The past few weeks have felt quieter, slower, and less like a blur. The shock and adrenaline of Vivi's diagnosis have begun to wear off, and what remains is something both comforting and unsettling: a new normal with nothing normal about it.

The hospital has become our second home. We navigate its hallways without needing to look at the signs. We know every nurse in the infusion clinic by name. And we know which drawer holds the good—or, more accurately, bad-for-you—snacks.

Every Wednesday, we check in for our regular appointment. Vitals are taken, Vivi’s port is accessed, and we wait for labs. Depending on her counts, we move forward with treatment, or we go home and wait until the following week, when we do it all over again.

We have finally, thankfully, gotten medication-taking under control. This is largely due to a decision I made out of desperation a few weeks ago: a nasogastric tube, or NG tube.

We initially tried to place it while Vivi was awake. It took two seasoned nurses and me holding her down—kicking and screaming—to snake the tube about a centimeter up her nose before we collectively admitted this wasn't going to work. We were eventually granted an exception to have it placed while she was sedated for her lumbar puncture.

If you had asked me immediately afterward whether I had made the right decision, I would have said absolutely not. Vivi woke from anesthesia furious and confused. An absolute terror. For a few hours, I was convinced I had only made everything harder.

But then it was time for her evening medications, and for the first time since leukemia entered our lives, she swallowed none of the bitterness. There was no gagging, no bargaining, no hour-long negotiation. The medicine went through the tube and into her stomach in minutes.

The next day, completely unprompted, she told my mother—her Gigi—“It’s much better.” And she’s right. The dread that used to consume our mornings and nights has largely disappeared and we have settled into this new routine with less stress and less tears.

We have also become familiar with the rhythm of Vivi’s blood counts. Numbers that once sent us spiraling no longer carry the same sense of alarm. That’s not to say we aren’t careful when Vivi’s counts are low. Hand sanitizer is stationed in every room of our house, sheets get changed every other day, and counters are wiped just as often.

But we now understand that the rises and falls are part of the process. Chemotherapy suppresses her bone marrow to eliminate the leukemia cells, and then, slowly, her healthy blood cells recover before the cycle begins again. It is a pattern that we’ll live with for many months to come.

And accepting that reality has changed the way we think about the days in between.

We've stopped waiting for life to begin again after treatment. Instead, we've learned to seize the windows when Vivi feels like herself. To say yes when her blood counts allow it. To collect ordinary moments when we can.

She recently had her first playdate since her diagnosis. She even returned to school for a few hours over two days last week. These may seem like small milestones from the outside, but to us they feel enormous—tiny pieces of a childhood we're fighting so hard to protect.

Vivi is currently in the early days of her second 28-day Consolidation cycle, which means we are back to the long days in clinic, the chemo administered at home, and the much-hated shots in her thighs.

In a few weeks, if all goes according to plan, she will have another bone marrow biopsy. We are hopeful it will show what we have been fighting for all along—that her leukemia is no longer detectable and that she has achieved remission.

I don't know when this life started feeling familiar. I only know that somewhere between the hospital visits, medication schedules, and countless lab draws, we stopped feeling like visitors in this world and started learning how to live in it.

It still isn’t normal. I hope it never feels completely normal.

But it has become our normal.

The best way I can describe this experience is being thrown sideways on a roller coaster. You’re locked in, heading down the track when, all of a sudden, it shifts. You’re yanked in another direction before you’ve even had a chance to brace yourself.

And just as you begin to recover from that turn, another one comes.

People ask how Vivi is. How I am. How we’re holding up. The truth is, the answer depends entirely on when they ask.

One day, we’re celebrating a good blood count. The next, she’s being admitted to the hospital after an allergic reaction to one of her chemotherapy drugs.

One day, we’re dancing around the kitchen to Taylor Swift. The next, she goes quiet and tells me: “Mommy, I just don’t feel like myself.”

We are now on Day 19 of Consolidation, the second phase of treatment. If Induction was about getting Vivi into remission, Consolidation is about keeping her there, targeting any remaining cancer cells that could still be hiding in the body. They may no longer be detectable, but if left untreated, could cause a relapse.

Because Vivi had a positive MRD at the end of Induction, we knew this phase would be harder. More chemotherapy. More clinic visits. More turns on the track.

