurance forms, salespeople, 1. Hay AWS. In: Anderson W. Boyd’s pathology for the surgeon.
problems with office equipment and personnel, and 8th ed. Philadelphia: WB Saunders, 1967:137.
other factors to forget that we are dealing with the
Reprint requests to:
feelings and lives of other people. Even with the
David J. Krutchkoff, DDS, MS
knowledge that errors were made, Mrs. T. perhaps Department of Oral Diagnosis/Pathology
could have accepted her fate had she simply felt that School of Dental Medicine
her doctors were concerned for her well-being. University of Connecticut
Farmington, CT 06030
Such are lessonsfor practice, lessonsfor life. Lest
we forget.

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Drive, St. Louis, MO 63146-3318,USA; phone (800)325-4177, ext. 4351. Subscriptions nmst beinforce
to qualify. Bound volumes are not available in place of a regular journal subscription.