January 22, 2009 - Method in the Madness?

I’ve been in Bradenton Beach, Florida this week, attending The Homiletical Feast – a preaching conference I attend each year. Not that Florida has offered any balmy weather: it’s been as low as 32 degrees here this week. The exegetical papers we’ve considered in the group have been high-quality, as usual, and the discussion and mutual support has been more valuable than words can say.

These 16 or so ministers are among my most valued colleagues. Over the years, they’ve become friends as well. We only meet once a year, but the four days we spend together are a time of talking, sharing and supporting one another, as we reflect on this demanding occupation.

Earlier today, one of my colleagues shared a poem by Larry Smith called “What You Realize When Cancer Comes.” He found it on Garrison Keillor’s The Writer’s Almanac program on American Public Radio. Here’s an excerpt:

“You will not live forever – No
you will not, for a ceiling of clouds
hovers in the sky.

You are not as brave
as you once thought.
Sounds of death
echo in your chest.

You feel the bite of pain,
the taste of it running
through you.

Following the telling to friends
comes a silence of
felt goodbyes. You come to know
the welling of tears.

Your children are stronger
than you thought and
closer to your skin.

The beauty of animals
birds on telephone lines,
dogs who look into your eyes,
all bring you peace.”

The poem ends with these words:

“You are in a river
flowing in and through you.
Take a breath. Reach out your arms.
You can survive.

A river is flowing
flowing in and through you.
Take a breath. Reach out your arms.”

The poem causes me to reflect on many of the things I’ve lived through, these past three years or so. One of the things I’ve struggled with, off and on, is the question: “Why?” What purpose is there in all this?

Smith’s poem captures the transformational aspect of cancer. When those of us who undertake this journey – however unwillingly – complete it, we are not the same people as when we began. Every step we take along the road changes us.

Thinking theologically, I’m led to ask once again what long-term purpose God may have in mind for my ministry. In allowing me to get this disease, curing me from its aggressive variety, then miring me in the interminable limbo of indolent lymphoma’s “watch and wait,” what’s God’s point? If it’s true, as we Presbyterians are inclined to think, that God calls men and women to ministry, then what call could there possibly be in cancer?

The Larry Smith poem suggests some possible reasons. “You will not live forever.” I have a visceral awareness of this truth, now, that has hitherto been a mere abstraction. “You are not as brave as you once thought.” No, indeed I’m not. I’m learning to live with uncertainty, and still rise to the challenges of daily living. “You can survive.” Yes, I can. I’m doing it. One day at a time.

I’ve had some difficulty sensing God’s will in the midst of follicular lymphoma. Aggressive cancer I can understand: it’s a challenge to be met, or die trying. Cured cancer I can likewise understand: it’s a triumph to be celebrated. But, this neither-here-nor-there, neither healthy-nor-unhealthy limbo, stretching on into the interminable future: what’s God up to?

Maybe the purpose is to nurture my empathy, my ability to connect with others. I’m not the only person whose life is fraught with ambiguity, is lived out in the gray country of uncertainty. Maybe I’m meant to be a fellow-traveler and accompany others. Maybe I’ve been enrolled in a school of perseverance, so I may help others persevere.

January 16, 2009 - Leadership: It's Personal

The recent news about entrepreneur Steve Jobs’ sudden medical leave from Apple Computer brings back memories for me. When you’re in a very public sort of job – like CEO of a company, or pastor of a congregation – there isn’t much of a right to privacy. You’re doing more, professionally, than just filling a box on an organization chart. Personality and profession are all wrapped up together. When you get sick, people feel they need to know.

Steve Jobs has pancreatic cancer. So far, he’s been one of the truly fortunate ones. Not only is he still around, more than 4 years later, but – except for several relatively brief absences – he’s thrived, remaining at the helm of the innovative company he founded. Now, Mr. Jobs has announced he’s taking another, longer leave to see to medical concerns – at least until June.

Apple stock has plummeted. It must be a terribly difficult spot to be in, knowing the stock analysts are watching him like hawks (or vultures?), ready to issue “sell” orders at the least sign of physical weakness. For a man like Steve Jobs, even getting the flu could have a notable effect on his company’s value. The fact that he’s actually stepping down for a time indicates that something is, indeed, seriously amiss.

At least one commentator has issued a call to privacy on his behalf. I agree with that. News reports speculating about the future of the company and the value of its stock are inevitable, I suppose, but it would be nice if the media could find some way to discharge their duty to the public without heating up Mr. Jobs’ life with their spotlights. He needs to find a place of peace and privacy where he can concentrate on healing.

