Will I know how to say goodbye? To say goodbye to my Nevisian family and a magical paradise in the Caribbean, a place that has been my family’s world for almost 20 years. Will I know how to say goodbye to my patients and friends while still maintaining a smile? Will I be able to accept, understand and be thankful that I lived each year there so profoundly, but that it’s now time to say farewell? Is it time to leave my house that I drew and dreamt of as a child, for someone else to occupy?
I already left physically seven years and seven months ago. I already closed my office, initially furnished with six plastic chairs, slowly becoming equipped with all possible furniture and equipment that two Cuban medical graduates, starting their professional lives, could afford, serving to the best of their abilities. I was not there when the sign that was erected 19 years ago was taken down. I prayed from afar, overseas and thanked YOU for being part of my life.
I have been writing to YOU, my brothers and sisters from around the world, but especially to my fellow beloved citizens of Nevis, where I started my island life in 2003. I wrote with the humble purpose of creating awareness of the many illnesses that can be prevented, and especially to highlight the great importance of positive living. I wrote and campaigned tirelessly, despite the challenges of language, from my office and public spaces such as banks, churches and community centres. I always laugh when I remember the many terrible drawings I used in my efforts to explain their medical conditions to my first patients. My English skills started in Nevis. You guys were so patient!
My children and I left Nevis in January 2018. After 3 months in Sweden, I learned that the cancer that entered my world in November 2012 was back. From April 2018 until now, my physical body and my spirit have been challenged in indescribable ways. It has not been an easy path, physically and even more emotionally. I had many reasons to succumb to depression and defeat when medications only worked for short periods and needed to be changed again and again. When I am asked if I often think about my mortality, I refuse to talk much about it. Do we hold our future? Only Almighty God does. Only He knows when and how. I decided that with any healthy cell in my body (including the ones in my brain), I have to keep swimming to live. I well understand that we are not eternal, our time will come, we may die of anything at any moment, but if death is not coming today, life is a given blessing to treasure.
Many ask me how I am calm, positive, friendly, and loving most of the time. How can one die if there is still a lot to give? When death comes, and it will come, I will go. Today I am alive. I am honestly completely happy most of the time. A stage four cancer patient can be completely happy despite daily challenges.
The journey of each one of us “cancer warriors” is completely unique. Some may develop breast cancer due to:
Non modifiable factors such as:
Age: The risk of breast cancer increases with age, with most cases occurring in women over 55.
Genetics: Inherited gene mutations, particularly in the BRCA1 and BRCA2 genes, significantly increase the risk of breast cancer.
Family History: Having a first-degree relative (mother, sister, or daughter) with breast cancer increases the risk.
Reproductive History: Factors like early menstruation (before age 12), late menopause (after age 55), never having children, or having a first child after age 30 can increase risk.
Dense Breast Tissue: is more prone to developing cancer. Previous Breast Cancer or Benign Breast Conditions.
Modifiable Risk Factors:
Smoking, obesity, hormone replacement therapy, unhealthy diet (especially high-fat/high calorie diets), exposure to chemicals such as those in pesticides, physical inactivity, alcohol consumption.
At the beginning of my journey I thought I did not have any of these factors but genetics studies done in the past two years have shown that I carry two types of mutations that are linked to cancer: ATM and PTEN as well as an expression of the famous BRCA2 that prompted American actress, Angelina Jolie, to remove her two breasts and womb. Even though Jolie did not have cancer, her mother had died of ovarian cancer at a relatively young age.
In addition, there was the issue of something called a Ki-67 score. A high Ki-67 score indicates that a large proportion of cancer cells are actively dividing, suggesting a more aggressive tumor that may grow and spread faster. That test was done after my surgery in Cuba in 2012. A value of more than 30 is considered high and with a high risk of recurrence. My Ki-67 score was higher than that from the beginning. The staging of the cancer was 2B. It had only spread to one lymphatic node, but not even completely. Like any other patient, I had hopes that it was the end of the journey after eight chemotherapies. (The first chemotherapy was done in Cuba, two at Dr. Erole Hobdy’s office at St. Thomas, USVI, and the last six at Dr. Hobdy´s office across from the Alexandra Hospital in Nevis, along with other cancer warriors.) What a blessing her services meant at the time for many patients, including our sisters in St. Kitts and other nearby islands. Now there is comprehensive oncological care in St. Kitts.
