Thursday, July 27, 2006

July 26, 2006 - Flashback

This afternoon, I stop by Dr. Lerner’s office for my monthly port flush. This five-minute procedure involves sitting down in one of the row of chairs in the Nurses’ Room, while one of the nurses runs a little saline solution through my implanted port, to dissolve any blood clots that may be blocking it.

I haven’t thought much about my chemotherapy for some time, but suddenly it all comes back to me. Vanessa approaches me with a heavy-duty, medical paper towel, on which she’s got balanced a syringe, an L-shaped needle, a tube and some little paper packets. “Which side?” she asks.

“The right, I reply,” pulling aside the collar of my shirt.

Opening the paper packets, she removes some cotton swabs, pre-soaked with red-brown Betadine solution, and wipes them over the area of my chest, below the right collarbone, where the port hides just under the skin. “Deep breath,” she says. Obediently, I breathe in deeply, then feel the familiar prick of the needle. It hurts a little more than a blood-test – it’s a bigger needle – but not much. Like most people, I used to dread needle sticks, but now I hardly give them a thought. I’m a pro. Cancer treatment will do that to you. This is nothing – a mere dry run, compared to an actual chemo treatment.

Taking up the syringe, attached to the needle by a plastic tube, Vanessa slowly presses the plunger. Instantly, I feel an odd, bubbling sensation in the back of my throat, accompanied by a peculiar plastic taste. That taste brings it all back, as though I were one of Pavlov’s dogs. I feel vaguely nauseated for a moment. It’s the prelude to chemotherapy – but, thankfully, there will be no chemotherapy for me today.

Moments later, Vanessa slips the needle out, tapes a wad of sterile cotton over the spot where it was, and hands me a billing form to drop off at the receptionist’s desk on the way out. It’s all over for another month. By the time of my next port flush, I’ll have had my CT and PET scans, and will be coming in to hear what Dr. Lerner has to say about the results.

But for now, the memory lingers...

July 25, 2006 - Fallow

Next to our house – the Manse – we’ve got a little vegetable garden. At least, most summers we do.

This year’s different. At planting time this past spring, I was feeling too sick to go out and buy the usual tomato, bell pepper, eggplant and zucchini seedlings and press them into the soft soil. (This, despite the fact that Claire had gone out and hoed up the little plot for me.) Somehow, amidst all the other things occupying our minds last spring, the planting kept getting put off – until, one day, Claire and I looked at each other and acknowledged it was simply too late.

What we’ve got is a garden of grass instead. The groundskeeping guys who cut the church lawns have been simply running their lawnmower over our erstwhile garden patch. There’s nothing else to be done with it.

It’s just as well, I suppose, because I’m taking vacation later than usual this year, and we’ll be away for most of August. We’d miss most of the harvest, anyway. But even so, it feels unnatural to walk down the driveway and see only close-cropped grass where, in any other summer, the tomato plants would be hanging low by now, weighed down with little green globes just beginning to turn red.

The farmers have a word for our garden this summer. The word is “fallow.” I looked it up, and discovered something I didn’t know about that word. I’d always thought “fallow” described a field that’s simply been left unplanted for a growing season, to allow the soil to recover. But there’s a little more to it than that. A fallow field is one that’s been plowed, prior to letting it sit unplanted. It must be pretty hard for an old-time, organic farmer to go to all the work of plowing a field, knowing it will yield no harvest. But that’s all part of the farming game. It’s delayed gratification.

This is an appropriate parallel to my life this year. I’ve got lots of tasks and projects half-begun, and abruptly abandoned. Certain plots of ground were plowed, then allowed to sprout nothing but nature’s “volunteers.” I’ll never catch up on some of those projects. Hard as it is on my pride, I’ll just have to let them go.

Some of them can’t be abandoned, though. Some time-management expert or other once described the art of choosing which tasks to ignore as the art of “creative incompetence.” It’s a label that just may apply to our 2005 tax return. There was no way I was feeling well enough to get the information to our accountant for April 15, so he applied for an extension on our behalf. Now, the August extension date is looming, and I’ve still got mountains of bookkeeping to catch up on. If I’m going to get away for any vacation at all this summer, I may have to phone him and ask if there’s any way he can get the IRS to grant an extension on the extension.

