The cancer journey of Mariano Nevarez brought him to Ohio State, where he found beauty and hope among the challenges of treatment. Nevarez and his wife, Lourdes Perez, were enjoying their lives as architects and grandparents in San Juan, Puerto Rico when the onset of unexplained breathing issues changed everything. “Around late summer 2021, I started having difficulty breathing through my nose,” Nevarez says. “I went to an ENT on the island, who did a CAT scan. Nothing really came up on that, so I went to another specialist who did a biopsy.” That test revealed a rare head and neck cancer known as a sinonasal undifferentiated carcinoma (SNUC) tumor, which is diagnosed in approximately 2000 people in the U.S. each year. “It was traumatic, because I had been a very healthy person all of my life until 67 years old, and suddenly they hit you with ‘You have a tumor,’” Nevarez says. The tumor had caused a break in Nevarez’s skull and risked spreading to his brain. The effects of the cancer, as well as its relatively rare incidence, would require advanced treatment that was unavailable in San Juan. “The doctors said that I had to fly up to the United States for treatment,” Nevarez says. “They highly recommended Dr. Ricardo Carrau, who’s also a Puerto Rican. He has been amazing — him and his team.” After speaking with Carrau, and conducting their own research, Nevarez and Perez decided to make the trip to Columbus. “This is a very rare tumor, and in Puerto Rico, there was no way he could have the treatment compared to the quality of the hospital here,” Perez says. So, the doctors were really pushing him to come to Ohio — to this hospital in particular.” Cancer upends the lives of all who experience it, along with their families, but for international patients who travel to the U.S. for treatment, the experience includes the added challenges that come with the uprooting of their lives and the sudden need to become familiar with new surroundings. “Your life is turned upside down,” Perez says. “He has cancer, but I always refer to ‘we’ because cancer is not one — it’s a whole family issue.” When the Nevarez family chose Ohio State, they began working with The James’ Destination Medicine team, led by Milly Valverde, MA, who immediately started assisting with the complicated process of moving to a new country for cancer treatment. “It was like magic,” Perez says. “We called Milly, and she helped to coordinate everything. It helped make the process easy.” Assistance with housing and other day-to-day needs are especially important for international patients, who, like all who experience cancer, must learn about complicated diagnoses and therapies, often with no previous knowledge of their conditions. Nevarez’s treatment team, which included Dukagjin Blakaj, MD, PhD, the director of Ohio State’s head and neck radiation oncology department, and Marcelo Bonomi, MD, worked with the family to ensure that they were fully informed during each step of every procedure. “Here, you know that the doctors are all together always talking about the case. We were faced with all these decisions, but the doctors and nurses explained everything,” Perez says. “They showed us all the images — the MRIs — and made it was super easy to understand where we're standing at the beginning, and where we’re standing now.” Carrau explained that, before Nevarez could undergo surgery on his tumor, they would need to reduce its size through chemotherapy and radiation treatments. “When the chemo starts reducing the tumor, the body is just incredible,” Nevarez says. “I thought they had to operate to close the skull bone, but the doctors said it will close automatically — the tissues will grow back and it will close and seal the site. It’s amazing.” Also fascinating to Nevarez was the double port implemented by his team that simplified many of the repetitive processes that often come with cancer treatment. “It was so easy for all the blood draws and for the chemotherapy,” he says. “They recommended it highly. Everything they suggested was necessary for a better quality life through the treatment.” The couple’s shared occupation gave them a unique appreciation for another aspect of comprehensive cancer care at The James — the hospital’s architecture, which was designed to aid in the treatment process through interior beauty and an abundance of natural light. “Being architects, we feel that this building has such a beautiful spirit. I said, ‘I'm coming into a five-star hotel’ when I came into the spectacular lobby and saw all the floors with the high ceilings and windows,” Nevarez says. “It was very fulfilling as a patient to see the aesthetics of all the surroundings — it helps a lot.” The facility’s design provided its greatest benefit to Nevarez during a family visit over the Thanksgiving holiday, when hospital visitation was limited due to COVID-19. “There's a little park here, and I could see all of my children and grandchildren from my window,” Nevarez says. “We explained that I was in the corner room, and I would turn on my cell phone light, and they would look up and see me.” Perez also found beauty in the campus and city that surround The James, as well as her new neighbors. “In the first two or three months here, I was crazy in love with the city and the people,” she says. “I drove through the university campus — it's beautiful.” While Nevarez and Perez each speak English, they were impressed with the translation services available at The James, as well as the diversity of the faculty and staff. “There were several staff members who knew Spanish, and I've seen how easy it is for people to speak through a translator over the telephone, in the appointments and everywhere,” Perez says. “The staff is very international.” Nevarez and Perez are happy to now be back in San Juan, but they enjoy revisiting Columbus during trips back to The James as part of Mariano’s continuing treatment. Nevarez’s cancer and its resulting therapies have presented many challenges — he experienced significant side effects from chemotherapy and his sense of taste has yet to return to its pre-cancer state — but he and Perez have no doubts that they chose the right place for his treatment. “If you get sick, The James is the place to come, 100 percent.”