Jason Glanzer watched little Abby's eyelids sag as her heartbeat monitor beeped rhythmically.
He watched as his wife climbed into Abby's hospital bed at the Nebraska Medical Center and closed her eyes for the first time in three days.
He waited until their breathing sounded shallow and measured. He waited until they slept. Then he hurried from the room.
He needed to find the nearest computer. He needed to read the newest research, skim the latest clinical trials, bone up on a brain tumor so rare that he hadn't learned about it in graduate-level biology.
He needed to know the odds. That was the truth. He needed the numbers, no matter what they were.
Before that terrible night, and after it, Glanzer has lived his career and his life immersed in such data. Does the new medication work 5 percent better on the test subjects? Does the inhibitor help slow the spread of cancer in a lab rat by half or by a third?
The University of Nebraska Medical Center researcher had spent years studying HIV in labs, and he would soon spend many more years studying cancer.
But now the numbers were no longer numbers. Now the numbers had a face, his 18-month-old daughter's, and she was sleeping in a hospital bed after having a tumor the size of a peach removed from her brain. And this marked only the beginning: Radiation was coming before her second birthday. She would endure chemotherapy before kindergarten.
He read the first trial. It gave children with Abby's cancer — children who had developed a similar brain tumor — a 20 percent chance. A second study: 30 percent. A third: 40 percent.
Jason fished a coin out of his pocket. A Sacagawea dollar, one that a vending machine had spit out as change.
He tossed it on the table.
Give her a coin flip, he thought. Fifty-fifty.
He found the latest clinical research, a more in-depth study done by a renowned radiologist at St. Jude Children's Research Hospital: 74 percent, it said. In the latest trial, 74 percent of the children had survived at least three years.
Jason Glanzer looked down at his coin. That's a start, he thought, and he logged off the computer and went back to the hospital room where his wife and their only daughter still slept.
Fathers put on bandages, and fathers give you pep talks about toughness, but not many fathers can do what Jason Glanzer did after his then-18-month-old daughter developed ependymoma, a rare brain tumor caused by cancerous cells.
“I had them save some of the tumor,” he says. “It's right next door. Wanna see it?”
He walks into the next room of the med center's oral biology lab, which is tucked into a basement nook inside the College of Dentistry on UNL's East Campus.
He approaches a metal canister the size of a refrigerator, grabs a handle sticking out of the canister's top and yanks. Liquid nitrogen vapor billows toward the ceiling like smoke. He shows me what he's removed: A metal tube filled with dozens of frozen vials.
In one of these vials are cells from Abby's tumor. When Jason can get some funding, he hopes to grow a cell line and study ependymoma in a lab.
“Someday,” he says.
But today, Jason and the other researchers here are already doing something that very much relates to Abby's 9-plus years of life, nearly half of them spent as a cancer patient.
For more than a year they have painstakingly studied thousands of options, run the numbers, calculated the odds. They have run trials with mice and quietly, hopefully, tabulated their success.
In one small way they are trying to make chemo slightly less awful. They are trying to make it so that cancer survivors — adults as well as kids like Abby — aren't so susceptible to a second bout with cancer, and a third.
If everything goes right — and this is science, so it most certainly might not — maybe the research here can contribute to a treatment that drives up the survival odds. Maybe they can drive up the odds, ever so slightly, that a child like Abby will learn to drive and graduate from high school and enter adulthood.
“Radiation and three main chemo drugs. ... These have been around for 40 years!” Jason says. “We spend billions of dollars a year! Where is the new stuff?”
He sounds like a frustrated cancer researcher. He sounds like a dad.
He remembers the waivers. Sign here, in case your child loses her ability to swallow during surgery.
Sign here, in case she goes deaf. Sign here, in case she's paralyzed.
The emergency surgery to remove the tumor in 2006 — a tumor that had just been discovered three days prior — went as well as could be expected. Within a month, Jason, Francie and Abby flew to Memphis, to St. Jude's and the radiologist having the most success treating her type of cancer in children.
He remembers the routine there. Up at dawn. In the waiting room each weekday by 8 a.m. Anesthesia, then radiation and then a groggy, hungry and frustrated toddler pulling out of her anesthetic haze by 11:30 a.m.
Lunch. Physical and occupational therapy in the afternoon.
Repeat. Repeat 33 times.
