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PromiseA publication of St. Jude Children’s Research Hospital Summer 2002

Charmel Vaughn: Public Relations Department 332 N. Lauderdale Sound Rebound Memphis, Tennessee 38105-2794 Sound Rebound 901-495-3306

Main hospital line: 901-495-3300 Donations: 1-800-822-6344 Physicians referrals: 1-888-226-4343 Public information: 901-495-3306 Visit our Web site at www.stjude.org.

St. Jude Children’s Research Hospital, American Lebanese Syrian Associated Charities and ALSAC are registered trademarks. Summer 2002 Promise ii Promise is a quarterly publication of the Department of Public Relations St. Jude Children’s Research Hospital was founded by the St. Jude Children’s Research Hospital 332 N. Lauderdale A publication of St. Jude Children’s Research Hospital Summer 2002 late entertainer Danny Thomas. It opened February 4, 1962. The hospital Memphis, Tennessee 38105 Promise St. Jude Children’s Research Hospital’s mission is to find cures for was created because of a promise Danny made during the depression era to children with catastrophic diseases Features through research and treatment. 3 Click. St. Jude Thaddeus, the patron saint of the hopeless. Hospital Director Donor Howard Jones Arthur W. Nienhuis, MD ALSAC National Executive Director Richard C. Shadyac 4 Sound Rebound “Show me my way in life,” Danny prayed. In return, Danny promised to build ALSAC/St. Jude Vice President of Christian rapper Charmel Vaughn Communications and Public Relations St. Jude Thaddeus a shrine. That shrine became a hospital that would treat Jerry Chipman Director of Public Relations Judith W. Black 9 Cooking Up a Fund-Raiser children regardless of race, color, creed or their ability to pay. This remarkable ALSAC Director of Communications Two decades of bake sales George Shadroui event also inspired the name of this magazine, Publications Manager Lois M. Young 10 Tailoring Treatment Editor A revolutionary genetic screening technique Promise. Elizabeth Jane Walker Art Director Jessica W. Anderson Photo Editor 15 In Their Own Words Phillip Murphy St. Jude poets Photographers Seth Dixon Laura Hajar 19 Less Pain, More Gain Evanne Newman Pain management at St. Jude Contributing Writers Tanuja Coletta Joe Hanna Alicia H. Matthews Highlights Guest Author Daphne Dawn Harrison Terral 2 Day of Remembrance Editorial Advisory Board Sandra d’Azzo, PhD Research Highlights Bonnie Cameron Leslie Davidson Pat Flynn, MD Perspective Amar Gajjar, MD Mark Hendricks 24 Daphne Dawn Harrison Terral Lisa Hill Ed Horwitz, MD, PhD A survivor for nearly four decades Julia Cay Jones, PhD Dana Marshall, PhD Ken Massey David McKee Promise is now available on the Internet! Keri Meyer Check us out at www.stjude.org/Promise. Carlos Rodriguez-Galindo, MD Clinton Stewart, PharmD Jerrylaine Walker, PhD Sally Wiard St. Jude Children’s Research Hospital is an equal-opportunity employer. For inquiries about John Zacher stories in this publication, call the Public Relations department at (901) 495-3306 or e-mail St. Jude Children’s Research Hospital, Memphis, Tennessee [email protected]. Visit our Web site at www.stjude.org/Promise. Articles and pho- tos may be reprinted with permission. ©2002. On the cover: St. Jude patient Charmel Vaughn. Photo by Seth Dixon. Highlights Click. One simple act has far-reaching consequences. LAURA HAJAR BY ALICIA H. MATTHEWS

Sometimes the flip of a switch continued to be supporters through have special meaning to Jones Children and emotions can affect a person’s life forever. the years,” says Jones, a real estate because he wrote them. Children with cancer and other Such a situation occurred nearly investor who lives in Santa Ana, Some people might not under- serious illnesses often adapt to their 30 years ago, when Howard Jones California. stand why a person who lives in conditions by repressing their emo- came home from the office and He later met the entertainer California would support a hospi- tions and covering up feelings of turned on his TV set. when Los Angeles County honored tal in Memphis, but Jones under- depression and anxiety, according “My wife and I were watching a Thomas for his humanitarian work stands that St. Jude research find- to a new study. television show that featured on behalf of children. Because of ings help children everywhere. Children may block out depres- Danny Thomas talking about his prior involvement with St. Jude, That is one reason he has embraced sion and anxiety symptoms to St. Jude. It was one of his original Jones felt privileged to participate the hospital as one of his most cope with the practical demands promotions where he performed to in the program. “It was so interest- important causes. He and his wife of their illnesses. But by repressing solicit donors for the hospital,” ing to meet Danny. I could just see have established a trust that helps their feelings, children may ignore Jones recalls. “We were so touched his commitment to the kids at provide for the hospital’s current important warning signs of their by the program that it brought St. Jude,” Jones says. “When he and future needs. Jones has also St. Jude parents who have lost children during the past two years release butterfly bal- loons during Day of Remembrance in April. More than 160 people attended the fourth illness or their emotional response tears to my wife’s eyes.” came to receive his award, he even redoubled his commitment to annual event. Families and staff members reflected on their experiences together, in to it, says Sean Phipps, PhD, of That interlude in front of the tel- brought a pair of shoes with him ALSAC/St. Jude by serving on the activities designed to foster healing and closure in the grief process. St. Jude Behavioral Medicine. evision transformed the Joneses’ that represented the children who Professional Advisory Board, a The study, published in the lives; their subsequent donations of had walked in the Teenage March group of national leaders who pro- January 2002 edition of time and money in turn have for St. Jude. He wanted to salute vide guidance and support for the The gene scene AML model Psychosomatic Medicine, will help institution’s fund-raising efforts. St. Jude scientists have identified A method that enables psychologists deal with children Working alongside other PAB a defective gene that may help researchers to study the develop- who may not indicate that they One TV program 30 years members, Jones helps to generate doctors better understand some ment of one type of acute myeloid ago inspired a lifelong are distressed. commitment to St. Jude. new ideas that will help propel

