Update on Dr. Dan

To Publish or Not to Publish?

2010-04-28T18:47:00.004-04:00

Today is the two month anniversary of Dan's passing into his new life with Jesus.

The first words friends utter in greeting to me are always the same, "How are you doing?" And I am happy to let you all know that I am indeed doing "fine". I really am. That doesn't mean that I don't cry or get choked up talking about him or about the grandchildren's bewilderment over when they can see Grandpa again.... But I really am doing fine. I am choosing to count my blessings, even in my grief.

I have spent the last two months writing thank you notes and responses to the many, many people who so kindly helped me or gave memorial gifts at the time of the funeral (which, by the way, turned out to be an absolutely wonderful evening of honoring Dan and glorifying the Lord! I have it on DVD, but I think 90 minutes is too long for U-Tube?) There is also a lot of life's business that must be tended to at times like these, so I have been tending to it.
But, if you are here on Dan's blog site, you are most likely seeking something concerning him and most likely you don't know what that something is. I suggest you review his former blogs and allow yourself to be blessed all over again.

Many, many of you suggested these writings be published. We did look into that prospect while he was alive and concluded that publishing a book is quite easy with all the self-publishing vehicles available. Marketing it is not easy. Soooo, I appeal to the wisdom and experience of you, readers. Do you have any informed suggestions concerning publishing a book of his blog entries? I do not want to spend a lot of money, let alone the time and energy, to publish a stack of books that just sit in boxes, being a tribute to vanity. (I don't want to make a lot of money, I just don't want to lose it!) The blogs are already public and will remain available. Would enough people be willing to buy in book format what they can get freely and easily on line?

"To Publish or Not to Publish?" (And "how"?) That is the question I ask you.

Leave a comment here. If you can't figure out how to leave a comment, you can email me at lindacrabtree1@hotmail.com.

Blessings to you, kind readers.

Linda

2010-03-07T15:50:00.002-05:00

It was a one week ago this evening that the Lord took Dan to be with Him.

Dan's decline the last two months of his life was rapid but the last two weeks it was precipitous and quite a battle to get ahead of the pain. I'm glad to report it was finally under control the last three days of his life.

My three daughters and I were at his bedside as the time for him to leave drew near. We prayed over him, thanking God for our life and heritage with this man. As his breathing became labored, Beth put on a YouTube production of "How Great Is Our God", and we sang along with it. He left this world at around 2 minutes and 50 seconds into the video. I mention the time, because as you will notice, if you watch it, the scene on the video is of a sunset on the sea. I doubt that you need an explanation of the imagery.

Here is the video, in case you haven't already picked it up on one of our daughter's blog sites.

We used the video to close out his memorial service with our daughter Beth singing How Great Thou Art. The following Bible Verses are the ones in the video. (It's hard to read them through tear-filled eyes.) They are a good synopsis of why we can face death with strength and confidence for today and for all of our tomorrows.
Dan faced the end with the courage he requested and I am confident he is no longer experiencing an energy crisis.

Thanks for sharing our journey. May you also walk yours with Jesus.

Linda Crabtree

John 3:16 "For God so loved the world, that He gave His only begotten Son, that whoever believes in Him shall not perish, but have eternal life.

Philp 1:21 For to me, to live is Christ and to die is gain.

Rom 6:23 For the wages of sin is death, but the free gift of God is eternal life in Christ Jesus our Lord.

Eph 2:4-5 But God, being rich in mercy, because of His great love with which He loved us even when we were dead in our transgressions, made us alive together with Christ (by grace you have been saved),

1Co 15:54-55 But when this perishable will have put on the imperishable, and this mortal will have put on immortality, then will come about the saying that is written, "DEATH IS SWALLOWED UP IN VICTORY. O DEATH, WHERE IS YOUR VICTORY? O DEATH, WHERE IS YOUR STING?"

John 14:27 "Peace I leave with you; My peace I give to you; not as the world gives do I give to you. Do not let your heart be troubled, nor let it be fearful.

Act 20:24 "But I do not consider my life of any account as dear to myself, so that I may finish my course and the ministry which I received from the Lord Jesus, to testify solemnly of the gospel of the grace of God.

Psalm 55:22 Cast your burden upon the LORD and He will sustain you; He will never allow the righteous to be shaken.

Deut. 30:19 "I call heaven and earth to witness against you today, that I have set before you life and death, the blessing and the curse. So choose life in order that you may live, you and your descendants,

Rom 8:28 And we know that God causes all things to work together for good to those who love God, to those who are called according to His purpose.

Mat 7:13 "Enter through the narrow gate; for the gate is wide and the way is broad that leads to destruction, and there are many who enter through it. "For the gate is small and the way is narrow that leads to life, and there are few who find it.

Psalm 18:2 The LORD is my rock and my fortress and my deliverer, My God, my rock, in whom I take refuge; My shield and the horn of my salvation, my stronghold.

John 11:25-26 Jesus said to her, "I am the resurrection and the life; he who believes in Me will live even if he dies, and everyone who lives and believes in Me will never die. Do you believe this?"

John 14:27 "Peace I leave with you; My peace I give to you; not as the world gives do I give to you. Do not let your heart be troubled, nor let it be fearful.

John 15:13 "Greater love has no one than this, that one lay down his life for his friends.

Daniel Wayne Crabtree, MD Dec.30, 1946--Feb. 28, 2010

2010-03-01T16:29:00.008-05:00

Last night, February 28, 2010, my beloved was called into the arms of Jesus as I and my daughters sang songs of praise to our Lord.

Our grief is great, but we do not grieve as those who have no hope.

We are confident beyond all doubt that we will be reunited one day

and again praise our Lord together.

Dan's and our prayer is that you too will choose to be devoted followers of Jesus Christ.

----Linda

Obituary Of Daniel Wayne Crabtree

Norfolk, Virginia. Daniel Wayne Crabtree, MD, 63, left this life February 28, 2010, after a two year bout with malignant melanoma, to enter Eternal Life in the presence of his Lord Jesus Christ. He is survived by his father, John B. Crabtree of Muskegon, MI; his loving wife of 41 years, Linda Newitt Crabtree; three daughters and their husbands, Kimberly/Alan Wilson, Elizabeth/Matthew Hunter, Christianne/David Page; and grandchildren Morgan, Madison, Matthew and Mark Wilson, Asher and Zephan Hunter, Evelyn and Adelaide Page. He is also survived by his siblings Dennis, Donald, James, Paul, and Debra Runyon. He is predeceased by his mother, Faith Crabtree.

Dr. Dan's medical career was long and varied. His training began as a chemistry major at Wheaton College, '69; medical school at Wayne State Univ. '73; and residency training in Family Medicine at San Bernardino County Hospital, '76. He practiced medicine in Muskegon, MI 1976-1986 where he started the group practice now known as Harborwood Family Medicine and served as Chief of Staff at Hackle Hospital 1984-1988. He then taught in academic medicine at both ORU/City of Faith, Tulsa, OK and ECU, Greenville, NC. Joining Sentara in 1990, he served in various administrative positions as well as a practicing physician. Dan concluded his career as founder and Medical Director of Personalized Family Medicine.

His goal as a physician was to treat the whole person with knowledge, grace and truth. He was known by his patients, as well as his colleagues, for his pursuit of excellence in medicine and in all areas of life. As an elder at Tabernacle Church of Norfolk, VA he sought to serve Jesus Christ by teaching the Bible, leading Care Groups and advising the leadership. During his convalescence, he wrote on his inspiring blog site, dancrabtree.blogspot.com, of his challenge to fulfill the Bible verse "Each day I am given, I shall not die, but live and tell of the works of the Lord" Psalm 118:17.

His family is very grateful for their heritage of love and faith.

Visitation with the family will be 5-9 PM, Wednesday, March 3, 2010, at Altmeyer Funeral Home, 5792 Greenwich Rd., Virginia Beach, Virginia. A memorial service will be held 7PM Thursday, March 4 at Tabernacle Church of Norfolk, 7000 Granby St., Norfolk, VA. A private burial will be at Forest Lawn Cemetery, Norfolk

Memorial gifts can be made in the name of Daniel W. Crabtree, MD to Christian Doctors Association, PO Box 7500, Bristol TN, 37621-7500. The gifts will be used to support the local student chapter of CMA.

Energy Crisis

2010-02-08T16:51:00.008-05:00

You have not been long on this planet if you have not been made aware of what is deemed a universal and growing energy crisis. As the industrialized world continues to invest millions in finding new sources of energy and improving the efficiency of current energy supplies, demand keeps growing. Recently, I have been dealing with an energy crisis of my own.

With an adjustment in my pain medication regimen and in my determination to borrow courage from Christ's example, by God's grace I believe I have crossed a new threshold in my appreciation of the positive power that suffering can have in our lives. While currently much improved, I have a more-or-less constant headache (due to brain metastases), frequent flares of a pinched nerve in the left thigh (meralgia paresthetica), periodic severe muscle cramps, and episodic pains from other growing melanoma deposits.

But the undisputed winner of the most disabling phenomena in my recent course is easy fatigue ability, generalized muscle weakness, and poor stamina, accompanied by occasional near black-outs when standing too quickly. This is an interesting phenomenon to me, since while on steroids I have not lost much weight -- rather I am losing muscle mass, tone, and strength. (As a physician, I am intrigued by the high-turnover metabolic processes that accompany unregulated cancer cell growth... )

Compared to my experience during the first few months of this battle with melanoma (when the tumors had spread rapidly throughout my spine and abdomen) I much prefer this current course (where the most critical and numerous growths are in the brain, yet I am still able to reason, write and relate). For those of you who conclude that I have given up the battle, please know that is not the case. I have already out-lived the most generous predictions of my survivability, cherish each day the Lord gives, and look forward to tomorrow.

Faced with an undeniably dwindling stamina, however, I seek to mine the experience for nuggets of truth that may help me and others facing similar challenges. When it comes to dealing with our weaknesses, scripture has plenty of counsel on the subject. Here are just a few:

Psa 27:14 "Wait for the LORD; Be strong and let your heart take courage; Yes, wait for the LORD" [It appears that demonstrating courage (see last blog entry) is predicated on learning what it means to "wait" for the Lord.]
Isa 40:31 "Yet those who wait for the LORD will gain new strength; They will mount up with wings like eagles, They will run and not get tired, They will walk and not become weary."
Psa 18:29 "For by You I can run upon a troop; And by my God I can leap over a wall."

As I experience profound weakness, I must learn to wait. In the original language of these passages, the process of "waiting" is more akin to posturing myself to spring into action at any moment than it is to passively sit, tapping my watch as the moments pass... Rather I need to alert all my senses to anticipate the next step I must take to keep my balance and stay on the path He has set before me.

Then I find that I begin to experience a paradoxical renewal of energy, coming from a source not to be explained by metabolic pathways or neurophysiologic phenomena. 2Cor 12:9 "And He has said to me, My grace is sufficient for you, for power is perfected in weakness. Most gladly, therefore, I will rather boast about my weaknesses, so that the power of Christ may dwell in me."

As I grow weaker physically, I find I am growing stronger in ways that transcend nutrition, exercise, and metabolic pathways. I find my strength coming from another source -- a breakthrough renewable energy supply found in the irresistible power of an intimate relationship with an all-wise, all-loving, omnipotent and holy God. This relationship rewards me with steadfast love, freedom from guilt, secure hope for the future, and a new passion for others.

The experience affirms an often over-looked conditional promise in scripture which I find myself just beginning to understand: 1Peter 4:1-2 "Therefore, since Christ has suffered in the flesh, arm yourselves also with the same purpose, because he who has suffered in the flesh has ceased from sin, so as to live the rest of the time in the flesh no longer for the lusts of men, but for the will of God."

The God who loves me is not capricious in the experiences He allows me to go through, but rather desires that I leverage them as tools in His hands to shape me into the very image of His righteous Son. He uses suffering to sculpt my character in ways that will last for eternity if I will but recognize and yield to the hammer and chisel of His love. My personal energy crisis is leading me to a new and boundless source of power.

Strengthened and sustained by your prayers,
Dr Dan

A much younger Dan & Linda

(before any thought of an energy crisis :-)

Take Courage

2010-01-27T14:28:00.018-05:00

Cowardly lion in The Wizard of Oz (Click here for video)

Courage: "the quality of mind or spirit that enables a person to face difficulty, danger, pain, etc., without fear; bravery."

From the very beginning of this journey with disseminated malignant melanoma, I have asserted that the loving God in whom I put my trust has our highest good as His aim. He has firmly established this certainty through the sacrifice of His Son, offering us an overcoming, transformed life that will last for eternity.

While we live on a fallen and rebellious planet, however, we will face difficulties, reversals, challenges and tragedies. In the midst of our struggles, He graciously provides strength and opportunities to grow in character and in intimacy with Him. I am convinced that these circumstances are a demonstration of the wise and irresistible love of a holy God -- He cares more about my character than my comfort or career; He values purity of heart over prosperity; and offers greater rewards in longsuffering than longevity.

One of the areas of character that He has been patiently working on recently is that of personal courage. Although I have already survived far beyond any reasonable expectations, there is evidence that the cancer is advancing. I have recently experienced bouts of rather severe pain presumably due to new or growing metastases of the brain and skeleton.

With the help of Hospice Care we are, of course, adjusting pain meds (and the meds to combat the side effects of those meds). Yet I find myself surprised by what I deem a deficiency of courage and endurance when the pain is severe. Although I have sat at the bedside of many a patient going through terrible suffering, there is nothing like personal experience. I am still learning...

As I study examples of courage in scripture, here is what I observe: Courage is a character trait that, when appropriate, the Lord commands. For example, when given a specific mission, the warrior Joshua is told: "Have I not commanded you? Be strong and courageous! Do not tremble or be dismayed, for the LORD your God is with you wherever you go." (Joshua 1:9) Or as He speaks to Daniel: "O man of high esteem, do not be afraid. Peace be with you; take courage and be courageous!" (Daniel 10:19) This implies to me that, in the face of adversity, courage is a choice I can make... and it is up to me to make that choice. It also made possible because God is with me in the midst of the challenge.

I also notice that, unlike some other character traits identified in scripture as evidence of the transformative power of faith (see the fruit of the Spirit in Galations 5:22-23), courage is more active determination than it is my surrender to a supernatural enabling. I must take courage. Of course, in the face of adversity a loving God makes His resources known with promises such as "Do not fear, for I am with you; Do not anxiously look about you, for I am your God. I will strengthen you, surely I will help you, Surely I will uphold you with My righteous right hand." (Isaiah 41:10)

I conclude that courage is a choice and a learned response, only evident in the face of threat or actual adversity. It is enabled by an ongoing intimate relationship with the One who, because of His great love for me, Himself endured incomparable suffering on a cross (Hebrews 12:2), overcoming death itself to ensure my eternal destiny: "He will swallow up death for all time, And the Lord GOD will wipe tears away from all faces" (Isaiah 25:8)

In spite of persistent and numerous metastastes in both brain and elsewhere I am truly grateful that I still have the capacity and opportunity to gain eternal benefits from the experience. Not to be compared with the difficulties faced each day by the brave men and women serving in active duty military, or the public servants who repeatedly risk their lives to protect or rescue those in need, this ongoing battle with advancing cancer is yet teaching me what it means to take courage. Thank you so much for your many expressions of love and support while on this journey.

May we all have the nerve to trust Him more,
Dr Dan

PS -- Thank you Lord for the new heart you gave me when I first trusted in you. Now I could also use a new (tumor-free) brain! (Or, like Dorothy, get to go home :-)

Pestilence and Promise

2010-01-16T20:12:00.014-05:00

My recent blog entry on "Whack-a-Mole" therapy reminds me of a refreshing true story of the power of child-like faith. Years ago, while living in Virginia Beach, our lovely (and rather large) yard was invaded with moles that eventually turned a fairly-well groomed and nicely graded lawn into an ankle-twisting, weed-choked, battleground. We did all the research on methods to rid ourselves of these pesky creatures and, one by one, tried them all.

I first tried flattening their tunnels (foolish and futile), then flooding them out (fun but never found any sputtered creatures surrendering themselves to me). Next I employed the mole traps -- and even bagged one of them this way -- but they kept on coming. Out of fear we may harm our dogs, we at first avoided the poison pellets, but eventually relented -- to no avail (fortunately the dogs survived). For weeks I could be seen stomping down mole tunnels in a ritual that must have caused the neighbors to think I had gone native American! Even our best efforts at grub control (moles' favorite food) did not stop the invasion. Meanwhile the yard and gardens were becoming an eye sore and risky to navigate.

Then one day our youngest daughter Christianne decided to take matters into her own hands. Inspired by the promises found in Psalm 91:1-6, she and her mother ventured out into the yard to face this pesky foe. The passage reads: He who dwells in the shelter of the Most High will abide in the shadow of the Almighty. I will say to the LORD, "My refuge and my fortress, My God, in whom I trust!" For it is He who delivers you from the snare of the trapper and from the deadly pestilence. He will cover you with His pinions, and under His wings you may seek refuge; His faithfulness is a shield and bulwark. You will not be afraid of the terror by night, or of the arrow that flies by day; of the pestilence that stalks in darkness, or of the destruction that lays waste at noon.

