Saturday, December 26, 2009

Stranger Than Fiction

One of the delightful traditions the Crabtree family has enjoyed down through the years is the re-enactment of the Christmas story as the entire clan gathers at our house for a time of feasting and fun. Using a "harmony" of the gospels (a chronological retelling of the life of Christ that borrows from all four gospel writers), I recite the story of the events surrounding the birth of Christ while the grandchildren, selecting their favorite character from our kid-friendly nativity set, role-play each person (or creature) in the story. In years past, a climactic scene was the sudden appearance of Baby Jesus from beneath the skirt of a paper-machete mother Mary! A much-coveted role each year is that of the arch angel announcing the birth of Jesus to the shepherds, especially when the "glory of the Lord shone 'round about them" (complete with special effects created by wildly waving a pen light above sheep made of cotton balls). Between narrations (that rival the baritone recitations of Alexander Scourby :-) we join in singing Christmas carols appropriate to that segment of the story, assisted by a sing-along video displayed on the TV above the creche scene. Over the years the presentation has become quite a production which the entire family thoroughly enjoys.

I have to admit, however, that we do take some liberties in retelling the story. For example, we compress the time between Jesus' birth and the visit of the Magi (which was likely at least two years after His birth and probably not at the stable in which He was born). We also edit out those parts of the story that are disturbing to us -- routinely eliminating the narrative about king Herod's slaughter of all male children in Bethlehem under age 2. (Matt 2:16)

The full story of the incarnation of God in the form of a human embryo, then as the babe in a manger and ultimately as the willing human sacrifice to redeem a lost generation is magnificent and awe-inspiring... but also terrifying. Terrifying as it exposes the awful cost of my sin, the inescapable reality of my responsibility and accountability before a holy God, and the terrible consequences of ignoring His overtures of love and forgiveness. Parallel to the story of God's mercy and grace is the story of evil as an active force in the world that we must not underestimate.

The tension between the ideal and the real is nowhere more palpable to me than in this ongoing battle with malignant melanoma. In recent weeks I have seen the progression of the cancer in a number of ways (visible, palpable and painful metastases, progressive fatigue and muscle weakness, worsening headaches, persistent episodes of scintillating scotoma, etc.), in spite of ongoing radiation and chemotherapy. In the midst of this battle, I am not overwhelmed or overcome, nor am I naive to the very real possibility of my imminent physical demise.

But because of God's intervention in human history 2000 years ago when He took on the frail frame of a man and showed us how to live an overcoming life in the midst of a sinful and imperfect world, I have every confidence in the ultimate victory and in His provision for those I love. Stranger than fiction, the story of Jesus points out both the reality and ultimate solution for the problem of evil in the world.

May you, too, know that victory --
Dr Dan

Sunday, December 20, 2009

Pharmaceuticals and Faith

Pictured above is my weekly regimen of chemicals designed either to slow the progression of my cancer, to deal with the side effects of those chemicals, or to treat some ancillary ailment. Yep! Facing a third year in this battle with malignant melanoma, I have officially joined the ranks of the chronically ill and settled into a regimen often ruled more by chemicals than by any creative pursuits.

It is impossible to tell which symptoms are due to the underlying battle with renegade melanoma cells (in brain, meninges, lymph nodes, long bones), which are due to the drugs designed to hold the cancer at bay, and which are due to the drugs designed to lessen the side effects of those drugs. Well, honestly, I have some idea which symptoms come from which source, but it is getting more and more difficult to discern which is more troublesome: the disease or the treatment?

One example: daily headaches. Likely due to the multiple deposits of metastatic melanoma within the skull, both the radiation specialist and the oncologists recommended high-dose steroids to reduce the associated pressure on the brain. Although this helped for a time, the steroids also resulted in muscle weakness, cramps, fluid retention, and fatigue. I was forced to cut back on the steroids, after which I regained some muscle strength and no longer look like a jack-o-lantern :-) The headaches are controlled now with Tylenol and an occasional Dilaudid.

As a physician, I fully anticipated this balancing act -- balancing the beneficial effects of drugs with their undesirable side effects. And I have the advantage of knowing which symptoms are likely due to the cancer versus the drugs designed to treat the cancer versus the drugs designed to treat the side effects of the drugs designed to treat the cancer (!) I also recognize that I need to pay attention to the basics: maintain a balanced diet and exercise even when I don't feel like it. The experience has taught me great humility and empathy for all patients who face similar challenges.

I have found the same principles apply to my spiritual health: when I am spiritually malnourished I am more susceptible to unhealthy and negative thoughts and less sensitive to the needs of others around me (just ask Linda!) On the other hand, to the extent that I read scripture, spend time in prayer, and look for opportunities to exercise the spiritual gifts He has given me (i.e., to express His love to others), I experience renewed energy, a greater optimism and a settled joy in each day.

Some pills are hard to swallow (e.g., acknowledging my greater dependence on others), so each treatment decision involves a risk-benefit analysis. It takes spiritual energy to put the needs of others ahead of myself (especially when I have very little energy to begin with). Fortunately, investing time in prayer, scripture-reading, and seeking opportunities to serve others ultimately results in a net gain in spiritual, emotional, and even physical strength.

With the help of the Great Physician, I continue to pursue a balanced regimen that includes both pharmaceuticals and faith. This regimen, thoroughly mixed with your prayers, is a prescription made in heaven!

Dr Dan

Friday, November 27, 2009

Thanksgiving "Top Ten"

In this season dedicated to giving thanks, I have decided to share with you my "TOP TEN" pick of blessings over the last year.

#10 -- My father and siblings: Among other challenges faced by my dad, four brothers and sister, my personal encounter with a life-threatening condition has renewed and strengthened a bond of authentic caring, thoughtfulness, tolerance, and appreciation for each member of my birth family that is enormously gratifying. I sense a closeness that we have not known since childhood (and perhaps never before with such quality and genuineness).

#9 -- My church family: A very special group of people who know and love God passionately have been an enormous support to me and my family during this battle with cancer. They have visited, called, encouraged, prayed, sent loads of cards, offered meals, transportation, labor, genuine love and fellowship. Particular gratitude goes to those in our "CARE group" with whom we meet weekly and who have faithfully supported the entire family through this difficult time. Other life-long friends who share the same passion for God have faithfully refreshed and strengthened us along this journey.

#8 -- My physicians and their staff: I could not have chosen a more competent, caring, or thorough-going team of professionals to shepherd me through this battle with malignant melanoma. The team includes Drs Rose, Alexander, Grosh, Sheehan, Larner, Randolph, Gould, Parent, Hood, and a host of others who work in the emergency room, in front of radiology CRT displays, or peering into microscopes. In addition, I am indebted to Dr Glenn Jones for assuming the care of my wife when her "favorite" physician became disabled!

#7 -- You: You who have shown an interest in my well-being and progress over the last 23-month battle with malignant melanoma, who have followed this blog regularly, who have commented, encouraged, sent cards, challenged, and prayed for me. Many of you are former patients. You have sustained me, strengthened me, motivated me, inspired me and truly overwhelmed me with your thoughtfulness and genuine concern.

The Crabtree Clan at Thanksgiving

#6 -- My grandchildren: Pure delight! Well, maybe not always pure, but always a delight! Morgan, Madison, Matthew, Mark, Asher, Zephan, Evelyn and Adelaide -- each with unique gifts, personal strengths and challenges; each a source of great pride and joy.

#5 -- My sons-in-law: Alan, Matt, and David each have demonstrated dedication to family and to my daughters that has been a source of great encouragement for me. In spite of the demands of career and ongoing education, each has made family life a high priority and each is seeking to honor God in all their endeavors.

#4 -- My children: Kim, Beth, and Christianne have more than accommodated themselves and their families to our situation -- they have leveraged the circumstances to enrich us all with their courage, creativity, and dedication to family. They have not put life on hold, but engaged in activities that reflect their passion for godliness, life, beauty, and love of others.

#3 -- My wife: Linda has been a faithful partner through some very difficult times this last year. Although I have not been bed-ridden as I was off and on during the first six months of this battle with cancer, I have been very dependent on her for transportation, nutrition, companionship, and, at times, as my peripheral brain. I cannot imagine life without her. Armed with a faith that has withstood the test of this trial, she has not missed opportunities to encourage others facing similar challenges.

