Tuesday, December 30, 2008

Taste and See!

As difficult as this year has been, it has been indeed one of the BEST years ever. Just witness all He has done in the following pictorial review of 2008 for the Crabtrees. (Please be patient as the program opens and the slide show begins -- hope you enjoy)

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May you savor the goodness of God in the New Year!
Dan

Tuesday, December 23, 2008

Just Deserts

The other day Linda and I attended a Christmas performance by the Old Dominion University madrigal singers held at our church. As we entered the spacious atrium decorated to resemble Narnia, we were greeted by one of the hosts who invited us to first visit the serving table, announcing “We are providing just desserts this evening. May I offer you some?”

I responded, “Jay, if I got my just deserts, I would not be here this evening!” To which he quickly replied, “That is true for all of us, isn’t it?”

Eleven months ago today, I was given a death sentence, informed that I had widely disseminated cancer that turned out to be an aggressive form of malignant melanoma. By all reasonable expectations (my own included), I should not be here today. Now after two cycles of high-dose Interleukin-2 therapy, radiation treatment to a left hip lesion, four gamma-knife procedures to the brain, a complicated port-a-cath removal, and a deep vein thrombosis, I am very much alive and anticipating the celebration of Christ’s birth with those I love. Do I deserve such favor?

The harsh reality is that we all have a death sentence. We have all been diagnosed with a terminal condition – it’s called the human condition. For all the millennia past, our mortality rate has been virtually 100%. In spite of all the advances in medicine, nutrition, and relative prosperity on the one hand, and all the devastations of war, disasters, and disease on the other, the death rate has remained unchanged.

And that is what we deserve. I know that is not politically correct, but the truth is that none of us deserves tomorrow. Genesis tells us that a good God gave us life, choice and sex so that we might propagate the gift of life. We squandered that gift when we each proclaimed our independence from the Creator. (Rom 3:23, 6:23) The natural consequence of my rebellion is death. But when I exercise the gift of choice and surrender my will to His, by His grace He restores my life. God sent His only Son to live a life that shows me how to truly live and to die a death that would conquer the grave. (1Pet 3:18)

And there’s the icing on the cake! Not only am I promised eternal life, but the life I now enjoy (day by day) is filled with joy, purpose, and peace. (Gal 2:20, 5:22-23) At the birth of Christ the angels proclaimed “peace on earth to men on whom His favor rests.” (Luke 2:14) The offer of “just desserts” still stands.

For me this has become a vital reality. I have tasted the bitter flavor of my just deserts, but in the days that remain I will satiate myself with His favor and feast on just desserts.

May you have a blessed Christmas!
Dan

Saturday, December 6, 2008

Night Vision

Beer wack! …wack cheer from Harlottesville. Tis thyme the MRI showed not one but mix sasses. Again the mix sasses were treated with fighly hocused ramma gays. I am fooing dine with only a height sledache. And after 25 train boomers my flinking is thawless! Yes, as you can see, I’m still tarp as a shack!

Just kidding – I truly am doing fine and grateful for the marvelous technology of gamma knife surgery that deftly destroys cancer cells while causing little harm to surrounding brain tissue. Although the previous MRI showed only a single new lesion of the brain, the highly detailed mapping MRI showed six new metastases and all six were treated with precision-guided gamma radiation.

I do not make light of the situation. We have never underestimated the formidable odds we face. From a strictly medical standpoint, the lack of decline in the number of new tumors appearing on each successive MRI of the brain is disconcerting and has significant potential implications for my overall prognosis. It is the central nervous system metastases that have always presented the greatest threat.

Our view of this battle, however, encompasses a more compelling reality. Indulge me while I relate another story from the Bible to explain what I mean. (2Kings 6:8-18)

The prophet Elisha, equipped with supernatural powers of espionage, frustrates and angers the king of Aram, one of Israel’s fiercest enemies. Resolved to eliminate the spy, the king of Aram sends a battalion of chariots to surround Elisha at Dothan in the cloak of night… an army sent to destroy one man.

Elisha’s servant wanders out to relieve himself and is panic-striken when through his blurry eyes he spots the enemy horde encircling the town. He runs to alert his master, breathlessly shouting “What shall we do?” In what appears to be the first-ever record of military surveillance employing “night-vision”, Elisha calmly prays that God will open the servant’s eyes to the reality of the situation.

With enhanced eyesight, the servant is amazed as he observes “the mountain full of horses and chariots of fire”, divinely deployed forces already in place to defend Elisha. The enemy, on the other hand, is struck with blindness and routed.

Our situation is not dissimilar. Once told that I was riddled with tumors “too numerous to count”, it appeared that an army of renegade cancer cells was about to take me out. By all reasonable accounts, this body should have been overrun by now. That is not the case. And although the threat persists (the enemy chariots have not disappeared), I can calmly point to a greater reality, a force that overwhelms and disarms the present danger. Not only do I benefit from shafts of invisible light in the form of gamma radiation, but more importantly I am surrounded by the indomitable reality of God’s unchanging love and the promise of eternal life. (Rom 8:37)

Like Elisha I can claim “Those who are with us are more than those who are with them.”

Grilled with fatitude,
Dan

Tuesday, December 2, 2008

Insistence of Persistence

“Yet because of his persistence he will get up and give him as much as he needs” (Luke 11:8)

While teaching his disciples about prayer, Jesus relates a story about a man who finds himself with an urgent need in the middle of the night. Weary guests have just arrived from a long journey and he has nothing to feed them. With no 24-hour convenience store available, he goes to the house of a friend, bangs on the door to rouse him from sleep, and calls out his request to borrow some bread. The friend is indisposed, having already settled himself and his family securely in their beds, and does not immediately respond. The knocking on the door and the plaintive appeals continue. Finally, because of his persistence, the friend gets up and gives him all that he needs.

We are learning the necessity for perseverance, i.e., the insistence of persistence, in this battle with cancer.

We just returned from Charlottesville where I underwent a full day of imaging studies and consultations once more. There is good news and bad news. The good news is that a repeat PET scan shows no evidence of active metastases below the neck. The lesion in the left hip region which was treated with radiation therapy in late October is now slightly smaller and expected to continue to resolve. I have had no pain or limitation of motion (no limp), all vital signs remain stable and labs are entirely normal. (This is nothing short of miraculous, given the devastating picture of widely disseminated lesions “too numerous to count” just six months ago!)

The bad news is that there is at least one new metastasis in the brain, which measures 5 mm and is located near the center of the left hemisphere. (Linda sighs, "Honey, it's all in your head!" :-) The source of the brain metastases is unknown, given the lack of evident tumor growth elsewhere, but they are thought to have pre-existed as microscopic clusters of cancer cells which only now have grown large enough to become visible on imaging studies. Regardless, the oncologist, radiation oncologist and neurosurgeon all agree that the most prudent approach is to repeat the gamma knife procedure to destroy this remaining brain lesion. Other options, including whole-brain radiation, repeat Interleukin-2 therapy or monoclonal antibody infusions were offered as secondary considerations. We are scheduled to return this Friday, December 5 for my fourth gamma knife procedure.

