March 12, 2012 – Job’s Comforters

One of the worries people often have when a friend is diagnosed with cancer, or experiences some other misfortune, centers around the question, “What do I say?”

Lots of energy is burned up fruitlessly trying to answer this question.  Even if an answer emerges, it can very easily turn out to be the wrong one.  Stories abound about unintentionally hurtful things well-meaning friends and family members have said to the newly diagnosed.

Yet, that’s no reason to stay away.  Friends need friends more than ever in times of trouble.

Here’s a little poem, “Comforters,” that gets to the heart of this matter.  It was written by a cancer survivor.  I can’t copy it here, because it’s under copyright, but you can easily read it by clicking on this link.

This calls to mind the ancient story of Job, the faithful man of God who’s suddenly afflicted by a perfect storm of suffering, including bad health.  Job receives a delegation of visitors, friends of his who are trying to comfort  him.  Each one presents an answer to the “Why?” question Job’s been asking himself ever since his troubles began.  Yet, each would-be helper fails miserably.

The first friend, Eliphaz the Temanite, comments philosophically on the inscrutable ways of God.  How hard it can be – he explains to his poverty-stricken friend, who has just lost his entire family and whose once-healthy body is covered with painful boils – for us to account for many of the things that happen, both good and bad!  There is no one who is without fault, so therefore it makes sense that no one is spared some measure of suffering in this life.  Besides, it could be that God – who’s noted for extending punishment for one person’s wrongdoings to the generations that follow – is simply collecting on some old debt.  The important thing is to keep returning to God, trusting in the Lord to bring healing and restoration in time:

“For misery does not come from the earth, nor does trouble sprout from the ground; but human beings are born to trouble just as sparks fly upward.   As for me, I would seek God, and to God I would commit my cause.  He does great things and unsearchable, marvelous things without number.... How happy is the one whom God reproves; therefore do not despise the discipline of the Almighty. For he wounds, but he binds up; he strikes, but his hands heal.”

[Job 3:6-9, 17-18]

The second visitor, Bildad the Shuhite, tells Job he’s just sure his afflictions must be his own fault, that he’s sinned against the Almighty in some way.  If he’s diligent about repentance, though, God just may have mercy and take away Job’s afflictions:

“Does God pervert justice? Or does the Almighty pervert the right? If your children sinned against him, he delivered them into the power of their transgression. If you will seek God and make supplication to the Almighty, if you are pure and upright, surely then he will rouse himself for you and restore to you your rightful place.”

[Job 8:3-6]

The third caller is Zophar the Naamathit.  He chides his friend Job for being so certain he’s blameless and undeserving of his terrible fate:

“Can you find out the deep things of God? Can you find out the limit of the Almighty? It is higher than heaven – what can you do? Deeper than Sheol – what can you know? Its measure is longer than the earth, and broader than the sea. If he passes through, and imprisons, and assembles for judgment, who can hinder him?”

[Job 11:7-10]

Yet, Zophar’s counsel is not without kindness.  He, too, urges Job to consider his burden of suffering as God’s correction, and repent:

“If you direct your heart rightly, you will stretch out your hands toward him. If iniquity is in your hand, put it far away, and do not let wickedness reside in your tents. Surely then you will lift up your face without blemish; you will be secure, and will not fear. You will forget your misery; you will remember it as waters that have passed away. And your life will be brighter than the noonday; its darkness will be like the morning. And you will have confidence, because there is hope; you will be protected and take your rest in safety. You will lie down, and no one will make you afraid; many will entreat your favor. But the eyes of the wicked will fail; all way of escape will be lost to them, and their hope is to breathe their last.” 

[13-20]

Commenting on the story of Job in his classic book, When Bad Things Happen to Good People, Rabbi Harold Kushner writes:

“Under the impact of his multiple tragedies, Job was trying desperately to hold on to his self-respect, his sense of himself as a good person. The last thing in the world he needed was to be told that what he was doing was wrong. Whether the criticisms were about the way he was grieving or about what he had done to deserve such a fate, their effect was that of rubbing salt into an open wound.


Job needed sympathy more than he needed advice, even good and correct advice. There would be a time and place for that later. He needed compassion, the sense that others felt this pain with him, more than he needed learned theological explanations about God's ways. He needed psychical comforting, people sharing their strength with him, holding him rather than scolding him.


He needed friends who would permit him to be angry, to cry and to scream, much more than he needed friends who would urge him to be an example of patience and piety to others. He needed people to say, ‘Yes, what happened to you is terrible and makes no sense,’ not people who would say, ‘Cheer up, Job, it's not all that bad.’ And that was where he friends let him down.”

[Harold Kushner, When Bad Things Happen to Good People

(Random House, 2001), pp. 120-121.]

Let us strive not to let one another down as well, when friends come upon hard times.  Just be there.  Listen.  Share the pain.  Offer to fill the water-glass or run some small errand.

You’re not there to fix it.  You’re just there.  And that’s what friends are for.

March 2, 2012 - A 12-Year Old Philosopher

Just a brief post today, to share something remarkable I just saw online.  National Public Radio’s “Morning Edition” show featured a story about a 12-year-old cancer survivor, Grant Coursey.  After multiple surgeries for neuroblastoma, a tumor wrapped around his spinal cord that was impeding his breathing, he’s considered cancer-free.

Grant was very young when he was receiving his treatment, but the experience has evidently made a big impression on him.  I’ve written upstream about how cancer monkeys with the stages of human development, often giving survivors perspectives on life that are more commonly held by much older people.  This certainly seems true of young Grant, as this exchange with his mother, Jennifer, demonstrates:

"I always kind of hoped that you didn't really remember much," Jennifer says, "but the scary stuff really stuck with you."

"Yeah. You know, I've got big scars all over my back from getting cut open," Grant says. "Whenever that kind of starts to twinge a little bit, like if I touch it wrong or something like that, it just kind of reminds me I'm lucky."

"Yeah," Jennifer says.

"You know, life is really good," Grant says. "And there's this saying that says if you've been close to death, you understand life more. And sometimes I think of that, and I think, you know, if this had never happened to me, I never would have understood how much life means, kinda. You know? What if I had died? I'd never have this amazing life."

"That's right," his mother says.

"That's crazy to think about," Grant says.

"It is crazy to think about," Jennifer says. "Well, Grant, I'm sure glad you got well."

"Yeah."

"I sure love you. And I hope you're picking up that I'm so proud of you," Jennifer says. "I'm so proud of you."

