By any yardstick, the odds look pretty good: If you're a kid, you only have about a one-in-two-million chance of contracting adrenocortical carcinoma, a particularly rare and virulent form of glandular cancer.
Statistically, that means that out of the entire population of Orange County, only one person should ever get it.
Maria Flores became such a person in 1982, at age 5.
Today, eight years and eight operations later, she continues a solitary fight with adrenocortical carcinoma. Inoperable tumors have spread throughout her body, often leaving her in great pain. They have constricted the blood vessels leading to her legs, causing them to swell painfully and confining her to a wheelchair. She must keep the pain in check with frequent medication, and oxygen is often needed to help her lungs function because of the tumors growing in them.
When she speaks, her voice quavers unevenly.
But, otherwise, it is difficult to tell that Maria Flores is hurting. She smiles as she talks about recently seeing the ocean for the first time, about whales and seals, about her friends at the hospital, about the prize she won in a drawing contest. She is, say the medical personnel who have worked with her at UCI Medical Center's cancer center, one of the rarest of patients: a teen-ager in pain who routinely seems more concerned about her family and friends and fellow pediatric cancer patients than about herself.
"She's the one who asks every time she comes down to the clinic, 'So who's in the hospital? How's so-and-so doing?' " said Kristy Zilly, a child life specialist in pediatrics at UCI. "She's always keeping up with the other kids who are in the cancer clinic. I don't get that from the other kids."
In turn, said Zilly, the hospital staff is always happy to see her.
"She's everyone's pet around here," Zilly said. "Almost everyone makes it a point to see her when she's here. They say, 'Oh, Maria's here. Let's go say hi.' "
One of four children of Leobardo and Alba Luz Flores of Placentia, Maria "has always been very caring and loving," said her father through a translator. "It's been very hard for us, but she tries to make everyone feel better. She's been very strong and very thoughtful. Just seeing her trying to keep a positive attitude helps us."
Such an attitude is all but unheard of among pediatric cancer patients, said Maria's oncologist, Dr. Violet Shen.
"These children, when they get cancer, they really have to go through a lot in their treatment, and it can make them very sick," Shen said. "They have to have a lot of needle pokes. Very few of them tolerate it very well. They usually hate it and fight it. And they can get very depressed and refuse to come to the clinic or see the doctor or take their medicine. But Maria's very brave. She has bad days sometimes, but she never gets angry or complains. She always smiles, even though she knows the disease is incurable."
Maria already has beaten very long odds.
Shen said that most people who are stricken with adrenocortical carcinoma die within three to five years. In Maria's case, surgeries and chemotherapy had removed or reduced the number of tumors in her body over the last six years, but about eight months ago tumors continued to grow without responding to treatment. And, as the pain became more acute, drugs had to be introduced in an attempt to lessen it.
But, said Zilly, "she would always try to put on a good face. When we'd be on an outing somewhere, she might have to go to the bathroom to be sick, but she'd come back and be apologetic, saying she didn't want to spoil the good time for everyone else."
When the hospital staff learned that Maria had never seen the ocean, they arranged a trip to the Scripps Institution of Oceanography and Sea World in San Diego. During the trip, said Zilly, one of the staff members heard Maria's labored breathing as she walked (she was not yet confined to a wheelchair) and offered to carry her.
"She said, 'No, I always breathe like this in the morning,' " Zilly said. "She was just so excited to be there. She made a point of bringing seashells home for her family."
Such forbearance may help ease the ordeals of other children with cancer, Shen said.
"I think that although we're not able to cure her, scientifically we have learned some (new treatments from her case)," Shen said. "In the future, we may be able to help more people through what we've learned. Also, she is so unusual, and she gives so much encouragement to the people who treat her. She shows she's able to tolerate the treatment. We know that she can do it, and so we can tell other patients that Maria can do it, that Maria took it very well, and they can, too."
When Maria herself feels the pain set in, she turns to artwork.
"Sometimes when I feel really sick and just lie in bed," she said, "I try to color. It kind of works."
Lately, Maria is proudest of a crayon drawing she did that won a drawing contest among the pediatric cancer patients.
"You had to color a picture of you going to the hospital," she said. "I drew a nurse putting an IV in my arm. Kristy called me today and said I'd won a prize."
In a talking balloon above her smiling self-portrait, Maria printed the words, "It didn't hurt."