Our confidence is in the Lord and in the power of persistent prayer. We are not discouraged. Right after telling his story, Jesus reassures the disciples with these words: “Keep asking, and it will be given to you; keep searching and you will find; keep knocking and the door will be opened to you…” (Luke 11:9) Our God is pleased when we, like the man in the middle of the night, acknowledge that we have no other friend to turn to meet our need. As Peter once said, “Lord, to whom shall we go? You have words of eternal life.” (John 6:68)

Grateful for your persistent prayers,
Dan

Wednesday, November 26, 2008

Giving Thanks, Gathering Joy


“In everything give thanks…” (1Thes 5:18)

As I write this entry in the journal of my journey with cancer, a quiet and gathering joy inhabits my thoughts. And I am as intrigued by the phenomenon as I am pleased at the opportunity to express my gratitude.

Words are hardly adequate to describe my appreciation to the hundreds of you who have prayed earnestly for me, sent cards, offered practical acts of kindness, and buoyed me up with words of encouragement. I have also received excellent professional care and the well wishes and support of many colleagues. The outpouring of love, genuine concern and generosity has overwhelmed both me and my family. We thank God for each one of you.

Of course He is the One to whom all praise is due – for demonstrating His steadfast love, His faithful presence, His power to heal, His mercy and grace. I smile as I contemplate the beauty of how He has worked “all things together for good.” (Rom 8:28) Among the many lessons learned over the past several months is a new understanding of the transforming power of irrepressible gratitude and pervasive praise. Let me review…

Before any of us drew our first breath God saw our brokenness and the consequences of a creation gone astray. While still in a state of rebellion, He declared clemency for us through the sacrifice of His own Son, (Rom 5:8) thereby sealing forever the certainty of His love. (1John 4:10) With faith enough to recognize this gift, as a young man I turned myself in and received His forgiveness. My life was changed and my future secured.

Relative prosperity, excellent health, a fulfilling career, a wonderful family, and pleasant circumstances engendered an attitude of gratitude over the years that was reinforced by numerous examples of divine protection and providence. Almost everywhere I turned and everything I touched affirmed I am loved of God, a beneficiary of His goodness. Under such circumstances, what's not to be thankful for?

Then in January of this year dramatic events shattered this pollyanna perception of what constitutes God’s blessing. I was given six months to live and by my professional experience I knew that it likely would not be a tranquil passage. From the stunning moment I learned that I had disseminated cancer, through the nights of intractable pain, during the rampant decline in strength, amidst all the side effects of Interleukin-2 therapy, He graciously reassured me that He had not changed. His love had not diminished and He was no less deserving of my praise. In fact, it was often in those moments of extremis that His intimate presence was most palpable.

So I learned to give thanks in the midst of the pain. As I related in a previous entry, I would combat the pain with anthems of praise or humming to recorded hymns. Notice I gave thanks not for the pain, but in the pain. For it was in the pain I could appreciate the quality of love that constrained His Son to suffer unimaginable agony for me while uttering “Father forgive them…” (Luke 23:34) And it was in the pain that, without answering why, I was aware of His personal favor.

I also learned that the surprising consequence of giving thanks in the midst of suffering was an exhilaration and imperturbable joy that both eased the pain and produced a settled peace impervious to further adversity. I am aware that there are biological correlates to this phenomenon that to me only reinforce the wisdom of the Creator’s instructions: “Rejoice always. Pray without ceasing. In everything give thanks...” Sow gratitude; reap joy.

Through this experience and in my astounding recovery I have gained a new certitude and capacity to celebrate the profound and changeless love of God.

My wish for you and your family is not simply a “Happy Thanksgiving” but rather the lasting joy of giving thanks.

Gratefully,
Dan

PS – We return Monday, December 1, to Charlottesville for a full day of imaging studies and follow-up exam. I will keep you posted.

Thursday, November 13, 2008

Wrestling with God

Then Jacob was left alone, and a man wrestled with him until daybreak. (Gen 32:24)

One of the strangest stories in the entire Bible is that of a man who, during one troubled and sleepless night, literally wrestles with God. The man, of course, is Jacob, who finds himself facing what he believes to be almost certain death at the hands of his brother whom, years earlier, he cunningly robbed of his rightful inheritance. Left alone to contemplate his fate, fearful for himself and his family, he is desperate and destitute. He grapples with God.

It is a long night…

When the struggle is over, he is left with a gimp and a new name. His life will never be the same. Having been “touched [in] the socket of his thigh”, he is told by his contender that his name will no longer be Jacob (deceiver, supplanter) but Israel (one who prevails with God). (Gen 32:25-28) He walks away with a physical reminder of the encounter in his hip and a brand new identity. The God of covenant not only saved his life, but protected his family, gave him a new purpose for living, and fulfilled the promise to make him the father of a great nation.

Two weeks ago I found myself lying on a table, left alone as a remotely controlled machine directed a powerful invisible beam of ionizing radiation to my left hip. As I lay there looking up at the artificial skylight created through back-lit ceiling panels, I thought of Jacob.

Our experience has taken us through many long nights. Spent of human resources, desperate for answers, we wrestled with God – and came away with His blessing. The permanent marker used on my thigh to map out the precise direction of focused radiation reminded me that I am now a marked man and will never be the same. I have encountered a faithful God who has assured me of His lovingkindness and secured my destiny.

As I contemplate this story further, I am impressed with the honesty of Scripture. The One who sacrificed His own Son so that we might “have life and have it abundantly” (John 10:10) is not dismayed at our honest contending with Him. In the story of Jacob, He invites the wrestling match. (Gen 32:24) The God of the universe is not too busy to set aside time for a one-on-One encounter that, though it may last the long night, leads us to a clearer understanding of His ultimate plans for our good. If we don’t give up, we not only survive the night, but face the day with a new confidence and hope.

A friend and former patient is still going through that long night. Some years ago, he lost his teenage son, a boy that I was privileged to deliver while practicing in Michigan. I cannot imagine the pain. He has an honest grievance with God. He recently wrote me, “If God loves us, why does He keep hurting us?” My heart aches for him and many like him who have suffered an enormity of loss I will never know. What I do know is that God does not shrink away when we honestly grapple with Him. Even His own Son, whose love constrained him to lay down his life for us, experienced the struggle. (Luke 22:42-44)

Having prevailed through our own long night, I have experienced His touch and the blessing that follows. In Jacob's own words: "I am unworthy of all the kindness and faithfulness you have shown your servant." (Gen 32:10) Daybreak has illumined a clearer confidence in the reality of His promise, the fulfillment and unimpeachable joy that comes with a new identity as His child. My prayer is that my friend will someday know the same.

Glad for the gimp,

Dan

PS – There is no more powerful and effective treatment concerning the dilemma of personal pain in the presence of a loving God than the best-selling novel called The Shack. I highly recommend it to you.

