A slight, pale 21-year-old with closely cropped hair, Caroline Bridges stretched and grabbed but could not pull the ribbons off her opponent's shorts in the flag football game.
She caught her breath as the other player rushed to the end zone under the bright lights of Boston University's Nickerson Field.
"Caroline, way to stay at it. Way to stay at it," the team captain shouted.
If he only knew.
To muster the energy to make it through the intramural game that October night, Caroline dug deep within herself. She fought exhaustion, stomach cramps, and weakness in her legs. She ignored a malaise from the chemotherapy drugs injected into her body the previous week. Her near-shaven head was not a fashion statement. Her hair was beginning to return after months of treatment for leukemia.
Most of her teammates knew she had cancer, but few were aware of the disease's residual effects when she returned to school this fall.
Caroline Bridges came back to college after more than a semester's absence, determined to force her way back into college's normal rhythm, even though life had become both a physical and emotional struggle as she continued to fight a disease that could kill her.
Her first months back tested her nearly as much as her months away. She coped with the toll of being a college student and cancer patient. Her illness fast-forwarded the timetable on her maturity, making banter around kegs at college parties suddenly seem inane.
Once content to keep personal thoughts private, Caroline now wanted to reveal her feelings to a bigger audience, especially peers. "Sometimes," she said, "I just want to yell at people, 'Look around you. Stop being so shallow.' "
Caroline plays out the typical college experience, that battle to fit in, to find a true self, to keep up, and to leap ahead, under a shadow foreign to most of her peers: mortality.
Days after the cancer diagnosis, she began a blog, a blunt accounting of her frustrations, fears, pain, and dreams. She saw the online diary as a sounding board for family and friends, but reached a larger audience than she ever could have imagined. Cancer's assault on her body and soul helped her discover a stronger voice.
Clearly, I am changed, but I can't say exactly how. All I know is I feel out of place at parties where cheap beer flows like water, drunk freshman girls are looking for attention, and drunk older guys are looking for the shortest skirt and the lowest shirt. . . . Will I re-adapt to the college social norm? I sincerely hope not.
Caroline grew up in a western Chicago suburb, the only girl and middle child of three. She was often happiest reading, yet overcame stage fright to dance, compete in debate, and sing in the chorus at a private girls' boarding school in Indiana.
She came to BU as a print journalism major in 2005, but switched to photography, bolder about taking pictures than interviewing strangers. Her freshman year, she blended into college life, played guitar in a band, and became part of a group of friends on the 11th floor of Warren Towers. The cluster formed her flag football team.
Her sophomore year, she continued in intramural leagues, shot photos for the BU newspaper, and juggled three jobs. But as the fall semester drew to a close in December 2006, she was abnormally tired. And, the tiniest bump now led to a large bruise.
Within days, she learned she had acute lymphoblastic leukemia, a cancer that attacks the blood cells. Doctors told her the disease was highly treatable, but required aggressive, often debilitating chemotherapy, and thus long hospital stays. Life came to a halt. Her mother flew in from Chicago and took her home for treatment.
Some of her college friends gave her a journal, hoping Caroline could write what she might never say to them. Forced to spend a total of four months in the hospital over a nine-month period, she used the journal and blog to sort out the searing changes to her life.
A few weeks after her diagnosis, she wrote in her journal about chemotherapy's destruction of her light brown hair and, with it, the damage to her self-image.
There is hair everywhere, The back of my sweater, The back of the couch, My blue fleece blanket. . . . They're mine. Coming out, Falling out. . . . My image is changing before my mirror. Eyes larger, cheeks hollower.
In February, she was in remission. But the specter of death hung in her thoughts in a blog entry. She knew there was a roughly 30 percent chance of relapse during the next five years.
I've realized that I'm not afraid of death. I by no means want to die. And I know that I'm not going to anytime soon. I still have a lot of stuff to do. But I've accepted that I will eventually die.
At another point, after learning in April that a stint in the hospital would have to be extended another week, she veered between optimism and depression.
Every day is a battle to keep a positive outlook, to remember that things will get better.
Her parents read the blog, watched her suppress complaints, and realized their daughter taught them how to react by example.
"If she's not feeling sorry for herself, she sure as heck didn't want us to feel sorry for her," said Howard Bridges, a retired Japan Airlines sales representative.
Back at BU, her friends said that Caroline, through her blog and e-mails during her absence, forced them to reexamine themselves.
"There's an invincible feeling that when you're in college, you're young, you can do what you want, and it will be OK," said Jon Seitz, 20. "In reading Caroline's blog, I realized how much I took it for granted, being at a college, being with my friends every day."
s much as Caroline revealed emotions in the blog, after she returned to BU in September, she was less candid in person with friends about the lingering challenges of her illness.
She did not talk about the seven bottles of pills on the dresser of her Allston apartment - including antibiotics, antinausea pills, and birth control to minimize menstrual periods and prevent blood loss. Her roommate was an acquaintance, not a confidant.
Unless asked, she was quiet about her self-imposed bedtime of 10 p.m. and the loss of 20 pounds and muscle off her 5-foot-5-inch frame.
Every social invitation posed a dilemma. Mingle with crowds, and she exposed herself to germs that could make her sick. Drink too much, and she risked dangerous interactions with medications.
After months away from the masses, she often chose to spend time with just a few friends. On a weeknight in mid-October, she sat on the couch in her third-floor apartment as Seitz and Kevin Sirois perched on camping chairs with guitars. The trio, friends since freshman year, planned to play at an open-mike night.
