When Life Hangs in the Balance

By Sara Bondell - November 13, 2023

Nicolás Gutiérrez Martínez called his parents to let them know he made his decision. He and his wife went to the airport and rented a sports car. They drove to Miami and danced the night away. In the morning, they drove to Orlando to park hop at Walt Disney World.

The couple were happy. They danced, they walked, they ate, they laughed. They didn’t let any sadness creep in. They forgot why they were there.

When a man with a prosthetic leg walked past Gutiérrez Martínez, reality slowly came into focus: This is going to be me.

In just a few days, the 32-year-old father would lose his entire leg. It was his last chance to stop the cancer growing inside his bones.

Save The Leg

In 2016, Gutiérrez Martínez was working as an electrical engineer in Santiago de los Caballeros, Dominican Republic. He was a newlywed and a new father, he and his wife juggling blossoming careers with raising their 3-month-old son.

Nicolás Gutiérrez Martínez and María del Pilar Castillo Almansa were newlyweds with a 3-month-old son when he was diagnosed with cancer in 2016.
Nicolás Gutiérrez Martínez and María del Pilar Castillo Almansa were newlyweds with a 3-month-old son when he was diagnosed with cancer in 2016.

Gutiérrez Martínez was proud of his healthy and active lifestyle. He was an accomplished marathoner and had just finished a practice run for his next race when he was called into a work emergency. After nearly 12 hours, he realized he hadn’t used the bathroom. When he tried to go, he had difficulty urinating. A visit to the urologist revealed a large tumor on Gutiérrez Martínez’s pelvis that was putting pressure on his bladder.

“When I found out, the worst was the uncertainty,” Gutiérrez Martínez said. “What was going to happen to my family if I wasn’t here?”

Gutiérrez Martínez was diagnosed with chondrosarcoma, a type of bone cancer that starts in cartilage, the smooth connective tissue that protects the ends of bones and most joints. Doctors in the Dominican Republic recommended amputation right away, but Gutiérrez Martínez was determined to find another way.

“I was going to teach my son how to walk and run the way my daddy taught me,” he said.

Gutiérrez Martínez spent the next month searching for a second opinion. His godfather reached out to a friend and physician in Florida for guidance, and he told them to go to Moffitt Cancer Center.

A Helping Hand

When Gutiérrez Martínez’s case came across the desk of International Patient Services Supervisor Marianne Brandt, she was instantly invested.

“Any time there’s a patient around my children’s ages, I tell everyone I adopt them. It’s a protection instinct,” Brandt said.

Moffitt’s International Patient Services Department helps patients and families from other countries transfer their care to the cancer center. This includes collecting necessary medical reports, helping with travel and lodging arrangements, providing financial guidance and offering cultural support. The department has helped patients from 133 countries, the majority coming from the Caribbean, followed by Latin America, Canada, the Middle East, Asia and Oceania. Since 2017, the team has helped coordinate care for more than 1,775 patients from around the world.

Marianne Brandt (right) helped Gutiérrez transfer his care to Moffitt. The International Patient Services Department has helped coordinate care for more than 1,775 patients from around the world since 2017.
The International Patient Services Department — including Martha Sanz, left, Gina El Mouallem and Marianne Brandt — has helped coordinate care for more than 1,775 patients from around the world since 2017. Brandt was instrumental in helping Gutiérrez Martínez transfer his care to Moffitt.

Brandt connected Gutiérrez Martínez with Moffitt’s sarcoma experts and helped gather his medical reports and imaging. She organized his itinerary for his first trip to Moffitt.

“When you greet a patient who shares your culture and language, the connection is immediate,” said Brandt, who is from Venezuela. “We try to be a little piece of home away from home and to be there for them for whatever they need. A hug, to sit down and listen to them, to find any resources they need while they are here. That is what drives our job.”

“Marianne is an angel who was put on our path,” Gutiérrez Martínez said. “She did everything she was supposed to do within her role and that she wasn’t supposed to do. She did incredible work on our behalf at the time we needed it most.”

A team of Moffitt physicians reviewed Gutiérrez Martínez’s case at a tumor board meeting and determined they could remove the tumor and save the leg. In April 2016, Gutiérrez Martínez had his first surgery.

Two months later, Gutiérrez Martínez was walking. By December, he was running again. However, a year later, follow-up scans showed the cancer had returned in his thigh.

“With sarcomas, not only the type but also the location impacts the rate of recurrences,” explained Odion Binitie, M.D., one of Gutiérrez Martínez’s surgeons. “For a pelvic chondrosarcoma, recurrence rates could be 20% to 30%, sometimes even higher.”