Tuesday, November 4, 2008

The Race Set Before Us


“…let us run with endurance the race that is set before us” (Heb 12:1)

One of the delights I have had during this lengthy period of convalescence has been the opportunity to spend more time with my grandchildren. And our favorite family activity when the weather turns cold (next to one of Mama Crabtree’s homemade pizza parties) is to compete with one another on the popular and highly interactive Wii video game system. Everyone from 3-year-old Evie to Grandma and me enjoy manipulating their look-alike Wii characters as they perform super-human feats of athleticism, high-speed vehicular stunts, or goofy bare-back competitions on cud-chewing farm animals.

In the midst of all the fun, there is plenty of opportunity to work on building character: persistence, patience, the value of teamwork, how to lose with grace, and (one I am still working on) how to win with humility :-) Clearly the lessons are not all aimed at the little ones.

The other day, my 7 year old grandson Matthew enthusiastically took charge of the Wii remote to enter the long-distance island run, an event among the Wii Fit games that requires running (in place) with a cadence that optimizes aerobic endurance. As his Wii character strode through parks, over green hills, past a beautiful waterfall, and dozens of encouraging on-lookers, I noticed that he was required to follow a pace-setting guide. His guide not only set the pace according to his ability, but also directed him all along the course, sometimes taking him off the beaten path. When he slowed down, his guide did not leave him in the dust, but waited for him to catch up. And when on occasion he ran ahead of his guide, his Wii character would inevitably fall flat on his face, then dust himself off and resume a more measured stride behind his vanguard.

I am so grateful that we have had a Great Guide along this journey, that He is setting the pace, ensuring our well-being, and marking out our course. (Hebrews 12:2) Past experience has taught us to keep Him in sight, avoid running ahead or lagging far behind. We have also learned He will sometimes take us off the beaten path. The words of the late Tony Snow come to mind and are worth repeating: “We want lives of simple, predictable ease—smooth, even trails as far as the eye can see—but God likes to go off-road. He provokes us with twists and turns. He places us in predicaments that seem to defy our endurance and comprehension—and yet don't. By his love and grace, we persevere. The challenges that make our hearts leap and stomachs churn invariably strengthen our faith and grant measures of wisdom and joy we would not experience otherwise.”

It is tremendously reassuring to know that He has set the course that lays before us; He knows the terrain and has personally conquered every obstacle. Ours is to keep pace, follow His lead, get up when we stumble, and share the joy in the journey. This is an exciting and highly interactive enterprise, which invites neither resignation nor hubris, but a growing confidence in the beneficent purpose and plans of the One who has run the race before us (2Cor 12:9). This is not a game for couch potatoes!

These past few weeks have demonstrated that He is indeed setting the course before us. Linda and I had the opportunity to visit family and friends in five states, witnessing with joy their response to the remarkable story of my battle with cancer, accentuated by the visible evidence of God’s power and grace. (Matthew 10:27) We also attended a Christian Medical & Dental Association conference aimed at exploring what new directions our Pacesetter may have in mind for those of us who have the finish line in view.

Then last week I alone returned to Charlottesville for consultation with my oncologist as well as the radiation oncologist to determine the best course of action to address the persistent tumor in my left femur. After some deliberation and authorization from my insurance carrier, a specially focused high-intensity radiation protocol was set up to take place in three daily sessions. (“Standard” radiation therapy protocols call for up to thirty sessions spread over six weeks.) As there was an excellent continuing medical education course offered at UVA later in the week, I had already arranged to stay in the area in our cozy camper, commuting to the conference and enjoying the fall colors. I simply excused myself when needed to jump over to the radiation therapy center for the 15-20 minute treatment session and ducked back into the conference. I have had no pain, nor worsening fatigue, nor other side effects usually associated with radiation therapy.

Clearly the course had already been set out before me. I am now scheduled to return to Charlottesville December 1 for repeat imaging studies and follow up. Thanks once more for cheering us on.

Keeping the pace with gladness,
Dan

PS -- And hoping to finish well...

Tuesday, October 14, 2008

Endurance and Endorphins


Therefore, since we have so great a cloud of witnesses surrounding us, let us also lay aside every encumbrance and the sin which so easily entangles us, and let us run with endurance the race that is set before us (Hebrews 12:1)

Although I have never aspired to run in a marathon, I can recall a time when I actually enjoyed running long distance in college. I remember the daily 3-mile route through campus and down tree-lined neighborhoods. I remember the times I would get a stitch in my side or a cramp in my leg that would ease as I ignored the pain and lengthened my stride. I remember the cold, crisp mornings when icy air threatened to freeze-dry my lungs only to thaw as I pushed through to a steady cadence and continued to stoke my metabolic engine. Breathlessness was transformed into resonant rhythmical respiration followed by an almost invincible sense of strength fueled by endorphins. On the days I did not feel like running, my roommate could be counted on to goad me out of the dorm, then encourage me all along the course, often setting the pace.

Notwithstanding our desire to sprint to the finish in our competition with cancer, it is now clear we have signed up for a marathon event. When we returned to UVA on Thursday, October 2, a high-resolution MRI uncovered not one but six new metastases of the brain. These were all treated without complication by the marvelous technology of gamma knife surgery. Another MRI of the left hip region revealed that the previous suspicious area of increased PET scan activity corresponded with a one-centimeter lesion in the bone marrow of the proximal femur (thigh bone).

Although none of these lesions is causing symptoms, the oncologist concedes that the declaration of a remission from the melanoma was premature and he anticipates that further intervention is needed. Considerations include local radiation to the hip, another course of high-dose Interleukin-2, or some other novel therapy. There is no sure strategy for this segment of the course we are set upon.

The parallels to long-distance running are clear. Endurance is the key to finishing the race and finishing well. We have already pressed through much of the pain and have a foretaste of the endorphin rush. We are catching a second wind and hitting a new stride. In large measure our progress is credited to many of you, our “great cloud of witnesses”, some of whom have run the same course.

Most of all, however, it is because of the One who has set the pace for all of us, who has run through every muddy mile and won for us the promise of an invincible life… and who runs along side us still, sometimes prodding and always cheering us on. (Hebrews 12:2)

More than anything else, our strength is renewed because “the lovingkindness of God endures all day long.” (Psalm 52:1)

Dan

PS – We are currently traveling, visiting friends and family in Michigan and Illinois while awaiting word regarding specific treatment recommendations. We will keep you posted



Tuesday, September 30, 2008

Father Knows Best



But He knows the way I take; When He has tried me, I shall come forth as gold. Job 23:10





This is not going to be anything close to a perfect analogy, but for those of you old enough to remember the classic TV sitcom from the 1950s and 1960s starring Robert Young, you will get my point.

Imagine you are able to select from a number of alternate endings to this most recent episode in the series on the life of Dr Dan, who has just returned from UVA and another round of extensive imaging studies to assess the progress of his response to Interleukin-2. Which would you choose?

A – No trace of cancer is found

B – Imaging studies are unchanged (architectural changes persist, but no new tumors)

C – There is evidence of a limited number of new metastases

D – Extensive recurrent metastases are discovered

Well, you can guess which ending I would have chosen… but (fortunately) I am not the author of this drama. The writer of this episode has chosen option “C”: The MRI of the brain shows a tiny new tumor of the left frontal lobe and the PET scan shows an area of faint but suspicious activity persisting in the left hip region. Lab studies remain normal, there is no associated pain and the patient’s clinical condition is stable.

