Makeup that Kristen Hertzenberg applies before another appearance as Christine Daae in "Phantom: The Las Vegas Spectacular" first covers the inch-long scar across her neck.
And then as she sits there in the dressing room beneath the $35 million theater at The Venetian that was built especially for Andrew Lloyd Webber’s blockbuster musical, she caresses a lullaby in a soft, lilting soprano.
Baby don’t you cry, gonna make a pie,
gonna make a pie with a heart in the middle.
Baby don’t be blue, gonna make for you,
gonna make a pie with a heart in the middle.
Her singing of a few lyrics of "The Pie Song" on this November evening not only brings back a memory, but also a gorgeous smile that seems to add even more light to her makeup mirror.
"That was the first song I sang to my 2-year-old after my surgery," the 34-year-old performer said. "I wanted to take it easy on my voice, but I knew right then my voice was going to be fine."
To anyone who has heard this lead actress in "Phantom" sing this month, it would probably seem incomprehensible that she could have had a cancerous thyroid gland removed in September — surgery that could have caused lifelong hoarseness.
Her vocal range, which has so much to do with the standing ovations she receives night after night, remains that of a gifted artist whose classical operatic training included a stop at the Austrian-American Mozart Academy in Salzburg.
And yet on Sept. 10, in an operating room at Summerlin Hospital, when Las Vegas surgeon Sina Nasri removed the butterfly-shaped gland located at the base of Hertzenberg’s neck, just below her Adam’s apple, there was no certainty that her beautiful soprano would remain intact.
The procedure runs the very real risk of damaging the recurrent laryngeal nerve, which runs immediately posterior to the thyroid gland. If the nerve is damaged, the patient is left with the kind of voice that worked well for Louis "Satchmo" Armstrong on "Hello Dolly," but is seldom called for in operas or in Broadway musicals.
Not surprisingly, it was that possibility that weighed most on Hertzenberg as she prepared for surgery and turned her into "ball of stress that I hid pretty well."
She wasn’t overly fearful about the cancer: Survival rates for thyroid cancer are high, with 95 percent of thyroid cancer patients achieving what could be considered a cure, or long-term survival without reoccurrence.
Nor was she that concerned about loss of the thyroid gland, despite the fact that it produces hormones critical to the regulation of heart rate, blood pressure, body temperature and weight. She knew she could take daily medication to replace them.
As she entered the surgical suite, Hertzenberg said she couldn’t help but think about how she had gotten to that time and place, about how quickly she had gone from thinking about herself as perfectly healthy to someone who could be on the verge of losing a gift that she had carefully nurtured.
In June, she had gone to her local primary care physician, Dr. Kochy Tang, for a regular wellness visit. The appointment lasted just 10 minutes, but in that time Tang became concerned about what she thought was a swelling around the base of her neck. Tang said the actress should see an endocrinologist about possible thyroid problems.
Hertzenberg told her sister-in-law, a Harvard-trained physician in Houston, about needing to see an endocrinologist, who immediately told her about a physician she heard speak at a medical convention in Las Vegas, one Dr. Firhadd Ismail, whose practice is in Southern Nevada.
"My sister-in-law said he was like a walking medical encyclopedia and that I should see him," Hertzenberg said.
In early August, Ismail ordered a needle biopsy of nodules found on her thyroid gland.
"I was very nervous about having a needle so close to my vocal chords, but I never really thought the nodules could be cancerous," Hertzenberg said. "Many people have nodules that are benign."
The biopsy wasn’t definitive for cancer, coming back with a "suspicious" finding.
Ismail said surgery was indicated. If the nodules were cancerous, the thyroid had to go.
Hertzenberg said she shed a few tears after learning she needed surgery but "didn’t have time to get real emotional." She had heard the jokes about health care in Las Vegas: The best place to go for complex medical care was the airport. Given that her voice was her livelihood and gave her the opportunity to carry out her dreams, she told Ismail that she was prepared to go anywhere in the world for the surgery.