After the eight chemotherapies, I was advised to take daily Tamoxifen tablets to prevent cancer recurrence. I did this for six months, but it caused thickness of the inner lining in my womb (hyperplasia of the endometrium), excessive bleeding and anaemia. Each type of cancer has its hormonal peculiarities. The type discovered in my body is Estrogen and Progesterone positive and ENHERTU negative. So I am to avoid anything that can raise the level of those hormones. I decided in 2014 to have my womb removed to avoid the excessive bleeding and to remove my ovaries to decrease estrogen levels and further complications. Despite all this, in 2015, during a three-month checkup in Puerto Rico, I was told that there were two enlarged areas in the infraclavicular area on the same left side where I had removed my left breast in Cuba. They suggested 25 radiotherapies. I was devastated, my body had hardly recovered from the extensive breast surgery, eight chemotherapies and the womb/ovaries surgery. How was I going to go through 25 radiation therapies?!!
My children were only six and eight at the beginning of my cancer journey; in 2015, they were nine and eleven. In all their wisdom, they wrote an unforgettable card to me, asking me to be strong, to never give up. When I abruptly travelled to Cuba in 2012, ten days after learning of the high suspicion of cancer, my son gave me his favourite teddy bear that he had named Mr. Brave. He advised me to hold him tight when I was feeling alone and scared, and I would feel his strength. I still always carry Mr. Brave with me. He comes with me to MRI scans, CT scans, treatments, doctors’ appointments and more.
I finished the 25 radiotherapies. I then managed to get an insane amount of money required to pay for six months of oral chemotherapy. My insurance covered it partially. I needed to take a loan to cover the rest, and help came without asking or expecting. An event held in my honour at Gillian Smith´s Bananas Restaurant at Hamilton, Nevis, will forever remain in my heart. My dear nurse and sister, Roxane Brookes, drove me there. The car park was packed; there were so many people from all walks of life contributing to this fundraising event. I always have problems accepting help. I hardly complain even to my own family. It is not easy to feel like a burden to your loved ones, in spite of them saying the contrary. Irene Macek, once my patient and then my guide, lovingly “forced me” to share my ordeal. My sisters from our NGO, “The Nevis Maternal Health Fund” (NMHF), formed in 2003, were on board, along with many others. In that ceremony, the family of my angel, the late Ruby Chapman, gave me a beautiful trophy that Ruby had left for me before she passed away. That trophy was made especially for her as the best female cricketer on the island. She had treasured it greatly and knew how much I admired her sporting achievements. That was the most precious gift.
The story of Ruby Chapman is, for me, the epitome of community love. With amazing speed, our community contributed and brought her back home, after almost a year on her own in Cuba with a very advanced cancer, unable to pay hospital bills. We all helped her purchase expensive painkillers until the day she rested. I love you, my sweet Nevis. Helping Ruby and others in the community brought healing to my soul. It is an honour to be part of such a loving community.
I will always be grateful to YOU for welcoming us to your island, sharing your blue sky and water, your streets and roads with us. I have witnessed and celebrated with you the many achievements made in different areas. YOU may not see it that way, but our Nevis is magical, blessed, special. I love the saying “We little but we Tallawah”.
My daughter was born at our hospital, and both children have often participated in the annual Christmas concert, waited in our car or on the maternity ward while we performed surgeries or other procedures. That hospital is part of them, as it is part of my husband and me. Our medical office in its three locations during those years in Nevis is part of their story, as are the different schools they attended, the many events they participated in. Our Church of Christ on Government Road was their second home. Pastor Denzil Roberts and his wife, Joan Roberts (Mommy Joan), carry the title my mother gave them, “J and J’s real grandparents”. I have met people who have become part of my DNA and will forever be part of my loving memories: people rich and poor, blue and green, Nevisian, Guyanese, Dominican, Indian and more, have added to the rainbow of my life.
