May 9, 2009 - A Most Useless Place?

Dr. Wendy Harpham sent me a link to the blog of Rabbi David Wolpe, who also has non-Hodgkin lymphoma. Several years before that, he had surgery for a brain tumor. Here, he writes about receiving his last Rituxan infusion, ending a two-year follow-up regime after chemotherapy for NHL:

“Recently I had the final infusion. But I was not at all sure that pulling away the safety net was a cause for celebration. My doctor poked his head into the curtained chamber to assure me that he expected a long remission. Kind of him, but what could he say?

Remission is cancer's suspended animation. The renegade cells are poised to return but no one knows when. It could be a month or a decade; for my type of lymphoma (one of the more than thirty varieties of Non-Hodgkin's lymphoma) there is no cure. So I am stuck in what Dr. Seuss – in a book I used to read to my daughter – calls “a most useless place. The Waiting place....’”

A most useless place. That phrase does sum up how it feels, sometimes. Unlike David, I’m out of remission – have been for a couple of years – but there are days when I, too, feel like I’m in suspended animation.

David’s experience is similar to mine, too, in that he is a member of the clergy, serving a congregation:

“I had the strange, surreal experience of hearing my congregants' shock that this could happen to the family of the Rabbi – as though professional piety was a shield against disease. As though God played favorites.

Right before my brain surgery I appeared in front of the congregation and asked them for their patience and their prayers. Three year later I was standing before them, bald. I witnessed the realization in their eyes that there are no guarantees, no protected people. No one is safe.”

No, no one is safe. Yet, that observation ought to be surprising only to those who believe God is some cosmic puppeteer, manipulating the lives and loves and illnesses of us poor, benighted souls who dwell below. Is cancer a thunderbolt, cast down in righteous anger from Olympian heights? I’ve never seen it that way – although I’ve met plenty of people, both inside and outside my church, who fear it may be.

Granted, there are strains within the biblical tradition that portray God that way. God punishes the ten spies who brought back an unfavorable report of the promised land by killing them with plague (Numbers 14:37). God gives the adulterous David and Bathsheba’s infant love-child a fatal illness (2 Samuel 12:15-17). Even worse, God famously afflicts Job with boils, not because he’s an unjust man but simply because God wants to win a debate with the devil.

Yet, before everything is said and done in the Hebrew scriptures, the Lord is portrayed as “merciful and gracious, abounding in steadfast love” (Psalm 103:8). That’s the majority witness. When it comes to the New Testament, of course, God not only sympathizes with human suffering, but personally undergoes it, becoming incarnate as Jesus Christ.

Yet, the ancient images of a capriciously angry God, that dread smiter of sinners, are maddeningly persistent. “What did I do to deserve this?" is the anguished cry we pastors hear again and again, whether spoken or unspoken, standing at the foot of many a hospital bed.

No one is safe. We’re all going to die. Some of us sooner than others. If we’re spared from some fatal catastrophe on the highways, we’re all going to hear some doctor admit to us, someday, “I’m sorry, but there’s nothing more medical science can do for you.” Is this God’s judgment?

The story of Adam and Eve in the Garden suggests it is. Death is, that story suggests, God’s judgment on the entire human race. That may be so, but, unless we toss out all the biblical witnesses to God as patient and merciful, it’s hard to make a case for God micro-managing the entries in our individual medical files. We belong to a race for whom that dark, old lullaby is all too true:

“Hush, little baby, don’t you cry,
for you know your mama is born to die...”

The divine decree of death is meted out to the human race en masse, not on a case-by-case basis.

The fact of death is perhaps the deepest mystery we children of Adam and Eve seek to plumb – as Rabbi David has himself come to realize:

“For now I am just waiting. I am trying to find my own way through this because, inevitably, I will be asked how I did it. Rabbis are supposed to be figures of authority and calm. It was hard enough to reassure my congregation that a fickle universe does not mean that God is absent. That belief does not indemnify me against adversity. That my faith through all this is unshaken. How does one live, Rabbi, is the question my congregants ask, of not so directly. Tell me, Rabbi – it is your job to know.

My answer, I now realize, is: Live as if you are fine, knowing that you are not. Death is the overriding truth of life but it need not be its constant companion. My safety net is gone. I feel, as all people in remission do, that each time I fly my hand may slip from the trapeze. But to live earthbound is to give the cancer more than it deserves.”

The place David and I find ourselves in may feel, at times, like “a most useless place.” On deeper examination – and, viewed through the eye of faith – it turns out to be anything but.

May 7, 2009 - Microscope-Ready

Good news, today, in the form of a news article about government allocations for medical research. The article in Bloomberg News reports on what one researcher calls “a stunningly large number” of dollars – $10.4 billion of ‘em, to be exact – that will be devoted to curing what ails us. “Breakthrough findings on obesity, AIDS, Alzheimer’s, Parkinson’s and cancer” are on the way, the article predicts.

President Obama has included this amount as part of his $787 billion shot in the arm for the economy. There’s been lots of talk about rebuilding the nation’s crumbling infrastructure through “shovel-ready” projects like bridges and highways. It’s nice to know there are some microscope-ready projects, as well, to benefit those of us with chronic illnesses.

There are some who say that, once you have cancer, never a day goes by that you don’t think about the disease, at least once. I’m pretty sure that’s continued to be true for me, during this extended period of watch-and-wait. Some days I think about it a lot, other days it’s no more than a fleeting thought. Yet the though is always there, if only lurking below the surface.

I would a great thing, indeed, if I didn’t have to think about it anymore.

It would be a great thing, as well, if some additional billions would be used to buy health insurance for those without it – although I suppose that’s coming down the pike soon enough, along with the rest of the President’s healthcare-funding proposal.

Why is this important? Check out this 7-minute video that tells what an impossible fix a hard-working American family can get into when cancer comes knocking at the door:



Quite apart from the humanitarian factor, cleaning up our nation’s broken healthcare-funding system – that leaks dollars like a sieve – will actually strengthen the economy.

Now, that’s the sort of win-win scenario that even a fiscal conservative ought to be able to appreciate.

April 26, 2009 - Libation

Responding to my April 20th entry, a reader named Christine writes:

“My cancer has progressed to the point where I am on my last leg of this journey. I was wondering if you could direct me to what the Bible says about facing death. In essence, what are your thoughts on dealing with grief and sorrow? My journey has been four years and as I approach the end, surprisingly I find that my emotional and spiritual struggle have not diminished but intensified.”

