For four agonizing days, then 7-year-old Audrey Heath’s body was worn down by a bacterial infection. She relied on extracorporeal membrane oxygenation (ECMO), a form of artificial life support, and a ventilator to stay alive.
Cleveland Clinic Children’s pediatric oncologist and hematologist, Seth Rotz, MD, knew when an immune system like Audrey’s is stripped from rounds of chemotherapy for acute lymphoblastic leukemia (ALL), the battle for survival while connected to ECMO can sometimes leave a young patient with cognitive impairments and other developmental issues.
However, when he walked into Audrey’s room in the pediatric intensive care unit (PICU), after she no longer needed ECMO, Dr. Rotz found Audrey sitting up in her hospital bed. She had a battery of questions prepared about white blood cells and other matters related to her disease, scribbled neatly into a notebook.
Audrey was connected to ECMO after a bacterial infection caused her to go into septic shock. (Courtesy: Nicole Heath)
“We always worry if the brain has gotten enough blood and oxygen after being on ECMO,” explains Dr. Rotz. “Audrey was much more lucid than I would have expected, and it was extremely reassuring to know she was fine.&rdquo
Dr. Rotz and Audrey’s parents, Nicole and Bill Heath of Avon, Ohio, had plenty of memories to reflect on earlier in September 2023, when 8-year-old Audrey rang the celebratory bell at Cleveland Clinic Children’s to signify the completion of her fourth phase and 27 months overall of cancer treatment.
Audrey, Nicole, Bill and Dr. Rotz celebrating Audrey ringing the bell at Cleveland Clinic Children's, for the completion of her cancer treatment . (Courtesy: Cleveland Clinic)
That milestone was also marked by a party hosted by Nicole and Bill for dozens of friends and family who had supported Audrey on her life-altering journey with ALL, a disease of the blood and bone marrow that is the most common form of childhood cancer.
Audrey was delighted the party featured “plenty of ice cream,” especially chocolate, her favorite. With treatment behind her, that also meant less frequent use of needles. “I didn’t like the pokes!” says Audrey, matter-of-factly.
Audrey getting a friendly visit from one of Cleveland Clinic Children's facility dogs, Kid. (Courtesy: Nicole Heath)
Her parents are incredibly thankful the treatment has put Audrey’s cancer into remission, which occurs in about 90% of ALL cases. “It was such an exciting moment when she finally got to ring the bell,” says Nicole.
Audrey’s medical journey began in May 2021, soon after she returned to in-person kindergarten after COVID-19 restrictions were lessened and classroom distancing requirements were reduced. One day, Nicole received a call from the school, informing her a teacher thought Audrey’s complexion was more pale and yellow than it had been previously.
In May 2021, Nicole received a call from Audrey's school telling her Audrey didn't look or seem well. (Courtesy: Nicole Heath)
Nicole made an appointment with a pediatrician, however, that evening Audrey complained of being tired and needed to rest often during their regular after-dinner walk through the neighborhood.
When Audrey suddenly started screaming repeatedly in pain, as she prepared for bed, Nicole and Bill rushed her to a local hospital and then to Cleveland Clinic Children’s. Six hours after Audrey’s arrival, at about 4 a.m., doctors shared the shocking news. Tests revealed Audrey had pre-B ALL.
“It happened so fast. You’re hoping surely there's just something off with her lab results and it's not cancer,” recalls Nicole. “But it was really happening, and our lives changed, just like that, in a flash.”
A team of pediatric oncologists and hematologists, led by Dr. Rotz, recommended a standard yet aggressive form of chemotherapy treatment for ALL, which began two days later.
Audrey underwent 27 months of cancer treatment. (Courtesy: Nicole Heath)
For several months, throughout the first phase of chemotherapy, Audrey had few, if any, complications. However, that changed when the treatment intensified during the second phase, ultimately leading to a Halloween night trip to Cleveland Clinic after Audrey contracted a bacterial infection. Her body went into septic shock, prompting the use of ECMO and the ventilator. She remained hospitalized for more than one month.
As Dr. Rotz explains, it is common for many children with ALL to contract fevers or bloodstream infections at times during treatment. “What was unusual in Audrey’s case was the severity of the infection. So, we ended up making some changes to her treatment plan to make sure we were not putting too much stress on her body.”
Audrey, Nicole and Bill, celebrating Audrey's last day of treatment. (Courtesy: Cleveland Clinic)
Another side effect, not uncommon in young patients with ALL, is the chemotherapy caused issues with Audrey’s bone development. It caused the bone to deteriorate and the right femoral head to collapse, causing her to walk with a noticeable limp. Ongoing physical therapy has improved that condition as her bones have very slowly repaired themselves. Now Audrey can run, swim and play with her friends without many restrictions.
Audrey concluded chemotherapy in August 2023. She remains in remission.
Audrey's family threw a celebratory party for her on August 13, 2023, on her last day of cancer treatment. (Courtesy: Cleveland Clinic)
Dr. Rotz raves about Audrey’s positive attitude and strength. “She takes her challenges in stride and figures out how to move forward with incredible resilience and maturity,” Dr. Rotz notes. “While she’s not considered cured at this point, she is in remission. Her prognosis is that she is very likely to be cured long term. We will continue to monitor her closely.”
Says Nicole, “This wraps up a chapter in her life we hope we never have to reopen. Audrey handled everything like a champ, and we are so grateful and proud.”
Audrey says she wants to be a doctor when she grows up so she can care for patients like her. (Courtesy: Nicole Heath)
Whether in school, or participating in cheerleading, Audrey is enjoying her nearly-back-to-normal life. On occasions she dons a white medical coat. In the future, she says she wants to be a doctor to help patients like her. When asked what advice she might have for others she states with a smile, “Anything is possible.”
Cleveland Clinic Children's