neurological diseases and treat leukemia (AML) in laboratory LAURA HAJAR California businessman St. Jude forward for many more nerve-degenerating accidents. mice should assist scientists study- Howard Jones and his wife decades. “The discovery could shed light ing cancer in humans. Improving treatment have established a trust After years of involvement with on the pathology of neurological The study is the first to devise a Scientists have found a new way that helps provide for the the hospital, Jones continues to hospital’s current and diseases such as Alzheimer’s dis- way of controlling the genetic of activating the anti-cancer drug future needs. hold a special place in his heart for ease, Parkinson’s disease and ret- expression of specific cellular tar- CPT-11. The discovery could lead the children of St. Jude, whose intitis pigmentosa (a degenerative gets. The method involved engi- to more effective treatment for courage never ceases to amaze him. eye disease),” says Jian Zuo, PhD, neering mice to express a mutated patients using CPT-11, improving “The kids are so enthusiastic, and of St. Jude Developmental Neuro- protein considered to be a trigger therapy of solid-tumor cancers in the personalization of care provid- biology. Researchers also found an of AML. adults and children. the kids from around ed by the doctors to each child is unexpected link between nerve “This model will help us The study describes the structure the country who had beyond anything offered at other degeneration and regeneration by devise better ways to diagnose of a rabbit liver protein that acti- participated in the walk. hospitals,” Jones says. “Because of studying the gene Nna1. AML, predict a patient’s chance vates CPT-11. The research, led His dedication was the vast research being conducted The discovery may help doctors for being cured using conventional by Phil Potter, PhD, and Mary unbelievable.” at St. Jude, I feel that if I needed who treat nerve-degenerating acci- therapy and develop new thera- Danks, PhD, of St. Jude Molecu- Each visit to St. Jude help I could put my grandchildren dents, such as head injuries and pies,” says James Downing, MD, lar Pharmacology, appeared in reminds Jones of that in the hands of St. Jude and not radiation-induced nerve damage. chair of St. Jude Pathology. the May 2002 issue Nature special day, because the have to worry.” The research, involving four insti- The findings were published in Structural Biology and used affected countless children suffering plaque awarded to Thomas by The click of a switch. It might tutions, was published in the the February 2002 edition of rabbit proteins purchased from from catastrophic diseases. “We L.A. County hangs in the Danny just affect the lives of generations March 2002 issue of Science. Cancer Cell. commercial sources. have been sold on the hospital Thomas/ALSAC Pavilion. The to come.l since that first encounter and have words imprinted on the plaque

2 Promise Summer 2002 Summer 2002 Promise 3 PHOTOS BY SETH DIXON

ST. JUDE patient CHARMEL VAUGHN blends RAP with RELIGION.

B Y E LIZABETH J ANE WALKER

n a Sunday afternoon across America. Like rock ‘n’ roll or Los Angeles; he comes from a in a makeshift pro- before it, rap’s rhythm revolution more bucolic setting—a small town duction studio, a 19- has infiltrated American culture. In in rural Mississippi. Inside the trim year-old musician a tidal wave of sound, the pound- red brick house at the end of a and three lovely ing beat of rap has begun to wash quiet cul-de-sac, the tunes are hot, Obackup singers raise their voices in over the Christian music industry, the tempo is infectious and the praise. They extol the blessings of as well. St. Jude patient Charmel lyrics are thought provoking. grace and the joys of faith. But this Vaughn is wading hip deep in that Today, the members of Saved ensemble doesn’t croon gospel sanctified surf. Untouchable Souljahs—Charmel, favorites like “Amazing Grace” or his sisters, Chamara and Chenita, “Kum Ba Ya.” They perform rap. and their friend Tonette Coffee— Yes, rap—that rhyming, rough- Music and mortality spend the afternoon laughing, hewn music that pulsates from Charmel doesn’t live in a dancing and rapping in Charmel’s cars, stereos and boom boxes bustling metropolis like New York bedroom-cum-production studio.

