Linda Hershey lost her nose to squamous cell cancer in 2007. She chose nose reconstruction surgery at Johns Hopkins, the beginning of her long journey of numerous surgeries to have her nose rebuilt.
Story and photos by Algerina Perna. Warning: Series contains graphic content.
Hershey, an operating room nurse at Lancaster Regional Hospital in Pennsylvania, had been involved in health care long enough to know that the likely diagnosis was cancer. Test results soon confirmed her fears, and she faced the only effective treatment: removing most of her nose.
One critical question remained: What to do with the hole left from the operation?
Hershey rejected a prosthetic nose, which was a relatively cheaper and uncomplicated option but required daily removal. Instead, she chose nose reconstruction at Johns Hopkins Hospital — a long, laborious process that involves moving skin, bone, cartilage and blood vessels from other parts of her body.
Six years later, Hershey’s ordeal has lasted longer — and been much more grueling — than she ever imagined. She has had more than a dozen nasal surgeries — and several additional surgeries and procedures on her eyes and sinuses stemming from the reconstruction.
Hershey, 68, acknowledges the toll: bouts of depression, severe pain and long recuperations. But she has only praise for her surgeon and manages to maintain her wry sense of humor about forgoing a prosthesis: “I’m OK with taking my teeth out at night; I prefer not to take my nose out at night, too!”
A fighter whose mass of salt and pepper hair frames her surgically altered face, Hershey speaks about the cancer with a frank, head-on approach. “I think from the day we are conceived in this world, there’s a plan for all of us. It isn’t so much what happens to you; it’s how you handle what happens to you,” she says.
Her medical journey began in August 2007. Once the cancer was discovered, she was referred to surgeons at Johns Hopkins, and on Dec. 12, 2007, much of her nose was removed in an operation that lasted eight hours.
As a nurse, Hershey had watched hundreds of patients face surgeries: heart transplants, joint replacements, tumor extractions. But she had never seen a nasal resection, in which the nose is removed.
Even with 42 years of nursing experience, she was unprepared for the emotional impact.
Two days after her surgery, the six-foot-long dressing was unraveled from the gaping wound in the middle of her face. The pain of that procedure was unbearable. “I’ve never experienced a feeling like that in my life,” she recalls. “I had a body freeze, a feeling like I was moving out of my body, losing consciousness.”
Hershey’s daughter, Tami Layman, was with her that day, holding her hand.
It isn’t so much what happens to you; it’s how you handle what happens to you”
A few hours after the dressing was removed, Layman, a certified nursing assistant from Woodstock, Va., helped her mother into the bathroom so she could look into the mirror. Layman could see the back of her mother’s throat through the hole in her nose.
Layman, 45, recalls, “She got a little bit teary-eyed, but she didn’t break down. She said, ‘Wow, that’s a big hole.’ I said, ‘Yeah, it’s a big hole …’ What else could you say to her?”
The squamous cell tumor — a growth of abnormal cells forming in the flat cells of the skin and the nasal wall — had grown since the diagnosis, and much more of Hershey’s nose was removed than expected. Layman didn’t care; she just wanted her mother to live.
Yet the nose resection — followed by radiation therapy — was just the beginning. Rebuilding Hershey’s nose would require a series of complex operations, all led by Dr. Patrick Byrne, director of Johns Hopkins’ division of facial plastic and reconstructive surgery, whom Hershey describes as having “a bedside manner that all doctors should have.”
In the next procedure, skin and tissue would be taken from her forearm and grafted onto her face as the foundation for her new nose. In other surgeries, rib cartilage would be harvested to form the structure of the nose, and ear cartilage used to form the right nostril end. A “template” would be cut into the skin on Hershey’s forehead; eventually it would be “transitioned down” to form the outer layer of the nose.
Hershey’s confidence in Byrne eased her concerns about the series of surgeries. It even helped prepare her for the surreal experience of seeing herself without a nose.
“Actually, I wasn’t as shocked as I thought I would be,” she recalls. In the three months since her diagnosis, she had accepted what was in store. “If I had any other doctor besides Dr. Byrne, it wouldn’t have been as easy.”
Not that it was ever easy.
Hershey’s next major surgery came in April 2008, when Byrne closed the wound in her face, transferring the forearm skin, as well as an artery and vein. A skin graft was also taken from her right thigh to protect the spot on her forearm where the skin and tissue had been removed.
The post-operative period for this surgery, which took more than 10 hours, was rough for Hershey.
A couple of days after the surgery, as her daughter helped her bathe in a hospital room shower, Hershey sobbed from the searing pain in her forearm, which had a wrist-to-elbow incision and was held rigid in a cast. Tears flowed uncontrollably at Layman’s comforting touch. It would take several weeks for the pain to subside.
Hershey was only seven months into her long journey. But now she and Byrne faced an extraordinary challenge: reconstructing her nose and restoring her pre-cancer appearance.
Tomorrow: Linda’s Journey, Part Two: A doctor’s challenge