Together they claimed the promises, walking the perimeter of the yard as they prayed against this pestilence. Within days the most remarkable phenomenon appeared at the borders of our property: While no new tunnels emerged in our yard, suddenly fresh trailing mounds popped up in our neighbors' yards on both sides! These fresh mounds literally stopped at the edge of our lawn and gardens. (I honestly don't recall if we ever apologized to our neighbors, but we certainly empathized with their plight :-)

We live in a fallen world... one beset with troubles, disasters, famine, floods, earthquakes, devastation, enormous needs and neglect... and yes, with mortal bodies that are subject to decline, disease and death. Countless times God has intervened in our lives, in response to informed child-like faith, to stave off or reverse these destructive forces.

Ultimately, as we put our full trust in Him, we are promised a bright future secure in His love: For this perishable must put on the imperishable, and this mortal must put on immortality. But when this perishable will have put on the imperishable, and this mortal will have put on immortality, then will come about the saying that is written, "Death is swallowed up in victory. O DEATH, WHERE IS YOUR VICTORY? O DEATH, WHERE IS YOUR STING?" (1Cor 15:53-55)

Armed with many such experiences that confirm His faithfulness, we are resting confidently in His love.

Dr Dan

PS -- The fact that melanoma usually starts out with a pesky "mole" on the skin has nothing to do with the moles mentioned in this story -- or does it??

Whack-A-Mole Therapy

2010-01-13T17:43:00.008-05:00

My recent experience with targeted radiation therapy for several symptomatic metastases scattered throughout my body reminds me of the popular (and personally frustrating) "Whac-A-Mole" game that I have played with my grandchildren at the pizza parlor or video arcade. The grandkids can usually beat grandpa at this game :-)

With the decision not to pursue additional forms of chemotherapy (each of which offers diminishing likelihood of remission of the cancer accompanied by increased likelihood of significant toxicity), we continued to pursue targeted radiation therapy for the more symptomatic lesions (outside the brain). I have had several of these (including lesions located over the left cheek bone, both arm pits, left medial thigh, and a more recent particularly troublesome one deep in the left pelvis). The left pelvic lesion caused rather severe episodes of pain, prompting ER visits to rule out diverticulitis or kidney stones. It ultimately showed up on a PET-CT as a growing lesion deep in the pelvic musculature.

Consultation with the radiation oncologist led to consideration of yet an additional targeted course of radiation therapy to the left pelvic region, but by the time the mapping imaging studies were completed, the pain had substantially subsided. I am grateful for the reprieve but fully understand that this or any of the other dozens of metastases could become more symptomatic at any time.

So I have decided it is time to stop trying to whack each mole as it sticks its ugly head out of yet another susceptible recess of my body. We are transitioning to hospice care with home health nurse visits to assist in pain management and other supportive services as needed.

In the midst of these circumstances I am reminded of a tender conversation between Jesus and Peter along the shores of Galilee shortly after His resurrection (John 21:1-19). Jesus prepares a grilled fish breakfast for His disciples and during an intimate conversation with Peter reveals something of his future: "Truly, truly, I say to you, when you were younger, you used to gird yourself and walk wherever you wished; but 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. Now this He said, signifying by what kind of death he would glorify God. And when He had spoken this, He said to him, "Follow Me!"

We are not promised a future of our choosing, but urged to choose to follow the One who holds that future in His loving hands. Recognizing God's sovereignty in our lives and His active grace that has brought me through many more months of quality and enriching life experiences over the last two years while battling this devastating cancer, I am constantly seeking the best path to glorify Him. Resting in His faithfulness, I have abandoned the strategy of anxiously whacking each mole and look forward to the challenge and promise of what it means to simply follow Him each new day.

Thanks for your companionship on this journey,
Dr Dan

PS -- Linda has been a steadfast, encouraging, energetic and wise companion through these recent events. I could not be more grateful for the gift I have in her.

Wisdom

2010-01-06T15:39:00.006-05:00

WISDOM [wiz-duhm] -- knowledge of what is true or right coupled with just judgment as to action

I have just made one of the most significant decisions of my life. Having recently completed another round of imaging studies that show remarkable progression of the metastatic melanoma both in the brain and elsewhere, I was offered yet a third alternative of chemotherapy (paclitaxel). After extensive research into its limited efficacy in stage IV melanoma with central nervous system disease, recognizing the likelihood of significant side effects, and having invested time in prayer, reflection, consultation with physicians and loved ones, I have decided not to pursue this option.

I will complete the current course of radiation therapy for local symptomatic metastases in the left thigh and left cheek and continue medication to prevent seizures, relieve headaches and treat other symptoms as they arise. If and when appropriate, I will enter hospice care. As always my life is in God's hands. All along I have sought His wisdom and I believe He has delivered on His promise (James 1:5). Both Linda and I are at peace.

I have already survived far beyond any early predictions of my longevity, given the extensive disease present at the time of diagnosis. And I continue to function remarkably well in spite of over 52 previous and numerous active brain tumors and multiple systemic metastases. I am surrounded by a loving, supportive family, attentive and adoring wife, numerous faithful friends, and a God whose grace and mercy strengthen me each day.

I cannot tell you how grateful I am for all your prayers, expressions of support, and practical acts of kindness toward me and my family. May you know God's richest blessings in this New Year.

Dr Dan

Stranger Than Fiction

2009-12-26T19:27:00.006-05:00

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

Pharmaceuticals and Faith

2009-12-20T16:09:00.006-05:00

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

Thanksgiving "Top Ten"

2009-11-27T19:20:00.027-05:00

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,
Dan

The Beast from the Northeast

2009-11-23T20:23:00.015-05:00

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

Many Happy Returns

2009-11-11T00:09:00.007-05:00

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!
Dan

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

Faith of our Fathers

2009-11-09T16:38:00.035-05:00

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!

Dan

Targeted Therapy

2009-10-28T23:36:00.009-04:00

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

Stepping Out

2009-10-24T21:24:00.004-04:00

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!

Christian: Fickled Fan or Faithful Follower?

2009-10-16T16:10:00.030-04:00

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 :-)

FAITH: Fire Escape vs. Fireproof

2009-10-14T16:05:00.011-04:00

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.

My Bucket List

2009-10-07T22:00:00.010-04:00

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.

En Garde! Eradicate vs. Palliate

2009-09-19T18:00:00.018-04:00

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.

Touche',
Dr. Dan

If I Should Die Before I Wake...

2009-09-11T12:32:00.018-04:00

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.

Perception vs. Reality

2009-08-30T22:21:00.009-04:00

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.

The Cost of Caring

2009-08-19T15:34:00.008-04:00

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...

Physician, Heal Yourself!

2009-08-15T10:29:00.004-04:00

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.

Gratefully,
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!

Update on My Noodle

2009-08-08T04:45:00.006-04:00

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

Joy in the Journey

2009-08-03T18:18:00.005-04:00

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.

Declaration of Dependence

2009-07-02T12:02:00.015-04:00

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!

The Purpose of Pain

2009-06-25T02:52:00.014-04:00

"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.

Sufficient Grace

2009-06-14T07:14:00.016-04:00

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.

Identity Lost (& Found)

2009-05-12T20:59:00.007-04:00

Identity theft is on the rise. The FTC reports that 10 million Americans fall victim to identity theft each year resulting in over $50 billion in lost revenue to businesses. A stolen identity can rob you not only of economic resources but also of emotional security and future financial opportunity. Not surprisingly a whole industry has emerged to provide an array of safeguards designed to enhance identity protection.

Linda and I had a recent encounter with a salesman that reminded me of the enormous power that personal identity wields in our lives. Not at all predisposed to purchase what this young man was selling, we concentrated our efforts on getting to know him and sharing a bit of our story. He was very engaging and did not shy away from this disarming discourse in personal matters. We learned that he is one of three sons of a local pastor and, although he is the only one in his family who did not pursue a college education, he has been very successful in his chosen career with obvious gifts, persuasive common sense and a compelling personality. In fact, once we opened this door he was more than eager to tell us every detail of what made him outstanding and unique.

Long story, short, we were introduced to his fully researched heritage as a descendant of the Moors of North Africa, inspiring him to abandon his father's faith and embrace the Muslim religion. We listened with genuine interest as our enthusiastic guide introduced us to the critical role that the (majority) non-white population played in our nation's formative years. We were exhorted to recognize Benjamin Banneker, a free black man, mathematician and astronomer, as a true founding father whose influence preceded that of George Washington. We were tutored in the role that the Masons played in designing our government, rooted in Moorish cosmology and culture. We even learned of the blessings that accompany those who are genetically endowed with a generous measure of melanin.*

Clearly our new acquaintance derived an enormous sense of self-worth and personal significance from his carefully fashioned and thoroughly articulated identity. Attesting to the tremendous power it held in his life was not only the fervor with which he shared its details (emotionally charged with hubris and a hint of anger), but also the sacrifice it must have cost him in his relationship with his father and siblings. It provided for him a basis for personal pride, a perceived context for his life, and a sense of destiny.

We all cling to that which makes us unique as individuals... to those characteristics of our past, our personality, passions, pursuits, or progeny that form our identity. The search for significance is universal and it is intimately wrapped up in our need to embrace a particular identity. When that identity is threatened, or its underpinnings found to be inadequate to sustain our self-esteem, we face a major personal crisis... a crisis more devastating than a stolen credit card.

When a rampaging cancer robbed me of all strength one year ago, a major underpinning of my identity was kicked out from under me. No longer able to make it through a full schedule of patients, I was forced to close an innovative new practice that I had begun less than 3 years earlier. The daily satisfaction derived from my identity as personal physician to so many individuals evaporated overnight. I was forced to examine the bedrock foundation of my true identity.

Of course my identity as husband, father, grandfather, brother, etc., had not changed and in these relationships I found (and continue to find) great reward and in each a renewed source of strength and fulfillment. Yet as satisfying as these relationships are, they too are inadequate, for they ultimately depend on the fidelity (and presence) of others to provide a sustained sense of personal purpose and selfhood. I could look to other characteristics to embellish my identity, such as clever blogger, handyman, great lover... (the list goes on :-) But experience has taught that all of these self-ascribed characteristics are ephemeral and not an enduring basis for one's true identity.

My experience with cancer has taught me not to rely on any of them. There is only one reliable and invulnerable foundation for my identity. It is unaltered by my circumstance. It cares not about my past or where my family is from or what I have achieved. It is more powerful even than my DNA. It is found in this verse of scripture: "See how great a love the Father has bestowed on us, that we would be called children of God; and such we are." (1John 3:1) I do not need to look elsewhere for my ultimate purpose, for self-esteem or fulfillment. There is but one right that I know is guaranteed and cannot be stolen from me by any man: "But as many as received Him [Jesus], to them He gave the right to become children of God, even to those who believe in His name." (John 1:12)

In this identity, as a child of God, I find my place in the universe, impervious to pain and adversity, confident in who I am and whose I am. What freedom! Free to be me and compelled to share His great love with others. I now pray for my salesman friend that he too will come to reclaim his true identity.

Dr Dan

*We all enjoyed a round of laughter as this white boy with malignant melanoma pointed out that I probably carry more melanin in my body than he ever will!

THERRAPPY

2009-04-21T12:48:00.009-04:00

Dr Dan sports a turban in the aftermath of a gamma knife procedure

I am happy to report that we have survived yet another gamma knife procedure (#6). On Monday, 4/20/09, Dr Sheehan focused ionizing radiation on ten lesions located in the right cerebral hemisphere. All told that amounts to 43 times that metastatic deposits in my brain have been placed in the cross hairs of the gamma knife device (some of them requiring more than one treatment session).

Perhaps because of the sheer number of lesions treated, or because of the close proximity to the previous procedure, this particular session proved to be the most challenging one yet. Having your skull suspended by four screws inside a titanium frame for hours at a time while high-energy gamma rays are destroying space-occupying lesions in your brain can produce a headache that crescendos to explosive proportions when the frame is removed.

During these sessions I have tested an age-old approach to pain management that I have found to be very effective. Let me share it with you. It is a method advocated in scripture and now touted by modern psychology as “cognitive therapy” – the power of positive thinking. It is the biblical antidote to depression and distress outlined in Philippians 4:8 “…whatever is true, whatever is honorable, whatever is right, whatever is pure, whatever is lovely, whatever is of good repute, if there is any excellence and if anything worthy of praise, dwell on these things.”

When in distress (physical, emotional or spiritual), I always have the choice to engage my mind in the prescribed pattern of this verse which I elicit with an acronym “THERRAPPY”. While I lie immobilized inside the gantry of the gamma knife machine, even while ionizing radiation is traversing my brain, let me invite you to listen in on some of my thoughts that were:

True – “There is no doubt that God loves me... This is truly wonderful technology…

Honorable – “What an honorable and brave man Captain Phillips of the Maersk Alabama must be to offer himself as hostage to the pirates in place of his crew…

Excellent – “Dr Sheehan and his staff are excellent clinicians… What an excellent experience to have participated in the baptism of ten new believers on Easter Sunday…

Right – “I certainly made the right choice in choosing Linda as my wife… I am so proud of my son-in-law for taking a stand for what is right…

Reputable – “When I grow up I want to be like my friend Hap, with a reputation as a passionate follower of Christ…”

Attractive (lovely) – “I am truly blessed to have such a beautiful wife… who surrounds me with beautiful things…

Pure – “What do I know that is pure? Ah yes, Jesus’ life and His unfailing love!... and I remember the pure delicate flavors of the gelato we enjoyed last week with friends…

PraiseworthY – I am overwhelmed with gratitude for the prayers of so many, for God’s amazing grace, for the fact that in spite of 43 brain tumors I am still able to praise Him!

While not refusing the blessings of modern chemistry (e.g., intravenous fentanyl), I have found this prescription for the mind to be truly therapeutic. You can try biting your lower lip, humming The Battle Hymn of the Republic, or screaming if you like, but this really works! Next time you are down in the dumps or distressed, try this mode of THERRAPPY. When taken with a generous potion of prayer, the outcome is guaranteed: “...And the peace of God, which surpasses all comprehension, will guard your hearts and your minds in Christ Jesus.” (Phil 4:6-7)

Dr Dan

PS – We will return to Charlottesville in two months for repeat imaging studies to assess the effectiveness of these recent procedures.

What Does It Matter?

2009-04-15T17:49:00.010-04:00

"What does it matter anyway? We all die in the end." -- the character Diana in Knowing.

I cannot let this Easter season pass without commenting on the enormous impact my recent experience has had on how I celebrate the Resurrection. My purpose is not to debate the veracity of Christ’s resurrection. (You are free to pursue that on your own. Here is just one resource.) In spite of “many convincing proofs” (Acts 1:3) an affirmative answer will ultimately be based on faith – it was intended to be so (Heb 11:6). Rather I am driven to urge you to contemplate the consequences to you and me if the resurrection is true.

In the recently released science fiction thriller Knowing, an astrophysicist (portrayed by Nicolas Cage) reviews the evidence of the incredible precision required for intelligent life to exist in the universe and poses to his students the philosophical alternatives to explain this remarkable phenomenon: Life exists either as a result of “randomness” (materialistic world view) or “determinism” (a more politically correct way of referring to intelligent design). He is then confronted with a document written by a little girl 50 years earlier who accurately predicts every major disaster including the events of 9/11/2001 and a world-wide calamitous event yet to come. At a climactic moment in the movie, with all mankind facing what appears to be inevitable and imminent destruction, the question is asked "What does it matter anyway? We all die in the end." The scene is reminiscent of another sci fi flick Aliens when Hudson proclaims, “Game over man!”

I wanted to shout out right there in the movie theater, “It does matter! The game isn’t over!” The Easter story, made more poignant by my own brush with death, has prompted me to contemplate anew “What indeed does it matter?” When Jesus was confronted with His imminent (and we might add untimely, unfair and horrible) demise, what impact did that knowledge have on His attitude and actions? What difference did the awareness of His rapidly approaching, active suffering and gruesome physical death make? As I pondered once more the details of His passion and resurrection, I found answers that resonate powerfully with my own experience.

Intimacy – The scene in the garden of Gethsemane portrays a relationship between the Heavenly Father and the Son that is at once intimate, honest, tender, and ardent. In a more public setting, He addresses God as “Our Father” but in this sequestered moment He pleads "My Father, if it is possible, let this cup pass from Me; yet not as I will, but as You will." (Mat 26:39) The Father responds by sending an angel to Him to strengthen Him. (Luke 22:43) I can honestly say that I have never known a more intimate, powerful, palpable presence of God than when I lay powerless, breathless, and wracked with pain one year ago as the melanoma was spreading rampantly throughout my body.