The next scene, therefore, will take us back to UVA medical center on Thursday, October 2, where I will undergo another gamma knife procedure to eradicate the brain tumor, then an MRI of the left hip and possibly radiation therapy to that region as well. This is akin to extinguishing a few "hot spots" where once there was a raging forest fire.

Although I would have chosen (and honestly was fully expecting) version “A” with a “happy-ever-after” ending to this episode, I am grateful not to be playing the lead role in version “D”. And after some contemplation, I am truly looking forward to the page-turning adventure of a script that only the Master Author can create. I must admit that I would not have written any of this story. But then I would not have known the depth of intimacy with my Creator, nor the wonder of His provision… the power of prayer… the peace of His palpable presence.

Linda and I agree, there is no going back to a “routine” life, one that runs on automatic pilot. We are forever changed, living by the moment, fully dependent and surrendered to a loving, wise, and awesome God. Indeed, Father knows best!

The LORD is good, A stronghold in the day of trouble, And He knows those who take refuge in Him. Nahum 1:7

Stay tuned for the next episode...
Dan

Saturday, September 20, 2008

For Goodness' Sake!

God saw all that He had made, and behold, it was very good.
(Gen 1:31)

I remember the first day of my college ethics class… the professor asked us to define “good”. Go ahead, give it a shot. You will quickly find yourself either chasing your tail in some circular reasoning or appealing to some other moral determinant that supercedes the essence of good. You will also quickly learn whether you are a moral relativist (i.e., that perceptions and circumstances define what is good) or subscribe to absolutism (i.e., that objective good exists, regardless of my perceptions and/or circumstances). It is not my intent to solve that debate here.

We all get comfortable, however, with our suppositions about what “good” looks like – “You made a good choice… It’s been a good day… The fundamentals of our economy are good…” In normal discourse we rely on a common understanding of what good is and often assume that our audience shares that understanding. Of course the opposite also applies: We make judgments every day about what is “bad” – “That was a bad decision… It was one of my bad hair days… The bailout is a bad idea…”

Now we don’t always agree on what constitutes good and bad, and at these times, we appeal to some standard, characteristic, or outcome that would convince our listener of the merits of our position. When we do this, we reveal to ourselves and others the basis upon which we determine the true nature of what we consider good.

If you were to ask me six months ago about my situation, it would have been disingenuous of me to say “It is good.” I had rapidly shed 20 pounds; I had frequent waves of nausea and no appetite; nearly all my strength was gone; there were nightly episodes of bed-soaking sweats, fever and chills; bone-wracking pain in my ribs and spine was a daily experience; and cancer was continuing to spread to brain, lungs, liver, spleen, lymph nodes and throughout my skeleton. Surely that cannot be considered “good”.

But in retrospect, it was good. More precisely, it resulted in many good and wonderful things.

If you have been following this blog since the beginning, you have seen the good – I have a faith in God that is stronger and more pervasive in my life, having passed the test of adversity; I have a relationship with my Creator that is more intimate, real and consequential than ever before; I have a greater appreciation for the steadfastness and power of His love, mercy and grace; armed with the certainty of eternal life, the prospect of death holds no dread nor fear; I have been humbled by the outpouring of genuine concern by so many and awed by the power of prayer; like never before I have learned to value the relationships I have with family and friends; indeed every human encounter now carries a weight of eternal significance in the light of this new perspective.*

Against incredible odds, I have experienced an extraordinary response to the high-dose Interleukin-2 therapy. As of my last check-up, my cancer is declared to be in remission. I am no longer in any pain; my strength and stamina have improved; I have recovered most of the weight I lost (and don’t need those extra pounds I was carrying anyway!) In one more week we will return to UVA for another series of imaging studies and examination to determine the trajectory of this remarkable healing.

But what if the outcome of my treatment were different? What if, like 94% of stage IV melanoma patients, I did not respond to Interleukin-2? What if ...? You can fill in the blank. You can probably write your own story. None of us is guaranteed a happy ending to every story. Ultimately, we are all terminal.

Among all the blessings of this difficult journey, the one that stands out the most is that I have learned that God’s character is not determined by my circumstances. When it comes to proving His character, He nailed that one forever when He sent His only Son to suffer and die for me on a cross. (Romans 5:8) Whether my situation is deemed good or bad, His goodness is unchanged. (Hebrews 12:5-6, James 1:2-3)

There is a popular song of praise that repeatedly answers the question “What is good?” The chorus rings “God is good all the time! All the time God is good!” I am one who now sings that phrase with greater confidence and joy than I have ever known before. And I will continue to sing it until time is no more.

Dan

*If you want a good read on how the prospect of imminent death might change your perspective, consider the book One Month to Live, by Kerry and Chris Shook.

Wednesday, August 20, 2008

Rewards


Enjoy life with the woman whom you love all the days of your fleeting life which He has given to you under the sun; for this is your reward in life and in your toil in which you have labored under the sun. Ecc 9:9

This past week Linda and I celebrated our 40th wedding anniversary with laughter and tears. This was the anniversary that almost wasn’t – since early on in my diagnosis neither of us expected me to be here through the summer.

We gathered our three daughters, their husbands, and the newest granddaughter (too young to be separated from her mother) for dinner at the Sheraton’s “City Dock” restaurant in downtown Norfolk. Then we all boarded the American Rover for an evening cruise on the Elizabeth River. It was a spectacular evening, complete with a golden sunset, followed by a full moon that kindly framed itself in the forward rigging of this 135-foot schooner as gentle breezes filled the sails and a strolling balladeer serenaded us with some of our favorite ‘oldies’. What a gift!

Speaking of gifts: A remarkable recovery from disseminated malignant melanoma – a gorgeous and healthy new granddaughter – the chance to celebrate 40 years of shared adventures with the wife of my youth – surrounded by three bright & beautiful daughters and their masterful godly husbands… each a reward of worth beyond my deserving. I’m telling you, this life of faith demands unbearable sacrifice! :-)

I have often taught in our adult Bible study class that the life of faith – the life that dies to self and follows Christ with full abandonment – is actually a form of Christian hedonism. It is not a life of selfishness, not driven by self-interest, but one that is rewarded in ways that selfish ambition could not imagine nor hope to gain. Scripture is full of examples (Ps 19:8-11, Ps 37:4, Prov 22:4, Matt 5:3-12, Matt 6:3-4, Luke 6:35, Phil 3:8, Col 3:23-24).

Christ himself is our model: “…Jesus, the author and perfecter of faith, who for the joy set before Him endured the cross, despising the shame, and has sat down at the right hand of the throne of God.” Heb 12:2 The Son of God, who loved us enough to pay the ultimate price, was moved and empowered by the knowledge that, in the end, there would be great reward.

It is ironic that the path to an abundant life requires a conscious choice to die, to surrender my plans, desires and energies to His sovereign purpose. The very things that I hope to gain through my own striving and clever design are ultimately achieved only by putting them to death. “For whoever wishes to save his life will lose it; but whoever loses his life for My sake will find it.” Mat 16:25

I have been blessed beyond belief. This journey, which has taken me to the brink of death and back, has already produced rewards I could not have anticipated, not the least of which is the outpouring of genuine concern and prayers from so many. I am enormously grateful.

