A boring, textbook surgery

Toronto, January 27, 2016 – It was an incredibly positive experience.

The day started with Shayne and Sabrina calling in, as we were driving to the hospital, to ask how I was feeling.  I told them honestly that I was a bit nervous, a bit anxious, and mostly hopeful.  Sabrina asked if I was wearing my most colourful bright pink socks – which I was!

IMG_0559The procedure I was going for was a right breast radioactive seed localization lumpectomy (seed removal) and complete axillary lymph node dissection.  In layman terms, it means removing the cancerous lump from my breast, as well as removing all the lymph nodes from under my right arm.  This was scheduled to be a two-hour procedure where I would be operated by Dr. Brian Pinchuk.

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As I was waiting outside the surgical room in a gurney, waiting to be wheeled in, Amin Naran, a friend who works at North York General Hospital, came by.  He said he saw my name on the roster, was expecting me and had a gift for me!  He came back with a pillow (apparently they are in short supply) and expertly positioned it under my head so I could rest comfortably.  He then told the OR staff to take extra special care of me because I am his friend.  God sends angels in many ways!

The mood in the operating room was relaxed.  Everyone took their time to introduce themselves to me and ask me how I was doing.  There was a humanness in the sterile operating room that I was not expecting to find.  As the anesthesiologist was looking for a cooperative vein to insert an IV, Dr. Pinchuk held my hand for the entire time.  And then when he left to “get his headlights” to start the surgery, his assistant, with a big smile and personality, took his place to hold my hand.  This simple gesture, at a vulnerable time, was all I needed to go into surgery feeling safe and secure.

But a little bit more about Dr. Pinchuk.  We first met him in December, when I was first diagnosed with breast cancer.  We were immediately struck by three things:

  • His clarity and precision in explaining the diagnosis and potential treatment plan (complete with exact pictures carefully labelled and drawn to scale!);
  • His good handwriting (doctors are notorious for writing illegibly); and
  • His patience.  We never felt rushed – he took the time to answer every question and to listen to everything we said.

It was at the first meeting, that I made the decision that I wanted him to do the surgery.  In my head, I figured that he would bring the same discipline of structure and preciseness when he performed the surgery.

Back to the surgery.  I was asleep through it.  In the meantime, Nagib spent the day pacing from the crowded waiting room to the somewhat quieter cafeteria downstairs (where he comforted himself in the company of a couple of Tim Hortons Double-Doubles).  Every so often, he would rush back upstairs to the crowded waiting room to check the scoreboard and update the results on Whats App so that the kids in Nairobi and New York could follow along.  You see, North York General Hospital has an amazing system where the patient’s family can electronically keep track of the patient’s progress:

Finally, after 2 1/2 hours, Dr. Pinchuk came out to see Nagib and told him the operation was “textbook” and that there were no surprises.

When my status changed to Purple (Out of Recovery), Nagib was allowed by my bedside in the Recovery room.  I have no recollection of what I said but apparently, I was very loving to him, the nurses, the volunteers, the orderlies, and everyone who passed by me.

Meanwhile, Dr. Pinchuk went back to the operating room for his third surgery of the day.  When he was leaving at the end of the day, he came by to check in on me and told me that the surgery was like a textbook, exactly as planned.  In fact he said, “It was actually quite boring!” – nothing untoward, nothing gone awry.  And then he smiled and said, “Boring is good, especially when it comes to you!”

I am home now and using this time to rest and sleep.  On my right side, there is a drainage tube that is attached to a container which is pinned to my clothing.  Every few hours, I have to drain and measure the fluids that come out of the surgical site.  I expect to have this tube for two weeks or so, until such time that the drainage stops.

Today, I had my first visit with a nurse at the local CCAC Community Clinic for wound care.  And now I realize why I am in so much pain.  There is a huge cut under my arm – I measure it to be about 8 or 9 inches.  It is in the shape of a smile!  So I am relying on strong painkillers every 6 hours to combat the pain.  I expect the pain will subside in a few days.

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In two weeks, I will be seeing Dr. Pinchuk again for a post-operative visit.  At that time, he will share with us the results of the pathology tests on the tissues he removed from my breast and from my underarm.  Hopefully, the results will show that the cancer has been completely removed.  Fingers crossed.  Then the plan is for me to start radiation at the end of February, every day for 5 weeks.

