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…”


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.


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.

Monday, June 16, 2008

A Second Touch

There are many wonderful stories of miraculous healing by our Lord in the gospels. You will be hard put, however, to find a single pattern and certainly no “formula” by which to predict who, how or when Jesus would intervene in the lives of the leprous, lame, or blind. Sometimes He heals long-distance with a spoken word (Matthew 8:5-13), at other times He lays hands on the afflicted (Matthew 8:2-3), and on occasion the afflicted simply touches Him in an abandoned reach of faith (Mark 5:25-29).

In no way does this suggest that God’s grace is arbitrary or random. Rather I believe He is careful to demonstrate the uniqueness and intimacy of each encounter. The focus remains on the relationship rather than the methodology. He will not be placed in a box.

On at least one occasion, Jesus accomplishes a miraculous healing in stages (Mark 8:22-25). In this instance His disciples bring to Him a blind man, imploring Him to restore his sight. With a combination of sanctified saliva and a touch of His hands the man opens his eyes to what appears to him as men “like trees walking around.” It takes a second touch by the Great Physician before he “began to see everything clearly.”

What is going on here? Does the need for a second touch somehow indicate a “brown out” in the divine power supply? Although we are not told specifically, the context of Mark’s gospel suggests that Jesus was providing His disciples a living lesson in how repeated surrender to His activity in the lives of men over time will yield 20/20 spiritual insight.

It is also possible that Jesus is demonstrating here that the benefit of his grace is to extend beyond the immediate recipient. Note that the blind man's new-found vision first provides progressive clarity in his perception of others rather than his own reflection. Jesus' every action reflects a divine purpose (John 5:19-20).

In this journey of faith I have had every confidence that on any given day the Lord could heal me instantly and completely. He has chosen not to heal me in this way. I am trusting Him no less for full restoration, gladly surrendered to His lovingkindness, however He chooses to demonstrate His power and love. I am also fully aware that there is a battle to be fought. My role is neither passive nor presumptive.

The time has come for me to enter the second round of Interleukin-2 therapy. I will be admitted today for placement of a central venous catheter followed by a series of high-dose Interleukin-2 infusions up to every eight hours over the next week until I can tolerate no more. The anticipated side effects include shaking chills, muscle aches, diffuse swelling, possible wet lungs and shortness of breath, generalized rash and itching, low blood pressure and even kidney impairment.

I conclude once more, God is in charge, not I. And He is good! He is ultimately more concerned about my character than my comfort (as Job learned, Job 42:5). He uses pain to foster a higher potential for personal purity (1Peter 4:1). He values longsuffering over longevity.

With eternity in better focus, I have begun to see things (and men) as never before.

Anticipating His grace and a second touch,

PS – Linda has been a tower of strength through all of this. Please pray for her as she spends endless hours at my bedside during the day, then camps out by herself at a nearby RV park each evening.

Sunday, June 15, 2008

Father's Day Blessings

On this Father's Day, I am privileged to have my Dad still around and to be around myself to enjoy my three gorgeous girls and seven wonderful grandchildren (with an eighth one due in July!).

Happy Father's Day, Pappy! I love you very much and appreciate the faith and character you have modeled for me. And thank you, Heavenly Father, for all the blessings of this life!

Speaking of blessings, imagine my joy in receiving the kind of love expressed by my offspring as reflected in this earlier posting by our middle daughter, Beth, shortly after the news of my cancer...
Sunday, February 3, 2008

Daddy's Little Girls

My dad is currently fighting the biggest physical and spiritual battle of his life. The physical battle is against stage IV melanoma skin cancer. The spiritual battle is against powers and principalities unseen and which I do not fully understand, "We wrestle not against flesh and blood, but against principalities, against the powers, against the world rulers of this present darkness, against the spiritual hosts of wickedness in the heavenly places.” I am fervently praying for a miracle for my dad. I am preparing for a heart break. In the midst of this waiting place that I am wading in, I am blessed with friends and family who love me and stand beside me as I tread through my grief.

Knowing that my dad might not be part of my current life-story for very much longer, I want to share with you some "Daddy Facts & Stories" that I hold dear.

