As she pulled up her white turtleneck patterned with blue whales, she whispered, "You have to pull it up very carefully."

Underneath her shirt, a small metal needle attached to a plastic tube pierced her soft skin, revealing an unexpected reality for both girls.

In October, Hope was diagnosed with acute lymphoblastic leukemia, the most common form of childhood cancer. Last fall, when Hope appeared sick with a severe cold, her mother, Sandy Rapp, took her to the pediatrician.

The doctor told Rapp that Hope had a viral infection, and she brought Hope home to rest. Days later, Hope had a nosebleed that her mother was unable to stop. She was taken to the emergency room, where physicians did blood work to determine the cause of the nosebleed. Upon the review of test results, doctors informed Sandy and Michael Rapp their daughter Hope had leukemia.

"That is when I fell apart. We thought it was an instant death sentence," Rapp said. "The doctors put her in an ambulance and sent her to Hershey (Medical Center) right away."

It was a Wednesday when Hope was diagnosed with leukemia. On Friday that week, doctors performed blood tests on Faith as a precaution. Dr. Andrew Freiberg, the twins' physician at Hershey Medical Center, told the Rapps that as Hope's identical twin, Faith had a 15 to 25 percent chance of being diagnosed with leukemia.

Sandy Rapp said blood tests found one of Faith's blood counts lower than normal. Though doctors informed the Rapps the low count could be the result of natural fluctuation, they suggested further monitoring of Faith's blood counts in the weeks that followed. Two weeks later, three blood counts had dropped, Rapp said, and Faith was diagnosed with leukemia.

"When they told us there was a chance that Faith also had cancer, I thought, 'We'll cross that bridge when we come to it,' " she said. "Then Faith was diagnosed, and I thought, 'But I'm not ready to cross this bridge yet.' "

Despite the shock of Hope and Faith's diagnoses, Sandy Rapp said she was comforted by the statistics doctors provided. Freiberg told the Rapps that the cancer has a cure rate of nearly 80 percent. Factors such as the age of the twins and their sex increase their chances of beating the disease, Freiberg said.

And because the Rapps are part of the Four Diamonds Fund, the twins' medical treatments for cancer are covered fully, and the Rapps do not have to concentrate on the financial aspect of Hope and Faith's medical therapy. The Four Diamonds Fund is aided yearly by the proceeds of the Interfraternity Council/Panhellenic Dance Marathon.

Both Hope and Faith began treatment for leukemia immediately following their diagnoses. After they were admitted to Hershey for initial consultations, Hope remained in the hospital for two weeks of treatment. Freiberg said the high count of leukemia cells in Hope's body required aggressive treatment and put her at a greater risk of relapse than Faith.

The first months of cancer were intense for both girls, Sandy Rapp said, and required the twins to visit Hershey three times each week for medical treatment.

Though Sandy Rapp said she remains anxious about the twins' medical therapy, she feels fortunate when considering the outcome of many other diseases.

"No matter how hard it must look to have twins with cancer, it could be a lot worse," she said. "There are much worse things out there that we don't have."

Freiberg said the primary phase of leukemia treatment, known as remission induction, is deliberately intense to eliminate all visible signs of leukemia from a patient's body. Strong doses of medicine distinguish pediatric oncology from its adult counterpart, he said.

"In pediatric oncology, our goal is to cure. We use much higher doses of medicine than are used in adult oncology," he said. "Patients may feel sicker due to the medicine, but their chances of beating cancer are better."

The twins are currently in the second phase of leukemia treatment, known as interim maintenance, Freiberg said. In March, Hope and Faith begin delayed intensification therapy, when they will be given large doses of chemotherapy drugs to kill any dormant leukemia cells remaining in the body, he said.

Though only three years old, the twins understand many of the procedures that are part of their treatments. Reciting the names of their medications and recognizing ones they described as "yucky," Hope and Faith present a knowledge of cancer that is surprising, given their age, Sandy Rapp said.

The twins have received their knowledge about cancer from the nurses of the Hershey Medical Center. The medical staff encourages Hope and Faith to have active roles in their treatments by explaining procedures and medicines to them.

During one of the twins' visits to Hershey, doctors performed a bone marrow test on Hope, Sandy Rapp said. Once she awoke from anesthesia, nurses allowed Hope and her sister to view cells from Hope's back under a microscope.

"When Hope could see that everyone was looking at her cells, she was proud," she said.

Though Hope and Faith's involvement in their medical therapy has helped to create a positive treatment environment for the girls, they still find some days exceptionally difficult.

Sandy Rapp said visits requiring shots are among the twins' least favorite. Treatments where anesthesia is used are also uncomfortable for the girls, Michael Rapp said.

"The twins have problems sometimes when they are partly put under," he said. "When they come out from under that medication, they act totally different than normal and that makes it really hard."

During the past four months, Hope and Faith have endured numerous doctor visits and procedures and have more intense treatments scheduled for March. As a mother, it is difficult to watch the twins go through the treatments, Sandy Rapp said. To help ease their discomfort, she mixes Hope's medicine with chocolate pudding and Faith's with strawberry syrup.

In addition to administering medicine with everything from pudding to peppermint patties, Sandy Rapp said she tries to make treatment days at the Hershey Medical Center special ones by giving the twins small gifts left over from those they received on Christmas. Despite her efforts to alleviate Hope and Faith's discomfort during their medical therapy, Rapp's intent is not to help the girls forget their experiences with cancer. To the contrary, a project she is working on may help them remember their days with cancer.

Sandy Rapp is keeping a journal of the twins' experiences so when they get older, they have a permanent record of their battle against and their hopeful victory over cancer. The journal, a witness to the twins' ongoing struggle, is a testimony of faith and hope for the Rapp family.