But the greatest reward continues to be a deepening relationship with the One whose love and grace transcend this fleeting life – for He reminds me “…I am your shield, your exceedingly great reward” Gen 15:1

Gratefully,
Dan

PS – I cannot overstate the reward Linda has been to me over the past 40 years, and particularly through this most recent leg of our journey together. As a token of my gratitude for her love and faithfulness, I offered the following toast at our dinner celebration, along with the gift of a diamond “journey” pendant.

Saturday, August 9, 2008

The Final Report (Part II)

We finally received a call late yesterday from Dr Grosh with details of the imaging studies and labs done on Monday -- and it is great news!

The MRI of the brain was reviewed in detail with the neurosurgeon, Dr Sheehan. It shows no new metastases and all previous tumors are either gone or in the process of disintegration from the second gamma knife procedure.

The bone scan, for the first time, shows significant improvement and maturation of the healing process from the previous extensive multiple metastases. No new lesions or signs of active destruction are evident.

The CT/PET scan, which detects any rapidly growing activity of tumor cells throughout the body, was essentially negative. There was one faint and ill-defined area of increased tracer activity in the left hip region, but no corresponding anatomic abnormality there on either the CT scan or bone scan -- so it is thought to be an artifact. There are still radiographic abnormalities in the liver which likely represent residual architectural changes caused by the previous tumor growths there. All labs were normal, including liver enzymes and non-specific markers for tumor activity.

Compared to the devastating images six months ago, this is nothing short of miraculous!

We will return to Charlottesville in late September to repeat these same studies and monitor the progress of healing. Meanwhile no active treatment is planned. We are enormously grateful to you for your prayers, to the physicians who have cared for me, and most of all to our God for His faithfulness, mercy and love.

Basking in His grace,
Dan

Friday, August 8, 2008

The Final Report

Clip art licensed from the Clip Art Gallery on DiscoverySchool.com

We have all experienced it – the anticipation (sometimes apprehension) while waiting for the final report, whether that was a grade in a course, a performance evaluation at work, a biopsy finding, or a test result. While waiting, we ruminate on the “what if’s” and the consequences of various outcomes. Our mind takes us down paths that will likely await us depending on those results.

This week has been a week of waiting for the final report on the extensive imaging studies performed at UVA on Monday, August 4. This series of imaging studies included a high-resolution MRI of the brain, a bone scan, and a whole-body CT/PET scan using a glucose-linked tracer called FDG to pick up any areas of high metabolic turnover (such as rapidly growing tumor cells). Having completed the full course of Interleukin-2, the results of these tests should reveal the degree of response and have a significant impact on future prognosis. After a very long day of fasting, poking, prodding, and lying perfectly still on a cold table for hours at a time, we anticipated learning the results when we met with the oncologist late in the day. Unfortunately, none of the final reports on these studies was available.

When we met with Dr Grosh he was able to pull up the images on the computer screen and together we reviewed the pixilated representations of my brain, skeleton, and vital organs. The preliminary verdict: no evidence of new or active tumor growth! But subtle changes here and there, and the possibility that a review by the radiology consultants on their high-resolution monitors could pick up additional findings, compelled him to defer any definitive assessment to those final reports*. We agreed he would call me in a couple of days, once the official reports were available. Although his nurse called to let us know he was pursuing the matter, we are still waiting…

Yep, we’re back in the waiting room (see my blog entry of 7/06/08). It has become a familiar place. We have learned that time spent here can be very valuable. While waiting to hear what the final reports may reveal, we have been listening to what the Lord may be trying to teach us.

During the wait, several thoughts have come to mind. First and foremost: God is still in control. Our future hope is not pinned to the result of some therapeutic agent or study result. Our hope is in Him. Psalm 20:7 puts it this way: “Some trust in chariots, and some in horses, [and some in PET scans], but we will remember the name of the Lord our God.”

Our future is secured, indeed guaranteed (Rom 8:38-39, Heb 6:17-19). We have asked Him for healing and He has given us far more – He has rewarded faith with fruit that cannot be measured in survival statistics nor calculated on a computer screen. Our lives have been unalterably changed for the good; we have a more intimate understanding of His love and faithfulness; and if my prayers have been answered, so have many of you.

Secondly, while waiting for the final reports we have the giddy notion that, precisely because God is still in control, the details of the results will not matter. Not that I will ignore the results, nor fail to act on them according to sound medical advice – but it will not alter my confidence in the One who knows my end from the beginning. In practical terms, even if the radiologist should report heretofore unrecognized new metastases in the brain or elsewhere, God’s eternal plan will not be altered.

In the Old Testament story of the men sent by Moses to spy out the promised land, those who understood the power of their God rendered a final report that was far different from those who did not. While both groups observed the obstacles to victory, those who knew the faithfulness of a covenant-making God reported “we will surely overcome” (Num 13:30). Their enemies, though formidable, would become their prey (Num 14:9). Regardless of any possible disparaging news in our final reports, any residual cancer will find itself in the cross hairs of a powerful and faithful God. All fear is eclipsed by God's lovingkindness. (1John 4:18)

Finally, I realize that there is ultimately only one final report that really matters. That is the report that I will receive when I enter into the presence of the Lord. C.S. Lewis wrote: “You don’t have a soul. You are a soul. You have a body.” This body, though very much cherished, is destined to fail me some day. The report that matters is the one that assesses the status of my soul.

A good friend and outstanding Christian leader entered into God’s presence yesterday. Howard Douthit, fellow elder at Tab Church, beloved husband to Ramona and father to Nathaniel, Joshua and Jonathan, succumbed to complications of cancer after a prolonged battle during which he inspired many of us with his courage and unflagging devotion to God. I am confident he has received his final report: “Well done good and faithful servant… Enter into the joy of your Master.” (Matt 25:21)

That is the final report I look forward to.
Dan

* Please understand that the preliminary results of the tests done on Monday are extremely encouraging. My clinical exam is essentially normal, my weight has stabilized, and I have reached an improved level of strength. My progress has exceeded most optimistic expectations and we are rejoicing in what the Lord has accomplished. I will update you once I receive word on the final reports.

Sunday, July 27, 2008

Life, Celebrated Daily!

If you fly into our town, you will be greeted with this sign as you leave the airport: It welcomes you to the city of Norfolk with the motto “Life, Celebrated Daily” and the ubiquitous mermaid, a symbol of the area’s maritime history.

The city motto has taken on special meaning for me over the last six months. This past week marks a significant milestone in that on January 23, 2008 I first learned that I had far advanced cancer throughout my body with a life expectancy of less than six months from that date. Not only have I survived beyond that initial predicted life span but have every hope of complete eradication of a cancer that at one time had invaded brain, lungs, liver, spleen, lymph nodes and nearly every major bone of my body. I have experienced an overwhelming supply of love from others and the magnificent power of God’s grace and healing touch.

