Monroe Carell Jr. Children's Hospital at Vanderbilt patient Nolan Queener plays with his beads of courage. (photo by Erin O. Smith)
Many families document their child’s life through pictures.
For some, like 20-month-old Nolan Queener, his story can be told in beads — hundreds of them.
The multicolored strands of beads provide an intricate account of his medical journey.
Yellow is the predominant color in his collection. It designates an overnight hospital stay. He’s at 378 yellow beads and counting, as of the first week of August.
“Officially, he has two sets of beads,” said Kayla Hubbard, Nolan’s mom. “He spent four months in the NICU, which is where I was introduced to the program.”
Nolan was born with methylmalonic acidemia, or MMA, a rare, inherited metabolic disorder where the body cannot process certain proteins properly. He is currently awaiting a heart and liver transplant.
He has been in and out of the hospital since he was born Dec. 6, 2024. His longest admission began Nov. 12, 2025. The family traveled nearly three hours from Vonore, Tennessee, south of Knoxville, for the specialized care he receives at Monroe Carell Jr. Children’s Hospital at Vanderbilt.
“It gives me something to do and keeps my mind busy,” added Hubbard. “It’s a really good way of keeping track of what he’s been through. It’s not been pretty, but the beads turn it into something pretty.”
The Beads of Courage Program, started in 2003, is a program of Beads of Courage Inc., whose mission is to provide innovative arts-in-medicine programs for children coping with serious illness, their families, and the clinicians who care for them. Through the program, children receive colorful beads that symbolize each step of their treatment journey. The beads provide a powerful dose of narrative medicine that visually translates their treatment experience and helps them cope with the many uncertainties of their treatment experience.
Today, more than 400 children’s hospitals around the globe participate.
Monroe Carell has been a licensed Beads of Courage partner for 15 years. The patient populations supported include:
- Hematology/Oncology, began in 2011 with the support of the Nashville Predators Foundation.
- Cardiology, began in 2011 with the support of the Brett Boyer Foundation and the Nashville Predators Foundation.
- Chronic Conditions, began in 2015 with the support of the Nashville Predators Foundation.
- Neonatal Intensive Care Unit (NICU) began in 2023 with the support of Ace Hardware.
Every week, Hubbard retrieves about 15 beads to add to the ever-growing collection. Beads are given for various accomplishments, milestones, procedures and challenges. Each participant records activities and treatments in a Beads of Courage Bead Prescription booklet. Each entry is connected to a specific color, shape and material of a bead.
“Your beads become a form of narrative medicine that will help make visible your story of strength and courage,” reads the back of one of the prescription booklets.
Katie Beard Smith, CCLS, Child Life Specialist in Monroe Carell’s NICU, has seen the program’s growth and impact on patients and families.
“There are times where it might seem like a silly little program and cute little beads, but the meaning prescribed to those beads is like a diamond engagement ring,” said Smith.
“It’s more than beads. It’s creating a space where people can tell their story and recognize difficult days, sit in it with them and celebrate the milestone, and recognize the monotony of it all. … It’s recognition that you are still going, fighting and showing up. I feel strongly that creating that space is half the intervention.”
Smith’s interaction with Sam Hatch was key during his nearly two-year treatment for embryonal rhabdomyosarcoma, a rare soft tissue cancer often occurring in children less than 10 years old.
Sam, now 11, was 3 years old when he was diagnosed. His therapy required 18 months of chemotherapy, a major abdominal surgery and six additional weeks of radiation and proton therapy.
When the program was introduced to the family, his father, Dupree Hatch, MD, Associate Professor of Pediatrics and Medical Director of the NICU, he did not think “beading” would be of interest to his son.
“Now, I don’t think there is a bigger believer in Beads of Courage at this hospital,” said Hatch. “There were multiple occasions where this would completely change his day and subsequently our day.
“I think what made the beads so special for Sam is that he would sit there with Katie, pick out beads, and he would talk to her about everything, even the difficult things. He loved that … It was therapy for him. Child life is an integral part of the success of this program here. He didn’t want to leave without doing beads with Katie.”
Sam finished his chemotherapy treatments in 2020, and his five-year scans the summer of 2025. To date, Sam has collected 684 beads.
“I can remember the things that I went through, and I can remember how I got through it,” said Sam. “The beads are something that I could use to take my mind off the day and the struggles.”
Sam’s beads are kept in a wooden jar displayed on a shelf at his home.
More than 700 beads make up the strand adorning the canopy of Verity Vincenti’s crib.
At three days old, she stopped breathing in her dad’s arms. She was flown by LifeFlight from the local hospital in Clarksville to Monroe Carell where she spent 40 days on a ventilator. She was hospitalized for 68 days while recovering from a myriad of infections that impacted her heart, lungs and brain.
The 22-feet of beads began as a way to recognize Verity’s life.
“It started in a very somber fashion,” said Kelsey Vincenti, Verity’s mother. “She was very, very sick. It was a way to create memories of our daughter along with handprints and footprints, just in case. But she continued to get better.
“It turned into celebrating milestones. It was important to me because it became a helpful way to reframe the situation.”
During the hardest moments when Vincenti could only sit by her daughter’s bed, beading gave her a purpose.
“This is such a big part of her story,” she said. “It’s a very defining experience. She is strong and the beads represent that strength. I hope to be able to use that as she gets older and experiences some challenges.”
To date, Vincenti’s favorite beads are the large silver heart (completion of treatment) and shooting star (hospital discharge) beads that rest side by side on the strand.
While Nolan awaits a new heart and liver, his mother continues to add to his Beads of Courage strand, which weighs in at nearly 5 pounds.
Hubbard said she encourages other families on the hospital floor to participate in the program to recognize the courage, strength, milestones and even tough days that a child experiences during a hospitalization or treatment journey.
Nolan has most every bead the program offers his mom said – all except the two she desperately wants — his transplantation beads.
Curious about the program? Visit the Family Resource Center on the second floor of the hospital.
