April 30, 2011 – Living Hope

Came across this little gem of an article today, in the online edition of Coping With Cancer magazine. It’s by Anne Lawton, an oncology nurse, and it’s about hope.

Hope, she's come to realize, is “the only word that matters” in her business.

Anne’s learned that, from the patients’ standpoint, the nature of hope changes over time. At first:

“People hope their doctor is good. They hope they make it through surgery, and they hope their cancer is treatable. They hope they can tolerate the chemotherapy.”

Later on in the cancer journey, many find themselves hoping for different things:

“They hope for a cure. They hope for a nice, full head of hair, eyelashes, and eyebrows. They hope the neuropathy and the other side effects go away. It's no longer just survival they hope for; they want their life back. They have a lot to do, and they hope the cancer never comes back.”

And if it should happen that the cancer does come back? Hope changes yet again:

“They hope for a life worth living, with few cancer-related side effects. They hope to live long enough for graduations, grandchildren, weddings, or that trip of a lifetime. They hope to complete their "bucket list.”

Finally, in some cases – though Anne doesn’t go there – when patients opt for hospice care, the hope is for freedom from pain, a clear mind, the opportunity to say farewell to loved ones and to know they’ll be provided for. A good death, in other words. When the time is right, no apologies are necessary for hoping for that.

Viewing hope as a continuum, can we really say it’s the same hope at the end of such a journey as at the beginning? I’d say yes, it is – although the hope has changed and matured. It’s grown, just as the patient has grown all through this troubling, painful, emotionally-taxing – and, yes, sometimes even spiritually-uplifting – journey.

1 Peter 1:3 celebrates how God “has given us a new birth into a living hope through the resurrection of Jesus Christ from the dead.” Living hope. I think that ol’ apostle was onto something.

By God’s generous grace, hope is alive. It grows and changes as we grow and change. Hallelujah!

An "N" of 1

I ran across this reflection today, in a Chicago Tribune article, from breast-cancer survivor Catherine Drew Gilpin Faust, President of Harvard University:

"I [remember] my meeting with my physician after the results of the exploratory biopsy. He was telling me what they found and what his thoughts were about what I ought to do.... I'm trying to digest this news, and I start peppering him with questions. What are the percentage chances of this? What are the percentage chances of that? And he answered all my questions, then he said, 'But just remember, whatever you have you have at 100 percent.' And that was such an important comment for me, because I realized, you know, whatever I learned, I was an 'N' of 1, and I had to figure out what that meant within this larger framework of all this information. I also thought it was an interesting thing to have a physician [who was] in a research medical center who was obviously a doctor doing clinical work as well as treatment to be able to remember that, that a patient is an 'N' of 1, not just one in a whole line of statistics. I've often thought of that as I've faced health challenges."

That's a rather perceptive comment on the part of her physician: "Whatever you have you have at 100 percent." Lots of us get stymied by statistics. We get preoccupied by the question, "What are my chances, Doc?" - and by whatever percentage answer the doctor may be so bold as to give us.

I don't fully understand the "N of 1" business. That's mathematics-speak, and I'm not so fluent in that language. I take it to mean, though, that each case is unique. There's no sense buying trouble by assuming someone else's cancer experience will turn out to be our own. Our experience is bound to be different in some way or another, because we're different.

I remember meeting with a friend not long ago, days before he succumbed to his cancer. He was recalling some of the treatment decisions he and his doctors had made along the way. Before deciding on some rather invasive surgery, the doctor had said he felt obliged to tell him that the chances of the surgery being successful were only about 5 percent.

"That's OK, Doc," my friend told him. "I figure I'm going to be in the 5 percent." (He wasn't, as it turned out, but he exercised his prerogative to think that way.)

That was his decision. Other patients in similar situations may decide differently, and I figure that's OK, it's their road they're traveling and no one else's. Yet, my friend chose to exercise his freedom of choice and not let statistics rule him.

He intuitively understood what President Faust is talking about. He knew he was an "N of 1."

The same would go for someone making the opposite choice, even if the odds looked very much better. I've known older patients who declined surgery or treatment when the chances of success were as high as 50 percent. The explanation went something like this: "I've lived long enough, and at my age, I can't expect to live much longer. I choose not to accept the harsh side effects and long recovery the doctors are talking about. Quality of life is important to me. I want to enjoy the days I have left."

According to "N of 1" thinking, that's OK, too.

Yes, there's a lot of science involved in the treatment of cancer. But there's also an art to it.

It's the art of living.

"If I take the wings of the morning
and settle at the farthest limits of the sea,
even there your hand shall lead me,
and your right hand shall hold me fast."

- Psalm 139:9-10

January 3, 2011 - Just the Facts

Today, I run across an updated fact sheet on Relapsed/ Refractory Follicular Lymphoma from the Lymphoma Research Foundation.

Although my initial staging was "B-cell, diffuse mixed large and small cell," the assumption Dr. Lerner and I have been making is that the relapsed cancer we've been monitoring for the past four and a half years is follicular lymphoma (a small-cell variety). It seems to be behaving in the indolent fashion typical of follicular lymphoma, anyway. After making its first appearance 8 months after my final round of R-CHOP chemotherapy, it's been snoozing.

We've still not been able to get an excisional biopsy of the relapsed cancer. The affected lymph nodes that keep showing up on my scans are not in an easy place to access surgically. There was one attempt to do so, with a swollen lymph node at the base of my neck. That brought me all the way to the operating table, but was called off at the last minute when the surgeon could no longer feel the affected lymph node.

Based on what I've learned about the disease, I'd say the fact sheet is a good one. It reflects some of the latest developments in research. It doesn't mention idiopathic vaccine treatments, though, that are still being researched.

The fact sheet communicates some wonderful news: that, thanks to the energetic researchers working in this field, there is now a range of possible treatments to choose from.

Here's another write-up, from the National Cancer Institute website. One line from that summary of recent research that catches my eye is this one: "For patients randomly assigned to watchful waiting, the median time to require therapy was 2 to 3 years and one-third of patients never required treatment with watchful waiting (half died of other causes and half remained progression-free after 10 years)."

I'm already past the 2 or 3 year median, and have a pretty good chance of landing in the one-third of patients that never require further treatment.

At such time as further treatment may be called for, I think I'd lean in the direction of radioimmu- notherapy (a single dose of Bexxar or Zevalin). Either of those medications seems to me to strike a good balance between effectiveness and quality-of-life issues. I'd rely heavily on Dr. Lerner's recommendation, of course, and would also go for a second opinion with Dr. Portlock, as I did before.

