Sufficient Grace

Is the glass half empty or half full?

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

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

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

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

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

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

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

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

Dr Dan

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

Identity Lost (& Found)

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

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?

"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!

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!

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

"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’”