Immediacy – Jesus seemed to sense the need for events and individuals to move to a point of decision, to “fish or cut bait”. Knowing what was lurking in the heart of Judas, and having just shared with him a portion of the Passover bread, Jesus urges him “What you do, do quickly." (John 13:27) He compelled Judas to get off the fence, stop the pretending and commit himself. Throughout this past year, knowing fully what is at stake, more appreciative than ever of both the inestimable value and frailty of this earthly life, I have gained a sense of urgency to share the lessons I have learned on this journey with cancer. I rarely miss an opportunity to tell my story and actively look for ways to engage others in conversation about eternal values. Each of us needs to make a choice. (Deut 30:19, Josh 24:15)

Immunity – Once Jesus made His choice in the garden, there was nothing that could deter Him from the course He had chosen. Fully conscious of both the suffering and separation that He was about to endure, He was impervious to dissuasion or discouragement. He put down a brief attempt by Peter to avert His arrest, commanding that he sheath his sword. (Mat 26:52-54) He was driven by an immovable purpose that no amount of adversity or humiliation would alter or defer. (Phil 2:5-8) While I cannot claim the same degree of immunity to difficult circumstances, this experience has engendered a new-found strength and resilience that is anchored in a firm relationship with Him. Stripped of all the external trappings of self-worth (e.g., esteemed physician, financial success, etc.), I have found a rock-solid foundation in my core identity and purpose as His friend and servant. (John 15:15)

Impassioned – Above all else, the story of Jesus’ tortuous death reveals His passionate fervor to complete that which the Father had called Him to do, and in the midst of His suffering to reach out to others with love and mercy. While in agony on the cross, He ministered to the repentant thief (Luke 23:43) and even uttered words of forgiveness to His torturers (Luke 23:34). Having a fresh taste of the Lord’s goodness and grace as He clearly sustained me when near death and favored me with a remarkable recovery, I am constrained to share the rewards of knowing Him with others like never before. My prayers for others are more specific, more frequent, and more fervent.

Invincibility – Finally, Jesus’ anticipation and confident expectation of His own resurrection allowed Him to claim victory over sin and death even before it was literally accomplished. (John 12:23-27) And in this anticipated victory He was filled with joy despite the enormous suffering He had to endure. (Heb 12:2) This is not a silly giddiness that ignores or denies the pain, but rather a transcendent satisfaction and elation that comes from certitude over the ultimate outcome of the battle. Whether you believe in the resurrection or not, Jesus’ disciples clearly did. There could be no other explanation for how their despondency was transformed into overcoming gladness, passion and sustained courage. My personal experience of this phenomenon is perhaps the most difficult to explain. Both Linda and I now possess a settled joy that, to the casual observer, sometimes appears inappropriate. I won’t try to fully explain it – I just know it is real. (Rom 8:37)

When confronted with imminent death, Jesus provided for us a powerful answer to the question, “What does it matter, anyway?” His life, His agonizing death, and His resurrection provide the tapestry upon which have been woven an image of hope and victory that can cover and protect us if we are willing to follow Him. “Since the children are made of flesh and blood, it's logical that the Savior took on flesh and blood in order to rescue them by his death. By embracing death, taking it into himself, he destroyed the Devil's hold on death and freed all who cower through life, scared to death of death.” (Heb 2:14-15)

In contrast to those characters in the movie who faced their inevitable demise with either panic or resignation, I have learned to live each day with a new intimacy toward my Maker, a sense of immediacy regarding decisions that impact our destiny, a newly-acquired immunity to adversity, more impassioned toward the needs of others, and sustained by a settled confidence in the ultimate victory. This is the life we celebrate at Easter. This is the life of faith.

May you too know the transformative power, freedom and joy of His resurrection.
Dr Dan

Gooood Friday!

2009-04-11T11:51:00.004-04:00

Sitting in a hospital bed this Good Friday, awaiting yet another gamma knife procedure (#5), and wearing my own ‘crown’ (a titanium frame held in place by four screws piercing my skull), I was reminded of the unbearable suffering our Lord must have endured.

Jesus was beaten and whipped within an inch of His life, mocked, spat upon, adorned with a crown of thorns, forced to carry His own cross, pierced with heavy nails through His hands and feet, and slowly suffocated to death while suspended between heaven and earth. Yet in the midst of His agony, He pleads on behalf of His torturers, “Father forgive them, for they do not know what they are doing.” [Luke 23:34]

Kind of a strange moniker for a day marked out by unbelievable torture and suffering, isn’t it? Yet we call it good, because in that day, and through that unique suffering of the God-man, we are forgiven. The consequences of my own rebellion were deflected from me to Him, absorbed by His broken body even as the ground absorbed His blood that day.

He was given no anesthesia, offered no intravenous fluids or narcotics, refusing even the paltry poultice of “wine and gall” [Matt 27:34]. With bittersweet emotion I take hold of the promise: “…by His wounds you were healed.” [1Pet 2:24] I remain in awe of His love, held captive by His goodness.

The mapping MRI done this Friday confirmed that there has been progression of the brain lesions, numbering at least twenty and several of these believed to be new. Given the time required to treat all these tumors, it was decided to target only those on the left side of the brain for this session. Even so, the process took the entire day. Thanks to great nursing care, a doting wife, and a little Dilaudid, I not only survived the ordeal but will enjoy taking the grandchildren to an “Eggstravaganza” (Easter egg hunt) at our church later today.

I am most grateful for all your prayers and genuine concern. May you too know His goodness!

Dan

PS – We will return to Charlottesville for another gamma knife procedure on April 20.

It's All in Your Head!

2009-03-26T15:12:00.011-04:00

Actual mapping MRI of Dr Dan's brain, horizontal cross-sectional view at the level of the orbits
(yellow spots represent melanoma deposits)

Truer words were never spoken. We just returned from Charlottesville after another round of imaging studies, lab tests and consultations with both the neurosurgeon, Dr Sheehan, and the oncologist, Dr Grosh. The PET scan indicates no evidence of active disease from the neck down, but the MRI of the brain demonstrates at least nine small tumors which have progressed in size since the last study. All but one of these appear to have been present on the previous scan (final report still pending). I remain remarkably free of any signs or symptoms from these metastatic deposits in the brain. So, indeed, it’s all in my head!

From a medical standpoint I appear to be somewhat of an enigma. It is unusual to demonstrate progression of melanoma tumors in the brain and yet have no evidence of active disease elsewhere, especially in light of the extensive metastases found throughout my body at the time of initial diagnosis.

Although it is clear we still face a formidable foe, it is also clear that nothing short of the miraculous could have brought me this far. One year ago I was immobilized with pain, emaciated, pale, unable to eat, hardly able to draw a breath at times, at the brink of death. Today I am pain-free with renewed energy, an insatiable appetite for all that life has to offer, and a little over-weight :-)

How we face the formidable foes in our lives is a matter of the head. The awesome reality of God’s peace that I have experienced through all this is a direct byproduct of how I choose to fill my head. Listen to these encouraging words: "You will keep him in perfect peace whose mind is stayed on You, because he trusts in You.” (Isaiah 26:3) "And the peace of God, which surpasses all comprehension, will guard your hearts and your minds in Christ Jesus." (Phil 4:7) I have put this to the test and know it to be true.

We have reviewed the treatment options with our consultants (whole brain radiation, stereotactic radiosurgery, ipilimumab infusions, or other investigational therapy) and have chosen to proceed with the gamma knife procedure. Because of the number of lesions to be treated, this will be done in two sessions, now scheduled for April 10 and April 20.

Meanwhile, I rest in this thought: “You, O Lord, are a shield about me, my glory, and the One who lifts my head.” (Psalm 3:3)

Dan

Living Life by the Slice

2009-03-09T13:50:00.006-04:00

"Give us this day our daily bread..." Matthew 6:11

My wife makes the most delicious homemade breads. Mmmm… Just writing about it makes my mouth water: the fresh-baked aroma, steam wafting from a warm loaf as I sunder through the delectable crust and render that first slice. At times Linda would urge me to continue paring the loaf until it was thoroughly divided into nice even slices, ready to be packaged and placed in the freezer for later consumption. But I prefer to sever and savor one slice at a time, while it is still oven-fresh, moist and delicious.

Now that is the way we are living life – one slice at a time.

To catch you up, on Wednesday, February 25, my local surgeon, Dr Randy Gould, removed a subcutaneous nodule from my left posterior shoulder, about the size of a small grape. This appeared for the first time on the PET-CT done at UVA on February 11 and proved to be an isolated recurrent melanoma. Then on Thursday, March 5, we traveled to Charlottesville to consult with Dr Grosh once more. At that time he thoroughly reviewed the recent imaging studies, biopsy results, and treatment options.

Because of subtle, inconclusive findings on the last MRI of the brain, the appearance of this new lesion of the left posterior shoulder (now removed), my stable physical condition, and the lack any laboratory abnormalities, it was decided to simply arrange another series of studies at the end of this month. If at that time there is evidence of progression of the cancer, Dr Grosh is considering a tertiary referral for entry into a clinical trial that uses the monoclonal antibody, ipilimumab. If there are limited brain metastases and no new systemic metastases, repeat gamma knife surgery may be considered.

But you notice the sentence begins with ‘if’ – that is a slice we have not yet sampled. And so it is for all of us, is it not? "If I finish this course as planned... If the economy turns around... If my 401K doesn't completely tank..." Life revolves around 'if'!

Knowing our penchant to want the whole loaf divided for us in clearly defined slices, Jesus urges us to trust the Father for each portion on a daily basis: “Give us this day our daily bread… your heavenly Father knows… So do not worry about tomorrow; for tomorrow will care for itself. Each day has enough trouble of its own.” (Mat 6:11, 32, 34) This caution is not just an accommodation to the harsh reality of life – rather He is advocating a healthy diet, a way of living that nourishes and satisfies our soul’s deepest hunger pangs.

So these days we mark our calendar in pencil. We consciously live life one slice at a time and savor each morsel. Though we may not know what the future holds, we know who holds the future and are truly satisfied.

The Bread of Life is right – it’s fresher by the slice!

Dan

PS – To complete this thought, consider an earlier blog entry that includes a poem “To End with ‘And’”

Patient is a Virtue

2009-02-24T17:19:00.005-05:00

The student lounge was filled with young men and women, each attired in crisp hip-length white coats that identified them as medical students. I had been invited by Dr Grosh to speak to the second-year class at UVA School of Medicine as part of a course he directs on the psychosocial aspects of cancer. I was happy to oblige.

As the students settle into the chairs and couches scattered about the room, I invite you to listen in to some excerpts of our conversation:

“It is great to be here today. If you ask me, I think Dr. Grosh is simply showing off his most successful cases. In fact I’m pretty sure he would not have asked me to participate if I had already succumbed to my cancer as planned six months ago. I am glad to be here today!

“Let me tell you a little about my medical career… I enjoyed a very busy practice with over 3,000 patients… increasingly frustrated by the economic realities of modern medical care that drove a wedge between the patient and his/her physician, sometimes developing a ‘fortress mentality’ in the office… I then launched a solo subscription practice that allowed me to focus on personalized, prevention-minded, proactive care that was mutually satisfying for both me and my patients…

“All this ended abruptly on January 23, 2008 with the startling news of disseminated malignant melanoma… I knew my prognosis was grim… underwent countless studies, punctuated by numerous emergency room visits while waiting to qualify for Interleukin-2 therapy… experienced rapid decline, shaking chills, night sweats, bone-wracking pain, weight loss, nausea, vomiting, and extreme weakness...

“The hardest task was sharing the news with my grandchildren… adjusting to life no longer defined by my profession… an altered body image… concerns regarding my wife’s future financial security…

“Throughout the diagnostic work-up and the demanding treatment protocol I gained a greater appreciation for the consequences of orders I had blithely written for patients in the past… a liver biopsy that resulted in excruciating pain following the procedure… a complete spinal MRI that demanded one to lie perfectly still on a cold hard table in a cramped noisy tube for 1½ hours… the toxic hospital food… the session with a nutritionist who persisted in inquiring about my dietary habits undeterred by my convulsive contributions to the emesis basin… the breezy hospital gowns… the frequent vital signs that ensured sleepless nights… the drug-induced diarrhea (and accompanying embarrassment of soiled bed linens)… the drug-induced constipation (and accompanying hemorrhoids)… [They heard all the gruesome details…]

“From this physician-turned-patient who still faces a life-threatening illness, let me leave you with three earnest recommendations:

1 – Cultivate a fortress mentality… but place the ramparts so that your patients and your family are safely within the fort. Boundaries are necessary but you must work diligently to place them so that you do not compromise your professional integrity nor sacrifice those you love the most. Gain the confidence needed to maintain a relationship with your terminal patients, even when you are no longer the treating physician. Regardless, recognize the unintended consequences of the orders you write and own them.

2 – Strike a balance between honesty and hope. I don’t believe ignorance is bliss, but brutal honesty without genuine caring and sensitivity can be abusive. On the other hand, hope propped up by false or vacuous claims is deceptive. Your goal is to help your patient live and to live each day to the fullest. In reality, none of us is guaranteed tomorrow.

3 – Don’t run from conversations about faith. When it comes to issues of mortality, your patient’s world view is absolutely critical in determining their response to a life-threatening illness. If you do not feel personally equipped to do so, ensure that a pastor, chaplain, or spiritual counselor is available to your patient.

“As a doctor who became a cancer patient, my faith has made all the difference. Although I would not have written this chapter in my life, I am extremely grateful for the lessons it has taught me. The experience has been transformative. Because of my faith in a loving and sovereign God, I have no fear of tomorrow but gladly celebrate each day. My hope for you is that, in the midst of your intense medical training and the unending reach for that next goal, you won’t neglect the rewards in store for you today.

“Thank you for your attention. I’ll be happy to answer any questions.”

I fielded a number of questions that day, but the one that is most memorable was asked by a young woman who said: “You seem to have weathered some difficult times with a very positive attitude and a bright outlook for tomorrow, but how do you handle the patient who clearly has no hope of survival, where death is imminent?”

“Great question. First of all, there were several times in my own experience when I thought death was indeed imminent. What buoyed me up in those times was a confidence that God was with me and that He had secured for me a future that transcends this brief earthly existence. I am convinced that if I did not have that hope, I would have been in deep despair.

“I recognize, of course, that not everyone shares this world view, so I simply invite them to consider it. Dr. Sigmund Freud, for example, embraced a different (naturalistic) world view. Resigned to the harsh reality of his world view, he described death as 'the terrors of eternal nothingness' and actually arranged for his own euthanasia when he determined that he could not face another day with cancer.

“I view my role as a physician to help patients live, even when (especially when) their days are few.”

I have learned that being (a) patient is a virtue!

Dan

PS – Want to rent a great movie that portrays a doctor who learns the virtues of being a patient? Check out the 1991 film starring William Hurt, The Doctor. A helpful discussion of the film aimed at medical personnel is found here.

Uncharted Territory

2009-02-14T13:03:00.004-05:00

Ask my family and you will discover that I love an adventure… often to their dismay. When hiking an unknown mountain path, I must explore what lies beyond the next bend, or discover what vista surely waits just over the next rise (sometimes leaving Linda to rest upon a rock). Whether sailing straight into a fog bank, canoeing through a mangrove maze, or schussing down a slope of virgin snow in cross-country skis, I love to go “where no man has gone before”.

I vividly remember one occasion in which my penchant for exploring uncharted territory could easily have ended in disaster. Wanting to share the thrill of adventure with my family, I loaded them into our new Jeep Wagoneer and set about on an off-road exploration of the Tennessee back country. Careening over the crest of a hill, and with lightning reflexes animated by my wife’s blood-curdling screams, I slammed on the brakes just feet from the edge of an 80-foot crevasse.

When the computer game called Myst was released in 1993, I was hooked. In this highly textured fantasy world, I was free to satisfy the need for exploration without risking life or limb or loved ones. The family was glad to make this venue of adventure a regular birthday gift.

Once more we are embarked on a real-life adventure into uncharted territory. Once riddled with cancer, by God’s grace I have navigated successfully through four gamma knife procedures to the brain, two cycles of systemic high-dose Interleukin-2, and three sessions of external beam radiation to the left hip. I have arrived in a place that few with stage IV melanoma have lived to experience. I am feeling great but there are challenges just ahead.

Our most recent visit to UVA on Wednesday, February 11, revealed a complex landscape: imaging studies suggest both significant improvement in systemic control of the cancer and possible persistence of tiny growths in the brain. All pertinent labs and my exam remain normal. Although my oncologist and neurosurgeon are exploring various options, there are no road maps to guide us through the next steps. There is no proven protocol for survivors like me.

I am reminded of another adventurer, spoken of in scripture. In Genesis 12:1, God tells Abraham to venture forth “to the land which I will show you”. Not knowing precisely what lay over the horizon, he set out, trusting God to guide him and supply his every need. He was not disappointed.

As we await the recommendations of my highly-competent physicians on this next leg of our journey, experience has taught us to fully trust in God as our guide. I’m looking forward to yet another adventure!

Dan

PS – On this Valentine’s Day, I am truly grateful for the one the Lord has given me as a faithful companion on this journey. As I awoke this morning, these were the thoughts I shared with Linda:

Waking to another day
Joy fills my heart anew…
The greater gift, I cannot say:
This breath I take, or you?

Happy Valentine’s Day!

Carib-being

2009-01-26T03:07:00.007-05:00

As I have shared on a number of occasions, one of the lessons learned on this incredible journey with cancer has been to celebrate each day, knowing that none of us is guaranteed tomorrow. And so indeed Linda and I have faced each and every day with a new-found joy and excitement, acknowledging "This is the day the Lord has made; we will rejoice and be glad in it!" (Ps 118:24)

Nevertheless, some days elicit more celebration than others -- like this past Friday, January 23, 2009. That date marked the one-year anniversary since the day we discovered my body was riddled with cancer and I was given less than six months to live.