Wow. I had to think about that one for several days, before attempting an answer. It’s not that I’ve never had to supply this sort of counsel before; it’s just that Christine poses her question so bluntly. Most people whom I visit in their final days raise the question obliquely, if at all. Whether they ask the question directly or not, I typically respond by sharing some of the great scripture passages that witness to God’s reliable presence.

For example, there’s Psalm 139, in which the psalmist imagines himself journeying to the very edges of the known world, only to find God still there beside him:

“If I take the wings of the morning and settle at the farthest limits of the sea,
even there your hand shall lead me, and your right hand shall hold me fast.” (Psalm 139:9-10)

For those who struggle with fatigue, cancer-related or otherwise, there’s always Isaiah 40:28-31, that promises:

“Those who wait for the Lord shall renew their strength, they shall mount up with wings like eagles, they shall run and not be weary, they shall walk and not faint.” (Isaiah 40:31)

Those of a philosophical bent may find some comfort in the timeless contemplations of “the Teacher” who wrote the book of Ecclesiastes. In these verses – immortalized for my generation by Pete Seeger’s folk anthem, “Turn, Turn, Turn” – he recalls how, in life, there is a time for everything, even a time to die:

“For everything there is a season, and a time for every matter under heaven:
a time to be born, and a time to die;
a time to plant, and a time to pluck up what is planted;
a time to kill, and a time to heal;
a time to break down, and a time to build up;
a time to weep, and a time to laugh;
a time to mourn, and a time to dance...” (Ecclesiastes 3:1-4)

THE BYRDS - Turn ! Turn ! Turn !
by danadi33

Certain psalms, like Psalm 69, pull no punches when it comes to voicing the honest cry of human anguish. Perhaps, Christine, you’ve felt like this in recent days:

“Save me, O God, for the waters have come up to my neck.
I sink in deep mire, where there is no foothold; I have come into deep waters, and the flood sweeps over me.
I am weary with my crying; my throat is parched. My eyes grow dim with waiting for my God.” (Psalm 69:1-3)

So, what does it mean to speak of God saving us, in a time of serious illness – perhaps even illness unto death? Some may be tempted to blithely drop a pollyanna catch-phrase, like “Expect a miracle!” Yet, this is unrealistic, maybe even deceptive. We all know miraculous reversals like this – the sort that cause doctors to scratch their heads and say, “I don’t know what happened, there’s no medical explanation for the way that tumor just disappeared” – are rare indeed. Besides, even in those fortunate cases where a terminal illness reverses itself, the patient is still going to die of something, eventually. No, that sort of miracle merely buys a little time, that’s all.

No, the only ultimate consolation comes from promises such as Jesus’ words in John 11:25-26:
“I am the resurrection and the life. Those who believe in me, even though they die, will live, and everyone who lives and believes in me will never die.”

Seeking to describe the life to come, Paul resorts to a variety of metaphors. In 2 Corinthians 4:16-5:1, he likens this present life of ours to a tent – a temporary dwelling, slated to be replaced by something more permanent:

“So we do not lose heart. Even though our outer nature is wasting away, our inner nature is being renewed day by day. For this slight momentary affliction is preparing us for an eternal weight of glory beyond all measure, because we look not at what can be seen but at what cannot be seen; for what can be seen is temporary, but what cannot be seen is eternal. For we know that if the earthly tent we live in is destroyed, we have a building from God, a house not made with hands, eternal in the heavens.”

In 1 Corinthians 15, Paul uses a different, organic metaphor, that of a seed planted in the ground – one I’ve cited just upstream, in my April 14th entry.

At the end of the day, though, all these are just metaphors. Such poetry, lofty as it may be, captures the emotion, but inevitably falls short on details – for, who can chart with certainty lands no human has visited, save on a one-way journey? (Jesus, of course, being the notable exception, and he wasn’t talking – not on that subject, anyway.)

In the course of my pastoral ministry, I’ve spoken with more than a few people who’ve had near-death experiences. There are more of these people around than you may think. Most are pretty quiet about it. They’re hesitant to speak of such experiences, for fear of being misunderstood – but, if you give them a chance, they’ll speak in hushed tones, eyes brimming with tears, of bright visions no words can capture. I feel incredibly privileged to have heard a few of these firsthand testimonies.

We can’t make too much of these subjective experiences, though. They’re elusive, dreamlike – merely the shadow of a suggestion of what the next life may be like. Still, I take some comfort, personally, in observing that, whatever these soul-travelers experienced, there was no terror in it: only a sense of comfort and welcome and peace.

Reflecting on his own impending death, the pseudonymous author of 2 Timothy speaks of his hopes and fears using the common coin of his own culture. He portrays his life as a “libation” – a sacred offering of wine, to be poured out onto the ground, as the Greeks and Roman were wont to do:

“As for me, I am already being poured out as a libation, and the time of my departure has come. I have fought the good fight, I have finished the race, I have kept the faith. From now on there is reserved for me the crown of righteousness, which the Lord, the righteous judge, will give to me on that day, and not only to me but also to all who have longed for his appearing.” (2 Timothy 4:6-8)

Back in my chemo days – when I was feeling sick as a dog and far from certain Dr. Lerner’s promises of a likely remission would ever come to pass – I wondered if my own life was turning out to be just such a libation.

It’s a powerful image, even though we have to work a bit to translate it into 21st Century terms. Then, as now, it defies reason to upend a perfectly good cup of wine and pour its contents out upon the ground: but sometimes that primitive calculus is the only response that makes sense in face of the absurdity we call “death.”

Surely, we protest, there’s got to be a better way. Surely, God – if the Bible’s descriptions of divine power are true – has the ability to arrange things in some other way for us.

The hard fact is, God chooses not to exercise that ability. Sooner or later, our life-force is bound to run out in rivulets, like that libation-offering, poured upon some unimaginably ancient block of stone.

A libation. That’s what we’ll be, one day.

Poured out. An offering to a God who (we can only hope) is, as the scriptures teach, “gracious and merciful, slow to anger and abounding in steadfast love” (Psalm 145:8).

If that is so, we will one day be able to affirm, with Paul, that:

“...in all these things we are more than conquerors through him who loved us. For I am convinced that neither death, nor life, nor angels, nor rulers, nor things present, nor things to come, nor powers, nor height, nor depth, nor anything else in all creation, will be able to separate us from the love of God in Christ Jesus our Lord.” (Romans 8:38-39)

That’s the sort of thing I’d be inclined to say to you, Christine, by way of summarizing the Christian witness about life and death.

