When Carlin Black was diagnosed with tongue and throat cancer in 2016, the 76-year-old tenor had some heavy choices to make.

Black had recently been offered a once-in-a-lifetime opportunity to sing Gustav Mahler’s Symphony No. 8 in E-flat major with a local orchestra, but he knew the cancer treatment options — chemotherapy and radiation — would ruin his voice for the performance.

“Mahler’s 8th is a piece that non-professional singers never get a chance to sing,” said Black, now 82. “It’s one of the absolute major choral works everyone wants to sing.”

Not only would the cancer threaten an end to his singing career, it had spread to his lymph nodes where it was in danger of launching a destructive expansion to other parts of his body.

“If I survive, I’ll sing Mahler’s 8th and live my dream, and if not, it was worth it.” Carlin Black 

In considering what he should do, Black recalled some advice he received in a book some years earlier and which he considered a guiding principle: Don’t quit living to avoid dying.

“He was very clear with us on what his wishes were, and we wanted to do everything possible to make that happen,” recalled Kaiser Permanente oncologist Jed Katzel, MD, a musician who plays the viola.

Black said when he sat down with his Kaiser Permanente care team in Santa Clara and told them his first priority was to sing a very important upcoming concert and not have radiation, “they looked a bit shocked.”

“But then they said, ‘Well, we can offer you infusion chemotherapy, which you are not going to like at all, but it will put the cancer on hold and buy you some time to sing.’”

Black jumped at the chance to sing his concert and thought to himself, “If I survive, I’ll sing Mahler’s 8th and live my dream, and if not, it was worth it.”

Dr. Katzel said Black’s case is a great example of how physicians can strike a balance between curing disease and caring for their patients, 2 priorities that can oftentimes be at odds with one another.

“It’s about listening to the patient’s wishes and desires and knowing the patient is often correct about the best plan of treatment,” said Dr. Katzel. “We knew we could put his cancer on hold with just the chemotherapy, but that it would come back, and when it did, he was still able to get curative treatment.”

Black sang his concert, and the cancer did indeed come back. He then did the full treatment of chemotherapy and targeted radiation. Now cancer free, he recently rehearsed for his next concert with the San Francisco Choral Society, Handel’s Dixit Dominus and new music by Chiayu Hsu.

San Francisco Choral Society Artistic Director Robert Geary has known Black for 27 years.

“It was hard to watch him go through his treatment,” said Geary. “He was knocked down pretty hard, but he’s resilient. He still came to sing and had to move down to bass for a while, but now he’s a tenor again.”

Kaiser Permanente head and neck surgeon Fidelia Butt, MD, who also was on Black’s care team, remembers him fondly and the learning opportunity Black gave his physicians.

“He taught me a lot about taking to heart a patient’s treatment goals and the value of shared decision making,” said Dr. Butt. “Instead of being dogmatic in our recommendations, following nonstandard care reasonably and tailored for the right patient can also provide positive outcomes all around. In this case we are grateful Mr. Black was able to realize his personal dream and be an inspiring cancer survivor.”

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