Happily we found a very special way to celebrate my survival: we embarked on another 7-day cruise vacation in the Caribbean! For those of you who have followed our story, you will recall that one year ago at this time we had already booked a Caribbean cruise and our sail-away date was imminent. The timing could not have been better. My oncologist suggested there was no better medicine for the present than a romantic get-away with my sweetheart. (Reading between the lines: "Enjoy the next few days, for I fear your days are few.") By God's grace, the "Big C" did not deter us from creating some great memories on the high seas.

So one year later we found ourselves once more imbibing in God's goodness and reveling in the joys of His creation: walking along a palm-lined beach, warm white sand fondling our toes... gazing at an endless horizon as the sun's rays shattered into a dazzling display of dancing rivulets on waters that vacillated between emerald green and deep azure (all the while, of course, slathered in a gelcoat of SP-30!) Our spirits soared as we witnessed a kaleidoscopic sunset, embraced tropical breezes, or gazed at star-studded skies, refusing to exhale the deliciously pure night air.

We are all drawn to such experiences -- encounters with our senses that elicit both delight and a deep insatiable yearning for perfection and beauty, a foretaste of a deeper reality whereby we long to be immersed in Eden once more. For the one-time atheist, C.S. Lewis, it was this universal human experience of yearning for the eternal (which he describes as "joy") that first drew him to acknowledge the existence of God. As the writer of Ecclesiastes declares, "He has set eternity in their hearts". (Eccl 3:11)

And as Linda and I have reflected on the events of the past year we have gained a new perspective on life. Well, perhaps not a new perspective, but one that is now more certain and consequential than ever before. It is an eternal perspective, one that affirms we are destined to embrace a reality that transcends this brief excursion on planet earth. In short, that we are made for paradise.

We also know that in this life we will not experience paradise. Many of our troubles, strife, and fears evaporate once we recognize that our struggle is rooted in a frustrated longing for paradise on earth. We are learning to smile on rainy days, to persevere through life's reversals, to more readily forgive each other's shortcomings, and to appreciate the potential for good in the most devastating of circumstances.

Yet He graciously continues to dole out free samples of the boundless joy that is to come. Check it out, next time you witness the birth of baby, or spy a soaring eagle, or stand breathless before a mountain range, or capture a rainbow in the afternoon sky. One year after the diagnosis of an unusually aggressive disseminated cancer, I am basking in the warmth and beauty of His goodness, love, and grace.

Dan

PS -- We return to UVA in Charlottesville on February 9, 2009 for repeat scans and a check-up. I will provide an update then.

Taste and See!

2008-12-30T12:16:00.005-05:00

As difficult as this year has been, it has been indeed one of the BEST years ever. Just witness all He has done in the following pictorial review of 2008 for the Crabtrees. (Please be patient as the program opens and the slide show begins -- hope you enjoy)

Make a Smilebox slideshow

May you savor the goodness of God in the New Year!
Dan

Just Deserts

2008-12-23T11:49:00.003-05:00

The other day Linda and I attended a Christmas performance by the Old Dominion University madrigal singers held at our church. As we entered the spacious atrium decorated to resemble Narnia, we were greeted by one of the hosts who invited us to first visit the serving table, announcing “We are providing just desserts this evening. May I offer you some?”

I responded, “Jay, if I got my just deserts, I would not be here this evening!” To which he quickly replied, “That is true for all of us, isn’t it?”

Eleven months ago today, I was given a death sentence, informed that I had widely disseminated cancer that turned out to be an aggressive form of malignant melanoma. By all reasonable expectations (my own included), I should not be here today. Now after two cycles of high-dose Interleukin-2 therapy, radiation treatment to a left hip lesion, four gamma-knife procedures to the brain, a complicated port-a-cath removal, and a deep vein thrombosis, I am very much alive and anticipating the celebration of Christ’s birth with those I love. Do I deserve such favor?

The harsh reality is that we all have a death sentence. We have all been diagnosed with a terminal condition – it’s called the human condition. For all the millennia past, our mortality rate has been virtually 100%. In spite of all the advances in medicine, nutrition, and relative prosperity on the one hand, and all the devastations of war, disasters, and disease on the other, the death rate has remained unchanged.

And that is what we deserve. I know that is not politically correct, but the truth is that none of us deserves tomorrow. Genesis tells us that a good God gave us life, choice and sex so that we might propagate the gift of life. We squandered that gift when we each proclaimed our independence from the Creator. (Rom 3:23, 6:23) The natural consequence of my rebellion is death. But when I exercise the gift of choice and surrender my will to His, by His grace He restores my life. God sent His only Son to live a life that shows me how to truly live and to die a death that would conquer the grave. (1Pet 3:18)

And there’s the icing on the cake! Not only am I promised eternal life, but the life I now enjoy (day by day) is filled with joy, purpose, and peace. (Gal 2:20, 5:22-23) At the birth of Christ the angels proclaimed “peace on earth to men on whom His favor rests.” (Luke 2:14) The offer of “just desserts” still stands.

For me this has become a vital reality. I have tasted the bitter flavor of my just deserts, but in the days that remain I will satiate myself with His favor and feast on just desserts.

May you have a blessed Christmas!
Dan

Night Vision

2008-12-06T04:23:00.009-05:00

Beer wack! …wack cheer from Harlottesville. Tis thyme the MRI showed not one but mix sasses. Again the mix sasses were treated with fighly hocused ramma gays. I am fooing dine with only a height sledache. And after 25 train boomers my flinking is thawless! Yes, as you can see, I’m still tarp as a shack!

Just kidding – I truly am doing fine and grateful for the marvelous technology of gamma knife surgery that deftly destroys cancer cells while causing little harm to surrounding brain tissue. Although the previous MRI showed only a single new lesion of the brain, the highly detailed mapping MRI showed six new metastases and all six were treated with precision-guided gamma radiation.

I do not make light of the situation. We have never underestimated the formidable odds we face. From a strictly medical standpoint, the lack of decline in the number of new tumors appearing on each successive MRI of the brain is disconcerting and has significant potential implications for my overall prognosis. It is the central nervous system metastases that have always presented the greatest threat.

Our view of this battle, however, encompasses a more compelling reality. Indulge me while I relate another story from the Bible to explain what I mean. (2Kings 6:8-18)

The prophet Elisha, equipped with supernatural powers of espionage, frustrates and angers the king of Aram, one of Israel’s fiercest enemies. Resolved to eliminate the spy, the king of Aram sends a battalion of chariots to surround Elisha at Dothan in the cloak of night… an army sent to destroy one man.

Elisha’s servant wanders out to relieve himself and is panic-striken when through his blurry eyes he spots the enemy horde encircling the town. He runs to alert his master, breathlessly shouting “What shall we do?” In what appears to be the first-ever record of military surveillance employing “night-vision”, Elisha calmly prays that God will open the servant’s eyes to the reality of the situation.

With enhanced eyesight, the servant is amazed as he observes “the mountain full of horses and chariots of fire”, divinely deployed forces already in place to defend Elisha. The enemy, on the other hand, is struck with blindness and routed.

Our situation is not dissimilar. Once told that I was riddled with tumors “too numerous to count”, it appeared that an army of renegade cancer cells was about to take me out. By all reasonable accounts, this body should have been overrun by now. That is not the case. And although the threat persists (the enemy chariots have not disappeared), I can calmly point to a greater reality, a force that overwhelms and disarms the present danger. Not only do I benefit from shafts of invisible light in the form of gamma radiation, but more importantly I am surrounded by the indomitable reality of God’s unchanging love and the promise of eternal life. (Rom 8:37)

Like Elisha I can claim “Those who are with us are more than those who are with them.”

Grilled with fatitude,

Dan

Insistence of Persistence

2008-12-02T16:12:00.008-05:00

“Yet because of his persistence he will get up and give him as much as he needs” (Luke 11:8)

While teaching his disciples about prayer, Jesus relates a story about a man who finds himself with an urgent need in the middle of the night. Weary guests have just arrived from a long journey and he has nothing to feed them. With no 24-hour convenience store available, he goes to the house of a friend, bangs on the door to rouse him from sleep, and calls out his request to borrow some bread. The friend is indisposed, having already settled himself and his family securely in their beds, and does not immediately respond. The knocking on the door and the plaintive appeals continue. Finally, because of his persistence, the friend gets up and gives him all that he needs.

We are learning the necessity for perseverance, i.e., the insistence of persistence, in this battle with cancer.

We just returned from Charlottesville where I underwent a full day of imaging studies and consultations once more. There is good news and bad news. The good news is that a repeat PET scan shows no evidence of active metastases below the neck. The lesion in the left hip region which was treated with radiation therapy in late October is now slightly smaller and expected to continue to resolve. I have had no pain or limitation of motion (no limp), all vital signs remain stable and labs are entirely normal. (This is nothing short of miraculous, given the devastating picture of widely disseminated lesions “too numerous to count” just six months ago!)

The bad news is that there is at least one new metastasis in the brain, which measures 5 mm and is located near the center of the left hemisphere. (Linda sighs, "Honey, it's all in your head!" :-) The source of the brain metastases is unknown, given the lack of evident tumor growth elsewhere, but they are thought to have pre-existed as microscopic clusters of cancer cells which only now have grown large enough to become visible on imaging studies. Regardless, the oncologist, radiation oncologist and neurosurgeon all agree that the most prudent approach is to repeat the gamma knife procedure to destroy this remaining brain lesion. Other options, including whole-brain radiation, repeat Interleukin-2 therapy or monoclonal antibody infusions were offered as secondary considerations. We are scheduled to return this Friday, December 5 for my fourth gamma knife procedure.

Our confidence is in the Lord and in the power of persistent prayer. We are not discouraged. Right after telling his story, Jesus reassures the disciples with these words: “Keep asking, and it will be given to you; keep searching and you will find; keep knocking and the door will be opened to you…” (Luke 11:9) Our God is pleased when we, like the man in the middle of the night, acknowledge that we have no other friend to turn to meet our need. As Peter once said, “Lord, to whom shall we go? You have words of eternal life.” (John 6:68)

Grateful for your persistent prayers,

Dan

Giving Thanks, Gathering Joy

2008-11-26T16:23:00.012-05:00

“In everything give thanks…” (1Thes 5:18)

As I write this entry in the journal of my journey with cancer, a quiet and gathering joy inhabits my thoughts. And I am as intrigued by the phenomenon as I am pleased at the opportunity to express my gratitude.

Words are hardly adequate to describe my appreciation to the hundreds of you who have prayed earnestly for me, sent cards, offered practical acts of kindness, and buoyed me up with words of encouragement. I have also received excellent professional care and the well wishes and support of many colleagues. The outpouring of love, genuine concern and generosity has overwhelmed both me and my family. We thank God for each one of you.

Of course He is the One to whom all praise is due – for demonstrating His steadfast love, His faithful presence, His power to heal, His mercy and grace. I smile as I contemplate the beauty of how He has worked “all things together for good.” (Rom 8:28) Among the many lessons learned over the past several months is a new understanding of the transforming power of irrepressible gratitude and pervasive praise. Let me review…

Before any of us drew our first breath God saw our brokenness and the consequences of a creation gone astray. While still in a state of rebellion, He declared clemency for us through the sacrifice of His own Son, (Rom 5:8) thereby sealing forever the certainty of His love. (1John 4:10) With faith enough to recognize this gift, as a young man I turned myself in and received His forgiveness. My life was changed and my future secured.

Relative prosperity, excellent health, a fulfilling career, a wonderful family, and pleasant circumstances engendered an attitude of gratitude over the years that was reinforced by numerous examples of divine protection and providence. Almost everywhere I turned and everything I touched affirmed I am loved of God, a beneficiary of His goodness. Under such circumstances, what's not to be thankful for?

Then in January of this year dramatic events shattered this pollyanna perception of what constitutes God’s blessing. I was given six months to live and by my professional experience I knew that it likely would not be a tranquil passage. From the stunning moment I learned that I had disseminated cancer, through the nights of intractable pain, during the rampant decline in strength, amidst all the side effects of Interleukin-2 therapy, He graciously reassured me that He had not changed. His love had not diminished and He was no less deserving of my praise. In fact, it was often in those moments of extremis that His intimate presence was most palpable.

So I learned to give thanks in the midst of the pain. As I related in a previous entry, I would combat the pain with anthems of praise or humming to recorded hymns. Notice I gave thanks not for the pain, but in the pain. For it was in the pain I could appreciate the quality of love that constrained His Son to suffer unimaginable agony for me while uttering “Father forgive them…” (Luke 23:34) And it was in the pain that, without answering why, I was aware of His personal favor.

I also learned that the surprising consequence of giving thanks in the midst of suffering was an exhilaration and imperturbable joy that both eased the pain and produced a settled peace impervious to further adversity. I am aware that there are biological correlates to this phenomenon that to me only reinforce the wisdom of the Creator’s instructions: “Rejoice always. Pray without ceasing. In everything give thanks...” Sow gratitude; reap joy.

Through this experience and in my astounding recovery I have gained a new certitude and capacity to celebrate the profound and changeless love of God.

My wish for you and your family is not simply a “Happy Thanksgiving” but rather the lasting joy of giving thanks.

Gratefully,
Dan

PS – We return Monday, December 1, to Charlottesville for a full day of imaging studies and follow-up exam. I will keep you posted.

Wrestling with God

2008-11-13T14:00:00.005-05:00

Then Jacob was left alone, and a man wrestled with him until daybreak. (Gen 32:24)

One of the strangest stories in the entire Bible is that of a man who, during one troubled and sleepless night, literally wrestles with God. The man, of course, is Jacob, who finds himself facing what he believes to be almost certain death at the hands of his brother whom, years earlier, he cunningly robbed of his rightful inheritance. Left alone to contemplate his fate, fearful for himself and his family, he is desperate and destitute. He grapples with God.

It is a long night…

When the struggle is over, he is left with a gimp and a new name. His life will never be the same. Having been “touched [in] the socket of his thigh”, he is told by his contender that his name will no longer be Jacob (deceiver, supplanter) but Israel (one who prevails with God). (Gen 32:25-28) He walks away with a physical reminder of the encounter in his hip and a brand new identity. The God of covenant not only saved his life, but protected his family, gave him a new purpose for living, and fulfilled the promise to make him the father of a great nation.

Two weeks ago I found myself lying on a table, left alone as a remotely controlled machine directed a powerful invisible beam of ionizing radiation to my left hip. As I lay there looking up at the artificial skylight created through back-lit ceiling panels, I thought of Jacob.

Our experience has taken us through many long nights. Spent of human resources, desperate for answers, we wrestled with God – and came away with His blessing. The permanent marker used on my thigh to map out the precise direction of focused radiation reminded me that I am now a marked man and will never be the same. I have encountered a faithful God who has assured me of His lovingkindness and secured my destiny.

As I contemplate this story further, I am impressed with the honesty of Scripture. The One who sacrificed His own Son so that we might “have life and have it abundantly” (John 10:10) is not dismayed at our honest contending with Him. In the story of Jacob, He invites the wrestling match. (Gen 32:24) The God of the universe is not too busy to set aside time for a one-on-One encounter that, though it may last the long night, leads us to a clearer understanding of His ultimate plans for our good. If we don’t give up, we not only survive the night, but face the day with a new confidence and hope.

A friend and former patient is still going through that long night. Some years ago, he lost his teenage son, a boy that I was privileged to deliver while practicing in Michigan. I cannot imagine the pain. He has an honest grievance with God. He recently wrote me, “If God loves us, why does He keep hurting us?” My heart aches for him and many like him who have suffered an enormity of loss I will never know. What I do know is that God does not shrink away when we honestly grapple with Him. Even His own Son, whose love constrained him to lay down his life for us, experienced the struggle. (Luke 22:42-44)

Having prevailed through our own long night, I have experienced His touch and the blessing that follows. In Jacob's own words: "I am unworthy of all the kindness and faithfulness you have shown your servant." (Gen 32:10) Daybreak has illumined a clearer confidence in the reality of His promise, the fulfillment and unimpeachable joy that comes with a new identity as His child. My prayer is that my friend will someday know the same.

Glad for the gimp,

Dan

PS – There is no more powerful and effective treatment concerning the dilemma of personal pain in the presence of a loving God than the best-selling novel called The Shack. I highly recommend it to you.

The Race Set Before Us

2008-11-04T14:56:00.016-05:00

“…let us run with endurance the race that is set before us” (Heb 12:1)

One of the delights I have had during this lengthy period of convalescence has been the opportunity to spend more time with my grandchildren. And our favorite family activity when the weather turns cold (next to one of Mama Crabtree’s homemade pizza parties) is to compete with one another on the popular and highly interactive Wii video game system. Everyone from 3-year-old Evie to Grandma and me enjoy manipulating their look-alike Wii characters as they perform super-human feats of athleticism, high-speed vehicular stunts, or goofy bare-back competitions on cud-chewing farm animals.

In the midst of all the fun, there is plenty of opportunity to work on building character: persistence, patience, the value of teamwork, how to lose with grace, and (one I am still working on) how to win with humility :-) Clearly the lessons are not all aimed at the little ones.

The other day, my 7 year old grandson Matthew enthusiastically took charge of the Wii remote to enter the long-distance island run, an event among the Wii Fit games that requires running (in place) with a cadence that optimizes aerobic endurance. As his Wii character strode through parks, over green hills, past a beautiful waterfall, and dozens of encouraging on-lookers, I noticed that he was required to follow a pace-setting guide. His guide not only set the pace according to his ability, but also directed him all along the course, sometimes taking him off the beaten path. When he slowed down, his guide did not leave him in the dust, but waited for him to catch up. And when on occasion he ran ahead of his guide, his Wii character would inevitably fall flat on his face, then dust himself off and resume a more measured stride behind his vanguard.