"I pick that up a lot, honestly," Grant says.

"Good."

Cancer’s a stern teacher, but an effective one.  Blessings to Grant, and to so many other kids like him who have had this tough but life-changing experience!

February 13, 2012 – Link to My Past

I’ve been recovering at home for the past week, following last Monday’s surgery for benign enlargement of the prostate.  Everything went well, as predicted, and I’m on track for a full recovery.  Tomorrow I’ll venture back over to the church office, and see how things go.

Today, though, I’m thinking about an object that came into my possession recently.  A few days before my surgery, I did a Google search for the name of my father’s old business, a high-end men’s clothing store called Wilton & Woolley.  It was located on Main Street in my hometown of Toms River, New Jersey.  (The “Woolley” name belonged to a silent partner, a haberdasher from another town who had fronted him some money to start the place.)  My father, Carlos E. Wilton, Sr., operated the store for a decade or so in the late 1950s and early 1960s, before getting out of the business in the nick of time, just before Toms River’s once-vibrant Main Street was bled dry by a new shopping mall on what was then the outskirts of town.  Dad used to tell my brother Jim and me that Wilton & Woolley was our family business, that we all owned it together and that one day maybe we kids would have it for our own.

I can’t imagine being a retail merchant, myself – even if an old-fashioned haberdashery like his could have survived to be a going concern today.  Yet, that’s the way my father used to think when we were kids, and who were we to disabuse him of the idea?

I was looking the other day for a photo of the Wilton & Woolley storefront to put on my Facebook timeline, and never did find one.  Google led me, instead, to an eBay page, where somebody was selling an old printer’s block with the Wilton & Woolley name on it.

It was a strange feeling to run across that item.  It felt vaguely wrong to see it there, like it was a piece of my family heritage on the auction block.

In fact, this hunk of wood and metal had never been owned by anyone in my family.  Back before the days of computer graphics, print shops would create metal plates they would insert into a rack beside similar blocks, along with a whole lot of the moveable type that was then their stock in trade.  Then, they would slather ink onto the whole assemblage, and run as many copies of the letterhead, handbill or brochure as might be needed.  Once the job was finished, printers would save blocks like this one to reuse in the future.  In fact, on the bottom of the piece of wood is the name and address of the long-shuttered print shop – evidently one my father patronized for advertising.  The store name appears in the jaunty, 1950s typeface he always used, the closest thing Wilton & Woolley ever had to a logo.

I felt like I had to have the thing, without knowing exactly why.  I’ve got no place to display it, no real use for it.  God knows we’ve already got way too much bric-a-brac in the house.  Yet, for 15 bucks I figured I could afford to free it from the auction block, so I did.

It arrived in the mail just after I got home from the hospital.  With its wood-block backing, it’s about 5 inches long. It’s hefty, substantial, reassuring to hold.  The wood still bears an ancient smear of black ink. To me, it feels like a link to my past.

I’ve got a few small items associated with my father, but not much.  Sadly, his life contracted in his later years, as he fell victim to years of substance abuse – alcohol and tobacco, the drugs of choice of his generation – and what was, very likely, undiagnosed clinical depression. After selling the store, he hit the road as a traveling salesman, first selling school library books for major publishers and, later, law books.  When he was motivated, Dad won all the sales awards.  Yet, inevitably, he’d grow tired of the grind.  He would slack off on the sales calls, get into some kind of argument with the bosses and they would part ways.   He jumped from one publisher to another in that way, every few years.  After he and my mother divorced, he switched to selling life insurance.  Abruptly, Dad moved clear across the country to the Central Valley of California, where he’d grown up, intending to start afresh in the life-insurance business out there.

My father ended his working life as a night clerk in a convenience store called the “Git-n-Go” (photo is not of his store).  By that stage of his life, he amiably settled for enough money to pay the rent and keep him in booze and cigarettes.  It didn’t seem to faze him when the store was robbed, twice, on his shift – once at knifepoint, giving him a little scar on his neck where the knife-tip had broken the skin.  He never even told us when these things happened.  We learned about them only years later.  Not a big one for communication, was my Dad.

After he almost died from a dissecting aortic aneurysm – that led to an air-ambulance helicopter flight to Stanford University Hospital for herculean surgery to give him a new aorta – he moved back east to Newton, Massachusetts, to an apartment down the street from my brother, Jim.  Dad had finally quit smoking by then – a month in ICU on a ventilator will do that to you – and there he lived the last year or so of his life, subsisting on two or three six-packs of Budweiser a day, because he figured it was better for him than the Canadian whiskey (and, later, vodka) he’d formerly favored.

Nothing of what my father did in his working life left any sort of legacy.  He always had the misfortune to find himself on the downward slope of major economic change, but did manage to bail out in time before the wave crashed.  First, the 1960s blue-jeans era reduced the market for “Mad Men” tailored suits and fedora hats.  Then, the advent of the shopping mall did away with most Main Street family businesses of any kind.  Dad did well in the book business for a few years, but was fortunate to jump ship before the Internet changed that world forever.  By then, I suppose he was feeling burned-out as a salesman, but it was all he knew how to do.  Life insurance was never a good fit for him.

I’ve only seen Arthur Miller’s “Death of a Salesman” once in my life, but I know I could never bring myself to do so again.  That grim drama’s just too close to home.

The printer’s block in my hand feels like a sort of legacy.  It’s solid and substantial, concrete evidence of a nearly-forgotten family business my father hoped and dreamed would outlast him.  Maybe he imagined that, in time, he would buy Mr. Woolley out, and he’d rename it “Wilton & Sons.”

At age 55, I’ve reached the stage of life where I’m thinking about my own legacy.  A couple of cancer experiences have pressed such ruminations upon me a bit earlier than most, and this recent surgery and slow recovery have reminded me once again that, as that spoilsport Isaiah puts it, “all people are grass, their constancy is like the flower of the field.” (Isaiah 40:6)

Myself included, of course.  Parish ministry is notorious, even in the best of times, for its abstract, hard-to-categorize results.  In this profoundly confused era, we who pastor mainline Protestant churches are all too often reminded that we’re serving a shrinking, aging market.  I’ve grown quite tired of reading articles in professional journals that include the familiar Cassandra-words: “If present trends continue...”