Stem-cell transplant is potentially the most effective treatment of all - but that's riskier, involves multiple side-effects and presupposes that a compatible donor could be found (we've already discovered that neither of my two brothers are a good match, so I'd have to depend on the national donor registry).

So, those are the facts (at this point in time).

December 2, 2010 – 5-Year Cancerversary

Hard to believe it’s been five years already, but it has. Five years ago today, I was diagnosed with cancer.

So much has happened since then. Those early days of uncertainty and fear, knowing that life would never be the same again. Telling the kids. Telling the church. Arranging for time off, to coincide with the predictable valleys in the chemo cycle. Persistent thoughts of dying, even though Drs. Lerner and Portlock and everyone else in the know kept assuring me I have one of those so-called "good" cancers - one that usually responds to treatment.

Once the treatment train had left the station, it picked up speed incredibly fast – or so it seemed. One day, I was given the news. The next, I was being wheeled into an operating room to get my port implanted.

My story didn’t unfold quite that fast, of course. That was just the way it felt to me. There was actually about a month between diagnosis and my first dose of chemo. I can’t recall much of what I did during that time. Once cancer enters your life, it’s hard to think of anything else. I felt numb.

Used to be, patients who reached their five year cancerversary without recurrence were considered cured. I still run into people who think that’s the case. In reality, cancer is such a multifaceted phenomenon that it’s impossible to generalize.

In my case, remission only lasted eight months – although, in truth, the cancer was probably there all along, lurking below the radar of those high-tech scans. “Watch and wait” was Dr. Lerner’s recommendation, confirmed by Dr. Portlock. Just sit tight. No need to shoot any arrows from the quiver until we absolutely have to. You have no symptoms. So, just sit tight. Trust us. This really is a sensible approach, even though it sounds like lunacy.

So, here I am today. Still watching and waiting. I’ve no idea how long it will be before the burgeoning population of cancer cells will reach umpteen million (or whatever the magic number is) and we’ll be discussing which treatment to try next.

Already, there are NHL treatments out there that weren’t available at the time I was diagnosed. Most aren’t quite ready for prime time, but it won’t be long now. Chances are, by the time we’ll be thinking seriously about treatment again, there will be some options available that weren’t even conceived at the time I was first setting out, five years ago.

There’s reason for hope, to be sure. Lord willing and the blood counts don’t rise, I’ll be here to observe quite a number of cancerversaries yet to come.

October 5, 2010 - This Is the Day

This excerpt from a Presbyterian News Service release tells the story of the death several days ago of singer/songwriter David M. Bailey:

"David M. Bailey, a singer/songwriter who moved audiences as much with his story of personal courage in the face of terminal cancer as with his music, succumbed to Glioblastoma on Oct. 2 in hospice care near his home in Charlottesville, Va. He was 44.

The son of Presbyterian missionaries, Kenneth E. and Ethel Bailey, Bailey was raised in Beirut, Lebanon. He spent some of his youth in Germany — where he learned to play the guitar and began writing songs — before returning to the United States....

In July 1996, he was diagnosed with Glioblastoma, a particularly virulent form of brain cancer. He then quit his corporate job and turned to songwriting and performing full-time.

'They told me I had six months. They were wrong,' Bailey said. 'Despite what you might hear, hope is a very real thing, and with every passing day, there are more and more reasons to hope.'

For 14 years he defied that diagnosis, writing and performing virtually non-stop, covering 45 states and 21 countries. His concerts were deeply personal, brutally honest accounts — rendered in a musical style that has been compared to James Taylor and Cat Stevens — of his struggles with his illness and his determination to make the most of whatever time God gave him.

His signature tune was 'One More Day.' The chorus goes:

'One more day when you can hold your children
One more day you can hold your wife
One more day when you can watch the grass grow
One more day when you can live your life.'"

It calls to mind the familiar scripture verse: "This is the day that the Lord has made; let us rejoice and be glad in it." (Psalm 118:24)

It's a lesson David taught us: how to live in the now, praising God for all good gifts. His music - and that lesson - will live on, through his recordings.

Prayers and good wishes go out to his family.

September 6, 2010 - His Music Lives On

In some earlier posts, I've written about a musician, David M. Bailey, who's been an inspiration to me. David's a brain cancer survivor who, after undergoing treatment the first time, reinvented his life as a singer-songwriter. Except for the times when he's been undergoing further treatment, he's been traveling the country, sharing his musical message of faith, hope and love in the midst of adversity.

Today, I received this e-mail, sent out to those on David's mailing list, presumably by a friend or relative:

"David was moved to hospice on Friday, September 3, following nearly a week in the hospital. He has been surrounded by family, friends and loving caregivers and has been pretty comfortable.

There’s a day to be filled with music
and a day for all melody to cease
there’s a day to arm yourself for battle
and a day to calm your heart for peace"

dmb 1996

Back in the 1990s, they told David his glioblastoma brain tumor was supposed to have killed him in 6 months. He beat the odds, obviously, by a considerable amount of time. Now that it appears his final days are upon him, let's remember him in prayer, asking God for comfort and expressing gratitude for his remarkable witness of faith.

I regret that I never got to hear David perform live. I do cherish those of his CDs I own, though, and I know many others do, too.

There may be a day for "all melody to cease," but it will only be for the briefest time. David's music will live on.

"Well done, good and faithful servant."

August 3, 2010 - Clinging to the Tail of Possibility

On vacation in the Adirondacks, I read a remarkable article from the August 2 New Yorker magazine. I was tipped to the article by my brother, Jim – though I later learned from Claire that members of her hospice team have been passing it amongst themselves, causing lively discussion in their weekly staff meeting.

I think “Letting Go: What should medicine do when it can’t save your life,” by Atul Gawande, may set off at least as much debate as his June 1, 2009 article, “The Cost Conundrum: What a Texas town can teach us about health care.” (which I discussed in a July 20, 2009 blog entry, “Where Not to Get Sick.”)

Gawande is a general surgeon who practices at Boston’s Brigham and Women’s Hospital, and who teaches at Harvard Medical School. He’s operated on a lot of cancer patients. Some benefitted mightily from his expertise, and others’ last days would likely have been more tolerable without the invasive procedures. Yet, hindsight is always 20/02, and ahead of time it’s always a tough call.

It’s his physician’s perspective that leads Dr. Gawande to question the lack of agreed-upon procedures for end-of-life decision-making in America. For a country with some of the most advanced medical care in the world, our practices in this area are remarkably haphazard.