Despite a long day of four scheduled surgeries (and an emergency case), Dr. Pinchuk had made a commitment to pick up his young daughter at 5:45 p.m. and take her skating.  As Nagib pointed to his watch, he smiled and said, “Don’t worry, I’ve got plenty of time.”  And, he kept that commitment to his family.

I wondered how the conversation would go with his family that day:
“How was your day, Daddy?” And he would say, “Rather routine.  Boring really.  Just another day at work.”  

I want him to know that for me, he was more than boring, more than textbook, and that the work he did saved my life.  And kudos to Nagib for taking such good care of me before, during and after surgery – every day he gives me another reason to fall in love with him all over again!

And, thanks to all of you for your many messages of love, good wishes and prayers.  Somebody upstairs was listening.

An Extraordinary Birthday

IMG_0573Toronto, January 25, 2016 –  He will not accept my Facebook Friend request. He is the sergeant in the kitchen, policing everything we eat. He calls me every day to find out if I have been to the gym.  And everytime I ask him a computer-related question, he responds by asking me “what are you trying to do?”, rather than just giving me the answer.

And this son of mine, Shayne, is also extraordinarily kind, exceptionally thoughtful and incredibly loving.  Case in point:  Making my birthday so very special and planning every detail even though he is more than 12,000 kilometres away, in Nairobi, Kenya.

Shayne called me from Nairobi at midnight on January 25th to wish me Happy Birthday. Great planning on his part given that Nairobi is 8 hours ahead of Toronto.

He had Nagib give me a present that he had gift wrapped earlier in January when he came home. And it was a most thoughtful gift – a beautiful, warm grey infinity scarf.  It was a symbolic gift because he was always cold in Toronto and was looking for different accessories to keep warm.  And he wanted to share that memory with me.

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Nestled in the gift bag was a card that was made by a woman in Kibera, Rose Nya Nguku. Kibera is the largest slum in Nairobi and some women in Kibera make handmade cards using recycled materials to provide income for their families. Kibera is also where Sabrina and Afzal established their first Kidogo centre.  Shayne’s card made me cry. And I cried and cried some more because I was so touched by what he wrote in it.  Sometimes a heart can only hold so much love.

Throughout the day, Shayne made contact with us through WhatsApp to check in and celebrate my birthday from afar.  And when his day was over, Sabrina was on the line from New York (same time zone) to celebrate my birthday with me.  It felt very coordinated and connected!

And then at night, Nagib and Sabrina (on WhatsApp) presented me with another gift that Shayne had conceived.  It was a small hand made journal in Kenya by Amani Ya Juu, which in Swahili means, Peace from Above.  He wrote on many pages of this journal. He pasted pictures. He wrote recipes with instructions. My favourites were “Banana Chai Protein Shake” and “Homemade Tzatziki sauce”.

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He included “Muni-isms” – things that I say way too often.  Like “worry is like opening your umbrella waiting for it to rain” and “you get what you Focus On”.  And then he got the family involved and had them write messages and post pictures.  A letter from my mom and sister are particularly poignant.  Nagib pasted a picture of Heinz Tomato Ketchup, 57 varieties, to remind me of my age — I seem to always forget!  Sabrina’s entries are heartwarming.  In one of her entries she writes, “a mom is a daughter’s first friend. And through life becomes her best friend”.  Shayne also got some of his friends involved in this project, which resulted in amazing stories and notes from people we know and love.  I heard from my mom that Shayne worked until 4 am on the day he was leaving Toronto to get the journal to a place where it was ready for my birthday.  I don’t think he particulary enjoys or likes doing this; he did it because he knew I would treasure it.

The three weeks that Shayne and Sabrina were home over the Christmas break were such a gift.

Shayne made us pancakes with sweet potatoes, and omelettes with green salsa.  He showed us that eating healthy did not mean sacrificing taste.

 

He introduced me to vanilla ice cream protein powder and skinny syrup English Toffee.  He baked Nagib a banana and chocolate birthday cake from scratch.  He listened to me without judgement; really listened to me – my fears, my hopes, my demons.  He introduced Nagib and I to the podcast “Serial” and I am hooked (I listened to all 10 episodes of season 1 in five days).  He made us promise that we would watch “Making a Murderer”, and we are hooked!

