September 16, 2009 - Leaving on a Jet Plane

Sad news today, about the death of Mary Travers (of Peter, Paul and Mary fame). A blood cancer was the culprit – in this case, leukemia, with which Mary had been living for some years now.

From an MSNBC.com news article:

“Travers had undergone a successful bone marrow transplant to treat her leukemia and was able to return to performing after that.

‘It was like a miracle,’ Travers told The Associated Press in 2006. ‘I’m just feeling fabulous. What's incredible is someone has given your life back. I’m out in the garden today. This time last year I was looking out a window at a hospital.’ She also said she told the marrow donor ‘how incredibly grateful I was.’

But by mid-2009, [Peter] Yarrow told WTOP radio in Washington that her condition had worsened again and he thought she would no longer be able to perform.”

The last time I saw the trio in concert was a couple years ago, at the Great Auditorium in Ocean Grove, here in New Jersey. I suppose it was not long after her transplant. Mary leaned heavily on a cane, but as she opened her mouth to sing, she was a force of nature.

She’s leaving. Not on a jet plane (would that it were so), but on a far longer journey.

Mary’s powerful voice for peace, justice, love, hope – and, yes, faith – will be missed.

Go with God, Troubadour.

Leaving on a jet plane
by Lancer_MX

September 15, 2009 - Natural Born Killers

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

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

From an article describing the new development:

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

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

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

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

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

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

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

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

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

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

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

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

September 14, 2009 - We're Number 37

My friend and fellow pastor Rob Elder shared this video on Facebook. Some guy's written this satirical ditty reporting that the World Health Organization has ranked the United States #37 out of all the world's nations in providing health care to its citizens:



From the WHO's press release on the subject:

"The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. The United Kingdom, which spends just six percent of GDP on health services, ranks 18th. Several small countries – San Marino, Andorra, Malta and Singapore are rated close behind second-placed Italy."

We can do better.

Yes, we can.

September 14, 2009 - I Stand Corrected

Friday I had a long-scheduled appointment with Dr. Lerner, following my most recent CT and PET scans. I didn’t feel at all anxious going into this appointment. One of the nurses had phoned me the day after the scan with a message from the doctor, saying there was no significant change. I’m still out of remission, but the cancer hasn’t grown perceptibly since it first reappeared. It’s the sort of ambiguous news I’m used to getting from this decidedly indolent cancer.

The news could have been better – “no cancer” – but that’s highly unlikely, from what I’ve been told about this form of NHL. It could also, of course, have been worse – “the cancer has grown.”

I’m at neither extreme. I’m living with ambiguity, learning to take comfort where I can amidst the uncertainty of watch-and-wait.

There was one peculiarity the nurse had mentioned. “Did you have a fall?” she asked.

“No, what makes you think that?”

“Well,” she replied, "the PET scan shows some hot spots near your right ribs. That’s consistent with a recent injury, or it could be just an inaccuracy in the test.”

Dr. Lerner explained, when I saw him, that the PET scan shows three spots on my ribs. If I don’t recall getting a jolt in the ribs, he said, it’s probably nothing significant – a false positive. This is because the more accurate CT scan shows nothing out of the ordinary. That’s the one we trust for a detailed diagnosis.

As for the thyroid nodule, the follow-up ultrasound revealed the nodule had grown no bigger. If that proved to be the case, my endocrinologist Dr. Sher had told me some months ago, it probably means the nodule is benign (as he suspected anyway, from observing it).

That’s the problem with all this high-tech medicine. These machines are so powerful, they sometimes reveal non-problems we never knew we had.

I did learn something new from Dr. Lerner this time around: a fine point about the grading of my disease. I’ve been telling people – and writing in this blog – that, after chemo, my grading changed from “diffuse mixed large and small cell” to “follicular lymphoma.” When I described my cancer as follicular lymphoma, Dr. Lerner corrected me. Scanning the pathology report from my most recent biopsy, he told me I don’t have that grade. What I have is “diffuse small cleaved cell” lymphoma.

They're similar. Both are B-cell. Both are indolent types. Yet, when my cells are slathered onto the microscope slide, they don’t display the follicles that give follicular lymphoma its name. (Here's a sample of diffuse small cleaved cell lymphoma I found on the Internet...)

Not being schooled in the ways of these tiny cells, I can’t imagine how that difference is important. Surely it will have some influence on my treatment plan, when the time for further treatment finally comes. The details are understood only by people who peer through microscopes.

In a Google search, I came up with a page that describes the difference:

“We have investigated the cellular origin and/or pathogenesis of follicular small cleaved cell lymphoma (FSCCL), diffuse small cleaved cell lymphoma (DSCCL) and intermediate lymphocytic lymphoma/lymphocytic lymphoma of intermediate differentiation (ILL/IDL) based on a series of immunologic and molecular genetic (bcl-1, bcl-2 and bcl-3 genes) studies. These studies have led to the conclusion that the cellular origin or pathogenesis of ILL/IDL and DSCCL is distinctly different from that of FSCCL: (1) FSCCL is a neoplastic counterpart of follicular center cells (FCC) of secondary follicles because of the presence of CD10 and bcl-2 gene rearrangement and the absence of CD5 and bcl-1 gene rearrangement; (2) DSCCL and ILL/IDL are a neoplastic counterpart of mantle zone (MZ) B lymphocytes because of the presence of CD5 and bcl-1 gene rearrangement and absence of CD10 and bcl-2 gene rearrangement; and (3) FSCCL scarcely develops into DSCCL, and the previously proposed concept that DSCCL represents a diffuse counterpart of FSCCL does not hold good.“

Well, that’s clear as mud, isn’t it?