Now classified as High Risk, she’ll complete two nearly identical 28-day cycles before another bone marrow biopsy determines what comes next in her treatment plan.

If her MRD is undetectable after these two months, we move forward with the next phase. If it isn’t, the conversation shifts to stem cell transplant. We’ve already swabbed every eligible family member to understand our best chances for a match, quietly preparing for a possibility we hope never becomes our reality.

Consolidation begins with cyclophosphamide and cytarabine. Cyclophosphamide works by interfering with the DNA of rapidly dividing cancer cells, preventing them from replicating. Because it can be harsh on the bladder, it’s given alongside four hours of IV hydration designed to flush the drug through the body quickly to minimize damage.

Cytarabine targets cancer cells in a similar way but is administered differently. We get the first dosage in clinic and then take the rest of it home. Vivi leaves the hospital with her port still accessed, and for three consecutive days I gather the supplies, sterilize our set up as best I can, and administer the drug through her port. On the last day, after one final saline flush and heparin lock, I deaccess her port, removing the needle from her chest.

Interspersed throughout Consolidation is 6-mercaptopurine, or 6-MP, an oral chemotherapy that works by disrupting the leukemia cells' ability to make new DNA. For Vivi, it means another disgusting, chalky medicine—one she'll take on and off throughout this phase before eventually taking it every day during Maintenance, all the way until treatment ends in 2028.

Then there are the lumbar punctures, better known as spinal taps. Nearly every week, Vivi is scheduled to receive intrathecal methotrexate—chemotherapy delivered directly into the spinal fluid to prevent leukemia from hiding in the central nervous system.

But we have quickly learned that leukemia rarely cooperates with a calendar.

We've already postponed two of Vivi's first three lumbar punctures—once because of an unexpected nosebleed in clinic and another because her blood counts were too low and she needed a transfusion.

The biggest shift on the track, however, came last Wednesday, when Vivi had an allergic reaction to Cal-PEG Asparaginase.

Unlike many chemotherapy drugs, Cal-PEG doesn't attack leukemia cells directly. Instead, it deprives them of asparagine, an amino acid they need to survive. It's one of the most effective drugs used to treat pediatric leukemia, but it's also one of the most likely to trigger an allergic reaction, affecting roughly one in four patients.

For Vivi, the reaction was abrupt. She vomited. Her face began to swell. Her heart rate climbed.

Within moments, the nurses were at her side administering Benadryl and steroids to stop the reaction before it progressed further. Thankfully, they acted quickly, and she stabilized. Out of an abundance of caution, we spent the night in the hospital so they could continue monitoring her.

Had Vivi tolerated Cal-PEG, she would have received one infusion through her port every few weeks. Instead, she’ll now receive Rylaze, an alternative drug that studies have shown to be just as effective. The downside is how it’s given.

Rylaze is administered as six intramuscular injections spread over a week and a half.

Friday, Monday, Wednesday, Friday, Monday Wednesday.

Six opportunities for tears, Band-Aids, and a little bit of bravery.

To avoid repeatedly accessing her port, Vivi comes home after each shot still connected. Between visits, I flush the line with saline daily, watch carefully for signs of infection, and carry the constant awareness—and worry—that a piece of tubing now connects the outside world to a vein leading directly to my daughter's heart.

And just as that series of injections ends, we begin the cycle again with another round of cytarabine. For much of Consolidation, Vivi will remain continuously accessed.

Last Friday, while Vivi was receiving her first Rylaze shot, a chant broke out somewhere across the infusion clinic. It started quietly, then grew until it filled the room and stopped all of us.

“Yay, no more chemo! Yay, no more chemo!”

I looked over to see a little boy surrounded by family, friends, and nurses—all of them celebrating the end of his treatment. There were hugs, tears, pictures, and the kind of applause that comes from people who understand exactly what it took to get there.

And I started crying.

Not sad tears, exactly. Something more complicated than that. Joy for that little boy and everyone who loved and supported him. Relief, borrowed from across the room, for what it must feel like to finally be done. And underneath all of it, something like longing because I could feel, in that moment, what it would mean to get off this roller coaster.

We have a long way to go. Years, still, on this track. But I truly cannot wait for it to be our turn.

Many people have told me how strong I am since Vivi was diagnosed with cancer. I know they mean it as a compliment, and I appreciate the sentiment.