Sabrina and I spent every minute of time she was available by being together.  We talked incessantly about weddings and happily ever afters. It was a magical, joyful time!  And then 3 weeks later, just like that, both were gone, and it left a void in our home.

And today, in spite of being so many miles away, Shayne and Sabrina gave me an extraordinary birthday.  I am so touched because I know that it took time, energy and planning. I guess that’s what love and family is all about. Now if only he will accept my Friend request on Facebook!

-Munira. 

Lessons Learned – Happy 2016!

There is a wonderful anticipation about the start of a new year.  It is a time of beginnings and of heralding the future with a sense of hope and confidence.  There is a sense of newness, of resolutions and reinvention.  The new year holds wonder and promise.  But before we jump headfirst into the new year, it’s important to reflect on the past year, and the lessons learned.

Some of these are learnings I have gleaned over the years; some are learnings from friends and wise people over the ages, and some are new and emerging explorations as a very active 2015 came to an end.

I’ve learned that God never gives us more than we can handle.  And just when you’re about to give up, He gives you the strength and resources you need to slay the dragons and emerge stronger and better.  And sometimes, when you least expect it, miracles happen.  I am learning to just have faith and to trust in God.

I’ve learned that you get what you focus on.  If you focus on the problem or what is not working or how awful your life is, that is all you will see.  If you focus on what is possible and the blessings in your life, that is what you will see.  So put your focus on what you want because “your focus determines your reality.” – Qui-Gon to Anakin, Star Wars Episode I.

I’ve learned that working hard doesn’t always mean working smart.  Working hard is about putting in the hours.  Working smart is about knowing when to delegate, what efforts require collaboration, when to put in a 100% effort (and when 76% effort is sufficient), and coming up with new – and smarter – ways of doing things.

I’ve learned not to sweat the small stuff.  Some people take life’s small nuisances with a shrug, while others freak out and blow up.  What if we put things in perspective so that we focus on the things that matter most?  That way not every “small stuff” in our lives becomes an irritant.

I’ve learned that you are what you eat (and that working out is as important for your mind as your body).  This is a fairly recent discovery for me as I replace sugar, white bread and processed food with greek yogurt, coconut oil, spinach and berries.

I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel. Maya Angelou said this, and she’s right.  Enough said!

I’ve learned that you have more control than you think.  Often when I feel like I have no choice, I ask myself, “if I had a choice, what would it be?”, and my mind generates many more options.  I am learning that you always have a choice and that you must be the architect of your life.

I’ve learned that good is the enemy of best.  With my insane desire to get done things quickly, I tend to sometimes settle for the good.  I am learning that, when it is an important enough matter, it makes sense to persevere and do what needs to be done to get the best outcome.

I’ve learned the importance of balance in life between work and personal time.  I am learning that balance does not always have to be exactly 50-50.  When working on a huge project or a deal, balance may mean 80% work and 20% personal life for a period of time.  Sometimes the balance may be 60% – 40%, or some other variation.  The key is to consciously seek balance, and be fully present during personal time.

I’ve learned to trust my instincts.  When something feels right, there is alignment between the head, the heart and the gut.  If there is a disconnect – if your head says something is right, but your instincts tells you differently, don’t do it!

I’ve learned that you can be an energy giver or an energy drainer.   With each interaction, you can choose to be an energy giver or an energy drainer.  An energy giver is optimistic, positive, other-centric and real. An energy taker is often pessimistic, a victim, negative, and self-centred.  Choose to be an energy giver!

I’ve learned that gratitude is the key to happiness.  There is something inherently powerful about living in a place of gratitude.  I find it helpful to think of three things that I am grateful about each day.  Gratitude begets gratitude.

I’ve learned to be the best me that I can be.  There’s always someone out there who is more successful, richer or has thinner thighs!  Comparing yourself to someone else is a game you’ll never win. As Oscar Wilde said, “Be yourself; everyone else is taken.”

I’ve learned that money doesn’t buy happiness.  Yes, money has its advantages.  But as I get older, I realize that there are things that are much more important –  like health, family, friends, community, being passionate about the work you do and having a purpose in life. 

