Marsha McGuire sneaked into a closet to make a phone call.

Her 11-year-old son, MacKale, had just had an X-ray of his painful left leg.

The word had come back: Bring him to Spectrum Health Helen DeVos Children’s Hospital tomorrow.

Marsha didn’t want MacKale to see her worry. But she also couldn’t bear the wait for test results.

She quietly called Deanna Mitchell, MD, a pediatric hematologist and oncologist who had treated MacKale for hemophilia since his birth.

Marsha asked Dr. Mitchell if she suspected cancer.

The doctor’s reply: “Yes, I think it is cancer. And I think we can save his leg.”

“I lost it,” Marsha said.

In tears, she told Dr. Mitchell, “I don’t care about his leg. I just want you to save my boy.”

Nearly seven years later, Marsha and her husband, Mike, watched MacKale dance and sing his way across a stage, the star in his high school musical.

They cheered as he played varsity soccer and served as co-captain of the golf team.

And they watched proudly as he graduated from Cadillac High School.

At 18, MacKale has faced and overcome a lifetime’s worth of health challenges.

He has hemophilia. He is a cancer survivor. And after his left leg was amputated, he learned to walk—and run, ski and dance—with a prosthetic leg.

How did he get through it?

MacKale does not know.

“I remember very little of it, to be honest,” he said.

He knows he had the support of his family and friends. And his school and community rallied to help the McGuires.

But as for the years involved with treatment—he spends little time thinking about that. Instead, he focuses on the future—looking toward college and a career.

MacKale’s forward-thinking attitude comes as no surprise to Dr. Mitchell.

“He is quietly courageous and very steady and very perseverant,” she said.

For MacKale’s mother, gratitude toward Dr. Mitchell runs deep.

“She enveloped him with her knowledge and her skill, and she saved him. We owe his life to her,” she said. “I love her dearly.”

Two rare conditions

MacKale has faced two rare and life-threatening diseases: hemophilia and osteosarcoma—bone cancer.

Dr. Mitchell believes there is no link between the two. In fact, she has found no other reported cases of a patient in the U.S. being diagnosed with both conditions.

The McGuires learned about MacKale’s hemophilia shortly after he was born.

Because of family history, they had him tested at birth and learned he has hemophilia A, also called factor VIII deficiency or classic hemophilia. The genetic disorder is caused by a missing or defective clotting protein.

Hemophilia causes people to bleed longer than others. Without treatment it can be life-threatening. And over time, it can cause permanent damage to joints.

But with safe factor and other clotting treatments, people with hemophilia can lead long, active lives, Dr. Mitchell said.

MacKale’s treatment has changed over the years, based on his age and developments in treatment.

As a small child, he received clotting factor after injuries. When he became older and more active, he received medication administered through a port several times a week.

Managing hemophilia is complex and challenging, Dr. Mitchell said.

But to MacKale, “this is all he has ever known,” Marsha said. “Hemophilia is no big deal to him.”

By age 11, he had gone to several camps for children with hemophilia and had learned to inject medicine into a vein in his arm.

He lived with some restrictions to avoid injuries: Football and hockey were not allowed. But he played team sports year-round, moving from soccer to basketball to baseball.

In 2015, at age 11, he injured his left leg playing soccer. When the pain persisted despite rest and treatment, his parents took him to the doctor.

That’s when he received the X-ray that detected osteosarcoma—bone cancer in his lower leg bone.

‘A blessing in disguise’

At Helen DeVos Children’s Hospital, MacKale began an aggressive chemotherapy regimen.

Although this was a completely new medical path for him, MacKale said his experience with hemophilia helped him get into the right mindset as he coped with chemo and long hospital stays.

“It was a blessing in disguise,” he said. “It prepared me for getting treatment and to be willing to work at something to get better at it.”

After 10 weeks of chemo, MacKale underwent “limb-sparing surgery.” The surgeon removed the cancerous tibia bone and replaced it with a donor bone.

The surgery was followed by six more months of chemotherapy.

During his frequent hospital stays, MacKale made friends with other children with cancer. Little ones looked up to him. And at 12, MacKale took on the role of the older, cool kid to the younger ones.

Dr. Mitchell recalled a toddler who adored MacKale and lit up every time he stopped by her room. She knew just a few words, but one of them was “Mac.”

MacKale finished his last chemo treatment in June 2016, but unfortunately that was not the end of treatment.

Despite the limb-sparing surgery, his left leg bone deteriorated. Unable to put weight on the limb, he used crutches for most of 2016 and 2017.

MacKale and his parents met with his doctors to discuss his options. He could undergo another surgery in an effort to save his lower leg. Or he could have the leg amputated.

MacKale chose amputation.

It was not an easy decision. But in talking with his parents and doctors, he decided that amputation offered him the most possibilities.

If he had another limb-sparing surgery, his doctors believed his leg would still have some weakness, and he would have restrictions on activities.

“I probably would never be able to run again,” he said.

He underwent surgery for an above-the-knee amputation of his left leg. After recovering, he began physical therapy at Mary Free Bed Rehabilitation Hospital.

“After that, everything was up to how hard I was willing to work,” he said.

And he was willing to put in the work.

In school, he continued playing golf. He served as manager of the soccer team until the day his coach asked him to play—and by senior year, he played on the varsity team.

In his sophomore year, he received a running blade, which made it easier to play soccer.

And he went to a Camp One Step ski program in Utah where he learned to ski on one leg, using outriggers—ski poles equipped with small skis for balance and turning.

“MacKale picked it up so fast,” Marsha said. “He just has a natural ability to ski.”

After three years without skiing, MacKale was able to return to the slopes with his parents and younger brothers, McCoy, 16, and MaGill, 14.

An inspiring moment

Although his cancer treatment is in the past, MacKale continues to see Dr. Mitchell for checkups for hemophilia.

Recently, she sent him a text and asked if he would be willing to talk to a young patient who was at the beginning of his cancer journey—and faced possible limb-altering surgery.

“I’ll talk to him right now,” MacKale replied.

He chatted on the phone with the doctor, the boy and his parents. MacKale talked about what he could do—swim, ski, run and play soccer.

And he discussed challenges: Ice skating and skateboarding are hard.

He switched to video mode and demonstrated how he walked and ran with a prosthetic leg.

“It was one of the most inspirational things I have seen in ages,” Dr. Mitchell said. “I am very grateful and inspired to think he wants to give back when he has gone through so much.”

‘A positive mindset’

This fall, MacKale will begin his first year at Kalamazoo College as a pre-med student.

His goal: to become an oncologist.

Ideally, he would like to follow in Dr. Mitchell’s footsteps and specialize in treating children with cancer.

“Kids are just so naïve, but in a good way,” he said. “A lot of times they don’t understand the significance of problems happening to them.

“They have nothing to do but look forward and have a positive mindset. That’s really cool. I want to stay around that more often.”

Dr. Mitchell is touched, but not surprised, to know MacKale wants to help other children.

“It’s gratifying,” she said. “I am so proud of him.”

But even if he chose another career path, she would be rooting for him just as much.

“I want every patient and survivor to follow their dreams,” she said. “I just hope he has a fulfilling, gratifying life, surrounded by people who love him and appreciate him.”