Letting Smeltzer return to the diamond carried risk. Radiation in the morning and chemotherapy in the evening had confronted his rhabdomyosarcoma for weeks. But the treatment also weakened his immune system and increased the threat of infection. Heightened levels of activity could have led to bleeding.
Smeltzer barely ate but vomited often. His diet largely consisted of protein shakes, random binges and the soft pretzels his parents, Tim and Christina, brought to satisfy his salty cravings. So he cut a deal with chief of oncology Greg Halligan. He could play, but if the scale dipped any lower he'd lose that privilege and go on a feeding tube.
"I put a lot of me being able to do what I can today because I stayed moving and played," Smeltzer said last week, nearly 14 years since his diagnosis. "It's crazy looking back, but I just took it day by day. Every time I step on the field, I know there may not be a tomorrow."
"The field" is currently in upstate New York, where he didn't allow an earned run in his first two starts for Triple-A Rochester. It was in Florida at the beginning of the year, as Smeltzer was promoted after going 3-1 with a 0.60 ERA and 33 strikeouts in five starts for Double-A Pensacola. And it could soon be Target Field, because the left-hander has gotten off the "roller coaster" of being traded and made changes to his mind and body to produce the best start to a season of his life.
A big league callup would fulfill a dream that Smeltzer held before cancer changed his outlook. It would amplify his message of support to kids who suffer the same way he did.
"Everybody has a purpose." the 23-year-old said. "God gave me the ability to pitch at these levels and to reach out to more people and kind of really make a difference."
Smeltzer visits a young Rancho Cucamonga Quakes fan in 2017.
Drafted by the Dodgers out of Texas' San Jacinto Junior College in the fifth round of 2016, the Voorhees, New Jersey, native was redirected into the Twins system last summer. On the road in Springfield, Missouri, Smeltzer and his Double-A Tulsa teammates played hacky sack in left field before pregame stretching. Word arrived that Los Angeles had dealt him and Luke Raley in a trade for big league second baseman Brian Dozier.
A three-hour Uber ride took the pair back to Oklahoma. They packed. Then with Smeltzer's wife, Brianne, and their two dogs, Marshal and Rookie, they made the 10-hour trek to Chattanooga, Tennessee, to join the Twins' Double-A affiliate at the time.
It meant goodbye to the organization that had not only broken him into pro ball but also reconnected him with Chase Utley, whom he had met during a trip to Citizens Bank Park when he was sick in 2005. But the Dodgers had converted him into a reliever, and he had a 6.08 ERA in nine appearances out of the bullpen.
"It's happy, it's sad," he said. "It sucks, it's great. It's kind of everything at once. It's all part of it. You've got to move on and hit the ground running."
There was no time to revert to starting in the final month of the season, so Smeltzer spent the offseason stretching back out with Rick Lademann at Beyond Motion in Naples, Florida.
Lademann, who once held performance coaching positions with the Rockies and the University of California-Berkeley baseball team, emphasized squatting to activate the southpaw's hips and build stability in his glutes. The goal was to construct a stronger base that could generate force and expand his range of motion in what was already a funky delivery. The result was a higher spin rate, which has helped him miss bats, something Twins director of Minor League operations Jeremy Zoll said the organization wanted to see.
The two refined Smeltzer's mental approach just as much as the physical. Pilates improves both, Lademann said, fostering a mind-body connection that forces participants to constantly think about "recruiting" smaller muscles that might not be used in traditional weightlifting.
"Because of his cognitive ability to take all of that in, that's what gives him the ceiling," Lademann said. "That's what's going to make him be in the big leagues for 10, 15 years."
With meditation, Smeltzer has learned to control his heart rate and harness his adrenaline. Before a start, he runs and stretches and does everything any pitcher would. But before throwing, he lies down in the outfield corner or bullpen. He doesn't think about hitters or cancer or his dogs or fishing. Just breathing.