I’ve learned that worry is like opening your umbrella waiting for it to rain.  Researchers have found that only 8% of the things we worry about are even likely to happen.  Worrying is a waste of time.   William Inge expressed it this way:  “Worry is like interest paid on trouble before it falls due”.

I’ve learned that if you’re not learning, you’re dying.  When I was 18, I worked with my Dad who was a smart and astute businessman.  At the end of each day, he would ask me what I had learned that day.  That created a lifelong desire for learning in me. The internet, news, books, TED Talks, workshops, Coursera and edX (free online university courses), conversations with other people, experiences – all provide endless sources of information and learning.

I’ve learned that there is no greater joy that giving back.  When you give back of your time, your knowledge, your compassion, your generosity, you make the world a better place.  And what you get back from serving others is priceless!

I’ve learned that life begins at the end of your comfort zone.  Each time I have tackled something new, I come alive.  Push yourself.  Test your limits.  Step beyond what you know.  You owe this to yourself!

I’ve learned that life is happening now Wayne Dyer said it best:  “Your life is happening right now. Make it amazing. Find your voice and make a difference…Be fearless.  Don’t die with your music still inside of you. There is no greater tragedy.”  What are you going to do in 2016 to live your life fully and fearlessly?

What are some of your learnings this past year?

As we bid farewell to 2015 and say hello to 2016, may people all over the world live in peace, happiness, love and abundance.  Happy New Year to you and yours from the Premji Family!

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The Plan!

IMG_0307Toronto, December 29, 2015 — We  left the appointment with Dr. Pinchuk today with a plan and a clear sense of direction!  And as we exited the hospital, my daughter Sabrina made an interesting comment based on what we learnt from our meeting with the doctor.  She equated breast cancer treatment with a flowchart where the options are generally quite straightforward depending on the type of cancer you have.

If you have invasive ductal carcinoma, are estrogen positive and HER2 positive (as I am), then the treatment generally calls for chemo, surgery, radiation and hormone therapy.

If you are estrogen positive, but not HER 2 positive, then there is a different, “standard’ treatment option.

If you are neither estrogen, nor HER2 positive, then the treatment is typically just a lumpectomy (or removal of the lump).

In a strange way, there is comfort in knowing that breast cancer research has advanced to a stage where there is almost a cookie-cutter approach to how it is treated.  This is in stark contrast to what I experienced with lymphoma and myeloma, where the treatment was more like a complicated spider graph with all kinds of equations and computations.

Unfortunately, my case is anything but usual so the standard option does not apply.   We all chuckled when Dr. Pinchuk said that the medical oncologist, Dr. Robson, used the word “unique” at least 10 times in his report to describe my history and his recommendation for a treatment plan specific to my situation (in consultation with Princess Margaret Hospital).  Specifically, the doctors are reluctant to give me chemo because it would weaken my bone marrow and may compromise my second stem cell transplant, which I will need when the cancer from the multiple myeloma comes back (hopefully, not for a few more years).

So the plan is for me to have surgery on January 26, 2016 (a lumpectomy as well as the removal of all the lymph nodes from my armpit).  This will be followed by radiation, five days a week, for 5 weeks, one month after surgery.  There is a possibility that I may still require chemo and we will know this for sure after the results of the biopsy from the surgery.  I have been told that the surgery itself is non-complicated, and that I will be able to come home the same day.  Woohoo!  However, I have been forewarned about the discomfort and side-effects from the removal of all the lymph nodes from my armpit.

With the incredible medical care I am receiving and the encouragement and support from family and friends, I’m optimistic and ready to begin treatment!  The timing is great and, if all goes according to plan, the surgery and radiation will be completed by April 2016.  This means I can look forward to going to New York in May 2016 to see Sabrina graduate from her program.  And that is something wonderful to look forward to and celebrate.

— Munira

Playing the Hand You Are Dealt

Complex. Complicated. Unique. If I had a dollar for every time I have heard these 3 words in the last month…

Nagib & Munira Premji

Toronto, December 24, 2015.  Complex.  Complicated.  Unique.  If I had a dollar for every time I have heard these 3 words in the last month…

Every doctor and health professional I have seen has uttered these words several times as they review my case, examine me, discuss treatment options and share their concerns.  3 cancers within 3.5 years is rather unusual, particularly when there is no history of cancer in my immediate family.

Continue reading “Playing the Hand You Are Dealt”