What will my children hold in their hands, one day, that reminds them of me, of my years of toil in the vineyard of the Lord?  A Bible, a calling card, a tarnished home-communion set, a disintegrating copy of one of the pulpit-helps books I’ve written?  As my books go out of print, much of what I’ve created, in the form of writings, lives now on the Internet: sermons once voiced in their time, but which now persist only as ghostly electrical impulses, mere droplets in a vast and ever-expanding sea.  As the church continues to lurch through rapid societal change, I wonder: will my grandchildren yet unborn even know what a sermon is – homely, spoken words of testimony, unadorned by electronic finery?

Ultimately, I suppose, my legacy is my children – as my brothers Jim, Dave and I are my father’s legacy.  After more than 20 years of ministry in one church, and 6 years before that of guiding others into ministry as a seminary assistant dean and admissions director, there’s also another group of people that are my legacy.  Those, of course, are the other lives out there I’ve touched – and, I hope on my best days – influenced for the better.  Sure, a great many of the babies I’ve held in my arms at the baptismal font have drifted away from the church in adulthood, but not all.  In a time of convalescence such as I’m now going through, the many cards, emails and other caring communications I’ve received remind me that what I do continues to be appreciated.

“O that my words were written down! O that they were inscribed in a book! O that with an iron pen and with lead they were engraved on a rock forever!  For I know that my Redeemer lives, and that at the last he will stand upon the earth...” (Job 19:23-25).  For any of us, our true legacy is no block of wood with lead type fixed upon it.  It’s flesh and blood.  As it was for my father, it will one day be true for me.  Soli Deo Gloria.

February 8, 2012 – A Visiting Nurse Comes to Call

My surgery went well, or so the doctor tells me.  I was discharged from the hospital after one night, with a catheter, and am now recuperating at home.

This morning I had a call from a visiting nurse.  She was here about 45 minutes, all told, and spent all but about 5 minutes of that time taking medical history and filling out legal-consent and billing forms. She took a quick glance at the catheter bag and told me what I can expect in the hours to come. A different nurse will come tomorrow and, if all continues to go well, remove the catheter.

OK, I understand this was an intake visit for a new patient, and the home-nursing agency is now on call 24/7 between now and tomorrow morning in case I should experience any difficulty – but, still, the ratio of time devoted to administration as compared to actual medical treatment seems more than a little skewed.

I thought it was a total waste of time going over my medical history and dictating my medications list to the visiting nurse, when this information could easily have been forwarded by my doctor or the hospital.

As pleasant and – I assume – as competent as the nurse was, the visit was a case study of all that’s wrong with American medicine today.  It was a tale of compartmentalized agencies, separated by a wall of bureaucratic HIPAA regulations, failing to communicate essential information with each other....  An experienced R.N., spending just shy of 90% of her time on paperwork that’s more important to the attorneys and the accountants than it is to the patient....  An insurance company, bailing on their responsibility to cover another couple of days in the hospital, sending a medically-unqualified patient home to maintain his own catheter.

Thankfully, I’ve experienced no complications or problems so far.  But it could easily have been otherwise.

What is wrong with this picture?

February 4, 2012 – More Surgery, Non-Cancer-Related

On Monday, I’ll be going into Ocean Medical Center for a long-postponed operation.  I could have had this done as long ago as last summer, but the surgery to remove my thyroid was more urgent, so this went onto the back burner.

For quite some time, I’ve been dealing with BPH, or benign prostatic hyperplasia – “benign enlargement of the prostate,” in everyday terms.  The word “benign” in that description needs to be emphasized: my PSA tests have all been normal, and there’s no reason to suspect any sort of malignancy.

The surgery I’ll be having is known as TURP, which stands for “transurethral resection of the prostate.”  According to my urologist, Dr. Daniel Burzon, it’s “the gold standard” in treating this condition: a long track record of success and a low likelihood of enduring side effects, even if the recovery from the surgery is a bit longer that some of the other alternatives.   I’ll spare you the somewhat grisly details of this procedure, Gentle Reader, but if you know how to access this blog, you’re probably very capable of doing a Wikipedia or Google search if you’re so inclined – and if you don’t mind some of the cringeworthy descriptions you’re likely to come across.

I’m supposed to show up at the hospital at 6:00 am on Monday for the surgery, and will stay there at least one night. I’m expected to be out of commission for the next week or so, and the doctor has told me I shouldn’t plan to lead worship on the following Sunday, because he doesn’t want me on my feet that long.

Since this is a cancer blog, I don’t expect to have much more to write about this experience in this space, beyond what I’m saying now.  Besides, given the nature of the surgery, I’m less inclined to comment about it publicly in any setting.  Because of my cancer history, though – and because of the fact that, to some minds, the words “prostate” and “cancer” seem to go together like peanut butter and jelly – I feel the need to get the information out there that I’m having this done, and that it’s in no way related to any malignancy.

January 8, 2012 – Lessons from the Cancer Wilderness

Reading the Gospel of Mark in preparation for today’s Baptism of the Lord sermon, I come across a rather jarring transition.  It’s not actually in Mark 1:4-11 - today’s recommended passage from the Revised Common Lectionary - but it ought to be.  The Lectionary editors took the coward’s way out and chopped the last two verses off Mark’s account of Jesus’ baptism.

They end their scripture reading with the heavenly voice saying of Jesus, “You are my Son, the beloved, with you I am well pleased.” 

Now, isn’t that special?  A heavenly benediction.

But that’s not where Mark ends his story.  Two more verses come along, before he wraps it up:

“And the Spirit immediately drove him out into the wilderness. He was in the wilderness forty days, tempted by Satan; and he was with the wild beasts; and the angels waited on him.” [Mark 1:12-13]

Wow.  So much for the warm, fuzzy feelings.  So much for God’s benevolent benediction. Let the story spin out to its natural conclusion, and suddenly God doesn’t look like such a kind, benevolent deity.  No sooner does God bless Jesus, the son, then God gives him a good kick in the pants (or the robe, as the case may be).

I am not making this up.  It’s right there in the original Greek.  Well, maybe it doesn’t say “kick,” but Mark says the Spirit “drove him out into the wilderness.”  The Greek word means “to throw out, to drive out, to expel.”  It’s the same verb Mark uses in chapter 11, verse 15, as he tells how Jesus “entered the temple and began to drive out those who were selling.”

Seems God is a Tough-Love sort of parent.