I am so grateful that we have had a Great Guide along this journey, that He is setting the pace, ensuring our well-being, and marking out our course. (Hebrews 12:2) Past experience has taught us to keep Him in sight, avoid running ahead or lagging far behind. We have also learned He will sometimes take us off the beaten path. The words of the late Tony Snow come to mind and are worth repeating: “We want lives of simple, predictable ease—smooth, even trails as far as the eye can see—but God likes to go off-road. He provokes us with twists and turns. He places us in predicaments that seem to defy our endurance and comprehension—and yet don't. By his love and grace, we persevere. The challenges that make our hearts leap and stomachs churn invariably strengthen our faith and grant measures of wisdom and joy we would not experience otherwise.”

It is tremendously reassuring to know that He has set the course that lays before us; He knows the terrain and has personally conquered every obstacle. Ours is to keep pace, follow His lead, get up when we stumble, and share the joy in the journey. This is an exciting and highly interactive enterprise, which invites neither resignation nor hubris, but a growing confidence in the beneficent purpose and plans of the One who has run the race before us (2Cor 12:9). This is not a game for couch potatoes!

These past few weeks have demonstrated that He is indeed setting the course before us. Linda and I had the opportunity to visit family and friends in five states, witnessing with joy their response to the remarkable story of my battle with cancer, accentuated by the visible evidence of God’s power and grace. (Matthew 10:27) We also attended a Christian Medical & Dental Association conference aimed at exploring what new directions our Pacesetter may have in mind for those of us who have the finish line in view.

Then last week I alone returned to Charlottesville for consultation with my oncologist as well as the radiation oncologist to determine the best course of action to address the persistent tumor in my left femur. After some deliberation and authorization from my insurance carrier, a specially focused high-intensity radiation protocol was set up to take place in three daily sessions. (“Standard” radiation therapy protocols call for up to thirty sessions spread over six weeks.) As there was an excellent continuing medical education course offered at UVA later in the week, I had already arranged to stay in the area in our cozy camper, commuting to the conference and enjoying the fall colors. I simply excused myself when needed to jump over to the radiation therapy center for the 15-20 minute treatment session and ducked back into the conference. I have had no pain, nor worsening fatigue, nor other side effects usually associated with radiation therapy.

Clearly the course had already been set out before me. I am now scheduled to return to Charlottesville December 1 for repeat imaging studies and follow up. Thanks once more for cheering us on.

Keeping the pace with gladness,
Dan

PS -- And hoping to finish well...

Endurance and Endorphins

2008-10-14T00:43:00.005-04:00

Therefore, since we have so great a cloud of witnesses surrounding us, let us also lay aside every encumbrance and the sin which so easily entangles us, and let us run with endurance the race that is set before us (Hebrews 12:1)

Although I have never aspired to run in a marathon, I can recall a time when I actually enjoyed running long distance in college. I remember the daily 3-mile route through campus and down tree-lined neighborhoods. I remember the times I would get a stitch in my side or a cramp in my leg that would ease as I ignored the pain and lengthened my stride. I remember the cold, crisp mornings when icy air threatened to freeze-dry my lungs only to thaw as I pushed through to a steady cadence and continued to stoke my metabolic engine. Breathlessness was transformed into resonant rhythmical respiration followed by an almost invincible sense of strength fueled by endorphins. On the days I did not feel like running, my roommate could be counted on to goad me out of the dorm, then encourage me all along the course, often setting the pace.

Notwithstanding our desire to sprint to the finish in our competition with cancer, it is now clear we have signed up for a marathon event. When we returned to UVA on Thursday, October 2, a high-resolution MRI uncovered not one but six new metastases of the brain. These were all treated without complication by the marvelous technology of gamma knife surgery. Another MRI of the left hip region revealed that the previous suspicious area of increased PET scan activity corresponded with a one-centimeter lesion in the bone marrow of the proximal femur (thigh bone).

Although none of these lesions is causing symptoms, the oncologist concedes that the declaration of a remission from the melanoma was premature and he anticipates that further intervention is needed. Considerations include local radiation to the hip, another course of high-dose Interleukin-2, or some other novel therapy. There is no sure strategy for this segment of the course we are set upon.

The parallels to long-distance running are clear. Endurance is the key to finishing the race and finishing well. We have already pressed through much of the pain and have a foretaste of the endorphin rush. We are catching a second wind and hitting a new stride. In large measure our progress is credited to many of you, our “great cloud of witnesses”, some of whom have run the same course.

Most of all, however, it is because of the One who has set the pace for all of us, who has run through every muddy mile and won for us the promise of an invincible life… and who runs along side us still, sometimes prodding and always cheering us on. (Hebrews 12:2)

More than anything else, our strength is renewed because “the lovingkindness of God endures all day long.” (Psalm 52:1)

Dan

PS – We are currently traveling, visiting friends and family in Michigan and Illinois while awaiting word regarding specific treatment recommendations. We will keep you posted

Father Knows Best

2008-09-30T10:36:00.009-04:00

But He knows the way I take; When He has tried me, I shall come forth as gold. Job 23:10

This is not going to be anything close to a perfect analogy, but for those of you old enough to remember the classic TV sitcom from the 1950s and 1960s starring Robert Young, you will get my point.

Imagine you are able to select from a number of alternate endings to this most recent episode in the series on the life of Dr Dan, who has just returned from UVA and another round of extensive imaging studies to assess the progress of his response to Interleukin-2. Which would you choose?

A – No trace of cancer is found

B – Imaging studies are unchanged (architectural changes persist, but no new tumors)

C – There is evidence of a limited number of new metastases

D – Extensive recurrent metastases are discovered

Well, you can guess which ending I would have chosen… but (fortunately) I am not the author of this drama. The writer of this episode has chosen option “C”: The MRI of the brain shows a tiny new tumor of the left frontal lobe and the PET scan shows an area of faint but suspicious activity persisting in the left hip region. Lab studies remain normal, there is no associated pain and the patient’s clinical condition is stable.

The next scene, therefore, will take us back to UVA medical center on Thursday, October 2, where I will undergo another gamma knife procedure to eradicate the brain tumor, then an MRI of the left hip and possibly radiation therapy to that region as well. This is akin to extinguishing a few "hot spots" where once there was a raging forest fire.

Although I would have chosen (and honestly was fully expecting) version “A” with a “happy-ever-after” ending to this episode, I am grateful not to be playing the lead role in version “D”. And after some contemplation, I am truly looking forward to the page-turning adventure of a script that only the Master Author can create. I must admit that I would not have written any of this story. But then I would not have known the depth of intimacy with my Creator, nor the wonder of His provision… the power of prayer… the peace of His palpable presence.

Linda and I agree, there is no going back to a “routine” life, one that runs on automatic pilot. We are forever changed, living by the moment, fully dependent and surrendered to a loving, wise, and awesome God. Indeed, Father knows best!

The LORD is good, A stronghold in the day of trouble, And He knows those who take refuge in Him. Nahum 1:7

Stay tuned for the next episode...
Dan

For Goodness' Sake!

2008-09-20T16:18:00.007-04:00

God saw all that He had made, and behold, it was very good.
(Gen 1:31)

I remember the first day of my college ethics class… the professor asked us to define “good”. Go ahead, give it a shot. You will quickly find yourself either chasing your tail in some circular reasoning or appealing to some other moral determinant that supercedes the essence of good. You will also quickly learn whether you are a moral relativist (i.e., that perceptions and circumstances define what is good) or subscribe to absolutism (i.e., that objective good exists, regardless of my perceptions and/or circumstances). It is not my intent to solve that debate here.

We all get comfortable, however, with our suppositions about what “good” looks like – “You made a good choice… It’s been a good day… The fundamentals of our economy are good…” In normal discourse we rely on a common understanding of what good is and often assume that our audience shares that understanding. Of course the opposite also applies: We make judgments every day about what is “bad” – “That was a bad decision… It was one of my bad hair days… The bailout is a bad idea…”

Now we don’t always agree on what constitutes good and bad, and at these times, we appeal to some standard, characteristic, or outcome that would convince our listener of the merits of our position. When we do this, we reveal to ourselves and others the basis upon which we determine the true nature of what we consider good.

If you were to ask me six months ago about my situation, it would have been disingenuous of me to say “It is good.” I had rapidly shed 20 pounds; I had frequent waves of nausea and no appetite; nearly all my strength was gone; there were nightly episodes of bed-soaking sweats, fever and chills; bone-wracking pain in my ribs and spine was a daily experience; and cancer was continuing to spread to brain, lungs, liver, spleen, lymph nodes and throughout my skeleton. Surely that cannot be considered “good”.

But in retrospect, it was good. More precisely, it resulted in many good and wonderful things.

If you have been following this blog since the beginning, you have seen the good – I have a faith in God that is stronger and more pervasive in my life, having passed the test of adversity; I have a relationship with my Creator that is more intimate, real and consequential than ever before; I have a greater appreciation for the steadfastness and power of His love, mercy and grace; armed with the certainty of eternal life, the prospect of death holds no dread nor fear; I have been humbled by the outpouring of genuine concern by so many and awed by the power of prayer; like never before I have learned to value the relationships I have with family and friends; indeed every human encounter now carries a weight of eternal significance in the light of this new perspective.*

Against incredible odds, I have experienced an extraordinary response to the high-dose Interleukin-2 therapy. As of my last check-up, my cancer is declared to be in remission. I am no longer in any pain; my strength and stamina have improved; I have recovered most of the weight I lost (and don’t need those extra pounds I was carrying anyway!) In one more week we will return to UVA for another series of imaging studies and examination to determine the trajectory of this remarkable healing.

But what if the outcome of my treatment were different? What if, like 94% of stage IV melanoma patients, I did not respond to Interleukin-2? What if ...? You can fill in the blank. You can probably write your own story. None of us is guaranteed a happy ending to every story. Ultimately, we are all terminal.

Among all the blessings of this difficult journey, the one that stands out the most is that I have learned that God’s character is not determined by my circumstances. When it comes to proving His character, He nailed that one forever when He sent His only Son to suffer and die for me on a cross. (Romans 5:8) Whether my situation is deemed good or bad, His goodness is unchanged. (Hebrews 12:5-6, James 1:2-3)

There is a popular song of praise that repeatedly answers the question “What is good?” The chorus rings “God is good all the time! All the time God is good!” I am one who now sings that phrase with greater confidence and joy than I have ever known before. And I will continue to sing it until time is no more.

Dan

*If you want a good read on how the prospect of imminent death might change your perspective, consider the book One Month to Live, by Kerry and Chris Shook.

Rewards

2008-08-20T13:50:00.010-04:00

Enjoy life with the woman whom you love all the days of your fleeting life which He has given to you under the sun; for this is your reward in life and in your toil in which you have labored under the sun. Ecc 9:9

This past week Linda and I celebrated our 40^th wedding anniversary with laughter and tears. This was the anniversary that almost wasn’t – since early on in my diagnosis neither of us expected me to be here through the summer.

We gathered our three daughters, their husbands, and the newest granddaughter (too young to be separated from her mother) for dinner at the Sheraton’s “City Dock” restaurant in downtown Norfolk. Then we all boarded the American Rover for an evening cruise on the Elizabeth River. It was a spectacular evening, complete with a golden sunset, followed by a full moon that kindly framed itself in the forward rigging of this 135-foot schooner as gentle breezes filled the sails and a strolling balladeer serenaded us with some of our favorite ‘oldies’. What a gift!

Speaking of gifts: A remarkable recovery from disseminated malignant melanoma – a gorgeous and healthy new granddaughter – the chance to celebrate 40 years of shared adventures with the wife of my youth – surrounded by three bright & beautiful daughters and their masterful godly husbands… each a reward of worth beyond my deserving. I’m telling you, this life of faith demands unbearable sacrifice! :-)

I have often taught in our adult Bible study class that the life of faith – the life that dies to self and follows Christ with full abandonment – is actually a form of Christian hedonism. It is not a life of selfishness, not driven by self-interest, but one that is rewarded in ways that selfish ambition could not imagine nor hope to gain. Scripture is full of examples (Ps 19:8-11, Ps 37:4, Prov 22:4, Matt 5:3-12, Matt 6:3-4, Luke 6:35, Phil 3:8, Col 3:23-24).

Christ himself is our model: “…Jesus, the author and perfecter of faith, 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 The Son of God, who loved us enough to pay the ultimate price, was moved and empowered by the knowledge that, in the end, there would be great reward.

It is ironic that the path to an abundant life requires a conscious choice to die, to surrender my plans, desires and energies to His sovereign purpose. The very things that I hope to gain through my own striving and clever design are ultimately achieved only by putting them to death. “For whoever wishes to save his life will lose it; but whoever loses his life for My sake will find it.” Mat 16:25

I have been blessed beyond belief. This journey, which has taken me to the brink of death and back, has already produced rewards I could not have anticipated, not the least of which is the outpouring of genuine concern and prayers from so many. I am enormously grateful.

But the greatest reward continues to be a deepening relationship with the One whose love and grace transcend this fleeting life – for He reminds me “…I am your shield, your exceedingly great reward” Gen 15:1

Gratefully,
Dan

PS – I cannot overstate the reward Linda has been to me over the past 40 years, and particularly through this most recent leg of our journey together. As a token of my gratitude for her love and faithfulness, I offered the following toast at our dinner celebration, along with the gift of a diamond “journey” pendant.

The Final Report (Part II)

2008-08-09T14:36:00.004-04:00

We finally received a call late yesterday from Dr Grosh with details of the imaging studies and labs done on Monday -- and it is great news!

The MRI of the brain was reviewed in detail with the neurosurgeon, Dr Sheehan. It shows no new metastases and all previous tumors are either gone or in the process of disintegration from the second gamma knife procedure.

The bone scan, for the first time, shows significant improvement and maturation of the healing process from the previous extensive multiple metastases. No new lesions or signs of active destruction are evident.

The CT/PET scan, which detects any rapidly growing activity of tumor cells throughout the body, was essentially negative. There was one faint and ill-defined area of increased tracer activity in the left hip region, but no corresponding anatomic abnormality there on either the CT scan or bone scan -- so it is thought to be an artifact. There are still radiographic abnormalities in the liver which likely represent residual architectural changes caused by the previous tumor growths there. All labs were normal, including liver enzymes and non-specific markers for tumor activity.

Compared to the devastating images six months ago, this is nothing short of miraculous!

We will return to Charlottesville in late September to repeat these same studies and monitor the progress of healing. Meanwhile no active treatment is planned. We are enormously grateful to you for your prayers, to the physicians who have cared for me, and most of all to our God for His faithfulness, mercy and love.

Basking in His grace,
Dan

The Final Report

2008-08-08T07:38:00.010-04:00

Clip art licensed from the Clip Art Gallery on DiscoverySchool.com

We have all experienced it – the anticipation (sometimes apprehension) while waiting for the final report, whether that was a grade in a course, a performance evaluation at work, a biopsy finding, or a test result. While waiting, we ruminate on the “what if’s” and the consequences of various outcomes. Our mind takes us down paths that will likely await us depending on those results.

This week has been a week of waiting for the final report on the extensive imaging studies performed at UVA on Monday, August 4. This series of imaging studies included a high-resolution MRI of the brain, a bone scan, and a whole-body CT/PET scan using a glucose-linked tracer called FDG to pick up any areas of high metabolic turnover (such as rapidly growing tumor cells). Having completed the full course of Interleukin-2, the results of these tests should reveal the degree of response and have a significant impact on future prognosis. After a very long day of fasting, poking, prodding, and lying perfectly still on a cold table for hours at a time, we anticipated learning the results when we met with the oncologist late in the day. Unfortunately, none of the final reports on these studies was available.

When we met with Dr Grosh he was able to pull up the images on the computer screen and together we reviewed the pixilated representations of my brain, skeleton, and vital organs. The preliminary verdict: no evidence of new or active tumor growth! But subtle changes here and there, and the possibility that a review by the radiology consultants on their high-resolution monitors could pick up additional findings, compelled him to defer any definitive assessment to those final reports*. We agreed he would call me in a couple of days, once the official reports were available. Although his nurse called to let us know he was pursuing the matter, we are still waiting…

Yep, we’re back in the waiting room (see my blog entry of 7/06/08). It has become a familiar place. We have learned that time spent here can be very valuable. While waiting to hear what the final reports may reveal, we have been listening to what the Lord may be trying to teach us.

During the wait, several thoughts have come to mind. First and foremost: God is still in control. Our future hope is not pinned to the result of some therapeutic agent or study result. Our hope is in Him. Psalm 20:7 puts it this way: “Some trust in chariots, and some in horses, [and some in PET scans], but we will remember the name of the Lord our God.”

Our future is secured, indeed guaranteed (Rom 8:38-39, Heb 6:17-19). We have asked Him for healing and He has given us far more – He has rewarded faith with fruit that cannot be measured in survival statistics nor calculated on a computer screen. Our lives have been unalterably changed for the good; we have a more intimate understanding of His love and faithfulness; and if my prayers have been answered, so have many of you.

