February 22, 2026 - Still an Agent

For anyone who's keeping track of this cancer journey of mine -- that's (thankfully) been stalled for many years of remission -- I'm now back in the active mode. I'm in the between-time, neck surgery now behind me and radiation therapy due to begin in just over a week.

I've been dutifully loading up on the anti-seizure medicine, gabapentin. Once I reach therapeutic level, it's supposed to have a salutary effect on the pain that often accompanies radiation therapy, building slowly as week succeeds week. The opiates will always be there as a pain-control strategy of last resort, but my radiologist is hopeful we can avoid them as long as possible, in order to stave off addiction.

Today I came across an online essay by a survivor named Hans Casteels. It's about the cancer survivor experience. It sounds true to life. Here's an excerpt:

"Alright, let’s not kid ourselves. The most existentially important thing for a person with cancer is not hope. It is not courage. It is not resilience. It is not even survival, which is awkward, because survival is the thing everyone else becomes absolutely obsessed with, like it is the only metric that matters, the only acceptable outcome, the only box that must be ticked before you are allowed to have an opinion about anything ever again. The real prize, the thing that sits underneath all of that Hallmark vocabulary, is agency. Control. The stubborn, irrational, deeply human insistence that you are still the one holding the pen, even if the paper is on fire and someone in a white coat keeps trying to take it out of your hand.

Cancer does not just attack cells. That is the PR version. Cancer attacks narrative. It storms into your life and immediately rewrites the plot without consulting you. You were minding your own business, worrying about normal things like whether your password was strong enough or whether the pizza place had started using cheaper cheese, and suddenly you are rebranded as 'a cancer patient,' which is a role that comes with a pre written script and very limited creative input...."

I can relate to this. When I pull up on my laptop, these days, a week's worth of online calendar and survey the colored blocks, the majority of them are now medical appointments. And that's before I've entered into the calendar the daily radiology sessions due to begin the first week of March.

Hans continues...

"And somewhere in the middle of all this, something subtle and brutal happens. You stop being a person who has cancer and start being cancer who has a person....

Everyone means well. That is the most sinister part. The system is designed to help you, save you, optimize you, extend you. But in the process, it often forgets to ask the one question that actually matters: what do you want to do with the life you are allegedly trying to preserve? Not 'what treatment do you want,' which is the fake version of agency. That is like asking someone on a sinking ship whether they prefer the red or blue life jacket. The real question is much more uncomfortable, which is why it almost never gets asked: what still makes your life feel like yours?...."

For me, at the moment, it's writing. Not just this blog, but the stuff I'm doing on my Substack, Curated Sermon Illustrations.

Reflecting on that work, I've started calling myself a holy ghostwriter -- tapping my personal sermon-illustrations database to provide a daily dose of metaphor, story, quotation or poetry for the benefit of colleagues still engaged in weekly preaching. It's a practical application of the system I promote in my recently-published book, Illuminating Sermons: Curating Illustrations that Inspire.

Because I can write the daily Substack posts in advance, it's well-suited to navigating the peaks and valleys of the cancer experience. Substack will obediently churn out my pre-written posts on a daily basis, even if I reach the point where the radiation has laid me so low that I don't feel like writing anything for a while.

More from my fellow survivor, Hans...

"Hospitals are efficiency machines. They run on throughput, compliance, standardization, measurable outcomes. None of those things map neatly onto the messy, irrational, contradictory reality of a human being trying to make sense of their own existence while their body is actively betraying them....

And that, ultimately, is the real existential fight of cancer. Not against death, which is inevitable and frankly overrated as a philosophical concept. The real fight is against becoming invisible inside your own life. Against waking up one day and realizing that everyone knows your diagnosis, your staging, your biomarkers, your treatment plan, your survival curve, but no one knows what you actually care about anymore. Agency is what keeps you from dissolving into a medical narrative. It is what lets you say, quietly but stubbornly, this is still my life. Even now. Especially now.

