Voicebox Hero

Some of the most famous voices in the world — Steven Tyler, Julie Andrews, Dick Vitale — have entrusted their pipes to Steven Zeitels, a relentlessly creative MGH surgeon whose latest breakthrough may make him a savior to countless cancer victims as well.

THE TROUBLE BEGAN IN THE LATE 1990s. That’s when the doctors got frustrated with John Ward. He had finally sought treatment for his raspy voice, and vocal therapist after laryngologist after ear, nose, and throat doctor recommended rest and therapy for what many of them pegged as laryngitis. But nothing helped, no matter how diligently Ward followed their orders. Years passed. His voice worsened to a whisper. Yet the diagnosis remained the same, just as the problem remained Ward’s and never any hospital’s. The man simply was not trying hard enough to save his voice, the thinking went. By 2002, with an outlook as bleak as it was unforgiving, John Ward began fearing for his way of life.

Ward was a professor at Northwestern University’s business school and a lecturer and consultant the world over, an inquisitive man and an expert on family businesses who loved what he did. He had a slight, unprepossessing frame; wore thin-rimmed glasses; and made little effort to hide his ever-retreating gray hairline. In presentations, Ward could no longer project his voice; he had to rely on strained necks and the kindness of forced smiles to get through a session. Ward hated that. So he began lugging around a mic, a small amplifier, and a whiteboard to his appearances. But he couldn’t shake the thought that his equipment distracted from his speeches more than they aided them.

His life outside the lecture circuit suffered, too. To spare his voice he carried around 35 index cards with common responses to everyday questions, each card with its own smiley face. Yet presenting one to a stranger or even an associate only elicited pity. He went to parties but found himself excluded from conversation. When he played host he had to limit the number of people he could invite: too large a group, and he couldn’t be heard. Some friends, perhaps only naturally, fell out of contact with him. What would Christmas with his family become? And what would he do for a living if he couldn’t speak? That thought scared him most.

In 2002, a colleague at Northwestern recommended Ward see a laryngologist in Boston, a guy named Steven Zeitels. He was a world-famous surgeon, with a short but thick build (“squat” would always come to mind when describing him), thinning red hair, a graying beard, and the perpetually half-closed eyes of the overscheduled. His former patients included Cher, Steven Tyler, and Julie Andrews. When Ward met with Zeitels in late 2002, Zeitels told him there was a 20 percent chance he had cancer of the vocal cords. A biopsy was scheduled.

Ward’s wife, Gail, the principal of a Chicago high school, couldn’t go to the appointment. That day she was hosting Chicago Mayor Richard M. Daley at a chamber of commerce luncheon. There, the minutes stretched into a couple of hours without a call from her husband. Finally, she called Zeitels’s office and got the doctor on the phone. He told her John had cancer, a tumor on each vocal cord.

“You hear the word ‘cancer,’ and you sort of lose your mind,” Gail says. But John Ward didn’t. “It was almost a relief,” he says. At last there was a culprit; he could try to find a way forward. Gail flew to Boston immediately so the three of them could discuss treatment options. That’s when Zeitels told them something else: He’d like John to be the world’s first patient for a new form of surgery. Working with minimally invasive lasers, Zeitels had repaired the broken blood vessels and incised the polyps and precancerous growths of hundreds of patients. He thought his lasers could also treat cancer, the heat from the light basically cooking the tumor. Radiation or chemotherapy would not be required; the laser would do all the work. Zeitels encouraged the Wards to do their homework — quite literally read academic texts — before making a decision. He also told them to seek outside opinions. Many of them.

And so they did. And each and every oncologist and radiologist said that Zeitels’s proposed surgery was a bad idea. Better to treat the cancer by proven means. The problem was that radiation precluded any other type of treatment. And what few doctors acknowledged was radiation’s own death sentence: an oftentimes successful remedy but a life with limited or no speech, because radiation in many cases stiffens the vocal cords beyond use.

Ward knew that was no life at all.

He called Zeitels back. As so many others had, he would entrust Zeitels with his future.

