Maria Martignetti is happiest when she's helping someone else.
The 7-year-old loves working in the garden, asks questions about everything and looks after her seven brothers and sisters whenever she can.
"She's a special kid," says her mom, Amanda Martignetti. "She has this fire to learn that I admire."
That same curiosity and optimism have carried Maria through months of surgery, chemotherapy and radiation after an unexpected diagnosis opened a new chapter in her childhood.
From slide to surgery
Maria had recently been to her annual checkup and was healthy and happy, looking forward to playing with her friends and siblings over the summer.
Then one afternoon in May, she came home from a school field trip complaining that her side hurt. Amanda knew Maria had fallen from a slide earlier that day, so she figured she had a bruise or maybe a sore rib. But when she lifted Maria's shirt, she immediately noticed abnormal swelling.
"When I touched it gently, she started crying and throwing up blood," Amanda says. "I knew something was wrong."
At the emergency department, Amanda braced herself to hear that Maria had appendicitis or a broken rib. Instead, imaging revealed a large tumor on Maria's right kidney.
“We didn't know exactly what we were dealing with,” Amanda says. “But I knew it was cancer.”
Maria was diagnosed with a Wilms tumor, the most common type of kidney cancer in children.
Soon after her diagnosis, Maria and her family met with Dr. Jonathan Walker, a pediatric urologist at Atrium Health Levine Children's Hospital, recognized by U.S. News & World Report as a ‘Best Children's Hospital’ for pediatric urology.
By the time Maria’s tumor was discovered, it had already ruptured.
“Having a tumor rupture doesn’t necessarily change the urgency or complexity but sometimes can make it more difficult to remove all of the tumor,” Walker says.
Maria’s tumor was large and filled most of her abdominal cavity. Walker says her care team had to decide whether the tumor itself could be safely separated from the surrounding organs, such as 
the liver, bowel, and great vessels.
Despite its complexity, Maria’s tumor was successfully removed.
Not long after surgery, Maria reminded everyone exactly who she was.
"Within about 20 minutes she was up walking laps around the unit," Amanda says. "The nurses were clapping for her."
Walker remembers seeing the change almost immediately.
“Maria has a lot of personality, which really came out after she started feeling better,” Walker says. “She became more talkative and began to fill her room with laughter. The whole staff loved spending time in her room, and it was wonderful to see her recovering so quickly.”
A coordinated plan
Surgery was only the beginning for Maria. Having a tumor rupture meant that Maria was going to need radiation therapy afterwards to make sure that any microscopic tumor cells left behind were treated.
Her care encompassed specialists in pediatric urology, oncology and nephrology, each playing a role in her treatment and recovery.
And because Levine Children's Hospital is part of the Children's Oncology Group, Maria also became one of the hospital's first patients enrolled in a newly opened clinical trial for Wilms tumors.
“Genetic testing showed favorable tumor biology, allowing doctors to reduce the amount of chemotherapy she would need while maintaining a high likelihood of a cure,” Walker says. “She is the first patient we have enrolled that was able to reduce the chemotherapy needed post-operatively, which will hopefully reduce her long-term treatment-related side effects.”
The comfort behind the care
For Amanda, the level of care they continue to experience goes hand in hand with the team providing it. Amid the whirlwind of helping her child face cancer, Amanda says she has never questioned that Maria was in the right place.
"I swear by this hospital,” Amanda says. “There wasn't one person involved in her care that I didn't trust. Nobody wants their child to be sick. But when they are, you need to know the people taking care of them are doing what's best for your child."
Amanda says that same trust extended to Maria’s pediatric oncologist, Dr. Erin Trovillion. Along the way, Trovillion found small ways to connect with and comfort Maria, including bringing her seashells to each chemotherapy appointment after learning how much she loved them.
“Dr. Trovillion has had such a huge impact on our family,” Amanda says. “Maria absolutely adores 
her. She makes her feel brave, and that has made such a difference throughout treatment.”
For Amanda, asking questions throughout the process has been her way of making sense of everything that has happened.
"I probably asked Dr. Walker a thousand questions," Amanda says. "That’s my way of making sense of things. He gave me complete reassurance and confidence that she was going to be OK. He saved her life.”
For Walker, the feeling is mutual.
“Maria and her whole family have been a joy to meet, and I feel honored to be involved in her care,” Walker says. “Every time I see her, it reminds me of why I love my job and how lucky I am to live and work in such a great place with amazing colleagues.”
Navigating a new normal
No matter how many doctor's appointments Maria has had, or how she's feeling by the end of the day, her bedtime routine always ends the same way.
"She asks God to watch over all the children who have cancer," Amanda says.
Maria still has treatments ahead, but there are more good days than hard ones now. She's learned how to coach herself through port access appointments by reminding herself to relax. And Amanda helped her face radiation treatments by using a little imagination.
"I told her, 'You get to go in a spaceship. Nobody is cooler than you,'" Amanda says.
Amanda has also explained cancer to Maria one conversation at a time, breaking down an inconceivable chapter of their lives into something more manageable.
"There isn't a playbook for how to handle when your child has cancer,” Amanda says. “I had to look at it analytically to help us navigate it. We started by calling her tumor a boo-boo. Then we explained the tumor was caused by something called cancer and that chemotherapy was going to help kill the cancer cells and keep her healthy.”
Maria’s new normal still includes hospital visits and treatments. But it also includes a little girl who loves to learn, looks after her brothers and sisters, and ends each day praying for children walking a road much like her own.
Learn more about pediatric urology care at Levine Children’s.
