CHARLOTTE, NC (Theoden Janes/The Charlotte Observer) - Ask Alexandra Marshall what she loves about swimming, and her cherubic face morphs into an expression that can only be described as blissful.
"Oh, I love this question," says the 23-year-old Queens University of Charlotte student, closing her eyes and smiling. "Swimming brings so much peace to my life. The stress that I might be having in life ... all kind of melts away when I jump into the water. When I'm underwater, it's very quiet. It's very peaceful."
It's a sense of peace, however, that has often been agonizingly elusive for Marshall over the past four and a half years, as she's endured a severe virus, then a devastating cancer diagnosis, then a rigorous chemotherapy regimen, then bouts with depression and resentment.
In May, she'll be leaving Queens about as profoundly changed as any student can be by their college years. There's just one more order of business she has to attend to as an athlete before that happens:
This week – just shy of the two-year mark of Marshall's last chemo treatment – she and a Queens team that has won three straight NCAA Division II women's and men's swimming championships head to the season-ending national meet at Greensboro Aquatic Center, where the Royals will try to make it four.
Does it matter to her how well she performs in her individual events – the 50-meter freestyle, the 100 free, and the 100 butterfly? Sure, she'd love to do well.
But she also realizes how lucky she is just to get the chance to swim again at all.
In summing up her experience over the past few years, Alexandra Marshall says: "It's been one hell of a ride." (Credit: David T. Foster III I The Charlotte Observer)
Smooth sailing, then troubled waters
Born Lara Alexandra Marshall, she grew up in Winston-Salem with her family calling her Alexandra, while most of her friends refer to her as Alex, or even Al.
To some extent, she probably gets her graceful fluidity from her mother Lucia, a former ballet dancer, and her killer competitiveness from her father Greg, a native of Québec City who was a track star in Canada as a younger man.
Alexandra tried ballet and track (among several other activities and sports), but it was swimming that stuck. In fact, Greg and Lucia sometimes would have to drag Alexandra and their younger daughter Christina home from the pool kicking and screaming at the end of long summer days. (Christina, by the way, is now a freshman on the very-good swimming team at McKendree University, a D-II school in Illinois.)
At age 11 – even though she was only swimming in a summer league at the time – Alexandra was entered by Greg in the age group state championship in Raleigh, where she nearly won the 50-meter freestyle race against much more seasoned kids. On the way home, Greg recalls, "she said, 'I think I might want to try club swimming and do year-round swimming so I can get faster.' "
She did, and it worked: Just a few years later, Marshall won an individual North Carolina 4A state title in the 50 free as a sophomore at Winston's Reagan High School. She'd go on to be named a high school All-American, compete in the 2012 Canadian Olympic Trials (she's got dual citizenship, like her dad), and eventually accept a scholarship from Queens.
Alexandra Marshall comes off the starting blocks at a meet during her junior year at Winston-Salem's Reagan High School; she earned all-conference, all-state and All-American honors in both her junior and senior years. (Credit: Photo provided to the Observer courtesy of the Marshall family)
But Marshall hadn't even been in Charlotte for three months when she first encountered troubled waters.
A week after setting a personal-best time in the 50 free in a meet, she woke up one morning near the end of October feeling a personal-worst.
She had a fever of 102, her skin was badly jaundiced, and her face was disturbingly swollen. Though she was used to grueling daily workouts, she barely had the energy to climb out of bed.
After mustering the energy to get to Novant Health Presbyterian Medical Center, things progressed quickly. Her gall bladder was severely enlarged. Her liver was failing. One test led to another, then another, then another. Eventually, a CT scan revealed a mass in her chest that concerned her doctors enough that they told Marshall an oncologist was being called in.
"As a freshman in college, 18 years old, when you hear the word 'oncology,' you're like, 'Wait, that's – that's cancer,' " Marshall says, remembering being racked with sobs. "And I was like ... 'I'm too young to have cancer. I don't want to die.' "
But almost as quickly as her life flashed before her eyes, it was over. The final, official diagnosis was the Epstein-Barr virus, also known as infectious mononucleosis.
Antibiotics were effective. Her symptoms dissipated. She got back in the pool soon after, and had a solid freshman season, swimming well enough to qualify for the NCAAs.
Life was normal again. She was acing her psychology classes, laser-focused on her career goal of becoming a sports psychologist to star professional athletes. As a sophomore, she was selected to the All-Conference team, was an All-American, and helped the Royals win their first-ever national title.
Everything seemed just fine. Until it wasn't.
'I have cancer. This isn't a joke.'
Between March and September of 2015, Marshall had a run of bouts with cold-like symptoms that were so persistent that her friends took to calling her "Sniffles."
Finally, in the fall, she dragged herself to her doctor, who (due to her freshman-year bout with mono) thought to order a chest X-ray. It revealed bad news – abnormalities on her lungs – so she was sent to a pulmonologist, who ordered a CT scan. Those results revealed worse news, that the mass in her chest had grown in size.
But the worst was yet to come.