I’m grateful that my congregation gave me such a place, during the acute phase of my illness. I used this blog to let them know how things were going, but that was my choice to do so. This online journal has also been a kind of therapy for me, providing a way to reflect personally and theologically on what’s been happening to me, and what God is doing in my life.

Sometimes I wonder, though, whether certain developments in the life of the church may be attributable to my cancer. As we struggle with issues of membership growth and finances, as nearly all mainline Protestant churches are doing these days, I ask myself whether some of this church’s particular challenges are attributable to my health outlook. Has this become “the church whose pastor has cancer,” in some people’s minds? How does my health situation affect long-range planning? Did the intense focus on my health back when I was receiving chemotherapy – as God’s people ministered to their minister – help or hinder the church’s overall mission in the long run?

These are mostly unanswerable questions. As with families, churches sometimes find they can’t choose or plan for certain eventualities. They have to face whatever comes.

Still, the questions remain in my mind. Leadership is personal – and nowhere is this more true than in ministry.

January 15, 2009 - Retirement Planning

Yesterday, Claire and I returned from Princeton Theological Seminary, where we attended a two-and-a-half-day Pre-Retirement Seminar sponsored by the Presbyterian Church’s Board of Pensions. Not that we have plans to retire anytime soon. That, God-willing-and-the-cancer-don’t-flare-up, is 15 years off at least. We went because the Board of Pensions encourages ministers over 50 to attend one of these conferences, and to bring their spouses with them. The idea is to get a head start on long-term financial planning.

The Presbyterian Church has a mighty good pension plan. It’s fully funded, and conservatively run – something we plan members surely appreciate in uncertain times like these. The sticky wicket, for those of us pastors who live in manses, is where we’ll live in retirement. The Board’s encouraging us to start thinking about the answer to that question now.

Claire and I found it a positive experience. The leadership – especially the financial-planning speaker – was excellent. Just what we budget-challenged liberal-arts graduates needed, even if it did feel odd to be thinking about retirement in our prime working years.

There were 20 or so participants, all told. Ages ranged from people in their early 50s, like us, to one man who’s just a few months from the proverbial gold watch.

My active cancer diagnosis sets me apart from my fellow participants. Will I make it to age 66 and 4 months – the threshold when Americans in my birth year can collect full Social Security benefits? Or, will disability be staring me down sometime before then, as a stem-cell transplant or some other treatment looms? If disability is in my future, will I recover fully after treatment and return to full-time ministry? So many unanswerable questions...

The more time I put between myself and the aggressive large B-cell lymphoma I once had, the more retirement planning makes sense. Indolent NHL is kinder, that way. When Dr. Lerner assures me I could still be doing the watch-and-wait thing years from now, I take him at his word - which is why I can even go to a conference like this in the first place.

Questions like these are, of course, imponderable. The only thing to do is to plan for the best-case scenario, and hope I’m prepared for anything worse that may come my way.

The conference program also included a presentation on maintaining personal health. I’ll be the first to admit I’ve got a long way to go in that area. I’m vigilant about anything cancer-related, of course, but anyone who knows me knows the diet-and-exercise thing is a tough sell. The spirit is willing on that one, but the flesh is weak.

So, Claire and I left Princeton with a lot to think about. One of the benefits of this particular meeting was that it encouraged us in ministry – that most other-directed of occupations – to try thinking about ourselves, and taking care of ourselves, for a change.

Point well taken, Board of Pensions. I’ll try to do better.

January 10, 2009 - Walking the Beam

This past Wednesday, I had a routine appointment with Dr. Lerner. It went as so many appointments have gone before: a port flush and blood draw, then a consultation in one of the examining rooms. The good doctor looked through my chart, listened to my heartbeat and breathing and felt for enlarged lymph nodes in the usual places: on my neck, under my arms and in my groin.

There was nothing to write home about, as they say. No change. More watch and wait.

Dr. Lerner ordered another PET/CT Scan (my last one was in September). I’ll see him again in three months. Should the scan turn up anything unusual, he’ll call and ask me to come in sooner.

“How soon do you think it will be before the cancer’s big enough to treat?” I ask him, as he’s getting ready to leave.

“Impossible to say,” he replies. “This next scan could reveal something. Or, it could be years.” He gives me a little smile, before moving on to the next patient.

I’ve been looking through another of Dr. Wendy Harpham’s books, After Cancer: A Guide To Your New Life (Norton, 1994). I’m not sure if the “after cancer” label applies to me, but I’m surely “after treatment,” so I figure I may find something useful in those pages.