I don’t feel very good about that. In fact, it’s going to make me feel rather incompetent to make the request. (That’s a little-known and seldom talked-about side effect of cancer: how the disease plays havoc with all sorts of mundane details of life – like personal finances.) Let’s just hope this particular incompetence of mine proves to be creative in some way.

There’s one thing that’s good about a fallow field, though. Plowing it up, then letting it sit for a season results in a stronger crop the following year. Just how that may be an outcome of my cancer experience remains to be seen...

Saturday, July 22, 2006

July 22, 2006 - The After-Prayer

How does one pray, after an experience like cancer, or after an experience with suffering of any kind?

Today I come across a remarkable prayer, written by holocaust survivor Elie Wiesel. A Nobel Peace Prize laureate, Wiesel has spent his life reflecting upon his childhood experiences in Nazi concentration camps. Having lost both his parents and his young sister in the camps, he wandered for a time, caught up in the ragged hordes of post-war refugees, until he found his vocation as a novelist. Wiesel has dedicated his life to preventing other holocausts, and seeking justice and comfort for victims of racial, ethnic and religious hatred. He is one of the heroes of our time.

He is also a man of faith: remarkably so, considering the trials he has gone through. Wiesel’s brutally honest, questioning faith is evident in this prayer, which is from his book, One Generation After:

“I no longer ask You for either happiness or paradise; all I ask of You is to listen and let me be aware and worthy of Your listening. I no longer ask You to resolve my questions, only to receive them and make them part of You. I no longer ask You for either rest or wisdom, I only ask You not to close me to gratitude, be it of the most trivial kind, or to surprise and friendship. Love? Love is not Yours to give.

As for my enemies, I do not ask You to punish them or even to enlighten them; I only ask You not to lend them Your mask and Your powers. If You must relinquish one or the other, give them Your powers, but not Your countenance.

They are modest, my prayers, and humble. I ask You what I might ask a stranger met by chance at twilight in a barren land. I ask You, God of Abraham, Isaac, and Jacob, to enable me to pronounce these words without betraying the child that transmitted them to me. God of Abraham, Isaac, and Jacob, enable me to forgive You and enable the child I once was to forgive me too. I no longer ask You for the life of that child, nor even for his faith. I only implore You to listen to him and act in such a way that You and I can listen to him together.”

It’s both a prayer and a declaration of faith, spoken defiantly into the screaming void that is human suffering. There are more differences than similarities between my brief season of suffering through cancer, and that of a concentration-camp survivor like Elie Wiesel. His experience robbed him of both his childhood and his family – and, very nearly, his faith as well. Of course, there is the major difference that Wiesel was the victim of moral evil, and I of illness (a form of natural evil). Yet still, we call out to the heavens. And still, we discern in the silence a kind of answer.

The answer is Love.

Thursday, July 13, 2006

July 12, 2006 - Closing Ranks

This evening I attend a support-group meeting at the Cancer Concern Center. I’ve been continuing to attend these meetings whenever I can. I don’t have a lot to share, these days, by way of medical news, but there’s something I like about this diverse group of people, united by the common experience of cancer.

If there’s a prevailing demographic for this group, it would be forty- and fifty-something women with breast cancer. Yet, while the breast-cancer contingent – always the most vocal, in cancer circles – has a slight majority in this gathering, there are men who come as well, and people with other kinds of cancer. We haven’t all had the same sorts of treatments, but there are enough experiences we share, across the many different types of cancer, to provide common ground on which to stand.

The group spends extra time addressing the concerns of a newly-diagnosed woman, who is facing the prospect of chemotherapy. She’s clearly frightened by it, and as we listen to her tell her story, I recall how scared I was in the weeks leading up to my treatments. We reassure her that, while chemo is no picnic, it’s also something that need not be completely debilitating. There is much joy to be discovered in life, even in the midst of chemotherapy. Mental attitude is important, as is seeking out sources of support (such as this group).

