A zestful exuberance marinates in the eyes of 17-year-old Nick Gagnon. His enthusiasm bubbles over as he explains the intricacies of cast-iron cooking and describes the cornucopia of cakes, cobblers, stews and vegetables that he has prepared. Nick discusses how the placement of coals on the top and bottom of a pot bakes food like a convection oven. Listening nearby, his mother, Suzette, smiles as Nick’s hands slice the air to illustrate the culinary method.
His excitement is a welcome sight—a cheerful scene in a dark drama that began in late 2010 when the teenager felt an unusual pain in his left leg. It’s a journey that led Nick to St. Jude Children’s Research Hospital, where he received treatment for a form of bone cancer and found an unexpected mentor in one of his favorite places: the kitchen.
A potful of hobbies
Although cooking is Nick’s passion, he has always had a well-rounded set of interests and hobbies. He played baseball, basketball and tried swimming before finding his athletic niche in the sport of rowing. As a member of the crew rowing team, Nick enjoyed the harmonious teamwork required to move a 60-foot, fiberglass boat through the calm rivers of his native Florida. Each day before practice Nick and his rowing club crewmates carried the boats—some heavier than others—from the boathouse to the river dock. Before launching, the entire team participated in a strenuous land workout of running, squats, push-ups and erging—a type of rowing simulation.
During a series of practices in October of 2010, Nick started experiencing pain in his left leg. Merely walking uphill to the boathouse became a painful task.
“My running performance started to drop, so my coaches asked if it was because I was getting bored with rowing. I said, ‘No, it just hurts,’” Nick says.
An X-ray in December of 2010 revealed a shadow on the upper portion of Nick’s femur. A magnetic resonance imaging (MRI) scan revealed a spot about 9 centimeters long. A local orthopedic oncologist performed a biopsy and diagnosed an osteoid osteoma, a benign bone tumor. Surgeons removed the tumor and replaced it with bone cement. Within two months, Nick was walking without the aid of crutches, but, more importantly, without pain.
Thinking this was a minor blip to his busy teenage schedule, Nick again poured his energy into the activity that spurred his love of cooking—the Boy Scouts.
As a 12-year-old scout, Nick had discovered cast-iron cooking, also known as the chuck wagon style that was popularized by late 19th century settlers of the American West. After his recovery, Nick’s main focus soon became his Eagle Scout project, which involved constructing raised garden beds at the local middle school where his mother served as a science teacher. Nick anticipated that the school’s students would eventually use the garden for various projects and experiments while he would satisfy the requirements to attain the scouts’ highest honor.
During the project’s planning stages in May of 2011, the pain in Nick’s leg returned. Assuming that he had not recovered fully from the osteoma removal, doctors placed Nick in physical therapy, which only made the pain worse. In July—just days after his 17th birthday and weeks before the beginning of his senior year of high school—an X-ray revealed a shadow near the same area as the previous one. An MRI of the femur indicated a spider-web pattern emanating from a central spot.
“When I saw that, I thought to myself that there was no way that could be removed,” Suzette says.
Recipe for success
Nick’s doctor sent results of a second biopsy to St. Jude. A team of physicians diagnosed osteosarcoma, a bone cancer that affects 400 children and adolescents under the age of 20 each year. After thorough research, Suzette and her husband, Greg, obtained a referral to St. Jude, where Nick’s cousin had been successfully treated for non-Hodgkin lymphoma a decade earlier.
“I thought that if we were going out of state, we were going to St. Jude because not only do they offer osteosarcoma treatment, but our niece had been treated there,” Suzette says.
Nick enrolled in the OS2008 protocol, which combines chemotherapy drugs with bevacizumab, a drug that slows the growth of new blood vessels. By choking off the blood supply to a tumor, bevacizumab helps prevent the cancer’s spread to other parts of the body. The drug has improved the efficacy of chemotherapy in adult patients with various types of cancer. St. Jude is building upon that base to conduct the novel trial in osteosarcoma patients, whose five-year survival outcome is magnified from 30 to 75 percent if the cancer has not spread at the time of diagnosis.
Nick’s cancer was confined to one area, but he still faced 10 weeks of intensive chemotherapy before undergoing limb-sparing surgery. Thirty weeks of additional chemotherapy would follow the operation.
“Decades ago, if you had osteosarcoma, your limb was amputated. A high percentage of those patients had the tumor come back in their lungs,” says Nick’s attending physician, Lisa McGregor, MD, PhD, of St. Jude Oncology. “From this, we know that even if we cannot see tumor and we just amputate, it’s most likely that the tumor has spread to somewhere else in the body. We administer chemotherapy after surgery to take care of any last tumor cells that still might be there.”
Because the chemotherapy was so intense, Nick had few opportunities to return home during treatment. Suzette resigned from her teaching position to stay with him. The teenager stayed in the hospital during treatments so that clinicians could ensure his body flushed out the drug to prevent organ damage. Nick needed almost all of the days between treatments for his body to fully recover.
Michael Neel, MD, of St. Jude Surgery performed Nick’s limb-sparing operation in November 2011, which required the removal of his upper left femur within four inches of the knee. Neel inserted a titanium rod to complete the procedure, which is comparable to a hip-replacement surgery.
Cooking up a storm
After the surgery, Nick worked with therapists in Rehabilitation Services to become accustomed to the prosthesis in his upper leg. He was also able to further his culinary foundation. His passion for food was well known around the hospital, so when TV personality and chef Giada de Laurentis visited St. Jude to film a Thanks and Giving segment for NBC’s TODAY show, he was a natural fit to help out. Airing on Thanksgiving Day, the segment featured Nick and other patients sharing their stories and preparing a “thank-you” meal for St. Jude physicians and scientists.
During the segment’s filming, St. Jude Executive Chef and Director of Culinary Operations Miles McMath learned of Nick’s ambitions. The two quickly bonded over culinary conversation. McMath, also a fan of chuck wagon cooking, says Nick’s enthusiasm is both impressive and inspirational.
When he sees Nick and Suzette in the hospital, McMath takes time from his busy schedule to talk food.
“It’s always nice to be able to mentor someone who has a passion for food like Nick does,” McMath says. “He would be feeling bad from the chemotherapy, and the only thing that would make him feel better would be talking about food. Just imagine what kind of passion he’ll have when he’s feeling better: He’ll be incredible!”
Nick also participated in other cooking projects and events at the hospital during his treatment. He returned home to Florida in May to undergo further therapy with the goal of returning to the kitchen in the near future. He has received an extension to complete his Eagle Scout project and has plans to enroll in a culinary program at his local community college after high school graduation.
“I love to cook,” Nick says. “You get to experiment and see what works and what doesn’t. There’s always something new to try.”
Reprinted from Promise Summer 2012