But the truth is, I don’t feel strong at all.

Especially this past week, the weight of her diagnosis has felt almost impossible to carry. As the shock has begun to wear off, the reality of what we’re facing has settled in a little deeper, and there have been days when it feels like it’s pulling me under.

It’s hard to move past hearing the doctors talk about stem cell transplants as the next step if this phase of treatment doesn’t deliver the results we need. I know they’re explaining every possibility, and I know they have to prepare families for every scenario. But once those words are spoken, they can’t be unheard.

People see strength because they see me holding it together. They read my edited thoughts. They receive my composed texts.

But the moments in between are far less polished, and that’s when I feel anything but strong.

I feel frustrated.

This past weekend, I looked my daughter dead in the eye and told her to “just fucking swallow.”

I had already spent more than an hour trying to convince her to take her medications. I asked if she wanted to hold her nose. I asked if she wanted music playing. I asked if she wanted a red or blue straw for the chaser. And whether that chaser should be milk or apple juice. I tried everything I could think of to make it easier for her.

I also told her how brave she was. I told her she was a superhero. I told her she can do hard things, and that I have, in fact, seen her do harder things. I tried everything I could think of to build her up.

But her anxiety and distress make the situation so much harder. And instead of swallowing quickly, she holds the medication in her mouth like a puffed-up blowfish, sometimes so panicked she actually blows, spitting it out all over herself, me, and/or the couch.

Most of the time, I am so grateful that the seriousness of this diagnosis is lost on her—that she doesn’t know what could happen if she doesn’t take these medications. But in moments like these, as I am stuck cleaning up the mess, I find myself wishing she could understand just a little of why I am asking so much of her.

I feel terrified.

Vivi has clinic on Wednesdays, and last week she received her first dose of cytarabine, a chemotherapy drug used to target rapidly dividing cells. She was then sent home with her port—her “tubey,” as we call it—left accessed so I could administer the remaining doses at home once a day on Thursday, Friday, and Saturday.

I received about thirty minutes of training, a one-pager instruction sheet, and a phone number to call if I needed help.

As if oral medications weren’t already a source of trauma in our relationship, the doctors also informed me that after Saturday’s final dose, I would need to deaccess her port—remove the needle and tubing myself.

There is a reason, beyond the 8 a.m. labs in college, that I did not pursue a career in medicine. Needles are not my forte. Bodily fluids are not my comfort zone. Sterile technique is not my strong suit.

And yet, there we were this past weekend. Vivi lying on the couch screaming, “Blood! Blood! Blood!” despite there being no blood at all (thankfully), while I did everything I could to appear calm and confident as I removed the needle from her body.

Needless to say, you can call me Dr. Alicia from now on.

I feel out of control.

As a parent, I had already accepted—at least in theory—that there is very little in life you can truly control. This diagnosis has only made that truth more evident.

No amount of organic food, no avoidance of plastics, no carefully made choices would have prevented this. And I don’t know whether it’s more freeing or disturbing to know that.

In her treatment, any sense of control is an illusion. When she is inpatient, we don’t know when doctors, nurses, therapists, or even housekeeping will come and go. We move through the day according to a schedule we don’t set.

When she is outpatient, it’s no different. We have very little say in what happens or when. We show up to the clinic at 8 a.m., and the day unfolds around blood draws, chemotherapy, procedures, and follow-up appointments we didn’t choose but simply attend.

And so in the midst of what feels like chaos, especially for a planner like me, I spent the better part of this past weekend trying to create some semblance of control at home.

I organized our playroom into a makeshift classroom: hanging world maps, lining up ABC books, assembling a dry erase board. Because Vivi’s blood counts will ebb and flow over treatment, we don’t know when she will be able to return to school, or see her friends, or step back into anything resembling normal life.

I know, on some level, that this redesign is my futile attempt to exert control in a situation that offers almost none. And still, I did it anyway.

I feel deep sadness.

Every few nights, Vivi and I sit on my bed while I spray detangler and leave-in conditioner into her curls, and slowly brush through what’s left of her hair.

The chemotherapy has made it shed constantly. It tangles easily now, matting at the back of her head, and if I rush through it, there are tears and "owies.” And so we take our time.

Of all the new routines cancer has introduced into our lives, this one has been the most emotional for me.

