“My Children Were My Motivation”: One Mother’s Fight to Stay Alive (Spanish)

Diane Reidy-Lagunes:
You have cancer. Your family has cancer. Cancer knows no borders or languages. However, to understand the science, the challenges, the possibilities, the prevention, and the therapies, it is easier to speak it in your language. I’m Diane-Reidy Lagunes from Memorial Sloan Kettering and welcome to Cancer Straight Talk Podcast. We want to be a source of information so that you – whether you are a patient, partner, family, or friend – feel more prepared and supported to face this fight against cancer. Today we have Elizabeth Cruz, an oncology registered nurse at MSK for over 18 years. Her role as a nurse is filled with a passion to nurture and educate patients on their journey with cancer and help them live a fulfilling life. We also have a cancer survivor, Belkis Chalas, who has lived 15 years with a diagnosis of stage 4 cancer in the small intestine. She was diagnosed at the age of 40 with two small children, and she’s going to tell us how she has been able to handle her situation, despite it not being easy. Her story will give us a new perspective on how living with a cancer diagnosis becomes a chronic condition where you can have quality of life. I'll tell you a secret: these are my people. Elizabeth has been my nurse for the last 12 years and Belkis is one of my dearest patients, and they are the best people to talk to about this topic because they live it every day. Friends, welcome to the show.

Elizabeth Cruz:
Thank you.

Diane Reidy-Lagunes:
Thanks for joining me. Belkis. I would like to start with you. Can you tell us a little about yourself and tell us about your diagnosis?

Belkis Chalas:
I was diagnosed December 23^rd of 2004. It was a diagnosis that we did not expect because I was previously being treated for a bacteria and the doctor told me it was chronic gastritis. My older sister came to visit me and invited me to come to the United States for a checkup. The doctor tells me that I have an obstruction from a previous surgery I had. He tells me that he is going to do an exploration to find out what is there. That's where my life begins getting dark because that's where they find the cancer, already very advanced in stage four, with metastasis. That’s when the darkness of my life starts.

Diane Reidy-Lagunes:
Oh, how strong. And what were your main concerns when you first got diagnosed with something so strong?

Belkis Chalas:
I really was so overwhelmed because they just didn't tell me at once. When I woke up, my older sister told me: Everything went well with the operation but they found cancer, but not any type of cancer, a strong cancer already in its last stage. It had evolved and the doctor was not giving us much hope. The next day, December 24, a date that I can never forget as long as I have life, I wake up and see so many people in the room. We are going to celebrate Christmas Eve. We, the Latino community, always celebrate Christmas Eve on December 24, but there was no such celebration because the situation was very sad. So that's where I start to think about the magnitude of what they told me. But my God, will it be that you are going to take away my children’s mother after you gave me that gift of being a mother, my God? Is he going to take their mother and leave these children orphans? In my family I had never heard of this disease. Why me? The doctor diagnosed me that I was going to live for two weeks because they didn’t think I was going to be saved, and he told me that not even chemotherapy could save my life. He was very blunt with me.

Diane Reidy-Lagunes:
That's a very, very strong road. Let's go to Elizabeth. Belkis told us that she had stage 4. Why is it important to define the stage of the cancer, and how is treatment determined in that regard?

Elizabeth Cruz:
Cancer cells are super intelligent, and their only job is to survive no matter what. They learn how to multiply and how to feed themselves. Some cancer cells gain a way to travel from the original site where they were born to other parts of the body. When cancer moves from the place where it was born to another part of the body, it changes the stage of the cancer.

Diane Reidy-Lagunes:
And how does that damage occur, that mutation? Do we know what it is caused by, what we eat or drink?

Elizabeth Cruz:
Good question. We don't know exactly what causes damage to the cells that become cancerous, but there are reasons beyond our patient's control. We know that there are some traits that put us in a higher category, for example: avoiding cigarette smoking reduces the chance of cancer, using sunscreen reduces the chance of skin cancer, drinking alcoholic beverages in moderation, and cutting down on high-processed foods. We can exercise more and eat more balanced meals. We don't know exactly why these mutations occur, but there are some things we can do to try to prevent them.

Diane Reidy-Lagunes:
Belkis, we often say that cancer is a family disease in the sense that it affects not only the patient, but the entire family, especially emotionally. What role did your family play then and now, 17 years later, living with stage four cancer?

Belkis Chalas:
Well, I would say that the role of the family is number one in one's life, because if one does not have the support of that, there is no reason to continue living. My children were my motivation. I asked God to extend my life until my children were 13 and 14 years old, so that they could do things on their own. Every time I thought I could miss my children, it made me sick and I talked to them. I would go to their bed and I would sit down and say, “I want you guys to fly high, to not be with people who don’t help you, but rather who benefit your well-being because otherwise, you will suffer. Look, if I die, what are you going to do?” And so on and so on. I mean, I balanced the situation in case I wasn't there, but they were my strong tower. My family was the one who helped me see the end of the tunnel.