"I think it's easy to meditate when you put yourself in a nice quiet, dark room, but that's not where we make our money," he said. "That's not where it counts."
It's a routine that differs from the superstitions that guided Smeltzer in the past. Pregame meals, socks or undershirts, even something as uncontrollable as the weather -- they all affected his mindset before. All he relies on now, he said, is the preparation work he put in over the last four days.
"Ever since I was a little kid, I think one of my best skills is the ability to kind of separate off-field and stuff between the lines," Smeltzer said. "So I think adding some of the new things I've been doing to what I've done in the past has put me more in control of my body and emotions and still pitching with that fire. Because that's who I am, and that's what's gotten me here."
Smeltzer gets Chase Utley's autograph while visiting Citizens Bank Park as a kid.
Months before doctors found the tumor and that fiery Little Leaguer's baseball future was in doubt, Smeltzer had to pee. A lot. Frequent urges to use the bathroom during a trip to Disney World raised questions. A Florida clinic, family doctor, urologist and trip to the emergency room didn't have answers.
The symptoms worsened -- at times, he had so much trouble going that he could count the drops -- then subsided until a tournament in late July. His mother noticed Smeltzer running off the field. Whatever was wrong was back. A teammate's parent knew a pediatric urologist and he suggested St. Christopher's.
It was a Friday night. They had a diagnosis by Monday.
"Never, ever expecting that," Christina Smeltzer said.
That night, Smeltzer sat in the hospital while his teammates won a championship without him. Aggressive treatment began.
"They make you sick to make you better," his father said.
Weekly, then monthly, then annual checkups continued even after Smeltzer went home. His cancer was officially in remission by 2012. He'll endure side-effects from the radiation for the rest of his life.
Baseball provided the best medicine. During his first game back that fall, Smeltzer wore a bandana over his bald head. He didn't have eyebrows. He got hit by a ball and proudly showed off the marks the stitching left on his tender skin. He told his dad that his stand-up double would have gone for three bases had his legs not been so tight from the shots they get each morning.
The game "flipped a switch" in Smeltzer's behavior at the hospital, said St. Christopher's nurse Peg Mulherin. He smiled instead of cried. He lost his fear of procedures and embraced being somewhat of a big brother to the other patients. He talked to the babies. When a younger boy was nervous about getting an IV port in his arm, Smeltzer showed off his.
"Devin couldn't get out of bed fast enough and rip his shirt off and go in and show the kid," Tim Smeltzer said. "He was like, 'Oh, it's pretty cool. Now you don't have to worry about the needle.' He was just 10 years old. And he went through hell in there."
Smeltzer's urgency to help came through the day he signed as a pro. He called Halligan, the doctor said, and claimed his achievement was secondary to the platform baseball gave him. And he's backed it up. Smeltzer's goatee-glasses combo is the design for his Catch Cancer Looking campaign, which sells merchandise to raise for money for St. Christopher's Katie's Krusaders charity.
Last month, Smeltzer bonded over port scars with Matthew, a Blue Wahoos fan who's survived leukemia. During his time with Class A Advanced Rancho Cucamonga in 2017, he befriended a lifelong Quakes fan, John, undergoing cancer treatment. He ensured the youngster was kept away from crowds and out of the sun because of his immune system deficiencies. John's mother wrote that her son nearly cried when the season ended and he knew he wouldn't see Smeltzer again until Spring Training.
"Until they see somebody else that's gone through the same thing who can really, truly say, 'I understand what you're going through and I understand how you feel,' it doesn't really register with them," Mulherin said. "So Devin has done that. He talks to these kids and gives them hope."
That hope lingers in the sports room at St. Christopher's even when Smeltzer isn't around to visit. In a small glass case rests a clean, white baseball smudged with juvenile cursive handwriting. "Thanks for everything!" it reads, "Love, Devin Smeltzer 7/14/06." The dot of the exclamation point is a tiny baseball. The black ink has started to fade.
"He needs to replace it," Mulherin said, "when he makes the Majors."