As I work through each tangle, my mind can’t help but wander to everything we’ve lost this summer. Beach trips. Pool days. Lazy afternoons at the playground. The ordinary routines that once felt so unremarkable and now feel like luxuries. The memories we aren’t making because so much of our time together has been replaced by medications, appointments, and procedures.

Vivi, somehow, is less affected by the hair loss than I am. She tells me it’ll grow back, and I know she’s right. But for now, it feels like one more thing cancer has taken from her.

With all the tangles, brushing her hair has become a long process, so this past weekend, with her permission, I grabbed a pair of scissors and cut it. To save us all a little pain, time, and bickering. Thankfully, her curls are forgiving and hide my uneven cuts.

Afterwards, I cleaned up the curls from my bed and threw them in the trash. Then I tucked Vivi in, kissed her goodnight, and went to cry in the bathroom.

People may say that I am strong. And maybe, from the outside, it looks that way.

But it certainly doesn’t feel like it in the everyday moments.

Since Vivi’s diagnosis, I’ve lost count of the times I’ve found myself wishing we could return to sender, not pass Go and collect the $200, or slide down the nearest chute to escape the reality we’re living in.

That isn’t strength. That’s having no other option but to keep going, to keep showing up—and to try, sometimes, not to curse quite so much.

We did not get the result we were hoping for from Vivi’s biopsy.

We were hoping for a negative MRD result. MRD, or minimal residual disease, measures whether any leukemia cells remain in the bone marrow after Induction treatment. A result below 0.01% is considered negative. A result of 0.01% or higher is considered positive.

Vivi’s MRD was 0.01%.

We were so incredibly close. The difference between negative and positive wasn’t one percentage point. It wasn’t even one tenth. It was the smallest measurable difference possible. We didn’t miss the mark by a mile; we missed it by a hair.

It feels like watching a Game 7 go into overtime only to end on a single shot. The outcome isn’t defined by a blowout. It’s defined by the tiniest of margins.

Because of this result, Vivi will move from Standard Risk to High Risk.

I am trying to keep perspective. The important thing is that her prognosis remains very good. This result does not change our expectation that she will beat this.

But it does change the road to get there. Her treatment will be more intensive, more frequent, and more demanding. It means more medicine, more appointments, and more difficult days for Vivi after everything she has already endured.

And it’s really crushing to accept that.

What makes today even harder was that yesterday was a really good day.

With the steroids finally behind us, it felt like—for the first time in weeks—I was getting my daughter back. She asked to draw. She laughed, and she wanted to go outside and blow bubbles. She slept through the night without waking up for a snack.

For a moment, it felt like we were getting ahead of this. Like maybe things could start to feel normal again.

Then today brought news we weren’t expecting. Just like the diagnosis we weren’t expecting. And the infection we weren’t expecting. And all together, it becomes something much heavier to carry than any one thing alone.

I know there are families facing far worse news tonight. I know how fortunate we are that Vivi's outlook remains so positive. I know all of that.

But today, I don’t really want perspective.

I just want tomorrow to be better.

Today is Day 29, the end of Induction. I am in disbelief it’s finally here and, at the same time, not surprised at all. These past four weeks have been the hardest in my life, and I’m not even the one undergoing cancer treatment.

Every procedure, every medication, every restless night has led us to this moment. Collectively, they are a blur; individually, each feels suspended in time—preserved with a clarity so sharp it cuts deep, leaving behind invisible scars.

Earlier this week, my dad said something that has echoed in my mind ever since. It surfaced again as I drove Vivi to the hospital this morning: “You asked God to save your daughter. He just didn’t tell you what it would cost.”

And as Vivi lay in the operating room undergoing her biopsy, lumbar puncture, and port (re)placement, I sat in the waiting room thinking about the price of my child being diagnosed with pediatric leukemia.

Of course, it’s impossible to quantify. There is the loss of innocence. The disruption of routines we once took for granted. The countless hours surrendered to worry. But living through a trauma like this also reduces life to the immediate and tangible. And as I reflect on the last thirty days, two items stand out as having run up the tab more than any others: twice-daily dexamethasone and an obscene amount of prosciutto.