I’m just glad my DSCCL is indolent, like the FSCCL I formerly thought I had. Keep your siesta going, cancer cells. I can wait.

September 8, 2009 - Turned Toward Blessing

Today I come across a blog entry from last April by Dana Jennings, a New York Times reporter being treated for aggressive prostate cancer. Dana is Jewish, and writes eloquently on the intersection of faith and cancer. Here’s an excerpt:

“One of our cultural verities about serious illness is that it often challenges our faith. But for me, if anything, having cancer has only deepened it, heightened it.

I have spent the past year in the dark ark of cancer, and there is no question that I have become a new man. I’ve been granted a wisdom that only arrives at the rugged confluence of middle age and mortality. And I know, soul deep, that I have not been cut open, radiated, and tried physically and spiritually so that I can merely survive, become a cancer wraith. Since my diagnosis – after shaking off the initial shock – I have kept asking myself, in the context of my belief: What can this cancer teach me?

The most surprising thing I’ve learned is that cancer can be turned toward blessing. Through the simple fact of me telling my cancer stories on this blog, many of you readers, in turn, have told your own stories. And that mutual sharing of our tales has changed my life for the good. Rabbi Abraham Joshua Heschel said, 'Life is not meaningful, unless it is serving an end beyond itself, unless it is of value to someone else.'”

I like Dana's concept of cancer being “turned toward blessing.” I won’t ever be able to consider cancer a good thing, but our miraculous God can wring blessings out of even the darkest episodes of life.

In a remarkable way we, too, can be turned toward blessing. When we are able at last to make the move from cursing our fate to blessing others by our actions, we know the seeds of healing are taking root in our lives.

September 7, 2009 - Happy With Your Health Insurance?

Today I heard a phrase I’ve been hearing a lot lately in news reports about the health-insurance debate. It’s the concept of people who are “happy with their health insurance.”

Are you one of those satisfied consumers? Are you truly happy with your health insurance?

You’d think there must be an awful lot of happy Americans out there, the way Washington politicians have been spreading that phrase around, thick as manure.

I suppose there may actually be a few pleased policyholders out there. The nature of insurance, after all, is that some people need it more than others. Those who don’t submit many claims tend to be happy with their coverage. They take comfort in holding that wallet card. They feel protected.

Even if their medical safety-net is spun from pure fantasy, they feel protected. Maybe even happy.

The true test comes with hard times. I wonder how many who are happy with their health insurance have chronic medical conditions? These are the people who deal with the real world of medical insurance, not fantasy.

I’m fortunate enough to be doubly covered. The Blue Cross/Blue Shield insurance I receive through the Presbyterian Church is pretty decent. The secondary Qual-Care spousal coverage we purchase at group rates through Claire’s employer, Meridian Health, is a valuable back-up. It takes a big bite out of my 20% Blue-Cross/Blue Shield co-pay – which, when it comes to things like PET scans, can add up to a pretty penny.

Even so, I’m not happy with my health insurance. I’m not happy because I know I have to watch both insurance companies like a hawk. I know their profits are dependent on their denying customers’ claims. I know they reward their employees when they find reasons to deny or reduce payments – if not with outright bonuses, then with favorable performance reviews. I know there are so many middlemen and -women involved in the whole unwieldy process, so many paper forms, faxes and e-mails flying around, that there’s a huge potential for error. Just one omitted or misplaced pre-certification, one out-of-network service booked in error, and I could be left holding the bag for big bucks.

That unwieldy insurance bureaucracy – so complex, even the doctors’ professional claims-processors can’t make sense of it – adds as much as 30%, by some reckonings, to the cost of my medical care. Ultimately, that’s the cost of employing an army of people to push paper and tap on computer keys, not to mention squeezing quarterly dividends out of the system to keep insurance companies’ stockholders happy. It has nothing to do with the quality of my medical care.

I’m not happy with that.

Then, when I imagine the prospect of pursuing cancer testing and treatment without any medical insurance, I’m even less happy – not so much for my own sake, as for the sake of my at-risk neighbors who must do exactly that. I’m not happy being the beneficiary of a system that values stockholders more than sick people.

Dr. Len Lichtenfeld, a physician, has it right, in an August 8, 2009 blog entry on the American Cancer Society website:

“We have too many instances-and too many bankruptcies-where ‘satisfied’ people suddenly found themselves not so ‘satisfied.’ I am willing to bet that you (and me) have no idea whether or not your insurance will be a facilitator or a barrier to your care if you or someone you love becomes seriously ill with a disease like cancer. You just don’t know.

So don’t stand there and rail against your Congressman or Senator because you are ‘happy’ with your health insurance. I wonder how many of you have had a serious, prolonged illness in your family. If your experiences have been positive, terrific. But don’t discount that many others have not been so fortunate.”

Those yahoos shouting their Senators down at town hall meetings don’t seem to realize that this issue transcends any individual right to happiness. Are you happy with your health insurance, Mr. Redface Shoutington? Too bad. Your happiness can’t come at the expense of your neighbor, who worked just as hard as you did over the years, but who was either self-employed or whose employer wasn’t as beneficent as yours when it came to health benefits.

It’s a moral issue. Never before, in human history, has care of the sick been viewed as sick people’s own problem. It’s always been a community responsibility.