1. Dad asks great questions: Who is the Boss of your life?
When I was four years old, I hated this question. You see, I really wanted to take part in communion at church along with my big sister and everyone else. My parents felt that I should fully understand the meaning behind being part of the body of Christ before I took part in the Eucharist. My dad sat me down and asked me, "Beth, who is the boss of your life?" I told him that he and my mom were the bosses of me. This was the wrong answer and it disappointed and frustrated me to no end! Even then, I hated to get things wrong. One day, it finally clicked. Jesus was the boss of my life. Jesus was the boss of my parents' lives. I finally knew the truth about the Truth. My dad led me towards a knowledge, acceptance, and love of Jesus at the tender age of four. Over the past 29 yrs of being a Christian, this faith of mine has become fortified as my own and it all started with this simple question. Dad, for this I am eternally grateful!

2. Dad is a good provider.
My father is a Family Practitioner and has always excelled in his career. Dad works very long, hard hours to ensure that his patients are cared for and to ensure that his family is too. My dad's hard work enabled my sisters and I the chance to live in beautiful homes, travel to wonderful places, develop our interests and talents, and generally live a very comfortable, secure life. My parents' financial sacrifices enabled me to go into my adult life well-rounded and debt free. I couldn't have asked for more.

3. Dad cares deeply for others.
When my family lived in Michigan, my dad had a private practice in a small town where he was deeply loved and respected by all of his patients. I'm not sure if it was because some of them were unable to pay for their medical bills, or if it was just out of a love for my dad, perhaps a bit of both, but patients would lavish gifts upon my father---especially at Christmas-time. Now I don't know about you, but I have never even considered giving a gift to one of my healthcare providers! But Dad gave his patients the kind of wholistic care and attention that motivated an outpouring of gifts. At times it really felt like my parents were celebrities. We couldn't go anywhere as a family without patients stopping us to greet our family. We couldn't go to church and just leave afterwards without myriads of people asking if my dad could just quickly take a look at this or that ailment. We couldn't go out to dinner without being interrupted several times by people wanting to speak with my dad. Personally resenting unwanted social attention and resenting having to always share my dad, I remember snottily asking him, "Why do all your patients love you so much?" His sincere and humble response has always stuck with me..."I think my patients know that I genuinely care about them and their total wellbeing. That's why." Dad, you have always been a role model to me on how to graciously care for others.

4. Dad loves Mom.
My father adores my mother. He's always thought she was hot, and over the years that passion has not waned. Growing up, this would get a bit embarrassing. I would want to show friends some pictures or video from our recent family vacation and there would inevitably be some picture of my mom in her bikini or some video snippet of my dad sweet-talking & hitting on my mom. My dad is very creative and enjoys writing rhyming riddles and poems for my mom. Many Christmases my Dad would write these little riddles in order to make my mom search for her Christmas gift. After going from clue to clue, my mom would eventually find some fantastic piece of jewelry hanging somewhere on the Christmas tree. It has always been so romantic to watch. As a little girl, this love and passion between my parents set the standard for what I'd hoped to obtain for myself. Dad, your adoration for Mom has always touched & inspired me!

5. Dad is a very patient man.
It is often said that if you pray for patience God will give you circumstances in life to cultivate that patience. Well Dad, I'm not sure if you asked for it, but the Lord granted you the cultivating experience of raising three high-strung, drama queens! My sisters and I tried and tested my Dad's patience with our continual squabbling, frequent outbursts of emotion, and (very rarely) sassy back-talk. My Dad took it all in stride. Whether it was helping me with my math homework (which always led to tears and fatalistic comments about never getting it) or helping me nurse a broken heart from a jerky-guy, Dad was there to be level-headed, calm, and patient. Thank you Dad for teaching me what patience looks like. I'm still working on emulating this one in my day to day life.