#2 -- God: This journey with cancer has welded my relationship with God, transforming it from an exercise of initial child-like faith into one of intimate trust and commitment -- paying dividends that include an imperturbable peace, courage, quiet personal joy, and a renewed passion for others to experience the same quality of relationship with Him. My identity no longer relates to what I do, but who I am in Him (transformed from a human doing to a human being, precious to Him).

#1 -- Malignant Melanoma: Ahh, where would I be today without YOU?! I would not have known the richness of these other blessings, nor the preciousness of each and every human encounter, nor the resilience and power of a mature faith in Christ, nor the depth and steadfastness of God's love in the face of enormous challenges. Each of us some day will face death. Whether or not mine comes as a consequence of this malignancy, I am grateful that I have been given the opportunity to face head on the implications of my mortality in the light of God's endless supply of love, mercy and grace! (See James 1:2-4, 1Peter 1:6-9)

Recent undoctored image of Dan
(notice absence of stethescope)

As the apostle Paul declares: "Who will separate us from the love of Christ? Will tribulation, or distress, or persecution, or famine, or nakedness, or peril, or sword? Just as it is written, 'For your sake we are being put to death all day long; we were considered as sheep to be slaughtered.' But in all these things we overwhelmingly conquer through Him who loved us. For I am convinced that neither death, nor life, nor angels, nor principalities, nor things present, nor things to come, nor powers, nor height, nor depth, nor any other created thing, will be able to separate us from the love of God, which is in Christ Jesus our Lord." (Romans 8:35-39)

At this time of thanksgiving, I do not wish you my same journey, but I pray you may know the rewards that come from the same depth of relationship with the God who loves us and supplies our every need.

With an ever-deepening attitude of gratitude,

Monday, November 23, 2009

The Beast from the Northeast

The Nor'Easter of 2009 at the Crabtree home

If you know where we live, you know that we just experienced one of the worst Nor'easters in this region in over a decade... four days of gale-force winds, high tides and heavy downpours that came to visit us from the remnants of hurricane Ida, November 11-14. Facing the northeast on the southern shore of the Chesapeake Bay, our house gets pummeled by these storms that, due to their tendency to loiter for days at a time, dump more rain and can cause more tidal flooding and wind damage than a hurricane. Although not unscathed, we survived the storm better than many along the coast.

Friends of ours not only lost a good portion of their protective dune, but had significant water infiltration, loss of power, a house fire ignited by a power surge, subsequent smoke damage, and the headache of a major clean-up. Other friends situated more inland had to deal with a gigantic oak tree that could no longer resist the wind and soil-loosening rains, crashing into their home with destructive force. Others were displaced or stranded by rising tidal flood waters, power outages, and/or direct structural damage from the storm. (For related videos of the damage, click here.)

By comparison we count ourselves fortunate to have suffered relatively minor damages so that we will not need to make an insurance claim. We never lost power and, due to the deposit of a large mass of vegetative debris from the Bay, have the potential for expansion of the protective dune barrier in front of our house. The tidal flooding never reached our home. Even our weather vane survived peak gusts of over 75 MPH.

In addition we were blessed with the timely arrival of Dr. Rod and Jeannie Mirich, dear friends from Danville, KY that we have known since our years in residency training back in Southern California. Aware of my impaired ability to keep up with the physical demands of several different projects around the house, they had planned this visit to help in whatever way needed long before the storm was even forecast. They were a God-send! Together we accomplished in a few days clean-up and spruce-up tasks that would have taken me weeks to complete on my own. And, of course, the fellowship was sweet.

Adjacent to our home is a public park on the Bay where the city stationed massive dumpsters, allowing citizens to bring storm debris for more convenient disposal. It was heart-breaking to see families discarding flood- and/or wind-damaged belongings, including mattresses, furniture, carpet, etc. I chided myself as I recalled how much I bemoaned the theft of a couple of bicycles from our garage earlier this year...

I am reluctant to admit it, but the experience has reminded me of how prone I am to allow material things to own me, rather than the other way around. You would think that, facing a terminal diagnosis, I would have learned that lesson! Of course the truth is that we own nothing in this world -- not really. All the physical things we enjoy are but a loan. Ultimately, they can be repossessed by the bank, claimed by the government to settle an unforeseen tax liability or by the imposition of powers of imminent domain. Genuine ownership is an illusion. We are but caretakers of everything we "own".

The Bible teaches that in reality God owns it all. We read in Psalms: "For every beast of the forest is Mine, the cattle on a thousand hills. I know every bird of the mountains, and everything that moves in the field is Mine. If I were hungry I would not tell you, for the world is Mine, and all it contains." (Psalms 50:10-12) Once I get my mind wrapped around this truth, I recognize I am but a custodian of things on loan from God... including my next breath! If I will but live that way, I will know true freedom from anxiety and disappointment. (Matthew 6:25-33)

The real beast does not come from the northeast... rather from the backwaters of my own heart. If I will but choose to rely on the steadfast character of God's love, I will withstand and overwhelm any tsunami of physical loss. "For I am convinced that neither death, nor life, nor angels, nor principalities, nor things present, nor things to come, nor powers, nor height, nor depth, nor any other created thing, will be able to separate us from the love of God, which is in Christ Jesus our Lord." (See Romans 8:35-39)

Ever more grateful for that which He has entrusted to us...
Dr Dan

Wednesday, November 11, 2009

Many Happy Returns

Linda and I surrounded by friends from her ladies' group known as the "Biblers"

Today is the xxth anniversary of the birth of a very special lady -- my beautiful bride, Linda. And I am so grateful to be here to celebrate her special day once more. While I always anticipated that I would be the one who, in our "sunset" years, would be the stronger, healthier provider/adventurer -- in many ways our roles have reversed as she has faithfully nursed me, nurtured me, encouraged me, chauffeured me, compensated for my newly acquired deficiencies, and served as my peripheral brain with patience and grace. There is no one on earth who has meant more to me.

And there are a scarce few that I know who have invested more in the lives of others with such passion, genuine love, wisdom, energy and grace... and with such a rich return on investment! Pictured above, for example, is a group of ladies (and their husbands) who all love each other as sisters, constantly encouraging one another in practical, meaningful ways and meet regularly for in-depth Bible study, prayer support and outright fun. On this occasion, this precious group of friends prayed over us, trusting God for grace and healing.

This special sisterhood began in the fall of 1990 when Linda (along with a next-door neighbor) mounted bicycles and canvassed nearly 400 homes in the Virginia Beach community where we had just moved to solicit their interest in a lady's home Bible study. Suffering saddle sores from that effort, their investment paid off with the launching of not one but two regular gatherings of women from diverse religious traditions who grew in their understanding of scripture and in their devotion to both God and others.

I could tell you story upon story of individual women, children and whole families whose lives have been forever changed for the better because of Linda's wise, caring, insightful (and often incisive) investment of love, practical acts of service and godly wisdom. Not only has she hosted neighborhood Bible studies, but spent countless hours one-on-one and in small groups of women, mentoring them on a host of knotty issues with exceptional practical insight rooted in biblical wisdom and genuine love. She has served with energy, creativity, and grace as women's ministry director at our church, hosted innumerable couples Bible studies, provided for temporarily homeless or abused women and families, and all the while invested her heart and soul (not to mention her considerable culinary gifts) into the lives of her adoring family.

Linda surrounded by her three favorite mentees, daughters Christianne, Beth and Kim

I could go on and on about her many talents, exceptional beauty (inside and out), considerable culinary skills, disarming hospitality, creative flower arranging, and penchant for making any social gathering that she hosts (whether family or friends) both memorable and meaningful. Her unique passion and skill for distilling complex biblical principles into practical life-changing applications is unsurpassed. It will take an eternity to measure the many happy returns attributable to this one fully invested life, of which I have been the chief beneficiary.

Happy Birthday, Sweetheart!

PS -- check out a previous entry on all this woman has endured by honoring me with her love and devotion.

Monday, November 9, 2009

Faith of our Fathers

My father, John Crabtree, on the occasion of his 95th birthday celebration!