Diane Reidy-Lagunes:
Sure, but you weren't born here. Your family helped you, but what was it like handling a cancer diagnosis and treatment in the United States without speaking English? What experience did you have in that regard?

Belkis Chalas:
Well, there was a situation that made it difficult for me, but I always found an angel – an angel who always helped me – in the church. There were people who spoke both languages ​​and I told them to help me if I needed to make an appointment or something, and they helped me. Then my children were learning the language. Well, I was more or less also using them for that, because the hospital where I used to go had a problem where they were always looking for someone to do the translation. Sometimes the person was not there, sometimes I had to wait, wait, wait until the person was available, because she was also translating for other people. So it was difficult for me, it was very difficult.

Diane Reidy-Lagunes:
Sure. We're going to hear from Belkis's daughter, Lisbeth, about how she grew up with a cancer diagnosis in her family and how she translated her mother’s pain.

Lisbeth:
It was not easy growing up with a mother who has cancer. It was made more difficult because I didn't know anyone who also had a mother or father with cancer, so I felt like no one understood me and I felt alone. There were a lot of hard times growing up, but the hardest thing for me, apart from being told all the time that my mother was dying, was translating her symptoms to the doctor when she was in pain. Every time she was in pain, we had to go to the emergency room and watch how they treated my mom like an experiment. She faced discrimination in those hospitals – not at Memorial Sloan Kettering – but at the hospitals where they first took her for the pain. As cliché as it sounds, I would describe my mother as very strong both physically and mentally, because she has been battling cancer for as long as I can remember. Her body has made it through a lot of surgeries and a lot of chemotherapy, and she hasn't let that get her down.

Diane Reidy-Lagunes:
Wow, a very strong woman.

Belkis Chalas:
It's hard for me. It's still hard for me to listen to my children express themselves, because as much as I wanted to prevent them from seeing that situation, they saw it. They grew up looking at their sick mother and hearing about cancer, cancer. But I was always strong. I always tried to be pretty and not let it change me. Because it is hard for an adolescent and for a child to see their mother who cannot accompany them to the park. Their mom who can't take them to the movies. Their mom who can’t go to meetings at school. I took advantage of the little moments when I felt good, and we used to go out. Always together so that they felt that they were in their family and that they saw their family as a normal family.

Diane Reidy-Lagunes:
It's a gift. Right now, we are going to listen to Belkis's son, Emanuel, and his experience with his mother's cancer diagnosis.

Emmanuel:
Myself and my sister never had the opportunity to enjoy much of our youth. When they took her out of the hospital, my mom always had this pain. You always had to go to the doctor with her and once my father was working, we just had to stay there. The most difficult moment I had to go through during the cancer process was seeing her in great pain and agony, which I do not wish for any child or anyone to see in their mother. Thanks to the Lord who has kept her alive and strong so that today we still have her, alive. I would say that she is a very strong woman. The strongest woman I have known in my entire life. Through everything that has happened, she has always cared about being there for us and that we missed nothing.

Diane Reidy-Lagunes:
We would say the same. Incredible, the children you have.

Belkis Chalas:
You know something doctor, I’m going to tell you an anecdote. My son, when he entered high school, he told me, “Mami, there are very problematic schools, many gangs. I want to learn a sport. I want to learn kickboxing.” I told my son, “Why are you doing that?” “Mommy, to defend myself if they come to hit me.” And he would act strong so that I could not say anything. Once, I told him, “Son, they beat you up a lot.” He says, “Yes.” I told him, “Please, I want you to stop that. I didn't raise a boy so they could kill him in a ring taking blows.” He tells me, “Listen to what I'm going to tell you: I'm strong. I came out of you. I’ve seen you get hit, hit and hit and you always get you back up.” So I always think of that. I had no answer. I simply kept quiet and continued guiding.

Diane Reidy-Lagunes:
We always want to protect our children but the realities and the difficult moments are when they learn, and it shows with his words. A lot of our patients go through financial difficulties, which is so challenging. Was it something that also affected you or your family?

Belkis Chalas:
Yes, too much. I thank this country because in the midst of the circumstance they gave me Medicaid, which helped me be able to face this disease and also help my husband. It had been very difficult without him because he didn't know the language, but he looked for a way to find a job. I also knocked on doors in different places to get the help that the government gave to disabled people who can't work. To be able to balance life and the system, that is very difficult.

Diane Reidy-Lagunes:
When you came to MSK, which is a cancer hospital, did you do it on your own or did you have a lawyer or someone to help you?

