"When I visualize," she said yesterday, "I think of the vaccine still working in my body."

Still fighting
Peggy Murphy's chemotherapy treatments began in July, but the port that was implanted to make the process easier never worked correctly. Surgeons had to remove it in August after it became infected. Murphy, whose longtime companion, Alan R. Craig, regularly drives her to Hopkins from her home near Lancaster, Pa., spent much of the summer in and out of hospital emergency rooms complaining of horrible pain, at times spitting up bile. She's taking large doses of Oxycodone. She's often emotional and forgetful.

In September, Murphy's doctors told her the chemo wasn't doing the job. Her entire spine was showing signs of cancer. She switched to a chemotherapy drug administered in pill form, which left her unable to keep anything down. She lost 15 pounds. Doctors recently adjusted the dosage to reduce the side effects.

The pain in her side that sometimes leaves her unable to sleep turned out to be from cracks in ribs weakened by the cancer. When those heal, she hopes to be in less pain. Meanwhile, her son is helping her search for a new clinical trial.

She is not done fighting.

No concerns
After hearing from Emens that her scans looked good, 38-year-old Darby Steadman took off on vacation with her two elementary-school-age children and her high-school-sweetheart husband. She visited friends in Atlanta, went to Boca Raton, Fla., and stayed in a beach house on St. Simons Island in Georgia that belongs to another woman in the trial. Steadman still must get the cancer drug Herceptin intravenously every three weeks to tackle the cancer remaining in her lymph nodes and spine. But she earned a two-month reprieve from Hopkins. Her fourth round of vaccine injections is scheduled for Oct. 28.

As the school year began, Steadman relished her new role as simply a mom and not a cancer patient. But over Labor Day weekend, while at a Christian family camp, Steadman fell off a zip-line. She broke her right ankle, which required surgery to repair. She can't drive. She can't go for walks in the neighborhood with her friends. She became a patient once again.

Emens' phone rang in late August. It was Susan Marangi, whose cancer had been in check even longer than Kristoff's. Marangi had been admitted to Mercy Medical Center after her back went out and the pain became too much to bear.

Because of her medical history, doctors ordered bone scans. The good news: the pain was from a compressed disc and some arthritis, not the cancer. The bad news: her bones were lighting up.

The cancer, they told her, had returned.

She tried to hide how she felt, but she was devastated. "We all knew this was an experiment," she said the day after she got the report. "It will work in somebody. I'm not throwing in the towel right now."

Emens found a way to squeeze Marangi into her schedule. The doctor wanted to see the scans herself.

Marangi's cancer has always been a slow-growing sort. She is, after all, alive 20 years after her diagnosis. But Emens agreed with the Mercy doctors. The cancer was back, she said, if only in a few small spots on the spine. It would also turn out Marangi's back pain was related to the cancer. The disease had weakened the bones and caused one of her vertebrae to fracture.

Emens changed Marangi's medicine and told her they would have to watch her more closely. But, the doctor told her patient, "There's nothing to be concerned about."

Those reassuring words are the ones Marangi heard the loudest. She was ecstatic. Those weeks of grieving for herself, of mentally preparing for an imminent end, seemed over.

"Do I need to give my dogs away and put my house on the market?" she asked Emens.

"Sue," the doctor replied, "you're not going anywhere."

more on the series
Online at baltimoresun.com/vaccine:

Watch a video of Annie Siple discussing her personal approach to the vaccine and breast cancer, and find more photos, videos and previous installments of the series at baltimoresun.com/vaccine