Four-year-old Sammy Leal fills a superhero coloring book page with blue ink as a nurse at Valley Children's Hospital fills one of Sammy's veins with a chemical concoction meant to shrink a tumor in her brain.
This is an intensive chemotherapy treatment, but Sammy is giggling. When it's over, she resumes flitting about a hospital playroom. She doles out hugs, wildly strums a toy guitar, and jumps on the back of a rocking horse.
"Her personality is bubbly, sparkly," says Alistair Robertson, Sammy's former hospital social worker. "Very happy, very cheerful, spunky, full of life, a bright ray of sunshine, just always a smile, loves to give hugs, and she just makes everybody's day."
This bright ray of sunshine is this year's ambassador for the annual Kids Day fundraiser for Valley Children's. Sammy was chosen as the 2018 child mascot because she's a remarkable girl who represents numerous services offered by the hospital through her team of more than half a dozen doctors and numerous nurses, and also because her resilience isn't unique at this Madera County hospital just north of Fresno.
"Sammy is a great example of how kids can be very happy and vivacious and embracing life while going through this," Robertson says. "It's not all sad, depressive, negative."
Sammy's mother, Jordyn Leal, calls Valley Children's her family's "safe place."
The Parlier girl was diagnosed with cancer when she was just 14 months old. Doctors first found a tumor behind her right eye, called an optic glioma, along the optic nerve in her brain that formed as a result of neurofibromatosis type 1 (NF1), an inherited neurological disorder that she'll have for the rest of her life.
The disorder and treatments have resulted in a number of other challenges _ including an infection in her gut, seizures, speech problems, nerve pain, nausea, vomiting and insomnia _ and also puts Sammy at greater risk for developing some disabilities, such as autism, and cancer along the optic pathway until she is 7 years old.
Her mother was cautiously optimistic after Sammy's last chemotherapy appointment Jan. 30.
Sammy had to start chemotherapy again in January of 2017 after previous treatments when doctors found a resurgence of cancer along her optic nerve _ this time, deeper in the center of her brain, but still in nerves that go to her eyes. Previous chemotherapy treatments helped control the growth of the tumor, even though some of the changes may never disappear, Leal says.
Brain cancer is the second most common childhood cancer behind leukemia, says Sammy's pediatric neuro-oncologist, Dr. David Samuel, who estimates Valley Children's sees between 20 and 50 new brain tumor cases each year.
"People always ask us the question, is the Valley seeing more instances than elsewhere?" Samuel says of brain cancer in children. "We can't say one way or another because we don't have the proof."
Still, Samuel says, children are roughly 50 times less likely to develop cancer than adults _ around 12,400 children are diagnosed with cancer each year compared to approximately 1.4 million adults. Samuel says much of that disparity is because children usually haven't had enough exposure to environmental risk factors, such as smoking, which cause many of the cancers in adults.
Samuel says around one in 3,000 children are born with NF1 _ half of which are a result of a new genetic mutation that currently affects around 100,000 people in the U.S.
Sammy will continue to be seen frequently by doctors for other health issues, but beating cancer this year for a second time remained something to celebrate.
"We are extremely grateful for the hospital," her mother says. "It's more of a home than our home is. My husband and I have grown up here and our daughter has grown up here."
After Sammy's last chemotherapy appointment, hospital staff presents her with a "No Mo Chemo" T-shirt that she slips over a shirt with a Batman symbol and the words "Girls Change the World."
Sammy eats celebratory cupcakes and then cheerfully poses holding a large sign her mother made for her, which reads: "If I can do this, I can do anything."