So, what is this wilderness, into which God is so determined to push Jesus?  It is, in the Jewish imagination, the place where the deepest of spiritual encounters happen.  Moses’ epiphany by the bush that’s burning, yet is not consumed...  The giving of the 10 Commandments on Mount Horeb (or Mount Sinai, depending on which story you read)... Elijah hiding himself in a cleft of the rock, surviving earthquake, wind and fire to hear that “still, small voice” – or that “sound of sheer silence” – that tells him everything’s going to be all right...  John the Baptist’s favored abode, where he clothes himself in animal skins and scarfs down locusts and wild honey for breakfast.  All these take place in the wilderness.

At its very root, Jewish spirituality – and, therefore, Christian spirituality as well – is a desert spirituality.  The Hebrew refugees who walk away from the fleshpots of Egypt, straight through the Red Sea waters, aren’t exactly going on vacation.  God opens the way for them through the waters not so they can move to a gated community and take it easy, after all those years of hard labor building pyramids.  No, God casts them into a daily struggle for survival, where they’ve got to learn the skills they need to live, or die trying.

With all that background, it’s hardly a surprise that, when God gives Jesus a blessing and sends him on his way, God sends him first into the wilderness.   It’s Jesus’ experience of testing, of trial.  It’s Messiah boot camp.  The angels are there to serve him, but I expect their role is more like Marine Corps drill instructors than pillow-plumping flight attendants.

Cancer’s a wilderness experience.  Its diagnosis can bring on disorientation, grief, depression, anger, anxiety, and a whole host of other grim responses.

The poet T.S. Eliot is aware that there are all sorts of deserts in life, not all of them having to do with sandy wastes and scorching sun. In his poem, “Choruses from the Rock,” Eliot has this to say:

You neglect and belittle the desert.
The desert is not remote in southern tropics
The desert is not only around the corner,
The desert is squeezed in the tube-train next to you,
The desert is in the heart of your brother.
[T.S. Eliot, The Complete Poems and Plays, 1909-1950 (1952: Houghton Mifflin Harcourt), p. 98.]

Sometimes the desert is in the cancer survivor’s heart as well.

I find it significant that Jesus’ experience of being “driven out” into the wilderness takes place immediately after his baptism.  What appears to us a jarring transition actually makes perfect sense.

Think of what baptism really means.  We baptized a baby in church this morning.  Cutest little girl you ever did see.  The congregation loved the way she looked adoringly and trustingly up at my face as I washed her forehead with water carefully warmed so as to spare her any unnecessary discomfort.  But that’s not the essence of baptism. It’s not the heirloom gown passed down in the family for generations, the party afterwards with the sherbet punch and finger-sandwiches and potato salad.  No, baptism is made of sterner stuff.

As practiced by the first generation of Christians – before there was a second generation to grow up in the faith – baptism often took place standing waist-deep in a swift-flowing river, and the person performing the baptism pushed you down under the water and held you there, just long enough that you felt short of breath and feared you might drown.  Then, just as all seemed lost, you were lifted up into fresh, breathable air, gasping and sputtering, thoroughly relieved you were not going to die at all, that day.

When parents bring infants for baptism, they do it because they wish the very best for their children.  The very last thing on their minds is a life filled with pain and suffering.  As parents, their natural inclination is to shield and protect their children from anything so harsh and threatening as that.

But, do you know what?  Life is filled with pain and suffering.  Like cancer.  As it says in the book of Job, “human beings are born to trouble just as sparks fly upward” [5:7].  Baptism offers no guarantee whatsoever that the life ahead of this little child, or any other, is going to be more comfortable, or more protected, than the life of an unbaptized baby.

What we in the church offer children, in baptism – and in the years of Christian Education that follow – is not so much a soft, cuddly blanket as a wilderness survival kit.  For surely, this human life of ours can seem at times very much like a wilderness sojourn.  To get through it intact, we need to be trained in the ways of the woods, and know where to look to find food and shelter.

Henry David Thoreau, who retreated to his famous cabin beside Walden Pond because he “wished to live deliberately, to front only the essential facts of life,” speaks of something he calls “the tonic of wildness.”  A tonic, of course – in nineteenth-century parlance – is a medicine, or more like what we’d call today a nutritional supplement:

“We need the tonic of wildness, to wade sometimes in marshes where the bittern and the meadow-hen lurk, and hear the booming of the snipe; to smell the whispering sedge where only the wilder and more solitary fowl builds her nest, and the mink crawls with its belly close to the ground.  We can never have enough of nature.  We must be refreshed by the sight of inexhaustible vigor, vast and titanic features, the sea-coast with its wrecks, the wilderness with its living and its decaying trees, the thunder cloud, and the rain which lasts weeks and produces freshets. We need to witness our own limits transgressed, and some life pasturing freely where we never wander.” [Walden (Houghton Mifflin, 1854), p. 257.]

The poet Wendell Berry expresses a similar vision of wild places in these lovely lines, in a poem called “The Peace of Wild Things”:

When despair for the world grows in me
and I wake in the night at the least sound
in fear of what my life and my children’s lives may be,
I go and lie down where the wood drake
rests in his beauty on the water, and the great heron feeds.
I come into the peace of wild things
who do not tax their lives with forethought
of grief. I come into the presence of still water.
And I feel above me the day-blind stars
waiting with their light. For a time
I rest in the grace of the world, and am free.
[The Selected Poems of Wendell Berry (ReadHowYouWant.com, 2010), p. 36.]

I like to think that, when the Spirit drove Jesus into the wilderness, it was – at least in part – so he could have experiences such as these.  Yes, Jesus’ sojourn in the wilderness is traditionally depicted as a time of temptation, a struggle with Satan.  Yet, I also think it had to include its moments of peace and stillness, of contemplation and wonder, of living close to the earth and close to God.

I find it comforting, as I reflect on my cancer experience, to recall the therapeutic value of my baptism.  As with Jesus’ own trip to the river, it was followed eventually by an experience of being driven into the wilderness.  The wilderness is a fearsome place, to be sure.  But it can also be a fearsomely beautiful place.

And therein lies today’s lesson.

December 30, 2011 - More on Out-of-Reach Zevalin

Dr. Vance Esler, oncologist and blogger, posted a comment on my last entry that's worth my cutting and pasting it here:

"Carl, it is an oversimplification to say that oncologists don't refer patients for Bexxar or Zevalin because it isn't in their own personal arsenal. In fact, a fair amount of the treatment is done by the medical oncologists.

Every day medical oncologists take financial risks. We buy and administer expensive drugs, hoping that the insurance carriers will reimburse us enough to cover the costs. We are used to this.

