Rings symbolize eternal love, no matter how they are fashioned.

On Thanksgiving Day last year, Christine Marcum received rings made of construction paper and of all her possessions, those rings are among the most cherished.

Each ring connects to another, creating a chain – the kind little kids make in school – with each link building a greater strength.  Inside each ring are messages and pictures created by those most important to Christine: her husband, two children, their spouses, four grandchildren and family pets.

Inside one ring, there’s a picture of a woman playing pickleball – one of Christine’s favorite activities – and this message: “Back on the court soon.’’

Inside another ring, a funny quip: “Taco, burrito, what’s that in your Speedo?’’

Rudi and Loki, Christine’s daughter’s family pets, sent pictures of puppies.

Another message spoke of the gravity of the diagnosis that Christine had learned of six weeks earlier: “Cancer sucks.’’

“There’s a lot of love in there,’’ Christine said of the paper rings – 42 of them, one for each day of radiation that Christine would begin on the Monday after Thanksgiving at UCHealth Cancer Center– Memorial Hospital Central.

For six weeks’ prior, Christine, a physically fit golfer, hiker and pickleball player, had already been in a battle against salivary gland cancer.

While washing her face one night before bed in August 2023, Christine noticed a tiny lump at the base of her ear, on the right side.  By chance, she had a dentist appointment the next day and mentioned the lump to her dentist.

“She gave it a look and said, ‘I think it’s a salivary gland,’’’ Christine said.

In the months that followed, a village of UCHealth medical experts from Colorado Springs, Pueblo and Woodland Park – all once strangers to Christine – would form a circle around her, a ring. Her journey started with an appointment with Dr. Jenny Allard, an internist, and in the days and months that followed, doctors, surgeons, nurses, radiology techs, nurse navigators, physicists, front desk ambassadors, nutritionists, social workers, audiologists, and countless others would provide care.

All of this happened about the time that Christine and Bill, her husband of 47 years, were preparing for a European cruise. Wanting to get the imaging quickly, Christine made an appointment at Pikes Peak Regional Hospital in Woodland Park. Results came swiftly. Dr. Allard called and let Christine know that the x-ray showed a mass. Allard ordered a biopsy.

With the cruise only days away and no time to waste, Christine scheduled a biopsy at Parkview Medical Center in Pueblo. The next day, she and Bill left for their cruise.

“The night we got on the cruise ship, I kept checking to see the results in the portal (My Health Connection.) I kept looking to see the results of the biopsy, and we’ve got jet lag, so it’s 2 o’clock in the morning (in Europe), and I hear a noise on my phone and, sure enough, I look, and the results are there.

“And there is a message from Dr. Allard saying, ‘Could we talk? And she wanted to do it at 5:30 p.m. (mountain time) after all of her patients had been seen, which was 2:30 in the morning for us. So, we just stayed awake for the next half hour.

“She told me the bad news and referred me to Dr. Susannah Orzell,’’ Christine said.

Orzell is an otolaryngologist, a head and neck cancer surgeon and microvascular reconstruction surgeon who practices at  UCHealth Ear, Nose and Throat Clinic – Memorial Hospital Central.

“From the first day that I met Christine, you could tell she is someone who is very vivacious, very healthy and takes great care of herself. She just had a great attitude,’’ Orzell said.

The tumor wasn’t bothering Christine; she did not feel sick, though she felt enormously fortunate that she didn’t wait until after the cruise to call her doctor. The cancer in the right parotid gland, one of the major salivary glands, had grown back toward the cranial area, into Christine’s ear canal and into lymph nodes in her neck.

“It was unusual in that it was near the main trunk of the facial nerve and where it exited the skull base,’’ Orzell said. It would require surgery that it some ways was complex.

“I had to, as part of the incision, resect part of the ear canal, which is not typical for routine parotid surgery. It was necessary to maintain a clear margin and get rid of the tumor as best as we could.’’

Among the goals during surgery: Preserve the facial nerve.

“The facial nerve allows you to move most of the important muscles in your face that help with facial expression, opening and closing the eye, and the ability to keep liquids inside your mouth when you are eating and when you are swallowing,’’ Orzell said.

Orzell also did a “neck dissection,’’ removing packets of lymph nodes in the neck area where the parotid is known to drain, perhaps leaving microscopic remnants of cancer.

The surgery left Christine with temporary paralysis on the right side of her face, a condition that has since resolved. In the immediate aftermath, however, Christine was unable to close her right eye. Doctors wanted to prevent dry eye or a corneal abrasion. Orzell asked Christine to see Dr. Fred Deleyiannis, a reconstructive plastic surgeon at UCHealth Plastic and Reconstructive Surgery Clinic – Colorado Springs who specializes not in cosmetic procedures but complex reconstruction.

Deleyiannis placed a small weight in Christine’s right eyelid, allowing her eye to close.

“He was wonderful – I love everything about his demeanor. He is so much like Dr. Orzell, a very calm demeanor. He tells you about your treatment. He lays it all out, the good, the bad and the ugly,’’ Christine said.

From the time that she received the cancer diagnosis, Christine had begun working closely with Dr. Mac Daly, a radiation oncologist who specializes in head and neck cancers at UCHealth Radiation Oncology – Memorial Hospital Central.

