As a doctoral student at Washington University’s medical school, Jackie is Justin’s only family member in St. Louis as he finishes his career playing basketball for the Bears. She keeps tabs on her younger brother, who she considers the equivalent of a twin.

On that day she was adamant. He needed to be careful. His compromised immune system would be susceptible to COVID. She recalled his response, which might have sounded flippant to anyone else.

“I told him he couldn’t get COVID because he’s been through so much,” she said. “He told me, ‘I’m not afraid of it.’”

COVID was not a trivial matter to Justin Hardy, but he already had been dealt a tougher opponent.

The seven days of isolation that followed were nothing compared to his 10-month journey with stage 4 stomach cancer, a diagnosis he received last spring after suffering abdominal pains that led to the ER trip.

What followed was a sequence of events as amazing as it has been harrowing. At the center of the story is an athlete with a rare disease for his age, 22, returning to college basketball and playing in every game this season.

Until he missed Friday’s game at Emory University.

“It’s hysterical to me that I have missed more games due to COVID than cancer,” Hardy said. “It’s a tough one to swallow.”

‘Just built different’

Hysterical is not a word that seems appropriate for the circumstances, but little about Hardy’s life with cancer has been the norm. Basketball is just one piece.

“I keep saying he’s just built different,” Jackie Hardy said. “I don’t know how else to describe him.”

Many dark days followed the news of a cancer that is diagnosed, on average, at the age of 68. They gave way to Hardy’s revelation that there was much to accomplish, even if he figured basketball was a thing of the past.

He followed through with an internship last summer while undergoing chemotherapy treatments. He returned to school from his home in Chicago, and worked his way back into shape after losing 50 pounds. He graduated in December with a degree in business administration and resumed tutoring students in subjects such as calculus and statistics.

Hardy also regained his starting job for the Bears. He averages 24 minutes a game, 11.5 points, 6.4 rebounds and 2.5 assists for the No. 4-ranked team in Division III. A 6-foot-5 forward, Hardy was rookie of the year in the University Athletic Association and then earned second team all-conference honors by averaging 14.3 points and 7.0 rebounds as a sophomore.

“I don’t necessarily think I’ve accepted that this is going on and what fate has dealt me,” Hardy said. “I don’t think I can be content and accept that this is happening. But it doesn’t consume my thoughts negatively like it did initially. At first it was a pretty toxic thing.

“At some point I had to come to terms. This is my life now and one day it changed forever. If I want to live life, I have to choose to put my best foot forward and attack it with a positive mentality. Someone said, ‘Positivity kills cancer.’ I don’t feel happy with the situation, but I do with where I am in life.”

Hardy will complete another round of chemotherapy at the end of January and undergo further testing to determine his status. The first round, he said, produced impressive progress but subsequent chemo has left him regressing slowly.

After undergoing genetic testing, it was discovered that Hardy has the CDH1 gene mutation, which made him a high risk for aggressive stomach cancer. Jackie and younger brother Nathan tested negative for the mutation. But Hardy’s mother, Karen, does possess CDH1.

The family was together at home after the diagnosis during the toughest days. The summer included a surgery during which heated chemotherapy drugs were injected directly to the tumor site.

“He went through a lot the first few months,” Karen Hardy said. “There was a time I watched him walk upstairs a half a step at a time. He’d take a step and then bring the other foot up to that step. I remember thinking he seemed so physically weak. Now, I watch him on the court and he’s back to dunking again and looks a lot like his old self. I hate to use the word miraculous, but it feels like it.”

Dr. Haeseong Park, a Washington University oncologist at Siteman Cancer Center, said she has not seen a case of stomach cancer in someone Hardy’s age in two or three years. She said he underwent aggressive chemo last summer when he was treated at the University of Chicago and has continued that at Siteman.

The regimen

Hardy’s treatment days are long and usually scheduled for a Monday or Tuesday so that he’s feeling well by the end of the week to play in games. Since some bad chemo experiences last spring and summer, he has endured the drugs without many side effects.

A session of chemo starts with blood work before he gets situated in a pod where he spends the day. First comes 1½ hours of medication to fight nausea and other side effects. He then receives a sequence of three chemotherapies that take from one to three hours each. Finally, he is attached to a device he takes home that pumps a treatment into his body for 24 hours.

“He’s tolerating the treatments really well, and that allows us to give him more treatment,” Dr. Park said. “It’s pretty amazing he’s still playing through all of this. It’s truly incredible. It’s very interesting. Sometimes you see patients who are unrealistically positive. He’s not like that. He knows the facts but remains positive and is pretty much doing everything right.”

Karen Hardy said her son is weighing the possibility of another surgery for the injection of medication to the spot of the cancer. He has tried without success to gain acceptance for clinical trials. Park said his tumor is undergoing genomic testing to determine if a treatment more specific to Hardy’s cancer might be helpful.

Meanwhile, Hardy has moved forward with the basketball season, trying to normalize life as much as possible. He is on a trip with the Bears this weekend. They won their first game without him and move on to play at Rochester, N.Y. on Sunday.

“From a mental standpoint, it was the best thing that could have happened for me,” he said. “You have the worst thing possible happening, and you get to experience the thing that brings the most joy. We’re having a phenomenal year. It all lines up perfectly. I didn’t think this was possible.”

Hardy said he occasionally does some Internet research on his cancer but realizes that can be a dangerous path to travel. He leaves most of that to his sister and mother.

Jackie Hardy is studying occupational therapy and will do her first clinical rotation soon at the Mayo Clinic. She said the experience has made her think about working with cancer patients undergoing chemotherapy. Karen Hardy’s reading has been more extensive.

“I find it fascinating and scary at the same time,” she said.

Hardy is hoping Washington University gets another opportunity in the NCAA Tournament. Two years ago, the team had advanced to the Sweet 16 when COVID ended the season with much for which still to play. With basketball now the center of his life, he wants that chance again.

‘Big event’ looms

At the end of the month, after his regiment of chemotherapy ends, he will undergo scans for the first time in months to find out if treatments are having an impact. Those reports are always telling moments that dictate what treatment might follow.

“That’s a big event,” he said. “The first one I got in July, to quote the doctor was ‘as good as I’ve ever seen.’ But I was getting racked by the chemo. I was in some really bad shape. The rest of the scans have been a progression in the opposite direction. It’s hard for me to understand the magnitude of how bad it’s getting sometimes.”

Dr. Park, however, was more optimistic, saying that Hardy’s overall health can be helpful in his ability to fight the cancer and withstand aggressive treatments. Work continues to find other treatments for Hardy, should they be necessary.

His family doesn’t doubt that he’ll be ready for whatever is next.

“I’ve seen his strength since Day One,” Jackie Hardy said. “There were some emotional moments when he got that diagnosis, but I’ve never questioned his hope, determination or resiliency.”