3-year-old Ural sits on the pink carpet in her room and assembles a 24-piece jigsaw puzzle by Anna and Elsa, from Disney movies.
She snaps piece by piece, moving aside the unsuitable ones, trying again and again and not giving up until she puts together the whole picture.
"I composed! Well done," she flatters herself proudly, and Mother Meirav claps her hands.
"My warrior," Meirav defines her, wrapping her in kisses.
"From the belly it was clear she was a fighter, and I love that. Her fighting spirit saved us both."
Meirav Moravati (47) found out she was pregnant in January 2018 after six grueling years of fertility treatments.
But the miraculous news was overshadowed by a large cloud: on the first ultrasound, which revealed that she was growing a healthy fetus in her womb, cancerous growths were also discovered.
Meirav was diagnosed with widespread ovarian cancer, and needed urgent chemotherapy and surgery to remove the ovaries and uterus.
The doctors even made it clear to her that if she waited with the treatments until the end of the pregnancy, she was risking her life.
But Meirav put a hand on her stomach, prayed, and asked her fetus not to give up and fight for their lives.
A few months later, Meirav is one of the few women in the country who underwent chemotherapy to treat ovarian cancer during pregnancy and a healthy baby girl.
She is now playing with Uriel in her room in the well-kept pavilion in Netanya.
On the walls hang colored stars, and also the name "Ural" in pink wooden letters.
On the bed is a large Minnie Mouse doll, in a birth toy stroller a puppy doll with a hat, and in the box under the window dozens of other dolls and soft teddy bears.
On the pink carpet is a small game slide, and in the corner is a white desk on which she likes to paint.
The living room is also the realm of Ural, with a fenced trampoline and dozens of books and puzzles.
"Now that I have this wonder, everything seems negligible," smiles Meirav El Ural, who has moved to jump on the trampoline.
"It looked like everything went by very quickly, but it really wasn't that light."
• • •
She was born and raised in Netanya.
She has a bachelor’s degree in management and political science from the Open University, and until her illness she worked as the director of a dental clinic in the city.
Her tone is fast and pleasant, only her tired eyes betray the roller coaster of her life.
She tells with wonderful openness about the death of her brother, who is one year younger than her, who died at the age of 14 due to a congenital heart defect, and about the sister who was born after his death.
For the exhausting chemotherapy treatments she underwent during her pregnancy and for the happy birth and fulfillment of the dream.
At times, during the conversation, she allows the tears to flow freely down her cheeks, and a moment later bursts into rolling laughter at the sight of a photograph of Ural smiling from a vacation to Elsa.
Ten years ago she was diagnosed with endometriosis, an inflammatory gynecological disease that produces endometrial-like cells outside the uterus, causing severe pain and even difficulty conceiving.
For six years, Meirav and her partner, who have since divorced, underwent 15 fertility treatments.
In some cases the embryos were absorbed, but fell at a very early stage.
On one occasion she even had to have an abortion at week 9. But the two did not give up for a moment on the parenting dream.
"It was clear to us that we were going with it to the end," she breathes deeply.
"This is not an easy time. Everything is measured and accurate, you can not do anything spontaneous because it is all about the treatments. But you have a goal, so you inject yourself with hormones, keep your body and think ovulation and heat, and especially all the time in anticipation, anticipation in anticipation."
That day, three and a half years ago, when the nurse from Assuta Hospital called to tell her that the treatment was successful and she was pregnant, she remembers as if it were yesterday.
"You do not understand how much you are waiting for this conversation," she says.
"In retrospect I can say that I felt the treatment was successful, but I could not know for sure until I got the results of the blood tests. I was at work, and suddenly the nurse calls and says that there is a high value of HCG (a hormone produced by the placenta and its level rises in the first weeks of pregnancy). ).
I took my bag and myself, and left work to tell my then-partner, who was at home.
"We both started crying. It was a cry of happiness, of relief, of wow. We knew we needed to do more tests to make sure the pregnancy was normal, and when I got back to work we decided not to celebrate or tell anything yet until we knew if everything was fine. But inside we were very excited." .
• • •
At week 7 of pregnancy, Meirav was called for a first pulse test of the fetus.
"You arrive without breathing, under pressure, praying that everything will be fine. Then the technician says that there is a pregnancy sac, and a pulse, and the size of the pregnancy is normal. And I ask if I can already breathe, and she says 'wait.'
"Then she goes over and over again with the device, and looks at the screen again and again, and sees more and more findings, and calls the doctor. Everyone knew I had endometriosis, so they thought it was cysts, but had to check what was going on there.
"I was immediately sent to see an appointment with Prof. Boaz Weiss, an ultrasound specialist and director of the Institute of Obstetrics, Gynecology and Fetal Imaging at Sheba Hospital. I finally got to him that day at 11 at night, privately. I did not want to wait for my appointment. After you go through all the treatments and are finally pregnant, you can not wait weeks to see a specialist.
