Child Cancer Awareness Month 2016

Child Cancer Awareness Month 2016

Be Aware

I have been acutely aware since waking up this morning that today is the 1st of September – the start of Childhood Cancer Awareness Month. I wish that I wasn’t Child Cancer Aware – not to the extent that I am now anyway. I wish that I could just roll back my life to a time four years ago when (despite my nursing qualifications) my knowledge of childhood cancer was almost non existent. Yes of course it’s important to be Childhood Cancer Aware but I wish that this was mere ‘head knowledge’ and not ‘heart knowledge’.

My ‘awareness’ of childhood cancer causes me to feel deep sadness and fight back tears every. single. day. The least wee thing can trigger this – a product display in the grocery store, a casual comment from a friend or work colleague, a memory that suddenly pops into my head.

This time three years ago Leah and I were in Bristol Children’s Hospital. The previous week Leah had been transferred out of her isolation cubicle on the Bone Marrow Transplant Unit to a beautiful ensuite room on their amazing purpose built Adolescent Unit. We had also been told the most fantastic news ever, which was that Leah’s bone marrow transplant had been successful and that she was fully engrafted. We were ecstatic. It was now going to be onwards and upwards, or so we thought.

Leah was allowed off the ward for short periods of time, so on the 2nd of September we very cheekily had a sneaky trip to the local Costa – this was strictly forbidden as Leah’s immune system was still very fragile.

Leah at Costa

Sadly our euphoria was short lived, as over the following weeks and months, side effect after side effect from the harsh treatments that she had experienced began to ravage Leah’s body, until finally – five months post transplant – these side effects also claimed her life. The cure proved as destructive as the disease.

Devastatingly, this is the reality of childhood cancer.

 

Catching a Donkey

Catching a Donkey

A few months ago, a post popped up on my Facebook page regarding a new grant that was being awarded by the Leukaemia and Lymphoma Research blood cancer charity (now known as Bloodwise), to understand and improve clinical management of hereditary blood disorders – namely some types of acute myeloid leukaemia and myelodysplasia.

I clicked on this link and read as much about this research project as I could find online. I discovered that the grant had been awarded to Professor Jude Fitzgibbon at Barts Cancer Institute in London, along with Professor Inderjeet Dokal and Dr Tom Vulliamy.

One of the genetic defects that their research will focus on is GATA2, which is the genetic defect that caused Leah’s myelodysplasia and monosomy 7. In this blog post I write about my initial reaction to being told that Leah had a Gata2 mutation.

I am very excited that this research is taking place. It won’t help Leah, as nothing can bring her back, or make us miss her any less. However ANYTHING that potentially improves the survival chances and lessens the toxic treatment side affects, for people with a similar diagnosis to Leah, is good news to me.

I immediately made contact with one of the professors involved in the research. We exchanged some emails. He invited me to visit him at the genetic laboratory in Bart’s Cancer Institute should I ever be in London. At that stage I had no plans to visit London, but “where there’s a will, there’s a way“.

Reminds me of an incident from my childhood. I was ten years old and living with a family in Muiríoch, in Co Kerry for four months, to improve my spoken Irish.

I was really excited, because Fear An Tí (the man of the house) had told me that there was a parcel for me in the Post Office a few miles away. There was no cars in our village, the only mode of transport was a donkey and cart. He said that if I wanted to have my parcel, I would have to catch the donkey in the field and hitch it to the cart.

I ran out of the house, determined to catch that donkey and retrieve my parcel. I imagined that it would contain some treats from home.

Muiríoch on the Dingle Peninsula, was a long way from my home in Cork City, so I only received one visit from my family during the almost four months that I spent there, on a Gael Linn Scholarship. It might sound like an unusual arrangement, to send a ten year old child off to stay with a family that she’d never met before, who spoke a different language (Gaeilge), but it wasn’t unusual in those days. I returned home with a fluency and a deep love for my native tongue.

Before I reached the field, Bean An Tí (the woman of the house) made him tell me that there was no parcel for me – he had been teasing me to see if I really would try and catch that donkey!

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As you can imagine, I was very upset and disappointed.

So yes, once I received the invitation from this professor, I became quietly determined to get there at some stage during their five year study.