In spite of the challenges presented by this battle with malignant melanoma, I have thoroughly enjoyed the opportunity it has presented to reflect and comment on the critical role that faith has played in how we face adversity and the reality of our ephemeral journey on this planet. Having just returned from a whirlwind trip to Michigan for my father's 95th(!) birthday celebration, I am reminded anew of my great fortune to have been raised in a home with a heritage of Christian faith.

While not a perfect family by any means, my parents faithfully gathered all six children to attend Sunday morning services at a local Baptist church just three blocks from home. I now recognize what an enormous task this must have been and am grateful for their efforts. Sitting in a circle on the clapboard floor of Mrs. Mistele's Sunday School class, I learned of the genuine love of God and took those first steps of faith to surrender my life to Him completely.
Me and my three older brothers, in our Sunday best

The entire Crabtree clan on the front porch of our Detroit home

Generations earlier, my great grandfather Will Crabtree modeled a life of faith before his family. My Dad fondly recalls riding behind his grandpa every Sunday on old Dolly, the family plow horse, to the Piney Grove Baptist Church in Winfield, Tennessee. En route, great grandpa would stop at a special spot where he would get down to pray by an old log at the roadside in preparation for the services to follow. My father knelt beside him. His 95-year-old knees still bend in prayer today.

Having a clear consistent example of genuine faith at an early age is a powerful influence in the lives of those who choose to follow Christ. While faith is not inherited, it is more often caught than taught. A Barna Group study published October 11, 2004 found "that two out of three born again Christians (64%) made that commitment to Christ before their 18th birthday. Less than one out of every four born again Christians (23%) embraced Christ after their twenty-first birthday."

I am enormously grateful that all three of our daughters, at an early age, chose to follow Christ. While their mother and I made sure they heard the remarkable story of Jesus' life, we also recognized that genuine faith is consequential and demands a lifestyle surrendered to His will. We consciously sought to model a consistent commitment to the Lordship of Christ in our lives.

In each case as they made their own decision regarding faith, their mother and I wanted to make clear that doing so meant more than simply giving mental assent to the facts about Jesus (His deity, His remarkable life, death, burial and resurrection). Rather, in terms they could fully understand, trusting in Him meant they needed to make Him the boss of their life! (John 1:12-13) Gladly He is, so that they now model for their own children that same quality of surrendered faith.

I know not how many days I may have to invest in the lives of those I love. In reality, none of us does! But I find myself ever more conscious of the enormous privilege and responsibility to share in both clear words and consistent actions the transformative power of faith in a loving God of mercy and grace.

Dad, Happy Birthday and thanks for a heritage of faith!

Wednesday, October 28, 2009

Targeted Therapy

Today I completed a course of laser-targeted radiation therapy for several metastatic deposits, including one of the left cheek, left axilla, and left upper arm. Pictured above is my "phantom of the opera" mask that allows precise positioning of the external beam radiation device for the facial lesion (just in time to scare the grandkids at Halloween!) Although the lesions themselves have caused some pain, the procedure is essentially painless.

I also consulted with Dr Alexander, my local oncologist, and was pleased to learn that my labs are all normal or near normal. The visual symptoms have not progressed and there has been no recurrence of transient shakiness of the right leg or arm. We have adjusted some of the meds to better control side effects while continuing on a form of oral chemotherapy.

You know I am prone to draw an analogy in the spiritual realm. I am reminded that even after we have surrendered our lives to God, there often remain some patterns of behavior or a besetting sin that, if unchecked, will metastasize and threaten our spiritual well-being. Although usually not a painless process, God's Holy Spirit targets this area like a laser beam, causing awareness, conviction, and a desire to eradicate the source. "If we walk in the [laser Light of His love] as He Himself is in the Light, we have fellowship with one another, and the blood of Jesus His Son cleanses us from all sin. If we say that we have no sin, we are deceiving ourselves and the truth is not in us. If we confess our sins, He is faithful and righteous to forgive us our sins and to cleanse us from all unrighteousness." (1John 1:7-9; see John 6:7-14)

Threatened with the very real possibility of a progressive decline in intellectual capacities, I am confronted with a "radioresistent" tendency to value the gift above the Giver. (Just ask my daughters if Dad has not on occasion attempted to use his intellect to humiliate them at a game of 221B Baker Street or failed to enhance their enjoyment of family time together by pulling out a point-busting, tile-clearing, triple letter-score, triple word score esoteric idiom to end a game of Scrabble!) Adjusting to this potential loss, I am forced to examine the source of my angst. Like a laser beam, the Holy Spirit targets my pride, in stages burning off the hubris and exposing the blind spots, gradually replacing these with a fresh perspective and power that acknowledges a loving, omniscient God is still in control of my life.

With half my brain fried behind my back !
(See how resistant some sins are?! Lord, have mercy!)
Dr Dan

Saturday, October 24, 2009

Stepping Out

My last blog entry suggests that there is an "all-or-nothing" commitment involved in becoming a Christian, i.e., a devoted follower of Christ who is transformed into a "new creation" by His grace, fully assured of a new (and enduring) life. I sincerely believe that this is true. But that is not to deny there may be many steps to be taken along the journey of faith before one crosses that threshold of genuine commitment. It certainly has been true for me. Every day presents a host of decisions that offer me the choice: will I yield to God's way or my way? Will I risk stepping out in full surrender to His control in my life, or pursue my own agenda?

Mark Buchanan, in his book, Your God is Too Safe, describes a territory at the border between Kenya and Uganda that is a no-man's-land of "domesticated lawlessness" -- a place where ironically the "endurance of inertia" lures a traveler to linger. Although not a safe place, it holds an attraction because it affords the sojourner the illusion of freedom from any intrusive authority.

Metaphorically, this transit in borderland pictures the journey of most of us who identify ourselves as Christians. We have taken the initial steps toward the promise of a transformed, resilient, overcoming life in right relationship with our Maker, but hold back from entering into the threatening and unfamiliar territory of full surrender to His sovereign rule in our everyday affairs. We settle into a comfortable inertia, stuck in a borderland between faith and doubt.

A great example in scripture of a man on such a journey is the life of Peter. In an early encounter with Jesus on Peter's journey of faith, Jesus instructs the veteran fisherman to "Put out into the deep water and let down your nets for a catch." Peter initially protests "Master, we worked hard all night and caught nothing, but I will do as You say and let down the nets." While beset with (reasonable, logical) doubts based on his own experience, he makes a choice: to follow Jesus' bidding. The result is an overwhelming net-breaking catch of fish. (Luke 5:3-11) This is a dramatic event that God orchestrates for a divine purpose in Peter's life.

Interestingly, Peter's reaction is not one of jump-for-joy elation over his good fortune to have a man in his boat who can, at His will, provide all the prosperity, security and "success" that Peter could wish for. Rather, he recognizes that he is in the presence of One who can control the universe and by that authority, can make demands on his own life. He melts before Jesus with the words, "Go away from me Lord, for I am a sinful man!" He recognizes that, to relate to such a One, he must come to grips with his own sin -- that tenacious tendency to wrest control of his life from any outside authority. (Here is dramatic evidence of God's uncanny ability to use circumstances to reveal hard truths to us. For his part, Peter was willing to face the logical consequences of that truth.)

Jesus does not leave him in his wilted state. Rather, He casts a vision of what life can be like if he will but chose to step out of his familiar/safe surroundings with the words: "Do not fear, from now on you will be catching men." He promises him a life of purpose that is focused beyond his own agenda and control. It does not promise to be entirely safe (as most of us count safety), but one in which he will never need to fear.

Presented with the choice, Peter leaves the familiar and takes one step at a time out of the boat in pursuit of an agenda that His Master will dictate. His journey is a study in human frailty, exuberance, doubt, courage, failure and triumph -- like that of many Christians. It is a life taken one step at a time. At some point, Peter stepped from the safety of the familiar environment of the boat which he captained, over the gunwale of self-sufficiency, past the tiller of self-direction, disentangling himself from the net of doubts, to pursue after a relationship with One who simply offered to make him a fisher of men -- likely having little clue as to what that meant!