Though the risk is very small, mononucleosis does increase the risk of getting Hodgkin's lymphoma, a cancer of the immune system and white blood cells. And a biopsy revealed that Marshall indeed had Hodgkin's.
Her parents were informed of the results first, and they drove down to Charlotte with Alexandra's sister to deliver the news in person, unannounced.
"Oh hey, guys!" Marshall said, greeting them with a surprised smile. Then it hit her. And the only word she was able to get out of her mouth was "no." Over and over and over again.
As her parents told her she had Hodgkin's lymphoma, a cancer of the immune system and white blood cells, she felt like the whole world was melting away.
Marshall would learn that it is actually one of the most curable forms of cancer – typically about 85 to 90 percent of patients with her severity of Hodgkin's (Stage 2) can go into remission with treatment – but at the time, Marshall says, she felt like she'd received a death sentence.
"I was like, 'I'm 20 years old. I have cancer. This isn't a joke. This isn't, 'Oh, nope, never mind! It's mono.' No, this is, 'You've been diagnosed with cancer. You have cancer growing inside of you right now. You have a tumor over your heart right now.' And once again, I was like, 'I don't want to die.' "
'War paint on, let's do this.'
Almost immediately, Marshall moved back in at home with her parents in Winston-Salem. Because her type of lymphoma can grow so quickly, they generally need to be treated immediately, and she started chemotherapy at Wake Forest Baptist Medical Center within a matter of weeks.
The plan called for a total 12 chemo treatments, one every two weeks, and the swimming pool was totally off-limits due to the risk of infection and illness. This meant several months away from the one place that had always brought her the most comfort, the most happiness, the most peace.
But after a good cry on the morning of her first treatment, Marshall put on her game face. "It just hit me: OK, I'm in a competition," she says. "I was just sort of like, war paint on, let's do this."
She also put on a happy face. The week before Christmas, she showed up on her chemo day at Wake Forest Baptist wearing a holiday onesie and a Rudolph hat; for her New Year's Eve treatment, she brought sparkling cider and festive hats for her fellow patients.
A little more than halfway through treatment, her scans showed that Marshall was in remission – but she stayed on schedule and completed the full 12 treatments.
And the chemo did to her body what it does to most people. It made her lose her hair. It made her nauseated. Irritable. Forgetful. She got neuropathy in her fingers and toes. She was constantly exhausted. After the 10th and 11th rounds of chemo, she needed assistance leaving the hospital.
But right when she needed it the most, she got a lift from her teammates. Watching live feeds of them competing at the NCAA championships during and after Treatment No. 11 helped provide a diversion; that weekend, they FaceTimed her as they jubilantly marched to the podium to accept the trophy. (The team eventually had each member's championship ring engraved with the words "We Kicked Cancer's Ass.")
A week and a half later, Dugdale and several teammates drove up from Charlotte to be there when Marshall rang the bell in a joyous ceremony signalling that she'd completed her last chemotherapy treatment.
She wore a Wonder Woman onesie. Zanetta Lamar, her oncologist, ditched her lab coat and put on a The Flash onesie for the occasion.
"We hugged, then maybe 20 minutes after the last drop of chemotherapy went into her body," says Lamar, an assistant professor of hematology and oncology at Wake Forest Baptist, "she took me to the side, and asked when she could get in the pool."
Lamar wanted her to be patient just a little longer, to make sure Marshall's blood counts fully recovered. Six weeks later, after her blood test came back normal, Lamar gave her the all-clear.
For the first time in nearly eight months, Marshall pulled on her swimsuit and headed straight for the pool at Winston-Salem State University.
"I just remember jumping in and sitting at the bottom of the pool, for like a minute. I just sat there. And I was just like..." she pauses, that blissful look blossoming on her face again, "I'm back in my happy place. I'd come to that summit. I'd climbed a mountain. I'd made it."
Little did she know, though, that she had another mountain to climb.
Struggling to stay afloat
Within a month, Marshall was back in Charlotte. Back in the pool. Back with her teammates. Ready to spend the summer of 2016 trying to get back into shape for what would be her junior season, athletically (she'd taken a medical redshirt while going through treatment).
She was trying to settle into a new normal. Except pretty much everything felt abnormal.
The bubbliness that had inspired her to dress like Wonder Woman and cheer up everyone around her evaporated, giving way to a young woman who suddenly lacked the motivation to be around others, and had trouble producing a smile or a laugh that wasn't artificial.
"I was trying to fit a triangle-shaped puzzle piece into a square-shaped puzzle piece, trying to put my old life into my new normal – and it wasn't fitting," she says. "So I was frustrated, and I didn't understand why things weren't working, and I didn't understand why I was feeling this way."
Depression is common among people who have received cancer diagnoses. What's unique about people Marshall's age who have been given cancer diagnoses is that, well, there just aren't very many.
According to the National Cancer Institute, about 70,000 people between the ages of 15-39 are diagnosed with cancer each year in the U.S., accounting for just 5 percent of cancer diagnoses.