Cancer can take your hair. Your energy. Your certainty. Your future. It can colonize your calendar and weaponize your body against you. But the one thing it should not be allowed to take, the thing that matters more than anything else in the end, is your authorship. Because once you lose that, you are not just sick. You are no longer the main character in your own story. And that, far more than mortality, is the deepest existential loss of all."

So, good friends, wish me well as I seek to keep this authorship thing going, in the midst of it all. If you want to check out my writing, you can do that by navigating over to my Substack. Feel free to subscribe to it, if you're so inclined, to get the daily emails. You can choose the free-subscription option, if you prefer -- I'm not in this for the money. I'm far more interested in staying relevant. And you can help me do that by reading what I write.

February 12, 2026 — Radiation on the Horizon

Today Claire and I went in for a consultation with Dr. Harry Quon, Associate Professor of Radiation Oncology and Molecular Radiation Sciences at Johns Hopkins Medical School. After performing the through-the-nostril scoping of my vocal cord area that I’m beginning to think is obligatory for laryngology patients, he shared some details about what’s ahead for my radiation treatments.

This Tuesday I’ll go in for a preparatory session with him, in which he’ll craft a custom plastic mask that conforms to the shape of my head. They’ll put that device on me each time I come in for a treatment. The purpose of the mask is to immobilize my head during the few minutes the radiation beam is being directed at my neck. Precise targeting of the beam prevents damage to other nearby tissues.

The doctor drew us a little diagram of the human neck. He told us he'll be directing the beam towards the space where the thyroid gland (for people who still have them) wraps around the front of the larynx. The purpose is to stop any thyroid-cancer cells that may still be remaining after the surgery from invading my larynx. The outer surface of the larynx will be irradiated along with other nearby tissue, but Dr. Quon's goal is to make that irradiated area as shallow as possible, so as not to damage the larynx.

With respect to the mask, he asked me if I have any problems with claustrophobia, and I was happy to be able to tell him that I don’t think I do. We’ll see.

Dr. Quon explained that, although the radiation sessions are brief, they’ll have a cumulative effect on me including especially fatigue, but also the likelihood of sunburn-like irritation to the skin of my neck. Some patients experience just redness, others sores and even blisters. Pain can become a growing issue over time, but they have ways of managing that. Some patients experience difficulty swallowing during the last weeks of treatment, but that side effect usually goes away once treatment is ended.

When I next see him, he’ll start me on a medicine called gabapentin. The primary use of gabapentin is as an anti-seizure medication, but that’s not why he wants me to take it. Apparently, it has an off-label prophylactic benefit of preventing nerve pain, if it’s started a couple weeks before radiation treatments begin.

He observed that my surgical incision is healing nicely -- which is good because radiation therapy typically results in a hardening of the skin in areas where the beam is directed. Towards the end of a series of treatments, patients sometimes need a massage-like form of physical therapy focused on breaking up hard masses that form under the skin.

My radiation treatments will probably begin in the first week of March. Fifteen minutes a day, five days a week. I should be able to drive myself there and back, the doctor says.

After the consultation was over, Claire suggested that we walk to one of her favorite places in the hospital, the larger-than-life marble statue of Jesus located in the atrium of the original hospital building. It’s called “Christus Consolator” by some, and “the Divine Healer” by others. Claire has memories of going to see it while visiting the hospital with her mother, who worked there for decades as a nurse. As sculptures go, it’s remarkably beautiful. Its location at what used to be the main entrance must have been quite moving to patients, back in the day. Because most people enter the sprawling hospital complex these days through other entrances, it's no longer something a whole lot of people get to see -- but it’s certainly worth a look. 

Here’s a write-up on the statue I found online:

“Baltimore society was shocked when the university opened in 1876 with no religious affiliation, as was customary for the time, prompting several news publications to question what kind of university it would become. At the hospital’s opening 13 years later, university President Daniel Gilman avoided any similar criticism by asking for ‘some friend of this hospital’ to fund the installation of a replica of the Christus Consolator statue in Copenhagen.

