Ocean Breakers

ShipOfFools_web_07292016But now thus says the LORD, he who created you, O Jacob, he who formed you, O Israel:
Fear not, for I have redeemed you; I have called you by name, you are mine.
When you pass through the waters, I will be with you;
and through the rivers, they shall not overwhelm you; …
For I am the LORD your God, the Holy One of Israel, your Savior.
(Isa 43:1-3 ESV)

Ocean Breakers

By Stephen W. Hiemstra

I have known fear.

We entered 1993 with my son set for surgery, with me in a new position, and with fear after fear mounting like ocean breakers crashing on the beach. When Maryam was then diagnosed with breast cancer [1], we were being bombarded with highly technical medical information which we had no criteria to evaluate—we were just pulling our hair out.

Shortly after Maryam was diagnosed with breast cancer her mother, Naranj, came from Iran to live with us. The kid’s (Christine, Narsis, and Reza) started calling Naranj, Mama Bozorg (big mother in Parsi), and soon we all did—she was an angel who lived with us off and on for the next ten years. Mama Bozorg often watched the kids while Maryam and I were off on doctor visits.

Throughout this period Maryam was fearful that she would die of cancer, while I questioned the advice we received from the doctors. Breast cancer is insidious—it starts out as a small lump the size of an eraser on the end of a pencil when you have no symptoms whatsoever. Her mammogram showed no lump; her doctor missed it; Maryam found the cancer in a self-exam. So before anything seemed out of the ordinary, my young, beautiful wife was undergoing physical exams by numerous doctors, often in front of me, and disfiguring procedures were under active discussion. It did not bother her; it bothered me. I felt abused and violated—facing similar circumstances, friends of ours divorced. In the end, we were never again be able to have children.

Desperate to understand whether our doctors were giving us good advice, I stumbled on the website of the National Cancer Institutes’ website.[2] On the website, I found a list of recommendations for the standards of care for each type of cancer and every stage of that cancer. This was called the physicians data query (PDQ). The PDQ allowed us to determine that Maryam’s doctors were giving us state of the art advice for her treatment. Consequently, Maryam had a lumpectomy, localized radiation, and a five-year regime of tamoxifen, consistent with the PDQ.

Meanwhile, I was hunkered down in my work just trying to stay employed—no work; no medical plan.

When I wasn’t working, I was working late nights to learn a new programming language, C++, which was all the rage, in part, because it allowed object-oriented program designs to be implemented. Developed by AT&T’s Bell Labs to implement complex telecom systems, C++ programming required a much higher level of abstraction than structured programming languages, like C or FORTRAN (Complien 1992, x).[3] Fearful of losing my job and fascinated with the prospects of C++, it was hard to be fully present at home where we now had three kids in diapers and no back up.

With my parents living in West Lafayette, Indiana and my siblings located in different place, family get togethers for holidays were fun, but not always easy to manage. Maryam and I were the first to have kids at a time when everyone else had not yet taken the plunge. People tried to be flexible, but the effect was like the Brady Bunch breaking into a singles club. For example, at one point my sister, Diane, invited us to Baltimore Harbor to take a day cruise on her new boat. It sounded like great fun to me, but unable to swim and afraid that a child would go overboard, Maryam resisted; she ended up watching the kids in the hotel room while I took the cruise with everyone else. It was awkward; just awkward.

Adding breast cancer treatments to our already awkward situation meant that we were stretched both physically and emotionally. Treatments were stressful and created tremendous uncertainty. I attended important doctor visits, but, often as not, I got kid duty while Maryam went to routine appointments alone because Mama Bozorg was quite elderly. Fortunately, Maryam refused to put up with bureaucratic run-around and insisted on her appointments and was disciplined in taking her medications.

Normally, it is risky for cancer patients to go to appointments alone, because cancer leaves one emotionally impaired and doctors often do not communicate well enough to be understood without serious cross examination. It is accordingly important to have a well-informed, advocate in the room, but at least a spouse. Another reason why an advocate is needed is because appointments were often hard to schedule and medically critical for treatment, especially on the second round with breast cancer. In the years since we went through these two rounds of cancer, I have seen other patients, who were not so assertive in getting their appointments and treatments,  needlessly pass away—cancer patients need advocates.

While we anticipated the medical problems associated with breast cancer and learned that a cancer diagnosis is no longer a death sentence, we did not anticipate social and psychological effects that invariably accompany cancer. Socially, we learned that most people have an emotional threshold below which they are supportive and above which they begin to back away—it was extremely painful to watch close friends and family back away. Psychologically, cancer is often associated with severe depression among all those that are touched. In our case, we learned to deal with the depression by taking evening walks together and by getting out of the house more often—Maryam by returning to work as a teacher and Stephen by returning to leadership in the church.

[1] This pattern of stress followed by diagnosis of a medical problem in the following year has been noted in family system’s theory, especially among families that are very close. Stress compromises the immune system which can over time invite opportunistic diseases, such as cancer, to develop (Friedman 1985, 121-146). It is not unusual, for example, to observe patients in an emergency development in the hospital suffering from a wide range of physical and psychological problems after a death in the immediate family.

[2] www.cancer.gov.

[3] Data structures and functions could be tied together to create objects that mirrored the processes being modeled and facilitated new more secure error-trapping routine to reduce program maintenance. Furthermore, C++ programs also facilitated Windows programming which allowed users to run complex financial models with menus, pick lists, and selection boxes so that no programming knowledge was required. Add to that hypertext help systems and graphics and the results seemed almost magical at a time when most people did not understand spreadsheets and word processing.

References

Coplien, James O. 1992. Advanced C++ Programming Styles and Idioms. Reading: Addison-Wesley Publishing Company.

Friedman, Edwin H. 1985. Generation to Generation: Family Process in Church and Synagogue. New York: Guilford Press.

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