Summer 2002 Promise 5 found a small bump on his leg. ment has watched Charmel interact never heard of those two terms his lyrics. With a beat machine, he The knot grew, in spite of medica- with his peers. “Charmel’s one of coinciding,” says Matthew Krasin, creates the tunes and rhythms, tions prescribed by the family those dynamic people others just MD, of Radiation Oncology. “At blending the sounds with an eight- physician. “My doctor said it was enjoy being around,” she says. “He first, I had to listen really hard to track recorder and transferring the probably a benign tumor, and he plays his CDs all the time, and the understand his music, because he finished product to a CD. “I do referred me to another doctor to do kids love them. They’re inspired by speaks incredibly fast. Now I’m my drums first,” he explains. surgery,” Charmel recalls. “It was how he has dealt with his situation bugging him to give me a copy of “Then I can go behind the drums huge by then, bigger than a soft- and by how he’s moving forward his CD before he becomes famous and put a bass line in. After that, I ball. It was like I had three knees.” to pursue something he feels and I have to pay for it!” Britton can add some piano or strings or When the surgeon realized the strongly about.” predicts that she’ll someday be guitar. It’s simple.” tumor was malignant, he referred St. Jude patient Jamaal Rasberry, telling Charmel’s fans “I knew him The process may be simple for a his patient to St. Jude. Charmel 18, forged a relationship with when...” person blessed with innate musical soon learned that he had Ewing Charmel by hanging out in the hos- This music that transcends race, ability and technical know-how, sarcoma, a cancer that arises in the pital’s Teen Room. “He’s a good age and gender barriers began to but it’s not as elementary as bone or soft tissues and rarely role model and a great friend,” evolve when Charmel was a small Charmel implies. “He’s very mod- occurs in African Americans. He observes Rasberry. “And I haven’t boy, composing raps in the living est,” says his mother, Vernita underwent chemotherapy, radiation talked to anyone who doesn’t like room with his sister. As their skills Mitchell. “He’s been playing the and an operation to remove the his music.” increased, the duo began to per- drums at our church since he was tumor. Then—just when Charmel form in their church. When a pop- in the sixth grade, and he can just thought the ordeal was almost ular gospel rap group held a con- go to the keyboard and pick over—he slipped and broke his Jammin’ at St. Jude cert and talent quest in Nashville, things out. He’s extremely gifted leg. Surgeons repaired the fracture, Rasberry is not the only person Tennessee, Charmel and Chenita in music.” but the tissue around the area jamming to Charmel’s music. traveled to the event and entered began to die. In March of 2002, Doctors, nurses, radiation thera- the contest. They won. “I can’t he underwent a third operation, pists and social workers through- begin to tell you all the concerts A firm foundation this time to replace the dead out the hospital are begging the that we’ve done since that time,” Members of Charmel’s church, tissue with healthy muscle and patient for copies of the CD he has muses Charmel. Agape World Overcoming skin tissue. created but not yet begun to mar- After writing “You Never Christian Center, prayed for their “He’s doing well now,” observes ket. “When I first learned that Know,” Charmel began composing young drummer as he battled can- St. Jude hematologist-oncologist Charmel was a gospel rapper, I’d melodies and beats to accompany cer. A week before each of “Charmel’s always got a smile on his face,” says Heather Haluska of the Child Life Sheri Spunt, MD. “Soon he should Charmel’s operations or Department. Other St. Jude staff members agree that the gifted rapper with the outgoing personality, gentle spirit and perpetual grin has influenced countless patients at the hospi- be able to boogie all he wants.” procedures, the Rev. tal, just by hanging out in the Teen Room and sharing his music. Doris Day would organ- ize a prayer vigil. The Attitude adjuster entire congregation Near the high-tech recording equip- You betta get saved, don’t try to St. Jude staff members have been would gather for an ment, an assortment of prescription resthave* tryin’ slowly get by. amazed by Charmel’s attitude hour each day to pray pill bottles is the only sign that this You never know… throughout his treatment and set- for the patient. Twenty- teen faces challenges beyond the backs. “He tries to find something six other “sister church- usual pressures of youth. Listeners of traditional rap good and positive out of every situ- es” also joined the call A beat spirals up, charging the might be surprised that a teen ation,” says Lunetha Britton, RN, to prayer. “God has been atmosphere with an almost palpa- would write such apocalyptic who coordinates the hospital’s awesome through it all,” ble excitement. Bodies begin to lyrics. But most teen-agers have Surgery Clinic. “A lot of patients says Mitchell. “I felt so sway as Coffee’s rich descant takes not contemplated their mortality his age are very angry because of upheld that I have been wing and soars above Charmel’s during a battle with cancer. the disturbance in their lives. But able to sit in the hospital deep rap. The instrumentals are Charmel has. He wrote this partic- Charmel has always focused on chapel and pray for sophisticated, the language is hip ular riff while undergoing a gruel- what he needs to do so that he can other moms that I see and the message is deadly serious: ing chemotherapy regimen. For a get where he needs to be. I’ve seen here.” musician who says he’s “saved and patients who were really depressed “I trust in the Lord in You never know if you gon’ live or sanctified,” writing “You Never until they started hanging out with everything that ever hap- gon’ die, Know” was a natural response to a him. His attitude, his personality pens to me,” says Steady spreadin’ the word of Jesus difficult situation. and his calmness seem to rub off Chamara Vaughn, Tonette Coffee and Chenita Vaughn join Charmel in his “production studio.” Charmel. “I think the Christ until he piercin’ the sky. In the summer of 2000, Charmel on them.” Although Charmel has been writing and performing gospel rap for many years, he became serious Lord took care of me I’m tellin’ my people the end is For more than a year, Heather about the genre after winning a Nashville, Tennessee, talent contest in 1999. He wrote the lyrics to through the whole thing. “You Never Know” while undergoing chemotherapy at St. Jude. Charmel aspires to earn a degree in comin’ man and that ain’t no lie *Resthave – to prolong Haluska of the Child Life depart- commercial music and then launch a career as a writer, performer and producer. Of course, prayer helped

6 Promise Summer 2002 Summer 2002 Promise 7 me through it. A lot of prayer.” the lyrics force them to think. For independent label,” he asserts. “I’m Charmel rarely talks about his instance, in “Breathin’ to Death,” not worried about my tumor com- faith during casual conversation; Charmel turns his gentle gaze ing back; I know it’s not gonna he prefers to communicate his toward citizens who are compla- come back.” Focused, optimistic, St. Jude saved the beliefs through music. And commu- cent and self-satisfied. and ever thankful for his health, life of her son. For nicate he does—his words flowing “We always dwell on the sinners— Charmel is primed to go forth the past two decades, Gemma effortlessly in a torrent that the drug dealers and all those peo- into the world—creating, perform- Wupperman has prompts listeners to ask, “How do ple,” he says. “But what about the ing and producing righteous raps been using her culi- your lips move that fast?” and ones who’ve got good jobs and that rock.l nary talents to show “Why did you decide to do degrees, but are still not living for her gratitude. Christian rap?” the Lord?” Although you give him no regard, You got your health from the Lord, Your fortune and fame You got your wealth from the Lord, Primed for rhyme Go all up in flames It is Jesus Christ that gives you life Critics of rap music howl that All your degrees He cares for you the milieu glorifies profanity, Are left in debris. Dare to believe it’s true endorses violence and demeans When it’s all said and done, Surrender to his way, women. Those detractors are cor- You’ll be hitting your knees But if you don’t your life’s in vain. rect, in some instances. But is the Beggin’ and cryin’ and asking God It’s in vain. Cooking Up a ethos of rap music morally incom- please... —Breathin’ to Death patible with the values of conserva- BY JOE HANNA tive Christianity? Charmel and his Although Charmel plans to pur- Fund-Raiser mom say no. “‘Amazing Grace’ sue a career as a writer and per- You can listen to Charmel’s song, and ‘Near the Cross’ are not going former, he also wants to produce “You Never Know,” online. Visit Take two parts elbow grease, one part gratitude and— Following the first year, the sale of to move everybody,” says Mitchell. CDs and recruit other gospel rap- the Promise magazine Web page at sweets was overshadowed by sales “For my generation, they were pers into the fold. “I’m going to go www.stjude.org/Promise. voilá! You have a series of bake sales that cover two of other dishes. Some items, such good. But this generation is living to college and study commercial as pelau, a chicken-rice combina- to the bump-bump, bump-bump- music and then start up a small, *Phat – great; addictive; well put together. decades and raise thousands of dollars for St. Jude. tion, retained the ethnic flavors of bump of rap.” her native Trinidad; others, like “And what’s a better way It began as a simple bake sale. thrilled to have played a role in aros con pollo, hailed from South to reach teens than through Today, it has evolved into a full- helping St. Jude continue the work America. rap?” Charmel interjects. fledged ethnic extravaganza, a culi- that saved her son’s life. “I want to When the fund-raising project “More people are listening nary delight for friends and cus- help other children the way my outgrew Wupperman’s home, Eric’s to rap than to anything tomers, and a special tribute to child was helped,” she says. school donated its facilities for her else.” Indeed they are. In St. Jude Children’s Research Wupperman and her family use. Gradually the events evolved 1998, rap became America’s Hospital. arrived at St. Jude only a couple of into what she calls “bring-and- top-selling format, eclipsing You see, Gemma Wupperman years after moving to the United buy” bake sales. People who came country, jazz and rock. But cooks to say “thank you” to States from Trinidad. A doctor told to buy the scrumptious food were the hottest new genre on the St. Jude for saving the life of her her that her young son had acute asked to bring items of their own entertainment horizon is son, Eric. lymphoblastic leukemia and that he to replace what they had pur- Christian music, which “I wanted to do something to needed treatment. The family had chased. Donations ranged from enjoyed double-digit growth help them out,” she recalls. “I no friends to speak of and no med- fruit baskets to potted plants: last year. couldn’t do bike-a-thons or golf ical insurance. Then the physician “anything that would sell,” says Charmel’s compositions tournaments or any of those things. suggested St. Jude as a place where Wupperman, who still caters to her blend the phat* texture of The only thing I knew how to do Eric could receive quality treat- customers’ demands for variety by rap with the Gospel message. was a bake sale.” The first year, ment. Although the family had baking about 40 different dishes. “We have a distinct sound,” Wupperman made a number of never heard of the hospital, they Wupperman, who lives in says Coffee. “Everyone can cakes and cookies and other sweets elected to follow the doctor’s Florida, has decided that it may be relate to our music.” “We and held a bake sale in her home. advice. “They were wonderful time to put the baking aside, but talk about the Lord, but we That sale raised between $300 and there,” Wupperman says about the she says she intends to continue have fun with it,” adds $400 for the hospital. St. Jude staff. volunteering for St. Jude. Chamara. “If you want to She recently put the finishing Wupperman never dreamed that And her son? He’s following in get out there and dance with touches on her 20th annual bake her bake sale would become a his mother’s footsteps. The 27-year- us, that’s OK.” The praise sale for St. Jude, which raised long-standing tradition or that it old cancer survivor is a chef Charmel has served as the drummer at his church, Agape World Overcoming tunes pull listeners in, but $3,000. Wupperman says she is would experience such growth. in Colorado.l Christian Center, since he was in the sixth grade.