Some anthropologists, I’m told, date the rise of the human race according to the first skeleton they ever dug up that had a broken bone someone else had set.

We’re all in this together. That’s where true happiness comes from.

September 6, 2009 - Positively a Survivor

Today I come across a helpful website for cancer survivors from “across the pond.” It’s the MacMillan/CancerBackup website – evidently, a recent merger of two cancer-support sites.

There’s a lot of helpful stuff here about feelings and relationships, and how they impact the lives of cancer survivors. One item I found myself nodding along with addresses the whole subject of “being positive” – that common advice others often extend to us. Some of us may find ourselves thinking we ought to keep a positive attitude all the time, and that this is somehow essential to our wellness. Not so, says this website:

“When you talk to people with cancer, even the most positive of them will admit to low times when they felt depressed and anxious. No one can be positive 100% of the time. It’s important that you don’t feel that you must always stay on top of things. Being positive doesn’t mean having to feel happy and cheerful all the time. It’s a positive thing to acknowledge and talk about your feelings – even when you’re feeling tired, worried, depressed or angry.

There may be times when you want to talk about a difficult topic like the chance of the cancer being cured or making a will. Comments about being positive are then not always helpful - in fact, they can be very upsetting.”

Sometimes, you just can’t respond positively to cancer. There’s sadness associated with it, anger, even depression. It does no good to try to stuff powerful feelings like these, to deny that they’re present, out of a mistaken belief that keeping a sunny attitude is somehow therapeutic.

I think the most therapeutic thing, actually, is to try to keep closely in touch with our true feelings, to acknowledge them, to deal with them appropriately. This doesn’t mean bleeding all over our friends and family, emotionally speaking. But it does mean freeing ourselves from any prejudgment that there’s a particular way we ought to be feeling.

Most of us, I suspect, would do much better if we’d seek to banish that little word “ought” from our thinking, when it comes to feelings.

September 4, 2009 - PTSD?

Here’s a selection from a recent entry in the blog of Kaylin Marie, a young adult with cancer:

“...cancer doesn't end once you're in remission. It becomes a terrifying part of you, kind of like how Tom Selleck and his moustache have become one single entity. It haunts your dreams. I could go on.”

She then quotes D.H. Lawrence:

"...Slowly, slowly the wound to the soul begins to make itself felt, like a bruise, which only slowly deepens its terrible ache, till it fills all the psyche. And when we think we have recovered and forgotten, it is then that the terrible after-effects have to be encountered at their worst."

– Cancer Is Hilarious blog, August 13, 2009

That’s pretty heavy. But it’s the reality of cancer. Once you have the disease, the thought of it never completely leaves you.

There are triggers that can bring the whole experience roaring back. I remember I had an old, green shirt I used to wear to my chemo sessions. It had buttons down the front, which was a convenience when it came time to access my port. It was old and just a bit threadbare, which meant I wouldn't much care if some Betadine stained it. For months after my treatments were over, I could take one look at that green shirt and feel a wave of queasiness come over me. The shirt was a trigger.

The good news is, this sort of thing does get better with time. I don’t imagine Kaylin Marie has discovered that yet, because her treatments were so much more recent than mine. Yet, even so, that shirt will be, forever after, my chemo shirt. It hangs in the closet. I rarely wear it. These days, though, I can stand to look at it without it carrying me instantly back to the chemo suite, like some magic carpet.

I suppose there are some elements of post-traumatic stress syndrome (PTSD) in the cancer experience. Time may not heal all wounds, but it does seem – gradually, imperceptibly – to heal this one.

September 3, 2009 - Help a Bald Brother Out

I don’t know why I’m on such a video kick lately. People send these things to me (often on Facebook), and I pass ‘em on.

Here’s Larry David, of Seinfeld fame:

Larry David: Help A Bald Brother Out - watch more funny videos

September 1, 2009 - A Little Medical-Insurance Humor

August 26, 2009 - The Passion of His Life

The death of Senator Edward Kennedy is a milestone for our nation. He was, and remains, a controversial figure – flawed like all of us, but undeniably larger than life. Not even his opponents can dispute the impact he has had in advancing a variety of populist causes.

Among Ted Kennedy’s most enduring legacies is his struggle for affordable health care for all Americans. In this video clip, he calls it “the passion of my life,” then explains some of the personal reasons why:



I can relate to many of the stories he tells. Even though I’m fortunate enough to have good medical insurance, my own experience as a cancer survivor has acquainted me with neighbors for whom illness threatens not only physical infirmity and death, but also financial ruin. This is deeply wrong. It is even more deeply wrong that wealthy corporations continue to squeeze vast profits out of this broken system. Medical and insurance lobbyists exercise such power on Capitol Hill that even the voice of the overwhelming majority of the American public may not ultimately be heeded.

The dream of universal health care is not yet achieved. Strident voices are disrupting public meetings, in ways that intimidate fair-minded people and undermine democracy.

I resonate deeply with these words of Jim Wallis, in a tribute to the Senator published today:

“On the occasion of his death, I pray that God may now move us as a nation to address the greatest commitment of Sen. Kennedy's life - the need for a comprehensive reform of the health-care system in America - as a deeply moral issue and one that calls forth the very best that is within us. May we honor the life and death of Sen. Edward Kennedy by laying aside the rancor, lies, fear, and even hate that has come to dominate the health-care debate in America this summer, and regain our moral compass by recovering the moral core of this debate: that too many Americans are hurting and suffering in a broken and highly inequitable health-care system, and that it is our moral obligation to repair and reform it – now.”