“Frequently, we will meet patients before surgery, so we can get the opportunity to participate in everything a patient might need during the full process. We don’t want patient delays or breaks in care related to events that could have been foreseen,’’ Daly said.

Meeting Christine early on her journey gave Daly the chance to prepare the technical side of radiation treatment. The process began with a conversation between Christine and Daly, who explained the potential side effects of radiation and risks.

“They had to make sure the treatment was exactly where it needed to be, because it was close to my brain, my hearing, my eye, my neck – it’s complicated,’’ said Christine. “And even that is overwhelming.’’

Christine had a “mapping scan,’’ essentially a CT scan, that helps to build a giant grid or coordinate system. This work is done on a computer and takes 10 days to complete.

“We take images and then set a coordinate in their body. After that, everything is going to be a coordinate, typically on the order of a millimeter or 3-millimeter increments,’’ Daly said. “Once we have someone scanned in a particular position, I can take all of their preoperative images or available imaging to make a great sandwich – where the tumor was, reading the operative report and talking to the surgeon about any concerns they have. That helps me define where the targets are going to be.’’

In radiation oncology, having a “deep bench,’’ as Daly calls it, is essential to high quality care.

“There’s no way for me to be excellent without every support member that I work with being excellent at their portion of the job,’’ Daly said.

This includes having a medical physicist, who provides quality assurance, evaluates metal or metal implants within the field of radiation and beam angles, and also considers potential pitfalls in the delivery of radiation. Beyond the physicist, a dosimetrist helps the physician design how radiation is going to enter and exit the patient and examines how to get radiation to the target but minimize the dose to critical structures.

Once a treatment plan is in place, it is subject to a peer review. Another physician checks the physician’s work; another physicist checks the physicist’s work.

“It is multiple layers of peer review. But, if you can imagine, we are mixing up medicine here. When you buy Tylenol, there’s already all of these quality assurances, so you can grab it off the shelf. There’s no grab-off-the-shelf radiation. It’s all created, so it has a lot of quality checks,’’ Daly said.

Before surgery and radiation, patients are connected with support services to manage “some things that we are expecting, including issues with opening your mouth, issues with tightness in your neck. The evidence would say that the sooner we start those interventions, the better we will be,’’ Daly said.

Having a village of multidisciplinary expertise, Daly said, is not by accident.

“UCHealth has invested, and they’ve built a program with multi-levels of expertise and that makes it appealing for patients coming in,’’ Daly said. “You can’t deliver treatment like this at the highest quality without those things in place. … It’s exceptional.’’

On the Monday after Thanksgiving 2023, Christine began 42 days of radiation at UCHealth Memorial Hospital Central.

“It was like Groundhog Day,’’ Christine said. “You wake up and every day was like the day before.  The appointment was always at 9 o’clock – that was kind of nice, it was the same time every day, so you didn’t have to look at your schedule.’’

Each day, quality care and efficiency were apparent.

“They moved you in and out,’’ Bill said.

Coming and going every day from the hospital for seven weeks helped Christine build a community with caregivers and other cancer patients.

“The technicians were amazing,’’ Christine said. “They are very kind and they’re counting down for you and asking: ‘How was your day?’ And you get to know other cancer patients and learn about their journeys because they’re there receiving daily treatments.’’

Each day when Christine came for treatment, a small piece of wax had been placed on a table. It was there for her to place over an old, metal crown in her tooth. That simple part of her care did not go unnoticed by Christine. She thought of the physicist, an unsung caregiver, an essential part of the village of people taking care of her.

Christine’s only real difficulty during radiation was trying to make herself eat – everything tasted terrible.

“She got down to under 100 pounds. It was getting kind of scary. They were talking a feeding tube,’’ Bill said.

Caregivers gave her recipes, and tips on how to make foods more palatable and keep it down. Christine’s mental strength powered her through.

She would go to the kitchen sink and tell herself: “You just have to swallow six swallows and then take a break.’’

Christine avoided a feeding tube. She still struggles with some loss of taste, dry mouth, hearing loss and tissue damage resulting from radiation treatments. She is grateful to have returned to hiking, golf and pickleball with family and friends.

At the end of radiation, Christine did what so many before her have done. She rang the bell, a tradition in cancer centers across America. It signals the end of cancer treatment. She also received a certificate declaring the victory.

“The staff comes in from their desks, where they check you in. Anyone that is available comes and, of course, the other patients, they get to see, ‘Ok, I can do it. I’ve got the next phase,’’’ Christine said.

Recent scans show Christine is now cancer-free.

Though no one ever wants a diagnosis of cancer, Christine, who remained pragmatic and thoughtful through her care, has advice for those who do see something amiss – perhaps a tiny lump, as she had.

“Do not ignore things,’’ she said. “You have to trust. You have to feel good about your care. I think that is really important because if you are not feeling confident that you’re getting the right care, then it is not as easy.

“The last thing you want to be worried about is, ‘Are they doing this right? Am I getting good advice? Am I getting the right tests that I need? Should I be seeking a second opinion?’ It’s just good to know that you have a path, and I was lucky enough to have that right away.’’

For those friends and family members who are supporting a loved one through the journey of cancer, keep sending those pictures from the family pets. Send cat pictures. Send funny notes. Send encouragement. Be like Christine’s friend who sent silly slippers with happy faces.

All of it makes it a little easier — the village, rings of construction paper, the jokes about Speedos.