Gawande points out that the financial costs of successful cancer treatment can typically be graphed as a bell curve: there’s a steep climb from the time of diagnosis to a sort of plateau, as very expensive scans and treatments are deployed. Then, there’s a drop-off in costs as the patient recovers. In the case of patients whose treatment is unsuccessful, the frequent result is half a bell curve. We throw some very big money at solving problems that are – statistically speaking – unlikely to be solved, sending the line of the graph soaring upwards. Because it’s a human life at stake, doctors typically follow the lead of patients and their families, ordering such last-ditch treatments if that’s what they want. In many such cases, the patient dies anyway, often after many days, or even weeks, of intensive care. If the ICU stay is long, those days can end up costing as much as – sometimes even more than – the cancer treatment itself.

These are agonizingly difficult decisions, some of the toughest in medicine. When to pursue extraordinary, experimental treatment? When to throw in the towel and admit that maintaining a reasonable quality of life for the patient whose health is in a tailspin is more important than the increasingly quixotic search for a cure?

Gawande remarks that nearly all categories of dying patients and their families – with one exception – are ill-prepared to wrestle with such complex, emotionally fraught decisions. When, as too often happens, everyone’s energies are single-mindedly fixed on the search for a cure, doctors fail to raise the what-if question of death at all. It seems to them premature. Yet, when that likelihood suddenly looms large, and quick decisions have to be made about such interventions as feeding tubes and ventilators, patients and families scramble to wrap their minds around the new state of affairs. Unable to achieve unanimity, a great many families fall back to the default position, which is to press on relentlessly in search of a cure – even though the doctors may know, full well, that chances of extending such patients’ lives by more than a few weeks are slim.

Granted – as Claire reminds me, based on her hospice ministry experience – there are some cultural and ethnic traditions that inform this process. Orthodox Jews, for example, typically make decisions within a moral framework that nearly always opts for treatment, no matter what the chances of success. African-Americans and Hispanics, bearing cultural memories of parents and grandparents to whom the system too often denied advanced care, are more likely than others to press for it, even against medical advice.

Referring to science writer Stephen Jay Gould’s oft-quoted 1985 essay, “The Median Isn’t the Message” – in which Gould tells the story of how, upon learning he had mesothelioma, he decided to take his place among the tiny percentage of patients who survive, and did – Gawande speaks of the “tail” of the statistical curve. That’s the narrow portion that stretches a good distance into the future, and includes the fortunate few patients who manage to beat the odds and survive a deadly cancer. It’s good to remember, when faced with such stories, that the statistical median is just that – a median. Always, there are some who do better than clinical expectations, others worse. An awful lot of people, though, are trying to ride the tail of statistical probability – far more than will end up actually being on it. Gawande writes:

“I think of Gould and his essay every time I have a patient with a terminal illness. There is almost always a long tail of possibility, however thin. What’s wrong with looking for it? Nothing, it seems to me, unless it means we have failed to prepare for the outcome that’s vastly more probable. The problem is that we’ve built our medical system and our culture around the long tail. We’ve created a multimillion-dollar edifice for dispensing the medical equivalent of lottery tickets – and have only the rudiments of a system to prepare patients for the near-certainty that those tickets will not win. Hope is not a plan, but hope is our plan.”

I mentioned above that Gawande identifies one category of patients and their families who are better prepared for end-of-life decision-making. He’s talking about those who have received hospice services. Alone among the specialties of modern medicine, the hospice movement is not afraid to face death head-on and talk about it with patients – well before the anxious moment in the little family waiting room just off the ICU, when a doctor (or, just as likely, a critical-care nurse) sits down on the vinyl-covered furniture with the family and informs them a decision needs to be made about discontinuing life-support.

Patients who have signed on for hospice care have already decided they’re not going to cling to the slim tail of possibility any longer. They’re going to strive for the best quality of life they can construct in the here-and-now, placing their hope somewhere other than joining the tiny percentage who defy medical expectations.

I can’t begin to recall the number of grieving family members I’ve spoken with who told me they wished their loved one had gone on hospice earlier. Claire confirms for me, from her experience working with bereaved family members, that this is a nearly-universal comment. Curiously, the vast majority of hospice patients live no longer than a few days. That’s not because hospice care is somehow bad for them – quite the opposite. It’s because, by the time most patients make this decision, they’re already so far gone that hospice functions as little more than a transfer-station between the hospital and the funeral home.

It’s not meant to be that way. The hospice ideal is for weeks or even months of active, but mostly palliative, treatment. The hope is that the hospice experience will provide a gracious space for patients and their families to work through the full range of issues – medical, emotional, spiritual – they need to deal with at the end of life. Surprising as it may seem, there are even some patients who go on hospice for a time, then go off it – their improvement has been such that the “six months or less to live” criterion of hospice admission no longer applies to them.

So, signing up for hospice care is not giving up, as some fear. Far from it.

The key to a higher quality of life for the dying, Gawande points out, is communication. One of the things hospice team members do exceptionally well is to encourage patients and their families to share their thoughts and feelings about dying, then to listen attentively and respectfully to what they say. Next, they help them think through what goals they have for the rest of their lives, and do whatever they can to help them attain them. “You don’t ask, ‘What do you want when you are dying?’” explains one expert. “You ask, ‘If time becomes short, what is most important to you?’” Gawande observes:

“People die only once. They have no experience to draw upon. They need doctors and nurses who are willing to have the hard discussions and to say what they have seen, who will help people to prepare for what is to come – and to escape a warehoused oblivion that few really want.”

The asking of such questions was meant to be a central part of the new health-care legislation recently passed by Congress, but politics blocked it. The Tea Party mob ignorantly slapped the label “death panels”on the funding for these vital conversations, then pressured Congressional leaders to excise it from the bill – which they did, so as not to lose the bigger battle. This is a terrible miscarriage of justice for the dying: the sacrifice of a proven care approach that offered real promise for enhanced quality of life.

When the only goal worth talking about is to beat the disease, Gawande concludes – no matter what that may mean in terms of unproven, experimental treatments – the statistical outcome in nearly every case is going to be disastrous. Which general would you rather have leading the troops into battle? George Armstrong Custer or Robert E. Lee?

“Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knew how to fight for territory when he could and how to surrender when you couldn’t, someone who understood that the damage is greatest if all you do is fight to the bitter end.”

This article is a good read, for anyone whose life has been touched by cancer – either their own or that of a loved one.

July 13, 2010 – Bendamustine Rising

Thanks to Betsy DeParry of the Patients- Against-Lymphoma group on Facebook, for posting excerpts from an article about Bendamustine in the treatment of indolent NHL.

