When Katya's Russian doctors exhausted all treatment options, she boarded a plane in Moscow and arrived 36 hours later in our small American city where her sister lived. In the airport, hugs were exchanged, a few tears were shed, and then they drove straight to our emergency room doors. Soon after, exhausted and painful, Katya arrived on our oncology unit. She cradled her left arm at an odd angle. When I introduced myself as her nurse, she looked at me without responding.