Cancer survivor has hole in throat for 4 years - why?

He says TTSH left him to live with condition; SGH later patched him up

This story was first published on Dec 14, 2014

Former security guard U. Govindan and his wife look back at 2006 to 2011 as the nightmare years that followed his treatment for cancer in his voice box.

Almost all that time, he had a walnut-sized hole in his throat. He could not speak, eat or drink. Food and liquid would seep out of the hole.

Neither husband nor wife had a good night's sleep, because the dressing for the hole in his throat needed to be changed every three hours, day and night.

They believed he would live out his days like that.

He says the last time he saw his ear, nose and throat specialist at Tan Tock Seng Hospital in 2010, the doctor told him plastic surgery was an option, but was hard to do and expensive - perhaps "more than $50,000" in private practice.

Mr Govindan, now 66, has a tape recording of that last exchange with his doctor which left him discouraged, and led to his seeking treatment at the Singapore General Hospital.

At SGH, he was seen by the head of plastic surgery and, within weeks, had surgery to close the hole. Well before his next appointment at TTSH, he was "a normal person again" - able to eat, drink and speak.

Today, he is well, he sleeps through the night and is able to eat his meals normally. He contacted The Sunday Times after reading a recent report about a Singapore Medical Council case, saying he still did not understand why his TTSH doctor left him believing he would have to live out his days with a hole in his throat.

The Sunday Times approached TTSH on Nov 24 with questions about Mr Govindan's case. The hospital replied last Friday. It refused to meet Mr Govindan with The Sunday Times present, citing patient confidentiality and its protocol. (See other story)

TTSH said in an e-mail reply that its surgical team had been planning surgery to fix the hole - termed a fistula - in Mr Govindan's throat, but he did not turn up for his appointment on March 2, 2011.

By then, he had already been treated at SGH. Mr Govindan insists the treatment plan was never conveyed to him. In fact, the last time he saw his TTSH specialist, the doctor told him that TTSH's plastic surgeon was too junior to perform the surgery.

The specialist who treated him is now in private practice and could not be reached. His clinic said he did not wish to comment.

Mr Govindan's story goes back to 2003 when he sought treatment at TTSH for hoarseness in his throat and found out he had cancer in his left vocal cords. This was cleared with radiotherapy.

In August 2006, a cancerous tumour was found and he had surgery the following month to remove it.

He was still warded at TTSH when he had an infection in his neck. His wife, now 60, says she complained for days about pus draining from his wound, but doctors said it was a normal discharge.

When they finally tested the discharge, the infection had spread.

The hospital told him the infection was caused by poor wound healing when one of his veins burst. This resulted in the hole.

TTSH says several attempts were made in 2007 to close the hole, but they were unsuccessful, although the size of the opening was reduced.

All that time, Mr Govindan had to be fed a liquid diet through a tube from his nose to his stomach. Even then, his saliva would flow from the hole.

His specialist sent him to a dentist to have a plastic cover fitted over the hole. Even with that, liquid and food would still trickle out.

By 2008 and still unwell, he had to stop working.

He continued to see the same specialist until September 2010 and Mr Govindan said he asked more than once if anything could be done to close the hole, but there were no more attempts to fix it.

He and his wife say that after she complained to the hospital that her husband's infection following surgery had not been checked despite her repeated requests for help, the specialist refused to let her or either of their sons be present when he saw Mr Govindan.

That was why Mr Govindan began taping all his consultations, so he could play back what the doctor had said to his caregivers at home.

The last time he saw the specialist, he asked if the hole could be closed. His tape recording has the doctor replying: "No, lah, if there was any other way, I would have closed (it), I would have told you already lah."

Recalling those days, Mr Govindan says: "There were times I would think it was no use living this way." He went about with cup in hand to collect the saliva which would constantly flow out.

"In the day, I would long for night to come. At night, I would stay awake waiting for daylight."

After he returned disheartened from his last visit to TTSH, one of his sons, Vijay, 36, a trading firm manager, Googled plastic surgeons and called the then head of department at SGH. Dr Colin Song felt Mr Govindan could be treated.

"I cried when I heard this," recalls Mr Govindan. He saw Dr Song and underwent surgery to close the hole in January 2011.

Contacted last week, Dr Song told The Sunday Times that the operation Mr Govindan needed "falls in the realms of reconstructive plastic surgery, so most surgeons would be able to do this".

"He did very well after the surgery," he said.

Mr Govindan was also referred to Dr Christopher Goh, SGH's ear, nose and throat head, who assured him he would be able to speak again.

Because Mr Govindan approached SGH himself and was not referred there by TTSH, he paid the private rate. The total bill was about $9,000 with insurance paying the bulk, and his Medisave the rest.

A week after the surgery, when the swelling and pain had subsided, he was a whole new man.

Last month, Mr Govindan asked TTSH for a medical report of his time there. He paid $160 and received a one-page report summarising his treatment over seven years.

It said he was cancer-free at his last visit in 2010 and that "multiple surgical attempts to close the fistula... were successful in reducing the size and symptoms of the fistula, but were not able to close the fistula".

Said Mr Govindan: "I just want to know why I was left to suffer for so long."