Bendamustine (trade names Treanda, Ribomustin) is a chemotherapy agent that’s been around for decades. It was developed in East Germany during the Cold War, which is perhaps why it was slow to catch on in the U.S. and Western Europe. It’s receiving a lot of attention these days as a treatment option for NHL, either in conjunction with Rituxan or on its own.

The full article is found in the issue of the American Journal of Health-System Pharmacy (2010; 67: 713-723). Authors are Anjana Elefante, Pharm.D., B.Sc.Phm., Clinical Pharmacist, Department of Pharmacy; and Myron S. Czuczman, M.D., Chief, Lymphoma/Myeloma Service, Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY.

Here are some excerpts from Betsy’s excerpts:

“Bendamustine is an alkylating agent that has a unique, multifaceted mechanism of action. Compared with other alkylators, bendamustine produces more-extensive and long-lasting DNA damage. Bendamustine also inhibits cell-cycle checkpoints, leading to mitotic catastrophe and apoptosis.”

Sounds pretty dire, eh? Well, the “DNA damage... mitotic catastrophe and apoptosis” is actually referring to cancer cells, so that’s not such a bad thing.

“Bendamustine is approved for the treatment of CLL and for indolent B-cell NHL that has progressed during or within 6 months of treatment with rituximab or a rituximab-based regimen. In Phase II and III trials in patients with indolent NHL and CLL, bendamustine has demonstrated response rates of 67–84% as a single agent and median durations of response of 7–21 months. Additional clinical trials are examining bendamustine as a single agent and in combination therapy for the treatment of hematologic malignancies and solid tumors. Adverse events associated with bendamustine are typically mild to moderate and can usually be managed with supportive care.”

Sounds pretty encouraging.

“NHL is the most common hematologic cancer and the sixth most common cancer in the United States, with an estimated 65,980 new cases and 19,500 deaths occurring in 2009. The histological subtypes of NHL fall into two major classes: indolent (slow growing) and aggressive (fast growing). Lymphomas with indolent histologies include B-cell follicular lymphoma, marginal zone lymphoma, small lymphocytic lymphoma, and cutaneous T-cell lymphoma. Lymphomas with aggressive histologies include diffuse large B-cell lymphoma, lymphoblastic lymphoma, and Burkitt lymphoma. Mantle cell lymphoma is classified as an aggressive lymphoma but possesses characteristics of both indolent and aggressive disease.

Treatment of indolent NHL depends on the histology and stage of the disease. Because indolent NHL is often asymptomatic in early stages, it is generally advanced (stage III or IV) at the time of detection. Treatment for indolent NHL typically involves a combination of chemotherapy and immunotherapy, such as cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus rituximab. Alternatively, other chemotherapy regimens may be used in combination with rituximab, including cyclophosphamide, vincristine, and prednisone and fludarabine-based regimens. Radiation and bone marrow or stem cell transplantation are treatment options in selected patients.

Indolent NHL is generally incurable. Patients typically follow a course of remission and relapse requiring multiple rounds of therapy with rituximab, chemotherapy, or both. Eventually, most patients become refractory to chemotherapeutic agents, rituximab, or both.[20] Therefore, new treatments are needed to prolong the duration of remission and overall survival for patients with relapsed and refractory indolent NHL.

Bendamustine is useful in that it shows little cross-reactivity with common first-line indolent NHL therapies. It is effective in patients refractory to rituximab, chemotherapy, or both...”

What about side effects?

“Bendamustine is generally well tolerated. The most common serious (grade 3 or 4) adverse events are hematologic in nature. Gastrointestinal events are also commonly observed but are usually mild to moderate in severity. Adverse events can often be managed with supportive therapies or dosage modifications.”

Translation: like other chemotherapy agents, it can throw your blood counts out of whack and it can make you vomit. Yet, they say these side effects can be pretty much kept under control with other drugs.

In the oncologist’s lexicon, “well tolerated” doesn’t mean you feel good. It means the doctors don’t usually have to cancel the chemotherapy because it’s making you so sick you can’t stand it.

In any event, this is another bit of encouraging news for me, for whenever it should happen that “watch and wait” ends and “go and do something” begins.

It’s good to have more than one arrow in the quiver, to be sure.

June 6, 2010 - Our Most Elusive Possession

Great column a couple days ago, from New York Times columnist Nicholas Kristof. Instead of gallivanting around Africa or someplace crusading against injustice, as he often is, his June 4th column is very personal.

That’s because he’s had a cancer scare: diagnosis of a kidney tumor 90% likely to be malignant, then surgery – and then, against the odds, a biopsy revealing he’s in the lucky 10%. The tumor was benign.

Still – and understandably – Nicholas had a scare, that led him (as cancer has led so many of us) to examine his life a little more closely. Here’s the result:

“This is trite but also so, so true: A brush with mortality turns out to be the best way to appreciate how blue the sky is, how sensuous grass feels underfoot, how melodious kids' voices are. Even teenagers' voices. A friend and colleague, David E. Sanger, who conquered cancer a decade ago, says, "No matter how bad a day you're having, you say to yourself: `I've had worse....’

I don't mean to wax lyrical about the joys of tumors. But maybe the most elusive possession is contentment with what we have. There's no better way to attain that than a glimpse of our mortality.”

Preach it, brother!

A few verses from the First Letter to Timothy come to mind:

"Of course, there is great gain in godliness combined with contentment; for we brought nothing into the world, so that we can take nothing out of it; but if we have food and clothing, we will be content with these."

- 1 Timothy 6:6-8

June 3, 2010 - Touched By an Angel

“During my illness, I had the presence of an angel that came and visited me...” This is a remarkable video, from the Livestrong website. The speaker is Matthews Brown, a leukemia survivor. It’s just under 4 minutes long, so it won’t take too much time away from whatever else you’re doing.



In the course of my ministry, I’ve heard some remarkable stories of spiritual experiences. I’ve never seen an angel, myself (at least, not the supernatural variety). Based on what I’ve heard from others, though, I’d say Matthews’ experience is unusual, but not as unusual as all that. Things like this happen to people more often than you may think.

We’ve all heard the truism, “God never gives us more than we can handle.” I found that to be true of my own cancer experience. From the square marked “Go,” it looks like it's a long way around the spiritual Monopoly board, but you do find yourself “passing Go” from time to time and collecting $200.

Let us give thanks for unsolicited, grace-filled experiences, through which we learn what remarkable spiritual resources are available to us, and how deeply we are loved!