8 Promise Summer 2002 Summer 2002 Promise 9 Tailoring treatment

pital’s doctors and researchers unveiled a new gene screening technique that will help future patients avoid the agoniz- When it comes to LEUKEMIA treatment, ONE SIZE does not fit all. A ing wait for a diagnosis. The new technique will also allow patients to undergo a more precise, tailored revolutionary GENETIC SCREENING technique devised at ST. JUDE treatment than has been available in the past. So far, ALL, despite its 80 percent cure rate, will allow doctors to tailor treatment with PINPOINT accuracy. has evaded some treatments because doctors have been unable to predict the risk of relapse and because of certain biological aspects of the cancer itself. Now it seems that ALL has met its match with a tiny glass disc called a gene chip. B Y T ANUJA C OLETTA Great revolutions Seven years ago, James Downing, MD, f Chase Coleraine, 12, ruled the world, the legs. At first his parents assumed Chase had gave a presentation that included a single Indianapolis Colts would win the Super Bowl, dived after too many loose basketballs or had slide mentioning a new method called Ithe St. Louis Cardinals would take home the taken one too many turns on the Pogo Ball. But gene expression profiling. The tech- World Series pennant, and the Memphis after many tense days and dozens of tests, they nique allows researchers to Grizzlies would sweep the NBA Finals. The learned the diagnosis: acute lymphoblastic screen thousands of genes at happy-go-lucky Tennessean with the charming leukemia (ALL). Chase’s father describes once to reveal a person’s grin is a sports nut. His summer baseball league the days it took to confirm the diagno- genetic fingerprint; the schedule has been stuck to the refrigerator since sis as a shocking blur. Chase’s mother process can determine January. If he’s not playing basketball or riding calls the waiting “pure hell.” a patient’s risk for his bike, he’s swimming or fishing or darting When they arrived at St. Jude relapse or other around on his scooter. Children’s Research Hospital, the treatment com- So when Chase started coming home from Coleraines discovered that Chase plications such school sluggish and tired, his parents, Jennifer had the home-court advantage as second and David Coleraine, got their first hint that in the best cancer-fighting malignancies something was wrong. Chase began experiencing arena in the world. Soon or infection. severe thigh pain and blotchy bruising on his after his arrival, the hos-

PHOTOS BY EVANNE NEWMAN

10 Promise Summer 2002 Summer 2002 Promise 11 At the time Downing made his subtypes have differ- Downing says. “It gives us an help researchers win the game beginning that we couldn’t do it presentation, researchers across ent gene expression insight we could never gain before against ALL. “This technology is without the kind of expertise and the world were beginning to patterns, but and shows that this kind of going to revolutionize medicine,” software the Hartwell Center pro- uncover the technology’s vast Downing says that expression profiling could be used he says. The microarray technolo- vided.” possibilities. Downing, chair of the level of distinc- in a clinical setting with incredible gy and mega-computing output The bulk of the analysis took the St. Jude Pathology depart- tion surprised the accuracy.” He credits the high provided by the Hartwell Center place in the center’s Clinical ment, now heads a team that scientists. The tech- level of precision to the St. Jude is to St. Jude research what a Applications Core Technology has published the largest, most nique proved 96 computing powerhouse, the Shaquille O’Neal slam dunk is for lab—also dubbed the Affymetrix