This cause was the passion of Ted’s life. May it become the passion of ours as well

August 25, 2009 - Be Your Own Advocate

Here’s a rather shocking statistic from a recent study: 25% of abnormal medical test results never get reported to the patient.

Part of this is due to the negligence of certain doctors and their staffs – although, in some cases, it has to do with the national shortage of primary-care physicians. Often, it’s the primary-care physician who wrangles the test results and reports them to the patient. If someone’s getting their basic care from a doc-in-the-box or an emergency room, the lab or specialist may not have a clear idea of the chain of command. (In case you don’t know, a “doc-in-the-box” is a nickname for a walk-in clinic, at least here in New Jersey.)

Whatever the reason, this number is way too high.

Actually, something like that happened to me with my colonoscopy several years ago (results were normal in that case). I didn’t hear from the gastroenterologist, and I simply told myself, "I guess no news is good news." On a subsequent visit to Dr. Cheli (my primary-care doc) a few months later, I asked him if he’d heard the results of my 50th-birthday colonoscopy. He hadn’t, and had one of his nurses call back, then and there, to the office of the gastro guy. Then, I overheard him talking on the phone to one of that doctor’s office staff, chewing them out for not sending the results to either of us. Good thing there was no abnormality – although his office evidently didn’t have a fail-safe procedure in place for checking back in the event of results that never came.

All of this just goes to show us patient types: in this crazy, dysfunctional medical system, we’ve got to be our own advocates. If we don’t look out for our own interests, it’s very possible no one else will.

A word to the wise...

So, what about the rest of you? Have any of you had difficulties with test results not getting reported to either you or your primary-care doc? Sound off in a comment, below...

August 23, 2009 - That's a Lot of "I Dos"

This afternoon, I officiated at a wedding. As I was recording the details afterwards in my pastoral record book, I happened to notice that this wedding was the 250th I’ve performed, since my ordination in 1983.

That’s a lot of “I dos.” It’s hard to believe I’ve been through the premarital counseling process with so many couples.

Maybe I should have offered the couple a prize. You know, something like: "Congratulations! As the one millionth customer to walk through the doors of this department store, you’re the lucky recipient of a shopping spree!" Don’t know what I’d offer a newly married couple, though... Somehow, I don’t think a coupon for a complimentary marriage counseling session would be much appreciated (and would be no bargain, anyway, since I don’t charge for marriage counseling).

I like doing weddings. They’re such joyous occasions. Every couple is so different, yet also so similar in their hopes and aspirations. As I scan down the list of names in my record book, I can still picture a great many of them. Some I haven’t seen since their wedding day (often because they were in typical young-adult transition, and moved elsewhere). Others are still right here in this congregation. For some of those couples, I’ve already had their kids in confirmation class (no weddings, yet, of any of their kids – I haven’t been here quite long enough for that).

Some of them, I’m aware, have divorced. A sad, but true reflection of national trends.

Personal anniversaries like this are great milestones. They remind me there’s much more to who I am than my cancerversary.

Thank God.

August 22, 2009 - Laughter Yoga

This little video is endearing – and not just because it features the always-amusing John Cleese as narrator. I’ve heard of India’s “laughter yoga,” but have never actually seen it before, in action.

I figure this stuff has got to be therapeutic – but, if nothing else, it looks like great fun:



I’m especially intrigued by the observation that it doesn’t seem to matter whether the laughter is forced or natural: the therapeutic benefit is the same.

Of course, as the doctor points out in the video, even if participants are forcing their laughter at first, after a few moments of looking at all those goofy faces, only a rock could keep from laughing in response.

Maybe laughter really is the best medicine.

August 19, 2009 - Resilience

A New York Times article speaks of a new sort of training the U.S. Army is implementing for more than a million of its soldiers: training meant to encourage emotional resilience.

The goal is to reduce the incidences of post-traumatic stress disorder in soldiers returning home from combat. The Army’s going ahead with the training program, even though some have expressed doubt that the service’s macho, just-suck-it-up culture is compatible with such a touchy-feely approach.

Behind the training is Dr. Martin Seligman of the University of Pennsylvania, a proponent of “positive psychology” – an approach that focuses more on wellness and prevention than on treating pathology.

“Psychology,” he explains, “has given us this whole language of pathology, so that a soldier in tears after seeing someone killed thinks, ‘Something's wrong with me; I have post-traumatic stress.’ The idea here is to give people a new vocabulary, to speak in terms of resilience. Most people who experience trauma don’t end up with P.T.S.D.; many experience post-traumatic growth.”

I find that remark of Dr. Seligman’s interesting with respect to cancer survivorship. For many people, the effect of cancer treatment seems similar to that of a soldier in combat. The key is to slow the logical progression from thinking of one’s life as normal to seeing it as utterly devastated. In reality, there’s a whole spectrum of possibilities between those two extremes. Cancer need not be a life-shattering experience, no more than a tour of duty in a war zone needs to be. Both experiences are difficult, even life-changing. Yet, both are survivable, psychologically speaking.

Many of us cancer patients, at the time of diagnosis, operate from a stereotypical, worst-case understanding of the disease. Our minds leap to the assumption that it’s a death sentence. We imagine the next words out of the doctor’s mouth, after “You have cancer,” will be “I advise you to get your affairs in order.” It’s not that way, of course, and is becoming less and less so as time goes by, as new treatment protocols emerge from the laboratories.