Secondly, while waiting for the final reports we have the giddy notion that, precisely because God is still in control, the details of the results will not matter. Not that I will ignore the results, nor fail to act on them according to sound medical advice – but it will not alter my confidence in the One who knows my end from the beginning. In practical terms, even if the radiologist should report heretofore unrecognized new metastases in the brain or elsewhere, God’s eternal plan will not be altered.

In the Old Testament story of the men sent by Moses to spy out the promised land, those who understood the power of their God rendered a final report that was far different from those who did not. While both groups observed the obstacles to victory, those who knew the faithfulness of a covenant-making God reported “we will surely overcome” (Num 13:30). Their enemies, though formidable, would become their prey (Num 14:9). Regardless of any possible disparaging news in our final reports, any residual cancer will find itself in the cross hairs of a powerful and faithful God. All fear is eclipsed by God's lovingkindness. (1John 4:18)

Finally, I realize that there is ultimately only one final report that really matters. That is the report that I will receive when I enter into the presence of the Lord. C.S. Lewis wrote: “You don’t have a soul. You are a soul. You have a body.” This body, though very much cherished, is destined to fail me some day. The report that matters is the one that assesses the status of my soul.

A good friend and outstanding Christian leader entered into God’s presence yesterday. Howard Douthit, fellow elder at Tab Church, beloved husband to Ramona and father to Nathaniel, Joshua and Jonathan, succumbed to complications of cancer after a prolonged battle during which he inspired many of us with his courage and unflagging devotion to God. I am confident he has received his final report: “Well done good and faithful servant… Enter into the joy of your Master.” (Matt 25:21)

That is the final report I look forward to.
Dan

* Please understand that the preliminary results of the tests done on Monday are extremely encouraging. My clinical exam is essentially normal, my weight has stabilized, and I have reached an improved level of strength. My progress has exceeded most optimistic expectations and we are rejoicing in what the Lord has accomplished. I will update you once I receive word on the final reports.

Life, Celebrated Daily!

2008-07-27T22:16:00.004-04:00

If you fly into our town, you will be greeted with this sign as you leave the airport: It welcomes you to the city of Norfolk with the motto “Life, Celebrated Daily” and the ubiquitous mermaid, a symbol of the area’s maritime history.

The city motto has taken on special meaning for me over the last six months. This past week marks a significant milestone in that on January 23, 2008 I first learned that I had far advanced cancer throughout my body with a life expectancy of less than six months from that date. Not only have I survived beyond that initial predicted life span but have every hope of complete eradication of a cancer that at one time had invaded brain, lungs, liver, spleen, lymph nodes and nearly every major bone of my body. I have experienced an overwhelming supply of love from others and the magnificent power of God’s grace and healing touch.

And to make this celebration even sweeter, this week we welcomed our eighth grandbaby into the family. On July 22 our youngest daughter Christianne Page gave birth to Adelaide Joy, weighing in at 7# 5 oz, 20” long. Kudos to Dr Holly Puritz who skillfully performed an urgent (repeat) cesarean delivery and provided much needed encouragement and TLC for both mom and daddy David throughout the procedure. As you can see, Adelaide is beautiful, healthy, and one of grandma and grandpa’s greatest joys. We are enormously grateful to be so blessed with this new little life at the same time that we are celebrating my new lease on life.

Through it all, the entire family has learned to celebrate life daily. None of us is guaranteed tomorrow. Each human encounter is precious. The marvelous promise that Jesus made 2000 years ago has become our daily experience: “I came that they may have life and have it abundantly.” (John 10:10)

Abundant life… We have learned that He was not talking about longevity, nor prosperity, nor even necessarily fun and happiness. He certainly was not talking about a pain-free existence or a life bereft of difficulties, trials, or adversity. What He has promised and delivered is a life of superior quality, a life abundant with meaning and purpose, a life rewarded with unimpeachable joy and a transcendent hope – all experienced daily.

Those of you who have participated with us on this journey through prayer and expressions of heart-felt concern are one source of our joy. May each of you be as blessed as we with an abundant life… celebrated daily!

Gratefully,

Dan

PS – I highly recommend Linda’s recent blog as she reflects on the significance of the arrival of Adelaide Joy.

Surprise! Surprise!

2008-07-20T21:43:00.004-04:00

God loves a surprise. He has a penchant for the unpredictable. Tracing His activity is a study in sacred spontaneity. I don’t think you will find this stated anywhere in Scripture, at least not explicitly, but just observe a few examples:

Surprise, Sarah! Though you haven’t had a period in 40+ years, you’re pregnant! (Gen 17:17, 21:2) Surprise, Job! All your livestock have been stolen or destroyed in the same day, your servants have been killed, and tragedy upon tragedy, all your children were lost in a house collapse! (Job 1:13-19) Surprise, Peter! Notwithstanding your protestations to the contrary, caught off guard, you denied me three times. (Matt 26:69-75) Surprise, Paul! Suddenly blind, you will soon see all I have in store for you. (Acts 9:3-16)

There are many more such instances of the unexpected in Scripture. This is not to say that God is caught unawares, nor that His actions are arbitrary or capricious – quite the contrary. It is often that an event that appears quite unexpectedly to an individual was foretold long before it occurred (e.g., Sarah, Peter). Further, not every sudden turn of events is a result of divine intervention, but rather the result of our own fallen and imperfect state and the presence of evil in this world. (Deut 30:17-19, Prov 6:14-15, Luke 13:4) We are even warned to be prepared for the unpredictable. (Mark 13:35-37, 1Cor 10:12)

And with every unexpected alteration in the fabric of our lives, God weaves a pattern that leads us to a greater understanding of His unstoppable love, mercy and grace. (Prov 16:9, Jer 29:11, Rom 8:28) Tony Snow, who was recently promoted to the life hereafter, said it best: “God relishes surprise. We want lives of simple, predictable ease—smooth, even trails as far as the eye can see—but God likes to go off-road. He provokes us with twists and turns. He places us in predicaments that seem to defy our endurance and comprehension—and yet don't. By his love and grace, we persevere. The challenges that make our hearts leap and stomachs churn invariably strengthen our faith and grant measures of wisdom and joy we would not experience otherwise.”

When I look back on the last six months of my own life, it is rife with surprise…

Jan 23, 2008 – Without warning, a “routine” CT scan performed for a prostate problem demonstrates disseminated cancer
Jan 31, 2008 – A liver biopsy report returns, demonstrating that the cancer is a particularly aggressive form of malignant melanoma. I am referred to UVA for consideration of Interleukin-2 therapy.
Feb 7, 2008 – Extensive test results reveal the cancer has spread to the brain, lungs, liver, spleen, spine, ribs and long bones. No primary source is found. Because of the brain tumors, I do not technically qualify for Interleukin-2 therapy, but Dr Grosh is willing to consider it if the tumors can be treated successfully with gamma knife surgery.
Feb 8, 2008 – Severe pleurisy-like pain raises the question of a blood clot to the lung. None is found.
Feb 11, 2008 – It is discovered there are actually five small tumors of the brain. All are treated with gamma knife surgery.
March 4, 2008 – After numerous imaging studies, several trips to the emergency room to rule out complications, IL-2 therapy is again postponed due to questions about possible pneumonia. Meanwhile I am losing weight (~20 lbs), in nightly pain, and getting weaker by the day.
March 10, 2008 – Having ruled out active infection, we finally begin high-dose IL-2 therapy (one week in hospital, one week recovering at home, then back for second week of therapy).
April 21, 2008 – Imaging studies show a remarkable response to the IL-2 therapy, unusual for someone with such extensive disease.
May 28, 2008 – The Port-a-cath device has to be removed due to breakdown of the overlying skin. Fortunately, no infection is found.
June 9, 2008 – Repeat imaging studies show persistent regression of the tumors elsewhere, but there are eight NEW brain tumors, again suggesting a fairly aggressive cancer. Repeat gamma knife surgery is arranged. This development again calls into question whether future IL-2 therapy will be tolerated. The decision is made to proceed.
June 14, 2008 – Unexpectedly, I develop recurrent pain in my left arm suggesting a nerve impingement in the neck. An MRI shows no nerve compression and the pain “spontaneously” subsides.
June 16, 2008 – We begin the second cycle of high-dose IL-2 therapy, suffer significant toxicities during each week of treatment, but avoid serious or permanent damage.

Then this past week we were hit with yet another surprise – one that threatened to shake our faith to the core.

Three days after discharge from the hospital I discovered a firm, tender nodule in my left arm pit. It was rounded, fixed, and rapidly enlarging without associated signs of infection. The clinical assessment was that this could very well represent resistant melanoma – particularly bad news having just completed the “final” course of IL-2 therapy. I alerted the oncologist and managed to arrange an open biopsy with a surgical colleague and friend, Dr Randy Gould.

Having experienced God’s faithfulness through a series of surprise developments, Linda and I determined that our trust in God would not be moved. His character (His unchanging love, mercy, and grace) are not determined by our circumstances. Even if this “surprise” meant my life here may be shortened, we affirmed that His goodness and lovingkindness are unwavering.

July 16, 2008 – Dr Gould examines me and is also concerned. He promises to get tissue at least to establish a diagnosis. During the procedure he spies a black hard mass, still highly suspicious for melanoma. But on further examination he discovers that the mass is simply a clot which had mounded up inside the vein where my previous central catheter had been placed. Pathologic examination of the vessel wall reveals no cancer and there are no surrounding lymph nodes. Subsequent venous ultrasound studies show the extent of the clot. No immediate treatment is necessary and I am reassured that this will resolve on its own with time. It is not the sort of clot that travels to heart or lung.

The God who loves surprises never stops loving us. His love for Job, Peter and Paul were never diminished, despite their circumstances. He is God, the sovereign One, and there is no more secure place than in the palm of His hands. We now look forward to whatever awaits us around the next bend: repeat total-body imaging to be performed on August 4 at UVA.

Continually surprised by His love,
Dan

A Word About Weakness

2008-07-13T17:24:00.006-04:00

as·the·ni·a (ās-thē'nē-ə) n. Loss or lack of bodily strength; weakness; debility.

Recently I had to complete paperwork to qualify for disability benefits – I never envisioned being at the other end of that process! When asked what about my condition prevented me from being able to work, I wrote down “weight loss, fatigue, asthenia”. Not currently in any significant pain, the predominant debilitating symptoms are these. No longer am I able to breeze through 12-hour days, mostly on my feet, and certainly not on any sustained basis. Loathe to admit it, I am too weak. I lack the sustained physical energy, muscle and mental stamina, to manage the longitudinal care of hundreds of patients as I once did.

As I have tried to share with you lessons learned during this journey with cancer, the one lesson I have yet to learn is how to accommodate my own weakness. Perhaps it is because I have almost always had more than my share of energy. “Blessed” for years with subclinical hyperthyroidism, my metabolism was in hyper-drive. Even after treatment for the thyroid condition, I required higher-than-average doses of synthetic thyroid medication, which seemed to keep me revved up, getting by with less than six hours of sleep, running circles around my wife, and driving her crazy with my ability to eat most anything without gaining weight.

Perhaps my difficulty adjusting to this new reality of weakness is my tendency to equate weakness with a defect in character or will. Of course I know better, but I have always operated on the semi-conscious notion that if you simply “buck-up”, you can overcome most any obstacle. Ask any one of my daughters how their doctor-daddy responded when they wanted to stay home from school because they did not feel well or it was “that time of month”.

And, although I am reluctant to admit it, part of my difficulty with weakness is that my self-esteem is linked to an achievement-oriented mentality and the desire to "be strong" for my woman whatever the circumstance. After all, she is the weaker vessel, right? Like it or not, I have a hard time shaking off these deeply ingrained patterns of thinking. I may yet need to learn (like a friend recently observed) how to become a human being (as opposed to a human doing).

Now I am confronted with a condition in which both the disease and the treatment rob me of energy; and no amount of self-will, positive thinking, or even sincere faith seem capable of restoring. This last course of high-dose Interleukin-2 zapped me of energy like I have never experienced before – just getting up from a chair or climbing a flight of stairs required enormous effort. Only now am I able to stay upright most of the day.

I know intellectually that there are lessons to learn through this experience of sustained weakness but I have yet to embrace them fully. The apostle Paul was apparently well tutored by weakness as he related to the Corinthian church his struggle with a “thorn in the flesh” (2 Cor 12:7-10). Beset with some chronic malady he was told by the Lord that he would not be rid of this condition, but rather “My grace is sufficient for you, for power is perfected in weakness.”

Power is perfected in weakness… Hmm, how does that work? Apparently that is what I must yet learn. What is the nature of this power? It certainly is not physical. No Olympic athlete cultivated weakness in order to achieve greater strength or stamina. It must be spiritual power, or as Paul puts it, “the power of Christ”. I must yet learn what that means experientially – this is not something to be comprehended through mental gymnastics. I suspect people like Joni Eareckson Tada and Dick Woodward know a bit about power perfected in weakness.

One thing I have learned: that is to be satisfied with uncertainty. In a conversation with my Dad the other day, he asked “When will you know you have been cured?” My short answer: “Never.” From a medical standpoint, I know the physicians will never declare me “cured”, even if no evidence of active cancer can be found. Rather, knowing that not every renegade melanoma cell can possibly be accounted for by any existing scan or test, they will declare me “in remission.”

And that is okay with me, for in this state of uncertainty (vulnerability, weakness), I am totally dependent on Him as my source of peace, hope and strength. That is where I belong. That is where I will stay. And one day I will be able to say with Paul: "Most gladly, therefore, I will rather boast about my weaknesses, so that the power of Christ may dwell in me."

Still learning and loving each day He gives,

Dan

The Waiting Room

2008-07-06T07:26:00.006-04:00

Aaah, we are all familiar with the waiting room, that place where you arrive to be seen by your physician, then wait (and wait) until he can finally actually see you. It is a place where many anxious moments pass ever so slowly. I have been on both sides of that room lately. At Personalized Family Medicine we eliminated the waiting room (retaining a small, pleasant reception area) through intelligent scheduling and allowing adequate time for each type of patient visit. But admittedly we did not eliminate all waiting. In God’s economy, I am now learning the value of waiting.

One of my favorite passages in Scripture is from Isaiah 40:31 – “But they that wait upon the LORD shall renew their strength; they shall mount up with wings as eagles; they shall run, and not be weary; and they shall walk, and not faint.” While scholars have debated the nuanced meaning of Isaiah’s poetic interlude, this promise from the Lord especially captured me this past week with practical power.

My first hope was that I would perhaps avoid this second series of hospitalizations altogether (“mount up with wings” and fly over this mountain) by receiving an “all clear” report from the imaging studies – that did not happen. Then, determined to make the most of it, I was anxious to race through this course in as short a time as possible, not miss a dose, and put the week behind me (“to run and not be weary”). Well, that did not happen either.

I discovered that this situation required me to learn to “walk and not faint”… to persevere, to plod through the day-by-day, hour-by-hour, minute-by-minute buffeting of my body and psyche in order to achieve the optimal outcome that my doctor (and my God) desire for me. It meant patiently waiting to collect the pre-treatment data (chest X-ray, EKG, lab); then riding inexorably through the many expected and unexpected side effects of treatment: chills, severe rigors, painfully strained muscles, limiting mobility, nausea, repeated vomiting, watery diarrhea, abdominal distress/distension, generalized swelling, shortness of breath, carpal tunnel syndrome due to the fluid retention, stomatitis, loss of all appetite, extreme fatigue and weakness, and, appropriate for the Fourth of July, a red splotchy itching rash surrounding pale white islands of raised whelts and blue lips!

With each new dose came a new combination of toxic effects, a strategy to ameliorate those effects, and in many instances the next dose postponed to allow time to recover. This particular course required the longest hospital stay yet to complete just 8 doses of IL-2, sometimes getting only one dose in over a 24-hour period. Beyond a doubt this fourth (and hopefully final) session of high dose Interleukin-2 therapy was the most difficult and protracted.

What was I to learn through this? First, He does not provide wings to surmount the circumstances in every situation. I have experienced that kind of rescue in the past, where I could view the problems in the valley from a lofty perspective and my only worry was to avoid plunging inadvertently into the next snow-capped peak! Sometimes He has us run like a troop through the thickets that would otherwise slow us down, renewing us with energy, quickening our pace, and cheering us on over the next hill. And sometimes He places us in a position that running or flying will just not achieve the best outcome – He comes along side to sustain us through the drudgery of the challenge we must endure and our strength is renewed to the very end. He reminds us, "It's the relationship, stupid!" He wants me to learn to know Him more intimately and it is during these times that I slow down enough to hear His heart beat (Isaiah 26:8, Psalm 46:10).

My role is to discern which course of action is most needed and to “wait” on Him to help me through it. It was just a day before being admitted to the hospital for this final round of IL-2 therapy when one of my mentors, Hap Struthers, a fellow elder at Tab church and a Hebrew scholar, pointed out that the verb translated “wait” in the King James version (elsewhere translated as “trust” or “hope”) has its roots in the Hebrew term for “lying in wait”, as in an ambush. Rather than a passive activity, it describes the one who seeks new strength as a person poised for action, every muscle taut in anticipation of God showing up in the midst of a difficult situation.