comprehensive study of its kind, IMAGE NAEVE OF CLAYTON COURTESY to 100 percent accu- Hartwell Center for Bioinfor- the Lakers. “The Hartwell Center lab after the company that manu- analyzing the cells from 360 rate in identifying matics and Biotechnology. gave us the power to analyze the factures the gene chip. The gene St. Jude ALL patients. ALL’s six known 4 million pieces of raw data that chip—also called a microarray or “I think this technology is subtypes and even Slam-dunk research came out of this study,” says DNA chip—is a small square glass opening a new door to the way may have detected a Hartwell Center Director Downing. “That is much, much wafer about the size of a dime, we examine cancer,” says new one. Since each Clayton Naeve, PhD, is certain more data than any of us were encased in a little black cartridge. Downing, who adds that the subtype is sensitive that gene expression profiling will used to. We knew from the very Each chip contains an array of study is a preliminary look that to different forms will require extensive follow-up. of treatment, the “This is a first step, but it comes findings will allow during a time in science when doctors to save the Avowed sports nut Chase Coleraine great revolutions are taking most intense thera- wears his baseball cap even when he’s place,” he continues. “It’s going pies for children at the hospital. Earlier this year, the to add incredible biologic with the highest- high-spirited youngster, shown with insights, incredible advances in risk leukemia. Brenda Steen, RN, endured days of diagnostics, and likely, incredible Although current waiting to obtain an initial diagnosis of acute lymphoblastic leukemia. advances in therapy.” ALL treatment is a Soon, such a wait may be a thing of While the decision to study refined process, tai- the past, thanks to new techniques gene expression as it relates to lored to a patient’s developed by St. Jude scientists. ALL seems like a no-brainer now, risk of relapse, the it was not so clear a year ago. present method of “It’s a very expensive study, and identifying high-risk when we started the study, we versus low-risk knew that there were other peo- patients has been ple doing similar work,” difficult and expen- Downing says. The technique is sive. It can require also being tested with other dis- up to 10 medical eases including lung cancer, breast Red means “on” and green means “off” on the gene chip. experts and about cancer and AIDS. “We critically To find out which genes are turned “on” or “off”— expressed or not expressed—in a cell, molecules represent- $1,000-worth of asked ourselves if doing this ing active genes are extracted, tagged with fluorescent dye tests from as many study at St. Jude would add value and washed over the chip. The expressed genes bind to as four laboratories. to the general body of leukemia their counterparts on the chip and are detected by measur- If gene expression research. Our belief was that ing the light given off by each cell on the array using spe- profiling proves to cial laser scanners. answer was a resounding yes.” be a better identifier, Large numbers of frozen clini- it could replace all cal samples had already been also have complete molecular, current diagnostic tests while giv- stored in St. Jude tumor banks. diagnostic, immunophenotype ing investigators much more The researchers would also have and cytogenetic data, as well as information than any previous access to clinical information outcome information. Doing this methods have done. The new gleaned by the hospital’s clini- study would definitely add value information can give researchers a cians, biostatisticians and pathol- for everybody working on adult broader understanding of a ogists. “We have a unique popu- and pediatric leukemia.” tumor’s biology, which in turn lation of samples because we’ve The research team had guessed could be used to develop new tar- treated our patients in a uniform that gene expression profiling gets for therapy. way,” Downing observes. “We would prove that various ALL “That is an important result,”

12 Promise Summer 2002 LAURA HAJAR several hundred thousand different says. “It’s going to help in several once the Human Genome Project— cells, each containing DNA mole- ways, especially to make accurate the federally funded effort to map cules representing a particular diagnoses. Even under the best out the 30,000 or so genes in n 1916, poet Robert gene. More than 12,000 genes are circumstances, it’s possible to mis- human DNA—is complete. Even represented on the chip by these classify 2 percent of patients since better would be special ALL or Frost wrote, “A poem ... DNA molecules. To find out which leukemia sometimes presents itself leukemic chips containing just genes are turned “on” or “off”— in unusual ways.” Pui adds that the genes that characterize the begins as a lump in the expressed or not expressed—in a the technique will be less expensive disease. throat, a sense of cell, molecules representing active compared to the host of other tools St. Jude will continue studying genes are extracted, tagged with used now; because diagnostic gene expression profiling, expand- wrong, a homesickness, fluorescent dye and washed over results will come back more quick- ing the study to include other rare the chip. The expressed genes bind ly, patients will also have shorter genetic occurrences with leukemic a lovesickness.... It finds to their counterparts on the chip hospital stays. cells. Through a St. Jude Web site and are detected by measuring The thousands of genes repre- (http://www.stjuderesearch.org), the thought and the thought the light given off by each sented on the chips used in the other researchers worldwide I cell on the array using spe- recent study represent only can access the 4 million pieces finds the words.” Some cial laser scanners. After 30 percent of the entire of raw data in the study’s investigators perform a human genome. Pui is database and offer their insights members of the St. Jude massive data analy- waiting for chips with on the topic. family express their deepest sis, they can use higher density to arrive Pui agrees with his colleagues the information that this is a groundbreaking time thoughts by putting pen to to determine Within the dime-sized in science. “This research parallels whether a Affymetrix gene chip is an advances being made throughout paper or fingers to keyboard. person is array of several hundred thou- the field with the completion of the destined for sand different cells, each contain- Human Genome Project, the ing DNA molecules representing a Here, a few of the hospital’s a good or particular gene. More than 12,000 growth of biotechnology and all bad prognosis. genes are represented on the chip by the advances in pharmacogenet- poets share their words with “We are essential- these DNA molecules. ics,” Pui says. “It’s explosive.”l ly getting a snapshot of the world. a person’s genetic status,” Naeve says. All results are valu- Ana Duran, age 11 able, even if they indicate that a person has little hope of respond- ing to conventional therapy. “Knowing that kind of informa- tion can save two to three years of barking up the wrong tree,” Naeve explains. “Instead, we can start looking for new approaches My Pencil Case immediately.” In By Ana Duran Naeve is confident that gene chip technology will move from In my pencil case I have a the research lab into the hands of Sharpener to take out all my bad doctors within the next three to Memories from my head: four years. Their Own An eraser to erase all my sins, Winning the game A ruler to be straight and By the time the gene chips Correct in my life, become a routine diagnostic tool, Scissors to cut off all that Chase Coleraine will likely be play- Makes me harm and, ing sports again on a regular basis. Words Finally, I have His doctor, Ching-Hon Pui, MD, is Many colors to brighten up my life! excited about how the technique Clayton Naeve, PhD, director of the St. Jude Hartwell Center for Bioinformatics will affect patients that come after and Biotechnology, believes gene chip technology will likely move from the Chase. “This is a big step,” he research lab into the hands of doctors within the next three to four years.

14 Promise Summer 2002 Summer 2002 Promise 15 St. Jude LAURA HAJAR By Hanna Haghayeghi

When I first came to St. Jude Lauren’s Legacy I was really scared. Lauren Nunes lost her battle with cancer November 26, 2001. She bequeathed her poetry to her mother, Mimi Nunes. Lauren’s poems chronicle the intensity of her Then I met the doctors emotions and fears, as well as the peace she found through her spiritual journey. And I knew they really cared. Here are two of her poems: “Hope,” written in December of 2000 and “Unknown,” which she penned only six weeks before her death. “She had aspira- tions of being a writer, among other things,” says Mimi. “Her ultimate goal was They said that the treatment would be really tough to have something published.” But I’m lucky because 6-8 months should be enough.