I’ve heard it said that the most difficult time, in the life of a cancer survivor, is the time of diagnosis. It would be one thing if diagnosis were like other trips to the doctor, for less-serious ailments – “Here’s what’s wrong with you, and here’s a prescription that will make you better” – but it’s never that way. By its very nature, cancer diagnosis is complex. It’s a process. We start out hearing, “There’s a possibility you may have cancer,” and go on from there, through multiple tests and scans, until the day when the diagnosis is confirmed. Then, other tests and scans may follow, to determine exactly what type of cancer it is, and what sort of treatment is called for. In between each step in the process, there are frustrating periods of waiting – for lab results to come back, or for an opening to appear in a doctor’s apppointment-book. As we wait, we wonder: Am I waiting too long? Will every week – every DAY – spent waiting set my recovery back? Should I make myself a nuisance in the doctor’s office, demanding the next possible appointment?

Then, there’s the vexing question of second opinions. Most experts agree that second opinions are a very good thing, when it comes to cancer treatment – good oncologists, in fact, value a team approach to diagnosis and treatment, and have no objection to waiting while the patient consults another physician. Yet, in those anxious days leading up to diagnosis, a second opinion can seem like just one more obstacle to getting on with it, to getting free of the disease.

That sort of thinking is a big mistake. There are few cancer treatments that are so urgently required that a few weeks devoted to seeking a second opinion is medically harmful. (In those rare cases, we can trust our doctors to tell us so – and to explain why.) There’s absolutely nothing wrong with telling our doctor of our desire for a second opinion – treating it as a collaboration, rather than a challenge. Even if we end up with no change in the proposed treatment, we’ll be able to undertake that treatment with greater confidence and less second-guessing.

A change in perspective is necessary, when it comes to cancer. Cancer is not like many other medical conditions, that can easily be resolved with a prescription, or with some sort of surgery. Even when cancer is treated surgically, there are years of tests and follow-ups afterwards, to make sure the surgeon “got it all.” No, for cancer survivors, it’s the moment of diagnosis that changes our lives – only it’s not a moment at all, it’s a season. Living through that season is one of the toughest things any of us do. We start out feeling isolated, and alone. We wonder who, out of all our friends, acquaintances, co-workers, can be trusted to bear the weight of our fearsome news. If we’re lucky, we find good people – family, friends, fellow church members, a dedicated cancer support group – who are up to the challenge of walking with us through it.

It’s a beautiful thing to watch the members of this particular support group close ranks around a new member – listening, helping, sharing strength. Why would anyone want to face an adversary like cancer alone?

Monday, July 10, 2006

July 9, 2006 - How Are You? (2)

Back on December 23, I wrote a journal entry called, “How Are You?” I was newly diagnosed at the time, and was struggling with how to answer that question, as it came up in casual conversation. Most people who ask how we are don’t really want a full-blown answer. Should I answer the question completely and truthfully, sharing the whole burden of my diagnosis? Or should I treat the question like the social pleasantry it is, and simply say I’m OK?

Today’s Sunday, and a certain number of worshipers pause at the church door to ask me the same question. Today, the answer’s a good bit easier to give: I’m in remission, and I’m feeling pretty good – although not quite back to my full energy level. (By most accounts, cancer fatigue takes several months to dissipate, following chemotherapy – so, I’m right on track.)

The question feels very different, today, than it did back in December. Back then, folks were only just learning of my diagnosis. To describe how I was feeling, in any detail, was to drop a rather large emotional bombshell on an unsuspecting victim. Yet, this morning, the people who inquire into my health already know I’ve got cancer. They also know I’m finished with my treatments. They’re just looking for some reassurance that progress is continuing.

Well, it is – and it's easy to tell them so. It's just not so easy to speak, these days, of passing particular milestones. Back when I was receiving chemo treatments, I could tell people with some precision where I was, within each 3-week cycle. Now, as the days of remission stretch on into the future, each day is not all that different from the day before. I know I'm continuing to make progress, but the changes are so incremental, it's hard to discern them.

