In Loving Memory of Enrique Mairena

On November 23, 2024, we tragically said goodbye to a beloved father, grandfather, brother, uncle, cousin, and friend, Enrique Ismael Mairena, affectionately known as Ricky. Born in Costa Rica on December 6, 1956, he truly lived by his native country’s motto…Pura Vida. He lived a life filled with love, kindness, and dedication to his family. Everyone fortunate enough to experience him was left better for having known him.

He leaves behind his wife of 44 years, Judith, his five children—Alex, Andrea, Marcus, Jessica, and Christian—and his eight cherished grandchildren: Jacob, Preston, Zachary, Chloe, Sebastian, Austin, Mateo, and Isla. Enrique wasn’t just a father to us; he was a father figure to so many others. He always offered wisdom, guidance, and unconditional love. He was the kind of person who made everyone feel valued and special, and his warmth touched more lives than we can count.

A Heartbreaking Journey

During a CT scan for an unrelated illness, doctors discovered a mucus-like growth on his pancreas. After two biopsies, they couldn’t definitively determine whether it was cancer, but it was suspicious and was slowly growing. A surgery called The Whipple Procedure was recommended to remove the growth. The doctor also suggested 2 months of chemotherapy prior to surgery. He got his first round of chemo the first weekend of November and within 2 days, his symptoms began to prevent him from eating. By that weekend, he went to the hospital because he felt tightness in his chest and continued having trouble swallowing food and liquids. He thought he would be checked, treated, and sent home, but little did he know, he would never leave that hospital. His condition worsened day by day and he eventually struggled to breathe, had to be put on oxygen, and was unable to close his mouth for days. In the end, he couldn’t even speak, and was visibly suffering.

Even in the face of this agony, Enrique fought with everything he had, hoping to be home with his family again, especially his grandchildren who brought him so much joy. His strength and determination are a testament to the incredible love he had for all of us.

A Preventable Tragedy

Enrique’s passing was caused by a severe reaction to receiving the chemotherapy drug 5-FU (fluorouracil), which is widely used to treat different types of cancer. The DPD enzyme plays an essential role in removing 5-FU from the body. Approximately 5-7% of patients carry a genetic DPD variant that can lead to a much greater risk of severe toxic reactions or death from receiving 5-FU. A person who receives this form of chemotherapy and doesn’t have this enzyme can burn from the inside out. What’s most devastating is that his death could have been prevented by a simple genetic test. This test checks for the presence of the DPD enzyme deficiency. This test is becoming the standard of care in Europe and certain US institutions. In 2022, the FDA suggested physicians discuss the possibility of testing with patients but has not moved to require pre-screening. The death rate in the US is estimated at 700 to 1,400 annually. Unfortunately, since this genetic test isn’t customary before giving 5-FU, it cost our family someone we love deeply. Even though insurance doesn’t cover the test, if we knew it was an option prior to him receiving chemo, we would have had it done simply for peace of mind. And he would still be here with us.

Our main goal in sharing Enrique’s story is to raise awareness so that no other family has to experience the pain we have to endure. We hope that his death will be a catalyst to change the medical industry’s approach to cancer treatment and save many lives in the future. Countless family and friends have reached out to us to offer your kindness, prayers, and support and we are eternally grateful to you. His legacy of love, generosity, and strength will live on in all of us forever. Together, we can honor his memory and turn our grief into a mission to protect others.