You can read other poems by Lauren Nunes by visiting the Promise Web page at During my biopsy, the doctors had a scare www.stjude.org/Promise. Soon I awoke in intensive care.

The nurses helped me when I was in pain They told me to keep still as they stuck my vein. Lauren Nunes, age 14 Hope I had 29 pokes in just 2 weeks That was enough to give me the creeps. I am something that you seek When no one likes you and Now I have a Hickman line Your family thinks you’re hopeless. And that is doing just fine. I am something that you seek Unknown Sometimes during my therapy I thought I might die When everyone is in despair and During those times, I would scream and cry. Everything goes wrong. It twists and turns inside you Tearing at the soft flesh. I have three to five months of treatment to go I am something that lifts you up You moan and groan in agony Although the treatment seems to go rather slow. Hanna Haghayeghi, age 11 When you are down and Pleading with it to stop. When you are ready to give up. “Go away” you shout, I can’t wait until the day I get out But it only echoes softly in the night. When it happens I’ll scream and shout. When asked if he knew of any patients who enjoyed writing I am something that will never die “What is it?” you wonder. poetry, Reggie Chavis responded, “Got a piece of paper?” and And is with you wherever you are. Only the wrenching pain can answer. quickly jotted this tribute to his mother, Sheila Chavis. The St. Jude will always have a place in my heart. Is there any hope? engaging young man from Louisiana passed away May 29, 2002, They have been there for me right from the start. I am something that if you are only after a valiant struggle with Ewing sarcoma. Hanging on by a string, “Yes,” the angels shout. I will pull you up. You look up into the dark sky Mom And see what you couldn’t see before. I am something that if you have “Where were you?” you say. By Reggie Chavis Led a bad life and want to change, He answers, “I’ve been with you all along.” I will redeem you. At first angry, but then humbled Mom is her name, For He did not leave you in the dark. She loves to play games. I am a feeling. She is my mom and Sheila is her name. All you need to get through the tough times, It grabs you again into a moaning fit. I am HOPE. He touches and holds you. It starts to pass away. She plays, Thank you, you shout. He only smiles. She helps, You don’t understand and so many questions come to mind. She pouts, He looks at you knowingly, but remains silent. But I think she hates trout. You start to ask. He raises His hand and Disappears into the night, but yet He is still there. She makes me mad by cutting off TV. I love her, You will never know why it happened, She loves me. But maybe you can learn and grow from it. Thank you, GOD, for giving a mom to me. For you will always feel His presence. Mom—that is what she will always be.

16 Promise Summer 2002 Reggie Chavis, age 12 Summer 2002 Promise 17 Claire Reed wrote this poem soon after her frightened 9-year-old daughter learned that she had osteosarcoma, a type of bone can- Side by Side cer, in her left leg. “The poem was written for Shaina, but it was Side by side based on Shaina’s feelings and thoughts. So it really is her poem, Mommy and me— too,” says Claire. Mother and daughter recited these words each night at bedtime until Shaina’s disease went into remission. In Together we’ll get through this, May of this year Shaina, now 12 years old, won top honors for a Just wait and see. science fair project chronicling the progression, treatment and remission of her cancer. Mommy stays with me Day and night. I’m not afraid ‘Cause it’ll be alright.

Side by side Every day we pray That things will get better And go my way.

Cancer is a mean And ugly cell. Chemo will kill it, And make me well.

I miss basketball And cheerleading too. Shaina and Shopping at the mall Claire Reed And going to school.

For poet and English teacher Mike Oehmann, the best way to Someday I will run take an emotional snapshot is through verse. In “Bedtime And jump and play. Robert Woodend, 13, is no stranger to pain. Like other patients using the Pain Story,” Mike captures the vibrant personality of his 6-year- PHOTOS BY SETH DIXON Management Service, he has taken many different medications since arriving at St. Jude old son, Matthew, and communicates the relief and love of a There is no price in August of 2001. “At one point, he couldn't sleep, because he was hurting all the grateful father. Matthew, who lives in Virginia, underwent That’s too high to pay. time,” recalls his mother, Julie Woodend. Robert completed his treatment in March. treatment at St. Jude for a brain tumor called ependymoma. “He's doing great, now,” says his mom. Side by side A lot of people do care. Bedtime Story Side by side Good wishes we share. He squints when he smiles, Less Pain, More Gain Dimples deepen and laughter cascades Side by side As he jumps up and down on the bed. One day at a time. He dawdles, delaying his bedtime. Side by side St. Jude takes pain management seriously. He’s having too much fun to sleep, It’s gonna take time. Hopping there in his underpants, B Y E LIZABETH J ANE WALKER Limbs long, skinny and white. His scar is a pale scribble along his hairline, Stretching across his forehead Mike and Matthew n November 7, A month later, that aching mouth. That’s when they called in And dipping to one temple; Oehmann 2000, Tommy throat was a fond memory, as the pain team.” A reminder, cold, stark and terrible. Montoya awoke Tommy lay in a hospital bed, The Pain Management Service But it’s the smile and squint we see now. with a sore throat. writhing in agony. “He didn’t have at St. Jude Children’s Research It’ll take some tickling, some rough house, While the rest of just one kind of pain,” recalls his Hospital comprises anesthesiolo- Maybe a story. But I’m thanking my lucky stars the country mother, Libby Montoya. “The gists, nurses, pharmacists, physical And a Guardian Angel or two, Oflocked to the polls, the high bones inside his legs and arms were therapists and psychologists who That this boy has miles to go school senior visited his family hurting. The nerves on the surface work with patients who have com- Before he sleeps. physician. By the end of the day, of his legs and arms were hurting. plicated pain issues. Clinicians America faced a presidential con- His shoulders and rib cage were refer their patients to the service if troversy. Tommy faced a diagnosis hurting. He had ulcers lining his the children have pain that is of acute myeloid leukemia. esophagus from his stomach to his unusually complex. “The body of

