Winter Storm in the Middle of Spring: First Episode

Winter Storm in the Middle of Spring: First Episode

The Beginning: In Dhahran

My story began in Dhahran, in the Eastern Province of Saudi Arabia. It was 2004, I was 23 years old, a mother to a toddler(who was eighteen months old) and an infant (who was three months old). I had been married for three years. My husband had completed his Master's Degree and was accepted to the University of Waterloo in Ontario, Canada, to do his doctoral degree.

I started packing my home.

My biggest concern at that time was finding empty boxes to fill with all of our belongings that were scattered throughout the house. Although we had only lived in that house for two years we had a lot of things because of the two little boys. The house was like a yard full of boxes.

My young son made a game of it, at one time hiding inside a box, and another putting his toys inside. But the great disaster was when he would take everything out of a box that I had already filled, and then clap his tiny hands celebrating his achievement that reversed my achievement! It was more fun for him than playing his usual games.

I was so busy, packing and running after my walking baby and infant, whom I sometimes had to carry in the baby carrier while packing to protect him from his older brother, who thought of him as a puppet or a toy. Putting the baby in the carrier also helped to keep him calm and fall asleep, smiling at Mommy and listening to her heartbeat.

My other concern was shopping for winter clothes to protect us from Canada's extreme weather. My dear friend Abrar had gone to Canada earlier that year. She was in Vancouver, one of Canada's warmest areas, but I still remember the phone call where she described to me the cold winter of Canada. She had been shocked when she arrived, walked out of the airport door, and the cold wind hurt her face. Everything was covered with snow. Everything was completely white. Just remembering her words now makes me shiver as if the cold air is beating my face.

Packing and shopping was difficult with my two little boys, but in the midst of my busyness I felt a strange painful tingling in my right breast, which continued for several days. I began to worry with many thoughts popping into my mind.

I remembered my late mother (may God shower her soul with mercy) who had had breast cancer when I was in primary school. I was not pessimistic but it is good to learn lessons from the past. Having a first degree relative diagnosed with breast cancer made me more susceptible than the general population. The thing that made me optimistic was that I was too young. I thought the disease only affected women over the age of forty.

I also remembered that my mother was diagnosed with ovarian cancer when I was in secondary school. Her doctor had a suspicion about a small ovarian cyst and asked her to follow up, but she was a busy physician, university professor, and a mother preoccupied with us. So she didn’t follow up, and that was the ovarian cancer that spread and caused her death. At that time, nearly twenty-five years ago, there was no awareness about the relationship between breast and ovarian cancer in young women who had breast cancer before menopause, and who had a family history or genetic factor. There was insufficient awareness that ovarian screening was as important as breast screening. No one suggested preventative surgery to avoid the risk of breast or ovarian cancer. What happened to my mother was a harsh lesson that made me think again and again that I would take a break from what I was doing and go to the doctor to check. Better safe than sorry.

I remembered that before I felt the pain I had a severe rash, cracked skin, and bleeding. The diagnosis was fungal infection from the baby’s mouth during the breastfeeding.

I was shopping with my dear friend to buy winter clothes when I told her that I needed to go to the doctor. We went together that day. My heartbeat accelerated when I was in the waiting room. When it was my turn I told the doctor about my situation and family history, explaining to her that I had a first-degree relative who had breast cancer.

Her response was, “You are a young woman and you are just twenty-three years old. It is normal for you to feel pain as a breastfeeding mother. Breast cancer usually comes without pain.”

I told her that this pain was different from what I had with my first child and I asked her for an ultrasound, but she refused.

I went out to my friend and told her what had happened. I was still worried and wanted to do an ultrasound, but as I got busier with packing I got distracted from thinking about it. Everything I was doing pushed away my anxiety.

In Jeddah

Two months after my doctor’s visit we moved to my hometown Jeddah, a city on the west coast of Red sea in Saudi Arabia, to say goodbye to our family before leaving to Canada. It was the end of December 2004, and our date of departure was January 4^th, 2005. The pain was still in my right breast and did not go away, but the accumulated tasks that needed to be completed helped me just ignore it. But then I spoke with my lovely father and he advised me to go for an ultrasound. He told me that in either case I wouldn’t lose anything. If the results were good – praying to God that it would be – great. And if the news was not good, early detection is one of the best cures for cancer. He said, “Go my daughter. We do not want to repeat the tragedy of your mother.”

I went to the ultrasound, and the radiologist who examined me was the same one who performed the first imaging to see my first baby and check his heartbeats almost two years before. In that same place was the beginning of my deepest joy. This was where I took my first steps on the path of motherhood, hearing my baby’s heartbeats for the first time.

But when my doctor asked me again,

"You are twenty-three years old, right?"

I replied “yes,” and her facial expression changed.

She said, "You are young, by God’s will you will be fine. But what I saw is not a good sign. It looks like a solid mass with an irregular wall. Please see a surgeon and do a mammogram.”