As it happens, I do. Wendy uses the metaphor of a gymnast walking the balance beam:

“Consider an analogy: Most of you could walk the length of a six-inch-wide beam placed on the floor. With the ground just inches away, you would focus on the beam and maintain your balance easily. If this same beam were raised five feet above the ground, most of you would weave and waver, flapping your arms as you tried to maintain your balance before falling off to the side. The beam would be exactly the same, yet the distraction of the ground five feet below would cause you to lose touch with the beam and lose your balance. Gymnasts learn to focus on the beam, not the ground. With practice, they rarely fall. When they do fall, they get right back on the beam. You, as a cancer survivor, must learn to focus on your present life, not on the uncertainties and unknowns of your future. It is a skill that can be learned and must be practiced.” (p. 214)

So, that’s what I’m doing, with all these doctor’s visits that reveal nothing worthy of note. I’m learning a skill.

Is my balance beam close to the ground, or high in the air? Impossible to say. Keep your eye on the beam, Carl. Keep your eye on the beam.

January 4, 2009 - The Last Chapter

The other day I was catching up on my reading, scrolling through the entries on some cancer blogs. On the blog of Mike Dellosso, a published novelist, I came across a short story he wrote, called “The Last Chapter.” (After clicking on the above link, scroll down to the very bottom of Mike's page for the link to his story.) He wrote it, he says, right after his own cancer diagnosis, as a sort of coping exercise.

I find it interesting to read, from the perspective of a cancer survivor. The story’s about a newly-diagnosed man, a construction worker, who learns from his doctor that his cancer is advanced and untreatable. He resolves to end his own life, then some experiences he has lead him to question that decision.

Here’s something Mike writes in another blog entry, dated December 30:

“I learned this: God is good all the time. ‘But how is getting cancer good?’ I have no idea. But I know this. God’s standard of goodness is not the same as ours. His understanding of goodness is on a different plane than ours. He sees things our eyes could never see. Knows things our minds could never even dream of fathoming. His idea of suffering is not the same as ours. He is God and I am not. And in that I have to place my trust.

I also learned this: God will never . . . ever . . . abandon me.”

Like the protagonist in Mike’s story, the news of a cancer diagnosis can shake our lives to their foundations. Most of us – like Mike, and like the man in his story – enter into this crisis and come out the other side, eventually, feeling stronger for the experience.

It’s one of the wonders of this experience called cancer.

“We know that all things work together for good for those who love God, who are called according to his purpose.” – Romans 8:28

January 2, 2009 - Hope Begins in the Dark

It’s a new year. Most of us are very glad to leave 2008 behind, with all the economic turmoil of recent months. May we have much better news in 2009!

There’s some encouraging news already on the cancer research front. A researcher at Cornell University named Michael King has developed something he calls a “lint brush” for the blood – “a tiny, implantable device that captures and kills cancer cells in the bloodstream before they spread through the body.”

This tiny, tubelike device contains a special protein called “selectin” on its inside surface. As blood cells flow through the tube, free-floating cancer cells bond to the selectin and are held there, so they can do no harm. Early test results indicate that about 30% of cancer molecules stick to the selectin on each pass. Since our blood circulates through the body constantly, this means that just one of these devices can eventually filter the body’s entire blood supply. Each repeated pass results in more cancer cells being corralled on the surface of the tube. Then, a second protein is released, causing the cancer cells to die.

I wonder if this device could work in the vessels of the lymphatic system, just as they do in the bloodstream?

Another article tells how scientists are scanning the ocean floor to discover new compounds that can be developed into anti-cancer drugs. The University of California at Santa Cruz has a set-up whereby sea-floor sediment is piped into special, chemical-scanning robots, that analyze them for compounds that could be useful to the pharmaceutical industry.

From the article:

“In its first year of operation, the lab has already had two interesting hits. One, the as-yet-unnamed product of a rod-shaped marine bacterium, is 98 percent efficient at killing the parasite that causes African sleeping sickness, a fatal disease common in sub-Saharan Africa. The other, dubbed ‘tamoxilog,’ is biologically similar to tamoxifen, a drug commonly used to treat breast cancer, though preliminary tests suggest tamoxilog is twice as powerful.”



Maybe the next big lymphoma drug is at the bottom of the sea, waiting to be discovered. Stranger things have happened.

Christian essayist Anne Lamott has written: “Hope begins in the dark, the stubborn hope that if you just show up and try to do the right thing, the dawn will come. You wait and watch and work: you don’t give up.”

I doubt if Anne was thinking about the inky darkness of the ocean floor when she wrote that. Her words are oddly appropriate, though: for this is surely a story of hope that begins in the dark.