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