Targeted Therapy

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

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

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

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

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

Stepping Out

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

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

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

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

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

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

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

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

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

Grateful for each step of the journey,
Dr Dan

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

Christian: Fickled Fan or Faithful Follower?

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

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

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

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

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

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

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

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

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

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

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

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

Grateful for all your concern and prayers,
Dr Dan

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

FAITH: Fire Escape vs. Fireproof

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

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

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

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

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

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

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

Fireproof Faith

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

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

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

Trusting you too will choose a fireproof faith,
Dr Dan

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

My Bucket List

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


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

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

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

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

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

Interestingly enough, even Jesus appears to have had similar contemplations as He faced the end of His life here on earth: "...who for the joy set before Him endured the cross, despising the shame, and has sat down at the right hand of the throne of God." (Heb 12:2) I am pretty sure that the joy set before Him had little to do with the ability to fly or walk through walls or any such fantasy adventure, but rather the ultimate unbroken and intimate relationship with both His Father and with those He came to redeem (you and me!)

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

Grateful for each day,
Dr Dan

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