The following essay by Stan Winokur, MD, is adapted from The Big Casino: America’s Best Cancer Doctors Share Their Most Powerful Stories, which was coedited by Dr. Winokur and -Vincent Coppola and published in May 2014. The book is available on Amazon.com and thebigcasino.org.
I looked into her eyes and said, “Joan, I am so sorry. I don’t have anything left. There are no drugs that I know of to make you better. Please forgive me.”
Joan B. was a beautiful 23-year-old woman who came to see me in 1983. She had a rare type of germ cell tumor of the ovary that had spread to her lungs. Her doctor had tried several different chemotherapy treatments without success. He finally told her she had only a few months to live.
Since cisplatin had just been shown by Larry Einhorn, MD, to cure testicular cancer in many patients, I suggested we try the agent on Joan’s tumor. She agreed and endured severe bouts of nausea and vomiting from the chemotherapy. However, her tumor completely disappeared within 3 months.
The Gift of Time
Joan continued in remission for more than a year and was able to go back to work and enjoy being with her 1-year-old baby. Eighteen months later, Joan developed a cough, and, soon enough, we realized her cancer had recurred, this time in her lungs. We restarted the cisplatin, but this time she obtained little benefit from the chemotherapy, and the cancer continued to grow. I tried several different conventional agents and, finally, experimental drugs, all to no avail. I came to the decision that no further chemotherapy would help stop progression of Joan’s cancer.
Joan has been a gift to me and has taught me many life lessons. She taught me to be grateful for every day.— Stan Winokur, MD
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When I knocked on the door before entering the examining room in which she stood waiting to hear about her latest test results, I had this overwhelming feeling of powerlessness. I entered the room, and despite myself, I began to cry.
“Doctor, are you OK?” Joan asked. “What’s happened? Did something happen to you?”
I looked into her eyes. “Joan, I am so sorry,” I said. “I don’t have anything left. There are no drugs that I know of to make you better. Please forgive me.”
She hugged me and said, “Don’t worry, Doctor. I’m OK. You will be OK. You’ve done a wonderful job. I’m so grateful for everything you’ve done. The past 2 years have been a gift and the best years of my life. Have you ever seen the yellow tulips in front of your office? I’ve seen them bloom twice.”
Joan has been a gift to me and has taught me many life lessons. She taught me to be grateful for every day. And she taught me to appreciate the gift of caring for patients with cancer. For that, I thank you, Joan. ■
Dr. Winokur practiced community oncology in Atlanta, Georgia, from 1973 to 1995. He is currently Medical Director of Axess Oncology and resides in Juno Beach, Florida.