6. Dad likes adventure (and he likes to fly through the air).
Whether it was dune-buggying over the sand dunes in Michigan, white-water rafting in Colorado, or "flying the hull" of his catamaran on the Chesapeake Bay, Dad loved to take us along on his adventures. Although we haven't yet located the picture to proove this (and Dad totally denies it happening), my sister and I swear that my dad had us stand by the open jaws of a crocodile at Everglades National Park. Ah yes, my father's love of adventure has created many-a-family-memory over the years....most of which end in my mother screaming "Daaaniellllll!!!!!" Let's see...there was the time that Dad was confident we could get over the snow and ice covered hill in his little Eagle Talon and we spun out mid-hill and almost fell over a cliff. There was the time that Dad just had to take that last-ride on his catamaran before the storm and the boat flipped trapping him out at sea. And if this were an episode of America's Funniest Home Videos and I could take all of the moments my dad has flown off of moving things it would look something like this:
4While manning the boat with clueless kids aboard, Dad gets bumped off the catamaran by a huge wave and flies through the air into Lake Michigan. Renegade boat almost crashes into a fallen tree on the beach but is saved by my then 12 yr old big sister, Kim.
4While running alongside my little sister's bike in an attempt to teach her to ride it, Dad gets a bit carried away with his speed and Chrissy begins to crash. Not wanting to fall on his 5 yr old, he flies through the air into a bunch of bushes and cracks a rib.
4While horseback riding with me, we decide to take our horses on a back trail at a full gallop. Dad's horse hits some gopher holes guessed it...Dad AND the horse go rolling, tumbling, and it finally ends with Dad flying into the air and landing on a patch of grass. Scared that the horse would run away, I leave my Dad injured in the grass to go after the horse. (My family still won't let me live that one down. Sorry Dad!)
4While skiing in West Virginia, Dad and I decide to try an Intermediate slope that somehow turns into Mogul Hell. I had just completed an entire month of lessons and was able to safely maneuver my way down but Dad...well...he did quite a bit of flying through the air. It was painful to watch.

Yes, my dad has had many adventures and we have been privileged enough to be a part of some of them! Thanks Dad for your passion for life and your willingness to take risks. I have been enriched (and amused) by all of our adventures together :).

7. Dad loves me.
When he helped me put baby blue-jays back in a tree....When he helped me learn gymnastics by flipping over the couch in the basement....When he helped me look after a sick and dying seagull...When he hugged me and told me never to hold my feelings in...When he took care of me all the times I was sick....When he listened to me ramble on about boys...When he video-taped all of my school concerts and plays...When he marveled at my beauty and dad told me he loved me. I have never doubted my father's love for me. His passion for Christ and his example as a Godly man has enriched and blessed my life beyond measure.

Dad, I love you. Please fight.

I will not die but live, and will proclaim what the Lord has done. Psalm 118:17

Posted by Beth Crabtree Hunter

Sunday, June 8, 2008

Round 2!

We are about to enter the ring once more for Round 2 in this fight against a rather formidable opponent.

The extensive tests performed last Thursday included comprehensive lab studies, whole body bone scan, MRI of the brain, and a CT scan of the neck, chest, abdomen and pelvis. The good news is that the remarkable improvement noted on the last scans six weeks ago was largely maintained – there were no new lesions in the lung, liver, spleen, spine or long bones. Also very encouraging is the fact that the labs were essentially normal with no elevation of markers of tumor activity. I have gained weight, have no significant neurological symptoms, and have progressively improved in strength and stamina.

The bad news is that 3 new brain metastases have appeared since the last scan and a group of enlarged lymph nodes at the base of the liver have increased in size by about a third. The size and number of nodules in the liver is unchanged and there remain two very small nodules in the lung which are also stable. Findings all along the spine and long bones are consistent with healing of innumerable metastases there.

The new brain lesions present a particular challenge since Interleukin-2 therapy can cause them to swell which could lead to serious elevation of intracranial pressure. Fortunately, my neurosurgeon, Dr Jason Sheehan, promptly arranged for me to undergo gamma knife surgery tomorrow, Monday, June 9. I tolerated this procedure quite well last February and have confidence that the Lord will take us through this second regimen successfully.

Assuming a good outcome from the gamma knife procedure, we will then return to Norfolk on Tuesday and come back to Charlottesville next Sunday for readmission on Monday, June 16 to commence a second round of high-dose Interleukin-2 therapy.

Both Linda and I are optimistic and ever grateful for each new day, thankful to God for His mercy and grace, and to you for your many expressions of encouragement and support. As I enter Round 2, I am much stronger than I was for Round 1, and trust that, buoyed by your faithful prayers, we will have much to rejoice over in another few weeks.


ADDENDUM (June 9, 2008):
Correction -- make that eight (8) tiny new brain metastases (picked up on a repeat high-resolution MRI), all of which were treated with gamma knife surgery today. I appear to have tolerated the procedure well with only a mild residual headache. I have been released and had my "chauffeur" drive me home to Norfolk today. We are fully engaged in this fight and appreciate having you in our corner.

