Immanuel

Phillips Academy is an exclusive prep school (grades 9-12) located in my hometown of Andover, MA.  Notable alumni include George H.W. Bush, George W. Bush, Jeb Bush, John F. Kennedy, Jr., and Bill Belichick.  Jeb and Bill graduated just as I finished 9^th grade in the Andover public school system.  Nope, I didn’t know either one of them.

On the edge of the campus, just a bit over a mile from my house, stands a chapel.  I remember Cochran Chapel for only one reason:  At Christmastime my parents would take me to live performances of Handel’s Messiah.  Handel’s music is superb, but the libretto written by Charles Jennens is based on the King James Bible and is positively glorious.  One solo is a combination of these phrases:

“Behold, a virgin shall conceive, and bear a son, and shall call his name Immanuel.”

(Isaiah 7:14)

 “God with us.”

(This is the interpretation of “Immanuel” given in Matthew 1:23.)

Some scientists have a really hard time believing anything that can’t be supported by evidence that complies with the rules that they have created.  For example, when introducing string theory in The Accidental Universe: The World You Thought You Knew, Alan Lightman says that “to explain what we see in the world…we must believe in what we cannot prove. …Such arguments, in fact, run hard against the long grain of science.”  Even so, sometimes those in the inner circles of science discuss God anyway.  Near the end of The Meaning Of Quantum Theory, Jim Baggott includes a section entitled “The hand of God?”  Although he summarizes some philosophical arguments, he doesn’t come to any compelling conclusion on the subject of God’s existence, nor does he say anything about his personal beliefs.  Lightman, on the other hand, readily confesses that he is an atheist.  Regarding God’s existence agnostics ask, “How could we know?”  As best as I can tell, agnostics approach their lives in pretty much the same way that atheists do.  So, for all practical purposes, agnosticism and atheism amount to the same thing:  “Us without god.”

The debate between those who accept “Us without god” and those who embrace “God with us” may or may not be resolved in the near future.  If God actually is with us, then wouldn’t at least some of us have some personal experience with him?

One of the choral pieces in Messiah is based on this:

 “For unto us a child is born, unto us a son is given: and the government shall be upon his shoulder: and his name shall be called Wonderful, Counsellor, The mighty God, The everlasting Father, The Prince of Peace.”

(Isaiah 9:6)

Life with cancer, and an incurable one to boot, involves a lot of questions.  The answers that satisfy me come from his truth (the Bible), and indeed he has been a wonderful counselor.  Only the Prince of Peace can give deep peace to a deeply distressed soul. God is with me, and he is mighty.

Since my youth I have listened to Messiah many times and it has been a profoundly positive influence on my soul.  You can listen to it here for free (the parts referred to above are the 6^th and 8^th tracks of the playlist).

Earwax and the New Abnormal

Over three months ago I was diagnosed with incurable follicular lymphoma, and I’m feeling great.  I still don’t feel like I have cancer, and thank God I’ve been able to teach all my courses and carry out my other responsibilities as a department chair, academic advisor, and academic program coordinator.

I’m still not being treated for my slow-growing cancer.  Clinical experience shows that if I’m supposed to live for x years and I’m treated now, then I’ll live for x years.  If I’m not treated now, then I’ll still live for x years.  Nope, there’s no way to know what x is.  In the words of Dr. Joe Stephenson (my oncologist), though, “it isn’t a matter of if it will get worse, it’s a matter of when.”  It might be in six months, six years, or even longer.  Nope, there’s no way to predict this, either.  Every three months Joe will check it:  the idea is to catch it just as it escalates.  I’m very glad that I’m not yet dealing with either chemotherapy or radiation, but from what people say it won’t be particularly pleasant.

And yet I’m just fine with all of this.  Although cancer now is and apparently always will be a part of my life, I’m continuing in my God-given roles as a disciple of Christ, husband, father, church elder, professor, and friend without stressing out over it all the time.  Would you expect to have an incurable cancer and yet be at peace about it?  To just accept it and get on with life?  This is my new abnormal.

What is normal, anyway?  Normally if a toddler lets go of an ice cream cone it falls to the ground and the kid starts crying.  To the kid, though, dropping the cone is abnormal.  Hence the crying.  Are adults much different?  When things don’t go as expected we become angry, annoyed, anxious, discouraged, embarrassed, envious, fearful, impatient, moody, perplexed, sad, upset, whatever.