Ismail said she was in luck; one of the country’s best surgeons for thyroid cancer was in Las Vegas. It turned out, Hertzenberg learned, that people come from all over the country to access Dr. Sina Nasri’s expertise. A Yale Medical School graduate who did his residency at UCLA, he had performed thousands of the procedures.
"I’m so glad I trusted Dr. Ismail’s advice," Hertzenberg said.
With surgery scheduled for early September, Hertzenberg not only kept performing in "Phantom," she also decided to finish an album she was recording, "Holidays From the Heart," with pianist Philip Fortenberry, the associate conductor for "Jersey Boys."
"We hurried into the studio for our sessions," Fortenberry said. "I could sense stress in her, but her ability to focus was incredible. She never broke down. We worked when she had the energy to do it, and the finished product is amazing."
Dana Satterwhite, Hertzenberg’s husband of nine years, said his wife "was pretty collected" up until the surgery,
"It was after the surgery, when we were in bed and it hit us between the eyes just how serious this all was, when we got pretty emotional."
The day before her surgery, Hertzenberg did the photo shoot for her CD cover as well as perform in "Phantom." The Christine Daae role is so taxing that she and Kristi Holden share it.
Early on Sept. 10, Hertzenberg entered Summerlin Hospital for what she hoped was a removal of benign nodules.
Shortly after entering Hertzenberg’s throat through a tiny minimally invasive incision, Nasri excised some of the lesions or nodules and sent them to the hospital lab for immediate examination. Within minutes, he learned his patient had cancer. In less than an hour, Nasri had safely removed the thyroid gland. Other surgeons often need more than two hours to perform the procedure.
"We also had to take out one lymph node," Nasri said, "The surgery was very effective, All the margins were negative for cancer. She did great."
When she returned home with a bandage on her neck, her 2-year-old daughter Shea was concerned about mommy’s "boo-boo."
"She was so loving," Hertzenberg said, choking up.
Hertzenberg still had some hospital treatment to undergo, this time at Sunrise Hospital and Medical Center. She was given a radioactive iodine pill that works to ensure that any microscopic areas of thyroid cancer which could be left are destroyed.
Because she became radioactive, she had to stay in an isolation room by herself for nearly three days. She also had to stay away from her little one for two weeks.
"That was pretty hard," she said.
Her recovery went well. She went on medication to regulate her hormones. Vocal exercises kept her voice at about 85 to 90 percent of its strength. Friends cooked for her. And family and friends who came in from across the country helped with Shea so her husband, Dana, could pursue his advertising career.
On Nov. 7, less than two months after cancer surgery, she returned to the stage.
"I did two performances that first night," she recalled. "I had so focused on my incision and my voice that I hadn’t done exercises for my body. It was really taxing on my back. I realized then I could have probably used a little more time off.
"But that night was still a great feeling. The entire cast of 42 applauded me. I felt their warmth and embrace."
Since returning to performing, she has also held a release party for her holiday CD and is preparing for shows with the Las Vegas Philharmonic next month.
Hertzenberg couldn’t be more grateful for how things have turned out.
"The first Broadway show my parents took me to as a young girl was ‘Phantom of the Opera,’ " she said. "I remember specifically wanting one day to be the girl that played Christine. And I made it. … And I continue to be able to do it because I had a great medical team and family and friends that supported me when I needed them."
Contact reporter Paul Harasim at firstname.lastname@example.org or 702-387-2908.HEAR HER SING
Musical: "Phantom: The Las Vegas Spectacular," The Venetian, phantomlasvegas.com
Las Vegas Philharmonic: "A Holiday Celebration" with Kristen Hertzenberg, Travis Cloer and the Las Vegas Master Singers, 2 and 8 p.m. Dec. 17, Artemis Ham Hall, UNLV, lvphil.com
Holiday album: "Holidays From the Heart," iTunes at Amazon.Com or KristenHertzenberg.com