Friday, June 6, 2008

Access (Part III)

There is an important feature about access that I failed to mention – one that I learned with much consternation during my years of medical training. While access to a bodily compartment is often critical to make an accurate diagnosis or to provide appropriate intervention in an acute injury or illness, it is also typically quite restricted.

I was happy to tell you about the successful subclavian vein catheterization that proved to be life-saving for my patient with the heroin overdose, but I did not mention the failed and perilous attempt at the same procedure just a few days earlier. Again it was an emergency situation, this time with significant intra-abdominal bleeding from blunt trauma. The small peripheral IV running in the left arm was insufficient to provide adequate fluid resuscitation, so the surgical resident directed me to perform a subclavian stick.

The point of entry, angle of approach, and depth of penetration must be precise. Start at the wrong place and all efforts will be futile. Too shallow an approach and you simply cause pain with no gain; too steep and you can puncture the lung; too deep and you may cause an arterial bleed. Well in this case my approach was too steep and I aspirated air instead of blood. Fortunately, the resulting partial lung collapse was minor and did not require a chest tube, but the experience taught me that successful access is gained through a very narrow window.

This proved true whether I performed a simple venipuncture, a spinal tap, a joint injection, or almost any other invasive procedure you can name. It is also true in many other life endeavors. Think about it: To sink a 20-foot putt and cinch the championship, Tiger Woods must envision and execute a very precise path for the ball on the green. The launch of the space shuttle requires rigorous attention to a set of very narrow parameters including timing, direction, acceleration and duration of rocket burn to achieve proper orbital insertion. Safe re-entry demands just the right angle of inclination. And we all have experienced the frustration of not being able to access some important financial information due to one misplaced letter or digit in a password. Not every mountain path leads to the summit.

Brian Clark knows all too well about limited access. An executive vice president of Euro Brokers, he was one of only four survivors working above the point of impact in the South Tower of the World Trade Center during the 9/11 attack. As the plane sliced through the building on an angle, causing enormous devastation from the 78th to the 84th floors, two of three available stairwells were completely destroyed. Brian, serving as a volunteer fire marshal on the 84th floor, led a group of seven to the one remaining portal of escape (“Stairway A”).

Brian relates what happened next: “So we started down that stairway and we only went three floors and… we met two people that had come up from the 80th floor – a heavy-set woman and a rather frail male. She said, ‘Stop, stop. You’ve got to go up… You can’t go down. There’s too much smoke and flame below.’ "

Brian was skeptical of placing their hope in a roof-top rescue. A heated argument ensued, but he could not convince the group. They proceeded back up the stairs. Brian meanwhile heard cries for help coming from a nearby office and left the group to rescue Stanley Praimnath, a banker trapped on the 81st floor. Together they made their way down the stairs to safety, escaping the building just minutes before it collapsed.

All those that chose to ascend the stairwell perished. In spite of passionately held beliefs to the contrary, the one and only route to safety was down Stairway A.

Earlier on this journey of faith (while still in post-graduate training), I wrestled with the possibility that there may be alternate paths to truth… that competing world views were equally legitimate, and perhaps my view of how one could know God was too narrow. Having become a “sophisticated” physician, I chaffed at the image of a Bible-thumping believer, labeled as “narrow-minded” or, worse, “intolerant” of those who embraced an alternative lifestyle.

Then I was confronted with Jesus’ own words: “I am the Way, the Truth, and the Life. No one comes to the Father but through Me.” (John 14:6) And again: “For the gate is small and the way is narrow that leads to life, and there are few who find it.” (Matthew 7:14) Far from unforbearing, if indeed there is only one way to safety, one path to eternal life, compassion would dictate the effort to convince others to follow you on this path.

Through this experience with cancer, I have seen the smoke and the flame and am convinced that, narrow and difficult though it may be, the one way to save your life is to lose it in Jesus Christ and follow Him (Luke 9:24). He is not simply a fire escape – He is truly the way to an abundant life (John 10:10)

Celebrating each step of the Way,

PS – The wound from the central venous access port is healing nicely. We are currently in Charlottesville awaiting final results of a battery of tests performed at UVA to determine the current status of the cancer. I will provide another update soon.