A close friend of Mr. Johns Hopkins, [local philanthropist William Wallace] Spence donated the funds to complete the statue — referenced by many as the “Divine Healer” — and it was unveiled on Oct. 14, 1896.”

It seemed a fitting detour to make as we’re on the threshold of this new healing adventure.

February 9, 2026 — Surgery Recap

Today, Claire and I went in for a consultation with my surgeon, Dr. Lelia Mady. We’d received a brief report from her on January 21, the day of the surgery, but this was a time to get more details.

Dr. Mady explained that she found the surgery to be more difficult than expected, due to extensive scar tissue in my neck from my two previous thyroid-cancer surgeries. Her written report references “numerous challenges which increased the complexity, time, and risk of the procedures.” Her report also refers to  “prior endocrine oncologic surgery as well as chemotherapy, radioactive iodine, and revision neck surgery which produced a tremendous amount of fibrosis in the neck and subsequent loss of normal tissue planes. The patient also had exceptionally challenging tumors involving multiple anatomically complex subsites of the neck. All of these factors together made the dissection and identification of critical structures more challenging than normal.”

She removed a large thyroid cancer tumor that had so thoroughly enveloped my recurrent laryngeal nerve (the one whose dysfunction has caused the paralysis of my left vocal cord) that it was impossible to save the nerve. Dr. Mady said she couldn’t even see the nerve, and it was probably removed along with the tumor. Bottom line is that there’s no hope of restoring healthy functioning of the paralyzed left vocal cord.

She explained that it was difficult to separate the tumor from my carotid artery — which the tumor had also wrapped around — but that she was eventually able to do that without damaging the artery.

She found thyroid cancer tumors that were in direct contact with the larynx, trachea and esophagus. In order to avoid damaging these essential structures, it was impossible to shave enough marginal tissue from those structures for testing to confirm that all the cancer has been removed. Dr. Mady explained that it’s likely that some microscopic thyroid cancer cells remain. Unless there’s something done to address this problem, there’s the possibility of the cancer invading the larynx, trachea and/or esophagus eventually.

The two treatment choices are watchful waiting and radiation beam therapy. She didn't mention the possibility of my swallowing another radioactive iodine pill, so I suppose that's off the table. Dr. Mady strongly recommends radiation because, if we were to wait and discover that the cancer had subsequently invaded the larynx, trachea and/or the esophagus, I could end up having far more serious problems.

We agreed that radiation is the way to go. She told me I could expect a call from the Johns Hopkins radiation oncology department to schedule an appointment with one of their specialists. I’ll also be having a consultation with Dr. Douglas Ball, my endocrinologist.

Dr. Mady shared a little about what to expect from the radiation treatments. For a period of 5 or 6 weeks, I’ll go in daily to the Sidney Kimmel Comprehensive Cancer Center in the Weinberg Building at the Johns Hopkins Hospital main campus for brief, daily radiation treatments to my neck. There are potential side effects from the radiation that the radiation oncologist will explain to me, including toughening of the tissues in my neck and superficial, sunburn-like burns to the exterior of my neck. They’ll need to monitor my carotid arteries carefully to make sure they retain their flexibility. For all the downsides of this approach, she thinks radiation therapy does offer the best hope of stopping the cancer’s advance.

Not the news we’d hoped for, but it’s not a huge surprise.  I’ll await a call from the radiation oncology department to schedule that consultation and get the radiation therapy appointments onto the calendar.

It’s fortunate that we live here in Baltimore City, just a ten-minute drive away from this world-class cancer treatment facility. I know I’ll be receiving the best care available.

More to come, as I learn more about what’s ahead...

February 7, 2026 — Normal Inspiration

It’s time for an update.

On February 3, I went in to see Dr. Alexander Hillel at the Johns Hopkins Medicine Greenspring Campus — in Timonium, just north of the city — for the injection into my paralyzed left vocal cord. It was not the most pleasant procedure, to say the least. I was conscious the whole time, so I’d be able to move my vocal cords on command.

