When it comes to people...

God’s will comes with its mercies and blessings, making it easier to bear. People’s comments and unwanted advice, however, are often more difficult for the cancer patient to tolerate. I am now talking about the people closest to the patient, Those who really love , care and want the best for their beloved patient. The best  as seen by them and from their point of view. This is where the unwanted advice and endless remarks begin.

“What!! you want to stay in America? Wrong...wrong…you must go back to Saudi…Dr. X there is better than excellent…what is keeping you in the States?” and she forgets that I have a husband who works in America…and that I  need more than  a good doctor who is just a breast  surgeon. In fact, I need a whole team of doctors, the most important being the oncologist who can choose the best chemotherapy for my type of cancer, which is considered rare since I am pregnant. I explain this to her and she is shocked because I am not taking her advice. She mutters “May Allah guide you to the correct path” i.e.her opinion is the “right path”.

As I drop my son off at the day-care center, I see a dear friend. When she notices me, she begins to lecture me without any introductions “I really think you HAVE TO get an abortion… This is my advice for you if you would listen”

Does she know all the details regarding this decision? No.

 Does she know the opinions of my husband , oncologist or my team of doctors? No.

Did I ask for her advice because I was confused and lost? No. Then, why all the unwelcome advice and unwanted opinions?

A close friend calls me unexpectedly…she cares about  me as she would for herself…and I know what a true devoted friend she is…she calls and starts talking with an angry voice… “Your mother told me that you plan to continue with the pregnancy…if the speaker is insane the listener is not…it seems that you’re not quite aware of what you are doing  and need someone to wake you up!!. At this point, she starts screaming “You are sick… you are ill…this is not a flu… this is CANCER…and on top of this what if you have a handicapped child because of getting chemotherapy while you’re pregnant.”

I think you now realize that what I mean. God’s will and fate are much easier to bear than  things that people say.

 Add to that, all the misplaced curiosity and strange questions that come from almost everyone. “Will they remove one breast or two?”

“The chemotherapy will make your hair fallout won’t it?”

“Why did you get cancer? I wonder what the reason could be.”

“How strange, you are a doctor and you still couldn’t detect the disease at an early stage.” In addition to countless more questions and comments.

Dear readers, cancer patients need the help, support and love from the people around them. Please, if you are close to someone suffering from cancer then do not try to impose or force your opinions and do not offer suggestions that may be hurtful. No matter how good your intentions are, it does not mean that your words will not cause pain. If you are just acquaintances then be sure that curiosity does not make you too bold and ask hurtful questions. If you can’t contain your curiosity, then look up the answers in a book or online and then you will know without having to ask.

Where is the Wisdom?

Now comes the most difficult topic and the most important, what is the moral to be learned or the message to be gotten from all that has happened? From my life changing so profoundly and quickly that it will never return to the way that it once was. What was the purpose?

 

 I didn’t need long to realize one important reason, it seemed obvious to me. My life, prior to the diagnosis, had seemed like a whirling vortex, which I stumbled through blindfolded. I was in my first year of psychiatry residency.  A specialization that I have been dreaming about since I was in high school. I wanted to be a distinguished psychiatrist who understood patients as whole human beings, as spiritual beings. Not one that merely looked at them through the lens of their diagnosis. 

 When I started the residency, however, it was nothing like what I had dreamed. The   workload was heavy and stressful. During the working hours, I did not really provide my patients with that they needed from a psychiatrist. I was busy doing menial tasks: filling forms, writing documents, admitting or discharging patients without having any real relationship with the people I was supposed to be taking care of. In the midst of this fast-paced life, I lost sight of who I was and what I wanted. What was the purpose behind this endless running? Why did I leave my country, family and friends to pursue my training in the US?

Not only did I forget my dream and stop being the humane doctor that I wanted to be, but I also deprived my beloved family of their most basic need from me, my being there for them. My son used to go from daycare, where he spent 9 hours a day, straight to the babysitter, until the time finally came for me to return home from work and we would put on our pajamas and fall asleep. 

 My life had become so fast paced that it had lost all flavor. I performed my prayers quickly so that I could return to my work. I used to see my husband only once every week or two depending on our on-call schedules. A voice was screaming inside of me, trying to tell me, this wasn’t the life I wanted. Where was the meaning? Where was the purpose? The giving? The relationships? Where was reading, meditating, writing and worship? Where did all the things that gave my life meaning go? I used to tell myself to be patient that things would only be this way for a while. A few years of chaos, perhaps and afterwards my workload would lessen, giving me more time. Time to remember who I was and what I wanted from life. 

I needed a chance, a moment to be with God and remember why. To remember the purpose, the goal, the intention behind all of this…a fresh start. I needed a moment to evaluate my current situation, to see if I was on the right path. Was I gaining the knowledge that I came to the US to learn? or was I doing all of this merely to get the title of “American board certified”, while only learning a fraction of what I had hoped to learn, because I was overwhelmed with performing other routine duties, that served work but not my purpose of working?

 I never would have allowed myself this pause. I saw standing still as failure. I wouldn’t have given myself the chance to catch my breath and take stock of my life. I thought that to continue running through my hectic life, no matter what happened, was strength. 