As her friends strummed, Bridges coughed away a remnant of her latest cold and jotted lyrics in a notebook. She sang in a sweet soprano voice, her words repeating a theme from some of her journal and blog entries: Her peers should care less about what others think and more about the big issues of life.
Don't think about who you feel you should be. Don't talk about what the others see. . . .
As the jam session ended, Caroline coaxed her friends to stay for a pot roast dinner. Eating at home was safer than in a restaurant where she was more at risk of germs. And, this evening, a week after a chemotherapy treatment, it was less tiring to stay in.
Even schoolwork presented physical challenges. Her three-hour photojournalism classes could be a test of endurance.
Sitting at a desk in the middle of a row and leaning against the classroom's cinderblock wall in mid-October, she napped minutes before class started. But she sprang out of her seat when the professor sent the class on a 50-minute deadline assignment to illustrate the previous night's Red Sox victory. Walking long strides, she dashed to Fenway Park, snapped photos, rushed back, and beat the clock.
After class, Caroline gave in to exhaustion and slept for three hours.
A few weeks later, in early November, she reached a breaking point. She had upcoming mid-terms and a makeup final from last year. She was in medical limbo. She had received seven months of chemotherapy treatment administered over varying lengths of time, and only a one-day treatment remained. But every week, doctors postponed the therapy because her white blood cell count was too low and her body too weak to withstand more drugs. And, that weekend, at her regular Saturday job at the BU recreation center, too many students demanded attention.
It was too much for me, when I have been going almost nonstop for over a month now. I broke down when I left the gym; I started crying so hard I couldn't breathe. . . . I can't handle the same type of stress or activity that I could a year ago. . . . I am very slowly relearning how to be busy me. . . .
Caroline yearned for a boyfriend, but found it hard to view herself as an object of desire. She was reminded too often that she was still a cancer patient, whose body had become a pin cushion to strangers.
Days after her early November blog entry about trying to cope, she went to Dana-Farber Cancer Institute for her final chemotherapy treatment. It was a pivotal moment toward becoming just a college student again.
In the hospital in-patient clinic, she closed her eyes as her head flushed with heat. For three hours, a liquid yellow mixture of the powerful chemotherapy drug slowly dripped into her veins.
The nausea, back pain from a spinal tap, and other physical remnants of the treatment disappeared days later. But she could not erase the feeling hospitals gave her, that she and her body were disconnected. She had plans to go out for dinner with a guy she liked, but she was unsure what she wanted in a relationship.
I have just spent the past eleven months being poked, prodded, examined, stabbed, drilled, injected, and who knows what else. . . . And I lost my hair. My whole identity as a woman has been somewhat compromised. . . . I need time to forget about all the people who have poked my stomach or examined my chest before I can let some guy touch me. . . . It's not that I'm not pretty; I just don't feel like it.
aroline tended to brush off praise about how brave she was. That is, until she began hearing from people she had never met.
BU Today, the university's online newsletter, picked her blog as one of the top five out of 150 entries in a university contest, and featured her in an article and video. Hundreds of strangers e-mailed her about how her words helped them. Then, the dean of BU's Medical School, Karen Antman, an oncologist, saw the video and decided that this frank young woman could be a powerful teacher for first-year medical students.
In late October, Caroline strode down the aisle of the medical school auditorium, climbed onto the stage, and sat across from Sumer Verma, a psychiatry professor.
As Verma began an hour-long exchange, one of Caroline's legs shook. The 67-year-old professor, trying to quell the student's nervousness, gently coaxed her to talk about the day she learned she had cancer.
"My life just stopped," she said.
The 170 students in the tiered auditorium were silent.
"How would you want one of them to confront you with an ominous diagnosis?" Verma asked.
"Respect the person's wishes. If they're mature enough to tell them, tell them. Don't treat them like a child," she said.
Verma probed deeper.
"We can kill your leukemia, but what does that do to you as a person?" he asked. "How does it influence you in your career, whether to have children or not?"
Caroline said she worried about the drugs' effect on her fertility, knowing that "every drug they prescribe could kill your ovaries."
She paused as she tried to describe thoughts about her future. "To me, it's, 'Will I be here next year?' "
Asked about her health now, Caroline's voice trembled. "It's hard to reconcile being a cancer patient and a college student."
How did the medical students in Chicago treat you, a BU student asked?
"That was one of the low points," Caroline said. Every morning during rounds, medical students crowded into her room, but rarely spoke to her. "To have them treat me as an object of study is demeaning."
Then, Verma asked what she wanted doctors to say if her cancer resurfaced.
Her face quivered. Her eyes glistened. "I have no idea. That would be devastating to me, having gone through this already."
Asked Verma, "Would you give up?"
"No," answered Caroline, her voice again strong.
Then, asked for her last thoughts for the medical students, she urged them not to look at a patient as a mass of blood cells to cure or as an object of pity because of a head nearly bald from treatment. "Just say, 'I respect you, and what you've gone through in trying to survive.' "
Verma looked at Caroline. "You are one of the gutsiest people I've ever seen," he said.
Slowly, the medical students rose to their feet and clapped, their applause a thunderous crescendo enveloping Caroline. Her eyes wide, she shrugged and grinned. Verma offered a hug, and she returned it.
"Maybe my words are powerful," she said later. "Maybe they can actually make a difference."
That night, in her blog, she brimmed with optimism.
Things are looking up. Peace.
Linda K. Wertheimer can be reached at wertheimer@globe.com.