But Bexxar and Zevalin are administered by nuclear medicine physicians, and they are NOT used to taking the financial risks. Furthermore, they don't know how to bill for such drugs, and they are afraid to try.

So no one in our 600,000 person service area offers the treatments. The medical oncologists are not licensed to dispense the drugs, and the people who are licensed are afraid to take the financial risks.

Thus, the medical oncologists are forced to look for alternatives."

Interesting perspective Vance has: that it tends to be the nuclear-medicine doctors who aren't up to speed on administering radio-immunotherapy agents like Bexxar and Zevalin, and are therefore more likely than oncologists to be at the root of the problems these effective medications have had in making their way into the marketplace.  Vance knows a lot more about this than me, so I'm happy to say that I stand corrected.

I find it pretty shocking that his 600,000-person service area in Texas doesn't have a single qualified specialist who's stepped up to the plate to offer these treatments to patients who could use them.

Still, to me this points out, once again, the shortcomings of our free-market, entrepreneurial approach to healthcare funding, that puts doctors in the position of having to assume unacceptable financial risks in order to deliver proven, effective treatments to their patients.  Those who are determined to keep the government out of healthcare funding are continually spouting the line that, left alone, the invisible hand of the market will eventually even everything out.  This is a clear example of just how false such economic dogma is, when applied to cancer treatments.

December 23, 2011– Mademoiselle Zevalin’s Empty Dance Card

Interesting article, here, about the difficulties ibritumomab tiuxetan (Zevalin) has been having, getting accepted as an effective treatment for non-Hodgkin lymphoma.

So, at the Oncologists’ Ball, why is Zevalin – which is actually a pretty hot little number – treated like such a wallflower?  Dr. John Pagel, of the Fred Hutchinson Cancer Research Center and Seattle Cancer Care Alliance, thinks he understands the reason:

“Unfortunately, oncologists still have to refer the patient to a radiation oncologist or nuclear medicine physician for administration of the drug, which can be a barrier for treatment in some cases.”

Gee, d’ya think?

For most oncologists to prescribe Zevalin for their patients, they have to give up the privilege of dispensing treatment themselves.  Since many oncologists – who have invested big bucks in elaborate chemo suites, where they dispense medicines costing tens of thousands of dollars – earn their money not just from the medical wisdom they dole out, but also from the meds, telling a patient “I think Zevalin could help you” means foregoing the income from several months of costly chemo treatments.

Is it any wonder so many oncologists stick to the classic approaches, which just so happen to use the treatment agents they’re licensed to dispense?

Zevalin, along with Bexxar (the other leading drug of this type), is the highly-effective Rituximab bonded with radioactive particles.  The CD-20 targeting agent in Rituximab seeks out and travels to the malignant cells – unleashing Rituximab’s own cancer-fighting properties – but then the radiation zaps ‘em again.  It’s a potent one-two punch.

Sort of reminds me of the sharks with laser beams that were the weapon Dr. Evil lusted after in the silly Austin Powers movies.  Rituximab’s the shark.  Radiation’s the laser beam.  Get it? (Can you hear the screams of a metaphor being stretched beyond all recognition?)

How do you suppose radioimmunotherapy studies of drugs like Zevalin are received at professional conferences, when very few of the members of the professional association are licensed to dispense the drug?  (Doctors who administer radioimmunotherapy have to be double-qualified, both in oncology and in either radiology or nuclear medicine.)  These docs-on-holiday hear reports of the science behind these treatments, and they can’t really argue with it, but it can’t fail to enter their minds that, in order to prescribe these drugs, they’ll have to let some other doctor’s practice collect the revenue.

I’m not charging oncologists with running some kind of cartel or cover-up.  It's just that I'm enough of a Calvinist to point out that they’re only human, and therefore such a thought can’t fail to enter their minds.

Again, it’s the basic structure of our healthcare system that’s the real root of the problem. Force doctors to function as small-business entrepreneurs who are paid according to treatments dispensed rather than according to clinical outcomes, and a proven drug like Zevalin gets pushed to the back burner.

It would be interesting for someone to study which sorts of oncologists are referring patients for radioimmunotherapy more often – those who own their own practices, or those who work for organizations like the Mayo Clinic, where they’re all on salary.

Are there any investigative journalists reading this, looking for a scoop?  Just crunch those numbers. I’ll bet you’ll see a correlation.

December 12, 2011 – Blue Christmas

It’s been a while since I’ve posted, I know.  I had the fall stewardship campaign at the church, then Thanksgiving, then the start of Advent – all the while dealing with the sandwich-generation issues that are my life right now: young-adult kids coming and going, and caring for my mother who lives nearby and has Alzheimer’s.  Life has been busy (and, thankfully, healthy)!

Yesterday, for the first time, we offered a Blue Christmas worship service at the church.  It’s something I’d hoped to explore in previous years, but it took the enthusiasm of our church’s Associate, Linda, to get it organized.

What a blessing!  Attendance was not large (nor did we expect it to be).  We’d promoted the service as a focused pastoral-care outreach to a select group of people: those who have experienced recent losses, and who feel a bit left out amidst the traditional pre-Christmas merrymaking.  For those who participated, it was a rich and meaningful experience – due, in large part, to Linda, who put together a carefully-crafted order of worship that emphasized the presence of God and the quiet beauty of the Advent season.

Judging from what I know of those who were present, most of the losses were due to bereavement, although we were careful to speak to losses of all kinds, including the loss of jobs and income in this difficult economy.

Cancer, of course, brings its own losses.  Even those who are fortunate enough to go into remission have lost the sense they once had of being healthy.  We’re reminded of that every time we fill in a medical-history form.  Always there is the reality of the cancer, and the thought in the back of our minds that someday it could come back.

Towards the end of the service, everyone was invited to come forward and light an individual votive candle in a blue-glass holder, in memory of their loved one or in recognition of whatever other loss they may have experienced.  The people did that by means of a white, hand-held candle they passed from person to person.  Each one used it, in turn, to light his or her own candle, then passed it to the next person, and so on.

It struck me, at the time, how powerful was the symbolism of that simple act.  Here was a group of people, each of them bearing a heavy burden of grief.  The road each one is walking is, by its nature, profoundly alienating.   Yet, each one passed the light to a fellow believer, all the same.

We receive ministry from others, yet Christ also calls us to offer it.  Even in a season of personal darkness, we can very often still find a little light to offer to another.  This is what life in Christian community, at its finest, is all about.