I was seated in something like a dentist’s chair. Dr. Hillel’s resident inserted the tiny camera, at the end of a fiber-optic tube, into my nostril and down into the back of my throat. Then, Dr. Hillel sprayed lidocaine anesthetic into my throat — bitter-tasting stuff that caused me to gag. (From what I’d read during some internet research I’d done a little earlier, I’d learned that the gagging is part of the procedure — that reflex spreads the lidocaine all over the vocal cords and surrounding tissues.)

After waiting a few moments for the anesthetic to do its numbing work, Dr. Hillel had me stick my tongue out. He grasped it firmly using a square of gauze and pulled it straight out. Holding my tongue in one hand and a special curved hypodermic needle in the other, and guided by the tiny camera, he asked me to say “eee-eee-eee” to close the vocal cords as much as possible. Then he injected the collagen-like material into my vocal cord in a matter of seconds.

The pain was well-controlled, and it was all over very quickly. (This is where you want a highly experienced doctor doing this procedure — I expect Dr. Hillel has done hundreds of them.)

The doctor asked me if I wanted to see a video replay. He showed me on a screen exactly what he’d seen as he performed the injection. I could see the needle penetrate my vocal cord, causing it to plump up before my very eyes.

Curing the paralysis was not the purpose of the procedure. That will only happen if the damaged nerve eventually recovers, which is anything but certain. The reason for plumping up the paralyzed vocal cord is to move its leading edge to the center of the voicebox, so the healthy vocal cord is able to touch it. It’s the opening and closing of the vocal cords, and their vibration in sync with one another, that causes speech.

It’s kind of like a pair of theater curtains in a traditional proscenium arch. The curtains open and close as a stagehand pulls on a rope. In the closed position, the two curtains meet neatly in the center. But if one of the curtains is damaged, and the pull-rope controlling it is stuck in the half-open position, the curtains can’t do their job.

An obvious solution would be to repair the jammed control mechanism (which is analogous to restoring the nerve controlling the vocal cord). But that’s easier said than done. The only other option, in this analogy, is to sew some more fabric onto the curtain’s leading edge, extending it to the center, so the functioning curtain can meet it.

After a few minutes of observation — to make sure my airway remained open — I was cleared for Claire to drive me back home. I was warned to expect a sore throat, once the anesthetic wore off, and to rest my voice for the next day or so.

The result is that I can now speak without the laryngitis-like breathiness I’ve had ever since my neck surgery. My voice still sounds kind of gravelly — but clearly the vocal cords are now meeting in the middle, because I can produce enough volume for someone to hear me from more than a few paces away.

This is considered a temporary solution. The body will absorb the filler material eventually, probably after a few months, and the breathy voice will return. We’ll reassess options at that time. Another temporary injection is a possibility, as is a permanent vocal cord implant — a more involved surgical procedure, done through a small incision in the neck rather than by going down the throat.

As I met Dr. Hillel that day, he drew my attention to a framed poster on the procedure-room wall, with photos of vocal cords in various medical scenarios. One of the photos depicted a single paralyzed vocal cord, my situation. The first photo of the display, though, was captioned, “Normal inspiration.”

For a preacher, “inspiration” has a different meaning, having to do with the presence of the Holy Spirit. The Greek word for “spirit” also means “breath” — so, in medical terms, normal inspiration has no theological significance. It simply means the air is moving through the vocal cords normally.

I’m glad to know I left that procedure-room more inspired than when I went in.

On Monday, Claire and I have a consultation with Dr. Mady, my surgeon. I'm expecting she'll interpret for us what the detailed pathology reports — which are now in — are saying. We may also discuss next steps for dealing with the thyroid cancer. Further watchful waiting is always a possibility, as is a repeat of the radioactive-iodine pill I last swallowed in 2011. Targeted radiation-beam therapy may also be in my future, assuming they can find something large enough to target.