Declaration of Dependence

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

"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

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.