There are some who maintain that one of the surest ways up and out of the pit of depression is to try to do something for others, however difficult it may be to get started on that.  I think there’s a lot to what they say.

The night before the Blue Christmas service – knowing how few are the liturgical and musical resources to use in planning such a service — I felt led to write the text of a hymn.  It was too late to get it into the bulletin for this year, but maybe we’ll use it next year.

The hymn is set to the hauntingly beautiful tune of The Coventry Carol - a familiar tune to many, but not one we’re used to singing as a congregation.  Not many people who enjoy listening to the Coventry Carol on their Christmas CDs are aware of this, but its lovely melody is desperately sad. It’s the keening lament of the women of Bethlehem, after their male babies and toddlers have been slaughtered by the soldiers of King Herod.  (According to Matthew 2:16-18, Herod was bent on murdering the young Jesus, whom he perceived as a threat to his rule.)  “Lullay, lullay, thou little tiny child” is a lullaby, to be sure, but it’s the last lullaby sung by a grieving mother to the dead child in her arms.  Pretty grim stuff, but also very powerful in a raw, emotional way.

(Scroll down for the hymn text...)

Comfort Your People, Lord

A Hymn for Blue Christmas Worship Services
Text by Carlos E. Wilton
Tune: “The Coventry Carol”

O Lord, we bring to you, this day,

Hearts that are raw with pain:

For sorrow has companioned us,

And in our lives does reign.

You promise to make all things new:

Comfort your people, Lord.

Would that we could turn back the clock

And for one precious hour

Reach out, clasp hands, and touch again

Love’s fragile, with’ring flower!

You cherish all times in your hands:

Comfort your people, Lord.

All through our lives we’ve trusted you

To be most fair and kind:

Though, in the dark night of the soul,

Anger enthralls our minds.

For freedom you have set us free:

Comfort your people, Lord.

We have not always trusted that

Fairness has been your way.

Too soon it’s seemed to watch our dreams

Float up and fly away.

For good, all things together work:

Comfort your people, Lord.

My soul, why are you so downcast:

Caught up in grief’s malaise?

We trust the day will soon arrive

When we will sing God’s praise!

Not Yuletide mirth, but Easter joy:

We ask this gift, O Lord.

Copyright © 2011, by Carlos E. Wilton.  All rights reserved.  Permission is given for congregations to reproduce the text of this hymn in worship bulletins, as long as the copyright information is included.

November 9, 2011 – Second-Guessing Symptoms

I’ve developed a sore throat today.

That in itself is unexceptional.  It’s November, and we’ve had some unseasonably warm days.  It’s the sort of weather when sometimes I go out without a jacket and discover it’s a little chillier than I thought, having observed the bright, inviting sunshine through the window.

Prime time for sore throats and other cold symptoms, in other words.

Yet, I can’t help recalling what they told me up at Sloan-Kettering about the dry mouth that’s a common side effect of radioactive-iodine treatments.  It can kick in any time from a day or two after the procedure until many weeks later.  And it can last up to a year.

The preventative?  Suck on sour candy to keep the ol' salivary glands a-pumping.

Sounds like old-timey apothecary’s advice, doesn’t it?

I bought a bag of sour balls and have been following instructions, although the last day or two, I’ve been slacking off.  Everything seemed fine, so I figured that was maybe OK to do.

My mouth doesn’t feel especially dry right now, but maybe this is how it begins, I tell myself.

On the other hand, maybe it’s just a plain, garden-variety sore throat.

After you’ve had cancer treatment, they give you long lists of symptoms to look out for. Very often there are so many of these, and they’re of such variety, that they can be easily be confused with other, minor ailments that come and go.

Yet, there’s something about our wayward minds that leads a great many of us to imagine the worst-case scenario.

Is my sore throat the result of suddenly-underactive salivary glands that were singed by the radiation?  Or is it just the beginnings of a common cold?

At lunchtime I drove over to the drugstore and invested in a jumbo bag of lemon-mint Ricola throat lozenges.  I figure that covers both eventualities.

Pucker up!

November 7, 2011 - Kyrie Eleison

This morning I rode the train back to New York City, for some follow-up scans at the Nuclear Medicine Department at Memorial Sloan-Kettering. One was a repeat of the same scan I had the day before my radioactive-iodine treatment.  The other was a CT scan.

Last Wednesday, the day before the treatment, I swallowed a pill containing a small amount of radioactive material. It was just for diagnostic purposes, the technician informed me, and was small enough that it didn't call for any special safety precautions.

The scanner wasn't the familiar donut-shaped CT scanner. It had the same exceedingly narrow table to lie down on, but instead of the donut there were a couple of square pads, each about the size of an old LP record album.  They could be positioned a number of different ways on movable arms.

When I asked, the technician told me it's called a gamma camera (at least in layman's terms). The difference between this scan and a CT scan, he went on, is that a CT scan provides its own radiation, but this gadget simply measures the radiation already present inside me. The contents of the capsule I'd just swallowed, in other words.

OK, so this is one of those bring-your-own-radiation joints.

I had a similar scan again today, with the difference that those square pads are looking for radiation emanating not from last Wednesday's appetizer but from Thursday's 120-millicurie main course. I suppose this gamma scan result, combined with the CT scan, tells the doctors something worth knowing about either the effectiveness of the radioactive-iodine treatment (whether there was indeed any residual thyroid tissue left over after the surgery and whether the radiation successfully zapped it) or about how my body's doing at getting rid of the radioactivity.

The technician who ran the CT scanner told me afterwards that there's going to be some kind of medical pow wow tomorrow, and that I should hear something not long after that.

What I can expect to hear, I have no idea, since my understanding has been that the radioactive-iodine treatment is merely a prophylactic measure following my (presumably) successful surgery. What these scans will actually tell the doctors is beyond me.

Before getting off the New Jersey Transit train, I'd been listening to music on my iPod.  I decided I was familiar enough by now with my itinerary through the New York subway that I could act like so many other straphangers and leave the headphones on. It so happened that I was listening to Gregorian Chant by the Benedictine monks of Christ in the Desert Monastery of northern New Mexico. I'd spent a week of my sabbatical with them a half-dozen years ago.


It was a rather odd experience to make my way through the bustling commuter crowd in Penn Station with the otherworldly tones of Gregorian Chant sounding in my ears. Although my noise-dampening headphones muted most of the station noises and P.A. system announcements, the louder ones were still intelligible. Those station noises sounded like they'd been dipped into the monastic chant like a waffle immersed in maple syrup.

