‘Hope for the best, prepare for the worst’: A deputy chief’s cancer story
Detailing the diagnosis process, plus the ‘lightbulb’ moment about underestimating the number of toxic fires we face
By Brian Cronin
I was first diagnosed with throat cancer in September 2011.
My only symptom, which started just three months earlier, was a dry throat, which I attributed to the part-time work I was doing stocking shelves in a grocery store. After several weeks of experiencing dryness, my girlfriend at the time convinced me to have it checked out.
My primary care physician (PCP) was not seeing patients at that time due to moving his practice to another location, so I had to go elsewhere. I went to a local clinic where a quick strep test was administered as well as a full strep test (results in 48 hours). As a precaution, I was placed on a 10-day antibiotic and urged to follow up with my PCP if the symptoms persisted. Both tests produced negative results.
I wasn’t worried. I assumed it would go away. I figured it was probably from stocking dusty shelves and opening cardboard boxes.
As directed, I was able to follow up with my PCP, who suggested allowing the antibiotic 30 days to work after a second examination of my throat revealing nothing at the time. Again, I wasn’t overly worried.
‘I was horrified at what I saw’
Over the next 30 days, I began noticing a slight difficulty swallowing and the sensation of something in the back of my throat. I was always trying to clear my throat.
Just prior to my follow-up appointment with my PCP, I got a flashlight to look at my throat in the bathroom mirror. I was horrified at what I saw. My throat was swollen almost to the point where it was fully occluded. This was the moment when my lack of worry transitioned to extreme concern.
I immediately made an appointment with my dentist to make sure it wasn’t an abscess of some type. My dentist took one look and strongly suggested I follow up with my PCP as soon as possible, which I did a few days later.
My PCP performed a thorough exam. A regimen of steroids was a possibility, but an Ear, Nose and Throat (ENT) specialist was the preferred next step.
I thought, “Shit, another doctor.” While I was contemplating this, my PCP said, “Let’s do that. I will make the appointment for you.”
As I waited anxiously for the next appointment, I kept up with my daily routine and work shifts at both jobs. In the back of my mind, I thought, “The dentist knows something, but he’s not saying, and my primary care knows something.”
‘I was hopeful and fearful at the same time’
A week later, I was sitting in the exam room of the ENT. The doctor entered the room, briefly introduced himself and took a quick look at my throat. He followed with, “We are going to take a biopsy of that.” I asked him what he thought, and his answer was blunt: “It’s either cancer or it’s not.”
A week later, the biopsy, followed by the worst sore throat in history.
I was hopeful and fearful at the same time: Hope for the best, prepare for the worst.
Another week later, the results.
The ENT walked into the room with my file, barely acknowledged me (doctors and their bedside manner), opens the file and says, “It’s cancer, follow me, you need a head and neck surgeon.”
And I did follow him at a very rapid pace to the desk to make the appointment.
I left the ENT’s office and headed to my part-time job to see my girlfriend. Outside the grocery store, I ran into a member of my crew – my driver – and a very close friend. I said hello and immediately started to cry. I was scared … but I never thought I wouldn’t be OK.
‘The worst part was the inability to eat’
Three days later, I was at Massachusetts Eye and Ear to see the head/neck doctor. He explained there was a 90% cure rate for my type of cancer and that I was late Stage 2, early Stage 3. My options were surgery or radiation and chemo. I asked him what he thought was the best treatment for me, and he more or less stated that it was my decision to make. I responded, “WHAT do you think?!” He responded chemo and radiation would provide the best result.
I was comfortable with the decision, mainly because the surgeon seemed emphatic about the right course of treatment for me.
Two days later, I had an oncologist and a radiation oncologist. According to both doctors, as a non-drinker and non-smoker, I was not the typical throat cancer patient. Both doctors attributed my cancer to firefighting.
Treatment would be 37 radiation treatments and four chemo treatments starting in October.
I tolerated the chemo pretty well after the first treatment, which negatively affected my kidneys. The radiation wasn’t bad until the last 10 treatments, which were more focused and burned the skin on my neck.
The worst part of the treatment was the inability to eat. The radiation made everything taste like metal. My weight dropped from 167 pounds to 132 pounds. I was treated frequently for profound dehydration. A feeding tube was inserted, and after a few tries with various liquid food and a brief hospitalization, I slowly began to get better and add weight.
I finished treatment on Dec. 7, 2011, but I was out of work for almost a year. And it was another year before I was back to a normal weight for me.
I still have trouble swallowing dry foods like bread and crackers, I have permanent dry mouth (radiation killed my small salivary glands), and some foods taste different or I no longer care for them. But as I tell everyone, it is far better than the alternative.
‘We never wore SCBA during overhaul’
I had been a firefighter for 32 years and was a lieutenant on an engine company at the time of diagnosis. When I spoke with my shift commander, he asked me how many fires I thought I had responded to in my career. I guessed between 200 and 300. He told me I probably had been to thousands of fires. I thought he was crazy. Mind you, this is a wicked smart guy. He explained that I wasn’t considering car fires (very toxic), brush and dumpster fires, and simple burned food/pan kitchen fires with Teflon pans being some of the most toxic environments firefighters enter.
It occurred to me, we never wore SCBA during overhaul (now known as the most toxic time on the fireground) or car fires.
I had started wearing SCBA at car fires after responding to one in my district with a new firefighter fresh from the academy. He got off the engine ready to go to work wearing his mask. I asked him, “What are you doing kid? We’re outside?” He calmly told me that is what they teach at the academy to protect themselves. From that day on, I wore my SCBA for car fires.
Since that time, I have made it a point to sit and talk with new recruits. “Teach me something you learned at the academy,” I say. Even as an experienced fire officer, I spend hours still learning my craft. I attend academy classes when I can, including an outstanding class at the Massachusetts Firefighting Academy on Cancer in the Fire Service, taught by Captain P.J. Roy of the Fitchburg (Massachusetts) Fire Department, whose dad, James Roy, also a firefighter, passed away from throat cancer in 2012.
And while as a chief officer, I no longer sustain the same exposures as an interior firefighter on the fireground, I realize I must follow the same post-fire protocols for showering and gear change/cleaning.
‘I was paying attention’
I returned to work full time in September 2012. I was happy to be back on the job. While I was not fearful of entering toxic environments, I was more mindful of good SCBA practices.
I have since promoted to captain and my current rank of deputy chief. I am now planning for my mandatory retirement in June 2021 – all because I can, because I was paying attention and caught my cancer early.
About the Author
Brian Cronin has been a member of the fire service for over 40 years and currently holds the rank of deputy chief of Operations for the Medford (Massachusetts) Fire Department. His fire service career began in 1979. He was promoted to lieutenant in 1987, captain in 2017 and deputy chief in 2018. He can be reached at firstname.lastname@example.org.