Seriously ill people almost always seek a second opinion — or maybe a third.
But when firefighter Chris Gauer was diagnosed with laryngeal cancer of the vocal cords at Kaiser Permanente, his own physician ultimately sought out 60 additional opinions on his case.
Gauer’s story begin in 2012, when after a persistent sore throat that made it nearly impossible for him to speak, the Rohnert Park resident scheduled an office visit with Charles Meltzer, MD, chair of chiefs for Head and Neck Surgery and a physician at Kaiser Permanente Santa Rosa.
Noticing some abnormalities on Gauer’s vocal cords but also knowing that his patient was a nonsmoker, Dr. Meltzer recommended voice rest. That was unsuccessful, and then an ensuing biopsy indicated cancer. After a course of radiation that December, Gauer seemed to be better.
“I was feeling good and went back to work after three months,” Gauer said.
But eventually his voice was raspy again. “At that point, I was really worried,” he added. “I knew that I had limited options for a second procedure.”
Dozens of Experts Review His Case
In a follow-up appointment, Dr. Meltzer was sure the radiation had not squelched the cancer.
To confirm, though, he took full advantage of Kaiser Permanente’s integrated system by referring Gauer to one of three specialty care clinics in Northern California, where his case would also be reviewed by the Case Conference Board Dr. Meltzer had founded.
The board meets virtually each Thursday to discuss the complex head and neck cancer cases of Kaiser Permanente Northern California patients. Up to 60 physicians from all specialties — ranging from medical oncologists to pathologists — participate, giving patients such as Chris Gauer an unprecedented opportunity to have their cases scrutinized. Ultimately, the board makes recommendations for more than 1,000 cases annually.
“The process is swift and accurate,” Dr. Meltzer said. “We refer patients for evaluation in the morning, the board meets mid-day, and the patient is given the recommendation directly afterward. More eyes and input means the best care for our patients. No one else can conduct a review on this scale.”
In Gauer’s case, there was only one solution — a laryngectomy. In November 2013, Dr. Meltzer and Jane Yang, MD, removed Gauer’s voice box and created a stoma, or permanent hole, in the lower part of his neck for breathing.
While Gauer’s diagnosis of throat cancer was devastating, his eventual successful surgery and recovery still meant he couldn’t return to the job he had loved for 11 years. The standard firefighter mask would not protect his vulnerable stoma from smoke.
One of the people acutely sympathetic to his loss was Dr. Meltzer, who called Richard Hartung, his old friend and a professor at Cal Poly San Luis Obispo, to see if his engineering students could invent a mask just for Gauer.
Amazingly, they did — and the mask worked. While it hasn’t yet been approved for use on the job, the experience gave Gauer hope — and perspective.
“Having gone through something very, very difficult, I haven’t had time to stop to worry about much else,” he said. “I have two beautiful children and a wife who love me — and that is all that matters.”
Today, Gauer speaks easily although with a faint rasp. He lifts weights daily and works behind the scenes at a Bay Area firehouse.
“Dr. Meltzer was absolutely crucial and incredible in the way he helped me and took a personal interest in me — he went above and beyond,” Gauer reminisced. “The care I got from everyone at Kaiser Permanente was phenomenal.”
Meet both Chris Gauer and Dr. Charles Meltzer in this video.
Have your own story to share about your care at Kaiser Permanente? We’d love to hear from you. Please email a brief summary to InsideKP-NCal@kp.org.