Belkis Chalas:
I arrived at the hospital as a reference from the person who interviewed me while I was applying for SNAPs help. So I had an interview with a doctor and when this man started talking to me, he said, “You got to the place where you had to get to. We are specialists in your type of cancer.” So now I know the name of the cancer I have. He is the one who opens my mind to everything, makes me understand and makes me see life with hope because he tells me, “You have a cancer called carcinoid. With that cancer, you are not going to die. We are going to treat it here with the relevant medications. Here we are experts in this type of cancer. People with this cancer survive up to 10 years.” Hey, this man gave me hope! Oh Lord! Oh mother! When he said 10 years, I saw that as a light that started shining. He said, “Don't worry, we're going to take care of you here.” My life changed completely! But he was wrong because I’ve already spent more than 10 years!

Diane Reidy-Lagunes:
Of course. Right now, you have a team: Elizabeth and I, who speak Spanish. How was it before, when your doctor didn't speak Spanish? And then tell us a little about your relationship, for example, with Elizabeth.

Belkis Chalas:
They told me, “We are going to put you with a doctor who speaks Spanish.” I said, “What?” Now I’m happy! When I spoke with the doctor the first time – with you, oh my God – it was there when I felt centered because I could express myself. I didn't have to have a person translate for me, to convey to my feelings. Nurse Elizabeth is like a sister to me because I adore her. She is my compatriot and I feel when I have a situation, I talk to Elizabeth and she understands me. She is always ready for any situation that I need her. I’m happy. I love you. Same goes to the doctor, I love you too. I love both of you. I feel very seen with you two.

Diane Reidy-Lagunes:
Thank you. Elizabeth, you take care of many patients who, in some cases, are much more difficult, who don’t have as positive of an attitude as Belkis. How do you reassure patients?

Elizabeth Cruz:
Well, thank you Belkis. My role as a nurse is to provide psychological, emotional support and educate patients and their families, because it is difficult when there is so much fear and so much uncertainty about, “What is going to happen to me? What's going to happen? What are the next steps?” We talk and we are always willing and available by phone or by email. And since Belkis and I have a relationship, we talk about what she likes, what's important to the patient, and we try to make sure that all of her needs are identified and that we give her resources. So listening to our patients is super important, with patience, compassion and respect. Obviously, when there is that relationship there, the same language is even more powerful because it unites us more.

Diane Reidy-Lagunes:
And Elizabeth, the American Cancer Society estimates that there are 1.8 million new cases of cancer in the Latino community. They have higher rates of preventable cancers, such as colon cancer or prostate cancer, which can be screened for. Tell us a little about what types of tests are important to go to the doctor for?

Elizabeth Cruz:
Yes, very, very important. There are things that cause cancer that are beyond our control, but there are also interventions we can carry out, such as diet and reducing smoking and highly processed foods. And these tests, or screenings as we call it, are done at various stages of our lives, because science shows us that they can detect cancer at a very early stage when we can take action to prevent it from developing. So it is important to always talk to your doctor and try to find out what answers you can get at this stage of your life. For example, for people who are between 45 and 50 years old, we recommend colonoscopies. For women over 40 years old, we recommend mammograms, because we see that these types of tests help us prevent cancers and are super important. And if you have any questions, talk to your doctor, talk to your nurse, so that they can remove those myths around screenings. There is no need to be afraid of it. They are tests that are well-tested, and we know that they help us a lot to prevent cancer.

Diane Reidy-Lagunes:
Belkis, you've spent 17 years with cancer. If you could go back and give yourself one piece of advice, what would it be?

Belkis Chalas:
Well, a very interesting question. 17 years ago, I would tell Belkis, “They have given you a medical sentence. They have given you a catastrophic diagnosis. But I have words for you Belkis: Fight! Have faith in God. Because faith is the certainty of what you expect and the conviction of what is not seen. Sometimes you ask, ‘Why me? I have been a good daughter, I have been a good mother, I have been a good wife, a good friend.’ I have to tell you that this disease has no face. It can come to a child as well as a young adult, an adolescent and a senior citizen. It does not have a face. You have just started with this disease. The first thing I’ll tell you is to fight.” The only thing I wanted was to hear people who spoke positively to me, who spoke to me like that. Now I can tell you Belkis, “Get up and fight. Put on your gloves and start fighting all the way to victory.” That's what I would say to Belkis today if I could see her.

Diane Reidy-Lagunes:
These are very important words for all of us. Elizabeth and Belkis, thank you very much for joining me. You have taught me a lot.

Belkis Chalas:
Thank you for giving me the blessing of having you as my doctor and Elizabeth as my nurse. It is a blessing for me.

Elizabeth Cruz:
It is an honor for me to be part of your journey and to be part of this team.

Diane Reidy-Lagunes:
Likewise. Thank you for listening to Cancer Straight Talk. For more information, or to send us any questions you may have, visit us at mskcc.org/podcast. Help others find this helpful resource by rating and reviewing this podcast on Apple Podcasts or wherever you listen to your podcasts. These episodes are for you but are not intended as a medical substitute. Please remember to consult your doctor with any questions you may have about medical conditions. I'm Dr. Diane Reidy-Lagunes. Onward and upward.