The challenge presented to each of us is how to respond to Christ's invitation to follow Him. The key is to take the step, to leave the deceptive "safety" of living in the borderland of indecision, doubt and half-commitment. Putting one foot in front of the other and dropping those things which ensnare or divert us, we by faith take another step in His direction.

This is the path I am set upon and I cannot tell you how much I appreciate so many of you sharing the trail with me.

Grateful for each step of the journey,
Dr Dan

* Pictured above is a pair of my sadly worn-out athletic shoes and their brand new replacements, purchased on faith that I will get sufficient use of them to make the investment worthwhile!

Friday, October 16, 2009

Christian: Fickled Fan or Faithful Follower?

My most recent blog about the three Hebrew men that faced incineration in exchange for their faith in God has stirred in me a growing uneasiness about calling myself a Christian. Not because I don't consider myself a true believer in Christ, but because I do... Let me explain.

As I come to grips with the likely reality of my impending death I am growing increasingly concerned about those I deeply care for who call themselves Christian but are amazed by my faith. While I genuinely appreciate the sentiment, I regard my faith during this time as basic to following Christ. I trust you will agree that there is a dramatic difference between being an admirer of Jesus and a disciple. “The demons also believe, and shudder…” (James 2:19)

The truth is that, some time after embarking on this journey of faith in God (especially after becoming a "sophisticated" physician), I recognized that I did not measure up to what scripture describes as a fully-devoted follower of Christ. I had heard the gospel message that Jesus offered me a free ticket from hell to paradise and I said "I'll take one!" Although purchased at an enormously high price, the cost to me was completely free! At a fairly early age, I became an enthusiastic fan. (For the details, see blog entry of 03/09/08).

Recently I have come to the conclusion that this slant on the gospel message (let's call it the popular or the "get-out-of-jail-free" version of the gospel), as understood by most individuals, amounts to an obscene lie from the pit of hell -- for it grossly distorts the true transaction that must take place to become a disciple of Christ with full assurance of eternal life. Although indeed all I need is faith (Ephesians 2:8-9), genuine faith does not come without first counting the cost, abandoning my own agenda for an all-out commitment to the One I am trusting. (Luke 9:23; 14:26-27)

The transaction by faith is simple yet profound and life-changing: "He came to His own and those who were His own did not receive Him. But as many as received Him, to them He gave the right to become children of God, even to those who believe in His name." (John 1:11-12) There is something to believe (i.e., the facts about Jesus' life and His claims to the Truth) and there is someone to receive (i.e., to surrender allegiance to, wholeheartedly pursue and obey). I fear that many struggle in the borderland between believing and receiving and may ultimately fail to enter the life-transforming rest that He promises. (See Hebrews 4:1-3, 11)

Why am I so exercised about this? First of all because this popular version of the gospel misleads us about the goal: eternal life (at least as popularly understood). Eternal life is not simply an enduring, unending life (floating on some cloud with harp in hand, or basking-in-a-tropical-paradise sort of existence) -- at least that is not how Christ defines it. During a prayer to the Father shortly before His crucifixion, Jesus says, "This is eternal life, that they may know You, the only true God, and Jesus Christ whom You have sent." (John 17:3) (Like He really had to explain that to the Almighty! He said it for our benefit.) Eternal life is ultimately life lived fully immersed in the reality of an intimate relationship with God the Father, Son and Holy Spirit. It is a qualitatively and dramatically different existence celebrated in a new relationship with my Maker, now and forever.

It is a life that is supposed to begin the moment I commit to follow Jesus, not some day when I trade skin and bone for some ethereal new reality. If I take the Bible seriously, I conclude that we are all going to live forever... some in eternal darkness and torment, some in fulfillment of all our best and highest dreams in perfect relationship with both our Maker and His (renewed) creation*. (See 2Peter 2:9, 1John 5:12, Romans 8:18-23)

Do you have eternal life? In this context, it is like asking me, "Are you really a married man? -- i.e., Has your life been turned upside down by an exciting unending mutual commitment to another person that alters all your priorities, allegiances, goals, hopes and dreams?" The answer lies in the reality of my committed relationship with a person I have been drawn to love, not primarily what I believe about that person, nor even what I hope a relationship with that person can do for me!

So secondly, this popular version of the gospel distorts the true nature of the relationship I must have with Christ: it is less about giving assent to facts about Christ just so I can gain some reward -- rather it is all about an utterly dependent and intimate relationship with Him, committing my life to follow His example. Following His example just may entail some suffering and loss. (John 16:33, Rom 8:18, Col 1:24, 1Pet 4:13)

Finally (and most importantly), this counterfeit gospel may ultimately rob those I passionately care for of a much-needed resilience in this life and even the eternal destiny that they long for in the next. (Review the scary scenarios that Jesus told in Matt 13:24-30 and Luke 23:23-30.) If your faith does not work for you, if you fear it would not stand up to a major loss or life crisis, I urge you to throw it out, or at least re-examine its foundation.

If we call ourselves Christian, we must soberly determine: Are we fickled fans ("Christian groupies") or faithful followers? Only those in the latter category are assured of eternal (qualitatively and quantitatively fabulous and resilient) life. Shadrach, Meshach and Abednego were willing to fry rather than deny or betray that relationship with the one true God. That is genuine faith. And that capacity in itself is a gift of God (Ephesians 2:8-9).

My earnest prayer is that, whether or not you are faced with a crisis similar to ours (and you most likely will some day), you will have the same confidence and genuine joy that stems from being a faithful follower of the One who has already conquered sin and death. From the testimony of thousands before me, that is the normal Christian life.

Grateful for all your concern and prayers,
Dr Dan

*I highly recommend a thoroughly biblical examination of the subject of eternal life in a popular book by Randy Alcorn, entitled Heaven. This book could dramatically change your outlook on the future and the way you live your life today :-)

Wednesday, October 14, 2009

FAITH: Fire Escape vs. Fireproof

As my physicians have transitioned from a strategy aimed at complete remission to one of palliation, I have to admit that I have wrestled once more with the issue of faith -- i.e., faith for complete healing in the face of what I have known all along to be an aggressive, devastating form of cancer which was already far advanced at the time of diagnosis.

Let there be no mistake: None of my medical colleagues who were knowledgeable regarding the nature and extent of my malignancy at the time of diagnosis over 20 months ago expected me to survive this long. And even now as it appears the cancer has overwhelmed all attempts at stemming its spread, I continue to amaze my physicians by the paucity of symptoms relative to the recent imaging studies (with extensive new metastases to the brain, meninges, left malar eminence, lymph nodes, left humerus and left thigh).

I have not only exceeded most expectations regarding cancer survival, I am honestly able to celebrate each day with relatively few outward signs of the advancing devastation within. The visual symptoms have stabilized, there has been no further seizure-like activity, and I have sufficient strength and stamina to enjoy the company of friends and family (including strolling the beach with my sweetheart and a recent visit to the grandkids in Pennsylvania that featured apple-picking and walks along the scenic Susquehanna River). With head in hands, my radiation oncologist recently remarked, "I have not seen anything quite like this."

I don't want to over-draw the analogy, but my circumstances remind me of the dramatic bible story of three Hebrew men who survived impossible odds. While in Babylonian captivity, Shadrack, Meshack, and Abednego were threatened with incineration in a fiery furnace if they did not bow down and worship an idol set up by king Nebuchadnezzar. The men steadfastly refused to worship any but the one true God, Yahweh, proclaiming, "If it be so, our God whom we serve is able to deliver us from the furnace of blazing fire; and He will deliver us out of your hand, O king. But even if He does not, let it be known to you, O king, that we are not going to serve your gods or worship the golden image that you have set up." (Dan 3:17-18) The king ordered them tossed into the furnace and while their executioners were turned to toast, they came out unscathed (without so much as a hint of smoke about them)!

What is so remarkable about this story to me is the steadfast confidence that these men had in the nature and faithfulness of their God, regardless of the circumstances they faced. At some point in their developing relationship with Yaweh, they had made a decision -- "No matter what the circumstance, we are going to trust in and remain devoted to our God." It was clearly a decision they had already made, as in the midst of the crisis, there was little time for debate and no evidence of equivocation or hesitation. They did not melt down in desperation, seeking an escape from the fiery ordeal, but had confidence that because they served a faithful God, they were ultimately fireproof!

