Tiny dancer

    It was like a Nutcracker dream sequence, in which the Mouse King and his minions attack Clara. But this performance was real—a production fraught with uncertainty and hope. In the midst of chemotherapy and radiation, Sarah Marchbank knew exactly what she had to do: Dance on.

    In the cool, blue glow of the spotlight glides a thin figure adorned in a glistening tutu. Her arms flow from her sides, slow and graceful like an ocean wave rolling in on a sandy beach. Jete. Pas de bourrée. Rond de jambe à terre. Arabesque. The normally shy ballerina’s confidence is strong as she bows to her audience. Une forte ballerina.

    The curtain rises

    Not quite two years ago, the body of this graceful dancer was gearing up for a performance that would rival any Nutcracker battle scene.

    Amid the sweltering Louisiana heat and intense ballet classes several days a week, Sarah Marchbank spent the summer of 2007 like a normal pre-teen—with one difference.

    “That summer, Sarah was walking around the house saying ‘I don’t want cancer. I don’t want cancer,’” recalls her mother, Laura. “We told her that we would always be vigilant and for her not to worry.”

    The Marchbank family was no stranger to cancer. Sarah’s dad, Johnnie, had battled stage III Hodgkin lymphoma when he was 21 years old. As a result, the couple had always closely monitored the health of Sarah and her twin brother, Blake.

    One August evening, Laura, a fourth-grade teacher, told her husband about a student who had complained of a bump on his neck. Overhearing the conversation, Sarah said, “Mom, I have a lump on my neck.”

    “She bent toward us and there was a lump under her earlobe,” Laura recalls.

    When 10 days of antibiotics did not eliminate the lump, Sarah visited a specialist, who initially suspected that the problem stemmed from an infection.

    A nasty infection it was not. The diagnosis was stage IV Hodgkin lymphoma. Characterized by the progressive enlargement of affected lymph nodes, this cancer occasionally spreads to the spleen, liver, bone marrow, bones or lungs. Laura was terrified. The next week, Sarah had an appointment at the St. Jude Children’s Research Hospital affiliate in Shreveport, Louisiana. Soon the family was at the hospital’s main campus in Memphis, Tennessee.

    “We felt so far away from home when we arrived,” Laura says. “The first day, though, we met a young patient waiting for his check-up. He was in remission and full of confidence. He told us we were at St. Jude, the best place in the world.”

    The battle begins

    “I remember my first encounter with Sarah and her parents,” recalls Monika Metzger, MD, of St. Jude Oncology. “Initially I could see the fear in their eyes and then disbelief when I said that chemotherapy would only be 12 weeks and that I expected her to continue dancing and going to school. This lightened not only Sarah’s eyes, but Johnnie’s, whose chemotherapy experience had been vastly different.

    “I could also see confusion in Johnnie’s eyes,” Metzger continues. “While for the most part Hodgkin is not hereditary, it can be familial in up to 5 percent of the cases. We can neither predict it, nor do we understand the genetics and environmental factors responsible for it.”

    Although Sarah’s first round of chemotherapy occurred at St. Jude, she was able to continue her treatment at the hospital’s affiliate, located just two hours from her home.

    “After school Wednesday afternoons, we would drive to the affiliate,” Laura says. “Sarah would get treatment Thursday, and then we would drive back home. Sarah slept in the car and went straight to ballet class Thursday evenings.”

    This hectic schedule continued throughout the course of chemotherapy. “That is what kept her going and kept her energy up,” Laura says. “She had a goal of performing, and she wanted to stay on that goal.”

    “I feel powerful, strong and graceful when I dance,” Sarah explains.

    After her third week of chemotherapy treatments, Sarah traveled from Louisiana to Houston, Texas, for a performance and then participated in a dance recital.

    “She was bald, but she danced,” Laura says.

    Stage fight

    Then the family had a scare. 

    “When I saw Sarah for her post-chemotherapy evaluation, she had a spot in her spleen that lit up, and I was very concerned about relapse,” Metzger says. Fortunately, a biopsy revealed Sarah had an infection. With the infection treated, she underwent 11 weeks of radiation at St. Jude.

    Despite slowly losing her hair and her strength, Sarah’s confidence never faltered.

    “Sarah did great during radiation,” Laura says. “She continued to dance and did not miss any school work. She graduated valedictorian from her sixth grade class with an A average.”

    Like the Land of Sweets dancers supporting their Sugar Plum Fairy, Sarah’s dance company filmed their rehearsals so Sarah could practice in her room at the Ronald McDonald House. She also auditioned by DVD for her middle school’s dance squad. She made the team.

    “I love it so much,” Sarah says. “I could not have come home after radiation and watched my friends dance. I just had to dance also. God gave me the strength to make it through.”

    When Laura’s strength waned, Sarah was her rock.

    “If there were days I would fall apart or was depressed, she would look at me and say, ‘Mom, it’s in God’s plan, and there’s something I’m supposed to do with this.’”

    In good company

    Even with the strength of the Nutcracker Prince himself, Sarah still had some fears.

    Child Life specialist Amy Kennedy helped calm Sarah’s nerves. “She had the hardest time with needle sticks,” Kennedy says. “I helped Sarah develop a coping plan. That was what worked best for her.”

    Kennedy also distracted Sarah at times when anxiety surfaced. “I needed some help making sure I had what patients wanted in the radiation clinic Child Life areas,” Kennedy says. “I gave Sarah the job of creating a list of things she wanted to see there. Giving patients a role in their treatment and environment—making them feel like they are in control of something—allows them to take ownership of their hospital experience.”

    Each day, Kennedy would ask Sarah if she had done her “homework.”

    “It made her laugh, which led to her talking and engaging more with me,” Kennedy says. “Sarah is an amazing girl.”

    “St. Jude took such good care of Sarah at every step to make sure there was no way she would feel uncomfortable,” Laura says. “If we had to be anywhere, St. Jude was where we needed to be. They took away the fear we had.”

    Standing ovation

    Before the Marchbanks came to St. Jude, Johnnie had agonized about the hardships his daughter would surely endure. In the 1980s, his treatment had been grueling. “He had 16 rounds of chemotherapy over a 10-month period and had to postpone graduating from college for a year,” Laura says.

    Johnnie was amazed that Sarah continued with her life as normally as she did.

    “To my surprise, the protocol had changed so much that it made Sarah’s chemo a walk in the park compared to what I had,” Johnnie says. “Sarah had two to three bad days a month, whereas I had two to three good days a month.”

    St. Jude physicians also helped Johnnie understand health risks he faces as a result of chemotherapy drugs administered during his treatment. “The doctors talked to him at great length about the cancer survivor guidelines to ensure he stays healthy,” Laura says. “They not only helped Sarah, but they also helped Johnnie to be aware.”

    Because Sarah is still at risk for relapse, Metzger continues to monitor her condition carefully.

    “I am thrilled that Sarah is doing so well, and while I know every visit is stressful for her and her family, I always look forward to seeing my little dancer,” Metzger says.

    Sarah’s ensemble has grown from family and friends in Louisiana to a troupe of new faces at the hospital.

    “I made a lot of new friends at St. Jude,” Sarah says. “Some of us call ourselves ‘The Fab Five.’”

    After months of treatment and being more than 250 miles from home, the ballerina’s spirit has never been stronger.

    “She never questioned that she would not be OK,” Laura says. “Sarah performed seven pieces when we came home, and she never complained of being tired. To see her on that stage still dancing is a blessing.”

    Reprinted from Promise Winter 2009

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