But radiation's end brought too-good-to-hope-for news: Little Abby's cancer was gone.
It brought promising odds: 60 percent of the kids like Abby don't develop a second tumor.
He remembers the day, more than two years later, when a doctor broke the news: Abby was in that unlucky 40 percent.
“That was the first time I had ever seen an oncologist cry,” Jason says.
The second time, Abby couldn't get radiation, which is known as the best treatment for this type of childhood cancer. The second time around it doesn't work as well. Even worse, a second intense radiation treatment often irreversibly damages a child's brain.
It was time for chemotherapy. Abby took a cocktail of chemo drugs at the Nebraska Medical Center once a month for six months. Every month she spent the better part of two days at the hospital.
Her hair fell out in clumps. One of the drugs damaged her kidneys. She had to go on a magnesium supplement. Another of the drugs is deemed so dangerous that a nurse wheeled a crash cart — the machine they use to try to reboot a stilled heart — into Abby's room before the first time she received it.
Abby's parents assigned themselves roles. Francie, who is a nurse, would stand and watch Abby as the dangerous drug was administered. If anything seemed wrong, she would point at Jason.
It was Jason's job to sprint to the nurse's station and scream for help.
During the six months of chemo, Jason couldn't bear to ask for the odds. He knew why the doctors tiptoed around the numbers now.
But as the six months ended, a flash of hope: The cancer was gone yet again.
But even that news came tempered by what Jason already knew. This time, the odds said the cancer would be back.
One of the twisted truths about cancer treatment is that it can mortgage your future even as it restores your present.
Every time Abby went to chemo, doctors pumped a drug called etoposide into her bloodstream. It attacked the cancer cells viciously — it's long been known as one of the best cancer fighters.
But it attacked her normal cells, too.
Let's say a million normal cells have to repair themselves, Jason says as he sits in a swivel chair in his lab.
He starts drawing squiggly lines on a sheet of scratch paper. It takes only one or two cells to do it incorrectly. He draws this process. And then a normal cell becomes a cancer cell, he says, and holds up the scratch paper.
So etoposide and other drugs killed the cancer, while at the same time making it more likely that your daughter will redevelop cancer?
“Yes,” Jason says. “That's what we're working on.”
In fact, Jason's lab, under the direction of med center professor Greg Oakley, is hip-deep in research meant to make etoposide less harmful to Abby and everyone else.
Jason and the other researchers have tested tens of thousands of compounds, looking for one that can block a certain protein in the body that repairs DNA.
They have published papers on the research, which has largely been funded by the American Cancer Society. Late last year they injected one of the compounds plus the drug etoposide into lab rats with tumors. The tumors disappeared. The work received a university award — Best New Invention of 2012.
The dream: Use this compound with etoposide, and suddenly a cancer patient needs far less etoposide to get the same results.
Use less etoposide, and a patient would leave chemo with less internal damage.
Less internal damage at the molecular level means a lower chance of redeveloping cancer, which means a higher chance of survival.
All the numbers, all the data, morph to one face.
Jason can't say precisely why or how his work as a researcher ended up connected to his own daughter's fight with cancer.
He can say this: “She got a lot of drug. I wish she could have gotten less.”
Abby is 9½ now, and she's headed into fourth grade at Montclair Elementary at the end of the summer, and those are the only numbers about which she cares.
She tells people that she had cancer, but Jason isn't sure she knows exactly what this means. She cannot remember the radiation at St. Jude's. She barely remembers the chemo at the Nebraska Medical Center.
She knows that every four months she has to get an MRI at the hospital.
She does not know the odds. She doesn't have the slightest idea about mortality rates.
“We're going to keep it that way for a while,” her father says quietly as he sits in his lab.
And maybe this is why it is good to be Abby, good to be cancer-free and playing soccer at recess and unaffected by the fact that you might be an outlier.
She has been cancer-free for nearly five years. Jason does not know exactly what the odds of that are, after not one but two childhood brain tumors. He knows they aren't good.
He has learned that sometimes it is best to look at the numbers, crumple them up and toss them into the trash. Or not look at them at all, because the truth about data points is they sometimes make you miss the point altogether.
“I think we're going to have a big party when she hits five years,” he says. He smiles wide at the thought. “That's going to be great.”
He no longer sounds like a frustrated cancer researcher.
Now he just sounds like Abby Glanzer's dad.
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