"I was sure these were cysts, and that if necessary we would have surgery, we would remove them and that's it. I had undergone such surgery before, it was simple and insignificant, and I went on with my life as usual. I thought it would be the same thing."
But Prof. Weiss diagnosed that it was not a cyst and ordered Meirav to come to the hospital the next day for further tests.
At the same time, she was referred to Dr. Tamar Perry, today the director of the gynecology and oncology department at Hadassah Jerusalem, and then the deputy to Dr. Yaakov Korach, the director of the gynecology and oncology department in Sheba.
"Dr. Perry is my angel," Meirav defines the doctor who went with her to the end, and who understood what was on her mind when she did not give up pregnancy in favor of the treatments. "Without her, it is not certain that Ural would have existed.
It's the most important part of my war to keep the pregnancy. "
Meirav was sent for blood tests, biopsy and MRI, and on February 22, 2018, she was diagnosed with widespread ovarian cancer, which created tumors in the ovaries and abdominal cavity.
"I was still in the first trimester of pregnancy, and the doctors told me that at such an early stage it would be better to have an abortion because I would need surgery and treatments. But I was not ready to hear. For a moment I did not think about cancer, just that I have a normal pregnancy. "I told myself I would go through everything. Hard not hard, I will get through this cancer. Just so they don't hurt my pregnancy."
After the difficult diagnosis, Meirav realized that she had to share with the extended family her medical condition.
"They got two lines for the price of one," she grins, "a line about the disease and a line about the pregnancy. We told my sister-in-law, and at my request she told the whole family. I could not grieve them."
How did they react?
"They stood behind my every decision and encouraged me. I remember once, that I bent down to take something, and my mother told me not to do it to keep the pregnancy. I told her it did not matter because probably it would not stay anyway. I did not know what. "To think. But she told me not to give up, not to give up. 'You do not know,' she told me, 'he upstairs arranges everything. There are miracles in the world.'"
"I put my hand in the incubator, and I did not believe this thing existed."
Meirav with little Ural, in infancy, Photo: From the family album
• • •
A few days after receiving the biopsy results, Meirav was invited to a meeting at the hospital for a treatment protocol.
"They asked me to arrive at noon because in the morning there was a meeting in a large forum of doctors. In retrospect, it turned out that at this meeting they discussed how to keep me pregnant. There were Dr. Perry, Dr. Korach and doctors in the field of obstetrics and abortion."
She stands on her feet, placing two toes on the wall.
So she stood outside Dr. Perry's room, her hand on the mezuzah, and asked in a whisper, "Do not take it from me." She is not a religious person, she will explain later, but at that moment it felt most right to her.
"A moment after the meeting, I was called to Dr. Perry's room at the gynecology clinic, and she told me that I had two options: the first is to start chemotherapy immediately, which means that the pregnancy should be harmed.
The second is to wait about three weeks, until I reach week 15 of pregnancy, then start treatments.
This means that the fetus will be able to develop in the meantime, and may be able to survive.
It was clear to me that I was maintaining my pregnancy, but the doctors asked me to return home and not make an impulsive decision. "
The doctors made it clear to Meirav that if she chose to wait a month with the treatment, the cancer could spread in her body and there was a danger to her life.
Medical knowledge about the dangers of chemotherapy for ovarian cancer in pregnancy has also been limited.
Abroad, only a few cases were known, and in Israel no such case was known at all. In addition, it was clear that the fetus was exposed to risks, such as developmental delay due to preterm birth or unknown injury as a result of chemotherapy.
"It was important for me to keep only the pregnancy, I was not so interested in what endangers me. I knew that I would not be able to get pregnant again, because after the treatments I would have to have my ovaries and uterus removed to prevent the formation of tumors again. It hurt me a lot. Pregnant, why should I give up what I already have?
"I told myself I wanted to hold the fetus inside as much as possible and give it everything. I asked to wait for a posterior transparency test, which is performed at week 9 and finds out if the fetus has Down syndrome, and it was normal. We turned to Rabbi Avraham Elimelech Firer, founder of the Ezra Center What we got was that I would get the cancer.When I asked about the fetus, he said on the face of it there was no need to terminate the pregnancy.
"I called Dr. Perry and told her I was continuing.
She referred me to the at-risk pregnancy ward, where of course they talked to me about the risks, but also told me that if I decided to keep the pregnancy they would fight with me to the end.
"After being told such a thing, you can not give up."
"The story of Meirav's diagnosis, disease and treatment is unique," explains Dr. Korach, director of the gynecology and oncology department at Sheba. The woman at excessive risk.
