Church Deacon Holds Ground Against Malignant Mesothelioma
Joe Goins is a 66-year-old retired machinist and longtime Baptist deacon. A humble man who is frugal with himself and giving to others, Joe has lived wisely, and well. He married his high school sweetheart, Wynema ("Nemie" to Joe). Joe tells me they have never been with another, and declares, "Do you know how lucky I am?" He smoked only briefly during the Army, and gave up the nasty habit, which did not agree with him. Joe and Wynema have three sons, one daughter, eight grandchildren, and four great-grandchildren. The machinist with a high school degree always put food on the table and made sure Wynema could stay home and raise the children.
They live on 40 acres of rolling hills in the country outside of Frankfort, the capital of Kentucky which never became a big town. Frankfort's countryside is some of the lushest, most picturesque land you'll ever see. The grass does get so green it looks blue. In August, the summer air is warm but fresh; in winters, which are relatively brief, the snow can pile up to the window ledges of homes.
The tidy Goins home has a finished-out basement complete with kitchen and bath which once served as his father-in-law's living quarters. He kept about two of the acres surrounding his home neatly mowed. He also worked a large flower and vegetable garden on the east side of the house. His 16 year-old Arabian and quarter horse mix, Star, is free to wander about in the remaining acreage.
The Lord and family surround Joe and Wynema. A sculpture of praying hands is in the living room; Joe readily finds a well-worn Bible when a question of Scripture comes up. In retirement, Joe continued what he had done for his church for years -- he taught Sunday school, led an adult Bible class, and ministered to the sick in their homes.
Across the road is the house of one of their sons, Troy, and his family. Their teenage grandson Troy, Jr. rides up on a four-wheeler to see if his grandfather needs any help. To the west is Wynema's land, which she inherited from her parents. Off to the north is the little pond where Joe and his sons and grandchildren like to fish. In town is Joe's 91 year-old mother, still living in her own home, but dependent on Joe to maintain her yard and house, get her groceries and run her to the doctor's, among other things. A temperate man who might have a couple of glasses of wine in a year and practiced moderation in all things, Joe thought he'd live as long as his mother, or longer, in a life some might call simple and others, simply idyllic.
So Joe thought until the Fall of 2002, when he began to feel unusually tired and run-down. In early January of 2003, Joe awoke one morning with terrible chest pains. That afternoon Joe met with his family physician, who guessed Joe had had a minor heart attack. After several tests, a heart-related problem was ruled out. He was admitted to Central Baptist Hospital in Lexington, Kentucky on January 14. After more tests, including a CT scan and a chest film, the doctors at Central Baptist noted a mass on Joe's right lung. On January 16, Joe underwent a needle biopsy. Pathological tests upon the biopsied tissue resulted in the shocking diagnosis of malignant pleural mesothelioma. Like many afflicted with this cancer, Joe still has difficulty pronouncing the word.
Joe was referred to a local lung specialist. After looking at Joe's medical record, the pulmonologist admitted to Joe that this was only the second case of mesothelioma he had ever seen and he did not feel qualified to treat him. This doctor wisely referred Joe to Dr. David Sugarbaker of Brigham and Women's Hospital in Boston, Massachusetts. Dr. Sugarbaker is one of the most prominent surgeons in the world specializing in the treatment of pleural mesothelioma.
Joe and Wynema traveled to Boston via "Mercy Med+Flight", the country's only charitable air ambulance, and met with Dr. Sugarbaker on February 4, 2003. The surgeon told Joe the latter would have to come back after undergoing tests to determine his suitability for surgery. Joe begged Dr. Sugarbaker not to make him travel back to Kentucky before surgery, to try to "work him in." Joe believes it was divine intervention or simply God's plan that another patient canceled surgery scheduled for February 6, and after getting the call the night before, within hours Joe found himself being wheeled into the operating room.
On February 6, Dr. Sugarbaker performed a right upper lung lobe wedge resection with removal of ribs two through five. The tumor had invaded the third and fourth rib, extending into the most superficial third rib cortex. Immunohistochemical staining performed on the removed tissue confirmed the diagnosis of malignant mesothelioma. According to Joe, the tumor Dr. Sugarbaker took out of his chest was the size of a grapefruit. Joe was discharged from the hospital on February 16, but remained in Boston for another 10 days so that his status could be closely monitored by Dr. Sugarbaker's team.