God wanted to give me this chance and, in his greatness, he knew that it would take something drastic to cause me to change and re-evaluate my priorities honestly. To see my life threatened in its entirety, unless a miracle happened. 

When death is this close it causes your priorities to change; some things appear more important, others seem less so. Career seems less significant. Certification, reputation and the American board become inconsequential after they had been everything in my life, after they had meant everything to me. You reassess your priorities, the ends you wish to accomplish and the means to those ends. 

I remembered that the American Board Certification was only a means to an end…a way to give, to be the qualified psychiatrist that can help people using a solid scientific basis. So how did the goal get lost and fade until it disappeared before the means.

Yesterday I sat talking to god alone. I spoke a lot and cried a lot. I felt an abundance of mercy and love overwhelm my heart. I prostrated myself before Allah gratefully thinking that this is the reason why I was created, for this closeness and for this happiness, and this is what I want to share with people and leave after my death.

Bombarded with the news

The Brest surgeon informed me that the diagnosis was indeed breast cancer. I had, by God’s grace, already learned of this an hour prior to the appointment and had therefore been able to shed my tears and somewhat gather my strength before arriving. Immediately after informing me of my diagnosis she began bombarding me with the hard decisions that I would have to make:” Alright we have a lot to work on . Regarding the surgery, due to the size and grade of the tumor, you will need a mastectomy ,we will not be able to do lumpectomy. As to chemotherapy, not all women require chemo after a mastectomy but considering your young age and again the grade and size of the tumor, you will need to undergo chemotherapy as well. This is where your pregnancy comes into it as I don’t think that we can delay the therapy until after delivery. Therefore, you will need to have it while pregnant or undergo abortion. However, if you decide to terminate this pregnancy, I don’t know the chances of your conceiving again after the chemotherapy ”.

 In the midst of everything that she was saying, I saw my husband flinch when she spoke of the possibility that I may not be able to conceive again. Despite this, he managed to stay collected and calm. While I, on the other hand, could feel my heart sinking lower with each new piece of information and I could hear a cynical voice rising up inside of me and saying: ”So fast? Is this all the time that it takes for all of this to happen? So quickly? So soon?” I began to realize, more so with each passing second, that my old life was gone and that there was now a “new Noor” with a new life. Soon, her breast would be removed, her hair would fall out from the chemotherapy and she might lose her baby and maybe never have another…Perhaps she doesn’t have much longer to live.

 As if what she had already said wasn’t enough, the doctor continued saying:” Considering how young you are, we should think about genetic testing. If you do have the gene that causes breast cancer then we have to consider removing the other breast and maybe the ovaries as well.

With all due respect to the doctor, the last comment was neither necessary nor urgent to be mentioned  at that time. I already had enough to deal with,I have just known about big aggressive tumor that is changing and risking my entire being. Therefore, this was absolutely not the appropriate time to discuss the possible danger that may affect the second breast or the ovaries at some point in the distant future. It is not prudent, in some cases, to say all that is known straight away.

Regardless, I managed to remain composed throughout the entire dialogue, asking many questions and discussing the available options. At this point, the surgeon realized that she didn’t have all the information necessary to answer my questions. She told me that she would invite an  oncologist  who have ling experience with breast cancer to give me more accurate information.  She left the room to page him leaving us alone. As soon as she closed the door a dam that had been holding back a waterfall of tears burst open and I muttered:” thank you God”. My husband stood to embrace me as I kept on crying. Minutes passed this way, with my mind blank, it was all just too overwhelming to think about, I was merely trying to ease some of the pain in my heart. After a few moments, I looked towards my husband and found him steady and smiling. I told him not to hold back his tears, that it was his right to cry and that he needed to as well. He smiled and his eyes filled with tears as he said:” If we both cry then who will be left to comfort us”.

There was a knock on the door, so I dried my tears quickly and my husband returned to his seat, as if nothing had happened. The oncologist came into the room, head lowered and back bent with a look of great sorrow on his face, and I thought:” Poor man, does he have to take on this sad appearance before all of his patients?” I smiled at him and it was as if he felt that he no longer needed to pretend. He smiled back at me and said in broken Arabic:” How are you? My grandparents were from Lebanon but I only know a few words of Arabic”. He began discussing all the recommendations and treatments, addressing all of our questions, and providing all the missing information that we needed to make a decision. I felt as if I was talking about someone else, discussing the options rationally and asking the appropriate questions, until he finished speaking and left the room giving me another chance to cry.

 Afterwards, a nurse came in and handed me a huge book entitled “Breast Cancer” and told me that it would be an excellent reference for me. I looked at the book and read the title, realizing for the first time that this label was now mine and that it represented me. The nurse then told me that the hospital had a support group for breast cancer patients where I could meet other patients and that they also had a dedicated social worker if I needed to talk about my feelings. It was a kind gesture but it only served to make me feel, more and more, that my identity, my life and needs, had forever changed from this day forth.