My son, Jonathan, came back home in 2023 for a few days before heading to St. Lucia to represent St. Kitts and Nevis in swimming, with pride, securing a medal. He learned to swim at Oualie beach. Water has always reminded him of home and has kept him focused during his life here in Sweden. He is on his way to Paraguay to again represent St. Kitts and Nevis on the continental stage. My daughter has continued with karate, even if she needed to start all over from white belt, twice, in two different styles, as the American Goju Ryu learned under Sensei Maynard, Stacy and George is not taught in Stockholm. Their values and solid foundation that carry them until today were given by educators in Nevisian schools, by members of our church and from many of you. The little girl and boy of six and eight at the beginning of my cancer journey are now 19 and 21, well-grounded, caring young adults in university. YOU, my Nevisian people, have a lot to do with their progress and success. We are forever grateful.
Despite severe challenges of the constant cancer treatment while in this, my new home, Sweden, I have been blessed to accompany my J and J (Josselyne and Jonathan) in a completely different life journey, as two black Caribbean teenagers trying to integrate into a northern European society. A new language needed to be mastered. Thank God they inherited the ease of learning languages from their father. I could not help them at all. They needed to quickly learn how to take buses and trains to go from point A to B. They did not have me as a “chauffeur” like in Nevis. A villa on an acre of manicured land was replaced by a small apartment, but love converted it into our palace. Resilience, gratitude and faith are a current that forever will run in our blood. God has brought me/us to Sweden. Only He knows the reasons.
I learned the Swedish language for almost a year; languages are difficult for me. In between treatments, I did all that was required to get my license as a doctor. It was not an easy task, as I do not come from the European Union.
After the confirmation that the cancer was back in different lymph nodes just three months after we arrived in January 2018, I have never had a break from treatments. I learned that at this stage of the disease I am dealing with, and because of its peculiar characteristics, lesions disappear for some time but are most likely to come back. I have been prescribed different types of medications, some oral, others intramuscular or intravenous and used them until they stopped working. I need to have an MRI, a CT scan, a mammogram and an ultrasound every three months and a blood test weekly. I have used five different regimes, each one of which has caused diverse side effects. I have even had “clear of disease” statements on several occasions.
Notwithstanding this crazy roller coaster of physical and emotional turmoil, I acquired my registration as a medical doctor in Sweden. I was given the honour to serve the female population here in Stockholm. I have served Swedes along with people from many other parts of the world, such as the Middle East and Africa. Many of my patients are refugees from countries at war. What a rich experience! This went on during the process of getting my license as a gynaecologist, which was going to take me triple the time stipulated, as I can only work twice a week. However, in December 2023, my new, calm life routine was shattered once more.
Because of mild headaches and dizziness, I requested a brain scan. Brain metastasis is a common reality, and even more so when metastasis already exists. I wanted to be wrong. But the results came back showing two tiny spots suggestive of cancer. I needed to stop my plans once more to get ready for brain radiation. This was done in April 2024. I accepted that I needed psychological and even psychiatric help. At that point, my type of chemotherapy was also changed. I had two scary daydreaming episodes. In one of them, I vividly let my body go in front of a train in motion and the other, I sank in the ocean, and I was happy that all was over. When I came back to myself, I knelt in prayer. All those medications can cause suicidal thoughts. I have been under so many treatments for 13 long years, and they have had an accumulative effect. I knelt in prayer and asked for help. The only help that heals is the one that comes from our Almighty. He never abandons us. He has never abandoned me. He continues caring for me.
Believe it or not, I am shy, and honestly, I would prefer to keep things private; that is why maybe I did not write for so long. It is not easy to feel “naked” while sharing difficult moments, but there is no point in keeping them to myself. I have benefited from many cancer warriors’ stories that “normalise” the many things that have happened and can happen to me during this difficult journey. I pray that if YOU or your loved one is one of them, their journey is way easier than mine.