Cancer survivorship is no picnic. But, it’s not death row either.

Elizabeth Edwards’ latest book is titled, Resilience: Reflections on the Burdens and Gifts of Facing Life's Adversities. I haven’t read it yet, although I did read her autobiography, Saving Graces: Finding Solace and Strength from Friends and Strangers. I find it interesting that Elizabeth has latched onto this word “resilience,” in light of all the trials she’s been through: losing a son, getting cancer, responding to her husband’s marital infidelity in the glare of national publicity.

I found an excerpt from the book online, in which Elizabeth tells of meeting a fellow cancer survivor named Mark Gorman. He carries around with him a slip of paper from a fortune cookie that says, “You cannot change the wind, but you can adjust the sails.”

So true.

Resilience. It’s a good word.

August 18, 2009 - The Breadth of God

Rabbi David Wolpe recalls how, when he was laid low by chemotherapy, a verse from the Psalms kept coming to his mind:

“From out of the depths I called unto God;
He answered me and set me free.” (Psalm 118:5)

“Out of the depths” is a classic expression of lament. Wolpe brings added perspective as a scholar of the original Hebrew:

“But ‘the depths’ can be translated as ‘narrowness’ and ‘free’ as ‘expansively.’ A literal translation is – ‘from my narrowness I called to God and I was answered by breadth, O God.’ My world grew through pain and the increasing recognition of the ways in which it both opened my heart and helped me draw closer to others in pain. A single verse opened a world and a way of seeing that gave me strength and the breadth promised by the verse itself.

My spirit opened to an infinitely larger Spirit. When in pain, we tighten up like a fist. It is easy to push others away – after all, they are not feeling the pain – and to turn increasingly inward. Only I matter; only my pain is real. The Psalm urged me to expand, allowing me to embrace others, to understand that pain need not always be private, unshared. Open up, the Psalmist taught; both in heaven and on earth you are not alone.”

- Why Faith Matters (HarperOne, 2008), pp. 159-160.

Paradoxically, the experience of serious illness can deepen the life of the spirit. That was Rabbi Wolpe’s experience, and in the long run, it's been mine as well.

There were no epiphanies – no memorable, soul-stirring moments of encounter with God. Just a broadening of life, at a time when all the wisdom of the world could predict nothing but a narrowing.

I’m not sure how often this is true of people who approach an experience like cancer without the resources of faith to draw upon. I’d be curious to hear some personal testimony from atheists or agnostics on that subject. It seems to me that, without faith, cancer therapy can only be a narrowing experience. So many limitations, so many life-changes, arise in the form of side-effects. Fatigue alone – probably the most common and pervasive of side-effects – is a significant narrowing experience.

The gift many people of faith are fortunate enough to receive, out of cancer treatment, is an unexpected experience of spiritual breadth.

It’s the breadth of God.

August 11, 2009 - Bring On Those Nanobees

There’s a widespread news story in the past couple days about “nanobees” – a technique of cancer treatment involving nanoparticles that head right for tumor cells. Researchers at Washington University in St. Louis have armed these tiny particles with melittin, a protein that’s the active ingredient in bee venom.

It’s a colorful image: swarms of nanoparticles racing through the body, locating cancer cells and stinging them to death. The fact that these particles are armed with a chemical found in actual bee venom verges on the poetic.

Here’s Paul Schlesinger, one of the researchers, commenting on why melittin shows such promise as an anti-cancer agent:

“Melittin has been of interest to researchers because in high enough concentration it can destroy any cell it comes into contact with, making it an effective antibacterial and antifungal agent and potentially an anticancer agent. Cancer cells can adapt and develop resistance to many anticancer agents that alter gene function or target a cell’s DNA, but it’s hard for cells to find a way around the mechanism that melittin uses to kill.”

So far, the researchers have had success in killing human tumor cells that have been implanted in mice. The nanobees have done their job on the tumors, delivering the melittin without causing ill effects in the mice.

This is important because, if melittin were injected directly into the bloodstream, it would attack hemoglobin cells. Somehow, when this protein hitches a ride on a nanoparticle, it holds off on its venomous attack until the nanoparticle delivers it to a cancer cell.

Yes, there’s a lot of lab work involved in developing a treatment like this. I find it interesting, though, that the new therapy’s essential ingredient is something found in nature – in the humble honeybee.

Whatever actual treatments may emerge from this new approach, it’s comforting to think that the answer was out there in nature, all along.

August 5, 2009 - Pulling the Boat to Shore

More from Rabbi David J. Wolpe’s Why Faith Matters...

Wolpe retells a centuries-old rabbinic parable, about a man in a boat pulling on a rope, in order to bring his boat to shore. From the illusory perspective of a passenger on the boat, it may seem as though the boatman is pulling the shore to him. In reality, of course, it is the boat that is moving. The land is solid, substantial, immovable.

Prayer is like that, says Wolpe:

“People have much the same confusion about spiritual weight and motion: In prayer, some believe that you are pulling God closer to you. But in fact the heartfelt prayer pulls you closer to God.

I have prayed in fear and in joy, in crisis and in calm. Each time I understood that what I was asking for was not the object of my prayer. My prayer that I would be healed was a prayer, stripped of all its topmost layers, to be assured that whatever happened would be all right. Every prayer in this way is a prayer for peace; it is peace in the world and in one’s soul, the certainty that the pain is not empty, the world not a void, the soul is not alone.”

- Why Faith Matters (HarperOne, 2008), p. 142.

