Machboos

I’ve recovered from my first surgery, so it is time to move on to the next steps of my treatment plan.  The results from my pathology report have determined what will be next for me. The results are scary, but I am reassured that my choice to have a double mastectomy was the right one.  My left breast is where I found my lump and that tumor is measured at > 2.1 CM.  The measurement is not exact, because the main mass is surrounded by smaller deposits of tumor cells. So the left breast is described as being “extensively involved by carcinoma in the left half.  The surgical margins are narrowly free of carcinoma”, which means that I will need to do radiation.  They also found a tumor in the right breast which is only 2 mm.  The surgical margins are clear, so I won’t have to do radiation on the right side.  There was a removal of 7 lymph nodes 6 on the left and 1 on the right side, the one on the right came back negative and 6 on the left that all came back as positive, which means I will have to do chemo.  During this time my cancer stage is still undermined.

My breast surgeon gave me a list of various medical and radiation oncologists.  Based on my pathology she thinks the treatment plan is going to be chemo followed by radiation, so she suggested that I choose my medical oncologist first.  There about five medical oncologists on the list.  I have no idea, which will be better than the other, so I go in the logical order.  Call the first person on the list.  I never got a response, so I move on to the second person on the list and was easily able to make an appointment.

The morning of my appointment I am completely nervous.  My two friends Amanda and Jeff arrive at my house and we walk to the appointment.  I feel my tension, but it stays at a minimum as we tell jokes and giggle with each other.  At the office they take my weight, temperature, and blood pressure then wait for the doctor in an exam room.  The oncologist comes into the room and greets all of us and invites us back to his office.

He goes through the pathology report with us again, concentrating on the 6 lymph nodes that are positive.  This, he explains is a significant number to have positive.  “We typically see only one or two lymph nodes that are infected but you had six.  Six were removed and all six came back positive.  Based on this you are at least stage III.  We will need to determine if it has metastasized, or spread through other regions of your body.  The most common places for breast cancer to spread is in your lungs, bones, and liver.  We will have you take a PET scan to see if it has gone to any of these areas.  If it has, then you will be stage IV. ”  Each point he delivered with an awkward smile.

The oncologist continued to explain, “We don’t know what stage you will be, so let’s go over the treatment plan as if you had stage III.  I will recommend that you do chemo.  If you don’t do chemo the chance of reoccurrence will be about a 50% and if you do chemo the chance is closer to 10%.”

Amanda interrupted, “Okay, well that sounds like pretty good odds.” She stares at me.  To me this sounded like awful odds.  I just nod a bit too numb to say or ask anything.

The oncologist continues, “I am going to recommend that you do 5 months of chemo. There is a 3 month option, but it is a bit newer and with the extensiveness and how young you are I would recommend the 5 month.”  He writes the two drugs on a note pad and I don’t hear it all as I’m wrapping my head around 5 months of chemo.

As my mind comes back into the room, I ask, “What are the side effects?”

He answers, “You will have hair loss.  You will lose your hair, eyelashes, eyebrows.”

A lump in my throat forms and tears start to well up in my eyes.  I am totally taken aback. Since I was told the pathology results I had known I will do chemo.  I have come to terms with the fact that I was going to lose my long hair, but it never dawned on me that all the other hair on my body would be effected.  I love my eyebrows and the news that I will look like an alien just shocks me!

Amanda asked, “I had a friend and she did some treatment with chemo and didn’t loose her hair.  Is that an option?”

The oncologist hesitates and with an awkward smiles and answers, “I would not recommend it in her case. ” He looks at me, “There is a treatment where you can freeze your hair.  You bring ice packs and you put them on your head every 30 minutes.  You will have either 12 – 16 treatments and they are fairly lengthy.  So you will need a friend with you, a cooler, and multiple packs.  It will end up being a burden and there is no guarantee it will work.”

He continues on with the other side effects, “Nausea. We will give you medicine to help you combat the nausea.  You’ll likely experience fatigue and your menstrual cycle will likely stop.  He asks do you want kids?”

I respond, “No.”

He asks, “Do want kids in the future?”

I respond, “No. How about tastes?”

“On some of the treatments taste buds can be effected. This is different for everyone.”

Jeff asks, “How about drinking. She likes to drink.”

He says “Yes you can drink. I have one patient who is younger and she likes her wine.  We monitor your blood levels and saw that her liver numbers were going high and we went to the board as it is not normal for the chemo to be doing this.  I chatted with her and found she was taking tylenol after drinking.”

“Ohhh”,  Jeff, Amanda, and I all said in harmony.  Tylenol and alcohol don’t mix, we are not amateurs here!

He says, “Yes, so we will watch you every week and if we see an issue we will let you know. You will have blood drawn at each appointment and we have a blood lab here to do the measurements.  Your body may not like drinking any more as well.  It will let you know.” After a pause and no more questions from us.  “Okay, after chemo you will have radiation. We will then recommend that you go on a hormone therapy that will stop the estrogen in your body.  This is a daily pill that you will take for 10 years.”

I asked, “Why?  I thought it was 5 years.”

He answered, “Studies have shown that 5 is okay in people that are older.  You are very young and to keep the chances of this growing, I’d recommend 10 years.”

Jeff asked, “What is her survival rate?”

He responds, “It’s really scary you don’t want to know.” He gives an awkward smile and responds, “Well there are tools and things I can plug in and give you a number, but it doesn’t really matter as this is about what happens to you.  Those are based on a larger population.  I don’t recommend we look at it.”