18 Promise Summer 2002 Summer 2002 Promise 19 knowledge for anything in medi- “There’s good science that has group provides about 150 consul- guidelines. The new standards will cine today is so humongous that come out that shows that you tations a month. “Not all hospitals be invaluable to health care work- there is just no way anybody can don’t breathe as well when you’re have pain services,” says Oakes. “I ers throughout the country. Most know it all,” observes Libby, who in pain, so you get a higher risk of think we’ve been very blessed with nursing and medical students is a registered nurse as well as a pulmonary complications after sur- the resources to have people dedi- receive minimal training in pain gery,” explains Linda Oakes, RN, cated to that service. I would like management. “Sometimes—what is MSN, St. Jude pain clinical nurse to see us become the cutting edge worse—they’re taught wrong infor- Both Robert Woodend and Tommy specialist. “Chronic pain influences in pain management in pediatric mation,” says Oakes. “Clinicians Montoya used patient-controlled anal- gesic (PCA) pumps to help manage your immune system, so you don’t oncology. Why shouldn’t we be? want to do better with pain man- pain. The patient receives a continuous heal well. You don’t eat as well; We’re already the leaders in pedi- agement, but they have not always infusion of pain medicine, but whenev- you don’t sleep as well. It really is atric oncology.” been given the education or the er he needs an additional dose, he sim- not just a case of ‘Oh, I don’t want tools to do so. We do not want to ply pushes a button. “Actually, patients to hurt’; pain management benefits Just say “yes” just treat the patients with complex may use less medication when they self- administer it compared to when they the whole body. We want our St. Jude is well on its way to pain problems; it is just as impor- ask a nurse to bring them a dose of patients to survive and to do that achieving that goal. The hospital is tant for us to help the patient’s pri- pain medicine,” observes Linda Oakes. with the least trauma possible.” the only pediatric institution mary team know how to treat that Doralina Anghelescu, MD, involved in a National pain. We do that by attending medical director for the Pain Comprehensive Cancer Network rounds and learning from them St. Jude parent. “The pain team Management Service, says the project to create standardized pain what is going on with the patients. knows what works with different We work together as a team to kinds of pain. They know what help all clinicians improve their drugs can augment each other and own ability to treat pain experi- which ones will interact. You really enced by children at St. Jude.” need one team calling the shots in Some health care workers have this area. I’ve been in health care been taught that children, especial- for 28 years, and I’ve never worked ly infants, cannot feel pain. “Many with a team that has the compre- studies have shown that infants do hensive capabilities of this group.” feel pain, and that they can remem- ber it in subtle ways down the No more bullet biting road,” says Oakes, who has pub- Cancer and its treatment almost lished several journal articles and always cause pain. Tumors press on book chapters in her field. Another nerves, bones and organs; radiation myth is that the use of prescription damages the skin and mucus mem- narcotics often leads to addiction. branes; chemotherapy agents inflict “I’ve been working in pain man- brutal side effects. In the past, med- agement formally for six years, and ical professionals treated pain I’ve not seen one patient who has almost as an afterthought—after become addicted because we gave all, eradicating disease was the pri- narcotics for pain,” Oakes says. mary goal. As cure rates increased, Pain Management staff take clinicians recognized the need to every opportunity to educate fami- alleviate suffering. They learned lies and re-educate staff members that by controlling pain they could through consultations, in-service actually speed recovery. Acute pain training and lectures. Team mem- increases a patient’s heart and res- bers study the medical literature piratory rates, metabolism, blood and travel the country searching pressure and stress hormones. for innovative treatments. They Children who are hurting need write pain management policies more oxygen. They have trouble for the institution, and they edu- participating in physical therapy or cate nurse practitioners, pharma- following the mouth-care regimens cists, residents and fellows who that are so important for those In May of 2001, Tommy Montoya was work at St. Jude. “Pain manage- undergoing cancer treatment. They so weak that he could not push the but- ment is such a growing science ton to give himself morphine during his also experience more depression, high school graduation ceremony. that we’re learning all the time anger and insomnia. about better ways to do it,” says