I like to think of this waiting process as similar to the mental attitude of well-wishers at a surprise birthday party for someone they love, all quiet and crouched behind the furniture. Together they are poised to spring upon their friend to lavish him with praise and affection as soon as he arrives. (Notice that passage does not say “he” that waits upon the LORD, but rather “they…”. This is a group endeavor!) I have sensed that I am joined by my many believing friends and family who were fully expecting God to show up in this situation, anxiously anticipating what He would do. Well, my friends, I am happy to report He did show up, and He is deserving of all our praise.

And of course, He kept His promise: Through this week, I have walked (sometimes crawled) through the most difficult circumstances yet, and I have not fainted. Thanks for being part of the waiting room party! May you, too, experience His renewed strength on your journey today.

Celebrating Him,
Dan

PS – Linda had a few more adventures while staying at the camper during the week and has been a tremendous source of strength from the Lord to me. I expect to be discharged today. We will spend one more day in the camper to recuperate and head back home for what we hope will be a full recovery. Next round of tests are slated for early August.

Lessons From My Grandchildren

2008-06-26T23:05:00.011-04:00

. Asher, Madison, Evelyn, Mark, Matthew, Me, Zephan, Morgan

One thing that has surprised and exhilarated me through this ordeal is how the Lord has used little incidents to speak to me of His wisdom and His love. My guess is that He has always been trying to reveal Himself in this manner, but in my life “BC” (before cancer) I was too busy (or deaf) to listen.

In a recent incident, my granddaughter Evelyn uttered what can only be considered a beautiful prophecy. Linda and I were visiting our oldest daughter Kim in her new home, helping organize and unpack. Christianne, our youngest, David, her husband, and their daughter, Evie were also on hand.

As the time came for us to leave, 3-year old Evie ran to me and wrapping her little frame around my leg exclaimed, “But I don’t want you to go home, because…” Her little mind conjured up her most persuasive argument: “…Because, I love you!” And then, “Can I have some strawberries?” (The latter phrase probably of no prophetic significance.)

Well, it looks like “because He loves me” my home-going will be postponed. I am so grateful to be so loved.

Another lesson I am learning was also inspired by my grandchildren. Awakened in the middle of the night with these thoughts, I committed them to poetry. I share them with you in hopes that you may embrace these truths without having to travel the same path.

To End with “And…”

Tucking our granddaughter into bed
Recounting the castles we made of sand
Sleepily now her prayers are said
“God bless Mommy, and Daddy, and…”

As dreamy delights wash over her mind
Her voice now fades to some distant land
I gaze at her peaceful face and find
That there’s promise in ending with “and…”

Once driven at a frenetic pace
Subscribed to all the profession demands
Breathlessly would I run the race
Little time for “ifs, buts, or ands”

Then arrested by my potential demise,
Malignancy confirmed with each scan
I pause to consider my fate a disguise
For new life that makes room for “and…”

To know Him in unending days
Starting now with the touch of His hand
“Herein is eternal life…” He says.
‘Tis futile to work to this end.

When once a period completed each phrase,
Every move made precisely as planned,
Now there are endless refrains of praise
As each day ends with “And…”

Prayerfully,
Dan

PS – a beautiful song that resonates this same theme is Chris Rice’s And His Praise Goes On, especially the final verse. Click on the title to read the lyrics, then the icon in the right upper corner to listen to the song.

Renewed in strength, we head back to Charlottesville on Sunday for the second week of this second cycle of high-dose Interleukin-2 therapy. This promises to be the most challenging session yet. We covet your prayers!

Be Strong & Courageous

2008-06-21T18:12:00.005-04:00

As I was nearing the end of this week of high-dose Interleukin-2 therapy, a number of the expected toxicities were cresting like waves against my body: the generalized swelling (gaining 17 pounds of water weight), muscle aches, bed-shaking chills, nausea, episodic vomiting, diarrhea (accompanied by a sore touche), stomatitis, abdominal swelling and pain, shortness of breath, difficulty sleeping and fatigue. Would this next wave take me down or would I still be standing when it receded yet one more time?

In spite of the side effects, I had successfully completed ten doses of Interleukin-2 and the oncologist was contemplating the eleventh dose to start at 1:00 a.m. on Saturday morning (today). If the numbers from the lab and vital signs came back okay, he would authorize the eleventh and final dose, if I also agreed that I was up to the challenge. At first I wanted to duck my head and simply let this one pass. Then the Lord’s Spirit spoke to me with the words uttered to Joshua centuries ago: “Be strong and courageous” (Joshua 1:6,7,9). Waiting for the doctor’s decision, I went to my Bible and reviewed the story of Joshua.

Now in no way do I compare myself to the mighty warrior that was Joshua, nor, for that matter, do I compare my circumstances to the enormous physical challenges and life-threatening situations that many others have faced, including our men and women in uniform.

But at some point each of us is placed at a point where we have to make a conscious choice to be strong and overcome our fears/discomfort/adversities or to take an easier path with less risk. It is seldom that I have truly had to be “strong and courageous”. Last night was one of them, though minor in the list of struggles faced by many others. Yet I learned something through it.

What is required at that moment is found in your spirit. To be strong at this point is a steeling of mental faculties, not necessarily an adrenalin boost in physical prowess. It is a willful process of taking inventory of priorities and view the situation with a broader perspective. To be courageous is to have faith that, whatever the outcome, a higher goal compels you to choose to face the situation with resoluteness and determination.

We find these characteristics, of course, in the life of Joshua. Facing the overwhelming task of leading a nomadic collection of tribes to conquer the inhabitants and settle in the land of promise, he was coached by God to do two things: be strong and courageous, and observe all the law of Moses. While there is a place for prayer, for faith, for surrender to God’s will, here the emphasis is on mustering up the internal qualities of mental fortitude, valor, and moral purity.

Knowing that I had a “multitude of witnesses” cheering me on, and taking personal inventory of these concepts, I determined that if Dr Grosh authorized an eleventh dose of Interleukin-2, I would stand against that wave as well. As it turns out, all my numbers were satisfactory except for one – my urine output was too low (owing to the fact that my stomatitis and abdominal pain had reduced my ability to take in enough fluids orally). Dr Grosh was satisfied with ten doses, cancelled the eleventh dose, and discharged me later this morning.

I am home now, feeling a little puny, but still upright and grateful to you all for your prayers. My prayer for you is that when your moment comes, you too will be strong and very courageous.

Gratefully,
Dan

PS – We will be home this week recovering, have some interim lab studies performed, and plan to return next Sunday for readmission on Monday, June 30 for the second week of this second cycle of IL-2 therapy.

A Second Touch

2008-06-16T04:40:00.008-04:00

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

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

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

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

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

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

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

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

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

Anticipating His grace and a second touch,
Dan

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

Father's Day Blessings

2008-06-15T15:16:00.005-04:00

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

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

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

Daddy's Little Girls

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

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

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

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

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

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

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

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

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

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

Dad, I love you. Please fight.

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

Posted by Beth Crabtree Hunter

Round 2!

2008-06-08T20:33:00.012-04:00

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

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

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

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

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

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

Cha-ching!
Dan

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

Access (Part III)

2008-06-06T02:22:00.007-04:00

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

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

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

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

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

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

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

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

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

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

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

Celebrating each step of the Way,
Dan

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

Access (Part II)

2008-05-28T19:19:00.003-04:00

Just a quick note to provide an update regarding our trip to UVA and the problem with the Port-a-Cath. I met with the interventional radiologist and determined that the current device had to be removed, since it was now partially exposed through a small defect in the skin. Fortunately, there was no sign of infection. The removal under local anesthesia proceeded without difficulty.

After discussion with my oncologist it was decided to delay placement of a new access port until after I have the repeat imaging studies scheduled for June 5. Based on that information we will have a better idea of which type of venous access device will be most appropriate.

Our trip to Charlottesville and back was speedy and pleasant. Thanks once more for your prayers and expressions of encouragement.

Gratefully,
Dan

Access is Everything

2008-05-27T17:27:00.005-04:00

It was 2:00 AM when the call came in to the emergency room alerting us to the arrival of a young male patient with an apparent drug overdose. Paramedics were already performing assisted ventilation as they wheeled him into the available trauma bay. The patient was poorly responsive, with a ghastly gray complexion, pinpoint pupils, a barely palpable blood pressure and a purple hue to the fingers and lips. As a second year resident on my ER rotation, his care fell to me.

We needed to gain immediate access to a vein in order to administer life-saving drugs and intravenous fluids. Several attempts to access a peripheral vein were frustrated by severe scarring at every available site – the result of years of self-injections of heroin. Even leg veins and groins were impenetrable. A hematoma under the tongue suggested that this patient had even tried to use the sublingual veins to get a desperately needed fix.

With no time to spare, I prepped the area just beneath the right clavicle to perform a subclavian catheterization with a large-bore catheter: “Check the landmarks, penetrate the skin just beneath the clavicle at the junction of the middle and lateral thirds, and aim for the opposite shoulder…” Success! Venous access established and within minutes the patient was awake, thrashing about, and breathing on his own.

I have vivid memories of similar heart-racing moments to gain access to critical bodily compartments: from delicate scalp-vein venipunctures on premature newborns, to emergency chest tube insertions in patients with an acute lung collapse, to difficult spinal taps in patients suspected of acute meningitis. Until we had established a reliable port of access, any attempt to reverse the patient’s deteriorating condition was compromised at best and sometimes impossible. (Watching "ER" on TV has often caused a visceral reaction as I relive some of those moments.)

Reliable central venous access is also essential for the administration of Interleukin-2 and, to facilitate that access, I had earlier undergone the placement of a semi-permanent device called a Port-a-Cath. This device consists of a titanium reservoir which was surgically implanted beneath the skin just below my right clavicle. The reservoir is connected to a catheter which is inserted into the major vein that empties into the right upper chamber of the heart. Unfortunately in the last two days, persistent tension on the overlying skin has compromised the capillary circulation resulting in the development of a pressure ulcer at one edge of the reservoir. As a result, I will now require revision of the implant. We leave tomorrow for Charlottesville to have this done. If not attended to, I will not be able to receive the planned second round of the Interleukin-2 therapy, scheduled for mid-June.

Access is essential in many arenas. It was to improve my patient’s access to timely and personalized medical care that I established Personalized Family Medicine a little over two years ago. The result (in my humble estimation) was a dramatic improvement in the quality of each patient encounter, in patient satisfaction, and hopefully in clinical outcomes.

Throughout this personal encounter with cancer the one thing that I have grown to appreciate more than ever is the direct access I have to the Great Physician. Because of what Christ has done, I have an open line to an all-powerful, loving God who is anxious to infuse me with spiritual health and strength that enables me to face any challenge (Ephesians 2:17-18, Hebrews 10:19-22). I am grateful that the One who is on call 24 hours a day, seven days a week, lovingly resuscitated me when I was near death (Ephesians 2:4-5).

It is also because so many of you have gained access to that same source of power through prayers of faith that I am witness to His awesome mercy and grace. Please continue to do so as we return to UVA to take care of this complication.

I will keep you updated,

Dan

Medicine or Miracle?

2008-05-20T01:00:00.009-04:00

I love the story of Scrooge as portrayed by George C. Scott in the 1984 TV adaptation of Charles Dickens’ classic A Christmas Carol. Do you remember the scene when Scrooge awakens to discover he has not missed Christmas? He is giddy with gladness, and every human encounter becomes an opportunity to share his new-found joy in living. That is precisely how I feel lately.

Appreciating like never before both the frailty and preciousness of life, I cherish even the most casual relationships and look for opportunities to tell my story. In the past I would assume there was plenty of time to catch up with neighbors, family and friends, to nurture those relationships over time – now I am tempted to hug total strangers! In conversations I now quickly dispense with superficiality, look for opportunities to express in kind the genuine love that I have received, and attempt to direct the dialogue to subjects of consequence.

In the process of sharing my story, I will mention my rapid decline, the delay in starting Interleukin-2 therapy, the remarkable outpouring of concern and prayer by hundreds of people, the awesome goodness and grace of God, and the miraculous and rapid regression of the cancer. I love to watch the response. Some immediately light up, offer praise to the Almighty, and become animated in their expression of joy. Others seem to need more time to process the information, offering their congratulations after a brief (and less animated) pause.

Of course as I ascribe my remarkable recovery to divine intervention, I recognize that some may not draw the same conclusion and need time to process their own ideas about cause and effect. Is it a miracle or simply the medicine? As a physician I have often wrestled with this question.

I like the definition of a miracle found in Wikipedia: “A miracle, derived from the old Latin word miraculum meaning ‘something wonderful’, is a striking interposition of divine intervention by a supernatural being in the universe by which the ordinary course and operation of nature is overruled, suspended, or modified.”

While trained in the scientific method, I am quite comfortable acknowledging a supreme being who is able to overrule, suspend or modify the rules of nature which He created in order to accomplish His purposes, to accomplish something wonderful. In my case, and in many similar cases I have helped manage, the miraculous and the medicine are not mutually exclusive operations – rather I see them as complementary.

If high-dose Inter-leukin 2 were the sole cause of my recovery, then why is it NOT effective in over 94% of patients with stage IV melanoma? Clearly there are additional forces that influence response and outcome. I believe in my case it has been the thousands of prayers that have gone up on my behalf – and a living, loving, all-powerful, transcendant God who has responded to those prayers.

Science aims to explain observable phenomenon, to answer the “how”, not the “why”. It is possible, even probable, that as our understanding of the “how” becomes ever more refined, we may actually peer into ways in which God accomplishes the miraculous. For example, as string theory predicts that within the same space many alternate universes may co-exist, it is not difficult to contemplate how Christ may have manipulated these alternate realities to convert water to wine. A personal, imminent, and good God may intervene in His own creation to accomplish His purposes – to answer the “why”.

I am grateful for Inter-leukin 2 and for the skilled physician who has supervised its administration, fully convinced that God has used this naturally-occuring agent to accomplish a miracle in my body. He is ultimately the author of it all and I celebrate Him!

It’s Christmas morning and I see the day in a whole new light!
Dan

In Remembrance

2008-05-08T04:54:00.007-04:00

Last Sunday I was privileged, as an elder of our church, to help serve communion. It was an emotional experience for many reasons, not the least of which was because I had not been able to participate in the Lord’s Table since my rapid decline three months earlier. By most reasonable predictions, I would most likely be receiving the elements on my death bed by now, if I had not already passed all need for bread or drink. And here I was, standing before the congregation who has so faithfully prayed for me, able to give thanks and to sing with them “By His stripes we are healed!”

I once heard a definition of the Eucharist (Holy Communion, Lord’s Table) that I love: it is a Greek term that means literally “good gift” or, more fully, “hilarious thanksgiving”. For me this last Sunday was indeed a day for hilarious thanksgiving. And I have the tear stains of many friends on the shoulders of my sport coat to prove it!

It is a tradition during the course of administering the elements to quote Jesus’ words at the Last Supper when He said, “Take, eat. This is my body which is broken for you. This do in remembrance of Me.” I have often wondered what He meant by those words. Did He really think we might forget Him or the sacrifice He endured?

Then I studied the meaning of “remembrance” in the original language. In this context it means much more than simply not forgetting. Over and over in Scripture we are told that God “remembers” His covenant (Gen 9:15, Ex 2:24, Ps 98:3, 106:45). Clearly an omniscient God does not require the jogging of His mind to recall His previous commitment. Rather, these passages demonstrate how He takes heed to what He has already promised and is moved to action on behalf of His people.

We read that He remembered Noah to rescue him from the flood (Gen 8:1); He remembered Abraham when He spared Lot from the destruction of Sodom and Gomorrah (Gen 19:29); He remembered Rachel to grant her a child (Gen 30:22); He “takes thought” of man (Ps 8:4) – i.e., He is keenly aware with a comprehensive understanding (“mindful” Ps 103:14). Even the plea of the thief on the cross “Remember me when you come into your kingdom” (Luke 23:42) is not an entreaty to avoid divine amnesia, but an appeal to God’s mercy (His character), and His covenant of grace.

So what does it mean for me to “remember” Him? I am to acknowledge His covenant, to honor His name, to celebrate (1Chron 16:4), to boast (Ps 20:7), to contemplate (Ps 63:6, 143:5), and to announce to others with audible praise (Ps 71:16) what He has accomplished through His victory over sin and death. And to add a crescendo to my praise, I am reminded that, because of what He has done, God does NOT remember my sins! (Is 43:25, Jer 31:34) I am to be moved to action, to love as I have been loved.

At a time when I might have been planning my own memorial service, I will rejoice in remembering Him and revel in His goodness!

Dan

Imprinted

2008-05-04T03:35:00.009-04:00

On the day before I underwent the thorough assessment at UVA and discovered the remarkable regression of my cancer, an event took place that I delight to relate to you.

Anticipating the need to be available for the first appointment in Charlottesville at 8:00 on Monday morning (and to save some money from the repeated motel stays), we decided to enjoy the outdoors and camp in the nearby mountains during the prior weekend. (See Linda’s blog entry “Mountain Momma”.)

As we were preparing to break camp at Seneca Rocks, WV, I came across two little furry objects lying in the roadway. I leaned over to investigate and beheld two bright orange and black downy chicks lying on their backs, legs clawing the air wildly. Looking around I saw no nest nor even an overhanging branch from which they may have fallen. A monsoon rain had kept us awake most of the night before and I assumed that somehow they had been transported here in the downpour.