On a more personal note, I’d also like to encourage you to try to step back and get some perspective on the faith-struggles you’re going through right now. A certain amount of angst is to be expected. Strong emotion is understandably part of the experience. Cancer stinks. So does an early death. There’s no way to sugar-coat such hard realities.

I wouldn’t be at all surprised if you’re feeling angry, as well. Just read through some of those biblical psalms of lament, and you’ll quickly realize you’re not alone in this.

Doubt can be part of the psychic landscape, as well. (Remember, even Jesus went through his own crisis of faith in the Garden of Gethsemane.) You may worry, at times, that you’re losing touch with all the beliefs you once held dear, but that’s simply what dying is like. It’s profoundly disturbing and disorienting (Hollywood cliches about falling gently back on the pillow notwithstanding).

There’s nothing more disturbing nor disorienting in all of life. If - as the Christian faith teaches - death is actually rebirth into a new way of living, then wouldn’t it be reasonable to expect a bit of birth trauma? Just try to keep your eyes upon Jesus, the one whom the letter to the Hebrews calls “the pioneer and perfecter of our faith” (Hebrews 12:2).

May God be with you.

April 25, 2009 - Take a Little Wine

“No longer drink only water, but take a little wine for the sake of your stomach and your frequent ailments.” So says 1 Timothy 5:23 – a little practical advice, in the midst of some miscellaneous exhortations at the end of this New Testament letter.

Who woulda thunk it? Who could imagine this homey, first-century medical advice would surface at a 21st Century cancer research conference?

It has, though – at least, according to a recently-released research study. From a news article describing it:

“Pre-diagnostic wine consumption may reduce the risk of death and relapse among non-Hodgkin's lymphoma patients, according to an epidemiology study presented at the American Association for Cancer Research 100th Annual Meeting 2009.... [The researchers] analyzed data about 546 women with non-Hodgkin's lymphoma. They found that those who drank wine had a 76 percent five-year survival compared with 68 percent for non-wine drinkers. Further research found five-year, disease-free survival was 70 percent among those who drank wine compared with 65 percent among non-wine drinkers.” (“Drinking Wine May Increase Survival Among Non-Hodgkin's Lymphoma Patients,” ScienceDaily, April 24, 2009.)

Admittedly, those numbers aren’t all that startling. The wine-bibbers get a mild statistical bump, that’s all. Draining Bacchus’ cup is clearly no panacea, but it does seem that “a little wine,” as the author of 1 Timothy advises, can be good for what ails ya.

Not every tippler will be happy with the study’s results, though: “Beer and/or liquor consumption did not show a benefit,” the report soberly concludes.

It’s just the vino, folks.

According to the article, wine has certain anti-oxidants that tend to retard tumor growth. This is consistent with some earlier studies that show wine (especially red wine) has a mild positive effect on heart health. An occasional glass of Chianti or Lambrusco is part of the highly-touted “Mediterranean diet.” Now, it appears the fruit of the vine does a little something for lymphoma prevention as well.

The oncologists aren’t exactly advocating pub crawls. Far from it: “This conclusion is controversial, because excessive drinking has a negative social and health impact, and it is difficult to define what is moderate and what is excessive,” says one of the lead researchers, by way of a disclaimer.

(Nota bene: 1 Timothy does specify “a little wine.” All things in moderation.)

I’ve always thought an occasional glass of red wine to be one of life’s little pleasures. It’s nice when something that tastes so good turns out to be good for you, as well.

Wine has even found its way into religious poetry on occasion. I close with these lines from the medieval Persian poet, Rumi:

“The grapes of my body can only become wine
After the winemaker tramples me.
I surrender my spirit like grapes to his trampling
So my inmost heart can blaze and dance with joy.
Although the grapes go on weeping blood and sobbing
‘I cannot bear any more anguish, any more cruelty’
The trampler stuffs cotton in his ears: ‘I am not working in ignorance
You can deny me if you want, you have every excuse,
But it is I who am the Master of this Work.
And when through my Passion you reach Perfection,
You will never be done praising my name.’”

– Mevlana Jelaluddin Rumi (1207 - 1273)

Salut!

April 20, 2009 - Known By Our Wounds

Sunday’s sermon afforded me an opportunity to mention cancer survivors’ issues. I was preaching on the post-resurrection appearance of Jesus in which his disciple, Thomas, needs to see and touch Jesus’ wounds in order to be convinced of the truth of the resurrection.

As I pondered anew the meaning of this familiar scripture text, it struck me how noteworthy it is that the disciples know Jesus by his wounds. It’s very true-to-life, psychologically speaking. Often, we do know one another by our wounds, by the adversaries we’ve bested (or are still struggling against).

From the sermon:

“Sometimes the scars are visible, peeking out from the surface of our skin. More commonly, our wounds are hidden: either beneath our clothing or concealed deep in the recesses of our soul - rarely talked about, seldom acknowledged. Those friends and family who know us well, know of their existence. They, too, know us by our wounds.

When neighbors of ours go through some grueling medical ordeal and survive it, we come to know them, too, by their wounds. See the neighbor across the street climbing into his car? You can't help but recall the triple coronary bypass he had a couple years ago. Greet your co-worker in the office one morning, the one whose speech is just a little fuzzy - the last reminder of the stroke that first took all her speech away, then slowly gave it back, word by word, through hard work with the therapists. Every time she opens her mouth, you marvel at how far she's come.

I suspect that, as many of you look at me, you can't help but recall the word, "lymphoma." Once you become a survivor of something like that, it becomes a part of who you are, for better or for worse. Our wounds, in life, have a way of molding and shaping us.”

