Magazine article Humane Health Care International

Hearing Margaret Estok: A Foreword

Magazine article Humane Health Care International

Hearing Margaret Estok: A Foreword

Article excerpt

In March 1993, Margaret Estok had an ultrasound that identified an adnexal mass. On April 15, 1993, she had a laparotomy that found a Stage III, epithelial ovarian carcinoma. Then her uterine tubes and ovaries were removed and samples were taken to see how far the tumor had spread. Even after this extensive procedure, microscopic disease remained. After the operation, she was started on chemotherapy in the form of cis-platinum and cyclophosphamide. Because she developed a marked fall in white blood cells during this therapy, the fifth and sixth course of treatment was changed to single agent carboplatinum. Treatment was completed in October 1993. She traveled to another province to be with her daughter and remained well until August 1994 when we found that a routine test for tumor activity (CA 125) was elevated. A physical exam and computerised tomography (CT) scan found no evidence of recurrent disease, nevertheless she was started on hyperimmune therapy.

In March 1995, she complained of gastrointestinal distress and abdominal pain. Her CA 125 was still elevated but a repeat CT scan and physical examination were negative. In November 1995, a CT scan demonstrated recurrent disease with measurable liver metastases. She then received three cycles of Taxol (a cytotoxic agent used in metastatic cancer of the breast and ovary when standard treatment has failed) but her disease continued to progress. In February 1996, Margaret was started on the first of three cycles of Topotecan (a "broad spectrum" experimental drug) but did not respond. Then, on her own, she explored the possibility of using Mifepristone (RU 486), the "morning-after" drug that is alleged to be effective in ovarian cancer. This agent was not available in Canada and she considered traveling to Germany to obtain it. However, her deteriorating health prevented her from making such a long trip. She died in early July 1996.

Margaret Estok was a woman of intelligence, determination, forbearance and a sublime sense of the ridiculous. I first met her when, as a psychiatrist, I counseled her husband, Michael, who was in hospital with a terminal illness. He felt, quite appropriately, that Margaret needed to be part of the treatment process and needed support as much as he did. …

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