And to make this celebration even sweeter, this week we welcomed our eighth grandbaby into the family. On July 22 our youngest daughter Christianne Page gave birth to Adelaide Joy, weighing in at 7# 5 oz, 20” long. Kudos to Dr Holly Puritz who skillfully performed an urgent (repeat) cesarean delivery and provided much needed encouragement and TLC for both mom and daddy David throughout the procedure. As you can see, Adelaide is beautiful, healthy, and one of grandma and grandpa’s greatest joys. We are enormously grateful to be so blessed with this new little life at the same time that we are celebrating my new lease on life.

Through it all, the entire family has learned to celebrate life daily. None of us is guaranteed tomorrow. Each human encounter is precious. The marvelous promise that Jesus made 2000 years ago has become our daily experience: “I came that they may have life and have it abundantly.” (John 10:10)

Abundant life… We have learned that He was not talking about longevity, nor prosperity, nor even necessarily fun and happiness. He certainly was not talking about a pain-free existence or a life bereft of difficulties, trials, or adversity. What He has promised and delivered is a life of superior quality, a life abundant with meaning and purpose, a life rewarded with unimpeachable joy and a transcendent hope – all experienced daily.

Those of you who have participated with us on this journey through prayer and expressions of heart-felt concern are one source of our joy. May each of you be as blessed as we with an abundant life… celebrated daily!

Gratefully,

Dan

PS – I highly recommend Linda’s recent blog as she reflects on the significance of the arrival of Adelaide Joy.

Sunday, July 20, 2008

Surprise! Surprise!

God loves a surprise. He has a penchant for the unpredictable. Tracing His activity is a study in sacred spontaneity. I don’t think you will find this stated anywhere in Scripture, at least not explicitly, but just observe a few examples:

Surprise, Sarah! Though you haven’t had a period in 40+ years, you’re pregnant! (Gen 17:17, 21:2) Surprise, Job! All your livestock have been stolen or destroyed in the same day, your servants have been killed, and tragedy upon tragedy, all your children were lost in a house collapse! (Job 1:13-19) Surprise, Peter! Notwithstanding your protestations to the contrary, caught off guard, you denied me three times. (Matt 26:69-75) Surprise, Paul! Suddenly blind, you will soon see all I have in store for you. (Acts 9:3-16)

There are many more such instances of the unexpected in Scripture. This is not to say that God is caught unawares, nor that His actions are arbitrary or capricious – quite the contrary. It is often that an event that appears quite unexpectedly to an individual was foretold long before it occurred (e.g., Sarah, Peter). Further, not every sudden turn of events is a result of divine intervention, but rather the result of our own fallen and imperfect state and the presence of evil in this world. (Deut 30:17-19, Prov 6:14-15, Luke 13:4) We are even warned to be prepared for the unpredictable. (Mark 13:35-37, 1Cor 10:12)

And with every unexpected alteration in the fabric of our lives, God weaves a pattern that leads us to a greater understanding of His unstoppable love, mercy and grace. (Prov 16:9, Jer 29:11, Rom 8:28) Tony Snow, who was recently promoted to the life hereafter, said it best: “God relishes surprise. We want lives of simple, predictable ease—smooth, even trails as far as the eye can see—but God likes to go off-road. He provokes us with twists and turns. He places us in predicaments that seem to defy our endurance and comprehension—and yet don't. By his love and grace, we persevere. The challenges that make our hearts leap and stomachs churn invariably strengthen our faith and grant measures of wisdom and joy we would not experience otherwise.”

When I look back on the last six months of my own life, it is rife with surprise…

  • Jan 23, 2008 – Without warning, a “routine” CT scan performed for a prostate problem demonstrates disseminated cancer
  • Jan 31, 2008 – A liver biopsy report returns, demonstrating that the cancer is a particularly aggressive form of malignant melanoma. I am referred to UVA for consideration of Interleukin-2 therapy.
  • Feb 7, 2008 – Extensive test results reveal the cancer has spread to the brain, lungs, liver, spleen, spine, ribs and long bones. No primary source is found. Because of the brain tumors, I do not technically qualify for Interleukin-2 therapy, but Dr Grosh is willing to consider it if the tumors can be treated successfully with gamma knife surgery.
  • Feb 8, 2008 – Severe pleurisy-like pain raises the question of a blood clot to the lung. None is found.
  • Feb 11, 2008 – It is discovered there are actually five small tumors of the brain. All are treated with gamma knife surgery.
  • March 4, 2008 – After numerous imaging studies, several trips to the emergency room to rule out complications, IL-2 therapy is again postponed due to questions about possible pneumonia. Meanwhile I am losing weight (~20 lbs), in nightly pain, and getting weaker by the day.
  • March 10, 2008 – Having ruled out active infection, we finally begin high-dose IL-2 therapy (one week in hospital, one week recovering at home, then back for second week of therapy).
  • April 21, 2008 – Imaging studies show a remarkable response to the IL-2 therapy, unusual for someone with such extensive disease.
  • May 28, 2008 – The Port-a-cath device has to be removed due to breakdown of the overlying skin. Fortunately, no infection is found.
  • June 9, 2008 – Repeat imaging studies show persistent regression of the tumors elsewhere, but there are eight NEW brain tumors, again suggesting a fairly aggressive cancer. Repeat gamma knife surgery is arranged. This development again calls into question whether future IL-2 therapy will be tolerated. The decision is made to proceed.
  • June 14, 2008 – Unexpectedly, I develop recurrent pain in my left arm suggesting a nerve impingement in the neck. An MRI shows no nerve compression and the pain “spontaneously” subsides.
  • June 16, 2008 – We begin the second cycle of high-dose IL-2 therapy, suffer significant toxicities during each week of treatment, but avoid serious or permanent damage.

Then this past week we were hit with yet another surprise – one that threatened to shake our faith to the core.

Three days after discharge from the hospital I discovered a firm, tender nodule in my left arm pit. It was rounded, fixed, and rapidly enlarging without associated signs of infection. The clinical assessment was that this could very well represent resistant melanoma – particularly bad news having just completed the “final” course of IL-2 therapy. I alerted the oncologist and managed to arrange an open biopsy with a surgical colleague and friend, Dr Randy Gould.

Having experienced God’s faithfulness through a series of surprise developments, Linda and I determined that our trust in God would not be moved. His character (His unchanging love, mercy, and grace) are not determined by our circumstances. Even if this “surprise” meant my life here may be shortened, we affirmed that His goodness and lovingkindness are unwavering.

July 16, 2008 – Dr Gould examines me and is also concerned. He promises to get tissue at least to establish a diagnosis. During the procedure he spies a black hard mass, still highly suspicious for melanoma. But on further examination he discovers that the mass is simply a clot which had mounded up inside the vein where my previous central catheter had been placed. Pathologic examination of the vessel wall reveals no cancer and there are no surrounding lymph nodes. Subsequent venous ultrasound studies show the extent of the clot. No immediate treatment is necessary and I am reassured that this will resolve on its own with time. It is not the sort of clot that travels to heart or lung.