As part of the sermon, I shared with the congregation a quote from surgeon and author Richard Selzer. I’ve long been an admirer of his writing. This is from an essay called, simply, “Skin.” It’s a doctor’s appreciation of this largest organ in our bodies, that covers and protects us, even as it serves as our interface with the outside world:

"I sing of skin, layered fine as baklava, whose colors shame the dawn, at once the scabbard upon which is writ our only signature, and the instrument by which we are thrilled, protected and kept constant in our natural place.... Gaze upon the skin as I have, through a microscope brightly, and tremble at the wisdom of God, for here is a magic tissue to suit all seasons. Two layers compose the skin - the superficial epidermis and, deeper, the dermis. Between is a plane of pure energy where the life-force is in full gallop. Identical cells spring full-grown here.... No sooner are these cells formed than they move toward the surface, whether drawn to the open air by some protoplasmic hunger or pushed outward by the birth of newer cells behind.... Here they lie, having lost all semblance of a living cellularity, until they are shed from the body in a continual dismal rain. Thus into the valley of death this number marches in well-stepped soldiery, gallant, summoned to a sacrifice beyond its ken. But let the skin be cut or burned, and the brigade breaks into a charge, fanning out laterally across the wound, racing to seal off the defect. The margins are shored up; healing earthworks are raised, and guerrilla squads of invading bacteria are isolated and mopped up." [Richard Selzer, Mortal Lessons (Simon & Schuster, 1976 ), pp. 105-106.]

We can look at scars, it seems to me, in two ways: as a reminder of something bad that’s happened to us, or as a reminder of a powerful process of healing that continues to be active in our bodies.

The nature of my cancer treatment has been such that I’ve never needed surgery. Consequently, the only cancer-related scar I carry on my body is the small one, near my collarbone, that marks the place where my chemo port was implanted (and where it remains to this day, in case it’s ever needed).

The scars, the wounds, I bear as a result of my treatment are of a less-visible nature. I’m more vulnerable now, and also more aware of my mortality. I operate less out of a sense of spiritual entitlement: no longer assuming the unconscious, childlike belief that if I just do the right thing, God will reward me. The universe doesn’t seem to be as safe a place as I once assumed it was: I’m all too aware that God has inserted a frightening degree of randomness into the creation.

Still and all, it’s not a bad place to be. Cancer may have beaten me up a little, but it hasn’t kept me down. I’m learning to move on from here, scars and all.

April 14, 2008 - Encounter with the Gardener

It was a glorious Easter this year. From the spectacular sunrise over the Atlantic at the 6 a.m. Community Sunrise Service, to the festive atmosphere at two well-attended services in our Sanctuary, it was a day to remember.

I decided to preach on a line from John’s Easter story to which I’ve never paid much attention before: “Supposing him to be the gardener, [Mary] said to him, ‘Sir, if you have carried him away, tell me where you have laid him, and I will take him away’” (John 20:15b).

It’s always struck me as odd that Mary Magdalene, who knew Jesus well, would mistake him for a gardener. Some commentators have speculated that maybe it was still dark enough to make it hard to pick out the details of another’s face. Others have wondered whether Jesus’ resurrection body was sufficiently different from the body he’d walked around in previously that maybe it was hard to make the connection.

And why a gardener, anyway? Sure, it was a garden tomb in which his body had been laid, but that doesn’t explain why John includes this otherwise insignificant detail.

In the sermon, I present the idea that maybe John is subtly trying to make a theological connection between Jesus the gardener and the story of another gardener: God, who set Adam and Eve up in the Garden of Eden, then later barred them from it on account of their disobedience.

From the sermon:

“We’ll never know what was in John’s mind, of course, but it’s certainly worth pondering. Maybe the man Mary looks up and sees, through tear-filled eyes, is the gardener, after all. As our Christian faith teaches, Jesus Christ is the second person of the Trinity, being – as the Nicene Creed puts it – ‘of one substance with the Father.’ That means it would not be inaccurate to say that the man who calls Mary by name, and whom she embraces, is the very same one who – most reluctantly – expelled Adam and Eve from the garden of Eden. He is also the very same one who, by his death on the cross, has opened the way back to paradise, one day, for those who believe in him, through the forgiveness of sins.

The image of Jesus Christ as the gardener is one that occurs elsewhere in the scriptures. In a famous passage from 1 Corinthians we often read at funerals, the Apostle Paul poses the question, “How are the dead raised? With what kind of body do they come?”

The answer he gives comes right out of the garden. It’s like a seed planted in the ground, he explains. The seed must crack open and die to its seed-nature, before it takes on the form the gardener truly intends for it:


“So it is with the resurrection of the dead. What is sown is perishable, what is raised is imperishable. It is sown in dishonor, it is raised in glory. It is sown in weakness, it is raised in power. It is sown a physical body, it is raised a spiritual body. If there is a physical body, there is also a spiritual body.” [1 Corinthians 15:42-44]

Paul even goes on, in that passage, to speak of Adam and Eve in the Garden of Eden:

“The first man was from the earth, a man of dust; the second man is from heaven. As was the man of dust, so are those who are of the dust; and as is the man of heaven, so are those who are of heaven. Just as we have borne the image of the man of dust, we will also bear the image of the man of heaven. What I am saying, brothers and sisters, is this: flesh and blood cannot inherit the kingdom of God, nor does the perishable inherit the imperishable.” [15:47-50]

The ‘man of heaven’ – the counterpart to our ‘man of dust’ – is, of course, the Risen Lord, Jesus Christ. When she first glimpsed him, Mary supposed him to be the gardener. She couldn’t have known, in that moment of confusion, how right she was.

If this is true – that Jesus Christ has taken over where God, the planter of the Garden of Eden, left off – then it has something to say to you and me about the sort of impatience we often fall into, as we look around at the mess and incompleteness of the world in which we live. There are weeds among us. There is blight. There are infestations of wriggling insects. From time to time there arises, on the horizon, a dark and seething plague of locusts, that threatens to devour the seedbeds we’ve so carefully tended.

Have faith, says the gardener. Have patience. The seeds are planted. The sun will shine. The soft, spring rains will fall. The growth will come, in the fullness of time.


It’s a sure thing. As sure as the stone rolled away from the doorway of the tomb.”

The Lord is risen. Alleluia!

April 8, 2009 - Michael J. Fox

Michael J. Fox was the guest on Monday’s The Daily Show with Jon Stewart. I watched it a day later on our DVR.

Fox, of course, is a Parkinson’s Disease survivor. I found him inspiring. Take a look and see for yourself:

The Daily Show With Jon Stewart	M - Th 11p / 10c
Michael J. Fox
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I was struck by the fact that Michael kept his 1991 diagnosis secret for seven years. Undoubtedly, that was a tough time for him. He was one of the hottest talents in Hollywood, but he was leading a secret life as a chronic-disease patient. The knowledge of his slowly-worsening situation was hanging over his head.