I made an appointment with a surgeon who was considered the best in town in the field of oncology, especially for breast tumors. I returned to my in-laws’ apartment in Jeddah. They had come from Yanbu Industrial City to say goodbye. All my boxes and luggage moved from my house in Dhahran to this apartment. I had to sort them out, deciding which to leave in my dad’s house and which in my in-laws’. The rest would be in our luggage or shipped to Canada. The place was jammed with boxes that were stacked like the thoughts stacked in my head. I tried to escape these thoughts by diving into the depths of my scattered luggage. I also had a list of visits to friends and relatives for farewells before traveling. Sometimes keeping ourselves busy may help to distract us from stress and anxiety, but if the escape is long, the confrontation will inevitably come.

I was counting down the days before my doctor’s appointment. I wanted this story to be over as soon as possible. There were only a few days left before we went to Canada.

The long-anticipated appointment date came and I met the doctor. I was nervous about the examination because he was a male doctor. I was so anxious during the clinical exam – he was nearly as old as my father. I think this is not easy for any woman from any culture, but probably more difficult for a woman from a Muslim culture who wears a hijab and covers her hair and body. This was the first time I had to reveal such areas of my body to a male doctor, but what could I do? I had no choice. It was a necessity. At that moment I asked God to help me face this, and hoped that I would not need to do this more in the future. I asked God to help me maintain my modesty, and to keep me feeling secure and comfortable.

The doctor told me that there was no significant mass that he could feel, but that he was not happy with the ultrasound due to the shape and nature of the visible mass. He asked me to have a mammogram and an MRI as well. He told me that both tests would give us more clues about the nature of the detected mass, and that an MRI is more accurate for young women under the age of 40 who have a family history of breast cancer. The doctor also confirmed that a biopsy of the mass must be taken. With my family history we must be cautious and it was better to be safe than sorry. I was a little worried about these tests that I was unfamiliar with and did not know how to do.

Things were getting busier with sorting, packing, and visiting, but the medical tests became a priority. I went to the mammogram appointment and thanked God that they were female technicians so I would not feel so uncomfortable exposing my body again. I wore the hospital gown with an opening in the front and stood in front of the machine. The technicians supported me, asked me not to move, and explained the procedure. The device would be adjusted to compress the breast to be flat, allowing X-rays to access the tissue. When the machine started, the pressure was more painful than I expected! But as the Arab saying goes, "pain for a second is better than pain for hours." The pressure pain for a few short moments would certainly be much better than the pain of cancer if it was not detected early.

I still remember those moments, the coldness of the room, its smell and its details. After the examination I asked to meet the radiologist, and I told the technician that I was going to Canada a few days later. She took me to the doctor and I felt some reassurance when I saw her. She had been a close colleague of my dear mother’s, (may God shower her soul with mercy). My mother loved her so much and consulted her often during her own battle with cancer. She stood in front of the radiology reading screens and repeated the same question that had been asked at every appointment or examination:

“You are only 23 years old, right?”

Again I said “yes,” while my heart beat hard.

She looked at me after a moment of silence and said,

“The mass is calcified and you should do a biopsy of it. Thankfully we were able to see it because you are breastfeeding and milk in your ducts can often obscure the imaging.”

I thanked her and left to get an MRI appointment. Unfortunately, appointments were too far away, so I went back to the other hospital with the surgeon. He was satisfied with the tests I already had and gave me an appointment for a biopsy with the possibility of removing the tumor based on biopsy results. The date was December 27th, just a week before the day we were to leave for Canada.

All my questions to the surgeon were about the duration of recovery after surgery and could I travel right away? Could I wear a baby carrier to carry my baby while traveling? Despite all the signs that were not reassuring I ruled out the possibility that it would be breast cancer. I trusted in God, I was optimistic because of my young age, and I was excited about traveling and that new stage of adventure in my life.

The doctor told me that I should stop breastfeeding and wrote me a prescription for medicine to dry up my milk.  was very sad, because breastfeeding is one of the best things that a mother can offer her baby. It is not just about feeding, it is also one of the most important elements of the love relationship that is built to continue and grow with the child in all stages of his life. With all the touches and eye contact and laughter between mother and child it can lead to the growth of a healthy child physically and psychologically. I asked God to make it easy on my baby, and hoped to continue our strong bonding after switching to bottle feeding.

I went back home and started to take the medicine. I had severe side effects, suffering intense vomiting and nausea. I was not surprised as that had always been my body’s reaction to hormonal changes. During both of my pregnancies I had developed a medical condition called Hyperemesis Gravidarum where vomiting exceeded 40 times a day and required hospitalization.

I tried to feed my baby with a bottle but he refused and cried and cried. The doctor advised me to hand him to someone else because whenever he smelled my smell he would cry for my love and milk. My mother-in-law and sisters-in-law alternated in offering the bottle. He looked at them and cried, still refusing the bottle. It was a difficult time for all of us.