God clearly states that the road to the new abnormal is paved with obedience:

“Oh that you had paid attention to my commandments!

Then your peace would have been like a river….”

(Isaiah 48:18)

In the interest of full disclosure I must say that sometimes I still disobey God.  On second thought, I don’t think I’m actually up to fully disclosing how disobedient I still am.  On third thought, Jeremiah 17:9 suggests that I don’t even know how disobedient I am.  So, on fourth thought let me just say that four weeks ago I disobeyed this clear command:

“Do not be anxious about anything,

but in everything by prayer and supplication with thanksgiving let your requests be made known to God.”

(Philippians 4:6)

A new problem related to my cancer arose suddenly and unexpectedly.  I was caught off guard by it and rapidly became anxious.  Discouragement quickly followed.  I needed to listen to what God says about such things, but my sin was like spiritual earwax that muffled his voice.  I didn’t even bother to ask him for help.  Apparently Elijah didn’t, either (I Kings 19).

The next day I realized that people were saying very pertinent things to me, but I largely glossed over them in my mind.  The following day I finally began to turn back to the Lord.  I spent some time reading my Bible and in prayer.  Shortly thereafter God reminded me of what had appeared to be an insurmountable problem in my life some years earlier.  It dawned on me that it was directly comparable to my current situation, and then I was shocked that I hadn’t made the connection.  God had solved that problem in a completely unexpected way.  I realized that the Lord was saying to me, “Brian, don’t you remember how I took care of you fourteen years ago?”  I felt remorse.  Then I repented.

God’s reminder was so quiet, so hushed that if it had been any quieter I suppose I wouldn’t have heard it.  He was so extremely gentle as he removed the earwax that I didn’t even realize he was doing it.  Thank you, Lord, for leading me back into the new abnormal.

Flapjacks On The Ceiling

By the time he was five years old, Wolfgang Amadeus Mozart could already play both the harpsichord and violin.  He went on to become a highly acclaimed composer of classical music.  Italian Maria Gaetana Agnesi was fluent in French by the age of five and by the age of 11 she also knew German, Greek, Hebrew, Latin, and Spanish.  She went on to become a mathematician and philosopher.  As children, these gifted individuals had opportunities and the means by which to take advantage of them.  I did, too.  As a young lad I was uncommonly self-disciplined and made sure that I got up early every Saturday morning so that I could quietly go downstairs, sit down in front of our black-and-white television set, and watch reruns of The Three Stooges.  I went on to become a college chemistry professor.

It’s difficult to overstate the influence of Moe, Larry, and Curly (and Shemp) on the psyche of generations of young people.  For example, the Western parody Goofs and Saddles has a scene where they dump ammunition into a hand-powered meat grinder, which then functions as a machine gun spitting out hot lead instead of fresh pork sausages.  As a young man I found this rather inspiring, but I never did figure out a way to get our old meat grinder in the basement to do the same thing (with bars of soap instead of bullets).  The many short films they starred in are unarguably the finest and most sophisticated that American culture has ever produced.  I’ve often wondered why, with all the high-cultural events we have at Bob Jones University, we’ve never had a formal program featuring selected episodes of The Three Stooges.  Hoi Polloi seems like a particularly good candidate to me.  But it’s the things they did with food that are the icing on the cake.

In An Ache in Every Stake the three apparently grown men bake a cake for a birthday party.  When it goes flat in the oven, Moe—the smartest of the three—hooks up a natural gas pipe and inflates the cake.  When they realize that they didn’t make it big enough, Moe tells them to “pump in four more slices.”  And Larry complies.  Right before putting it back into the oven.  Yes, this was another seminal moment for someone who now uses denatured ethanol explosions in freshman chemistry classes to illustrate the concept of the stoichiometric limiting reactant.

Some of my most treasured childhood memories involve formally dressed adults in lavishly appointed mansions throwing cream pies and other delicacies at each other (on TV).  Most Stooges scholars identify In the Sweet Pie and Pie as being the best of this genre.  If you’ve never seen a Stooges’ food fight, then you’ve really missed out, and I’m not the only one to say so.  Did you know that throwing pies at people is so important in the English-speaking world that there’s a Wikipedia article on pieing?

Time to get back to my cancer.  Moe, Larry, and Curly stow away on a train to Hollywood in Movie Maniacs so that they can become stars.  During the trip Curly decides to cook breakfast and settles on flapjacks (a.k.a. pancakes, hotcakes, or griddle cakes).  He makes a monster in a large cast iron skillet and flips it into the air so that he can cook the other side, but it gets stuck on the ceiling instead.  It’s only a matter of time before Moe looks up at the ceiling, just an instant before it lets go and lands on his face.