Fox tells how he went a little crazy during those years – drinking too much, that sort of thing. But then, he came to a point where he grew comfortable with his diagnosis. He stopped fighting it. He learned to go with the flow. I wonder if that coincided with his going public with his medical situation?

It’s always tough to live a lie. Little by little, it tears you up inside. I’ve never regretted going public with my cancer diagnosis, as soon as I was sure that’s what it was.

I could relate to these words of his: “Once you accept it and fix it in space and say, ‘This is this and it’s not anything else and it’s not going to go away any time soon, and you're going to have to deal with it’ then you open up to all the stuff that’s around it and say, ‘Wow, this gives me an opportunity to help people out, this gives me an opportunity to look at things in a way that I might not have looked at them before...’”

Fox even gave voice to the cancer survivor’s mantra, at one point: “It is what it is.” How many times have I heard people with cancer say that?

Note it, and move on.

There’s a kind of strength that comes from facing our life-situation honestly, and trying to live as resolutely as we can in the present. It does little good to pine for our pre-diagnosis days, nor does it help us to obsess about the future. The art of living with a chronic disease lies in living in the now.

Accept it. Fix it in space, as Fox says. Admit, “This is this and it’s not anything else and it’s not going to go away.” Then, go searching for the blessings that are still around: and there are many.

Thanks, Michael. You’re a great example for all of us.

April 6, 2009 - Looking for Life in All the Wrong Places

Jesus’ triumphal entry into Jerusalem is what I preached on yesterday. No surprise there – it was Palm Sunday.

Actually, it’s not a foregone conclusion that a sermon on the Sunday before Easter will be one of the Palm Sunday passages from the Gospels. This past Sunday is also called “Passion Sunday,” so lectionary-minded preachers have the option of expanding their field of vision to include any incident from Jesus’ last week before the crucifixion.

This week I took the traditional approach, looking at John’s version of the triumphal entry (John 12:12-19). Generally, I resist the easy path of harmonizing the various Gospel accounts (by “harmonizing” I mean combining all the details of these different witnesses’ testimony into a single version). Whenever I focus on just one story, treating it as though it were the only account we have, I find it so much richer in meaning.

Examining John’s account, I found myself fixating on verse 17: “So the crowd that had been with him when he called Lazarus out of the tomb and raised him from the dead continued to testify.” Unlike the other Gospel-writers, John sees Jesus’ triumphal entry as the direct outgrowth of Jesus’ greatest miracle, the raising of his friend Lazarus from death. The people waving palms by the roadside were ecstatic because of what Jesus had done for Lazarus. Since waving palms was like waving a national flag, that also says the crowds understood this unprecedented miracle as a sign that Jesus is the hoped-for Messiah.

From the sermon:

“Having heard the good news of the Lazarus miracle, these people are looking for life – but, they’re looking in all the wrong places. The life they’re looking for is very much like the new life of Lazarus: a mere extension of human life. Jesus may have raised Lazarus from the tomb, but he didn’t resurrect him – not in the sense that Jesus himself would soon be resurrected. When Jesus is raised on Easter, he’s raised to life eternal. Lazarus is merely resuscitated: he’s given maybe a decade or two of extended life, after which, he too will die – this time, for good.

By the same token, you know, there are lots of people today putting enormous energy into discovering ways to extend human life. Whether it’s preventing cancer, developing a new open-heart surgery technique or finding a cure for HIV/AIDS, these are all commendable efforts – but, even these pale before the good news of Easter. Easter’s not about resuscitation, such as Lazarus experienced. Easter’s about resurrection: resurrection to a life that’s not merely extended, but eternal!”

As I continue to trek to Dr. Lerner’s office for my monthly port flushes, and less frequently to hospitals for CT or PET scans, I’m very interested in extending my own life. All this, of course, is played out against the backdrop of the Christian promise of eternal life, which is something altogether different.

And that’s what Easter is all about.

April 2, 2009 - Healthcare Reform Petition

Remember this guy?

The “Dean Scream,” marking the meltdown of Howard Dean’s insurgent presidential candidacy, was one of the more memorable moments in modern presidential politics. Dean has been hard at work ever since, as national leader of the Democratic Party. Now, he’s turning his efforts to work with President Obama on addressing health-care reform.

He’s looking for signatures on a petition he plans to bring to Congress, asking for a public health-insurance option. While it may not turn out to be universal health care (which I, personally, am convinced is the only way for our nation to go), the Obama plan would at least require everyone to have insurance.

A publicly-provided insurance option will likely be a cornerstone of that plan. The insurance industry is marshaling their substantial political and financial clout to try to block any such option that could compete with the products they offer.

Since private insurance has failed so abysmally, for so long, to provide affordable medical insurance options for Americans, I think we, the voters need to stand up to them and say, “Enough!”

Won’t you sign the petition?

We won’t see Howard Dean screaming about this. He’s been speaking more softly in recent years. Sign the petition, and you’ll give him (along with President Obama) Teddy Roosevelt's proverbial big stick as well.

I’m Carl Wilton, and I approved this message.

April 1, 2009 - A 150th Birthday Party

On Sunday afternoon, I had a small role in the worship service commemorating the 150th Anniversary of the Presbytery of Monmouth – the regional governing body of our denomination, the Presbyterian Church (U.S.A.). Monmouth Presbytery has administrative responsibility for 47 churches in this part of central New Jersey.

All I did was read a brief scripture lesson, but the Asbury Park Press photographer chose that moment to snap the color photo that graced the front page of our local-news section on Monday. There I was, right in the middle of it.

For those of you blog readers who’ve been wondering what I look like as I’m doing my preacherly thing, here it is:

The church is the Presbyterian Church of Toms River, the largest in the Presbytery. It also happens to be the church in which I grew up, and where I served for a few years in the 1980s as Assistant Pastor.

150 years is a long time. Far longer than any human lifetime. Some of the congregations of the Presbytery are even older. Shrewsbury was founded in 1672. Old Tennent dates back to 1685. The church I serve, Point Pleasant, is a youngster compared to these. It was founded in 1882.

It’s often pointed out that corporations, which the law treats as though they were persons, are immortal. The same can be said, I suppose, of churches.

The preacher for the occasion was Rick Ufford-Chase (a former Moderator of the General Assembly, the highest office in the denomination). He made a lighthearted remark about maybe coming back 50 years from now for the Presbytery’s 200th anniversary. Rick is only 6 or 7 years younger than me, which would put him in his mid-90s on that occasion. I’d be 102.