If you’re a cancer survivor, how has the spiritual side of the experience been for you?

April 20, 2010 - Hope IS a Miracle

This past Sunday, I preached on the story from the Acts of the Apostles about the raising of Tabitha. It’s one of a small number of biblical passages that recount not merely a healing, but the raising of a person from the dead. Although the Apostle Peter performs the miracle, it’s clear he sees it as the work of the risen Christ.

Preparing my sermon, I was struck by a rather unusual detail. Before performing his miracle, Peter cleared the room. Why was that?

I figure it was because Peter was none too sure of his ability to do anything helpful. This isn’t a sick woman, he thought to himself. It’s a dead woman. Dead is dead (unless, of course, you’re talking about Jesus’ resurrection, but that’s a story for another day).

You’d think, had Peter been more confident, he’d have practiced a little showmanship. You know, given the miracle some pizzazz. Wow the crowd.

But, no. Peter will have none of that.

When in doubt, pray. Having no other option, that’s what Peter decides to do. Falling to his knees, he offers fervent prayers to God: to get him out of this situation, to do something to help this grieving community – and, yes, even this poor, deceased woman, wherever in heaven or earth her soul may be.

After praying, Peter turns to Tabitha and simply says, “Tabitha, get up.” She does! The crowd outside is astounded when they see their beloved Tabitha, alive again. It just may be, though, that the most befuddled person in the village that day is Peter himself.

Many of us have been there before, in situations that seemed hopeless. It’s a story repeated time and again, in hospital corridors and family waiting rooms, as a doctor says to an anxious family, ”I’m sorry, there’s nothing more we can do.”

We’ve all heard of deathbed miracles, of course, but we also know these are few and far between. I told the folks in church on Sunday that the one miracle I have seen, time and time again, is how hope – that most persistent of Christian character traits – has a way of arising out of even the darkest of situations.

Sometimes that hope is as simple as being able to persevere, to get up and face another day without falling apart emotionally. Sometimes it’s the ability to let go and die with dignity. Sometimes it’s reconciliation with a loved one that we never imagined could have happened.

On his knees, alone in that small room except for the corpse stretched out on the bed, Peter may have feared his hope-reservoir had run dry. But then, when he least expects it, God breaks in once again, revealing new possibilities.

Such hope differs from what usually passes for hope in our culture – at least, as the word is used in everyday speech. Eugene Peterson points out that what a lot of people call hope is in reality something different. It’s wishing, not hoping – and wishing and hoping are not the same thing:

“Wishing is something all of us do. It projects what we want or think we need into the future. Just because we wish for something good or holy we think it qualifies as hope. It does not. Wishing extends our egos into the future; hope grows out of our faith. Hope is oriented toward what God is doing; wishing is oriented toward what we are doing.”

Peterson goes on to say that we can picture wishing as though it were a line coming out from us with an arrow on the end, pointing into the future, pointing toward that thing we most want to possess.

Hope is just the opposite. It’s a line that comes from God out of the future, with its arrow pointing towards us:

“Hope means being surprised, because we don’t know what is best for us or how our lives are going to be completed. To cultivate hope is to suppress wishing – to refuse to fantasize about what we want, but live in anticipation of what God is going to do next.” [The Contemplative Pastor: Returning to the Art of Spiritual Direction (Eerdmans, 1993)]

To me, that’s a beautiful and liberating insight. Yes, we all want certain things in this life. Yet, our wishes and God’s intentions for us may not always coincide. At times, God may have an entirely different plan – which means that, for us, the way of freedom and peace lies not in somehow pulling God around to our way of thinking, but rather letting go and trusting God to be in control.

April 5, 2010 - An Idle Tale?

Preparing my Easter sermon based on Luke 24:1-12, I was struck by the reaction of the male disciples to Mary Magdalene and the other women who brought them news of the empty tomb and of the angel’s message: “Why do you seek the living among the dead? He is not here, but has risen.”

Their first response was to consider it “an idle tale.”

“Idle tale” translates an uncommon Greek word whose meaning is “nonsense” or “delusional.” If the women’s breathless announcement is in fact the first Christian proclamation, then it means we preachers started out with a score of 0 and 1 from the get-go.

Which is no big surprise – because the resurrection isn’t exactly an easy truth to absorb. In contradicts one of the most foundational of human experiences: that dead is dead, and there’s no coming back.

I thought about that sort of thing a lot when I was feeling ill from my chemo treatments. What if the treatments were unsuccessful and I was soon going to die, I asked myself? What if, someday soon, I was going to shut my eyes not only to this world, but to everything else? What if this life, this consciousness, that is me would suddenly blink out of existence? What would have been the point of it all?

My mind danced with that bleak idea from time to time, but didn’t invite it home. I kept returning to the truths of my faith, and especially this truth that is the resurrection.

I told the folks in our church yesterday that this whole “idle tale” response is actually a sort of backhanded testimony to the truth of the resurrection. If you were to set out to make up a story about a man being raised from the dead, would you be so quick to admit that some of the people who most wanted to believe it to be true rejected it, at first?

Similarly, if you were going to go out and make up a story about a man being raised from the dead, would you include details that made you, yourself look like a clueless doubter – as was the case with Peter? If you were interested in spreading a made-up story in the intensely male-dominated Roman world, would you make women the first witnesses of the resurrection – women, who were considered, back then, to be second-class citizens, whose testimony the male-dominated society considered unreliable?

Of course not. There are an embarrassing number of loose ends connected with the Easter narrative. Four different gospels tell the story, as well as certain passages from the letters of Paul – all of them differing from the others in one detail or another. If your purpose were to make the whole thing up, you would have managed your sources a little better.

The result is that it’s impossible to put the various Gospel accounts together in a single narrative – just as it would be if there had been multiple witnesses recording their impression of a single, dramatic incident, each from a different angle.

The resurrection is jarring and unexpected. The great Reformed theologian Karl Barth says somewhere that it’s “not a natural ‘therefore’ but a miraculous ‘nevertheless.’” Archbishop of Canterbury Rowan Williams – a distinguished theologian as well as senior leader of the worldwide Anglican Communion – likens it to the Big Bang. When we celebrate Easter, he writes, “we are really standing in the middle of a second ‘Big Bang,’ a tumultuous surge of divine energy as fiery and intense as the very beginning of the universe.” (Tokens of Trust, p. 95)

These are outrageous claims – but in their very confusion, contradiction and sheer outrageousness, they’re true to life, in an odd way. Such a mind-bending, paradigm-busting event could never be encapsulated in a tight, little spin-controlled story.