In Meirav's case, the diagnosis at such an early stage of pregnancy required a review of the existing medical literature, discussion and multidisciplinary consultation, which included at-risk pregnancy physicians, teratologists (dealing with the effects of medications on pregnancy and lactation, BA), oncologists and gynecologists.
"The purpose of the protocol that Meirav received was, first and foremost, to ensure that oncology treatment is carried out flawlessly so as not to impair the chances of recovery, while closely monitoring the development of the fetus and the health of the pregnancy.
"The decision to choose an unusual scenario of this kind, of maintaining the pregnancy during the treatment, requires understanding and cooperation with the woman, and Meirav had an intuitive and direct understanding of things already in the first conversations. The treatment is successful. "
• • •
Meirav decided to undergo the treatments during her pregnancy.
According to the treatment plan, she had to come once a week to receive small doses of the chemotherapy drug, instead of one dose once every three weeks.
The first treatment is scheduled for April 1, 2018, week 15 of pregnancy, Sunday on the week of Passover.
"At least they let me celebrate Seder before we started," she laughs.
"I came to the gynecological oncology ward with a lot of worries. Automatically, when you get there, you start crying. Everyone told me everything was fine, that I would get through it, but I kept thinking 'what will happen to the pregnancy?'
That's what interested me. "
The first treatment lasted only a few minutes, as Meirav suffered from chest pain.
The second treatment, a week later, was also stopped because she experienced shortness of breath and was found to be allergic to the drug.
"I felt nauseous, I had no air, and I fainted. They wanted to give me all kinds of medicine, and I had to warn that I was pregnant. They told me 'live first, do you take care of the fetus?'
"But I said yes, that I was doing what was right for the fetus. By then I already knew it was a girl, I could say it was for her."
To prevent another allergic attack, the doctors extended Meirav's weekly treatment to about 12 hours at a time, during hospitalization, during which they changed the dose of the medication.
At the same time, she would go for pregnancy follow-up tests at the hospital, and the ultrasound tests for the fetus would also check the condition of the tumors.
"I would talk to my stomach all the time," she puts a hand on where her fetus grew.
"I would say to the baby, 'Hold on, I'm with you, I'm watching over you, be strong.' I kept dripping to her, 'Fight, fight, fight.'
"And after they managed to overcome the allergy, I even felt good. Apparently the pregnancy did good to the body, which finally managed to hold the substance. Even my hair did not fall out."
At the end of the first round of treatment, an MRI scan showed that the tumors had shrunk.
Meirav was already 29 weeks pregnant, and the fetus had developed properly.
The next stage was a combined operation: in the first stage a caesarean section, and in the second stage the removal of the remaining tumors in the abdominal cavity, and the removal of the ovaries and uterus to prevent the formation of additional tumors.
To clear the body of the chemotherapy and allow the fetus to develop a little more, it was decided to wait a few more weeks until surgery.
"I asked that the first part of the operation, the birth, be done under partial anesthesia, so that I could hear the baby's crying, to know that she was out, that she was breathing," Meirav straightens up.
"Anesthesia was needed from the anesthesiologists, because it was first a partial epidural anesthesia for the caesarean section, followed by a full anesthesia for the surgery to remove the ovaries. I received permission."
• • •
The surgery is scheduled for August 6, 2018, week 33 of pregnancy.
Meirav spent the past month mostly at rest.
She arrived at the hospital the day before the surgery, for tests and preparations.
She was hospitalized in the gynecology and oncology ward, but in the room next to the women's ward.
"On the day of the surgery I got up at 6 in the morning and waited. It was a nerve-wracking wait. I sit on the bed and wait, and the whole family comes, and friends, and then they call me for surgery. They brought me a wheelchair, but I asked to get on my feet."
An entire team from the Department of Pregnancy and the Department of Gynecology and Oncology, in addition to anesthesiologists and nurses, was waiting for her in the operating room.
"I also announced that I was not ready to be operated on until the doctors from the fetus arrived. It was clear that the baby would be born prematurely, and I wanted to see them before the birth, knowing that the baby would also be in good hands. "My partner was with me during the caesarean section."
Ural was born at 8:30 in the morning with a meager weight of 1,600 kg. "You are lying on the bed and suddenly you hear crying.
And that's wow, not perceived, "this time tears of excitement flowed down her cheeks." I heard the crying and cried myself, but I could not see her because they wanted to take her straight for tests.
After all, she also received chemotherapy and was born prematurely.
"But Dr. Rakefet Yoeli-Ullman, today the deputy head of the high-risk pregnancy ward in Sheba, who accompanied me, stopped everything, said 'wait,' took the baby and placed it next to my face.
I will never forget her warmth in that moment.
This moment, when she touched me for the first time, is for life.
I was willing to give up and not kiss her so they would take care of her, but the doctor told me it was okay.
