One Butler High graduate fought way harder than his classmates to earn his diploma, although he wasn’t feeling up to attending commencement.

Nick Iman, 18, of Butler Township, spent six weeks in Children’s Hospital in Pittsburgh, endured grueling chemotherapy, narrowly avoided a feeding tube after a 70-pound weight loss and is awaiting a major surgery to remove a cancer-filled thrombus in his abdomen.

Those are just a few of the challenges Iman and his mother, Pamela Tonini, have faced since going to the Butler Memorial Hospital emergency room on Jan. 25 due to Iman’s intense stomach pain.

“I came home from work and he was telling me ‘It really hurts,’” Tonini said.

She told her son to take a shower, and he came downstairs afterward in even more severe pain.

“He said ‘I can’t take this anymore,’” Tonini recalled.

Scans at the emergency room showed what doctors thought was a hernia, swollen lymph nodes and fluid around Iman’s kidneys.

“They did an ultrasound and sent him to Children’s (Hospital),” Tonini said. “This was two weeks before his 18th birthday.”

“I think we got there in like half an hour,” Iman said of the ambulance ride.

Team after team of medical personnel rotated through the room Iman occupied in the Children’s Hospital emergency room.

“At one point I was 28 hours without sleep,” Tonini said.

Iman was admitted to the hospital, and the next day, a urologist told him and Tonini that the hernia was actually a tumor. They made the determination because of the nearby swollen lymph nodes and fluid around Iman’s kidneys.

“They said it’s classic,” Tonini said.

Doctors told her that the intense pain Iman experienced was actually the fluid sacs around his kidneys bursting onto his kidneys.

Although his kidney function was decreased, the surgery to remove the tumor and place a stent went ahead two days later.

Iman was diagnosed with Stage 4 testicular cancer, which only 250 others aged 17 and under have at any given time.

The next day, Iman had a CT scan without contrast to get a better picture of what was going on in his abdomen. The contrast liquid would have been too hard on his weakened kidneys.

“They found, by accident, an embolism by his lung,” Tonini said.

Another CT scan, this time with contrast, performed a few days later, revealed the thrombus, or large blood clot, was cancerous inside.

Surgery was initially ruled out at that time because the thrombus was too close to Iman’s diaphragm to get the instruments in.

Lesions also were found on five of his vertebrae.

“That’s why they put it at Stage 4,” Tonini said.

Iman endured four rounds of chemo in a 21-day cycle at Children’s before being released.

“Two days later, I went to give him his meds, and I said ‘Baby, you don’t look good,’ and he said ‘I don’t feel good.’”

When a thermometer revealed a fever of more than 100 degrees, Tonini and Iman headed back to the Children’s Hospital emergency department.

“Here, he had thrown clots in his right leg,” Tonini said.

That meant two weeks in the pediatric ICU, where Iman received a Heparin drip in an attempt to bust his blood clots.

He recalled his mindset at that point and the importance of the presence of those he loves.

“I’m worried for my life, here,” Iman said. “When it was bad, my grandma was always there to comfort me and tell me ‘Your village is gathering.’”

By that, she meant the people donating to one of two online fundraisers, sending frozen meals and giving the family gift cards to sustain them during that shocking and difficult time.

“No kid should have to make the decisions he had to make,” Tonini said.

She said her son chose his treatments, including those that impact reproduction.

Iman said at first, he let his mother make his medical decisions.

“After a while, I got more involved in treatment and learned about my diagnosis,” he said. “The surgeon explained ‘I’m borrowing from his future to save his life now.’”

Now, Tonini and Iman are waiting for surgery to remove the thrombus and all related lymph nodes with evidence of cancer. That should occur at the end of June.

The surgery was scheduled for June 3, but Tonini told the surgeon her son had missed prom and half his senior year, and she did not want him to miss graduation too.

She said the surgeon heartily agreed. Tonini will soon receive a call with a date when the seven teams of doctors, specialists and other medical professionals can be lined up to participate in the six- to eight-hour operation.

“The team at Children’s is extremely attentive and extremely caring,” Iman said. “There’s a lot we wouldn’t have been able to do without them.”

Iman said his 70-pound weight loss was one good thing that came from his diagnosis.

“As bad as it is that I lost the weight the way I did, I’ve never felt so good about myself,” he said.

He said his dad and stepmother are also very supportive, and school chums have texted or visited him in the hospital.

“It was nice to see them,” Iman said.

But he is especially amazed at the unwavering love, support and caregiving he has received from his mother since his cancer journey blindsided the two of them.

“If I didn’t have her, I’d be lost in the world,” Iman said. “I will never be able to express my gratitude in words to her.”

He said Tonini’s overprotective tendencies also helped.

“If it weren’t for that quality, I don’t think I would have gotten through this as efficiently as I did,” he said.

Tonini said her son is a different person now — he is more social and grateful for family.

Iman agrees, saying he enjoys spending time with people now instead of constant gaming, as was his habit in the past.

“Cancer shows you that your life has a limit and you only live once,” he said.