Dexamethasone is a corticosteroid that works by directly destroying leukemia cells and amplifying the effectiveness of other drugs in the treatment plan. It is the workhorse of Induction, carrying much of the weight of driving the disease into remission. It is remarkably effective, but it collects its payment in other ways.

First, it is intensely bitter, with a harsh, lingering aftertaste that makes it especially difficult for children to take. For Vivi, who only ever had to take berry-flavored Motrin before this, it was a jarring rejection. The medication would trigger her gag reflex almost instantly, and what should have been a simple part of treatment became a daily ordeal.

Every morning and night, we spent hours coaxing, bargaining, and building her up just to get through it. We tried everything—crushing it into chocolate syrup, mixing it into pudding, hiding it in applesauce—searching for anything that might make it tolerable.

What made the situation even more difficult was one of dexamethasone’s well-known side effects: significant mood changes. The emotional swings could be so intense, sometimes tipping into periods of heightened anxiety, agitation, or what felt like a kind of emotional overload. And even outside of medicine times, our sweet and generally easygoing Vivi could suddenly feel unrecognizable—her reactions fierce, her frustration immediate, her fuse gone in an instant.

Dexamethasone also disrupts sleep, fracturing nights into something uneasy and shallow that never quite delivers rest, no matter how many hours are spent in bed. And it drives a powerful, unrelenting appetite, often with a particular pull toward salty, savory foods.

For Vivi, that meant prosciutto. Pounds of it. Midnight feasts, constant grazing, and a steady chorus of “I’m still hungry.” It is not an exaggeration to say that over the past month, she consumed the better part of an entire pig in charcuterie.

The consequence of this has been significant and rapid weight gain, nearly a quarter of her body weight in a single month. Enough to make it uncomfortable to move, to sit, to breathe, to sleep. Enough that, at times, I catch myself searching for the little girl I brought into the ER four weeks ago beneath all the swelling and puffiness.

The doctors have assured us that it is temporary. The appetite will fade. The weight will come off. Rationally, I know they are right. But knowing that has not made it any easier to watch.

And this, too, must be part of the price. To sit beside her through the tantrums, the tears, the endless hunger, the sleepless nights, the gagging, and the vomiting. To absorb her anger when she has nowhere else to put it. To love her when she is at her hardest to love and when she needs it most. To show up, every single time, and remind her that whatever this treatment demands of her, she will never have to pay for it alone.

Early next week, we’ll learn the results of today’s procedures and whether we get to move on to Consolidation. But tonight, for the first time in twenty-nine days, there is no dexamethasone dose waiting for us in the morning. And that makes the tab feel a little less.

Because this is my first update, I thought it would be helpful to explain B-ALL generally before getting into Vivi’s particular story. I’ll do so with the very big disclaimer that I am no medical expert—just a mother who has consumed every pamphlet handed to me and consulted every medical journal and article I can find.

Also, a heads up that this is long, so maybe grab a snack.

About B-ALL

B-ALL, or B-cell Acute Lymphoblastic Leukemia, is a fast-growing, aggressive cancer of the blood and bone marrow. It develops when the bone marrow produces too many abnormal, immature white blood cells, which crowd out healthy cells and weaken the immune system. While it can occur in adults, it is most often seen in children. Signs and symptoms can include recurring fevers, easy bruising, fatigue, and pain in the bones and joints.

To diagnose B-ALL, doctors perform blood tests, imaging such as X-rays, a bone marrow biopsy, and a lumbar puncture (more commonly known as a spinal tap). From there, genetic testing of the cancer cells helps doctors understand the makeup of the disease and define a targeted treatment plan.

Unlike most cancers, doctors don't assign stages to leukemia. Instead, they use risk categories to define prognosis and match the intensity of treatment to the severity of the disease. Risk stratification in B-ALL is determined by evaluating a combination of factors: the patient’s age, white blood cell count at diagnosis, specific genetic and cytogenetic mutations, and the cancer’s response to initial treatment, which is measured by something called Minimal Residual Disease, or MRD.

All of these elements—the diagnostic tests, genetic analysis, and risk stratification—work together like pieces of a puzzle, each adding a layer of understanding that shapes the final treatment recommendation. No single result tells the whole story; it is the picture they form together that guides the team's approach.