 

THE VOCAL CORDS ARE TWO FOLDS OF TISSUE COMPOSED OF MUSCLE, ligament, and mucous membrane that stretch horizontally across the larynx. They are tiny, no more than 25 millimeters long in an adult man, and vibrate every time you speak — 440 times a second when singing the A above middle C, for instance. It’s tough to find any muscle in motion that’s as pliable, as athletic, as the vocal cords. Nothing else in the body sustains the trauma that the vocal cords endure, and yet nothing is as resilient to that trauma. Nothing better expresses our feelings. To lose these small pink folds is to lose one’s sense of self.

Very few people realize this. Steven Zeitels is one of them. His is a 30-year fascination with the vocal cords that’s led him to think and act with an agility rivaled only by that of the tissues he repairs. He is the rarest of doctors, a highly specialized surgeon who draws his ideas from outside his field, an innovator late into his career who’s found what appears to be a cure for vocal cord cancer — a cure perhaps applicable for other cancers — but who has already moved beyond that, to something new, something else, something that will routinely keep him in his office, once again, until 2:30 in the morning and forever overextended, those eyelids always half-closed.

 

ZEITELS GREW UP IN NEW ROCHELLE, NEW YORK, in the 1960s and early ’70s, the younger son of an orthodontist and a schoolteacher. His parents didn’t insist he and his brother go to medical school, but “they pushed us that way,” Zeitels says. His brother, Jerrold, is a general and plastic surgeon in New Jersey.

Zeitels enrolled in Boston University’s six-year undergraduate and medical school program in the fall of 1975. Almost immediately he became, of all things, a leatherworker; he couldn’t stand studying all the time and needed something to do with his hands. “It’s the way I’m wired,” he says. Zeitels found a guy teaching a night class in Boston, and soon struck out on his own, developing a sense of style that suited him. It suited others, too: The following summer, Zeitels was selling his creations to a leather store in Woodstock, New York. He became so good at his craft that a year later he financed part of a trip through Europe by setting up shop in villages, fashioning American-cut leather goods, selling them on the weekend, then moving on to the next town.

Zeitels wanted to be a surgeon, but didn’t know what kind. Hoping to learn from the best, during his sophomore year he walked into the office of Dr. Stuart Strong, the chair of ear, nose, and throat (ENT) surgery at BU. He asked Strong to be his adviser. It just so happened that Strong was fascinated with the larynx, and worked with another pioneer, Dr. Charles Vaughan, who held the same passion.

The field soon consumed Zeitels: so dichotomous, these vocal cords, so strong and yet so fragile, requiring immense precision with every swipe of the scalpel. Or laser, as it turned out, because in 1971 Strong and his team had become the first to use the device on damaged vocal cords. This led Zeitels, after finishing his residency, to study the history of laryngology, every improvement since the specialty’s advent in the early 1800s. “We are all a product of what came before us,” Zeitels says. (In his office today hang framed portraits of the field’s pioneers, and on his bookshelves lie tattered copies of their texts and autobiographies.) This study of not only what came before him, but why and, more importantly, when, obsessed Zeitels. He still gives impromptu lectures on the subject. Like: “Hardly any major thing happened in our field when a person was past 35 or 40,” Zeitels says. “It’s why Einstein developed relativity at 28. Because when you become vested in a pathway, it’s hard to evolve…. [People] get known for something and they want to hold on to it. As you get older, your life gets more complicated — family, children, responsibility, and systems — so it’s very hard to be creative in that environment. You have to force yourself to be creative.”

In 1995, Zeitels published an exhaustive history in the field’s journal of record, The Laryngoscope. By that time he was working at the Massachusetts Eye and Ear Infirmary in Boston, and had broken ground of his own by operating on the precancerous lesions that grow on the vocal cords. He thought if he lifted up the flaps of the growth and used saline to blow it up like a balloon, he could then cut it out with microsurgical dissectors and scissors. And that’s what Zeitels did: the world’s first controlled microdissection of dysplasia and papalomatosis of the vocal cords.