Among the ways in which having cancer at her age left Marshall feeling isolated: When she was back at home going through treatment, her friends and teammates' lives at Queens went on without her; they maintained bonds, shared adventures, developed inside jokes that she wasn't there for. When she was at Wake Forest Baptist for chemo sessions, many of the other patients were three times her age and – while they viewed her as fun – they also viewed her as a bit of a novelty.
And when she got back to Charlotte after ringing that bell, she tried to keep cancer out of the conversation because she was desperate to feel normal again. So she bottled up everything she was going through physically and emotionally.
Alexandra Marshall says swimming was a diversion during her dark days. "I looked forward to jumping in the pool and losing myself for a couple hours. Finding the sensations of the water, feeling how the water felt on my skin with the bubbles. Just soaking in all of these sensory feelings ... it was truly an escape for me." (Credit: Courtesy of Queens University of Charlotte)
Her mother could sense something was wrong.
"The toughest thing for me, as a parent, is I wanted to be there for her and hold her," says Lucia Marshall, "and I couldn't be driving down to Charlotte every time she was having a tough moment. That was super-, super-hard."
Little did she know just how bad things had gotten for her daughter.
While sitting on the pool deck at the Levine Center for Wellness and Recreation recently, Marshall goes quiet for several seconds when asked if she ever felt suicidal.
Then, she starts slowly: "There were some days when it did get that bad. And that was honestly terrifying. I'd never felt that way. It was very rare ... but I'd be lying if I said I never had those thoughts."
Shortly before the beginning of the fall semester in 2016, she says, she hit rock bottom.
"I really felt kind of like ... nothing," Marshall recalls. "I didn't feel anything towards anything. I was just very numb and very shut off."
She retreated to Winston-Salem, where she finally opened up to her mother about her struggles. When she returned to start classes, she also started seeing a therapist at Levine Cancer Institute, and over the next several months was able to come to grips with the fact that her feelings weren't atypical, and that they were treatable.
She was able to talk about them openly with someone, which helped her not feel so isolated; she found ways to relax, and ways to return to positive thinking; she learned that she could only control what she could control. She was finding happiness again.
Meanwhile, in the water, Marshall seemed to have barely missed a beat, earning all-conference honors in 50 free, 100 fly and 100 free, and All-American status in the 50, 100 and 200 free.
Then last March, right around the one-year anniversary of her last chemo treatment, she fell just short of her goal at the NCAA meet.
And the resentment came flooding back.
Putting everything into perspective
Her time in the 50 free was 23.01 seconds, a personal career in-meet best at that distance, good for second place – her highest finish at the NCAAs in three previous attempts.
But she'd wanted to go under 23, and she burst into angry tears on the pool deck afterward.
"I mean, honestly, it was just the frustration of being sick," Marshall says. "I was thinking, if I hadn't gotten sick, I would have been able to go that time. ... I was pissed off at the cancer, just felt like it had stripped me of everything."
Her coach, Jeff Dugdale, was incredulous.
"I actually got angry with her," he says. "I was like, 'Are you kidding me? Are you kidding me?? Will you put things in perspective? You beat cancer, and you're gonna sit there and have tears over getting second at NCAAs and going your best time? Yes, I believe you're superwoman, but holy cow, you're also human.' "
Marshall stayed in her funk the rest of the meet and underperformed in her other events, but in the days and weeks that followed, she used that sentiment to re-focus her perspective.
There's more to life than swimming, Alexandra. The pool can still be your happy place, but your times in the water don't define you. You've got an amazing family, amazing friends, amazing teammates. You overcame cancer. You overcame what you faced post-cancer. You're alive. I mean, what more do you want? What really is important to you?
The answer, she realized after much soul-searching, is that she wants to help other children and young adults through the types of struggles and feelings of isolation she faced.
So, later this year, Marshall will begin a graduate-degree program in Health and Exercise Science at Wake Forest University with an eye toward someday working as a therapist or counselor in pediatric oncology.
"Sports psychology is great," she says, "but I think that life is sort of calling me in a new direction."
She's shared her story at local schools and charity events, and she recently spearheaded the creation of a new program within Charlotte-based cancer-fighting nonprofit 24 Foundation called 24brAYAvr that focuses on the specific needs of adolescents and young adults with cancer. Her first 24brAYAvr fundraising event is next month.
Alexandra Marshall with her father Greg at Bank of America Stadium last October, when she was invited by the Carolina Panthers to bang their Keep Pounding drum before a game. (Credit: Photo provided to the Observer courtesy of Alexandra Marshall)
But first, there's the NCAA Division II swimming championships in Greensboro to attend to later this week. How badly does she want to end her rollercoaster career as Queens University of Charlotte athlete on a high note?
"I'm very competitive. I love to race. I am always striving to be better, and always competing with myself. Swimming is a huge part of my life," she says. "But I've learned, too, that it's not all life has to offer. So I think if there are outcomes that don't go the way that I want, then that's OK. ... I feel like the water has settled, and I'm good with everything now. I'm happy with everything."
Perhaps for the first time in her life, Alexandra Marshall feels the same way outside of the water as she does in it.
"I'm at peace."