Gutiérrez Martínez returned to Tampa for a second surgery, where the surgical team removed the tumor in his thigh and a portion of his pelvis.

The cancer would come back two more times over the next two years. Gutiérrez Martínez was stuck in a revolving door of surgeries to remove new tumors and treat recurrent infections. Still, he never gave up hope.

“My motivation was that I wanted to live,” Gutiérrez Martínez said. “I love my entire family to the moon and back and didn’t want to be missing from their lives. It was either fight or give up and surrender, and I wasn’t going to die.”

Time To Change Course

When the cancer returned again in multiple places in 2019, Gutiérrez Martínez was ready to reevaluate his options. His son had learned to walk and run with his father. It was time.

“After all these surgeries, it doesn’t matter how much faith you have, you can’t keep continuing to do the same thing and expect different results,” Gutiérrez Martínez said. “The best way to stop the tumor was to amputate.”

Gutiérrez Martínez made the phone call to tell his parents, then left with his wife for what he calls his farewell leg tour. He had doubts about how he would continue living his active lifestyle, but he was never afraid.

“I think I have a lot of faith and a lot of optimism,” he said. “I knew I was going to lose the leg and I knew this was the only way forward, the only way to resolve this for good.”

Gutiérrez and his family reunited with Odion Binitie, MD, in 2023 at Moffitt.
Gutiérrez Martínez and his family reunited with Odion Binitie, M.D., in 2023 at Moffitt.

Gutiérrez Martínez needed a complex and rare surgery called an external hemipelvectomy, which involves the removal of the entire leg at the hip along with a pelvic amputation.

After his surgery, Gutiérrez Martínez spent three months recovering in Tampa. His son came to visit and told his dad he was mad at God because he had taken his leg away.

“I had to explain to him God had given me the opportunity to take the leg away so I could be here with him.”

Gutiérrez Martínez returned to the Dominican Republic in February 2020, just as the world was shutting down for the pandemic. He started watching videos online of other pelvic amputees riding bikes and set a new goal. He may not be able to run again, but if he continued his physical therapy and practicing with his prosthesis, maybe he could bike. In October — just 12 months after losing his entire leg — Gutiérrez Martínez rode a bike for the first time.

“It was an incredible moment,” he recalled. “We were on our street and my son was with us. He hit my bike with his and we all fell and started laughing. We got back on and kept at it. What a metaphor for life to create.”

Gutiérrez Martínez now rides up to two hours a day, three days a week. It’s an incredible accomplishment for someone who is missing what’s known as his “sitting bones,” the bottom part of the pelvis that absorbs the body’s weight while sitting.

“It affects the way you sit, the way you balance with or without your prothesis,” Binitie said. “Unlike in a below- or above-the-knee amputation, there is no residual limb to attach a prosthesis to. It takes a lot of physical therapy to sit, to transfer weight, to walk. A lot of this goes to his drive and zest for life as an amputee of that high of a level. He is the type of person where nothing can keep him down.”

Gutiérrez Martínez is still working to overcome challenges associated with his amputation. He struggles with chronic urinary incontinence and has days where he needs to come home from work for a few hours to take his prosthesis off and rest.

But if you ask him, Gutiérrez Martínez says he lives a normal life. His family’s business is thriving, he bikes and swims and takes his now 7-year-old son to the city plaza to watch him play. He routinely sends photos and videos to his doctors and Brandt.

Gutiérrez says he lives a normal life despite what he's been through. He enjoys biking, swimming and spending time with his family.
Gutiérrez Martínez says he lives a normal life despite what he’s been through. He enjoys biking, swimming and spending time with family.

“He is so inspiring being a young man with a son and all these things happening in his life,” Brandt said. “I personally learn a lot from patients because they show you how resilient they are. They have a lot of faith as they keep moving.”

Gutiérrez Martínez had a small recurrence in his abdominal wall in April 2021 that required surgery, but since then has been cancer free. If he catches anyone looking at his prothesis or missing limb, he doesn’t want their pity.

“With this very bad experience, I feel grateful it happened to me because it made me a better person. I know that’s ironic, but I am immensely grateful to God that I am able to walk beside my wife.

“I have fought a huge battle and was able to overcome it. I don’t lack strength. I don’t lack faith. I do lack a leg, but I have other things to make up for it.”

This article originally appeared in Moffitt's Momentum magazine.

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