Hardly recovered from the intense pain of the surgery, Joe next endured 14 cycles of chemotherapy under the care of a Lexington, Kentucky oncologist. His treatment cycle consisted of a Cisplatinum and Gemzar "cocktail" one week, Gemzar alone the next week, and the third week off. After the Cisplatinum-Gemzar cocktail, Joe would spend nearly the entire following week in bed, barely able to walk to the restroom. The treatment of just Gemzar left him nauseous and weak for the next 24 to 36 hours. His hearing has been affected adversely (and, apparently, permanently) by the chemotherapy.
Joe makes himself eat, trying to recover from the weight loss caused by his cancer and chemotherapy. It is a testament to this effort and prior good living that he looks surprisingly good for a man who has had mesothelioma for close to a year and undergone radical surgery and lengthy, nauseating chemotherapy. Still, he tires easily and becomes "shaky" when over-stressed.
He can no longer mow his yard. His vegetable garden lies neglected. His horse Star is starting to act up and get a little wild. A good but spirited horse, Star "needs to be rode, and rode hard", Joe says with a hint of a malicious grin, but there is no way he could ride now. Troy, Jr. is afraid to ride Star, and Troy, Sr. doesn't have the time. Just walking Star from the house down the grassy slope to his fenced-in acres now involves some risk to Joe; he is simply not strong enough or agile enough to handle the little "tricks" Star plays from time to time. He cannot drive, and Wynema now has taken over the care of Joe's mother. Joe has had to give up teaching Sunday school and leading adult Bible study. Although he could still visit the sick (with Wynema driving him), Joe does not feel he is "spiritually right" to tend to others yet. He keeps his own dark thoughts at bay mainly through a fierce discipline to prayer and Bible study.
As Wynema seemingly always has been, she remains there for Joe, strong, steadfast, prayerful, and at times unexpectedly and uproariously funny. Knowing Joe was dreading the ordeal of testimony, she handed me a slip of paper in confidence the day before his deposition, which in turn I passed to Joe just before his cross-examination. The note, apparently photocopied from another source, reads:
Today's mighty oak is yesterday's nut that held its ground.
Joe chuckled and passed the saying back to me before the defense attorneys began pitilessly trying to trip him up. The slip of paper is now pinned to my office wall, a daily reminder of Joe Goins, a testament to how great a man can become if he will simply -- and as the saying implies, crazily -- hold his ground. Joe Goins has been a pillar of strength for his family and his community by sticking to his principles, day after day. Whether Joe is one of the rare few to outlast mesothelioma or not lies in God's hands, but that outcome cannot dim his life's work. Count me among the many touched by Joe pulling for him to hold his ground, once again.
*** POSTED SEPTEMBER 15, 2003 ***
An Update -- 1/13/04
Throughout the spring and summer Joe worked hard to regain the strength and energy he was once took for granted. A setback came in late November when the results of a follow up CT scan revealed a new mass located in the same vicinity of the original tumor. The tumor, though not large, was biopsied on November 22, 2003. The pathological testing of the tissue specimen confirmed the return of mesothelioma. An appointment with Dr. Sugarbaker was immediately scheduled.
On December 9, Joe met with Dr. Sugarbaker. The examination and consultation with Dr. Sugarbaker resulted in the decision not to re-attempt surgical intervention but to use chemotherapy to shrink the tumor. The chemotherapy will be administered in Lexington.
Joe began radiation treatments on Tuesday, January 6. Arrangements were made with so that he could receive his radiation treatments in Frankfort. He is scheduled to receive radiation five days a weeks and will continue until he has completed a cycle of thirty treatments or six weeks. On Friday January 16, Joe and Wynema will travel to Lexington to meet with his oncologist and schedule his chemotherapy. Joe still recalling the adverse reactions he had with the cocktail of Cisplatin and Gemzar, has been assured that this go-a-round will not be as severe.
Joe feels good about the treatments. Dr. Sugarbaker is coordinating all of his treatment and communicating with both doctors in Frankfort and Lexington. Although the radiation makes him extremely tired, Joe advises that he "feels pretty darn good" as long as he takes a nap right when he gets home from his daily radiation treatment.. Wynema does her part by preparing nutritious and delicious meals that Joe always eats. He claims that he has been able to maintain his weight because he will eat even when he is not hungry.
Once Joe has completed all of the radiation and chemotherapy prescribed by Dr. Sugarbaker, he will return to Boston for further analysis. If radiation and chemotherapy successfully shrinks the tumor, Dr. Sugarbaker will not operate. However, if the treatments were unsuccessful, surgical intervention will likely be necessary.
Mr. Joseph Goins passed away on November 24, 2004