Six months after the first brain scan, three other small spots appeared. This led to a second brain radiotherapy. A follow-up brain MRI done just two weeks ago showed a small decrease in four of them. One is a fraction bigger, and a tiny new one is suspected. Other lesions in my body have miraculously disappeared, and the one in the chest is much smaller. If in the next three months the small suspicious one in the brain persists, radiation therapy to that one may be done.
The main side effect I deal with daily is chronic fatigue (tiredness that does not go away even if you sleep), but my cognitive abilities are still intact. Amen. The treatment I am currently undergoing was approved for use in 2022. It did not exist when I first got diagnosed in 2012. There is hope. Science is advancing, and YOUR prayers have helped me through the years.
Many ask if I am not scared to share my story. Many state that not everyone wishes others their best. I heard to my dismay that I was already dead. I heard the same for some of my patients. I am not dead. I am still here. I share because I will always believe in the goodness of people. I believe in lifting each other, in not losing time because life is too complicated and short to give our energy to unimportant things. We are all HERE and NOW. We only have this life to be happy and spread our knowledge and love to make others’ paths in life better than ours.
I am writing to you while holding a ticket from Stockholm to St. Kitts, waiting for the last eight hours to pass before heading to the airport. There is no Corona restriction to worry about. Despite my health reality, I am strong. My wonderful team of oncologists gave me the OK to travel!!! I am coming home after almost eight years.
I’ll say goodbye physically to the three locations where I had my office, and I will say goodbye to the people in my church, my colleagues, and many of you. I will say goodbye to my house with its many trees, some of them planted by us on special occasions like J and J´s birthdays and growing at the same time as my children.
I am coming home and saying goodbye, not because I am dying, but because I am not saying goodbye to life. My love for life, my belief in collective prayers and trust in our Almighty is way stronger than my fear of dying. If we do not feed ourselves with faith, we are feeding the illness. I will say goodbye because, realistically, I do not know if the brain metastasis I am dealing with now will eventually affect my cognition, but it may never happen.
I am hopeful that the next results scheduled for September will be even better than the last ones, and I will be able to keep serving in any capacity possible in my profession, in a place the Lord decided is my home.
I am returning to my beloved Nevis a bit more fragile than before, apologising in advance as I know it will be impossible to visit and interact with many of you. Many know how much I treasure a warm hug. Apart from the brain radiotherapies I had, I am presently under weekly chemotherapy. I wish I were physically as strong as before to go to the community centres and give a public presentation as I did in the past. I wish I could participate in one of our breast or cervical campaigns and examinations around the island, but instead, I would be meeting only a few of you.
I hope I may be able to meet some of you in person on the two following occasions:
After the 7-9 p.m. Bible class on Tuesday, 12th August at the Church of Christ, Government Road, Charlestown
At 7 p.m. Wednesday, 13th August at Henry’s Memorial Wesleyan Holiness Church, Buck’s Hill, Gingerland.
On Wednesday, 20th August at 7 p.m., I will be taking part in the radio show “On the Mark” with the Honourable Eric Evelyn.
I am writing these final words as we are almost touching down in Miami. Tomorrow we will be in our beloved St. Kitts and Nevis. I am already feeling the warm weather. I am already imagining the local twang, and I cannot stop both smiling and crying for happiness. Thank you, my beautiful Federation. Thank you for opening your arms to Essien and me almost 20 years ago and for opening them once more. I am coming back home, and when I leave, as I did before, I will carry in my heart your beautiful beaches, your blue sky, your palm trees and your love, which is reciprocated by my love for you all.
LOCAL SURVIVORS MADE THESE VIDEOS POSSIBLE WITH LOVE FOR ALL OF YOU. These can be viewed on Youtube
http://youtu.be/NKiTE8MsSNA“HPV AND CERVICAL CANCER”
http://youtu.be/ZYf-KDwx4M0 “FACING BREAST CANCER”
https://www.youtube.com/watch?v=DE6fCtD2fA (Breast cancer detection can be done by you)
Thank you once more. With infinite love.
Dr. Jessica Bardales
A blessed woman.