With all those lights of inquiry shining upon it from so many different angles, the resurrection is like a person moving across a room, lit up by a strobe light. You know how that looks: a person lit by a strobe seems to move in a series of jerky, disjointed snapshots, rather than the seamless, smooth motion of movie film. Under such lighting, you can get a general sense of what’s happening, what various events are taking place – but not how they flow from one to the next.

There are still significant gaps in our understanding of the resurrection – and always will be, this side of heaven. That doesn’t mean it’s not true. It means it’s a truth too big, too complex, too wonderful for us to fully comprehend.

March 8, 2010 - Hope on the Horizon

The big medical conference each year in the field of lymphoma treatment is ASH – the American Society of Hematology. This year’s conference, I understand, contained good news for people like me with indolent lymphomas – particularly follicular lymphoma. Check out this video interview with Dr. Dr. Ephraim Hochberg, Director of Clinical Lymphoma Research at Dana-Farber/Massachusetts General Hospital:

An Expert's Perspective on the Latest in NHL from Patient Powerr on Vimeo.

It’s encouraging to hear this lymphoma researcher speak of turning the corner and heading into the home stretch on some long-term research efforts. The longer my lymphoma remains sluggish, the longer my watch-and-wait treatment approach continues, the more likely it becomes that some new medicine will be available when I need it.

January 9, 2010 - Everything In Its Time

Today I run across an inspiring story on National Public Radio: the saga of one Seun Adebiyi, who has dreams of becoming – I am not making this up – Nigeria’s first contender in the Winter Olympics one-man sledding event called skeleton.

Seun (who pronounces his name “Shawn” when here in the United States) missed making the Nigerian Olympic swim team by a tenth of a second. So, he turned his attention to winter sports, setting his sights on the skeleton event. A student at Yale Law School, who was brought to this country as a child by his immigrant mother, Seun sounds very American. Yet, he does have Nigerian citizenship – which means that, as he trains 5 hours a day on the skeleton track outside Salt Lake City, he’s possibly the only Nigerian aspiring to represent his country in this event.

Seun’s circum- stances sound like those of the Jamaican bobsled team that was the subject of the 1993 Disney film, Cool Runnings – with one exception: he’s just been diagnosed with cancer.

And not just any cancer. Seun’s got two aggressive forms: stem-cell leukemia and lymphoblastic lymphoma.

The most promising treatment for him is an allogeneic stem-cell transplant, one requiring closely-matched cells from a living donor. (It’s the type of stem-cell transplant I’d need to have, should it ever come to that.)

Seun’s problem is that people of African descent aren’t well-represented in the donor registry – and for patients who are actually from Africa, the outlook is even bleaker. Still, that didn’t stop Seun and his mother from traveling to Nigeria recently to set up that country’s first bone-marrow registry.

Seun’s best chance lies in a cord-blood transplant, which he’s going to be having soon at Memorial Sloan-Kettering Cancer Center in New York City.

The online audio of NPR’s story on him is well worth the 5 minutes of your time it will take to listen to it. As NPR correspondent Mike Pesca summarizes Seun’s description of his situation, “Living with cancer is like living an extremely concentrated, extremely potent version of life.”

And how. It’s an apt description of what it feels like to go through the cancer-treatment experience.

Then, Pesca relates another thing Seun said to him: “There is a time for all-out effort, and then there’s a time for surrender.” Seun’s approach is to pull out all the stops during the weeks leading up to his transplant, training for that ordeal with the same intense effort he’s brought to his Olympic bid. Yet, he knows there will come a time when he can do nothing but trust the expertise of the Memorial Sloan-Kettering doctors and the technological wizardry they have at their disposal.

Truly, there is a time for everything in life – as I reminded a family just yesterday, at the funeral of their 104-year-old matriarch. At the funeral home, I read these beloved words from the third chapter of Ecclesiastes:

“For everything there is a season, and a time for every matter under heaven:
a time to be born, and a time to die;
a time to plant, and a time to pluck up what is planted;
a time to kill, and a time to heal;
a time to break down, and a time to build up;
a time to weep, and a time to laugh;
a time to mourn, and a time to dance...” (Ecclesiastes 3:1-4)

On an on the ancient poem goes, weaving its way in and out of all life’s adventures. Its words sound a very different note at the funeral of a centenarian than they do on the eve of a twentysomething’s risky stem-cell transplant. Yet, the best any of us can do, regardless of our circumstances, is to trust that, in God’s providence, there is indeed a time for everything.

I’m beginning to learn, myself, that this has much less to do with the duration of life than with its quality. A long, serene run of 104 years is a beautiful thing. But then, so is a young man’s 80-mile-an-hour dash down an icy hillside in search of Olympic gold.

Either way, I believe the Lord is standing by, to guide and to bless.

December 15, 2009 - Expectancy

This time of year, we Christians find ourselves – if we can stop our frenetic holiday preparations for a moment and be still – in the season of expectant waiting known as Advent.

It’s a tough season for most folks to wrap their minds around. Anyone who pays attention to the liturgical year feels oddly suspended between the now and the not-yet. This isn’t helped by the fact that the recommended biblical texts for Advent are of two distinct kinds. On the one hand, there are apocalyptic passages that warn of the final judgment and the return of Christ to judge the earth. On the other, we’re handed kinder, gentler stories like the Annunciation: the angel Gabriel’s visit to Mary, announcing Jesus’ impending birth.

It can be tough, during Advent, to figure out what, exactly, we’re meant to be waiting for. Are we waiting for Christ to come crashing in and judge this mad, mixed-up world for what it is? Or, are we imaginatively placing ourselves into the Christmas story, waiting for him to be born in Bethlehem again in our hearts and minds?

I have a new appreciation for the ambiguities of waiting, ever since entering my extended, watch-and-wait treatment mode. Of course, unlike the waiting associated with Advent, the thing I’m waiting for is not good. I’d just as soon have my lymphoma remain in couch-potato mode as long as possible. Yet, I do also live my life attuned to subtle signs that could develop.

Every three months or so, I go for another scan: a moistened finger held up to test the wind. Today’s the day: another CT scan at Ocean Medical Center.

Unlike the classic prayer of Christians, “Even so, Lord Jesus, quickly come,” I’m very happy to keep on waiting.