The God who loves surprises never stops loving us. His love for Job, Peter and Paul were never diminished, despite their circumstances. He is God, the sovereign One, and there is no more secure place than in the palm of His hands. We now look forward to whatever awaits us around the next bend: repeat total-body imaging to be performed on August 4 at UVA.

Continually surprised by His love,
Dan

Sunday, July 13, 2008

A Word About Weakness

as·the·ni·a (ās-thē'nē-ə) n. Loss or lack of bodily strength; weakness; debility.

Recently I had to complete paperwork to qualify for disability benefits – I never envisioned being at the other end of that process! When asked what about my condition prevented me from being able to work, I wrote down “weight loss, fatigue, asthenia”. Not currently in any significant pain, the predominant debilitating symptoms are these. No longer am I able to breeze through 12-hour days, mostly on my feet, and certainly not on any sustained basis. Loathe to admit it, I am too weak. I lack the sustained physical energy, muscle and mental stamina, to manage the longitudinal care of hundreds of patients as I once did.

As I have tried to share with you lessons learned during this journey with cancer, the one lesson I have yet to learn is how to accommodate my own weakness. Perhaps it is because I have almost always had more than my share of energy. “Blessed” for years with subclinical hyperthyroidism, my metabolism was in hyper-drive. Even after treatment for the thyroid condition, I required higher-than-average doses of synthetic thyroid medication, which seemed to keep me revved up, getting by with less than six hours of sleep, running circles around my wife, and driving her crazy with my ability to eat most anything without gaining weight.

Perhaps my difficulty adjusting to this new reality of weakness is my tendency to equate weakness with a defect in character or will. Of course I know better, but I have always operated on the semi-conscious notion that if you simply “buck-up”, you can overcome most any obstacle. Ask any one of my daughters how their doctor-daddy responded when they wanted to stay home from school because they did not feel well or it was “that time of month”.

And, although I am reluctant to admit it, part of my difficulty with weakness is that my self-esteem is linked to an achievement-oriented mentality and the desire to "be strong" for my woman whatever the circumstance. After all, she is the weaker vessel, right? Like it or not, I have a hard time shaking off these deeply ingrained patterns of thinking. I may yet need to learn (like a friend recently observed) how to become a human being (as opposed to a human doing).

Now I am confronted with a condition in which both the disease and the treatment rob me of energy; and no amount of self-will, positive thinking, or even sincere faith seem capable of restoring. This last course of high-dose Interleukin-2 zapped me of energy like I have never experienced before – just getting up from a chair or climbing a flight of stairs required enormous effort. Only now am I able to stay upright most of the day.

I know intellectually that there are lessons to learn through this experience of sustained weakness but I have yet to embrace them fully. The apostle Paul was apparently well tutored by weakness as he related to the Corinthian church his struggle with a “thorn in the flesh” (2 Cor 12:7-10). Beset with some chronic malady he was told by the Lord that he would not be rid of this condition, but rather “My grace is sufficient for you, for power is perfected in weakness.

Power is perfected in weakness… Hmm, how does that work? Apparently that is what I must yet learn. What is the nature of this power? It certainly is not physical. No Olympic athlete cultivated weakness in order to achieve greater strength or stamina. It must be spiritual power, or as Paul puts it, “the power of Christ”. I must yet learn what that means experientially – this is not something to be comprehended through mental gymnastics. I suspect people like Joni Eareckson Tada and Dick Woodward know a bit about power perfected in weakness.

One thing I have learned: that is to be satisfied with uncertainty. In a conversation with my Dad the other day, he asked “When will you know you have been cured?” My short answer: “Never.” From a medical standpoint, I know the physicians will never declare me “cured”, even if no evidence of active cancer can be found. Rather, knowing that not every renegade melanoma cell can possibly be accounted for by any existing scan or test, they will declare me “in remission.”

And that is okay with me, for in this state of uncertainty (vulnerability, weakness), I am totally dependent on Him as my source of peace, hope and strength. That is where I belong. That is where I will stay. And one day I will be able to say with Paul: "Most gladly, therefore, I will rather boast about my weaknesses, so that the power of Christ may dwell in me."

Still learning and loving each day He gives,

Dan

Sunday, July 6, 2008

The Waiting Room

Aaah, we are all familiar with the waiting room, that place where you arrive to be seen by your physician, then wait (and wait) until he can finally actually see you. It is a place where many anxious moments pass ever so slowly. I have been on both sides of that room lately. At Personalized Family Medicine we eliminated the waiting room (retaining a small, pleasant reception area) through intelligent scheduling and allowing adequate time for each type of patient visit. But admittedly we did not eliminate all waiting. In God’s economy, I am now learning the value of waiting.

One of my favorite passages in Scripture is from Isaiah 40:31 – “But they that wait upon the LORD shall renew their strength; they shall mount up with wings as eagles; they shall run, and not be weary; and they shall walk, and not faint.” While scholars have debated the nuanced meaning of Isaiah’s poetic interlude, this promise from the Lord especially captured me this past week with practical power.

My first hope was that I would perhaps avoid this second series of hospitalizations altogether (“mount up with wings” and fly over this mountain) by receiving an “all clear” report from the imaging studies – that did not happen. Then, determined to make the most of it, I was anxious to race through this course in as short a time as possible, not miss a dose, and put the week behind me (“to run and not be weary”). Well, that did not happen either.

I discovered that this situation required me to learn to “walk and not faint”… to persevere, to plod through the day-by-day, hour-by-hour, minute-by-minute buffeting of my body and psyche in order to achieve the optimal outcome that my doctor (and my God) desire for me. It meant patiently waiting to collect the pre-treatment data (chest X-ray, EKG, lab); then riding inexorably through the many expected and unexpected side effects of treatment: chills, severe rigors, painfully strained muscles, limiting mobility, nausea, repeated vomiting, watery diarrhea, abdominal distress/distension, generalized swelling, shortness of breath, carpal tunnel syndrome due to the fluid retention, stomatitis, loss of all appetite, extreme fatigue and weakness, and, appropriate for the Fourth of July, a red splotchy itching rash surrounding pale white islands of raised whelts and blue lips!

With each new dose came a new combination of toxic effects, a strategy to ameliorate those effects, and in many instances the next dose postponed to allow time to recover. This particular course required the longest hospital stay yet to complete just 8 doses of IL-2, sometimes getting only one dose in over a 24-hour period. Beyond a doubt this fourth (and hopefully final) session of high dose Interleukin-2 therapy was the most difficult and protracted.

What was I to learn through this? First, He does not provide wings to surmount the circumstances in every situation. I have experienced that kind of rescue in the past, where I could view the problems in the valley from a lofty perspective and my only worry was to avoid plunging inadvertently into the next snow-capped peak! Sometimes He has us run like a troop through the thickets that would otherwise slow us down, renewing us with energy, quickening our pace, and cheering us on over the next hill. And sometimes He places us in a position that running or flying will just not achieve the best outcome – He comes along side to sustain us through the drudgery of the challenge we must endure and our strength is renewed to the very end. He reminds us, "It's the relationship, stupid!" He wants me to learn to know Him more intimately and it is during these times that I slow down enough to hear His heart beat (Isaiah 26:8, Psalm 46:10).