Absent the means to nurse two little birds to independence, I said a little prayer for them and went on to pack up our nearby campsite. When I checked the roadway ten minutes later, the chicks were gone. I hoped that their mother may have found them and ushered them to safety.

Then I heard a beseeching little chirp at my feet. It was one of the chicks who had somehow found his footing and apparently followed me the thirty yards to our campsite. I introduced Linda to the little guy, alerting her to beware of this critter underfoot. But he took no interest in Linda whatsoever. As I went about carting supplies from the camper to the car and scouting the campsite for other items, my new-found friend was at my heels, yipping and yawning its beak as if to receive a tasty morsel from this surrogate mother.

One of my strides easily required a dozen little hops by my fuzzy friend, but every time I turned around he was there. At one point the insistent creature hopped up on my shoe as I was packing the trunk. Amusement turned to irritation and I decided to confine the little guy to a bucket while we completed the task of hitching the camper to the car. Just then the kindly old manager of the campground drove up in his golf cart and we offered him the gift of this little bird who had so quickly and freely adopted me as his sole provider and protector.

The manager laughed as he explained that the chick was a woodcock hatchling, one of what was likely a large brood often found hiding in the grasses (without a real nest). A game bird that spends most of its time in the brush, the chicks are left to fend for themselves at a very early age. Apparently, this particular chick got lost in the crowd and “imprinted” on me as his mother when I eyeballed him on the roadway. He assured us that the bird would be fine as he gently lifted him from the bucket and deposited him in some nearby brush.

As I have thought about that little bird, I now believe ours was no chance encounter. On the eve of learning of the remarkable regression of my cancer, I think he was sent to remind me of some important truths.

Like that little creature, at one point helpless and vulnerable, I am to find my footing and follow my Creator – wherever He goes. Whenever He moves, I am to follow at His heels, acknowledging my utter dependence on Him. The strength of my attraction to Him is to be no less than the powerful instinct that little chick displayed when he imprinted on me. I want never to be far from Him and always “underfoot”.

More than that, I am reminded of God's promise to His people as He instructed them “Open your mouth wide and I will fill it.” (Psalm 81:10) The picture He is portraying is that of a mother hen eager to feed her chicks, whose scrawny necks and gaping beaks are craned upward to receive whatever morsel she may have to offer. Our covenant God is more than willing to fill us with good things. He is not a reticent benefactor or reluctant healer. Rather He takes joy in blessing us. He is, above all else, a giving God. (Psalm 37:23-26, Micah 7:18) I am glad!

My part is to become as humble and helpless as that baby bird.

Dan

Good News!

2008-04-22T09:53:00.003-04:00

Monday was a day of non-stop imaging studies (including bone scan, CT of neck, chest, abdomen & pelvis, and MRI of the brain), lab tests and doctor visits at UVA. The preliminary results* indicate a response to the gamma knife surgery and Interleukin-2 therapy that Dr Grosh, my oncologist, describes as “remarkable” and “unique”. His carefully chosen words belie a suppressed enthusiasm and perhaps even a little amazement, given the advanced progression of the cancer at the time of initiating therapy.

Reviewing the usual response rate of 15%, he acknowledges that most responders start out with a much more limited tumor burden than did I. Then he smiles broadly as he concedes the significant role of prayer. The nurse who witnessed my earlier rapid deterioration fights back the tears as she observes the dramatic improvement in both my physical status and the evidence of tumor regression. This is GOOD NEWS!

I said publicly at the beginning of this journey that God must be up to something. This story of one man’s remarkable recovery from a life-threatening and devastating disease is not just so I can live a few more years (although I am so grateful for each day He grants me). None of us will likely escape physical death.

Is it possible that perhaps He is giving us a glimpse at His strategic plan to redeem all of His creation? The truly good news is that indeed God is in the business of restoring that which was lost as a result of man’s rebellion. This is the heart of the gospel (Latin for good news) – i.e., that Christ came not simply to provide us an escape from judgment and a ticket to heaven some day, but also to ultimately restore that which God originally intended when He made you, me and the earth we inhabit.

Jesus said, “Behold, I am making all things new.” (Rev 21:5) And Paul writes that along with our redemption “the creation itself will be liberated from its bondage to decay and brought into the freedom and glory of the children of God.” (Rom 8:21). While it is clear that complete restoration of fallen creation awaits future events, I believe He intends for that restoration to begin here and now as you and I participate by faith in His mission.

My recent experience is a parable of God’s loving intent to re-establish His dominion over both the spiritual and physical dimensions in our lives. Your prayers of faith on my behalf have been effective in this regard and I am most grateful. My prayer for you is that you too will know the full measure of His power to “make all things new.”

Learning to live fully in the light of His good news,
Dan

* MRI of the brain showed no evidence of tumor. The multiple tumors of the lung, liver and spleen have either disappeared or regressed significantly and findings in the skeleton are consistent with an active healing process with the formation of new bone. Lab studies were essentially normal. We now await repeat studies in six weeks and if any cancer persists, anticipate another round of Interleukin-2 therapy in mid June.

Faith in Free Fall

2008-04-17T01:26:00.004-04:00

While on this journey that, by all expectations, should have landed me in hospice care by now, I have wrestled with the quality and nature of faith. For me it has been exhilarating and rejuvenating to discover once more the simplicity and power of child-like faith, the kind of faith that transformed my life in the first place.

As I have studied examples of faith in scripture, listened to many of you who have encouraged me to trust and persevere, and engaged my mind and spirit in the exercise of faith in the face of improbable odds, I have come to some conclusions I would like to share.

The first and foremost is that my faith needs to be directed toward a Person, not a phenomenon. In the famous “mountain-moving” passage, Jesus’ first instruction to His disciples is to “Have faith in God.” (Mark 11:22) My faith is to be directed not at moving the mountain, not at my healing, but at my Helper – the One who made me, loved me and sacrificed His own life to redeem me.

I have also noticed that there appears to be at least four sorts of faith:
· Filtered Faith – i.e., faith that must first pass through some grid that I create. If this can be said to be faith at all, it is the kind with strings attached. I will trust God only if He behaves in a certain way or meets certain expectations I have. Sometimes I am barely aware of creating a filter through which my faith must pass, as when I try to put God in a box, ensuring that He will not demand too much from me, make me uncomfortable, or disturb my sense of justice or rightness. The rich young ruler was interested in following Jesus until it meant giving up his riches. (Luke 18:18-23) I need to examine what filters I have interposed in the process of trusting God. I need to let God be God.

· Faltering Faith – i.e., that kind of faith that begins in earnest but is weakened by doubt, misgivings, or disbelief. The source of my doubt is usually circumstances that seem to contradict that for which I have trusted God, or it may originate from the tug of “reason”. The man whose son was exorcised and cured of seizures struggled in this way, saying “I do believe; help my unbelief.” (Mark 9:17-27) When my faith is thus weakened, I need to recognize the source of my doubts, refocus my confidence in the certainty of His words, and take courage in the manifest power of what He has already accomplished through His miraculous life, death, and resurrection.

· Forced Faith – i.e., the kind of faith that borders on presumption. Based on the premise that true faith must operate as if that for which I am trusting God has already (and actually) happened, I must never acknowledge any evidence to the contrary. This kind of faith assumes that God has accomplished that which He promised in the here and now and in a manner that I perceive most appropriate. Moses allowed himself this kind of faith when he struck the rock in the wilderness, with grave consequences to him personally. (Numbers 20:7-12) Rather I need to learn to rest in the quiet confidence that God will accomplish what He has promised in His time and in His way.

· Free-Falling Faith – this is the faith of a child falling confidently into the strong arms of her father. This is the kind of faith that, in spite of that which is uncertain, rests secure in the certainty of the loving intent of an all-powerful Heavenly Father. This is the quality of faith exemplified in Hebrews 11 in which many experienced great victory but others, “having gained approval through their faith, did not receive what was promised” (Hebrews 11:39) Ultimately, faith is not about getting something I need or desire, but rather about growing in a relationship with the One who knows my end from the beginning.

I’m still learning how to live this way and grateful for each day. I’m learning how marvelous His love is and how earnestly He desires to have an intimate relationship with each one of us.

Thanks for adding your faith to mine,
Dan

PS – We leave this weekend to return to Charlottesville for an all-day session of testing and scanning on Monday, April 21, to assess the current status of the melanoma. I am looking forward to delivering a good report on our return!

The Fog of Faith

2008-04-10T04:01:00.012-04:00

Photo by Tobin Rogers

It is very early in the morning as I peer out my window at the Chesapeake Bay. The scene is unusual as I notice the air is calm and the familiar lights of the Bay Bridge-Tunnel are no longer visible. I know in my mind that the 20-mile long monumental structure is still out there but a dense and eerie fog has rolled in, obscuring it from view.

An involuntary yawn rolls over me and I am alarmed by a sensation deep in my gut. I've felt that before... when my liver was palpably swollen with multiple cancerous growths. I test it by taking another deep breath, then simply lean forward and there it is once more. Further self examination reveals tenderness high in the epigastrium. Yesterday, there was no such discomfort.

Here I thought my opponent was on the ropes, when he comes bounding back to land a punch in the gut. So now I begin to doubt, and the confidence I had regarding complete healing begins to erode. I ruminate on the "what if"...

John the Baptist knew what I am talking about. (Luke 7:19-21) He has introduced the world to "The Lamb of God", he has heralded in no uncertain terms the coming of the Messiah in the person of this carpenter from Nazareth. Now he is in a dark dank dungeon, his head about to be separated from his body, when he sends a message to Jesus: "Are You the Expected One, or shall we look for someone else?" I can imagine his honest misgivings.

How does Jesus respond? Does He castigate him for entertaining such doubts? Without condemnation, He simply instructs John's disciples to "Go and report to John what you hear and see" and then sings his praises in superlative terms: "Among those born of women there is no one greater than John..." Jesus' response to doubt: "Remember my words; contemplate my miraculous deeds."

Interestingly, He does not rescue John from prison, nor lobby against his mistreatment, nor intervene at his beheading. He points him to evidence that his mission (and his faith) was valid and not misplaced. He honors John's honest doubts with assurance that he is beloved.

Frankly, I was expecting the fog... this fog of faith, this crisis of belief. If there were no fog, the faith would go untested. The pain in my gut is real. The contest is not yet over, but I will not be in terror of the mist. Whether the fog clears or not, I am confident the bridge is still there. I will listen to His remarkable words and take encouragement from His miraculous victory over death. And I am assured of His love.

May you be as well,
Dan

PS -- please see Linda's most recent blog entry on Courage and Surrender to get a very insightful perspective on faith from the standpoint of the spouse of a cancer patient.

The Body

2008-04-09T01:29:00.007-04:00

You’ll forgive me if I have had a little preoccupation with my body lately. Some remarkable things have been happening to it. Most visible to me (at least after every shower), is the conspicuous loss of muscle mass and subcutaneous fat. My body image has dramatically changed as I have shed more than 25 pounds and 2 waist sizes. During the peak of fluid retention, every area of my body felt water-logged, including legs, lungs, and even abdominal viscera. In addition I have gone through something akin to a reptilian molt cycle, shedding several layers of skin in an itchy snowstorm of flaky epidermis. The new me is something like a shaggy scare crow with elephant feet!

During the period when I was wracked with pain, I had hoped to somehow detach my conscious self from my body to ameliorate the pain without the side effects of medication. And while progressive muscle relaxation, isolation of the sources of pain, prayer and praise proved to be potent pain modification techniques, I found myself still attached to this body. It would not be shaken off – it stubbornly remained a fully integrated and intrusively present part of my conscious experience.

Some of you may say “Duh!” Others may wish to point me to the benefits of transcendental meditation. In the Judeo-Christian tradition, I have concluded that it is a good thing, while on this side of the grass, to stay attached to, and in tune with, one’s body. With or without the pain, fully ensconced within this physical frame, I am fully alive, grateful for the parts that are functioning well and attentive to those that are not. In fact, I am never more alive than when I feel the full assault of pain in my body.

It is no accident that a major and powerful metaphor for the community of believers in the New Testament is “the body of Christ”, implying that the church is a vibrant living organism rather than a cold, insensate organization. Birthed in faith, it is an inter-dependent fellowship in which each member moves in concert with one another in response to and fully attached to the Head.

I have been in AWE of the practical demonstration of this reality as I have been the beneficiary of the genuine love and concern and offers of help from literally hundreds of Christians both in my local church and those around the world. These, each members of the “body” and in tune with the spirit of Christ, have related to this member in such a real way that they have been driven to fast and pray for my healing and to join me in this battle against cancer. The authentic caring for one another has been both palpable and powerful (1Cor 12:25-26) and an evidence that HE is fully alive and still in the process of accomplishing His redemptive work in our world.

I am grateful for my body, frail as it is, but especially for His body. My prayer for each of you is that you will know and experience full health and abundant life within your body and all the benefits of being attached to His body.

Dan

Navel Battle

2008-04-06T13:47:00.008-04:00

I have had plenty of opportunity lately to contemplate my navel… and my bowel, my liver & spleen, my lungs, my heart, my lymph nodes, my muscles, my spine, my joints, my skin, even my brain. As a patient who is also a physician, I have envisioned the battle going on at the cellular level as Interleukin-2 has modified the mind-boggling complex immune system to induce an all-out attack on those renegade melanoma cells, clusters of cells and tumors spread throughout my body. And although I have reeled under the collateral damage inflicted during this battle, I have also experienced the humbling and spirit-soaring sensation of the cancer’s steady retreat and the gradual restoration of energy, stamina, appetite, and vitality.

I’ve had a ring-side seat in a contest where the odds against victory were enormous. And although the final round has not yet been fought, I wouldn’t give you two cents for the other guy. He’s going down. This body has been battered but making a come back.

These are the sort of contests our God specializes in… consider scrawny David against Goliath (1Sam 17:49), Moses trapped between hordes of chariots and the Red Sea (Ex 14:16), Jehoshaphat against an alliance of nations formed to wipe out the Jewish people (2Chron 20:21-22), Hezekiah against a decree of certain death (2Kings 20:1-6), and the list goes on. In each of these cases God intervened through the agency of something that man offered to Him in faith – a tiny pebble, an uplifted staff, a choir singing His praise, tears shed in a desperate prayer – and used it to accomplish the miraculous.

The battle going on in this body is being won through the agency of a biologic agent that God created and we humbly have accepted as a tool in His hands to overcome all odds and demonstrate His power to heal and restore. Now as I contemplate my navel, I am in awe of His love, mercy and grace.

Thank you for your part in the ultimate victory.

Dan

PS -- The picture above is not really my navel... Mine is lint-free!

From This Day Forward...

2008-04-04T11:14:00.004-04:00

“From this day forward… ‘til death do us part”
She could never have imagined what her words ordained…
Did she know what was in store when she first tried to shake off the thought “You’re going to marry that boy” as she eye balled an awkward towheaded scrawny guy trying to impress her with lame humor? Could she have anticipated the consequences?

The hardships of serving as sole bread-winner during those early years of training…
Teaching smelly third-graders, creating a home on a shoe-string, preparing meals, late-night lesson plans, surviving the flu, long lonely hours while her husband buried himself in medical books…
Nine full months of vomiting, walking an icy sidewalk while in labor, excruciating birth pangs, sleepless nights, colic, dirty diapers, living on borrowed money…
Adapting to inner city life, tracing helicopter spot lights overhead, enduring burglaries, fending off a vicious canine with babe in arms, surviving a house fire…
The rigors of residency, lungs laden with southern California smog, widow to the every third night call schedule, another nine months of vomiting, sore breasts, dirty diapers…
Suffering a brush with death due to meningitis, forced to recover quickly to save her small children from the care provided by a professionally distracted husband…
Then learning to live in the shadow of her husband’s new career, swallowing hard as he is adored and praised while she must be satisfied with his leftovers, aware of his warts…
Learning to serve as solo manager of household and family (and another “surprise” nine months of nausea), providing microwave meals to her late-night husband…
Silently adjusting to the unique compromises of the “doctor’s wife”, constantly sharing him with other women who bare their souls and their bodies in his presence…
Dramatic changes in her husband’s career uproot her from her dream home on the lake, familiar surroundings and lifetime friends; a subsequent series of biennial moves stretch her ability to cope with change…
The children grow, she launches a real estate career to support their college education, the nest empties…
Her roles as wife, matriarch, confidant, counselor, spiritual mentor, gourmet cook, perpetual hostess, never end and expand to enfold a larger church family…
She survives hurricanes, shares in the heartache of her daughters’ miscarriages, suffers the loss of a loving pet…
Then at the cusp of a promising season of ease, the news that her husband has malignant melanoma that is already rampant throughout body and brain…
While her future security is threatened, she becomes fulltime nurse and constant companion, endures more sleepless nights, witnesses his wasting while she coaxes him to eat, massaging swollen legs, reading to him for encouragement and comfort, all without complaint…

Could she ever have foreseen what those vows would bring her way, “for better, for worse, for richer, for poorer, in sickness and in health…”?
Yet her life of devotion and over-coming endurance flows not from a sense of obligation to a covenant – rather from a fathomless heart of self-giving love that this heart is still studying and aspiring to emulate. Her vows and her subsequent faithfulness flow from a capacity to love that astounds and confounds me, and inspires me to be more than I am.

My dearest Linda, this scrawny guy’s highest aim: to love you in kind
Dan