Obama Family Lights National Christmas Tree of Hope

From Denny: This is one of the "lighter" moments of a Presidency... :)

Visit msnbc.com for breaking news, world news, and news about the economy

September 25, 2009 - A Survivor's Testimony: Never Give Up

Here’s a video containing the testimony of Dr. Samuel Gruber, a longtime lymphoma survivor:

The Survivors Club - Doc Gruber - Lymphoma Survivor

There’s a lesson for us here about the importance of being our own advocate: of keeping up with the medical literature (as best we can, anyway), and talking with our doctors about the things we read.

There’s also a comforting truth in what Dr. Gruber says about the rapid pace of research in lymphoma treatments. The longer we hang on, the more new treatments will become available.

Reason for hope!

September 15, 2009 - Natural Born Killers

They’re calling it a “master switch” that can turn on the immune system’s ability to fight cancer.

Maybe that description’s overblown, or maybe it’s not, but British scientists have surely made a breakthrough by identifying a gene that stimulates the body’s production of NK, or “natural killer” cells, a type of white blood cell.

From an article describing the new development:

“Infusions of natural killer cells donated from volunteers are already given to some cancer patients. However, because they come from another person, they are not a complete match and so do not work as well.

The discovery of the 'master-switch' – a gene called E4bp4 that causes ‘blank’ stem cells to turn into natural killer cells – paves the way for a drug to boost the patient’s own stock of the cells.

(Natural killer cells, highlighted in red, in the spleen of a virus-infected mouse. To find where this picture came from, click here.)

Researcher Hugh Brady, of Imperial College London, said: ‘The natural killer cell was like the Cinderella of the white blood cells, we didn’t know very much about them.

We knew a little bit about how they work but we didn’t know where they came from.

We stumbled on this when researching childhood leukaemia. We thought the gene was involved in that. It turns it probably isn’t but it has a very important role in the immune system.

With a bit of serendipity we have found the key to the pathway that gives rise to natural killer cells.’”

A lot more research is needed, says Dr. Brady, before any medication that stimulates natural-killer cell growth is ready for prime time. Scientists aren’t even 100% sure that NK cells always have a beneficial function:

“Now finally, we will be able to find out if the progression of these diseases is impeded or aided by the removal of natural killer cells from the equation.

This will solve the often-debated question of whether NK cells are always the ‘good guys’, or if in certain circumstances they cause more harm than good.’”

Good guys? Bad guys? It’s a cell-eat-cell world out there in the microscopic regions of the human body, it would seem.

Let’s just hope the scientists are onto a whole lot of new good guys with this one.

July 22, 2009 - Dulanermin

Paging through an old copy of Cure magazine (a publication for cancer survivors), I notice a headline in a full-page ad: “Have you been diagnosed with Follicular Non-Hodgkin’s Lymphoma (NHL) following previous rituximab therapy?”

“That’s me,” says I to myself.

Reading on, I discover it’s an ad for a clinical trial being conducted by Genentech – the drug company that brought us rituximab (Rituxan). They’re also the people who flew Claire and me to Las Vegas a few years ago, to give a little motivational talk to their sales force.

Down at the bottom is a serial number I can use at the clinicaltrials.gov website, to find out more about this study.

I visit that site, key in the number, and come up with a page describing a study of a new investigational drug called Apo2L/TRAIL – trade name, Dulanermin.

It’s a Phase II clinical trial – which means it’s still in the early stages of investigation. As of now, the trial is also fully subscribed: which may be just as well, since I’m not sure I’d want to risk the side effects of a Phase II trial when I’m still in a watch-and-wait mode and feeling good.

It’s interesting to read about this new drug, all the same, because it could be in my future.

Here’s the scoop, from an Amgen press release of a couple months ago (the Amgen pharmaceutical company is conducting this research in partnership with Genentech). Dulanermin is one of a family of “highly selective therapies to induce cancer cell death.” Well, who can argue with that?

“In cancer,” the article continues, “the dysregulation of apoptosis is critical in the development and survival of tumors.” I know, from previous reading, that apoptosis is cell death – the normal tendency of cells to die according to a genetically-preset timetable, only to be replaced by new cells. In cancer cells, the apoptosis switch is turned off, allowing them to continue to grow and wreak havoc in the body. “The dysregulation of apoptosis” is inscrutable medical jargon for “throwing a wrench into the genetic machinery that would otherwise cause cells to die when they reach the end of their natural lifespan.”

Dulanermin – if it fulfills the hopes of the pharmaceutical researchers – would yank that monkey-wrench back out of the machinery, so cells would continue to die according to their normal timetable and would never morph into cancer cells.

The article defines dulanermin as “a recombinant human protein that targets death receptors 4 and 5.” Sounds like something out of Star Wars: “Luke, your mission is to fly your X-fighter along the surface of the Death Star and take out death receptors 4 and 5. May the Force be with you.”

Go for it, Luke.

Is this the next Rituxan? Impossible to say. Clinical trials like this are being conducted all the time, mostly below the radar of non-medical types like me. Every once in a while, a full-page ad jumps out at us, a reminder that this valuable work is going on.

Kudos to the researchers for keeping up with this sort of thing.

Who knows? If this one ever makes it to a Phase III trial, maybe they can sign me up.

April 26, 2009 - Libation

Responding to my April 20th entry, a reader named Christine writes:

“My cancer has progressed to the point where I am on my last leg of this journey. I was wondering if you could direct me to what the Bible says about facing death. In essence, what are your thoughts on dealing with grief and sorrow? My journey has been four years and as I approach the end, surprisingly I find that my emotional and spiritual struggle have not diminished but intensified.”

Wow. I had to think about that one for several days, before attempting an answer. It’s not that I’ve never had to supply this sort of counsel before; it’s just that Christine poses her question so bluntly. Most people whom I visit in their final days raise the question obliquely, if at all. Whether they ask the question directly or not, I typically respond by sharing some of the great scripture passages that witness to God’s reliable presence.

