The cat eye cancer sign

Anifa* was annoyed, very annoyed. Rukiya*, her insensitive sister-in-law, had gone overboard. The family was together for Idd-Ul-Fitr at her mother-in-law’s house, including Rukiya, who was home from Canada on holiday.

Rukiya was holding 20-month-old Maimuna* on her lap, taking selfies with her, when she noted that Maimuna’s right eye seemed to repeatedly end up with an odd reflection. She spun Maimuna around and scrutinised her eyes before loudly concluding that Maimuna’s right eye looked like a cat’s.

Anifa was livid. Rukiya had been rubbing her the wrong way since her arrival a week prior, but this was the last straw. Anifa grabbed Maimuna and headed off to her car. She strapped her daughter into the car seat, slid behind the wheel and drove off.

When they got home, Maimuna had dozed off. Anifa put her straight to bed in her little crib and settled in for the night. She called her husband, Osman*, who was miles away in South Africa. 

Osman, a paediatrician by profession, had gone to South Africa to further sub-specialise in paediatric oncology. He wanted to treat children with cancer. He had left home when Maimuna was barely three months old. He had seen her briefly when she was a year old when he had come back on a short break. Now, he had only a month to go to come back to his family. 

The couple’s evening video calls were something they both treasured. They would catch up on each other’s day and connect as best as they could. Anifa tried to hide her annoyance but despite the distance, Osman knew there was something bothering her.

Anifa did not want to talk about it. She wanted to focus on the positive. She was excited that her husband would be back home soon and that she was also winding up her master’s research project. They chatted about their daughter and all the new sounds she was making as she expanded her vocabulary. Rukiya’s inflammatory comment was quickly forgotten.

The next day, during their evening chat, Osman brought up Rukiya. He had been speaking to his mum, who told him about the altercation over Maimuna. Osman had called his sister, upset at her callousness. Rukiya was apologetic about how she spoke but she did insist that Maimuna’s eye didn’t look right. She even sent the pictures she took to Osman.

When Osman saw the photos, he froze. It was a difficult conversation to have with his wife. As a soon-to-graduate paediatric oncologist, he could feel the dread settling in the pit of his stomach. He managed to convince Anifa to take Maimuna for an urgent review with an ophthalmologist but he couldn’t calm her anxiety.

Two days later, Anifa was sitting in front of the ophthalmologist, with her husband on the phone. Maimuna was in the post-anaesthesia care unit next door with her grandmother. She had undergone examination under anaesthesia to look into her eye and ascertain what was happening back there. The doctor, in a very empathetic tone, broke the news to them that Maimuna had what appeared to be a retinoblastoma, a tumour of the eye.

Retinoblastoma is a rare cancer of the inner light-sensitive lining of the eye, commonly occurring in children below the age of five. One of the earliest signs of the cancer is a white reflection in the child’s pupil, known as the cat’s eye sign. 

It was an agonising two weeks as Maimuna underwent a battery of tests and reviews by the medical team caring for her to determine the best treatment approach, one that would ensure complete eradication of the cancer while preserving her sight as much as possible. Thankfully, the cancer involved only her right eye and even better, had not spread beyond the eye.

It was even more difficult for Osman, racing to complete his fellowship and get home in time for his daughter’s treatment initiation. By the time his flight was touching down, Maimuna had checked into the hospital in preparation for her first chemotherapy session the next morning. A very subdued Rukiya was waiting for him at the airport, ready to take him straight to the ward. 

Maimuna’s treatment comprised chemotherapy spread out over several months, combined with radiation therapy. Hugging his daughter close to his chest in the aftermath of the first session, Osman shook his head at the irony of life. He could not believe that his first assignment as a paediatric oncologist was to be a parent to a young one battling cancer.

He rocked her to sleep for the short periods that the nausea would allow her to. He cleaned her up while she wretched and ensured her intravenous line remained secure. He wrapped his free arm around his distraught wife while Maimuna slept and he answered the phone when his mother and sister called to check on Maimuna.

It has been a long walk back to health for Maimuna. Today she is a lively four-year-old celebrating her first cancer-free year! She is counted among the 80 to 90 per cent of children who are able to beat this cancer. She is extremely lucky to have escaped with her sight mostly intact.

Anifa and Osman have Rukiya’s “big mouth” to thank for their daughter’s early diagnosis. The family is now closer than ever. 

Dr Bosire is an obstetrician/gynaecologist