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Paul Coskie, 22, has faced more adversity in his young life than most people endure in a lifetime: Traumatic head injury at 13, cancer diagnosis at 17, relapse at 21.
Paul's unbelievable cascade of tragic events began in 2001, when he was struck by a car in his Upton, Mass. neighborhood while bicycling without a helmet. Thrown 10 feet in the air and landing on concrete, he sustained a traumatic head injury and was not expected to survive.
Through a year of intensive care and rehabilitation, he learned to walk and talk again, finally returning to the loving arms of his parents and seven siblings, and finishing high school.
In her book Unthinkable: A Mother's Tragedy, Terror, and Triumph through a Child's Traumatic Brain Injury, his mother, Dixie Coskie, chronicles the year her family spent with Paul at death's door, and offers tips to others confronted by a similar catastrophe.
A year after the accident, she wrote: "Through your experience, Paul, our family has been startled from slumber and awakened to a life that is fragile, a gift, and worth living."
Then, in 2005, a second blow: Paul was diagnosed with leukemia. A year later, he received a bone marrow transplant at Dana-Farber/Children's Hospital Cancer Care, in which he received healthy new marrow donated by his younger brother, Kevin.
After remaining cancer-free for two years, he is back in treatment, receiving the oral chemotherapy drug Gleevec.
Dixie Coskie calls Paul's cancer diagnosis Unthinkable 2.
"When he had persevered after the accident, fighting to heal and working to take steps once deemed impossible by his doctors, I could not fathom that he might be handed another death sentence," she says.
Still, the family pushed forward once more, with the siblings lining up to see who could donate stem cells to Paul.
"Cancer is a different beast," Dixie points out. "It lingers, and it seems there is often trouble around the corner. You only have power over how you react. Because Paul had such courage and strength after the accident, we thought, okay, we can do this again."
Recognizing that Paul would need extra support, his care team at Dana-Farber/Children's Hospital Cancer Care invited Brian Delaney, PsyD, an expert in pediatric brain tumor patients and survivors, to offer support and counseling because Paul's challenges were similar to those of the patients Delaney sees.
There is no formula for supporting young patients and families who have extra challenges, he says. Each family has its own way of dealing with a child's cancer, no matter what their circumstances are.
"We support parents by listening to them," he says. "They know their child best, and we use their guidance to shape the child's clinic experience."
In Paul's case, music was one important strategy for coping.
"Having cancer has not been fun, but the music program has been awesome," says Paul.
"Music is a part of Paul that is healthy," says Dana-Farber/Children's Hospital Cancer Care music therapist Brian Jantz, who has worked with Paul through the Zakim Center for Integrative Therapies for five years.
"This is where he can be creative, expressive, and successful. When it's hard to find words for what you are feeling, music can come from a very deep place."
Watch Paul play guitar in his music therapy session at the Leonard P. Zakim Center for Integrative Therapies
To learn more about the Coskie family and the book Unthinkable, visit www.dixiecoskie.com.