For example, there’s Psalm 139, in which the psalmist imagines himself journeying to the very edges of the known world, only to find God still there beside him:

“If I take the wings of the morning and settle at the farthest limits of the sea,
even there your hand shall lead me, and your right hand shall hold me fast.” (Psalm 139:9-10)

For those who struggle with fatigue, cancer-related or otherwise, there’s always Isaiah 40:28-31, that promises:

“Those who wait for the Lord shall renew their strength, they shall mount up with wings like eagles, they shall run and not be weary, they shall walk and not faint.” (Isaiah 40:31)

Those of a philosophical bent may find some comfort in the timeless contemplations of “the Teacher” who wrote the book of Ecclesiastes. In these verses – immortalized for my generation by Pete Seeger’s folk anthem, “Turn, Turn, Turn” – he recalls how, in life, there is a time for everything, even a time to die:

“For everything there is a season, and a time for every matter under heaven:
a time to be born, and a time to die;
a time to plant, and a time to pluck up what is planted;
a time to kill, and a time to heal;
a time to break down, and a time to build up;
a time to weep, and a time to laugh;
a time to mourn, and a time to dance...” (Ecclesiastes 3:1-4)

THE BYRDS - Turn ! Turn ! Turn !
by danadi33

Certain psalms, like Psalm 69, pull no punches when it comes to voicing the honest cry of human anguish. Perhaps, Christine, you’ve felt like this in recent days:

“Save me, O God, for the waters have come up to my neck.
I sink in deep mire, where there is no foothold; I have come into deep waters, and the flood sweeps over me.
I am weary with my crying; my throat is parched. My eyes grow dim with waiting for my God.” (Psalm 69:1-3)

So, what does it mean to speak of God saving us, in a time of serious illness – perhaps even illness unto death? Some may be tempted to blithely drop a pollyanna catch-phrase, like “Expect a miracle!” Yet, this is unrealistic, maybe even deceptive. We all know miraculous reversals like this – the sort that cause doctors to scratch their heads and say, “I don’t know what happened, there’s no medical explanation for the way that tumor just disappeared” – are rare indeed. Besides, even in those fortunate cases where a terminal illness reverses itself, the patient is still going to die of something, eventually. No, that sort of miracle merely buys a little time, that’s all.

No, the only ultimate consolation comes from promises such as Jesus’ words in John 11:25-26:
“I am the resurrection and the life. Those who believe in me, even though they die, will live, and everyone who lives and believes in me will never die.”

Seeking to describe the life to come, Paul resorts to a variety of metaphors. In 2 Corinthians 4:16-5:1, he likens this present life of ours to a tent – a temporary dwelling, slated to be replaced by something more permanent:

“So we do not lose heart. Even though our outer nature is wasting away, our inner nature is being renewed day by day. For this slight momentary affliction is preparing us for an eternal weight of glory beyond all measure, because we look not at what can be seen but at what cannot be seen; for what can be seen is temporary, but what cannot be seen is eternal. For we know that if the earthly tent we live in is destroyed, we have a building from God, a house not made with hands, eternal in the heavens.”

In 1 Corinthians 15, Paul uses a different, organic metaphor, that of a seed planted in the ground – one I’ve cited just upstream, in my April 14th entry.

At the end of the day, though, all these are just metaphors. Such poetry, lofty as it may be, captures the emotion, but inevitably falls short on details – for, who can chart with certainty lands no human has visited, save on a one-way journey? (Jesus, of course, being the notable exception, and he wasn’t talking – not on that subject, anyway.)

In the course of my pastoral ministry, I’ve spoken with more than a few people who’ve had near-death experiences. There are more of these people around than you may think. Most are pretty quiet about it. They’re hesitant to speak of such experiences, for fear of being misunderstood – but, if you give them a chance, they’ll speak in hushed tones, eyes brimming with tears, of bright visions no words can capture. I feel incredibly privileged to have heard a few of these firsthand testimonies.

We can’t make too much of these subjective experiences, though. They’re elusive, dreamlike – merely the shadow of a suggestion of what the next life may be like. Still, I take some comfort, personally, in observing that, whatever these soul-travelers experienced, there was no terror in it: only a sense of comfort and welcome and peace.

Reflecting on his own impending death, the pseudonymous author of 2 Timothy speaks of his hopes and fears using the common coin of his own culture. He portrays his life as a “libation” – a sacred offering of wine, to be poured out onto the ground, as the Greeks and Roman were wont to do:

“As for me, I am already being poured out as a libation, and the time of my departure has come. I have fought the good fight, I have finished the race, I have kept the faith. From now on there is reserved for me the crown of righteousness, which the Lord, the righteous judge, will give to me on that day, and not only to me but also to all who have longed for his appearing.” (2 Timothy 4:6-8)

Back in my chemo days – when I was feeling sick as a dog and far from certain Dr. Lerner’s promises of a likely remission would ever come to pass – I wondered if my own life was turning out to be just such a libation.

It’s a powerful image, even though we have to work a bit to translate it into 21st Century terms. Then, as now, it defies reason to upend a perfectly good cup of wine and pour its contents out upon the ground: but sometimes that primitive calculus is the only response that makes sense in face of the absurdity we call “death.”

Surely, we protest, there’s got to be a better way. Surely, God – if the Bible’s descriptions of divine power are true – has the ability to arrange things in some other way for us.

The hard fact is, God chooses not to exercise that ability. Sooner or later, our life-force is bound to run out in rivulets, like that libation-offering, poured upon some unimaginably ancient block of stone.

A libation. That’s what we’ll be, one day.

Poured out. An offering to a God who (we can only hope) is, as the scriptures teach, “gracious and merciful, slow to anger and abounding in steadfast love” (Psalm 145:8).

If that is so, we will one day be able to affirm, with Paul, that:

“...in all these things we are more than conquerors through him who loved us. For I am convinced that neither death, nor life, nor angels, nor rulers, nor things present, nor things to come, nor powers, nor height, nor depth, nor anything else in all creation, will be able to separate us from the love of God in Christ Jesus our Lord.” (Romans 8:38-39)

That’s the sort of thing I’d be inclined to say to you, Christine, by way of summarizing the Christian witness about life and death.

On a more personal note, I’d also like to encourage you to try to step back and get some perspective on the faith-struggles you’re going through right now. A certain amount of angst is to be expected. Strong emotion is understandably part of the experience. Cancer stinks. So does an early death. There’s no way to sugar-coat such hard realities.

I wouldn’t be at all surprised if you’re feeling angry, as well. Just read through some of those biblical psalms of lament, and you’ll quickly realize you’re not alone in this.

Doubt can be part of the psychic landscape, as well. (Remember, even Jesus went through his own crisis of faith in the Garden of Gethsemane.) You may worry, at times, that you’re losing touch with all the beliefs you once held dear, but that’s simply what dying is like. It’s profoundly disturbing and disorienting (Hollywood cliches about falling gently back on the pillow notwithstanding).

There’s nothing more disturbing nor disorienting in all of life. If - as the Christian faith teaches - death is actually rebirth into a new way of living, then wouldn’t it be reasonable to expect a bit of birth trauma? Just try to keep your eyes upon Jesus, the one whom the letter to the Hebrews calls “the pioneer and perfecter of our faith” (Hebrews 12:2).

May God be with you.