I've used the analogy, before, of an old-fashioned sailing ship at sea. In keeping his log, the ship's captain would talk of landmarks sighted, while sailing close to shore. Things were different during the long ocean crossing. The vista from the quarterdeck remained featureless. The only indications of progress were the daily sextant readings and the record of "the log" – that chunk of wood on a rope, that a midshipman would cast overboard and time, as it drifted back towards the stern.

I'm not so introspective, myself, that I'm inclined to make a daily inventory of how I'm feeling, through these latter days of recovery. And so, the answer to the "How are you?" question is becoming more and more of a social pleasantry.

I'm still not quite used to that. I feel like I ought to have more to say. Most days, I don't – and that's a good thing.

Saturday, July 01, 2006

June 28, 2006 - Thanks, Tarun

Sometime in the midst of my long process of diagnosis, I did what many others do, under similar circumstances. I went on the internet, searching for information that could help me understand the challenges before me.

I found a plethora of medical information on sites like those of the National Cancer Institute, the Leukemia and Lymphoma Society, the Lymphoma Research Foundation and Web MD. I also found more than my share of less-reputable websites hawking spurious herbal remedies and other quack cures. I avoided these, sticking to sites affiliated with reputable scientific and medical organizations.

Yet, even as I was mastering the medical jargon and becoming better informed, I realized I was looking for something more. The technical information had its place, but I also craved some information of a more personal nature. I wanted to know what it feels like to go through cancer treatment, as reported by someone who’s actually been there.

Very soon after I started this blog, I received an e-mail from a twentysomething physician-in-training from India by the name of Tarun Jacob, who had stumbled across one of my posts while doing his own web-surfing. I first wrote about him in my December 17, 2005 blog entry. Tarun also has non-Hodgkin lymphoma, and has likewise been keeping a blog as a chronicle of his experience.

Tarun was a couple of months ahead of me throughout the chemo process, receiving treatments similar to my own, so his blog entries were touchstones for me. Tarun then went on to receive radiation treatments(directed, in his case, at a mass in the chest rather than the abdomen) – something I was spared, at the last minute, when Dr. Portlock at Memorial Sloan-Kettering took a second look at my PET scan results and decided it was not medically necessary for me. Dr. Lerner concurred. The fact that he received radiation and I did not enabled me to catch up to him, so that he and I received our favorable PET scan reports within a couple weeks of each other. By the grace of God, we’re both in remission.

A special connection, for me, is that the hospital where Tarun is finishing his medical training is the Christian Medical College in Vellore, in Tamil Nadu – a hospital established by Presbyterian missionaries years ago, and which has received significant funding from our denomination over the years. It’s clear, from the cutting-edge treatments Tarun has received, that CMC Vellore is right up there with hospitals in the United States, in terms of equipment, medicines and medical expertise.

Tarun’s a half-generation younger than me. As he was diagnosed, his wife, Anne (also a physician) was expecting their first child. Before Tarun’s cancer treatments were finished, young Koby was born, strong and healthy (proud Papa posted lots of photos for his blog readers to see). Once their training is completed, Tarun, Anne and Koby plan to travel to one of India’s more remote provinces, to join the medical staff of a mission hospital.

I can hardly imagine what it must be like to be diagnosed and treated for cancer while in one’s early twenties, still in school, and just starting a family (I found it hard enough to go through these things in mid-life, with our kids nearly grown up). To his credit, Tarun has managed the whole process with remarkable persistence, courage, good humor and faith. The motto of his blog sums up his outlook: “Life’s a Journey, Not a Destination.”

Recently, Tarun posted his final blog entry – explaining that, with the increasing demands of his medical rounds, he can no longer make regular posts. I’m going to miss traveling to Vellore, via the internet, to see the latest photos of Tarun, Anne and baby Koby, and to read of the daily events of their lives – as well as the big news about Tarun’s treatments and scan results. Life is made up of a vast number of these little moments – truly it is a journey, rather than a destination. Brother Tarun, I want to thank you for sharing those moments with me, and with so many others!

I’ll leave you with a blessing I so often share with my congregation: “Go in peace, to love and serve the Lord, rejoicing always in the power of the Holy Spirit!”