Just to remove any ambiguity, he’s certainly no donkey and he definitely hasn’t disappointed me!

The opportunity for the visit presented itself much quicker than I anticipated, as when the girls and I were planning our trip to Bristol, we ending up including a few days in London.

I contacted the professor and we arranged a time and a date. He asked me to email him some questions to focus our discussion when we met. This is when I started to panic.

I did my nurse training in an era when nurses barely spoke to doctors. Certainly they never questioned them about anything. When I was a student nurse, Sr Bosco repeatedly told us “Keep your bowels open and your mouth shut and you will get on well in this hospital.”

It’s an inner dialogue that I had to constantly combat once Leah became seriously unwell early in 2013. I quickly discovered that as her parent, I was her voice, her defender and her advocate.

I also learned that my “gut instinct” as her Mum was sometimes more accurate than their medical training or hospital tests. Some doctors listened to me, some didn’t.

Many battles were fought (graciously, I hope) and many (but, by no means, all) were won – for Leah’s benefit, not mine.

The final battle sadly, was when I asked what my options were for Leah’s end of life care and the answer I was given was that I had no options – because Leah had respiratory failure and was on a ventilator, she would die in ICU.

Despite Sr Bosco’s near successful attempts to silence me, they underestimated the fact that they were talking to the girl who, at ten years old, was determined to run around that field until she caught the donkey and hitched it to the cart.

Thanks to the help of a work colleague and the input of a specialist in paediatric palliative care from the WHSCT – who dropped everything at short notice to make the 140 mile round trip to Belfast City Hospital – Leah died in peace and dignity, surrounded by love, in the N.I. Children’s Hospice.

I write about Leah’s end of life care here.

So a few weeks ago, I prayed and asked God to help me put together a few questions/discussion points for my meeting with some members of their research team.

The Bible says in James 1:5
“If any of you lacks wisdom, you should ask God, who gives generously to all without finding fault, and it will be given to you.”

I will tell you this, I pray for wisdom constantly, I really need it.

I managed to put together twelve questions/discussion pointers and sent them off. The professor seemed happy with them.

As the day approached, I again started to feel a little nervous, as the internal dialogue fuelled by Sr Bosco’s admonition, replayed in my head.

Thankfully, my eldest daughter decided to accompany me. She is doing a biology degree at Queen’s University which includes some modules on genetics.

We had been sent a map of the Charterhouse Square Campus where the Haematology-Oncology Centre is located and advised which tube stations were nearest. However I hadn’t thought to research how to get from the tube station to the Campus. Nor could the SatNav on my phone make any sense of the information I was giving it.

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Thankfully Rachel has excellent navigational skills that she did NOT inherit from me. We arrived at the unmanned locked security gates of the campus with just minutes to spare. I spied a young man approaching and asked if he could help us. Turned out, he works with the professor and was able to escort us right to our destination. I uttered a silent “Thank you, Lord.

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We were given a most interesting tour of their genetic laboratory. We had an hour with some members of the research team. They were absolutely lovely. We learned about their research. We also learned more about Gata2 genetic mutations and the very unpredictable way in which they can affect different people. I have increased in my understanding of how Leah’s GATA2 mutation (T354M) affected her personally.

I will continue to hope and pray that their research results in many more people who have Gata2 deficiencies surviving and having minimal treatment side effects.

As for the rest of our time in London?

I worshipped God at Holy Trinity Brompton on Sunday and enjoyed the lively style of their 11.30am service.

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Afterwards I nipped into Harrod’s Food Hall for a bite of lunch.

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On Monday, we went to London Zoo – I loved the sloth.

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Miriam definitely didn’t love the spiders.

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Rachel got up close and personal with a ring tailed lemur.

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After the Zoo we hung out for a bit in Camden. I found a Smoothie Bar while the girls shopped in Cyberdog – definitely not my scene!

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On another occasion we got henna painting on our hands and ate yummy Gujarati food at Sakonis in Wembley. We visited an Asian friend who very kindly dressed Rachel up in a Sari – I think she looks beautiful!

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The two girls also visited the Natural History Museum and Madame Tussaud’s. Our Avios Points, accumulated over many years, paid for our tickets into both London Zoo and Madame Tussaud’s.