 

 

 

"Make use of five before five: Make use of your youthfulness before you reach old age, make use of your health before you fall sick, make use of your wealth before you become a poor, make use of your time before you become busy and make use of your life before you die.”  prophet Mohammed PBUH

From perfect health… to Cancer

A doctor… a mother of a three-year old … and 3-months pregnant… And just a few weeks ago… I celebrated my 30th birthday.

The story began with a small lump… I noticed it at the beginning of my pregnancy but didn’t take it seriously… then after a while I decided to ask my Obstetrician about it. She referred me to a Brest surgeon and said laughingly: “Given your age and the fact that you are pregnant, I am not concerned. But let’s just double check”

The surgeon didn’t utter a word… all she said was “let’s do an ultrasound".

My fears increased with every passing moment and I kept fighting them… but one day they took on a different form and turned from mere fears into scary imaginings.

Thoughts of leaving my husband and my son… thoughts about who I could trust to take care of them?... I kept thinking of my friends and who amongst them I could trust to be a good wife to my husband and a mother to my child?... it was a painful thought which brought me to tears…and at times it appeared silly and unfounded so I couldn’t share it with anyone and kept it to myself …

I went for my ultrasound appointment at the same hospital that I work at… “This is not a simple cyst, there is a solid mass  in one of the cyst sides… I can’t tell what it could be. We need to take a biopsy and we need to do it fast… come in the day after tomorrow for the biopsy"

At the very same moment and while I was still feeling overwhelmed with the news, my pager Beeped, calling me to attend to an emergency…

I held back my tears,tried to ignore my fears and  ran towards the emergency room… I could hear the patient talking but I was in a completely different world… I wasn’t thinking about what the doctor said...I was just distracted by the sinking feeling in my heart and I kept murmuring to myself "May God be with me"

The biopsy day came by quickly… and since I work at the same hospital, I kept checking the results on the system every three hours although my appointment for discussing the results wasn’t for five days…

I had a strange feeling while I waited for the result… A deep voice telling me this was cancer… the way it looked on the ultrasound, the way it felt ,and the signs I kept seeing everywhere I looked… but I kept reassuring myself that there is no real reason to be concerned …

The five days passed while the results did not come up in the system yet. And the day of my appointment with the breast surgeon arrived. It was a  Friday...

After the morning rounds , which I really enjoyed that day, I went directly to the on-call room to check for the biopsy  result on the system and I kept praying that it was out, that is until I actually saw it...

My eyes went all blurry with fear… I didn’t know how or where to read… I scrolled to the middle but I couldn’t comprehend anything, so I scrolled down to the very end and I saw one line that shattered all my expectations: “Invasive Ductal carcinoma Stage 3/3"

Everything became blurry…and I heard a loud voice, which later I recognized as my own…

I was repeating loudly in Arabic " alhamdulillah... Alhamdulillah" which translate as: all gratitude is to God or simply... Thank you God!

I kept repeating this unconsciously while my breathing became heavy and my heart beat too fast...  Then my tears started falling... Why? I don’t know... What was I thinking? I don’t know.

All I remember from that time is my voice saying "Alhamdulillah” mixed with the voice of gasping for air while crying out loud…

Then I started thinking: this marks the end of my life as the healthy strong Noor... This is the beginning of a new phase... I don’t know how long it will last or when it will end.

I called my husband and when he replied I said quietly: “How are you darling?"… "The results are out"…"I need you"… I didn’t say anything more and he didn’t ask me to, he just said "I will be here" and then hung up and for that I was grateful because there was no way I could tell him the diagnosis…

It was 12 p.m., a time at which the on-call room is usually occupied by interns having lunch, but thank God it was empty that time and I was able to enjoy the privacy.  I kept thanking God and I remembered the prayer that Muslims are thought to say at the time of hardship: "O Allah, reward me for my affliction, and give me something better than what I have lost” Then I kept on crying and praying.

I remember those moments now with deep gratitude and I thank God deeply for making me utter those words at such a difficult and confusing time… it wasn’t me… it was Him…

I thank him for giving me the chance to receive the news while on my own, in a closed room, where I was able to cry and weep without being seen. If the result had come out only an hour later, I would have had to receive it at the clinic while listening to the doctor saying "whatever she could come up with" to ease the situation.

My husband arrived and I met him at the hospital's main gate. I smiled, said "thank God" and we walked in together. Then a few minutes later, he heard me weeping and hugged me..he asked me to see the results himself as he thought that I might be wrong.. Back to the on call room where he read it

For the few minutes that preceded my appointment I kept crying in silent… so that by the time of my appointment all my tears had been shed… and I went to the clinic without any tears left.

The doctor came in smiling: "How are you doing?" how is work? How is your pregnancy, anymore morning sickness? How was the biopsy? “Just trying to fill the time before she gets into he topic, "Ok... Now we know what is going on”, so I said "I know…I read the report" and amazed she said: "you know?" I smiled and said “I saved you  breaking the bad news”. She replied: “Oh it is such a relief… I didn’t know how to tell you”..." ok we have to move fast... We now have an urgent goal… we want to get rid of this cancer and we have a lot of decisions to make"

And she started telling me all the details, and all the painful treatment  options… leaving me feeling bombarded…