I found the chant changing my attitude towards the day, and about my fellow-travelers as they charged about every which way, Manhattan-style, on whatever urgent business had brought them to those subterranean transit-chambers.

Kyrie eleison, sang the monks of Christ in the Desert. Lord have mercy.

Kyrie eleison on me, medical pilgrim that I am.

Kyrie eleison on the Wall-Street type in the pricey tailored suit with the American flag pinned to his lapel.

Kyrie eleison on the woman in a chador, pulling her sleepy-eyed preschooler along by the hand.

Kyrie eleison on the two soldiers leaning against the wall in their desert-camouflage uniforms.

Kyrie eleison on the young woman with the flowing black hair and the hoop earrings, tottering along in suede boots with impossibly high heels.

Kyrie eleison on the homeless man on the bench, and on the transit cop prodding him awake and ordering him to move along.

Standing on the uptown subway platform, looking across the two sets of tracks at my downtown-bound counterparts, I decide to launch some silent kyries at 'em.

Random acts of prayer. It seems somehow subversive.

They have no idea, those people I've picked randomly out of the crowd to target with my kyries. Do they even know someone's just blessed them?

Do I realize the same, when I've been similarly blessed by some other anonymous fellow-believer?

I feel, in those moments, like we're all swimming together in a sea of blessings.

November 3, 2011 - Radioactive Blood

"Is he strong? Listen bud,
He's got radioactive blood.
Can he swing from a thread?
Take a look overhead.
Hey, there,
There goes the Spiderman."

When my brother, Jim, first read an email from me explaining the details of today's radioactive iodine treatment, he said he hoped I'd tell him if I turned up with any Spiderman powers.

Bill, a minister friend of mine, mused that maybe when I come down from this particular mountain, my face will be shining like Moses'.

Another colleague, also named Bill, wondered if we'd be singing "Shine, Jesus, Shine" in church on Sunday.

That's what family and friends are for, you know: to make fun of you at any opportunity.

There's a lot of radiation humor out there. It's a black humor, of the sort that speaks to our free-floating cultural anxiety about this invisible peril, undetectable by anything except a Geiger counter (which almost none of us happen to own, in any case).

From the precautions the staff here at Memorial Sloan-Kettering took with the four little capsules I swallowed at about 10:30 am today, you'd think I was imbibing Tincture of Black Death or something.

As I write this, I'm ensconced in a special treatment room here at MSKCC, whose walls, I understand, are lined with lead. The room can accommodate as many as four patients in its row of comfy chairs, but my only partner today is a twentysomething woman I'm calling Andrea, a Hodgkin lymphoma survivor who, in a curious coincidence, has a medical history remarkably similar to my own (successful lymphoma treatment just over 5 years ago, and a subsequent thyroid cancer diagnosis that came to light through routine follow-up scans).

After undergoing scans earlier this morning for the purpose of measuring the "uptake" of the slight dose of radioactive material we swallowed yesterday, we each had a briefing from Chris, the pleasant and attentive radiation safety officer I met yesterday.

Olivia, the nurse who, yesterday and the day before, stuck me in the derrière with my Thyrogen injections, has been hovering around, seeing to our creature comforts. She's our flight attendant for this little excursion into Cancerland.

Soon after that, Dr. Dunphy and the resident working under him, Dr. Ashima Lyall, entered the room, reverentially bearing The Dose.

I have to say, never in my life have I experienced such an elaborate ritual surrounding the act of swallowing a few pills. Laid out on the standard hospital-room table before me was a disposable pad and a couple of pairs of latex gloves. Like a pair of priests preparing to handle the sanctified host, Dr. Lyall and I donned our gloves. There was a smidgen of liturgy: she asked me to repeat my name and date of birth and compared the patient number on my paperwork with her own.  Then, she opened the soup-can-sized lead canister in front of me and, using a pair of the biggest tweezers I've ever seen, lifted out a small plastic vial with four ordinary-looking white capsules tucked inside it.

She explained that the number of capsules corresponds with my prescribed dose of radiation, 120 millicuries. Olivia and Dr. Dunphy looked on as Dr. Lyall used the giant tweezers to lift out each capsule in turn and place it in a little plastic cup nestled inside a lead-lined holder.

Four capsules, four swallows of water, and the deed was done. Drs. Lyall and Dunphy removed the lead-lined sacramental vessels, directed me to take off my gloves, and had me place them alongside Dr. Lyall's on the disposable pad. Then, the pad was folded up like an altar-cloth and whisked away to wherever they take low-level radioactive waste here at MSKCC.

Then, the team went through the same procedure with Andrea, my partner in treatment, before bidding us adieu.

Precisely two hours after our pill-swallowing ritual, Andrea and I will be released from our lead-lined holy of holies for our respective journeys home.

In my case, Claire will drive me, with me sitting as far as possible away from her, in the back seat on the passenger side. Once we return home, we're supposed to avoid any prolonged physical proximity to each other, within a radius of about 3 feet. Fleeting contacts are OK, they tell us, but no sitting together on the couch or sharing the same bed.

It seems that a monastic asceticism follows the Rite of the Dose.

Within 24 hours, Chris informed us earlier, 80% of the radiation will have made its way out of my body, mostly through the urine. (Drink plenty of fluids, yada yada.)

My instructions are to return to the mountaintop on Monday morning, for a set of follow-up scans.

I don't think my face is shining. But, you never know.

November 2, 2011 - Medi-Commute, Day Two

Back on the commuter train again, early in the morning. Headed for Manhattan, for my second Thyrogen injection and a bit of low-dose radiation so the docs can check the pipes and see how they're working (in the trade, they call that "measuring your uptake").

No precautions needed for the radiation dose I'll get today. Tomorrow (as I learned in detail yesterday) is a different matter. No close proximity to people for a couple of days, take special care to avoid children and pregnant women, sleep separately from Claire, use a different bathroom if possible, wash laundry and silverware separately. Above all, clean up meticulously in the bathroom, because it's mainly through the urine that the stuff passes out of the body. 80% will be gone in the first 24 hours, and the rest soon thereafter.

All this was conveyed to me by Chris, my friendly "radiation safety officer," who was good enough to stop by and see me a day earlier than usual, to answer some particular questions I had.