I kissed her and passed her on to the doctors.
I told them they would do whatever it took to make her okay.
"Then the doctor said 'now you'. It was weird, because all this time I was not thinking about myself, about my treatment, about my problem. But after I let the doctors treat the baby, it was time to treat me."
While Meirav stayed in the operating room, Ural was transferred to a preterm infant and put in an incubator and given oxygen to help her breathe.
Three hours later, Meirav woke up in the recovery room.
"I opened my eyes, recognized Dr. Perry and my mother, who told me it was me, that I was after, and immediately asked them to make sure everything was fine with the baby.
I worried about her, not me. "
On the day of the operation, Meirav was bedridden and saw her daughter only in photos taken by relatives on her cellphone.
It was only the morning after the birth that she received permission to enter prematurity, while in a wheelchair.
"I counted the minutes until I could see her," she smiles.
"When I arrived in infancy I put my hand in the incubator, and I did not believe that this thing existed. From that moment on my recovery no longer interested me.
"I had a hard time seeing her with all the devices, and I talked to her all the time. I told her 'fight, do not give up,' and she slowly progressed. She was very light. On the first day she was connected to oxygen, and then to Zonda. Slowly. Slowly they started taking out the Zonda and teaching her to eat from a bottle.
"We were so worried, and only after she was born did we buy baby equipment. So we also decided to call her Ural, because she is the light from God, the light at the end of the tunnel of my life."
"I was told 'first live, do you take care of the fetus?', But I answered yes, that I do everything for her," Photo: Efrat Eshel
• • •
A week after the birth and surgery to remove the tumors, Meirav could already be released to her home.
But Ural remained in infancy, and Meirav rented a room in a motel for supervision and rehabilitation.
Every morning she would arrive prematurely, stay a whole day with her baby, and in the evening go back to sleep in a hotel room.
"After the great miracle of the birth happened, and the surgery happened, and she is alive and I am alive, it was inconceivable to me to leave her there alone."
Were there also thoughts of a future that was missed?
"When you experience what I experienced, you recover from cancer and you have a child, you do not think about the next child. You concentrate on recovery and worrying that the chemical treatment you underwent will not affect your daughter in any way. ".
Three weeks after the birth, with Ural still in infancy, Meirav began another round of chemotherapy treatments, as part of a pre-determined protocol.
During the first treatment, the two were still in the hospital, Ural in infancy and Meirav in a motel.
In the second treatment, a week later, they had already returned home.
The round lasted two months, during which Meirav came to the hospital once a week for treatment.
At the end of the second round, she continued for another year with biological treatment with the drug "Austin", which was given in the hospital once every three weeks.
The goal of treatment is to kill any cancer cells that might have been missed in surgery.
"Despite the difficulty in the treatments, I did not feel tired or weak," says Meirav.
"My personal miracle gave me the strength to continue. I saw no reason to stay in the hospital anymore. After all, there was no more pregnancy, and I did not need special supervision. I wanted to go home, with my daughter.
"I was focused only on caring for her, not me. Because of miscarriages she had to be fed more often and kept longer than usual. If she could be left in a cotton ball, we would do the same. Until a year ago, when she was two years old, she was treated at the Institute of Development. "The boy is in the HMO, but she has developed well. Today I sit with her at home, watching and not believing."
She got up slowly to Ural's room, smiling an apologetic smile.
To this day, she suffers from the side effects of chemotherapy, including excessive fatigue and muscle aches.
"I always promise her that one day I will have more strength to run after her at the playground."
In addition, she was sent for genetic counseling in Tel Hashomer, and a genetic test revealed she was a carrier of BRCA1, a genetic mutation that can cause breast and ovarian cancer in women, breast and prostate cancer in men, and pancreatic cancer and melanoma in both sexes.
She is being treated at a pain clinic in Sheba and is undergoing urgent follow-up to detect breast cancer.
"It was only when I got to the cancer clinics that I realized how many women do not follow up, how many women do not really guard, and it's a shame that the detection time is critical here. I went through so much because of the cancer, and if it is detected relatively early it can be treated.
"Actually, this pregnancy saved me. If I hadn't gotten pregnant, I wouldn't have had an ultrasound, and they might not have detected the cancer in time. You can't feel ovarian cancer until a very advanced stage. In retrospect, I looked at the ultrasound tests I did for six months. Before the cancer was discovered, and it was not there, which means it developed very quickly.
"But all I went through was nothing compared to this great gift I received in life. In all this inferno I discovered that there are miracles in the world, and my daughter is the most visible and miraculous miracle that can be. Sometimes I look at her when she sleeps and do not believe. Is she mine? Is she really here?
"I clung to pregnancy to get through the treatments, but everyone has to hold on to something to get through it. To hold on to the dream, not give it up. Ural is my dream, that I live it every day."
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