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A team from Nuclear Medicine and 6B (Head and Neck) at Toronto General Hospital worked on their days off so that a patient could get his cancer surgery 10 days early, saving him vital face and neck functions.
"Every week this patient's tumour was visibly larger, you could see that it was rapidly invading his cheek bone," said Dr. Douglas Chepeha, head and neck surgeon at UHN. "With their rapid turnaround, the team completely changed the type of operation he had.
"I can do a better operation with the team supporting me. They really made a difference in his life."
As a result of the team's efforts, Dr. Chepeha left intact the facial nerve that closes the patient's eyelid, and did not have to remove lymph nodes in the face or neck.
Removing these lymph nodes could result in nerve weakness of the face and shoulder, in addition to swelling of the face and neck from the buildup of lymph fluid.
The team's effort began with Romeo Cruz, Clinical Nurse Co-ordinator for the Head and Neck Inpatient Unit, 6B, who received an email from Dr. Chepeha on a Saturday last fall to expedite a patient's Operating Room (OR) date to Monday, instead of waiting for a further two weeks.
An OR time suddenly became available because the patient originally scheduled for Monday developed medical complications preventing surgery.
Romeo rolled up his sleeves, reaching out to the OR and Nuclear Medicine teams, who responded quickly. Judy Gabrys, Nuclear Medicine Clinical Supervisor, was on vacation, sipping a cognac in a café in Vilnius, Lithuania. With her BlackBerry close by, she noticed the email asking for help and texted her team of nuclear technologists.
Three technologists interrupted their respective leisurely Saturday afternoon of brunch, baseball and relaxing with pet parrots to jump in and co-ordinate an important nuclear imaging test for Monday morning before surgery. The test helps the surgeon pinpoint the exact position of tissues such as lymph nodes.
Being able to locate and test the first or sentinel lymph node – to which cancer cells are most likely to spread from a primary tumour – results in minimally invasive surgery, with less potential damage to nerves, and other branches of lymph nodes. It is also one of the most important factors in determining a patient's chance of recovery.
Then, Romeo called the patient.
When Robert Brown, 76, got the unexpected call on a Saturday afternoon, he was surprised and relieved at the same time.
A diagnosis of squamous cell carcinoma on his cheek in August 2017 gave him "the surprise of his life," he recalls, and quietly admits that he was anxious about the tumour.
"I could see it growing daily, and here I was waiting. I wanted to get the surgery done. Ten more days of anticipation is fairly stressful. I did want to get going," he says.
Robert credits the Nuclear Medicine Imaging team and Romeo with making it all seamless on Monday morning.
"As soon as I got in, they whipped me into the imaging room, and then into the OR," he says. "There was no delay. Everyone was very friendly and helpful, and that helped me to feel calm and well cared for."
Waiting for him in Nuclear Medical Imaging were three technologists: Karen Stratton, Linda Neglia and Paul McCrossin. They prepared the imaging suite, camera and a radioisotope which acts as a tracer, helping the surgeon locate the critical lymph nodes in the neck.
The technologists also made sure that the other scheduled patients did not have to wait for their diagnostic procedures as a result of Robert's unexpected patient visit.
"We understand the importance of OR time – every minute counts," says Paul. "We're a team. We help each other out."
Judy echoes that sentiment: "It's a commitment to excellent patient care. They'll sacrifice lunches, breaks if they have to. Our patients love the staff here. That's because we treat our patients like family."