I do not know what lays in store for me and my family in the coming months. I do not know how long I will be able to continue to competently share these thoughts with you or articulate them intelligibly. But I know one thing for sure -- God loves me (and you). He settled that for all time when He did not spare His own Son from a fiery ordeal, from unimaginable suffering and an agonizing death, in order to spare me from the devastating consequences of my own self-will and waywardness. (Rom 8:32, 2Cor 5:21) I know (by faith) that He conquered death through His resurrection. And by His grace, I have made a decision based on both experience and hope (like thousands before me) -- "Yeah though He slay me, yet will I trust in Him." (Job 13:15)

Knowing the tragedy of expecting God exclusively to provide a fire escape in every difficult/perplexing situation, I earnestly share the following thoughts:

Fireproof Faith

I have seen the charred remains of those before me
A fallen race in endless flight to self-destruction
The acrid smell of misplaced hope and all that "should be"
Now licked by flames of persistent equivocation

The heat is on, the furnace door gapes wide before me...
Nearing my melting point, will I become unhinged?
Or will I trust the One who walked this way before me
And in full surrender perhaps emerge unsinged?

The time has come to test if faith can flourish
When the heat says "Halt", I know I now must choose...
Will I still linger, my nagging doubts to nourish
Or in full surrender affirm I've naught to lose?

Trusting you too will choose a fireproof faith,
Dr Dan

PS -- Having again declined whole brain radiation, I am continuing on a course of palliative therapy that includes a form of systemic chemotherapy (Temodar) and a more limited course of radiation therapy that focuses on specific symptomatic skeletal and soft tissue metastases.

Wednesday, October 7, 2009

My Bucket List

Now that my physicians have moved from an aggressive treatment strategy with a goal of complete remission to one aimed primarily at palliation, I have been irresistibly drawn to contemplate those things that I have always wanted to accomplish or experience but have not yet achieved -- i.e., my "bucket list" (the things I want to happen before I "kick the bucket").

A recent film by the same name, starring Jack Nicholson (as a billionaire corporate executive) and Morgan Freeman (as a working class mechanic), effectively highlights both the allure and folly of frantically pursuing adrenaline-pumping experiences as a means of finding ultimate fulfillment in however many days are accorded to each of us in this fleeting life.

Always ready for an adventure (see blog entry of 2/14/09), recently I have been tempted to pursue some of the more exotic and crazy undertakings of my fantasy musings -- like hang gliding, sky diving, or even base jumping. (Please do not tell Linda!)

Honestly, I am not sure of the source of these crazy urgings, for I surely do not have an underlying death wish -- just an irresistible desire to soar like a bird :-) From the deck of our home on the Chesapeake Bay, I have watched with secret envy and awe as a phalanx of pelicans soar effortlessly overhead, then swoop to within inches of the breaking waves in perfect formation. Don't tell anyone (and please no psycho-analytic comments), but I have even been known to fly in my dreams with no more 'equipment' than my spread arms and pointed toes, swooping and soaring like those pelicans in endless weightless fantasy.

I am not sure what your ultimate fantasy may be, but one thing I have learned on this journey with cancer is that no flight of fancy or adrenalin-pumping adventure can compare with the sustained satisfaction and sheer joy of heart-warming and life-affirming relationships. This is also the conclusion that the protagonist in The Bucket List comes to realize after a frenetic pursuit of one adventure after another just as his new best friend succumbs to the irresistible ravages of his terminal illness.

And I am a man blessed with many such relationships, particularly those of family and close friends. For this I am enormously grateful and find myself relishing with greater delight than ever before. Watching soaring seabirds , fantasizing about my own effortless flight from some spectacular summit, or the realization of my wildest adrenalin-pumping adventure will never overtake the deep abiding satisfaction of holding my adoring grandson while roasting a marshmallow to golden perfection (see recent photo of Mark Daniel and me above), or guiding my youngest grand-daughter as she takes her tentative first steps, or walking hand-in-hand with my sweetheart in the golden light of the setting sun along the beach.

Interestingly enough, even Jesus appears to have had similar contemplations as He faced the end of His life here on earth: "...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) I am pretty sure that the joy set before Him had little to do with the ability to fly or walk through walls or any such fantasy adventure, but rather the ultimate unbroken and intimate relationship with both His Father and with those He came to redeem (you and me!)

Would that my greatest passion will be to return such love in kind!

Grateful for each day,
Dr Dan

PS -- The recent head MRI shows progression of the brain metastases (including for the first time a sheet-like spread over the covering surface of the brain). As noted earlier, treatment options are extremely limited at this point. After much contemplation, prayer, and consultation with both family and doctors (including a physician friend who is director of a hospice service for one of my former hospital systems), I have decided (again) to decline whole-brain radiation. However, after a very difficult (all-night-head-in-the-toilet) initial experience with the chemotherapy offered by my current oncologist, adjustment in the sequence and timing of meds has happily resulted in much greater tolerance. Subsequent imaging studies, labs and visits will assess my response. I will assuredly update this blog as developments warrant.

Saturday, September 19, 2009

En Garde! Eradicate vs. Palliate

Let the high praises of God be in their mouth, and a two-edged sword in their hand
Psalm 149:6

My physicians have crossed a boundary line this week. For the last (incredible) 20 months we have sparred with cancer, ever hopeful of inflicting a devastating blow that would mean the complete demise of this formidable foe. Now after six painful biopsies, four difficult rounds of high-dose Interleukin-2 (37 doses in all), tedious radiation therapy to the left hip, and seven gamma knife procedures to the brain (targeting 52 brain metastases), I find myself totally in a defensive posture.

At our last visit to UVA on Thursday, we received the news we expected: "Because of the evidence of persistent central nervous system disease, we have little to offer. Another round of Interleukin-2 is no longer an option, as it could cause fatal swelling of the persistent lesions within the brain. You do not qualify for any available national clinical trials."

In spite of the aggressive strategies employed thus far, there is evidence of ongoing injury to the central nervous system and obvious progression of tumors elsewhere. There is a persistent distortion of a small area of the left upper visual field and episodes of altered sensation in the right leg and arm have prompted the initiation of anti-seizure medication as a precaution. A couple of the systemic metastases have become painful as they continue to enlarge unchecked.

What is being offered is a form of chemotherapy that can arrest or slow the progression of both central and peripheral metastases. In addition, local radiation therapy may relieve pain associated with selected metastases. Again, these are clearly strategies that are designed to alleviate the effects of, but cannot reverse, this cancer's aggressive advance.

Throughout this battle I have repeatedly asserted that, while grateful for the benefits of modern medicine, my ultimate trust has been in the grace and mercy of a loving and sovereign God who knows my end from the beginning and cares more about those I love than I ever could. That is not to say I surrender -- by no means! It is simply to acknowledge that a loving and all-wise God is my referee in this battle and I will yield to His decisions. It also means that, should I lose this bout with our mortal foe, I have not lost the battle -- for He has already secured the ultimate victory.

It also means I will not surrender to fear nor seek desperate measures simply to prolong my life another day. I will continue to engage our enemy with all the weapons that modern science and a merciful God supply, hopefully with steadfast courage and faith. "The weapons we fight with are not the weapons of the world. On the contrary, they have divine power to demolish strongholds." (2Cor 10:4)

We are currently awaiting collaboration between Dr Grosh and our local oncologist Dr Alexander to design our next "parry". Your prayers and words of encouragement are greatly appreciated.

Dr. Dan

Friday, September 11, 2009

If I Should Die Before I Wake...

I never liked this rather morbid childhood prayer from the eighteenth century:
Now I lay me down to sleep,
I pray the Lord my soul to keep;
If I should die before I wake,
I pray the Lord my soul to take.
Not only does it focus on a rather morbid subject, it suggests that my eternal destiny is dependent on my pleading with a rather capricious God who could decide at His whim whether or not to admit me into His presence.

Not how you read it? Well, compare that prayer with a rather more confident assertion by the apostle Paul:
While we live in these earthly bodies, we groan and sigh,
But it’s not that we want to die and get rid of these bodies that clothe us.
Rather, we want to put on our new bodies
So that these dying bodies will be swallowed up by life.
2Cor. 5:4)
Remarkably, this passage asserts that my destiny (by faith) is not some disembodied state of mind or spirit but rather something more akin to what I already know and experience, only without the inexorable decline and deterioration attendant to my current physical body.