Treatment for B-ALL in children is delivered in five distinct phases, each with a specific purpose. For now, the most important one to know is the first—Induction—which typically lasts about four weeks and aims to rapidly eliminate leukemia cells and bring the disease into remission. The remaining four phases follow in sequence, and I will explain each as we get to them along Vivi's journey. In total, treatment spans two to three years, with girls generally finishing closer to two years and boys closer to three.

Despite being the most common childhood cancer, B-ALL is still remarkably rare, with roughly 2,800 newly diagnosed cases in the United States each year. And yet, thanks to decades of research and increasingly tailored treatment protocols, the five-year survival rate for children with B-ALL is between 85% and 90%. It is considered one of the most curable pediatric cancers.

The last thing I’ll mention is that the cause of B-ALL is still not fully understood, though researchers view it as an unpreventable, multi-step biological accident. The predominant theory is that it develops through two separate genetic mutations occurring at two different points in time. The first is believed to happen in utero, establishing an initial genetic change that then lies dormant in the bone marrow, sometimes for years. The second is thought to be triggered later by a common infection, which activates those dormant cells and causes them to grow uncontrollably. Notably, some people carry that first mutation their entire lives and the second trigger never comes.

About Vivi

Unfortunately, for Vivi, that was not the case and so here we are.

On the evening of May 19th, I took Vivi to the ER after she spiked a fever for the second time in a week. This time, I also noticed small, purplish marks dotting her hands, legs, and the skin under her arms. I have since learned that these spots are called petechiae—tiny pinpoint marks caused by minor bleeding beneath the skin. If you are ever inclined to Google the combination of fever and petechiae, I will save you the anxiety: it is not something to take lightly.

The doctors in the ER performed a Complete Blood Count, or CBC, which is a common blood test that measures the total number, size, and type of cells in the blood. This test has since become almost a daily occurrence for us, and knowing what I know now about B-ALL, the results that night were clear. Blasts were present. Her white blood cell count was elevated. And her platelets were practically nonexistent—5,000, when the lower end of normal is roughly 150,000.

Vivi was initially categorized as Standard Risk at diagnosis based on two factors: her age, which was under ten, and her white blood cell count, which was high (16,000) but nowhere near the 50,000 threshold that would have placed her in a higher risk category. On May 21st—Day 1 of Induction—Vivi underwent surgery for a bone marrow biopsy, a lumbar puncture, and port placement. During the lumbar puncture, she also received her first dose of chemotherapy, delivered directly into the spinal fluid.

We waited over a week for the results, but they confirmed two more critical pieces of Vivi’s puzzle—and both were the news we had been hoping for. First, that the cancer had not progressed to her central nervous system. And second, that she was further stratified as Standard Risk Favorable, a subgroup defined by highly curable disease and the best overall prognosis within the standard risk category.

Over that same period, we watched Vivi’s cancer cells drop dramatically, all the way to undetectable. She was proving to be an early rapid responder, and that strong initial response to chemotherapy is one of the most meaningful indicators of a good prognosis and a lower risk of relapse.

And yet, even with all of this incredible news, the road has not been straightforward. Chemotherapy is remarkably effective at eliminating cancer cells, but it destroys the good cells in the process. Vivi’s immune system has essentially been wiped clean, and we have experienced setbacks because of it.

On May 28th—Day 8, and the day we were originally set to go home—Vivi spiked a fever. For children undergoing chemotherapy, a fever is often the only early warning sign of a serious infection, and in an immunocompromised patient, that is not something that can wait. It warrants immediate attention, every time. The following day, blisters appeared in the creases of her fingers. Together, the two kept us in the hospital for an additional four days while the team investigated. Blood was drawn for cultures, and antibiotics were started as a precaution. While a definitive cause was never identified, the most likely explanation is that both were side effects of the chemotherapy itself.

On June 1st—Day 12—we finally went home. We lasted twenty-four precious hours before being readmitted, this time for what turned out to be a bacterial infection. The culprit was pseudomonas, a bacteria that is known for its ability to form a protective film on plastic surfaces, which makes it extremely difficult to clear from a port. As a result, Vivi had to undergo surgery to remove her port: the same one that had been placed just two weeks earlier, still healing, now gone.

We are still in the hospital completing a seven-day course of antibiotics, with the hope of going home in two days on June 10th—Day 21—after Vivi receives her next round of chemotherapy.

