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The 9-year-old boy lay on a surgical bed outside the operating room early one July morning. Tears ran down his father's face as he held his son's right hand.

The dad stared at the boy's right arm.

Pictures of his son flashed in his mind: Chase throwing a baseball during a Little League game, revving the throttle of his four-wheeler, casting a fishing line for bluegill and bass on their acreage surrounded by rolling hills and pasture.

The father began quietly talking: The doctor will do everything to save your arm, but there's a chance that when you wake up, your arm will be gone.

The boy looked at his dad.

I know you, mom and the doctor will do all you can to save it.

But, Chase said, repeating his parents' words, my life is more important than my arm.

***

When did it get to this point, when the choice staring at the boy's parents was his life or his arm, and so there really was no choice at all?

Parenthood is a series of decisions, each seeming to carry the weight of a child's future.

Craig and Michelle Caspersen, like all parents, wrestled with choices for their only child: Should we let Chase get a cellphone? Is he too young for a sleepover? Should we sign him up for gymnastics?

Now, when confronted with their son's bone cancer, those decisions seemed less important.

***

It was February 2010. As they ate dinner at home in Boelus, Neb., near Grand Island, Michelle noticed a bump on Chase's arm.

About an inch long, a half-inch wide and a quarter-inch high. Oval-shaped, on the top of his right arm near the wrist.

Michelle pushed up Chase's sweatshirt sleeve. The bump felt hard, but Chase said it didn't hurt.

Chase lived in cargo shorts and T-shirts and liked his hair, prone to forming cowlicks, clipped short. He shot hoops. He usually played first or third base.

His parents figured he had pulled a muscle at gymnastics. Or maybe banged his wrist riding his four-wheeler.

Michelle touched the bump every day or two. Still the same size.

She'd ask Chase if it hurt.

“No, Mom,” Chase told her, pulling his arm away.

About a month later, on a Friday, Michelle drove with Chase to her parents' home in Alma, Neb., for Easter weekend. Chase turned 9 that day.

Michelle's “mom gong” suddenly went off during the two-hour ride.

Her mother's instinct told her to get the bump checked. Fast.

***

A physician assistant in Alma examined the bump the next morning. An X-ray revealed cloudy patches that could signal a healing injury — or a malignant tumor within a forearm bone.

The PA told Michelle to see Chase's pediatrician immediately.

Michelle and Craig didn't worry too much as they ate Easter ham and pumpkin pie. The bump was probably from a sprain or strain. Chase is only 9 and rarely gets sick, Craig thought.

Chase's pediatrician in Kearney scanned the X-ray on Monday. After conferring with a radiologist, the pediatrician was straightforward: It was probably osteosarcoma, a form of bone cancer.

Michelle's stomach tightened. Craig's mouth got dry.

Their minds raced: How serious was this? Would they lose Chase?

Many childhood cancers are curable, but chemotherapy and surgery would be necessary.

The doctor also mentioned a possible outcome, one that stung: amputation.

He advised the couple to see a pediatric oncologist as soon as possible.

Michelle and Craig told Chase the doctor was a little concerned and wanted others to look at the bump. No need to worry the boy.

They had to make more decisions.

Go to the children's hospital in Denver or the one in Omaha? Stop at home or go straight to the hospital?

The family piled into Craig's pickup and headed to Omaha with only the clothes on their backs.

***

Technicians slid Chase into the tube of an MRI machine and asked if he was scared.

“A little,” the boy said in a higher-than-usual voice.

Tests at Children's Hospital & Medical Center confirmed the pediatrician's diagnosis: osteosarcoma.

Nationally, osteosarcoma affects just five out of a million children and teens per year. There's no known cause.

The MRI showed the tumor's location. A CT scan provided some good news. The cancer had not spread.

The cancer can be deadly because it spreads to the lungs. When the cancer is caught before it spreads, the cure rate is 60 to 70 percent.

Even so, Chase's parents had to prepare for a long year.

Chase would immediately have three months of chemotherapy.

Dr. Sean McGarry, an orthopedic surgeon specializing in bone cancers, laid out the two scenarios post-chemo:

If the tumor shrank enough, the surgeon could remove it and replace the damaged section of Chase's bone. No amputation needed.