Lately, I catch myself “groaning and sighing” as I, like so many others before me, come to grips with the frailty and ephemeral nature of this earthly life. In spite of the best efforts of modern medicine, untold prayers of faith on my behalf, and my own confident trust in a loving, powerful, and faithful God, I cannot ignore the possibility that He wishes to promote me into His very presence sooner than I had planned – i.e., that this dying body should be swallowed up by life!

And so I am learning to live in that tension between fighting tooth and nail for another day here on earth with those I love versus yearning for that ultimate promotion. The object of my faith has not moved. He has never been closer. I believe He is simply giving me a clearer vision of what it means to truly live.

Please don’t misunderstand me. Death is an enemy and I will continue to be fully engaged in the battle against this our common foe. But I also recognize that, through Christ’s death and resurrection, our mortality is revealed to be a temporary eclipse of the bright orb of eternal life He offers when we trust in Him.

Recent events have served to highlight this tension. I am not yet healed. I have never experienced full remission of the malignant melanoma and in this tug of war, the melanoma is gaining the upper hand once more. The neurologic signs of brain metastases have progressed even after this last gamma knife procedure, while recurrence of malignant growths elsewhere go unchecked. That is reality. But what is also real is that this physical life, frail and flawed, is only a foretaste (albeit marvelous and good) of eternal life. That, by faith, is what still awaits you and me.

Here is how the apostle Paul expressed this tension: “For to me, to live is Christ and to die is gain” (Phil. 1:21). These are not the words of a defeatist desperate man, but someone who has learned to live with the tension between the inestimable value of this fleeting life and a confident hope that transcends our earthly existence. I am a student of that reality.

Let me suggest a new nursery rhyme (well maybe for the accelerated nursery crowd)…
Now I lay me down to sleep
Confident that He will keep
The promise of new life in Him –
Though briefly now eclipsed by sin

Already passed from death to life
No longer bound by mortal strife
May I be found with smiling face
When I am called home by His grace

On this anniversary of 9-11 when nearly 3,000 people suddenly faced their eternal destiny, may we all take stock of the inestimable value of this life – and live each day as if it is our last.

Grateful for your prayers,
Dr Dan

PS -- We return to Charlottesville on Thursday Sept 17 once more to discuss treatment options (if any) with Dr Grosh.

Sunday, August 30, 2009

Perception vs. Reality

On Friday, August 28, we returned to Charlottesville for yet another (seventh) Gamma Knife treatment session. This time, nine brain lesions were targeted with ionizing radiation (that makes 52 lesions to date) -- all but one of these was pre-existing and had progressed in size since the last treatment session. Unfortunately, at least one of these lesions encroached upon the optic tract in the right side of the brain, causing an intermittent distortion of a small area in the left upper field of vision (similar to but more psychedelic than the image depicted above). Closing one eye neither improves nor worsens the temporarily warped image.

Although this particular session resulted in more severe side effects than ever before (headache, nausea, vomiting, dizziness, fatigue), I am happy to report that all those symptoms have nearly completely resolved in 36 hours. The intermittent distortion of an area in the left upper visual field, however, has so far persisted. Time will tell...

Meanwhile, whenever this painless "scintillating scotoma" occurs, I am forced to mentally compensate for the distorted image in order to reconstruct reality. Having had many years of experience regarding the true nature of the world around me (and the people in it), I have had little difficulty staying oriented and readily recognize familiar faces in spite of the transient distortion. (If I briefly look at you askance, please forgive me.)

Out of all the potential ill effects of this devastating cancer, I have found this single (relatively minor) dysfunction to be more troublesome than all the weakness, pain, breathlessness, or malaise I experienced when metastatic melanoma was rampant throughout my body. When I ask myself why this is so, I conclude that it is because (perceptually at least) this complication threatens my ability to recognize the world as it truly is. During these episodes of distorted vision, I am forced to call upon well-learned patterns of proportion, symmetry, and pre-recorded images to reconstruct the reality that is before me. I am so grateful that I have that well-established frame of reference.

Not everyone is so fortunate... A young child with a "lazy eye", if not corrected early, will become blind in that eye, due to the inability to reconcile the widely divergent images streaming from each orbit. And some dear people I know who have suffered devastating losses early in life's journey have had their vision of God diminished or distorted. I am thinking of a number of former patients of mine... one whose husband died leaving her with seven young children to raise alone, another who lost his sixteen year old son... both of whom continue to struggle to see God as holy, loving, and just. There are countless others who, because of a devastating event or a slow-growing despondency of spirit, have a distorted image of the God who promised "life, and life abundantly".

I have no easy answer for these my friends. I only know that when I was given clear sight, I was introduced to a God that did not spare His own Son from all the suffering and pain that we experience, in order that by trusting in Him, we might know Him as He truly is and enjoy life with Him forever. In spite of the temporary distortions of my current vision, I cling to that reality.

May you too see Him clearly,
Dr Dan

PS -- Future treatment for the residual systemic melanoma is uncertain. Dr Grosh would like to assess the effectiveness of this most recent Gamma Knife procedure before committing to another round of high-dose Interleukin-2. Many thanks for all your prayers.

Wednesday, August 19, 2009

The Cost of Caring

We all know what it costs to truly care about someone. You who are parents have endured sleepless nights with a sick child or a teenager staying out late. You who are lovers have suffered distress when your loved one was out of touch, injured, or ill. You whose spouse is a public servant, corporate executive, minister, counselor, serviceman, performer, or [fill-in-the-blank] dedicated professional know the compromises that must be made to accommodate his/her career.

I don't know how many of you fully appreciate the price that must be paid by a physician's spouse who must share their loved one with an often-adoring and large patient population, many of whom have related the most intimate details of their lives (and bodies) with that one who promised fidelity to "you and you only". Now I know Linda is going to be a little embarrassed by this, but I cannot exaggerate my praise for this woman who has sacrificed so much for my career and personal fulfillment.

It would take reams to tell of the intimate times interrupted by a beeping pager, the postponed dinner dates, the seasons of virtual single-parenting, the nights she endured my emotional "left-overs" after a difficult day at the office, or the months of uncertainty caused by a malpractice claim of outrageous dimensions. Why would anyone choose such a life? Although I am not sure she (nor I) fully understood the sacrifices she would have to make on the day we shared our vows, I am so glad she did!

By the way, this past Monday, August 17, marked forty-one years since we shared those vows... and I became a very rich man :-)

As part of her anniversary gift, I offered her something I have never been able to give her before -- the gift of privacy. I offered to close out this very public venue in which we have shared our thoughts, triumphs and struggles in the face this life-threatening condition, and to spend this season (however long it may be) focused on one another, on family, and on our most intimate friends.

With words of encouragement, she turned me down, citing the potential benefit to those of you who share similar struggles and have yet to find answers in religion, philosophy, or contemplation alone. It is in that spirit, and in honor of the love of my life, by God's grace, as long as I am able, I commit to continue to share these thoughts.

Oh please don't think this is a sacrifice for me -- it's really quite selfish on my part, as fulfilling as having this creative outlet has been. My point is to honor the love of my life (and our daughters), whose sacrifices for me have been beyond all reason. And to honor the One whose ultimate sacrifice for us all has made this struggle a great joy! He is the One "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. " (Hebrews 12:2)

I am inspired both by my wife and by the One who gave her to me, for their love and sacrifice on my behalf. At the risk of sounding maudlin, I truly desire that my life may honor their devotion... and that you, too, will know such love.

Counting the Cost,
Dr Dan

PS -- We just learned that Drs Sheehan and Grosh have decided to proceed with yet another gamma knife procedure for the brain metastases (scheduled for August 28), followed sometime later by a repeat regimen of high-dose Interleukin-2. Stay tuned...

Saturday, August 15, 2009

Physician, Heal Yourself!