The next significant milestone is June 18th—Day 29. On that day, Vivi will undergo another bone marrow biopsy, lumbar puncture, and the doctors will replace her port (let’s hope this one lasts longer than two weeks!). During the lumbar puncture, she will receive another round of chemotherapy delivered directly into the spinal fluid, just like she did on Day 1.

After this procedure, we will receive the final piece of Vivi’s puzzle—her end-of-Induction MRD, which will tell us whether any leukemia cells remain detectable in her bone marrow. A negative result is the goal and would confirm that Vivi has responded to the treatment exactly as hoped. It would also lock in her final risk categorization and define the path forward.

A reflection

When I was little, I loved doing puzzles with my dad. We would spend what felt like hours at the kitchen table, sorting pieces, connecting edges, slowly bringing a picture to life. Sometimes, if the puzzle was particularly beautiful—which, at seven years old, usually meant it featured pink kitties—he would frame it for me to hang in my bedroom.

I’ve been thinking a lot about that lately. Ever since the doctors used that word, “puzzle,” to describe how they determine Vivi’s prognosis and treatment plan.

In a way, I think that’s what these posts are. Each one is a piece: a moment, a result, a setback, a small victory. Individually, they may not tell the whole story. But together, they connect to everything that came before and everything still ahead.

I don’t know what the finished picture looks like yet. But God, I hope it’s beautiful.

And I hope that one day Vivi reads every one of these posts and sees the picture they created together—her story, piece by piece—and just how strong she was through all of it.

It’s been nearly three weeks since my four-year-old daughter, Vivi, was diagnosed with B-cell Acute Lymphoblastic Leukemia (B-ALL).

Vivi loves riding horses and wearing dresses. She reminds you to brush your teeth because it’s important. She tells you to “drive safe” when you’re heading out. I cannot put into words how proud I am to be her mother.

Until now, Vivi has had two ear infections in her entire life. I took her to the ER after she spiked a fever for the second time in a week and I noticed small, purplish marks dotting across her hands, legs and under her armpits. When we arrived, they took her vitals and moved us into an exam room to draw blood for standard testing.

I don’t remember how much time passed before a doctor asked me to step outside. The results were concerning. Her platelets were extremely low. They were admitting us for the night.

The doctor went on to say that this could be anything—an infection, or cancer. And then: “If it’s cancer, it’s the one that you want.”

In the span of five hours, I went from holding my daughter’s hand as she skipped into the ER to signing paperwork consenting to her cancer treatment.

People tell you that when something life-altering happens, you find clarity; that the noise falls away and what matters most rises to the surface, clean and obvious. Maybe that’s true with time and introspection. But what I found in that hallway, and every day since, has been a lot of tears and contradictions.

My daughter has cancer, and yet I’m supposed to feel fortunate—and I do, which is its own strange thing to sit with. I’m angry she has it, and I’m grateful it’s this particular type. B-ALL is the most common and most treatable childhood cancer, with decades of research and clinical trials pushing survival rates upward of 90%. Her prognosis is good, and I am hopeful she will be like one of the many success stories people have generously shared with me these past few weeks.

It’s unfair that we’ve had no time to process any of this. And yet I feel incredibly lucky that we didn’t have to wait. Vivi received her first chemotherapy treatment fewer than 48 hours after we walked into that ER, which is remarkable. I’ve heard stories of symptoms dismissed as something minor, families waiting weeks before anyone said the word “cancer.” We didn’t have that. The harder conversations around the fears, the grief, what normal even looks like now will have to happen later.

I have also been so thankful for the tremendous support we’ve received—and especially for the many people who have reached out to share stories of their own children who had cancer, finished treatment, and have gone on to live completely normal lives. It has made me feel less alone in a way I didn’t know I needed. And yet that’s its own contradiction, because I would never wish for anyone else to be put in this situation. To have to watch your child get poked with needles more times than you can count, take medicine every day that makes them gag and throw up (Vivi calls it “exploding”), and wince as bandages tug at their sensitive skin.

Three weeks in and I still haven’t found clarity. Instead I find myself trying to reconcile these contradictions. But maybe clarity comes from recognizing I don’t have to. That both things can be true—the anger and the gratitude, the grief and the relief, the dread and the hope. It isn’t easy sitting in the tension, especially when so little else feels within my control. But if Vivi can do hard things, so can I.