My role is to discern which course of action is most needed and to “wait” on Him to help me through it. It was just a day before being admitted to the hospital for this final round of IL-2 therapy when one of my mentors, Hap Struthers, a fellow elder at Tab church and a Hebrew scholar, pointed out that the verb translated “wait” in the King James version (elsewhere translated as “trust” or “hope”) has its roots in the Hebrew term for “lying in wait”, as in an ambush. Rather than a passive activity, it describes the one who seeks new strength as a person poised for action, every muscle taut in anticipation of God showing up in the midst of a difficult situation.

I like to think of this waiting process as similar to the mental attitude of well-wishers at a surprise birthday party for someone they love, all quiet and crouched behind the furniture. Together they are poised to spring upon their friend to lavish him with praise and affection as soon as he arrives. (Notice that passage does not say “he” that waits upon the LORD, but rather “they…”. This is a group endeavor!) I have sensed that I am joined by my many believing friends and family who were fully expecting God to show up in this situation, anxiously anticipating what He would do. Well, my friends, I am happy to report He did show up, and He is deserving of all our praise.

And of course, He kept His promise: Through this week, I have walked (sometimes crawled) through the most difficult circumstances yet, and I have not fainted. Thanks for being part of the waiting room party! May you, too, experience His renewed strength on your journey today.

Celebrating Him,
Dan

PS – Linda had a few more adventures while staying at the camper during the week and has been a tremendous source of strength from the Lord to me. I expect to be discharged today. We will spend one more day in the camper to recuperate and head back home for what we hope will be a full recovery. Next round of tests are slated for early August.

Thursday, June 26, 2008

Lessons From My Grandchildren

. Asher, Madison, Evelyn, Mark, Matthew, Me, Zephan, Morgan

One thing that has surprised and exhilarated me through this ordeal is how the Lord has used little incidents to speak to me of His wisdom and His love. My guess is that He has always been trying to reveal Himself in this manner, but in my life “BC” (before cancer) I was too busy (or deaf) to listen.

In a recent incident, my granddaughter Evelyn uttered what can only be considered a beautiful prophecy. Linda and I were visiting our oldest daughter Kim in her new home, helping organize and unpack. Christianne, our youngest, David, her husband, and their daughter, Evie were also on hand.

As the time came for us to leave, 3-year old Evie ran to me and wrapping her little frame around my leg exclaimed, “But I don’t want you to go home, because…” Her little mind conjured up her most persuasive argument: “…Because, I love you!” And then, “Can I have some strawberries?” (The latter phrase probably of no prophetic significance.)

Well, it looks like “because He loves me” my home-going will be postponed. I am so grateful to be so loved.

Another lesson I am learning was also inspired by my grandchildren. Awakened in the middle of the night with these thoughts, I committed them to poetry. I share them with you in hopes that you may embrace these truths without having to travel the same path.


To End with “And…”

Tucking our granddaughter into bed
Recounting the castles we made of sand
Sleepily now her prayers are said
“God bless Mommy, and Daddy, and…”

As dreamy delights wash over her mind
Her voice now fades to some distant land
I gaze at her peaceful face and find
That there’s promise in ending with “and…”

Once driven at a frenetic pace
Subscribed to all the profession demands
Breathlessly would I run the race
Little time for “ifs, buts, or ands”

Then arrested by my potential demise,
Malignancy confirmed with each scan
I pause to consider my fate a disguise
For new life that makes room for “and…”

To know Him in unending days
Starting now with the touch of His hand
Herein is eternal life…” He says.
‘Tis futile to work to this end.

When once a period completed each phrase,
Every move made precisely as planned,
Now there are endless refrains of praise
As each day ends with “And…”


Prayerfully,
Dan

PS – a beautiful song that resonates this same theme is Chris Rice’s And His Praise Goes On, especially the final verse. Click on the title to read the lyrics, then the icon in the right upper corner to listen to the song.

Renewed in strength, we head back to Charlottesville on Sunday for the second week of this second cycle of high-dose Interleukin-2 therapy. This promises to be the most challenging session yet. We covet your prayers!

Saturday, June 21, 2008

Be Strong & Courageous

As I was nearing the end of this week of high-dose Interleukin-2 therapy, a number of the expected toxicities were cresting like waves against my body: the generalized swelling (gaining 17 pounds of water weight), muscle aches, bed-shaking chills, nausea, episodic vomiting, diarrhea (accompanied by a sore touche), stomatitis, abdominal swelling and pain, shortness of breath, difficulty sleeping and fatigue. Would this next wave take me down or would I still be standing when it receded yet one more time?

In spite of the side effects, I had successfully completed ten doses of Interleukin-2 and the oncologist was contemplating the eleventh dose to start at 1:00 a.m. on Saturday morning (today). If the numbers from the lab and vital signs came back okay, he would authorize the eleventh and final dose, if I also agreed that I was up to the challenge. At first I wanted to duck my head and simply let this one pass. Then the Lord’s Spirit spoke to me with the words uttered to Joshua centuries ago: “Be strong and courageous” (Joshua 1:6,7,9). Waiting for the doctor’s decision, I went to my Bible and reviewed the story of Joshua.

Now in no way do I compare myself to the mighty warrior that was Joshua, nor, for that matter, do I compare my circumstances to the enormous physical challenges and life-threatening situations that many others have faced, including our men and women in uniform.

But at some point each of us is placed at a point where we have to make a conscious choice to be strong and overcome our fears/discomfort/adversities or to take an easier path with less risk. It is seldom that I have truly had to be “strong and courageous”. Last night was one of them, though minor in the list of struggles faced by many others. Yet I learned something through it.

What is required at that moment is found in your spirit. To be strong at this point is a steeling of mental faculties, not necessarily an adrenalin boost in physical prowess. It is a willful process of taking inventory of priorities and view the situation with a broader perspective. To be courageous is to have faith that, whatever the outcome, a higher goal compels you to choose to face the situation with resoluteness and determination.

We find these characteristics, of course, in the life of Joshua. Facing the overwhelming task of leading a nomadic collection of tribes to conquer the inhabitants and settle in the land of promise, he was coached by God to do two things: be strong and courageous, and observe all the law of Moses. While there is a place for prayer, for faith, for surrender to God’s will, here the emphasis is on mustering up the internal qualities of mental fortitude, valor, and moral purity.

Knowing that I had a “multitude of witnesses” cheering me on, and taking personal inventory of these concepts, I determined that if Dr Grosh authorized an eleventh dose of Interleukin-2, I would stand against that wave as well. As it turns out, all my numbers were satisfactory except for one – my urine output was too low (owing to the fact that my stomatitis and abdominal pain had reduced my ability to take in enough fluids orally). Dr Grosh was satisfied with ten doses, cancelled the eleventh dose, and discharged me later this morning.

I am home now, feeling a little puny, but still upright and grateful to you all for your prayers. My prayer for you is that when your moment comes, you too will be strong and very courageous.

Gratefully,
Dan


PS – We will be home this week recovering, have some interim lab studies performed, and plan to return next Sunday for readmission on Monday, June 30 for the second week of this second cycle of IL-2 therapy.