This entry is one of the more difficult ones to write. (No, it is not about the debate over healthcare reform.) For those of you who have been following these writings for over a year now, I am compelled to share a sobering lesson. With each journal entry I have sought to relate some element of truth that our experience has brought to light or perhaps was made more powerful through its practical application in this difficult situation. Each entry has also proved to be a therapeutic outlet for me as it has challenged this left-brained physician to exercise those more creative faculties traditionally thought to reside in the right cerebral hemisphere.

Now after six gamma knife procedures, targeting 43 metastatic deposits in the brain, I am facing the reality that recent studies indicate the persistence (and active enlargement) of at least four of these malignant growths. In addition several new metastases are evident elsewhere in the body in spite of four toxic multi-dose courses of Interleukin-2. We are currently awaiting the collaborative recommendation of my oncologist and neurosurgeon at UVA. The treatment options are extremely limited.

Although I am currently having remarkably few symptoms, I am forced to recognize the very real potential that, with or without further intervention, my faculties may (soon) progressively decline. In the past, as I have witnessed this same phenomenon in my patients (either due to malignancy or other degenerative process), I have been moved to console the family and help them compensate for their loved one's deteriorating mental capacities.

Now threatened with the same potential decrepitude, I am prompted, while I still may, to share with you what many may deem obvious: Worship the Giver and not the gift!

My sincere desire, in offering these biographical musings over the past 18+ months, has been to share some of the lessons learned along this difficult journey with cancer. Your comments, prayers, and heart-felt support have bolstered both me and my family as we have travelled this road together. I also recognize that the very challenge of sharing these thoughts in some creative and constructive way has been a source of great personal satisfaction... and potential pride.

The threat of losing those faculties that have made this creative outlet possible is perhaps the most difficult to face. But as I ponder why this is so, I am forced to recognize that I have subtly arrived at the place where I have worshipped the gift above the Giver. It is far more healthy to hold all such gifts with an open hand. (This is a hard pill to swallow.)

Even as Jesus was consoling Peter who had failed miserably during his greatest testing, He warned him that "when you grow old, you will stretch out your hands and someone else will gird you, and bring you where you do not wish to go." (John 21:18) Jesus' love for Peter had not diminished and his future was never more secure. But that streak of independence would yet yield to complete surrender.

Regardless of what lies in our path just ahead, the good Giver has not changed... He will not stop giving all the grace we need for the journey.

Ummm... Oh, yeah, thanks honey... Dr Dan

PS -- I invite you to check out Linda's latest blog. You will find her creative juices still flowing freely!

Saturday, August 8, 2009

Update on My Noodle

In the PET-CT gantry I lay like a mummy
As rads pulsed in and out once more
All I could hear was a grumbling tummy
Until I awoke to my snore!

This study is aimed to inform my physician
If the brain MRI changes they see
Reflect an ongoing destructive condition
Or the remnants of dying debris.

Though the tech says the study is 'perfect'
All that means is the image is sharp.
We'll now have to wait for the verdict...
Will I play with the kids or a harp?

"Some trust in chariots and some in horses..."
Yet our future is His and not man's
So we'll await the next treatment courses
As we rest secure in His hands.

Thanks so much for your thoughts and prayers,
Dr Dan

Monday, August 3, 2009

Joy in the Journey

Fair weather or foul, the joy indeed is in the journey! Linda and I just returned from a three-week vacation to the Pacific Northwest. During the first week we caught up with life-long friends in a lakeside cottage near Eugene, Oregon. The next week we explored the Olympic National Park region and spent a day basking in the elegant beauty of Victoria, British Columbia. Finally we boarded a cruise ship in Vancouver and spent the next week exploring the southern coast of Alaska all the way to Anchorage. We even had a chance to visit my eldest brother, Dennis, during an extended layover in Denver.

We had great weather in Oregon and Washington state, but on this our first journey to Alaska we encountered back-to-back days of cold, rain, and cloudy skies. Although this was a disappointment, we were still awe-struck with the magnificence and expansiveness of our surroundings. Knowing this would probably be our only trip to this region, we made the most of each day, enjoying one another's company, feasting on great food, and imbibing the natural beauty (misty as it was) that surrounded us. We did spy whales, porpoise, sea lions, moose, and many varieties of birds.

We also encountered some very wonderful people, including Ramona Douthit, the widow of a very good friend (Howard) who lost his battle with cancer last year. Howard was (and continues to be) an inspiration to me as a man who, in spite of dreadful suffering, found joy in the journey. His steadfast love of God and unshakable devotion to his family helped him navigate tempestuous waters with inspiring courage and strength.

It appears that we, too, are headed for troubled waters once more. Within hours of returning to Norfolk, we travelled to Charlottesville for another full day of imaging studies and consultations. The news is mixed: While I have few symptoms and lab studies remain normal, there are several new lesions identified on the PET-CT (involving the neck, axillae, and left hip region) and troublesome findings on the MRI of the brain. The brain images suggest either swelling and disintegration of previously treated lesions, or possibly progression of these same metastases. The good news is that there do not appear to be any new brain lesions.

After deliberation, my consultants have recommended a dedicated PET-CT of the brain to determine if the lesions there are actively growing or resolving. Resumption of high-dose Interleukin-2 cannot go forward if these lesions are actively enlarging, so it is not yet clear what course of action will be recommended. We return to Charlottesville this Friday, August 7, for the PET-CT study.

Meanwhile, our confidence in the Master travel agent is unshaken. We don't yet know what is beyond the next bend, but have learned to expect jaw-dropping vistas of His faithfulness and love.

May you, too, know joy in the journey,
Dr. Dan

PS -- I was given the distinct privilege of speaking to our church congregation on "Facing Our Fears" this past Sunday. You can listen to the message by clicking HERE. Feel free to write me if you want a copy of the outline and/or PowerPoint presentation.

Thursday, July 2, 2009

Declaration of Dependence

On the eve of our nation's celebration of Independence Day, we have just returned from UVA where all the recent imaging studies and the path report from the recent needle biopsy of the right axilla have confirmed that our personal battle with the tyrant called malignant melanoma is not yet over. Given what is recognized by all as a 'remarkable' response to high-dose Interleukin-2, Dr Grosh has recommended another course of this 'biological warfare' agent.

Interestingly, on the Fourth of July last year I was still in the hospital completing the fourth and 'final' round of this rather toxic regimen. (See blog entry of July 6, 2008.) Having cancelled our usual holiday activities, I limped home to recoup and await the outcome of that particular skirmish. One year later, I continue to be amazed by the extent of my recovery (as do my physicians :-) and by the awesome grace afforded me by a loving and faithful God.

The Fourth of July is a big deal for our family and this year I look forward to celebrating the holiday enthusiastically with them. As we all celebrate the freedoms we enjoy as a nation on this Independence Day, I am compelled to reflect on the life-changing liberty I have discovered in the midst of this ongoing battle with cancer -- a liberty that derives from an utter and complete dependence on my Maker. Therefore, with all due respect to the founding fathers, I would like to share with you my "Declaration of Dependence" (You may need to click on the image to read it):

Declaring one's inadequacy and dependency on another is not a macho nor popular thing to do, but this battle with cancer has exposed for me the folly of a Rambo-I'll-do-it-my-way approach to life. Because I have learned to depend on Him completely, having surrendered any presumption of 'unalienable rights', I now thoroughly enjoy Life to the fullest, Liberty that emancipates me from all fear and worry, and irrepressible Happiness that comes from His loving pursuit of my well-being and a settled sense of hope and purpose.

May you, too, enjoy such freedom this Independence Day.

Dr Dan

PS -- Because there are no new brain metastases, a repeat gamma knife procedure is not deemed necessary at this time. We are scheduled to return to UVA July 30 for repeat imaging studies and pre-admission workup, anticipating hospitalization for IL-2 therapy on August 3. Should be a fun summer!

Thursday, June 25, 2009

The Purpose of Pain

"God whispers to us in our pleasures, speaks in our conscience, but shouts in our pains: it is His megaphone to rouse a deaf world." C.S. Lewis, The Problem of Pain

We just returned from UVA where I underwent an ultrasound-guided needle biopsy to assess whether or not the three small areas of increased metabolic activity in the neck and right arm pit that lit up on a recent PET/CT scan actually represent recurrent melanoma. The experience served as a helpful reminder to me that pain has a purpose.