No wonder so many scripture passages describe God as a rock that cannot be moved.

So much about the way we live our lives is egocentric. We really do believe – as the ancients believed about their home, the earth – that the universe revolves around us. One of our deep, spiritual tasks, as we mature through life, is to dispossess ourselves of this mistaken notion.

Cancer has a way of bringing that truth home all the sooner.

August 1, 2009 - In the Now

I’m sitting on the screened-in porch of our little house in the big woods – what they call, here in the Adirondacks, our camp. These are the waning days of my vacation.

I’m joined here today by our college-age daughter, Ania. She’ll be with me through the weekend, before we make the long drive home on Monday.

I picked Ania up at the train station in Fort Edward, near Glens Falls, late Friday night. The train was nearly 3 hours late – good ol’ Amtrak – so by the time we drove the couple hours back up to our camp, we didn’t get to turn in till 3 a.m. Needless to say, we both slept through the morning.

Ania’s working on a jigsaw puzzle, one she remembers from when she was much smaller. Of all the things we could be doing, this is what she wants to do right now, and that’s fine with me. This is her time, and I’m happy to simply enjoy it with her.

Turns out the puzzle is missing a couple of pieces. That doesn’t faze her. To Ania, it’s all about the process, not the product.

I’ve had a week and a half to ease myself into relaxation mode, but Ania has the gift of being able to jump right into it. She’s much better at living in the now than I am. I take a lot longer to shed all the to-do list items I typically carry around in my head.

Living in the now is a survivorship skill. Some of us are just slow learners.

July 31, 2009 - Praying in the Tube

Finishing out my vacation, I’ve been enjoying some quiet time up at our Adirondacks place, near Jay, New York. One of the good books I’ve been reading is Why Faith Matters, by Rabbi David J. Wolpe. David thoughtfully sent me a copy of his book, after reading my May 9, 2009 blog entry about him.

The book has a lot to recommend it. It’s a thoughtful, honest answer to recent critics from the scientific world, like Christopher Hitchens and Richard Dawkins, who have ridiculed faith and elevated scientific insights in its place. (It’s also a quick read, very accessible to people without extensive training in either theology or science.)

David is in the same place I am on that question, maintaining that religion and science need not be in conflict with one another. There’s no reason why a scientist cannot also be a religious believer, nor a believer someone who also accepts the insights of evolutionary biology or physics.

One part of the book that speaks personally to me is when David shares his personal experience as a cancer survivor. Like me, he has non-Hodgkin lymphoma, in an incurable form. Some years previously, he had surgery to remove a brain tumor. Here, he writes of his experience of prayer, as he’s undergone various medical tests:

“Throughout my various illnesses, I prayed. My prayer was not answered because I lived; my prayer was answered because I felt better able to cope with my sickness. Each time I go for my regular tests, the CT or PET scans or an MRI, each time I am moved into the metal tube that will give an image of sickness or health, I pray. I do not pray because I believe God will give me a clear scan. I pray because I am not alone, and from gratitude that having been near death I am still in life. I pray not for magic but for closeness, not for miracles but for love.

The novelist George Meredith wrote, ‘Who rises from his prayer a better man, his prayer is answered.’”

– Why Faith Matters (HarperOne, 2008), p. 25.

Some of the most heartfelt prayers any of us pray are those uttered “in the tube.” When we find ourselves in the tube, what do we pray for? Miracles?

I’ve wondered, on similar occasions, what the point is of praying for a negative test result (“negative” is, of course, a positive or good result in medical parlance). The machine, be it CT scanner or PET scanner or whatever, is simply taking a picture of whatever is there. I’m not praying for the result to come out skewed, of course – it’s in my best interest that the test be accurate, that my doctors fully understand whatever’s going on inside my body. When we offer prayers in the tube, are we praying that, if there’s a malignancy there, God will vaporize it then and there, in the few seconds before the picture is taken?

No, as David indicates, I think prayer is a good bit more complex than that. When we pray, we often do have specific results in mind, but more importantly, we’re seeking to be in communion with God, and perhaps also to feel a sense of solidarity with others who form the community of prayer. Indeed, we pray “not for magic but for closeness, not for miracles but for love.”

Of miracles, C.S. Lewis once wrote: “Miracles are a retelling in small letters of the very same story which is written across the whole world in letters too large for some of us to see.”

The point is, to catch that larger vision.

Prayer changes things. Prayer changes us.

July 22, 2009 - Dulanermin

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

“That’s me,” says I to myself.

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

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

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

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

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

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

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

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

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

Go for it, Luke.

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

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

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

July 20, 2009 - Where Not to Get Sick

If you haven’t yet read Atul Gawande’s article in the June 1, 2009 New Yorker about the high cost of health care in McAllen, Texas, you should. It’s a must-read for anyone who’s following the health care funding debate.

Why McAllen? Why should that dusty burg at the southern tip of Texas have the highest per capita health care costs in America? Gawande’s article is a detective story, chronicling his efforts to answer that question.

The answer he comes up with is that McAllen’s doctors are responsible for many of these elevated costs. They order up a whole lot of costly, high-tech medical tests, more than most other doctors around the country:

“The most expensive piece of medical equipment, as the saying goes, is a doctor’s pen. And, as a rule, hospital executives don’t own the pen caps. Doctors do.”

Remarkably, the highly-tested patients of McAllen are no healthier than patients elsewhere. Compared to some cities with lower medical costs, they actually do worse.

