May the Odds Ever be in Your Favor

By Rayan Kaakati, Neurobiology, Physiology, and Behavior

Being born female automatically registers you in a game of Russian roulette: one out of eight women will have invasive breast cancer during their lives. Breast cancer is a disease that starts in the tissues of the breast and is statistically fatal for about one in thirty-six women (Breast Cancer Facts), but that does not mean it is a walk in the park for its survivors or even for women who end up not developing the disease. My closest experience with breast cancer has been with my Aunt Hala, who was born in Lebanon in 1962 and still lives there. Hala was diagnosed with breast cancer in 2006. To Lebanese, cancer is referred to as “The malicious disease” or, reminiscent of Lord Voldemort, “the-not-to-be-named disease.” People refuse to even mention the word cancer (“sarattan” in Arabic), and many who get it are kept in the dark about what is afflicting them. They pass away unaware of their real condition, thinking they have a bad cold instead of lung cancer or a bad intestinal infection or an ulcer rather than gastrointestinal cancer, and so on.  However, this silence is not the case with breast cancer; everyone is aware that once you have a lump, you end up losing your entire breast through a mastectomy, as in Hala’s case, or if you’re “lucky”, then you end up having a lumpectomy and only a portion of your breast is removed. And if the odds aren’t in your favor, you may end up losing your life all together.

Hala, the youngest among five sisters, initially ignored her lump. The thought of having the disease was stressful enough to send her into complete denial. By the time she casually mentioned it to one of her sisters a few weeks after discovering what felt like a “hard lump” in her right breast, hoping the older sister would also be nonchalant about it, the disease was at stage three. The denial phase of cancer is common for most women, as studies show that more than one third of women who feel a lump in their breast postpone going to the doctor for at least three months (Jauhar). This could be due to multiple reasons, such as the cost of cancer treatment, fear of a mastectomy, the terror of chemotherapy, or the thought of death.

Soon after her first doctor’s visit, Hala went from denial to acceptance; the anger stage never came. She put up a strong front that helped all of us cope with this dreaded intruder into the family. Aisha, the eldest of the sisters, had a hard time accepting that Hala had cancer and kept hoping it would be benign until the mastectomy. Another aunt insisted that she should not accept the surgeon’s recommendation of “carving her up” and kept referring to the surgeon as the “butcher.” Others unknowingly opted for a worse approach—not talking about the issue at all—giving Hala the feeling that the Angel of Death had parked his chariot outside her door.

It is stressful enough for a person to be diagnosed with stage three breast cancer, but what is overlooked is the barrage of issues that surface that forces you to look at your illness as only one of many issues that unfold.  You are forced to alleviate the pain and worries of others as they worry not only about you, but also about themselves, because you having cancer makes the Russian roulette game even more dangerous for them. I could only imagine how my other aunts felt as they watched Hala battle cancer, as the doctor informed them during the six chemotherapy and twenty-five radiation sessions that the risk of them developing breast cancer doubles automatically since they now have a close blood relative— their baby sister— with the disease. The barrel was now staring them hard in the chest, and the troubles of searching for the best doctors and hospitals with the latest medical equipment and treatments only added to their worries.  Hala’s main worries came from informing relatives overseas, receiving constant phone calls and visits from well-wishers, and pondering over the the big brain teasers of “what if’s.”

The “what if’s” invaded Hala’s thoughts day and night: what if I lose both of my breasts, or the cancer is metastatic and spreads to other parts of my body, or what if the cancer I have is not responsive to chemotherapy, or worse, what if I have prolonged illness and my body wilts away?