Chances are, I won’t be around for the bicentennial. I’m not even figuring in the lymphoma as I say that, just the ordinary wear and tear of life (not to mention the actuarial tables for males in our culture). Yet, like a business corporation, the church of Jesus Christ lives on, notwithstanding.

Or, maybe not like a corporation. More like another sort of corpus, or body. The Body of Christ.

Now, that’s immortality.

"Now you are the body of Christ and individually members of it."

- 1 Corinthians 12.27

March 22, 2009 - Waeger Still Wins

Another cancer survivor whose blog I’ve been following has succumbed to his disease. Dan Waeger, a young man with lung cancer, died last Monday, March 16. I’m a little behind on my blog reading, so I only just realized it.

(Prayers and good wishes go out to you, Meg. From your blog, it certainly does appear that you and Dan had a very special relationship indeed. No doubt you’ll miss him terribly.)

The blog Dan and his fiancee Meg have been writing is called, “Waeger Will Win.” Less than a week before Dan’s death, Meg wrote a little reflection on the meaning of winning, when it comes to cancer.

She was recalling something she’d heard Lance Armstrong say at a conference. Lance was relating a brief conversation he’d had with the chairperson of his foundation board. “This is fun,” said the executive to Lance, caught up in the enthusiasm of whatever project they were working on.

“It’s only fun if we win,” replied Lance.

Lance Armstrong is, of course, one of the most competitive people on the planet. It’s no wonder he’d view the work of curing cancer as the biggest, baddest bike race of all.

Meg offers a different perspective. She has some wise words to share about winning:

“But when Lance said that to the Livestrong audience, I remember thinking that judging victory in cancer solely by ‘winning’ is maybe worth another look. After all, many cancer survivors, like Dan, don't see the ultimate victory in being cured. There are 100s of cancers, and to ask for a cure sets a high bar, and one that may be unrealistic in our lifetime. This is not a ‘one-size-fits-all’ solution. Many cancer survivors would be ecstatic if their cancer could be managed as a chronic disease - like diabetes or AIDS. Or if genetic testing could even narrow down the treatment options so that they avoid toxic and crippling treatments as a cruel form of trial & error.

The day I heard Lance speak was about 3 weeks after we’d found out that Dan’s cancer had spread. I knew that even then, if Dan’s ‘win’ could only be fun if he was cured, than we were in trouble. If he passed on from cancer, we would surely say that he ‘lost his battle.’ But as many of you’ve pointed out, Dan’s story isn't a straight win/lose scenario. There are more ways to win than just judging the score.”

Indeed. In this life, there are winners and there are winners. Some win by conventional means, edging out a host of competitors by crossing the finish line first. Others start winning from the first moment they leave the starting line, regardless of the outcome.

We can be winners in the here and now, not just in the distant future. From everything I’ve read of Dan Waeger, he seems to have been one of those people who began winning from the first day of his diagnosis.

Faith helps create winners like Dan, of course. The Apostle Paul has something to say on that topic:

“But we have this treasure in clay jars, so that it may be made clear that this extraordinary power belongs to God and does not come from us. We are afflicted in every way, but not crushed; perplexed, but not driven to despair; persecuted, but not forsaken; struck down, but not destroyed; always carrying in the body the death of Jesus, so that the life of Jesus may also be made visible in our bodies. For while we live, we are always being given up to death for Jesus’ sake, so that the life of Jesus may be made visible in our mortal flesh. So death is at work in us, but life in you.” – 2 Corinthians 4:7-12

Clay jars. Amphorae, they called them – ordinary, everyday vessels used in the ancient world to carry water, wine and all manner of other liquids. To Paul’s readers, clay jars were about as exciting as Tupperware – and just as commonplace.

Yet, this is the image he chooses to describe the treasure of the Gospel – the very treasure that enables God’s people to be “afflicted... but not crushed... perplexed, but not driven to depair,” and so on.

In the world of cancer, the winners are not only those competitors who go charging across the finish line, pedaling furiously. Somewhere back on the racecourse a rider sits under a tree, dozing in the summer sun. He will not open his eyes again. He will not cross the finish line. He doesn’t need to. The finish line has come to him.

(To Meg and all of Dan’s circle of family and friends: blessings be upon you in these days of goodbyes. Remember what goodbye means: “God be with you.”)

March 21, 2009 - Let's Hear It for L19!

Here’s a very encouraging article about an exciting new approach in B-cell non-Hodgkin lymphoma treatment. Thanks to Dr. Wendy Harpham for sending me the link.

Swiss researchers have found a way to use a human antibody called L19 to recognize and target newly-formed blood vessels that occur in tumor tissue.

The team of researchers, led by Dr. Dario Neri, used rituximab (the same monoclonal antibody I received along with my CHOP chemotherapy) in conjunction with L19. From the article:

“The success of the Neri team’s new therapeutic approach relies on the ability of the immunocytokine L19-IL2 to attract and activate certain white blood cells, including the so-called natural killer cells, towards the tumor, thus potentiating the therapeutic activity of rituximab.”

Early trials using the new approach with mice were encouraging, then the scientists were able to replicate those results in humans. In the before-and-after PET scan images below, all the black spots, indicating active lymphoma, disappeared following treatment (the remaining dark areas in the right-hand photos are the brain, heart and bladder that always show up dark in PET scans):

Now, the researchers are moving on to develop the treatment for more widespread use. New medications using L19 are in phase I and II clinical trials, according to the article.

Yes, indeed - there are good things coming down the research pipeline!

March 15, 2009 - Magical Thinking

Reading in Dr. Wendy Harpham’s After Cancer: A Guide To Your New Life, I come across a passage I think may speak to my situation. Ever since my cancer treatments ended, and particularly so since I went out of remission, I’ve found it difficult to plan for the future. I’ve tended to take things as they come, responding much more passively than ever I used to.

It’s a consequence, I’m sure, of the disorienting experience of going from reasonably good health to treatment for a life-threatening disease. During my treatments, I suddenly found myself wondering if I’d ever get to do the things most people expect to do in their middle and later years: see my children get married, be blessed with grandchildren, experience further professional advancement, retire, leave a legacy of some sort, etc. Suddenly, it seemed like everything could be abruptly cut off. I found myself grieving things I wasn’t even sure I was going to lose.