Zeitels succeeded in part because of his leatherwork in college: It made him ambidextrous, a necessary skill for a procedure in which a cut a millimeter too deep would damage the vocal cords, but where one too shallow would leave some of the lesion intact, and therefore able to grow back. The problem with Zeitels’s surgery, however, was that no one else could repeat it. No one else in the field could be as precise. As he looked to publish his findings in an atlas on the larynx, one editor told him, “You can’t write that! People can’t do that!” His findings were published anyway, but the editor was right.

In the late 1990s Zeitels believed he’d found another surgical method with more-mainstream applications. Dr. Rox Anderson was a dermatologist at Massachusetts General Hospital who had developed a class of lasers in the 1980s that could treat birthmarks on a baby’s skin; the laser targeted the abnormal blood vessels that caused the birthmark while leaving the pattern of vessels around it almost untouched. Zeitels wondered if the laser could be used on the vocal cords. He and Anderson began a collaboration, and in 1999 they tested a laser for the vocal cords. It worked largely as Zeitels had imagined: destroying the abnormal blood vessels that the precancerous lesions needed to grow, but sparing the healthy blood vessels beneath. “He’s a Renaissance man,” Anderson says. “There aren’t too many people who would go and get a laser like that and use it on the vocal cords.”

Over the years Zeitels has designed more than 20 new laryngeal procedures and produced three patents. Acclaim in the field has led acclaimed voices to him. Julie Andrews came to Zeitels in 2000, shortly after reaching a settlement with a New York doctor whose efforts to repair her voice had damaged it beyond use. Zeitels performed a surgery that restored the flexibility of her vocal cords, and she is finally singing again. “If anyone can create a miracle, it is Dr. Steven Zeitels,” Andrews writes via e-mail. When Steven Tyler broke a blood vessel on his vocal cords, he went to Zeitels. “I got to know him really well,” says Tyler, who even learned about the leather bags his doctor used to make. “I just fell in love with him.” After the surgery, and a recovery time of just three weeks, Tyler decided, “I just wanted to scream this to the world.” The two filmed a segment for National Geographic, and later appeared on the Today show. “Zeitels is the one,” Tyler says.

A lot of other people have thought that, too. By 2003, Cedars-Sinai Medical Center in Los Angeles had approached Zeitels to open a voice center there. Salary was discussed; arrangements made. But at the last moment, and largely at the behest of Rox Anderson, MGH counteroffered. It had to create a new position and endow a chair at Harvard Medical School, but Zeitels decided to go with MGH. “Why?” he says. “The science that goes on here.”

Indeed, in late 2002 and early 2003, Zeitels found over the course of three careful operations that he could burn the cancerous tumor off of professor John Ward’s vocal cords, just as he had heated the precancerous growths of other patients. By early 2004, Ward was recovering nicely—and with a voice that sounded better than it had in years.

 

TAKE A MOMENT TO CONSIDER YOUR OWN VOICE. 

Now go back and read aloud that last line. What’s interesting is that my words on the page became something else when you spoke them. They became an expression of who you are. Anyone who heard you carry out my request heard your curiosity or bemusement or whatever it was you felt as you spoke. They heard your singular timbre but also drew conclusions about what you’re like, sized up your erudition and warmth. So something that was distinctly mine became something distinctly yours — and only because your voice gave you away again. It happens all the time. Any anxiety we feel, any bravado — all there, for friends and strangers to take in, ringing through whatever muffle we might try to put on it.

But the truth is, we seldom consider any of this at all. Our identity is our voice and our voice our identity, and writing that is rote — until you no longer have your voice. And when you don’t, when you’re Richard Rodgers of Rodgers and Hammerstein and late in life a cigarette habit forces the removal of your larynx, you learn to speak by swallowing air and burping it back up. But what you miss more than humming tunes are your witty rejoinders at dinner parties. Burping out a response takes too long. The moment always passes. “That was profoundly depressing for him,” Mary Rodgers Guettel says of her late father, who died in 1979.

