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Together: “You can’t fight these battles alone.”

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A cancer diagnosis is never welcomed news. Today it seems commonplace to know someone who has been affected by cancer in one capacity or another. But when children are diagnosed with cancer, the news seems unbearable. For Tom and Tasha Mangrich, this news came when their four-year-old daughter, Avery, was diagnosed with an aggressive, fast-acting cancer that would change their world.

In spring 2016, the Mangrich family attended a movie at the Lodi cinema. As they were ready to start the show, Avery, their middle daughter, revealed she couldn’t see the screen. “It was all black,” recalled Tasha, thinking back to that first time Avery’s sight was affected. Over the next couple of months, Avery would regularly complain of “lights being turned off.” But it wasn’t until August 2016 that Tasha noticed Avery’s right eye protruding. “Something wasn’t right,” she said.

First Detection 
Leaning on her intuition, Tasha got Avery in to see their family pediatrician immediately. It was a Friday afternoon, but the doctor was able to examine her and referred Avery to UC Davis, where she would have an appointment with an ophthalmologist the following week.

Yet between the time of her appointment with her local pediatrician and UC Davis, Avery started to have vision problems and acted confused and disoriented. During the ophthalmologist appointment, two doctors examined Avery and stated that they needed to go to the UC Davis emergency room right away. “It was a long night, as Avery underwent a CT scan, MRI and other tests,” Tom recalled. It was clear from the imaging that Avery had some kind of mass behind her right eye socket, but it wasn’t until the biopsy report that their worst fear was confirmed. Avery was diagnosed with rhabdomyosarcoma, a very aggressive and fast-moving cancer. In addition, they found cancer cells in the meninges, the protective layer that covers and protects the brain and spinal cord. “The tumor behind her eye was growing through her optic nerve into her brain,” said Tom. Her type of cancer was also known to metastasize to the lungs, so this called for aggressive treatments. 

The Mangrichs had not expected this kind of news, and yet the doctors also assured them they were lucky the tumor had revealed itself by protruding outward. If the cancer had grown internally, diagnosis would have made treatment more complicated and survival rates lessened. Treatment had to be quick, but surgery was not recommended due to the location of the tumor, Avery’s age and the fact that she might lose her eyeball and vision. The oncologist recommended radiation and chemotherapy as her first line of treatment.

Prior to the diagnosis, Tasha was beginning pre-requisites for the nursing program at San Joaquin Delta College. Now, with the news of Avery’s diagnosis, she knew her focus had to be on her daughter “I took off a year while she was in treatment,” she said. 

Advocates in Unexpected Places
Tasha’s decision to take a break from the nursing program came at the right time. Avery’s first treatment of chemotherapy caused a reaction in her body and she developed a 104-degree fever. “It was terrifying to watch our spunky girl transition to a weak and lethargic child, and she only got sicker,” recalled Tasha. “It was horrifying recognizing your child might die from an infection as a side effect from chemo and not the cancer that we were fighting. The chemo destroys so many things.” Avery had developed pneumonia, which turned into a 28-day stay in the hospital. “It was a hard time for all of us. It was hard for Avery,” said Addison, Avery’s older sister. “We just wanted her to feel better.” Tasha and Tom would rotate from Sacramento to Lodi to stay with Avery, but the infection wasn’t going away. 

Hopelessness lingered over them, yet Tasha and Tom found support from their faith and community. One of the greatest supports came from Avery’s nurses. “The nurses were advocates of getting her home, because she would bounce back,” referring that Avery’s condition would improve if she was in the comfort and familiarity of her home. It was here Tasha recognized the important role nurses play and reinforced her future vocation. “When Avery got sick, my vocation solidified; this is definitely what I’m going to do,” she remarked. “We were at the hospital regularly and we had an assigned nurse, and she became part of our family and part of our support system.”  

Finally, the doctors performed a bronchoscopy and were able to find the right antibiotic to treat Avery. The fever finally went down and oxygen administration was lowered, Avery was able to go home. 

Treatment in Boston
Avery’s treatment would soon continue, and by now Tom and Tasha had made friends with other families with children who were going through similar cancer treatments at the hospital. One family shared about a new specialized radiation at Massachusetts General Hospital, or MGH, in Boston, which was the first of its kind in the world. The Mangrichs took note. MGH had developed an innovative proton radiation therapy. Unlike traditional photon therapy, they were using high-energy proton beams to target the tumor precisely, with less collateral radiation to surrounding healthy cells and tissue. 

“At first it wasn’t even imaginable,” said Tasha. Boston, across the country, would be out of their patient care network, which meant higher cost, and they would have to halt treatment with UC Davis. But Tom and Tasha were determined. They knew there were some risks, medically and financially, but after careful planning they set up treatment in Boston and connected their local doctors with those from Massachusetts General to make it work. “Once we got it, it was a seamless transition,” remarked Tom. 

What Tom and Tasha hadn’t expected was the outpouring of support from their community. Meal trains and gifts started pouring in for Avery and even her sisters, Addison, and younger sister Ashlynn. “It was so overwhelming and amazing to see the support that we had.” A local organization, Cancer Kids, run by Don and Peggy Walters, provided gift cards for necessities such as gas or groceries during their treatment. Their uncle and aunt, along with many family members, coordinated a benefit dinner for Avery with over 300 attendees to help raise money for the cost of hospital expenses. 

That November, Tasha, Avery and Addison left for Boston to continue chemotherapy and start radiation, while Tom stayed home with Ashlynn. By Christmas, they were all together in Boston. “It turned out to be the best thing we ever did,” said Tasha. The treatment paid off and the radiation oncologist observed that the proton therapy was working. The tumor was shrinking. And just like at UC Davis, Tasha carefully watched the care the nurses gave to her daughter, even to her family. “We were immersed in the hospital, and paying attention to what they were doing, how close they were with us.” These encounters reinforced what she witnessed at UC Davis and Tasha knew at some point she would finish her nursing program. Avery’s treatment lasted until January 2017, when the family returned to California to continue care under UC Davis. 

In May 2017, after ten months of treatment, Avery had her final chemotherapy and her doctor gave them the news they hoped to hear. She was now in remission. The Mangrichs were hesitant to feel content, but the process of treatment was over. Yet Tasha never forgot the kindness and care of the nurses.  

Today, Thriving
Six years after her diagnosis, Avery continues to be in remission and is an active ten-year old at Vinewood Elementary School, participating in a variety of activities including soccer, dance and art. “I want to be a veterinarian,” she affirmed. Fortunately, Avery’s memory of the initial years is dim. “She doesn’t remember any of it,” reported Tom, grateful those early years would not stay with her. But the experience was life-changing for Tom and especially for Tasha, who would return to her vocation. 

Last year, Tasha resumed the nursing program and graduated in May 2022. In August, she accepted a position at San Joaquin County General Hospital to work in their intensive care unit. “I’m excited to care for patients and their families in hopes of making a difference in other lives like so many nurses did for my family,” she smiled. 

Looking back, Tom and Tasha recognize that Avery’s cancer is something they never want anyone to go through; nevertheless, it allowed them to see the importance of having a strong community. “You can’t fight these battles alone,” said Tasha. “Having each other and having such a strong support system, including our nurses, allowed us to become stronger in a weak situation. It truly takes a village.”