Since entering remission – and then, after that, the uncertain, watch-and-wait period I now find myself in – I’ve outwardly returned to normal activities, and even taken on a few more. I’m crazy busy, having thrown myself back into not only my pastoral duties and my part-time seminary teaching, but also taking on new work as our presbytery’s Stated Clerk. I’ve made myself so busy, in fact, that I don’t have to look very far into the future. (How convenient.) Just keeping up with the present is taking all my energies.

Perhaps I’m pursuing what Wendy calls magical thinking:

“Planning for the future means having confidence that the plans will come to fruition. You lost a lot when you got cancer. You feel vulnerable. You want to protect yourself from avoidable loss and pain. If, on any level, you are insecure about your future , you will feel anxious when you start to make plans, because you do not want to lose any more.

Sometimes a component of magical thinking makes it difficult for you to make plans. You may feel that if you make plans, you are setting yourself up for a problem that will sabotage the plans. ‘If I don’t make plans, there won’t be any plans to get ruined. If there are no plans to ruin, I won’t get cancer.’” [Wendy Harpham, After Cancer: A Guide To Your New Life (Norton, 1994), pp. 288-289.]

A little later, she gives this sage advice:

“Waiting for everything to be back to normal before you see yourself as really living is a waste of precious time. There is no time like the present.” [p. 298.]

Things are never going to get “back to normal” for me, medically speaking. Even if I enter into a solid remission and stay there, I’ll still have to keep going for scans, facing the reality of a possible recurrence. The only sensible response is to keep on living, in spite of it all.

Easy to say. Hard to do...

March 13, 2009 - Message of Hope from David M. Bailey

A song lyric, today, that singer-songwriter David M. Bailey just sent around in an e-mail to his fans:

“Well it ain't any fun when they tell you you have cancer
And it sure don't help when they say they have no answer
At the time you'll think it is the greatest curse
Let me tell you there is one thing that's worse
If they tell you it was gone but now it's back
When you thought you'd won but you're still under attack
Talk about taking the wind out of your sails
It's only tragic if you're thinking that hope fails
Because hope, my friend did not let you down
No, it carried you across the rocky ground
And it set you on this water that you know
It will hold you til the breeze begins to blow
Don't you worry if the tide is still too low
The day will come when your courage starts to grow
Before long you will see it overflow...”

I’ve written about David before. He’s a brain cancer survivor, who’s been going through some rough stuff of late, as he’s had to go for further surgery.

He seems to be bouncing back from that (I understand he’s begun performing again), but I’m sure there are days when the realities of his situation get him down – which gives birth to lyrics like this.

One of the things I like about his song lyrics is his determination to live from hope:

“When the rain comes down let the little light burn
Keep on to the point of no return
Decide that you will do more than survive
Each day is a chance for you to thrive
And thrive you will if you make that your choice
Faith, hope & Love still need a voice...”

Here’s a homemade video of David singing a song he wrote just 9 days after his brain surgery:



Keep on giving voice to the faith, hope and love that keep you going, David. Our good wishes and prayers are with you.

March 9, 2009 - More Questions About Maintenance Rituxan

Steve, a reader of this blog, reminded me of a 2006 European study that found “dramatic” results in follicular NHL patients who were receiving maintenance Rituxan treatments. Unlike the one I cited yesterday, this study includes patients who have received R-CHOP.

Those patients in the study who received R-CHOP, and who subsequently received maintenance Rituxan, experienced an average of 52 months without their disease progressing – as opposed to 23 months in the control group. That’s more than double the time.

That raises a lot of questions for me. My disease has already returned, but it’s not doing much of anything. Every time I go for a scan, the verdict is, “Still there, but no bigger.” Dr. Lerner has me on “watch and wait,” the reasons being that (1) my slightly enlarged, malignant lymph nodes are doing no immediate harm, and (2) when they get large enough to treat, there’s a high likelihood that a second round of chemo will put me back into remission (and, if I receive a stem-cell transplant instead, there’s even the possibility of a cure).

I don’t know whether starting on Rituxan-only treatments is still an option for me, at this stage – everyone in the research studies presumably began receiving them right after their chemo. Even if maintenance Rituxan is still available to me (and if we could convince the insurance company to fund it), I’m still not sure it’s the best idea. Dr. Lerner’s cool-under-fire strategy of waiting till we see the whites of their eyes before we start blasting away appeals to me.

Questions, questions. What if? When? Why? Why not? You never get away from the questions, when you’re a cancer survivor.

“Wait for the Lord;
be strong, and let your heart take courage;
wait for the Lord!”

– Psalm 27:14

March 8, 2009 - The Treatment I Didn't Get

Today I run across a Reuters news article about rituximab (trade name, Rituxan), the monoclonal antibody drug I received along with my chemotherapy. It seems a research study has just demonstrated good results for “maintenance therapy” with Rituxan – in other words, continuing treatment with the drug over time, even after the cancer has gone into remission:

“An improved disease response was seen in 22% of rituximab-treated patients versus just 7% of control subjects....

Three-year progression-free survival was also higher in the rituximab group: 68% vs. 33% in controls. In the subgroup of 282 patients with follicular lymphoma, the corresponding rates were 64% and 33%. Higher overall survival rates were seen in the rituximab group as well, although the differences fell short of statistical significance....

‘Observations from this study inform the design of future studies and add to a substantial body of evidence that the combination of rituximab with chemotherapy is a new standard for patients with indolent lymphoma who require treatment,’ the authors conclude.”

At the time my R-CHOP chemotherapy ended (the “R” in R-CHOP stands for Rituxan), I was aware that some patients were continuing to receive monthly treatments with Rituxan for a year or more, as a preventative measure. This was, and continues to be, somewhat controversial. At several NHL patients’ conferences I attended, the medical experts making the speeches said the jury was still out on whether or not maintenance Rituxan does any good. With the tremendously high cost of this medication, many medical insurers had labeled it “experimental,” and were not funding its use in maintenance treatment. (I never took the matter up with my insurance people, because Dr. Lerner didn’t recommend maintenance Rituxan in my case.)

Well, now the jury has filed back into the courtroom and delivered their verdict: maintenance Rituxan does work – at least for indolent NHL patients who have had the CVP chemo regimen (cyclophosphamide, vincristine and prednisone). The researchers didn’t focus on patients who’ve had the CHOP chemo cocktail, rather than CVP – although, since vincristine and prednisone are two out of the four drugs in CHOP, I would think there’s a pretty good chance maintenance Rituxan would have improved my long-term prognosis, as well.