Women who get the disease worry about the hardship of treatment, the dreaded five-year wait before you can be blessed with the “in remission” certificate, and the lifelong uncertainty about whether the disease will resurrect itself. One year after her mastectomy, the doctors reassessed her progress and recommended an oophorectomy, which is the removal of the ovaries in order to reduce the amount of steroid hormones, progesterone and estrogen, circulating in the system (Eldor and Spiegel, 81). Hala’s doctor explained to her that estrogen was to tumor cells what fertilizer is to weeds. As a consequence of the oophorectomy, she developed osteoporosis, which is the weakening and dissolving of the bones caused by a lack of estrogen. Currently, Hala still has osteoporosis and is taking Provila once a month to strengthen her bones, in addition to the calcium supplement she takes every day. Hala and her sisters were grateful to her doctor for taking the time to inform them about the disease. Consequently, mammograms have become an annual tradition in my family that was never strictly adhered to before Hala’s ordeal. In Hala’s words, “by understanding my disease and available treatment options, I voluntarily accepted the poisonous medications the doctor prescribed me.”

Hala described her medications as “poisonous” after experiencing the bouts of vomiting, lack of appetite, weakness, and severe nausea every time she would take them (this is not to mention the burning feeling, after each one of the twenty-five radiation sessions Hala attended, that would only go away once she rubbed a pound of Biafine ointment on her breast).  In fact, every time Hala came near the Rezk Hospital in Beirut for her chemotherapy session, she would automatically show “anticipatory nausea and vomiting.” This phenomenon occurs at the sight, smell, and sound of the treatment center that reminds patients of previous chemotherapy sessions (National Cancer Institute). Once the stomach-twisting feeling of nausea crept over her, not even the prescribed Zofran could stop it. There came a time when Hala felt so defeated during the chemotherapy sessions that she wondered whether it was easier to succumb to the disease than to withstand the punishment of the medications. Her six chemotherapy sessions, twenty-one days apart, strangled the life out of her, and in the words of Hala: “The doctors will strangle you and the disease to the brink of death—hoping the disease will surrender first”.

The breast of a woman signifies the bounty of a crop, the generosity of a rain cloud over a thirsty land yearning to be quenched.  Humans are born to suckle the juice of life from the breast the minute they exit the womb, when cancer targets that organ, an afflicted woman cannot help but feel an onslaught upon her being. Nature, for some unknown reason, has thrown a poison into her wellspring, and modern medicine’s “cure,” to date, is as cruel as the disease itself.

While many studies have characterized those affected by breast cancer, based on age, drinks per day, smoking, race, breast-feeding, etc, a cure or a vaccination for the disease has not been discovered yet.  Women are still waiting for a quantum leap in the field of medicine, where gene therapy or manipulation of various amino acids will eventually replace chemotherapy, radiation, and the surgical carving up of patients. Nine years after her breast and ovaries were taken from her,  Hala still stands strong as a powerful symbol to all women. By enduring through the physical, mental, and spiritual tribulations of cancer, Hala has been a positive impact on her family and community as she openly discusses her experience battling cancer and is an avid promoter and participant of regular breast cancer screening—and most importantly—she is a survivor. 

References:

Board, A.D.A.M.. “Breast cancer.” Breast cancer. U.S. National Library of Medicine, 17 Nov. 2012. Web. 30 Apr. 2014. <http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001911/&gt;.

“Breast Cancer Facts : The National Breast Cancer Foundation.” http://www.nationalbreastcancer.org. N.p., n.d. Web. 30 Apr. 2014. <http://www.nationalbreastcancer.org/breast-cancer-facts&gt;.

Eldor, Liron, and Aldona Spiegel. “Breast Reconstruction after Bilateral Prophylactic Mastectomy in Women at High Risk for Breast Cancer.” The Breast Journal 15 (2009): S81-S89. Print.

Jauhar, Sandeep. “First Battle Of Cancer: Deep Denial.” The New York Times. The New York Times, 12 June 2000. Web. 30 Apr. 2014. <http://www.nytimes.com/2000/06/13/health/cases-first-battle-of-cancer-deep-denial.html&gt;.

“National Cancer Institute.” Nausea and Vomiting (PDQ®) –. N.p., n.d. Web. 30 Apr. 2014. <http://www.cancer.gov/cancertopics/pdq/supportivecare/nausea/Patient/page1/AllPages/Print&gt;.

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