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.