It’s not that McAllen’s doctors are less competent than doctors elsewhere, or that they’re morally challenged. Gawande’s explanation is that the entire medical system in McAllen is engineered – to a degree not typical of many other communities – to encourage doctors to order marginally-necessary, or even unnecessary, tests, and to prescribe costly treatments that may be no more effective than cheaper alternatives.

There are lots of reasons for this. According to Gawande, it’s a complex constellation of factors, including:

- a high rate of for-profit, physician-owned medical facilities;
- an entrepreneurial culture that sees doctors as businessmen and -women, rather than healers;
- a well-founded fear of lawsuits that leads to defensive medicine;
- comparatively less coordination of care than in other places, leading to duplication of services.

“Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coordination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check.”

It’s the system’s fault, says Gawande. This is a classic example of a systemic problem.

Gawande compares McAllen to another town that’s in the lowest 15 percent of health care costs, nationwide: Rochester, Minnesota, home of the world-famous Mayo Clinic. The most significant difference is that a high percentage of doctors in Rochester are employees of the clinic, rather than entrepreneurial owners of their own little medical businesses. Success in that setting is measured in healthy patients, not the number of patients served. The medical system in Rochester is engineered to maximize health outcomes rather than profits.

They say this article has become required reading in the White House, by staffers tasked with proposing to Congress a workable fix for the health-care funding crisis.

No wonder.

The American solution to medical cost-containment, until now, has been to rely on the insurance companies to ride herd on all this Wild West confusion. The only problem is, the insurance companies are no more concerned with positive health outcomes than physicians are. The insurance companies work for their stockholders, not for the patients.

We need to develop a health-care system that does work for the patients. Other countries (Britain, Canada, France) seem to know how do this better than we. This is a rare opportunity for our national leaders to think outside the box and develop a funding system that truly serves the greatest number of people.

Just don’t blow it, politicians. Take the lobbyists’ hands out of your pockets and pay attention to your constituents. We’re hurtin’ out here – especially in places like McAllen, Texas.

July 15, 2009 - A Common Story

Last night, Claire and I, along with our daughter Ania and niece Elizabeth, went to a midnight premiere of the film, Harry Potter and the Half-Blood Prince. It did not disappoint.

We’ve been fans of the Harry Potter books for some time, and have eagerly awaited each film as it’s come out.

I was struck by how many people showed up at our local multiplex (they were showing the film on at least two of their screens, possibly more). It’s a remarkable thing how many people of all ages have come to know and love these stories: enough to fill cinemas across the country till half-past three in the morning – and on a workday, at that. Judging from the comments we overheard, a great many of our fellow Potter-o-philes are very familiar indeed with minute details of J.K. Rowling’s teenage-wizarding yarn.

It’s a great thing to have a common story.

I was led to wonder how many people, in these days of secularism, feel such a passionate connection with the biblical story? Once upon a time, novelists, playwrights, screenwriters and other creative types could assume their audience could easily recognize biblical allusions. For example, I’ve been listening to a recording of Steinbeck’s great novel, East of Eden, as I drive around in the car. The book’s loaded with biblical symbolism. Were Steinbeck writing today, would he bother to tie his story so closely to archetypal biblical tales like that of Cain and Abel? Would his readers care?

The success of the Harry Potter oeuvre – and Tolkien’s Lord of the Rings before it – speaks to this secular culture’s hunger for a common story, a deeply moral tale grounded in religious sensibilities.

Every time I attend my monthly Leukemia and Lymphoma Society support group (and it’s been several months now since I’ve been there, due to schedule conflicts), I’m impressed by the power of the common story we cancer survivors share. The details, diagnoses and treatments may differ, but there’s a deep well of common experience. In a very real way, the story of my fellow group members is my story too.

Yes, it is a great thing to have a common story.

July 6, 2009 - A Week in Rivendell

Claire and I are spending the week at the Presbyterian House in Chautauqua, New York. Part of the venerable Chautauqua Institution, the Presbyterian House is an old-fashioned guesthouse that accommodates about 65 people. It’s adjacent to the 5,000-seat open-air Auditorium that’s the site of the principal concert, lecture and worship events that take place here.

I’m serving as Chaplain at the Presbyterian House. My duties are pretty light: I preached a sermon on Sunday, offer grace at meals and will conduct a program of my choice on Thursday evening (I’ll lead a discussion on John Calvin, since his 500th birthday is the next day). For this, Claire and I get free room and board for a week, as well as a “gate pass” that gets us into most of the concerts and events that take place here. A generous offer on the part of the Presbyterian House board, for which we’re very grateful.

Chautauqua’s quite an experience: a throwback, in many ways, to the early years of the 20th Century. It’s a picturesque lakeside village filled with Victorian-gingerbread houses. Cars are pretty much banned 7 days a week; the whole place is surrounded by a fence, and – except for Sundays – you have to have a gate pass (admission ticket) to get in. Some people own homes here, and others either rent places or stay in the many hotels and guest houses. Lots of people we’ve met have been coming here for decades.

Sitting in the Auditorium on Sunday, listening to Samuel Wells, chaplain of Duke University (the preacher for the week) give an excellent sermon, I was struck by how insular Chautauqua is. Introducing Sam was Joan Brown Campbell, former director of the National Council of Churches, who’s now head of the Department of Religion here.

Chautauqua is a bastion of old-time, liberal mainline Protestantism. While most historians agree the Protestant Ascendancy in America reached its high-water mark decades ago, in the Eisenhower era, you’d never know it here in this place. Looking out at the nearly-full auditorium, listening to the spirited singing of classic hymns accompanied by a massive pipe organ, I was struck by how much the place feels like a protected island in the storm.

