In 2023, Peggy, a vibrant 63-year-old woman, entered my life under the most challenging of circumstances. She was diagnosed with inv(3) acute myeloid leukemia (AML), an aggressive and relentless disease, and faced a grim prognosis. From our very first conversation, I knew Peggy was different. She exuded strength, determination, and an unyielding zest for life.
AML with inv(3) is a rare and particularly life-threatening subtype of acute leukemia associated with primary resistance to standard chemotherapy. Complete remission rates are as low as 20 to 30 percent even with intensive induction therapy. The median overall survival for patients with inv(3) AML is dismal, often less than six months.
For Peggy, the odds were daunting, but her spirit refused to waver.
She had already endured immense loss after her sister succumbed to breast cancer years earlier. Perhaps it was that experience, coupled with her steadfast personality, that shaped her resolve to fight. From the start, I was transparent with her about the realities of her disease and the uphill battle we faced. Despite this, Peggy’s mantra was clear: “Let’s do everything we can.” And so, we embarked on this arduous journey together.
Peggy underwent several lines of intensive chemotherapy, each more grueling than the last. Yet her disease remained unresponsive, and the hope of reaching stem cell transplantation, our ultimate goal, began to slip away. In early 2024, the situation grew dire. She developed fungal pneumonia, and her disease continued to progress.
After careful evaluation and heartfelt discussions with Peggy and her family, we made the difficult decision to stop active treatment and shift our focus to symptom management and palliative care. I will never forget the conversation we had that day. Peggy, ever pragmatic yet hopeful, listened intently. She expressed gratitude for the honesty and clarity but also a quiet determination to make the most of whatever time she had left. Though I expected her decline to be swift—weeks, perhaps a few short months—Peggy defied every expectation.
Over the next 14 months, Peggy lived more fully than many people do in years. She attended family weddings, cheered at football matches, and remained an active participant in the lives of those she loved. She embraced life with a spirit that was nothing short of extraordinary, and her deep faith played a pivotal role. She often spoke of the comfort she found in prayer and how this became a source of strength, helping her navigate the uncertainties and challenges with grace and courage. To me, it was inspiring to witness how her spirituality intertwined with her resilience.
Throughout this journey, Peggy and I developed a special and close bond. Our relationship extended beyond the traditional physician-patient dynamic. She trusted me not only with her care but also with her hopes and fears. She taught me lessons in courage, grace, and the immeasurable value of human connection.
Her story is a powerful reminder that sometimes, less is more. As health care providers, we often feel compelled to continue aggressive treatments, even when the odds are stacked against us. We cling to the belief that one more line of therapy might make a difference. Peggy taught me that there is another way, one that prioritizes quality of life, human connection, and an openness to the mysteries of life that science cannot fully explain.
Too often, the pressure to “do everything” arises not just from patients and families but from within ourselves as clinicians. We fear being perceived as passive or giving up too soon. The cultural and systemic focus on aggressive care often leaves little room for pausing to consider whether our interventions truly serve the patient’s best interests. Peggy’s journey forces us to confront this tendency, acknowledge the harm that overtreatment can cause, and reconsider the gaps in our understanding. How do we reconcile our drive to treat with the potential harm of overtreatment?
As clinicians, we pride ourselves on the progress made in cancer care, but stories like Peggy’s remind us of the limits of our knowledge. Despite advances in genomics, targeted therapies, and supportive care, there remains so much we do not understand. Why does one patient defy the odds while another does not?
Peggy’s story also challenges us to embrace the art of medicine as much as the science. While evidence-based protocols are vital, they cannot account for the intangible factors that make each patient unique: their values, relationships, and resilience. Sometimes, the greatest gift we can offer is not another line of chemotherapy but the courage to shift the focus to what truly matters: living fully, loving deeply, and courageously finding meaning in the time we have.
Thank you, Peggy, for teaching me this lesson. It is one I will carry with me forever.
(This article was written with explicit permission from Peggy. She has read the draft and given consent for its publication. Her hope, like mine, is that her story will inspire other health care providers to pause, reflect, and embrace the holistic care that every patient deserves.)
Rita Assi is a hematology-oncology physician.
