Diagnosis Part II: Killer Boobs

Spoiler alert, I was diagnosed with high-grade ductal carcinoma in situ (DCIS) – stage 0 breast cancer. After the biopsy results, I went to another two hospitals seeking other opinions, everything was consistent, it was DCIS – and apparently, this was good news. The cancer cells were still inside the milk ducts and had not spread to the breast or beyond. The next step was to do imaging: a mammogram and an MRI to determine the size of the tumor and make sure my left breast was “clean” from any cancer cells. All doctors agreed on the same thing, the solution was to immediately surgically remove the tumor from my body. This is when we started to have the conversation about the possible surgeries: lumpectomy or unilateral/bilateral mastectomy.

I had heard the word mastectomy for the first time circa 2013 upon Angelina Jolie’s decision to do a preventative bilateral mastectomy as a BRCA gene carrier. I never really thought about how traumatic it is or could be to lose your breasts. I started to google images of women who had had different types of mastectomies and realized there is so much to think about. Some women were able to keep their own skin and nipples while some women were not. Some women opted to go flat and not get a reconstruction. Some women reconstructed with fat/muscle and tissue from other parts of their body while some women just had an implant. What was I going to do? The idea of losing one or both my breasts was horrifying. How was I going to look after surgery? What will my scars be like? How does it feel to not have a breast? If I remove just the one, will I be lopsided my entire life? How will this affect the way I view my body, my own self-confidence?

Then I sent this to the WhatsApp support group with my friends, laughing hard:

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I went through a lot of imaging before we decided upon my surgery. First, I did a mammogram, a very uncomfortable exam. The radiologist squeezes each breast into two slides in the most uncomfortable positions. It’s not fun. Mammograms are not advisable for women under the age of 40 for two reasons: first of all, our breasts are too dense, and mammograms may not be able to capture any disease if present, and second, the unnecessary exposure to radiation from an exam that may not even be accurate due to the density of young women’s breasts. If you are over 40, however, please do make mammograms part of your yearly screening routine. Many Dubai hospitals will do them for free during Breast Cancer Awareness month in October every single year.

After seeing 3 oncologists and 5 surgeons in both Dubai and Abu Dhabi, I chose to get treated in Mediclinic City Hospital with Dr. Anett Al Hamadi. I needed to do an MRI in order to determine the size of my tumor and also make 100% sure my left breast was in the clear. Here is an interesting fact about breast MRIs, due of the hormone imbalance during our menstrual cycle, I only had a 4-day window to do my MRI if we wanted to avoid “false positives” – cysts and other things that could appear in the image and alter the results. We booked the MRI exactly in that window and I wanted to make sure it was done then. I had had enough of so many tests, and as the result-oriented, extremely controlling person I am, I was frustrated and needed to do this surgery and get this over with.

Unfortunately, 3 days before my MRI, my dad had a severe heart attack and was hospitalized in critical status in Ramallah. I traveled the morning after the incident, crossed the Jordanian border and was with my dad at the hospital by 5 pm. I spent two weeks in Palestine before my surgery and it was a true gift. I was able to witness my dad’s strength and own willingness to live, which inspired me so much in how to tackle my own disease. Yet, most importantly, I fed off my mom’s warrior energy every day, a woman so powerful, yet so humble that she does not realize that it is her spirit that has led my fight against cancer. I am in awe of her and my attempt to recreate her strength is the least I can do in her honor.

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I was in a race against time to find an MRI machine in Palestine so I would not have to wait another month to get the process moving. Sadly, Palestine is full of occupation realities, one of them being that there isn’t a single MRI machine in the occupied West Bank suitable for breast MRIs specifically. This really upset me and sent me on an existential spiral of frustration: why is it that when it comes to female-specific disease there is no real effort to ensure there is the right equipment/tools for diagnosis? I had to resort to a medical agency to get an appointment in an Israeli hospital in Jerusalem. I ended up doing my MRI on the night after the Sabbath, Sunday at 1 am accompanied by a very, very distant family member who was the only one with a Jerusalem ID. Once again, occupation realities, my parents – and most of my family – are not allowed into Jerusalem without a special permit and my brother, who flew all the way from Colombia because of dad’s and my condition, was not allowed into Palestine at the Israeli checkpoint. We truly take freedom of movement for granted, don’t we?

I sat inside that MRI machine on my knees for 40 minutes. I was breathing very slowly in a conscious attempt not to move at all and barely listening to Eric Clapton, the loud sounds of the machine drowning the melody of Leila somewhere on the background. I was thinking about how grateful I am not to be claustrophobic. MRIs must be a nightmare for those who are. In my mind, it was just one more exam to get through. One more step closer to getting rid of this stupid cancer.

I came back to Dubai ready for my next step. I would spend the next two weeks waiting for the results of my MRI and of my BRCA gene test. At some point through the diagnostic process, I was advised to do the BRCA gene test in order to make sure I was not a carrier of the BRCA gene, which if you’re a carrier increases your possibilities to develop breast and ovarian cancer. The test is expensive (US$1,800 approx.) and not covered by insurance. I decided that peace of mind was more important and did the test with IPS Genomix in Dubai. The results take 5 – 6 weeks to come back.

I was already very impatient, I just wanted to know what was going to happen. In almost comedic fashion, I received the MRI results in Hebrew. I had to send them back to the agency for translation, which took another few days. In between, however, I received the first piece of good news: I was BRCA negative. That was a huge relief. It meant I was not genetically predisposed to get cancer. It also meant, however, that I had nothing to blame it on. The “why” began attacking me again and this is when I decided to see a therapist once a week and also began doing some energy healing sessions in order to get some perspective over the diagnosis.

Focusing on my mental health during this time was very important to me. I had to get past a lot of demons before I began tackling my disease. I felt that I needed to understand “what for” rather than “why” this was all happening to me. It was that small change in semantics that made all the difference. No, I still don’t think cancer is a gift. It is not a gift. Cancer sucks and going through it is a bitch and a half. It just meant that I would focus on what this experience brought to my life in a more positive way. It still means that I am looking for the meaning beyond it, taking it day by day always with a little bit of humor in between.