Today, sadly, is the last day of our holidays, but we get to take all our happy memories home with us.

Blood Brothers

Blood Brothers

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This is what Leah posted on Facebook this day last year – a photo of Simon with the T-shirt that she bought him for Christmas.

It states MY BONE MARROW SAVED MY SISTER’S LIFE.

Simon’s bone marrow did save Leah’s life.

Leah died as a result of rare side effects of her treatment.

On the 1st July 2013 Leah had her second bone marrow biopsy. The initial results from Belfast City Hospital were very reassuring as they had shown no advance in Leah’s myelodysplasia.

The samples were then sent to Bristol for more detailed analysis and I asked no further questions. A lot of  the more advanced haematological investigations can only be done in England or Dublin, not in N. Ireland.

One sunny day in September 2013, as I was calmly walking down the six flights of stairs in Bristol Children’s Hospital to go do some shopping, I bumped into our lovely consultant Dr C..

In the course of our conversation, he informed me that the bone marrow biopsy samples they had received in July, had shown some very worrying changes. In his words “there was abnormal cells revving up, ready to take off”. I was gobsmacked by this information.

In that moment I understood why, in a matter of four days in mid July, Leah had gone from being fifth on the waiting list for a bed in the transplant unit, to being first.

I was very glad that I hadn’t known about these results before now – there’s only so much bad news any one person can bear.

Leah’s transplant cured her myelodysplasia and monosomy 7. However she still had to live with the potential consequences of the GATA2 genetic defect that had caused her myelodysplasia and monosomy 7 in the first place. Leah understood this.

Leah was the first person in the UK to be diagnosed with her particular variant of a GATA2 genetic defect.

GATA2 genetic defects had only been discovered in September 2011 so they couldn’t tell us exactly how Leah would be affected long term.

Myelodysplasia has a high risk of relapse, so to prepare her body for transplant, Leah had a very toxic cocktail of chemotherapy that combined busulfan, mephalan and cyclophosphamide.

The decision to use this exact combination of chemotherapy drugs was not one that Leah’s consultant in Bristol made lightly. Dr C. spent weeks mulling this over and emailing colleagues around the world for a consensus of opinion regarding what would optimise Leah’s chances of survival long term.

Simon’s bone marrow, combined with the medical expertise in Bristol, provided Leah with the best possible opportunity for surviving her diagnosis. Without Simon’s bone marrow, we could have lost her much sooner.

Leah also received excellent medical care in Belfast City Hospital. However, sadly for our family, Leah was only on loan to us.

As Leah says in her Facebook post, she and Simon “never got on“. This is true – the sibling rivalry between them was intense.

Leah was 15 months older than Simon. As a “middle child” Leah often felt that she didn’t get enough attention.

Simon attended Speech Therapy from the ages of 2 – 8 years and I spent a lot of time working on his Speech Therapy homework.

As a little girl, Leah used to be quite jealous of the amount of undivided attention that I had to give Simon. This was probably a significant factor in the intense sibling rivalry that developed between them.

In April ’13 when Leah’s three siblings were being tested for compatibility of their bone marrow, it seemed unthinkable that Simon could be “the one“.

I even asked Leah jokingly on the day that they were getting tested “If Simon is found to be the only one compatible, would you really accept his bone marrow?” I’m not sure what her reply was.

A week later we got the phone-call to say it was Simon. Leah broke the news to him with the words “You and me are going to be blood brothers.” She smiled at him and he smiled back.

From that day forward, their relationship improved. To see the lovely card that Leah made Simon to thank him for donating his bone marrow click here.

In Bristol Leah used to tell me how much she missed all of her family, including Simon.

In Leah’s short life she realised what was truly important – peace with God and the love of family and friends.

We must have done something right – she was always smiling!

We must have done something right – she was always smiling!

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Thank you to everyone who prayed for Horace & I and sent us encouraging messages for our first return visit on Tuesday past to Belfast City Hospital.

We arrived just after 8am & left again around 1.30pm. We were well supported by our TYA (teenage & young adult) cancer nurse specialist & by Horace’s sister Evelyn.

