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,


  1. Dear Dr Crabtree,

    I read with great interest a letter that your brother wrote to the Muskegon Chronicle recently. I am a former patient at Harborwood Family Medicine in Muskegon (John Mulder was my PHP). I was diagnised with stage III malignant melanoma in January 2002. I have been very fortunate to be NED since March 2002. I did interferon ( Sends a shiver down my spine just typing the word) for only 6 weeks out of a recommed 1 year. I know that you hwve been through way more than I could imagine but please know that there are many people alive and doing well many years after their diagnosis. I found a lot of good information and support on a web site called the melanoma patients information page (MPIP). I will pray for you and your family.

    Ann Kowalski

  2. Dear Dan and Linda, still praying for you through the many ups, downs, and ups. Blessings, rod and jeanie

  3. Dr. Crabtree,

    I saw the letter in the Muskegon Chronicle, and new I needed to share this story with you. I was your patient as well as my entire family, we still talk about how we miss having you as our Physician. You took a cyst off from my patella, I was about 13-14 years old. I asked if I could watch, you said if I would like. I watched as you explained everything to me, answered all my question and, were so kind. When finished I told you how cool that was, your response was maybe you will go into the medical field someday. I become interested in the medical field off to nursing school I went, I currently work at Hackley Emergency room. You are one of people who inspired to pursue my dreams. I don't expect you to remember me, Lord knows I can't remember all the patients that I see, but I wanted to let you know you played a part in my decision to go to Nursing school. I pray for strength and peace for you and your family. God Bless, Lacey

  4. Dr. Crabtree,
    I, too, saw your brother's update in the Muskegon Chronicle. Our young family were also patients of yours and have many fond memories. Our young daughter was hospitalized with a partially collapsed lung, and you personally called and talked to me about things she might have choked on and inhaled. Also, I I saw a little Golden Book in the store one day called Dr. Dan, the Bandage Man. Bought it without further thought and we read it every time the kids had to see you!
    I will continue to read your updates. The expressions of your love relationship with the Lord are phenomenal.
    BB in Muskegon

  5. Precious One,

    I just want you to know that Bob and I are continuing to pray for you for a complete healing.......
    knowing that "NOTHING is impossible
    with God". Remember Ed's miraculous
    healing! I know what you are experiencing must be very difficult
    right now; however, I know God's grace will meet your every need and
    that HE will not give you more than you can bear.(1Cor.10:13). You are so special to SO many people...I was so very blessed to
    have you as my physician. You will always be "precious" to me.
    Anita Trotman Avery.

  6. I have been following your blog since you started it. A lifetime friend of mine goes to your church and told me about you. I'm a cancer patient, too. I've been praying for you and your family.

  7. Dear Dan and Linda,
    We continue to pray for you both of you as you both go thru many challenges. Many blessings and prayers to both of you and your families as well. We continue to pray for you all. Susan

  8. Dr. Crabtree,
    I also read with interest in the Muskegon Chronicle about your health and felt the need to write. You might not remember me but I was a 25 yr. old patient with cancer and you were my family physician at that time (I am now 53 yrs. old). I feel because of your early diagnosis that I am here today. Not only was I impressed with your skills but also your bedside manner. Even after you referred me to an oncologist (Dr. Upton, Grand Rapids, MI) you visited me while I was hospitalized for a week due to complications. You found out through Dr. Mirich that I was in the hospital (Hackley Hospital). There are not many doctors nowadays that do that. I feel that your support at that time helped in some way to beat my cancer. I will always remember you with fondness and wish you good luck in this journey.
    Chris Gilchrist