None of these lesions was palpable on exam and the ones in the neck were too tiny to even attempt to biopsy. The interventional radiologist therefore directed his attention to the right arm pit. The aim was to visualize the exact location of the suspicious nodule with high-frequency sound waves, impale it with a large bore hypodermic needle passed through the skin into the center of the lesion, and aspirate tiny bits of tissue into the shaft of the needle and attached syringe.

He began by pressing the ultrasound transducer firmly into my right axilla and in short order identified an abnormal lymph node deep in the recess. After prepping the area and providing a local anesthetic, he made a tiny incision in the skin and guided the needle toward its mark. Because of the relatively small size of the target lesion, the difficulty visualizing the needle on the ultrasound image, and the typical reluctance of lymph nodes to hold still while being attacked by a sharp instrument, repeated thrusts with the needle failed to produce any tissue. These maneuvers did produce considerable pain, however.

The radiologist offered additional local anesthetic to the deep space in my arm pit, but I declined. “It looks like we have a tough guy here,” he quipped to the technician. “Not really,” I replied, “But by the nature and location of the pain, I can tell when your needle is pressing against the involved node.” So I turned from passive subject to active participant in the procedure.

As the physician made repeated attempts to skewer the elusive mass from different angles, my grimaces and muffled yelps served as confirmation that his stiletto-like probe was zeroing in on the intended target. This game of thrust and parry continued for a full hour. Then with an “Arghhhh… Ohhhh, yeah… That’s it!” the hard little mass could resist no longer: a delft stab through its midsection finally yielded adequate tissue for pathologic examination.* The cheers arising from the gallery were deafening :-)

I’m really not a glutton for punishment, and now that the procedure is over, I’d say the level of pain was really quite tolerable. It certainly cannot be compared to the still-vivid memories of excruciating torment that attended a complicated liver biopsy eighteen months ago. Nor am I averse to taking pain meds when needed – More than once has Dilaudid brought me from the brink of unconsciousness triggered by unbearable pain to a state of complete relief and relaxation.

But this most recent encounter with pain has underscored the positive role that noxious stimuli and their physiologic response play in our lives. Indeed, pain produces a reaction in us that is both protective and life-affirming. Repeated admonitions to a toddler to avoid the hot stove or the flame of a candle are seldom heeded until that first misadventure. It took the painful experience of a dislocated toe to teach me not to descend our slick hardwood stairway in stocking feet!

This beneficial role of pain is dramatically and tragically revealed in those medical conditions in which the normal pain mechanism is impaired, such as the peripheral neuropathy that often accompanies advanced diabetes. I recall one diabetic patient of mine who suffered third degree burns to her feet by exposing them to excess heat without any awareness of pain or injury. She ultimately lost both feet.

Of course there are those conditions which produce chronic debilitating pain that seemingly has no positive protective purpose (e.g., fibromyalgia, reflex sympathetic dystrophy, primary neuralgias, etc.) And many suffer unbearable emotional pain from the loss of a loved one, repeated rejection, or other adversity. To be honest, it is in these circumstances that pain seems to mock us rather than preserve us.

As one who has experienced the destructive side of pain, the intractable bone-wracking pain that accompanies the rampages of disseminated cancer, I can sympathize with those for whom this type of suffering is a daily experience. My entire professional career (and that of my colleagues) was devoted to preventing and/or alleviating this kind of misery.

Nevertheless, even here I have found that pain has a purpose. I can say with honesty that, as strange as it sounds, I never felt more alive than during those long nights when I was immobilized with pain from head to toe caused by the rapidly advancing malignancy. In the midst of what was clearly “the valley of the shadow of death”, my head and heart were compelled to confront whether life consisted solely of this biologic existence or indeed encompassed eternity.

As C.S. Lewis suggests, it was in the midst of this kind of pain, that God used a megaphone to reassure me of His promise: “I came that they may have life and have it abundantly.” (John 10:10b) He came. He lived as one of us. He knew rejection. He suffered a measure of pain I will never know. And He did it all that I might know what it is to truly live. My personal experience with pain stripped me of any pretense of self-sufficiency. It taught me to celebrate His presence and His promise, secured by trusting Him fully. It continues to be a remarkable journey.

Dr. (Pincushion) Dan

*As expected, the microscopic analysis of the needle biopsy specimen demonstrated the typical pigment-laden, distorted cellular architecture of malignant melanoma. We return to UVA next week to discuss treatment options with Dr Grosh.

Sunday, June 14, 2009

Sufficient Grace

Is the glass half empty or half full?

The way I answer that often depends on what is in the glass! I recall gagging down two very full glasses of liquid chalk (unsuccessfully disguised as a peppermint shake) in preparation for a contrast-enhanced CT of the abdomen... ugh! Examining the small amount that remained in the Styrofoam container, the technician chided me with a malicious smile: "Ah, but Dr Crabtree, you know you must drink it all." Chugging the last remnant of this awful concoction seemed an impossible task.

When Jesus faced the unimaginable horrors of the crucifixion (and the imminent separation from the Father) He implored "My Father, if it is possible, let this cup pass from Me... if this cannot pass away unless I drink it, Your will be done." (Matt 26:39, 42) Fortunately for us He found the strength to drink the full cup to the dregs.

Then there is the apostle Paul who speaks of a "thorn in the flesh". (1Cor 12:7-8) While Bible scholars debate precisely what physical disability Paul suffered, it is clear that in this regard he was running on empty and he desired to be full -- i.e., to be whole once more. Three times he asked the Lord to remove this ailment. (Hmmm, only three times?) What really intrigues me is the Lord's response...

Whether faced with a bitter cup of suffering that must be drunk to the full, or drained of strength and longing for a full cup of refreshment, our Lord assures us "My grace is sufficient for you." (2Cor 12:9) Nice words, but what help are they really? I am learning the liberating reality of what these words reveal about the life of faith.

Regardless of my circumstances (no matter what is in the glass), God's grace (those gifts that attend an intimate relationship with Him, Eph 1:7-14) will literally fill up or overwhelm whatever the need is so that I can declare "I am satisfied" -- it will be sufficient for me. The Father sent an angel to minister to Jesus in the garden and He was strengthened. (Luke 22:43) Paul was able to conclude: "Therefore I am well content with weaknesses, with insults, with distresses, with persecutions, with difficulties, for Christ's sake; for when I am weak, then I am strong." (2Cor 12:10)

I am happy to report that my glass is more than half full! On June 11 we returned to UVA for a repeat PET/CT scan and MRI of the brain. As of yesterday we learned the results: Of the 18 brain tumors that were treated with the gamma knife procedures in April, all but 3 have regressed and there does not appear to be any new intracranial lesions. The 3 remaining lesions are only slightly larger and display some surrounding edema, suggesting positive effects of the radiation. The PET/CT, on the other hand, reveals three tiny new areas of increased metabolic activity, two in the posterior neck region and one in the right arm pit. These may represent newly developed metastases outside the brain. None of them was detectable on physical exam. Aside from some degree of increased fatigue, I am doing well with no pain and no apparent neurologic impairment. My doctors agree, compared to the devastating disease noted when first diagnosed one and a half years ago, I am doing remarkably well.

Dr Sheehan, the neurosurgeon, recommends simply observing the brain lesions for now and repeating the MRI of the brain in two months. Dr Grosh plans to pursue a needle biopsy of the lesions of the neck and/or right axilla, if the interventional radiologist determines this is feasible. Should the results of the biopsies prove positive for melanoma, I may face a repeat course of high-dose Interleukin-2. I will keep you posted.

Although I had hoped for a complete remission by now, I am truly "well content". Filled up by His grace, my glass is brimming with goodness, knowing His faithfulness, refreshed by evidences of His love (powerfully displayed in the love of family and friends), and constantly satisfied with the rewards of walking this journey with Him. Thanks for your continued prayers.

Dr Dan

PS -- Please pray for my sister-in-law, Genelle. For years she has suffered a progressive neurologic condition that has left her with extreme weakness so that she is now hardly able to speak and has difficulty breathing at times. Initially thought to have MS, a subspecialist has confirmed that she actually has Lou Gehrig's disease (ALS). Her husband, my brother, Paul has been a tower of strength, but I suspect his glass also could use a refill.