We initially spent quite a while with our Bristol haematologist & our Belfast haematologist. Then Horace & Evelyn went off for a walk in the sunshine while I went “walkabout” in the hospital with our TYA nurse.

She and I visited the Bridgewater Outpatients Suite & ICU & some other places. I was able to show my appreciation to some of the many staff who had been very kind to us.

When I was thanking the nurses in ICU one of them remarked “We must have done something right, for she was always smiling!” It was true – as Leah lay in ICU on a ventilator, she smiled and laughed and hugged people she cared about and told us that she loved us. If she caught me looking sad she pulled up the corners of my mouth into a smile with her fingers. She radiated joy and peace. She knew that death was a possibility and she was ready to meet God.

I had some very positive conversations on Tuesday with various members of staff who were involved in caring for Leah. Although difficult and painful for me, it was also very healing.

An extra bonus before leaving the hospital was a meeting for coffee with a mum from Ballymena whose child had a bone marrow transplant in Bristol around the same time as Leah. Her child is slowly recovering. My friend and I had a great chat, we had so much catching up to do.

Horace & I then met with our eldest daughter Rachel for lunch in the nearby “Mad Hatter” cafe that we used to go to when Leah was with us. Some of the staff recognised us and sympathised with us on our loss.
I really felt upheld in prayer throughout it all and I felt a deep sense of peace in my heart – thank you all so much.

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The main purpose of the meeting with Leah’s Bristol haematologist & her Belfast haematologist was to discuss the findings of the mini post mortem that had been done on Leah’s lungs.

After Leah died a biopsy was done on Leah’s lungs and a tissue sample taken. I wasn’t overly hopeful that there would be any major revelations from this. I was just hoping that there would be no “nasty surprises” i.e. I was hoping that the pm would NOT tell us that Leah had in fact died from an illness that could have been prevented or treated, if it had been diagnosed in time.

From that point of view it was “good news” – they tested the tissue sample from her lungs for everything they could think of testing for and EVERYTHING came back negative, so Leah’s cause of death remains “idiopathic pneumonia syndrome”.

Wikipedia describes this as follows – “Idiopathic pneumonia syndrome is a set of pneumonia-like symptoms (such as fever, chills, coughing, and breathing problems) that occur with no sign of infection in the lung. Idiopathic pneumonia syndrome is a serious condition that can occur after a stem cell transplant.”

The doctors on Tuesday gave us all the time we needed – we discussed lots of different aspects of Leah’s illness and we talked about our memories of Leah herself too.

"I only have eyes for you"
“I only have eyes for you”

Leah had a GATA2 gene mutation – this type of genetic defect is rare and was only first discovered late in 2011. Leah was the first person in the UK to be identified with her particular variant of it. Leah’s bone marrow transplant cured her myelodysplasia and monosomy 7 but could not eradicate the underlying genetic defect and Leah understood this.

After her transplant Leah asked Dr C what other ways this genetic mutation could affect her body but he explained that as research into GATA2 genetic defects was all so new that this information did not exist as yet but as it became available from other parts of the world then he would pass it on to us.

I have now asked Dr C that as future discoveries enable them to retrospectively make sense of the jigsaw pieces of Leah’s various symptoms and complications that he will come back to me and tell me, as my brain likes to make sense of these things. In particular, the spontaneous spinal fracture that Leah experienced after only 3 months on steroids is not fully explained. Her steroid therapy had actually been discontinued the month before her spinal fracture was even diagnosed.

Nevertheless Leah has now received the ultimate healing and is rejoicing forevermore with her Saviour in heaven. I like to listen to these words by Matt Redman and imagine what it’s like for Leah to no longer have a broken body –

“Endless Hallelujah”

“When I stand before Your throne
Dressed in glory not my own
What a joy I’ll sing of on that day
No more tears or broken dreams
Forgotten is the minor key
Everything as it was meant to be

And we will worship, worship
Forever in Your presence we will sing
We will worship, worship You
An endless hallelujah to the King”

Psalm 116:15-17 Living Bible (TLB)
His loved ones are very precious to Him, and he does not lightly let them die.”

On Thursday 22nd May ’14 some special people have arranged to take me to see/hear Matt Redman playing live in Belfast – I’m so excited but I know it could be emotional too.