Relapse

In the summer of 2007, Dalal decided that we spend the summer in Philadelphia. Coinciding with my 8th birthday on 07/31/2007, we were on our way to the United States again. It was a good opportunity to have CHOP run additional tests and make sure she was healthy and stable. We lived in the same apartment building (St. James) and spent a wonderful three month vacation in Philly. The hospital's test results were all good and there was no indication of the disease returning. Several months after our return from the vacation, in January 2008, we were having a barbecue dinner in our yard. The weather was cold, and I remember Dalal insisting to stay outside and help my mother. The next morning, she had a headache and couldn't go to school. The pain only got worse and moved to her left ear. She was hurting and couldn't even tolerate the lights of the house; they made her headache worse. In respect to her, the house went completely dark for a few days. When she was taken to an ENT (Ear, Nose, and Throat) specialist, his diagnosis was a sore throat even though she didn't feel any pain in that area. She was eventually given a dose of morphine to alleviate the pain. The next morning, she was taken to the same hospital she received her chemo in (King Faisal's hospital). They decided to halt the maintenance therapy even though it only had one month left. The tests performed showed an ear infection that required her to take two strong antibiotics. After three days, it was discovered that the bacteria was resistant to one of the antibiotics, so they switched it with another one. Dalal suffered from excruciating pain in this condition for a whole month.

She was extremely happy to hear that the doctors were going to perform a surgery to extract the pus and fluids. When a child is that happy that they will undergo surgery, it truly reflects how much pain they are enduring. After days and days of suffering from awful diplomacy and terrible patient service that left dalal suffering and my parents furious, the operation finally took place. Test results showed that the severe infection and late diagnosis led to a perforated eardrum (hole in the eardrum) and severe hearing loss. A procedure called tympanoplasty (eardrum repair) needed to be performed to fix this. The doctors decided to postpone this procedure until the maintenance therapy was over. The final therapy dose was given on March 16, 2008. The doctors congratulated her and told her that she was now as healthy as any normal person. Her test results were very positive; there were absolutely no traces of the tumor and it was concluded that radiotherapy was not required. When summer came, we decided once again to head to Philly for the vacation. However, my parents also decided that Dalal would undergo her eardrum repair at CHOP after the unnecessary suffering they went through in the current hospital. We took off on July 5, 2008, but this time without my father as he had to stay to take care of his ailing mother and attend important work meetings. Once more, Dalal chose the St. James apartments.

A week later, the ENT specialist at CHOP took a look at Dalal's ear and found that the hole comprised 75% of the eardrum. They urged for the eardrum repair to be performed as soon as possible as further delays could lead to severe repercussions. The oncologist had to approve this operation first, after making sure Dalal's condition was stable enough. A few days later (July 15, 2008), she examined Dalal and was very pleased with her health condition. She performed a CT scan (computerized tomography) of the upper body and the results were pleasant. This type of scan is a more sophisticated form of normal X-rays where 360-degree X-ray beams are used to produce cross-sectional images of the body. The oncologist had never seen Dalal that healthy before and knowing that she successfully completed the chemotherapy, she immediately gave the green light for the operation to be performed. Before leaving, however, she scheduled an appointment a month later for a PET scan (positron emission tomography). This scan uses a glucose (sugar) solution that has radioactive tracers in it. The solution is injected into a vein in the arm and the body organs and tissues absorb it. Since cancer cells often consume more glucose than normal cells, they can be "seen" through the radioactive tracers. PET scans are able to detect cancer cells that CT scans or MRI (magnetic resonance imaging) cannot normally detect. Later on, my father was left wondering why the oncologist scheduled the PET scan a month later and not on that particular day; perhaps it was fate. Nonetheless, the eardrum repair was scheduled to be on September 15, 2008, exactly two months after the oncologist's appointment.

Meanwhile, despite this complication with her ear, we decided to enjoy our vacation and make the most of it. Dalal had endured so much for the past two and a half years; she triumphed over the malicious lymphoma after a fierce battle that saw physical and emotional pain, constant nausea, sleeping problems, frailty, and the desire to cry over the slightest agitations. But there she was, standing victorious over cancer. If she beat the emperor of all maladies, there was no way she was going to let an ear infection get the best of her. Suddenly, tension began building up when something unexpected happened. Dalal complained of the exact symptoms that she had two and a half years ago (March 2006); pain in her left shoulder, loss of appetite, and fatigue. Fear struck my mother, hoping to god that the cancer was not resurfacing, especially since just a few days ago her oncologist ensured that she was completely fine. The scheduled PET scan appointment was only a few days away, so my mother anxiously waited. When the day came and the oncologist examined her again and performed the PET scan, she reassured my mother that Dalal was completely healthy and claimed that the symptoms were most likely a result of the ear infection. However, she noticed that my mom was indirectly expressing her fear of a relapse so she asked her to wait until the PET scan results were out for a definitive answer.

My mother and Dalal returned home as the results needed a couple of hours to come out. At 6:00pm on August 15, 2008, my mother got a call from the oncologist asking her and Dalal to immediately come to the hospital with spare clothes, not disclosing why. They immediately sensed that this phone call was ominous and were extremely worried and tense. When they arrived, they felt a despondent atmosphere and an unusual reception from the hospital crew. The oncologist sat right next to Dalal and looked my mother in the eye saying,

"Unfortunately, Dalal's cancer is back."

Those five words spiraled a whirlwind and erupted an earthquake in my mother's and Dalal's hearts. Those five words abruptly and painfully changed our lives. My mother froze in disbelief and could not even speak. Dalal panicked and screamed in utter shock, quickly asking the oncologist,

"What do you mean?!"

"Unfortunately, Dalal, the scans showed that the lymphoma tumor grew again."

That's when my sister erupted and cried in anger and sorrow to the point where no one around her could dare to calm her down.