20 Promise Summer 2002 Summer 2002 Promise 21 Oakes, who has traveled to Solving the puzzle Tommy developed Guillain-Barré we had previously physiological responses to pain. El Salvador and Venezuela to Tommy Montoya’s case chal- syndrome, a rare disorder in had very little Systematic desensitization exercises teach nurses through the St. Jude lenged even the most seasoned which the immune system attacks experience with reduce their anxiety levels. Clinical International Outreach Program. pain specialists. “He was just such part of the peripheral nervous this, it meant doing psychologists at St. Jude also use Members of the service are also a puzzle,” recalls Anghelescu. system. Tommy was almost totally a little research on hypnosis, visual fixation points researching better strategies for “Every day we struggled with paralyzed. “The nerves that my part to come and guided imagery to block out treating pain. St. Jude recently par- something new.” Tommy suffered control your motor activities disin- up with the best pain. “You don’t eliminate the ticipated in a multi-site study that from multiple kinds of pain simul- tegrate in Guillain-Barré,” says way to deliver the pain experience, but you do reduce used fentanyl patches to provide taneously, and the pain changed Libby. “The paralysis doesn’t go therapy. Fortunately, the degree of mental processing pain relief for children. The patches as his treatment progressed. “He away until those nerves grow we were successful.” that is given to it,” explains Miles. adhere to the skin and continuous- was on different concoctions of back. As they grow back, the The Rehabilitation “There are so many aspects of ly deliver a narcotic that controls things at different times,” recalls nerves are very sensitive. So Services department treatment that children have no pain. Traditionally, the patches Libby, “different combinations now Tommy had another source provided Tommy control over. By using tools to have been used for adult patients; of morphine, as well as other of pain.” with support gar- help manage pain, they feel that the St. Jude study found that ones drugs to treat the bone pain. He One Saturday evening, Tommy ments to compress they’re doing something that con- containing smaller doses of medica- would swallow lidocaine to deaden lay in the hospital, tormented with his throbbing nerve tributes to their health and welfare. tion could be used successfully on the pain from his mouth and horrendous pain that seemed endings. “Some- Nothing lifts somebody out of a children. “Ultimately, the drug throat ulcers. Then he developed impervious to treatment. The times pain can be feeling of helplessness as much as company we worked with will peripheral neuropathy, which St. Jude staff called Anghelescu associated with inac- having success.” make these patches available on means that the nerve endings at home. All night, she searched tivity,” says Lola Members of the Pain Manage- the market,” says Anghelescu. were inflamed from the chemo- for a way to diminish Tommy’s Cremer, a physical ment Service say they find fulfill- Other upcoming research projects therapy.” suffering. At 6 a.m. Sunday morn- therapist and mem- ment in contributing to that suc- include a study to determine the In March of 2001, Chris ing, she walked into Tommy’s ber of the Pain cess. “Many times, children come best way to give anesthesia for pro- Montoya donated bone marrow hospital room and handed a jour- Management into the Pain Clinic miserable, and cedures and projects to evaluate so that his brother could under- nal article to his mother. “This is Service. “We also when they leave my area they’re new methods for managing postop- go a bone marrow transplant. what I’d like to try with Tommy. helped Tommy by smiling and saying ‘Thank you,’” erative pain. Then the unthinkable happened: I want you to see it and under- enhancing his says Alisha Broglin, RN. “Parents stand it,” she told Libby. Linda Oakes, RN, MSN, St. Jude pain clinical nurse special- mobility, which come in tense and in tears, and “During the night, ist, is always ready to share pain management tips. In her reduced some of they leave relaxed and smiling. Dr. Anghelescu had rolling red “library,” she trundles educational materials for the discomfort relat- That’s when you know you’ve found an article on the staff members and informational publications for patients ed to prolonged made a difference.” Internet about a cardiac and parents. inactivity.” drug, and how it could Pain Management Life after pain interact and block the Teamwork works Service psychologists assisted In May of 2001, Tommy left spastic nerve endings to Although Tommy does not Tommy in dealing with the St. Jude for four hours to attend prevent the pain,” says recall much of his treatment, he inevitable feelings of depression his high school graduation. He Libby. “She cared vividly remembers the neuropathic that accompanied his interminable was so weak that he could not enough about me as a pain. “You know the sensation battle with pain. “In the first six push the button to give himself person and as a cardiac you get when your leg’s asleep weeks of his senior year in high morphine during the ceremony. nurse to recognize that —a shooting tingling?” he asks. school he was told that he had “He would turn in his wheelchair I was going to want to “I’d get those up and down my leukemia. For the next year, he and say, ‘Mom, I need more mor- know how this drug legs all day long and all night spent every holiday as an inpatient. phine,’ and I’d punch the button works. And it was long.” That’s depressing,” says his mom. for him,” says Libby. amazing. It worked! The clinical pharmacist on the “But members of the pain team In the ensuing months, Tommy’s “I have a special service is routinely consulted for knew about an antidepressant that pain diminished and his strength spot in my heart for dosing recommendations for vari- also helped with neuropathic gradually increased. In January of Dr. Anghelescu for ous medications used to treat pain.” this year, Tommy drove to St. Jude many reasons,” Libby pain. John McCormick, PharmD, Mark Miles, PhD, and his col- and returned his wheelchair, continues. “But I will admits that Tommy's case was leagues in Clinical Psychology braces, canes, crutches and other never forget how she complicated. “We thought we wield an arsenal of behavioral assistive devices. He didn’t need took her weekend to had used every class of pharmaco- weapons in the war against pain. them any more. search the Internet logic agents that were available to Many Pain Management Service “Tommy’s still with us, and Doralina Anghelescu, MD, medical director for the Pain Management Service, and find something treat Tommy’s pain,” he says. patients learn to fire those he’s leukemia free,” says his thank- pauses with Tommy Montoya during his recent visit to the hospital. This fall, Tommy else to make my “Then Dr. Anghelescu proposed weapons. Relaxation techniques ful mother. “And that made it plans to enroll in college, where he will study computer engineering. child better.” the use of the cardiac drug. Since help children counter the body’s all worthwhile.”l

22 Promise Summer 2002 Summer 2002 Promise 23 Perspective In 1965, she was patient No. 504 at a fledgling hospital called St. Jude. Today she’s a cancer survivor. A blood donation advocate. A mom.

By Daphne Dawn Harrison Terral

“Even though I have ‘grown up and moved away,’ I am still part of the family.”

I will never through regular correspondence, I forget my last still miss the St. Jude experience. outpatient visit. There was something about going I went through back to the place where I had the usual bat- defied the odds and survived. It tery of routine was a blessing to those who had tests and then treated me, and a blessing for me waited patient- to be able to thank them again. I ly for the doc- was a part of a family there, and tor to enter the even though I have “grown up and Daphne, Scott and Elliott Terral examination moved away,” I am still part of the room. After the family—it is just a different dynam- I was only 4 years old when I exam, the doctor determined that ic in the relationship. began having recurrent bouts with everything was perfectly fine. Then I have worked in volunteer what a rural country doctor diag- he informed me that I was being blood banking services for the past St. Jude patient Jody Burton Hooper doesn't wait in waiting rooms. He draws. nosed as a stomach virus. The doc- released as an outpatient. It meant 11 years. It is a very fulfilling and Whenever he comes for checkups, the young Texan packs his sketchpad along with his tor assured my mother that I would that I did not have to return to rewarding profession. I get to share toothbrush. Since arriving at St. Jude at the age of 12, Hooper has created scores of get over it, and that we should just St. Jude again. my story and tell others how drawings—catching fellow patients and family members in action. In the rendering let it run its course. But finally my When I was 8, 10, 12, even 20 important blood donations are to above, a teen-aged St. Jude patient spends a quiet moment rocking another patient in a common room at the Ronald McDonald House. “I knew I wanted to be an artist when mother took me to a pediatrician in years old, I prayed for the day that cancer patients. I was 5,” says Hooper, who originally came to Memphis with a rare brain tumor called Clarksdale, Mississippi, who real- I would not have to go back to the When I was going through ther- an astrocytoma. Now, many years later, as Hooper undergoes treatment for a recur- ized that I had Wilms tumor, a can- hospital for a check-up. But when apy at St. Jude, they could never rence, he continues to capture the world around him on paper. He says he tries to give cer of the kidney. I traveled to that day finally arrived, I was tell me if I would be able to have viewers of his art “a glimpse of something beautiful or kind.” He believes that a posi- Memphis to have surgery and to shocked, surprised and deeply sad- children. They just didn’t know. tive mindset is of paramount importance when a person is undergoing hardships. “Attitude is everything,” he asserts. “I'm going to live!” undergo radiation treatments at dened by the prospect of being sep- But I did have a son. He is 9 years St. Jude Children’s Research arated from this institution that old. His name is Elliott Terral, and Hospital. Today, I am a healthy 41- had meant so much to me. he is just awesome. year-old. I remember much of my It was a very emotional day. I Thanks to my St. Jude “fami- stay in 1965, but one aspect of my remember driving out of the park- ly”—my lifesavers—I now have a relationship with St. Jude that ing lot and looking back to remem- family of my very own. l many supporters probably don’t ber the scene forever. Even though know is the long-term commitment the After Completion of Therapy Dapne Dawn Harrison Terral and her they provide to former patients. Clinic keeps in touch with me family live in Louisiana.

24 Promise Summer 2002