This raises a lot of unanswered – and probably unanswerable – questions for me. Chief among them is, if I had received maintenance Rituxan, would my remission have lasted longer than it did?

Hindsight, as they say, is 20/20. I’m not going to run off and ask Dr. Lerner about maintenance Rituxan now, but it does give me something to think about. Maybe I'll ask him what he thinks of this article, next time I see him...

March 7, 2009 - A Cure for Cancer? Not.

“We’ve launched a new effort to find a cure for cancer in our time.” Those were President Obama’s words at Thursday’s Healthcare Summit in Washington.

A few days earlier, he said much the same thing in his address to Congress.

This sort of promise by a politician is not new. Richard Nixon proclaimed as much, back in 1971. It’s stirring rhetoric, and I certainly applaud the intentions behind it, but the promise is very likely impossible to fulfill.

The reason? Cancer isn’t just one disease. All the experts are saying there’s no magic bullet, no wonder drug like the Salk polio vaccine, that will suddenly send the nation’s oncologists scrambling to find a new medical specialty.

Cancer is dozens of diseases, maybe even hundreds. Yes, it’s characterized by the tendency of certain cells to grow uncontrollably, rather than shuffling off to die (as their genetic programming would ordinarily direct them to do). Yet, the causes of this cellular misbehavior are legion. It’s highly unlikely that a single, miracle cure is out there, waiting for some enterprising researcher to uncover it. Why, it’s even unlikely there could be a single cure for non-Hodgkin lymphoma – which, by all accounts, is a family of dozens of different diseases.

That’s no reason to stop trying, of course. Surely, there are cancer cures waiting to be discovered, through even modest increases in research funding. If the political slogan, “finding a cure for cancer,” is what it takes to build support for this cause, I’m surely not going to stand in the way.

So, Mr. President: when it comes to rallying Americans to support the cause of healthcare reform, particularly increased funding for cancer research, I say, “Go for it!” Yet, when you hold out the dazzling prospect of a single cure for cancer, I’ll consider that more of a rhetorical flourish than a statement firmly grounded in medical fact.

March 2, 2009 - Power of Blog

One of the tough realities of following cancer blogs is that, from time to time, someone you’ve come to know and respect in this strangely intimate medium dies. This is what’s happened in the “Clusterfook” blog written by Lisa, a young wife and mother who’s been dealing with ovarian cancer for several years now.

One of the last topics Lisa blogged about was what she called “power of blog” – a concept similar to power of attorney, but having to do, instead, with who would take over her blog. As she entered hospice care, she had to find someone to whom she could entrust her username and password, so as to inform the blogosphere of her death.

Her husband is not evidently much of a computer person, so she turned to a fellow blogger. On Saturday, February 28, Lisa’s friend, Karl, posted news of her death.

Just over a month ago, Lisa mused about the reactions of some readers, who said they found her blog “too depressing.” I never had that reaction, myself, as I read her words. I found Lisa consistently blunt and down-to-earth as she described her decline in health, but she seasoned those grim facts with a quirky sense of humor and a passion for living her days to the fullest.

Here are a couple of excerpts from that post of January 26:

“As heart breaking as death is, I’m doing O.K. with everything that’s happening. Do you hear any ‘woe is me?’ in my writing? Do I sound like I feel sorry for myself? Am I crying out for pity?

No, no and no.

Every day I strive for inner peace and so far I’ve found it. I consider myself one lucky chick-o-dee, perhaps I should say I’m a blessed chick-o-dee to have such calm and inner peace.

That’s not to say that I don’t cry. Crying is a release of emotion for me but I’m not crying every day. Usually I cry when having deep, heartfelt discussions with family members and friends. Those moments when we are brutally honest about how we feel about each other and say to each other the things we should be saying but usually never have the courage to say. Then the day comes when it’s too late to say what we’ve always wanted to say.

If you ask me, it’s a gift to have those opportunities right now. My advice to you is don’t wait until you are facing death to tell those dear to you how you really feel about them. Whatever is holding you back…let it go.”

In a post just prior to that one, Lisa related what it had been like to tell her 8- and 11-year-old girls (whom she calls by the pseudonyms “Cam” and “Teeny”) that she was dying:

“Telling Cam and Teeny the truth, that I’m not going to get better, was one of the most heart breaking things I’ve ever had to do. It is NOT easy to tell your children that you are dying. Listening to them cry was one of the worst things I’ve ever heard. Not being able to fix it is the worst feeling in the world....

Dude [that’s her blogging nickname for her husband] and I decided to deliver the news to the girls last Saturday afternoon, a few hours before they had to go to church. Teeny has been consistently lighting a candle for me every week and she finds a lot of comfort in going to mass with Dude. Cam doesn’t complain about going nor does she get real excited. Dude and I thought they might find some extra comfort in going to church after talking to us earlier in the afternoon.

I’ve been too sick to go to mass for a while so Dude takes the girls by himself. He said that each girl was snuggled up as close and as tight to his side as they could be during mass. And of course, Teeny lit a candle as she always does. When she got home she told me that she still believes in the hope that I’m going to get better. God, how I wish that little ray of sunshine was right....

My kids are strong but they have been dealing with cancer in their lives for five years. I hope the lessons they’ve learned and continue to learn make them stronger and don’t scar them. Although how do you tell an 8 and 11 year old there’s a lesson to be learned when their mom dies?

Well, I’ve got them surrounded by great people and a good support system that I hope pulls through for them. That’s how you do it.”

Lisa’s blog has a subtitle: “It Is What It Is.” I can remember repeating that phrase on numerous occasions, myself, during the acute phase of my illness. I can remember taking an odd sort of comfort in it. There’s something strangely liberating about shedding all the myriad worries and distractions of everyday life in order to focus on one, true thing: living as well as you can.

One of the reasons “It is what it is” is comforting is that it reflects a fundamental truth: a cancer diagnosis is a lot scarier through the windshield than it is in the rear-view mirror. Eventually you adapt, your family adapts, your friends adapt, as together you learn to face the future, whatever it may hold. A few people around us are never able to do that, and withdraw – but most manage to make the transition eventually.

Yes, it is what it is. And, sometimes, it can even be beautiful – like Lisa’s indomitable spirit. Truly, that’s the “power of blog.” Prayers and good wishes go out to all who love Lisa and miss her.