After a tumor shrinks, there's space around it called the “margin.” The bigger the margin, the more likely McGarry could remove the tumor without contaminating healthy tissue.

The tumor's location — where nerves and blood vessels in the hand connect with those in the arm — made the margin even more important. Any damage would significantly hurt Chase's ability to open and close his hand, move his fingers, bend his wrist and raise and lower his arm.

If the chemo hadn't had enough impact on the tumor, the surgeon would likely need to amputate just below the elbow.

McGarry, a faculty member at the University of Nebraska Medical Center, told Craig and Michelle he was hopeful he could save the arm. But he made no guarantees.

Surgery was scheduled for mid-July, when McGarry would know the better choice.

***

Chase began throwing up repeatedly into a washtub a few hours after his first chemo treatment.

The air smelled of chemo chemicals mixed with the vomit's acid odor.

“God, why are you putting us through this?” his dad thought.

Chase received chemo Wednesday through Sunday at Children's Hospital, enabling the family to go home a few nights each week. The intravenous chemo took either four or 48 hours, depending on the type.

Chase started folding and unfolding his hands before a treatment. He cried and told his parents he was tired of the drugs and wanted to go home.

Craig, who's 47, sometimes curled up next to his son, put his hand on the boy's wrist and prayed: “God, please get us through this and take the tumor away.”

Craig lost an aunt to breast cancer when he was 12. His family had talked about her pain, how she withered to nothing.

He didn't want that for Chase, who never seemed to stop moving.

The Caspersens lived on 19 acres adjoining relatives' properties, giving Chase hundreds of acres to explore. He loved Murphy, his Labrador-poodle mix, Siamese cats Selena and Lucy, and his goldfish Rowrow.

He liked to joke around. He wore glasses with eyeballs on springs to make the nurses laugh.

But he wasn't himself in the hospital. The chemo wiped him out.

Some kids with cancer use a tube to be fed either through their noses and into their stomachs or directly into their stomachs.

The Caspersens knew they wanted to avoid a tube. One more medical intervention, one more reminder Chase was sick.

The cancer specialist said Chase needed calories, calories, calories.

When Chase felt like eating at 2 a.m., Craig drove to McDonald's for a cheeseburger and fries. The boy devoured Arby's beef and cheddar sandwiches and vanilla ice cream with chocolate syrup.

His hair fell out in clumps, covering his pillow. He received dozens of ball caps — Husker football, WrestleMania, Superman — but rarely wore them. He shaved his head and accepted his new look.

The Caspersens set up a makeshift office in the hospital room. Michelle, who's 45, creates fragrances for a living, and Craig owns a custom-cabinetry company.

Both knew how to make business decisions: hiring workers, buying advertising, adding products.

But making decisions about Chase's treatment was different. They had no medical background and often relied on instinct.

Two weeks before the July 14 operation, McGarry asked to meet with the couple.

The surgeon's eyes were watery as he talked: Recent scans showed Chase's tumor had not shrunk as much as he had hoped. There was not a good margin.

The safest option, the one that would more likely ensure the cancer would not spread and Chase would survive, was to amputate.

***

The Caspersens went shopping later that day.

They knew their boy might lose his arm. They wanted an artificial one ready as soon as possible.

Initially the plan was to amputate just below the elbow, but McGarry determined amputating just above the elbow would make a prosthetic work better.

The salesman didn't have a complete prosthetic arm to show them, only sections, including a piece with two metal pads that opened and closed to serve as fingers.

The Caspersens were frustrated. Not only might Chase lose his limb, they couldn't even get an idea of what a replacement arm might look like.

They became more resolved to seek second opinions.

Craig wanted to look Chase in the eye when he was a teen and assure him they did everything possible to avoid amputation.

Michelle wondered how they would deal with Chase's frustrations if he lost the arm.

How would he play baseball? Hold a pencil? Get dates in high school? Have job options as an adult?

McGarry contacted three orthopedic surgeons who specialize in bone cancer. Two agreed that amputation was the best option.