I was concerned about two things. The first is Sunday morning. Chris assured me that I should be fine to stand up in front of the congregation and lead worship, hand the Communion bread and cup trays to the servers and shake hands at the door. There's no problem with my being in the vicinity of kids or expectant mothers, either, by then. In any event, he told me, even during that first couple of days I only need to be cautious about being right next to another person for more than a few minutes. As in a crowded subway car, or sleeping next to my Beloved. My Sunday-morning pastoral contacts are fleeting, and it's nearly three days later, besides, so no worries.

My dose, Chris told me - which has probably already been determined by a little medical confab that took place yesterday afternoon, involving Dr. Fish and Dr. Mark Dunphy (my new nuclear medicine specialist), plus a few others - will be between 75 and 150 millicuries. It's based on clinical considerations - numbers from my blood tests and such - not body size.

My second question had to do with a side-effect I'd heard about but hadn't paid much attention to - although, given my line of work, I should have. Chris told me a little more about this, but it was the tall, gangly and cheerful Dr. Dunphy who gave me the lowdown. For up to three months after downing the pill, I could experience the onset of a persistent dry-mouth condition.

As anyone who does public speaking knows well, that could be a problem. There's a low-tech way to reduce the risk of dry-mouth, Dr. Dunphy told me: drink plenty of water right after the treatment, and - beginning 24 hours afterwards and continuing for a couple of days - suck on sour hard candies. This side-effect happens when the salivary glands sustain some collateral damage from the radiation. Because sour candies inhibit salivation, I shouldn't start on them immediately after the treatment - allowing the glands to push as much fluid through them as possible - but after those first 24 hours, they have a beneficial effect.

I've just heard a doctor prescribe candy. Seriously. If I'd heard that when I was a kid, I never would have believed it.

As for other side-effects, some people do experience mild nausea, but they'll give me Zofran, an anti-nausea med, as a precaution, as well as a script for some more to take home with me, should I need it. After enduring six rounds of Adriamycin, the Red Menace, back in 2006, I'm not too concerned about that. How bad could a single little pill be, compared to that devil's brew coursing through my veins?

Some people also get slightly swollen cheeks and/or some nagging pain in the vicinity of the jaw and neck, in the weeks following the treatment. Chipmunk cheeks and a pain in the neck, to use the non-clinical terms. OK, I'll cross those respective bridges if I come to them. Sounds like more of an annoyance than anything.

These are the things on my mind, as I sit amongst my dozing, reading, iPod-listening fellow-commuters. Onward and upward, for us all.

November 1, 2011 - Next Station: Radiation

I'm writing this on the train, headed into New York for an appointment with the Nuclear Medicine people at Memorial Sloan-Kettering. My first-ever blog posting from a smartphone.

Several weeks ago, I got a call from someone in Dr. Fish's office, who told me a shipment of Thyrogen was expected at long last, so I could finally schedule my radioactive-iodine treatment.

For the past week or so, I've been on the exceedingly weird, no-iodine diet that's expected of those who are about to gulp down the nuke pill. The diet requirements are complicated, but the shorthand version is that it's a no-salt, no-bread, no-dairy, no-seafood, no-egg-yolk, no-canned-foods, no-food-coloring diet. All those things have iodine in them. What I'm allowed to eat is pretty much any fresh fruit or vegetable, plainly-cooked meats, plain pasta, olive or vegetable oil, oatmeal, unsalted peanut butter, matzo, English muffins, real fruit sorbet, coffee and tea (brewed in the pot from loose leaves - because evidently there's iodine in whatever they make teabags from).

It's not so much the salt that's the issue, but the iodine that's added to nearly all salt (Kosher salt, which isn't iodized, is permitted in moderation). I haven't shaken salt onto my food in years, but the problem is the large number of prepared foods that contain salt, whether you ask for it or not.

The diet is bland and uninteresting, but I haven't felt overly hungry on it. The problem is the forethought and planning required. I think I've read more food-ingredient labels in the past week than I've read in the past year (and put most of them back on the grocery-store shelf afterwards, after spying that four-letter word, "salt"). It's virtually impossible to eat out, so that means just about the only food alternative while driving around is something you've brown-bagged with you. Eating out with friends on Sunday at a pancake house, I had a bowl of fruit and a cup of coffee.

The diet continues through Thursday morning, when I swallow the pill. The point is to starve my body of iodine so that, when the radioactive iodine from the pill starts coursing through my bloodstream, any tiny, leftover bits of thyroid tissue will smack their lips, grab their knife and fork, tie a napkin around their neck and belly up to the front of the chow line. Then, it's curtains for them.

The weirdness will continue after I leave the hospital outpatient unit on Thursday. I can eat anything I want, but I'm going to be radioactive. Riding on mass transit is verboten. When Claire drives me home, I've got to sit in the back seat on the right side. They'll give me a get-out-of-jail-free card, so if a Homeland Security Geiger counter picks me up as we're entering the Lincoln Tunnel, I won't be whisked off to an undisclosed location.

After we get home, I'm supposed to stay a few feet away from other people at all times. Claire and I will enter old-time TV-sitcom land, sleeping in separate beds. I'll wash my dishes, silverware and laundry separately. When using the bathroom, double-flushing is the rule.

If we still had a first-grader in the house, the easiest explanation would be to say that I'll have cooties.

As for the dog and the cats, when I asked Dr. Fish about them a few months ago, she said: "You're not going to like this answer, but pets don't live long enough to experience the adverse effects of the radiation."

Oh. There's something to ponder. Especially coming from a Fish: ba-boom (rimshot).

Whether or not I'll be able to shake hands at the church door this Sunday remains to be seen. I certainly won't put anyone at risk, but the folks at MSKCC assured me that, according to the earlier schedule we discussed that had me swallowing the pill on a Wednesday, that would be no problemo. Just in case the shift to Thursday makes a difference, Linda, our church's associate, is scheduled to preach. It is a Communion Sunday, so I'll have to be sure to mention to the medical mavens that I'd be handing out the trays of bread cubes and the little cups of grape juice.

We Presbyterians don't believe in transubstantiation, but it's wise to beware of radiation.

Sitting here on the train, amongst the morning commuters with their iPods and newspapers, I'm aware that I've got a very different reason for going into the city than most of them. My goal today is a Thyrogen injection, who-knows-what further medical tests and to get further briefed on what to expect on Thursday.

Tune in to the next thrilling episode of The Adventures of Nuclear Pastor and the Iodine Pill.