Or you’re Dick Vitale, the ESPN commentator, and you could not stop crying when Dr. Zeitels diagnosed the ulcerous lesions on your vocal cords last year. It was the fear of cancer, sure, but more than that, “I wondered if I would ever be behind a microphone again.” Zeitels later said it wasn’t cancer, and that, yes, Vitale should return to the game. After Vitale’s surgery in early December, and after six weeks of voice rest (“very difficult,” he says), he flew to Boston to unveil his new voice to his doctor. Zeitels asked him to speak, but Vitale couldn’t. Zeitels repeated himself, said it was all right, that Vitale should count to 10. Finally Vitale began, “One…two…three….” Later, in the car, Vitale’s wife, Lorraine, asked him why he’d frozen in Zeitels’s office. “And he said, ‘I was worried my voice had changed,'” Lorraine says. “He was worried he wouldn’t have a career any more.”

That same fear mounted in Scott Solombrino. He owns a limo company in Boston, Dav El. He, like John Ward, carried note cards after his surgery with Zeitels to rest his voice. But it didn’t work. People — clients — just pitied him. Or yelled at him. “I had to keep writing, ‘I’m not deaf! I’m not deaf!’ on these cards,” Solombrino says. Finally he gave up traveling until he could speak again.

Eli Tannenbaum, an Israeli geologist who works with oil companies, had to give up traveling, too. Before he found Zeitels, he’d come to a realization. “A man without a voice is a dead man,” he says.

Zeitels has restored all of their voices, burned with his laser or cut with a scalpel all of their ailments. To show their gratitude, Zeitels’s former patients have built him his own state-of-the-art clinic at One Bowdoin Square. It takes up the entire 11th floor, just above Senator John Kerry’s office. His patients have also established a nonprofit agency, the Institute of Laryngology and Voice Restoration, to ensure that Zeitels will always have the means to innovate. Dr. Andrew Warshaw, chief of surgery at MGH, says he’s never heard of another group of patients who have gone to such measures for a doctor. The patients all say it took losing their voices to realize how important they were.

 

FIRST IN MAY IN ORLANDO, and then at a major laryngology conference in July in San Francisco, Zeitels presented his findings: In the past five years, 22 patients who received his laser treatment for vocal cord cancer had recovered fully, with no signs of recurrence. His research could have implications in the coming years for other mucosal-based cancers, like that of the gastrointestinal tract. Until then, more patients will be needed to further the study. Currently there’s no shortage. As the news this summer spread, Zeitels’s schedule booked up months in advance; he’s treated roughly 40 people in the past four months for cancer, some patients bringing their own doctors so they can learn the procedure.

One Friday in August, he stopped by a check-in desk at MGH’s operating room, deep bags beneath his eyes (as always), to tell a nurse about a kid and his father who had flown in the day before from Saudi Arabia and demanded surgery. Zeitels had been in the operating room till after midnight. It was just past 7:30 a.m. now, and he would be in surgery until midnight again. “Crazy, huh?” Zeitels said. The nurse gave a slight nod.

A few hours later he was operating on a vocal cord cancer patient from Israel, Ran Shohat, who’d heard about him through the Israeli comedian and actor Sefi Rivlin — another of Zeitels’s cancer patients. Zeitels peered through a powerful microscope while the rest of the medical team watched the procedure on a high-definition television. The cancer was a gray and red bulbous blob that Zeitels burned with the KTP laser, the same one he and Rox Anderson helped develop years ago. Smoke rose from the cancer as the laser moved back and forth across it. The shriveling remains looked like the charred fat of a grilled steak, and, as always, the underlying tissue was left almost untouched. In two hours, the surgery was done.

Zeitels is 50 now. By history’s account, he should be through innovating. And yet, three days before the surgery on Shohat, there he was in his lab, showing off his latest development. It’s a gel that he’s working on with MIT; Zeitels can inject the stuff into inflexible vocal cords in the hopes that they become pliable again. Unlike his cancer treatment, the gel would be for anyone whose voice had grown weary from years of use, performers, or radiation-treated voices that even the laser can’t help. It is the culmination of Zeitels’s innovations. “It will be bigger than the cancer stuff,” he says. Human trials are set to begin in two years.

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  • Stonea

    A month ago I went for an operation to removed growth in my vocal cords.After the operation I was given two months to rest my voice but my voice never returned and I had to go back to work.I am now frustated especially when people ask me if wether I am sick.Want can I do as I am in South Africa and Boston is far for me.please help