While the third said that amputation was probably the safest option, the specialist told McGarry he could try to save the limb. It might be possible if McGarry could determine during surgery that the tumor could be removed completely.

The advice helped confirm for McGarry that removing the tumor and saving the limb were possible.

McGarry advised Michelle and Craig that trying to save the arm was riskier because tumor cells could spread during the surgery. But he was willing to try.

The Caspersens told him yes, try to save the arm. But if it were necessary to save his life, amputate.

***

On that July morning, when nurses wheeled Chase away from his dad, through the doors of an operating room at the Nebraska Medical Center, the boy began to cry.

His parents were at his side through all the tests and treatments. Now Chase was alone.

Chase's grandparents, an aunt and a cousin waited with Craig and Michelle. They tried to make small talk, but the conversations didn't go anywhere.

Craig thumbed through a Sports Illustrated and other magazines, but didn't get past the first sentence or two. At one point, the “Jeopardy” theme played on the television.

Michelle tried to distract herself in the gift shop. She carried a glass cross in her pocket and prayed that Chase and his arm would be saved.

She pictured Chase with a stub of an arm.

About 11 a.m. Michelle and Craig received the first hourly update from the surgical nurse.

The surgeon is dissecting, the nurse said on the phone — cutting through skin and tissue to reach the tumor.

Hour two: still dissecting.

Hour three: still dissecting.

Hour four: still dissecting.

Michelle began to wonder: If the surgeon needed to amputate, wouldn't that have started by now? Is this a good sign?

An hour later, the phone rang again. The nurse told Michelle something the mother will never forget: “I have really, really, really good news for you.”

***

After the nine-hour surgery ended and Chase's anesthesia was wearing off, the Caspersens could see their son.

Chase rolled out of the elevator. Michelle and Craig walked alongside his bed as nurses pushed it down the hall.

Chase turned to see his mom and dad.

The boy's right arm — the one he used to throw a baseball, write his name and pet Murphy — rested on top of a pillow. It was heavily bandaged but all in one piece.

“Look, Mom,” Chase said, wiggling his five fingers.

Halfway through the surgery, McGarry had realized he could save the arm, and the nurse had called to deliver the good news.

The chemo had created a shell around the tumor. The shell consisted of tumor cells killed by the treatment and protective tissue produced by the body.

Scans had shown a shell. But they didn't reveal whether it would be tough enough to keep cancer cells from spilling out when the tumor was removed.

As he began to peel nerves away from the tumor, McGarry could tell the shell was firm enough.

The shell also made it easier to remove the roughly 5-inch-long tumor without damaging surrounding nerves and blood vessels.

Lab testing during the surgery determined that McGarry had gotten all the cancer out. Then he used a bone donated from a deceased 56-year-old woman to replace the section of Chase's arm bone damaged by the tumor.

Later that night, as Chase slept, his parents turned off all but the bathroom light and cracked the door open.

Craig stretched out on a couch. Michelle lay down on a bed next to Chase's.

As she looked at her son, she noticed the bathroom light shone on his bandaged arm, like a spotlight.

It was a sign from God, she thought, that they made the right choice for their child.

***

Michelle heard the basketball thump outside their house. It was Chase and his dad shooting hoops in the driveway.

Other times this spring she'd glance out the window and see Chase and his dad working in the garden or hear her son revving his four-wheeler.

Ten months after his surgery, those have been the best moments for Michelle.

Chase's cancer is in remission, which means there is no evidence of cancer in his body. If his cancer stays in remission for five years, it's likely that it will never return. He underwent five months of chemo following his surgery to help ensure it won't return.

A surgical scar runs along the top of his arm from the tip of his pointer finger to his elbow. It will fade but always be there.

His right hand and arm work nearly as well as before the surgery. He can write with a pencil, cast a fishing line, play video games and tie his shoes.

His dad can see that Chase's arm is nearly back to normal.

On the first nice day of spring, father and son, each wearing a baseball glove, stepped outside. The grass was just starting to turn green.

Chase gripped the baseball in his right hand, pulled back his arm and threw.

Craig felt the thump in his glove from his boy's throw, and he smiled.

Contact the writer:

402-444-1122, michael.oconnor@owh.com

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