Out there, mainline Protestant churches are struggling against fearsome cultural tides that threaten to sweep us away. Many local churches are enmeshed in “worship wars” that pit fans of guitar-accompanied praise songs against those who love organ-accompanied hymns. We’re beset by interminable, destructive debates over sexual ethics. My own baby boomer generation seems to be the first generation of Christians ever that doesn’t understand what committed, regular financial stewardship is all about, so many churches are cutting budgets and downsizing (and were doing so even before the present recession began). Out there, these are tough days to try to pastor a mainline Protestant church.

In here, though – inside the Chautauqua bubble – it’s as though none of this were happening. Life goes on here, as it has for generations. The faces of the preachers, lecturers and musicians change, of course, but the overall program is much as it’s always been.

Bill, a friend of mine, describes it as "Disneyland for intellectuals."

A literary metaphor occurred to me, as I was sitting there that first day, that to me describes the role Chautauqua plays in the mainline church. This place is Rivendell.

In J.R.R. Tolkien’s The Hobbit and The Lord of the Rings trilogy, Rivendell is the sheltered community of elves, whose powerful magic keeps creeping evil at bay. Much of Middle Earth is quaking in fear at the advancing armies of Saruman, and his more-powerful ally, the Dark Lord of Mordor, but in Rivendell, all is peaceful. When Frodo Baggins and his band of travelers reach Rivendell after facing all manner of perils, they know they are safe for as long as they tarry within the elves’ circle of protection.

Eventually, even the elves themselves will depart their “last homely house,” and somberly sail off in their elegantly-crafted sailboats to eternal life in the Grey Havens – which seems to function, in the Tolkien novels, as something like heaven. But, for the present, Rivendell is a haven in the storm, a place of rest, refreshment, and re-equipping for the battle.

I can use this sort of R&R in a personal sense, of course. I haven’t been thinking about cancer much, while I’m here – although a few Presbyterian House residents, knowing of my history with lymphoma, have come up to me to share their own struggles with the disease. I’ve been thinking a good deal more about how wonderful life in the mainline Protestant church would be if all our congregations were filled with members and ministers like the good folks here. There’s a real spirit of caring and openness and generosity that permeates the place. Would that we could recreate it in our own communities back home!

Looking out over the auditorium congregation, I was also struck by how much gray and white hair there is. This place is teeming with AARP members. Many of the younger folks we’ve met – twenty- and thirty-somethings with kids in tow – are here with their parents and grandparents. It’s a popular spot for family reunions. Would the younger ones choose to come on their own?

All of which raises the question.... Whither mainline Protestantism? Will this congenial crowd return to their home churches, refreshed and renewed, equipped to bear witness to the gospel in edgy, new ways? Or, will they hang around spiritual oases like this a while longer, before packing it in and sailing off to the Grey Havens one day?

I’ve got a feeling the renewal of the mainline church won’t be sparked in places like Chautauqua. As wonderful as this place feels, it’s more about the past than the future.

But even so, it feels good to rest here a little while. Even the Fellowship of the Ring had to take a breather in Rivendell.

July 3, 2009 - Profits and Pain

A recent editorial in one of my favorite journals, The Christian Century, raises a pertinent question about the present healthcare-reform debate:

“The logic of putting citizens into a government-sponsored insurance pool is clear: it drastically cuts overhead, equalizes care, and meets the needs of those who can't afford or obtain coverage from for-profit insurers, who cut their costs by excluding patients with serious medical problems – precisely the people who most need the insurance and the medical care. But that logic alone will hardly slay the hardline defenders of the for-profit insurance system. The political and practical question of the moment... is whether there is any viable compromise – is there a coherent incremental step between the private system we have now and a full-fledged single-payer public plan?”

President Obama seems to think there is – which is why he’s backed away from his campaign promise to move expeditiously to a single-payer health system. Now, he’s mired in the boggy no-man’s-land between the single-payer advocates on the one hand and the insurance companies (clinging to the tattered remnants of our dysfunctional healthcare-funding system) on the other. He’s dodging rotten tomatoes being hurled from both sides.

It’s a battle of ideologies: between the free-market true-believers on the one hand – who are convinced not only that “the business of America is business,” as Calvin Coolidge famously said, but that the best marketplace regulation is no regulation – and those who believe history teaches, on the other hand, that a capitalist economy will end up eating its young if government doesn’t step in with some timely regulation.

In the same issue of The Christian Century, social ethicist Gary Dorrien makes this important observation:

“A fair amount of time has to be spent repeating over and over that single-payer is not socialized medicine, and a public option among private competitors is even farther from it. But we are approaching the point where opponents of health-care reform will start to stress the opposite concern. Their concern is not that a government program won’t work. The real worry, for all who want to keep the present system, is that a government program will work too well.”

“Working too well,” of course, means cutting into Big Insurance’s profits.

Are profits always good? That’s the essential question. Are they still good, even when the unfettered pursuit of profits causes pain for increasing numbers of people? How many of our neighbors must feel pain before the larger culture sits up and takes notice, demanding substantive change? How many uninsured and undertreated Americans is our system willing to throw under a speeding ambulance, before we’re willing to even consider following the lead of just about every other industrialized nation, implementing a national health-insurance system?

That’s the question I sigh and ask myself these days, anyway, as I scan the headlines.