Jeff starts to tear up.  I look at the doctor and say, “He cries for me so I don’t have to.”

Jeff says, “Stop making fun of me!”

“Someone has to.” I explain. We all laugh and the tension in the room is released a bit.

He starts to wrap up our appointment, “so the next step is to get you a PET scan booked.  If you have stage 4, none of this treatment will matter.”

I ask, “What will the treatment be?”

“It depends on where it has spread and what has happened.  There are too many possibilities to look at now.” He responds with an awkward smile. “Let’s first see what the results are and take it from there.”

This seems prudent.  So we say our goodbyes.  He walks us to the receptionist and I make an appointment.  I am thankful for my friends being there Amanda is organized and, well, Jeff cries for me.  We all go to lunch to process the information together.  Our conclusion is that we like this guy.  He smiles awkwardly at bad news, but I find it strangely endearing.   I see no reason to shop for another oncologist.  He won me over with his quirky smile, intelligence, and how he handled our questions.  He was honest and straight forward; I left feeling like I can trust him, which is great progress.  However, I can’t help feeling sad and depressed.  The reality of how long the process is going to be and how much of myself and lifestyle will be affected.  It is a shock and so instead of facing it, I am going to make some yummy food while everything still works.

In Bahrain there is a common dish mixed of meat, rice, vegetables, and spices.

It is an Arabic dish in the Persian Gulf it is called machboos, where in other areas of the Middle East it is called kbasa.  The version I am making is a chicken and rice that is claimed to be traditional in Bahrain.  It sounds yummy.  Comforting, and perfectly distracting.

The recipe calls for black dried lime… I have no idea where to find that!  I look up and find that it is indeed black dried lime.  You can get it as a lime, or ground into a spice.  I go to a Middle Eastern store and don’t see any.  A bit more research and the spice is named limoo. I have a spice store near by and talk to them about it and they introduce me to a Persian lime spice or lemon omani, which is ground black lime.  When I was a kid I used to eat dried lemon peel and the seasoning reminds me of that smell.  It has a tangy citrus quality.

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The recipe calls for a seasoning mix called baharat.  This is a spice mix that is used in various Middle Eastern cooking.  There is a version called Gulf baharat or kebsa.  This is of course a spice mixture more commonly used in the Persian Gulf region.  As I am cooking Bharian food I use this version of the spice mixture.

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Then season the chicken with the baharat, turmeric, cumin, and cardamom.

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Cook the onions with the lemon omani.

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Then add the chicken to the pan and add the remaining ingredients.  The chicken cooks for an hour.  After I remove the chicken and broil while the rice cooks in the stock.  I serve the chicken over the rice.

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I thought the chicken was overcooked and a bit dry.  I probably should have used a thermometer or cooked just the dark meat.  However the rice is flavorful and delicious.  It is reminiscent of chicken and rice my mom makes, but with much more flavor and complexity.  It is a perfect comfy distraction to an information heavy day.

 


Recipes

 

Gulf Baharat

 

Machboos

Original Recipe can be found here

  • 4 1cups water
  • 3 cups basmati rice
  • 1 can diced tomatoes
  • 1 chicken, cut in half
  • 3onions, finely chopped
  • 1cup cilantro, chopped
  • 1 jalapeno pepper
  • 1 teaspoon ground lemon omani (dried black lime)
  • 2 teaspoons baharat spice mix
  • 1 12teaspoons turmeric powder
  • 1 teaspoon cumin powder
  • 2 teaspoons cinnamon
  • 1 teaspoon cardamom powder
  • 2 garlic cloves, minced
  • 1-inch ginger, grated
  • 3 tablespoons butter
  • 1cup lemon juice
  • 3 tablespoons olive oil
  • 3 teaspoons salt
  1. Cut the chicken in half.  Heat the water and leave aside.  In a small bowl, mix the baharat, turmeric, cumin, and cardamom together and add to the mixture one teaspoon of salt.  Sprinkle half of the spice mixture on the chicken halves.
  2. Heat oil in a large cooking pan, fry the onions until golden brown, then add to the pepper and the black limes.
  3. Add the chicken to the onion mixture and turn it over a few times in the pan. Sprinkle on the chicken a teaspoon of cinnamon and the rest of the mixed spices. Turn the contents all together so the chicken is coated with the spices, cover the pan and let it cook on medium heat for 3 minutes.
  4. Add the garlic, chopped ginger, and tomato cubes to the pan and turn the ingredients in the pan a few times.  Cover again for 3 minutes on medium heat.  Sprinkle with the rest of the salt and pour water on while its still hot.
  5. Cover the pan and let it cook for about 1 hour, or until the chicken is cooked.  Add the chopped cilantro 5 minutes before you remove the chicken from the stock in the pan. While the chicken is cooking, wash the rice well and soak for 10 minutes in cold water, then drain.
  6. Remove the chicken from the pan and put on an oven tray, brush with some oil and sprinkle with the rest of the cinnamon powder and grill in the oven until the chicken is golden brown.
  7. Add the rice to the chicken stock, stir, then let it cook on low heat until the rice absorbs the stock and is almost done.
  8. Sprinkle with lemon juice over the rice and place the butter pieces on the top.  Cover the pan and cook on low heat for 30 minutes.
  9. Serve the rice on a large serving plate and place the grilled chicken halves on the top.
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