When David Llano was diagnosed with leukemia in June 2014, the news came as a shock.
Then 17, Llano had just finished his junior year of high school, and he was looking forward to a summer of hanging out with friends. Instead, he was immediately hospitalized at Lucile Packard Children's Hospital Stanford.
For the next few months, he was extremely ill, as he received chemotherapy treatments and eventually a stem cell transplant.
I wrote about his experience in a feature story for Stanford Medicine magazine. As the article explains, teens and young adults with cancer face biological and psychosocial challenges distinct from those of other cancer patients, both in treatment and as they recover.
During my reporting, I spoke with Stanford child and adolescent psychologist Emily Ach, PhD, who frequently works with teens who have cancer.
"The rift between the patient's experience and what's happening with their peer group is a real challenge to figure out," she told me.
Llano said he felt this rift when he returned to high school four months after his diagnosis. From the story:
The first day back at school was harder -- weirder, really -- than he expected.
"People I didn't even know would go up to me and hug me, be really touchy with me," he said. "All the kids pitied me."
His experience isn't unusual, psychologist Ach said. "Maybe at college reentry, kids are more sensitive and appropriate, but not necessarily," she said. "In high school, they're pretty reliably not, and being different in any way is really hard."
When Ach is helping patients prepare to return to school, she reminds them that although many aspects of having cancer are outside of their control, they get to choose how much information about their illness to share.
"Kids vary widely in terms of how open they want to be," Ach told me. For instance, some teens are comfortable responding to a question about a scar by saying, "Oh, I was treated for leukemia. That's where I had a port for my chemo." Others might prefer to say, "I don't really want to talk about it. I was sick, and I had a medical procedure."
Regardless of the specifics, planning responses for awkward questions helps, Ach said. "For a lot of kids, coming up with that on the spot is really hard, and the potential to be caught off-guard is so anxiety-provoking," she said.
Like many young cancer patients, Llano initially had trouble seeing what his future would hold: "You don't really have an identity," he said. "You're like, 'I have cancer and I'm trying to figure out who I am.' "
He kept up a few close friendships from before his illness, but decided to complete his senior year of high school at the hospital school at Packard Children's. There, other students had their own challenging medical journeys and wouldn't be surprised by what he'd been through.
Llano also became active in peer advising at the hospital, helping other teens navigate the challenges of cancer.
He is now in good health and planning a career as a child-life specialist.
Photography, including image of cancer survivor David Llano at his Sunnyvale home, by Timothy Archibald