Currently my follicular lymphoma is growing very slowly, and nobody knows how long it will be until it worsens and requires some kind of treatment.  It could be years, but barring unforeseen circumstances, sooner or later that flapjack is going to fall off the ceiling and hit me.

There’s room for a lot of fear in this picture.  How soon will it need treatment?  Will we catch it “in time” before it gets really bad?  Is the cancer in the process of spreading right now, even as I sit here at home and write this?  Will it worsen to the point where harsh chemotherapy will be recommended?  It’s in my neck:  Will it affect my voice?  If I decide to take chemotherapy, how badly will it damage my immune system?  Will I get so sick that I won’t be able to teach anymore?  How much pain will I have?  How much will it affect my mind?  What will my life be like?  How long will I live? 

My oncologist looked at all of my risk factors and based on his experience he doesn’t think I’m going to die anytime soon.  Most of the time I still feel pretty good, and when I don’t it seems largely like any other busy semester when I get tired.  But last Friday night I did have a major fight with fear.

When I googled “how do you deal with fear” this evening there were 220 million results.  There must be a lot of fearful people out there.  I don’t want a trick or tip that gives me a quick fix for a little while.  I’m looking for a solution to the mental and emotional conflict so that fear can be conquered. 

The prophet Jeremiah relates an incident where God told him to observe a potter making his wares (see Jeremiah 18).  God uses it as an analogy in which He is the potter and the nation of Israel is the clay.  As I sat in my chair, this passage came back to my mind and I began grappling with how it relates to my situation.  I began wrestling with my fear, and with difficulty I began talking to God about it.  I wrestled with the Divine Potter.

Christ made a bold, striking statement to those considering following him:

“If anyone would come after me, let him deny himself and take up his cross daily and follow me.”

(Luke 9:23)

Is this really necessary?  Self-denial?  Every day?  Jesus also promised that he would give peace to those that love him so that they need not be afraid (John 14:27).

As fathers let their children wrestle with them, so God held me gently as I struggled against him.  “Brian, do you trust me?”  One does not answer such questions flippantly.  I began to relax my efforts, and he loosened his grip.  Willingly I gave up.  “Oh Lord, you are the potter and I am the clay.  Do anything you want to do with me.”  And immediately my fear evaporated—once again I was at peace.  God always does what he says he will do.  Last Friday night this veteran insomniac slept uncommonly well.

A Rattle In An Old Car

Sometimes things don’t turn out the way you expect them to.  In the way of review, I have B cell non-Hodgkin’s lymphoma, a cancer in my lymph system.  B cells make antibodies, and I have some cancerous B cells.  The particular sub-type I have is called follicular lymphoma.

Yesterday I met with Dr. Joe Stephenson (my oncologist) to discuss the results of the tests done over the last couple weeks.  The bone marrow biopsy shows that the cancer is not in my bone marrow.  Whew, that is a blessing.  It is also low-grade, or indolent, which means that it’s growing slowly.  That’s also good.

The CT and PET scans show that I have cancer in the upper part of the right side of my neck (where I found the lump), lower in my neck in the general vicinity of my larynx (voice box), and part way over in my right shoulder.  I had hoped for quite a bit less than this.  However, the same scans don’t show any cancer beyond these areas.  The extent to which cancer has spread is rated on a scale of 0-IV, where 0 means that only the original tumor is present and it is small.  IV means that it has spread to locations distant in the body.  Mine is classified as stage IIA.  My condition could be better or much worse.

My cancer is incurable.  This isn’t entirely new news because Joe told me this the first time we met.  He indicated that clinical experience in treating follicular lymphoma shows that treating it at my stage with chemotherapy or radiation doesn’t change outcomes.  In other words, experience has shown that if I were treated right now it wouldn’t have any effect on how long I live.  And no, there isn’t any way to make an accurate prognosis to indicate how long I’ll live.  One journal article I read indicated that a person with follicular lymphoma could live for three years, 25 years, or anything in between.  Based on all the factors involved in my case, Dr. Stephenson’s opinion is that I may very well die of something completely unrelated to my cancer.

However, I’m supposed to see the oncologist once every three months for the rest of my life.  I already have my next appointment scheduled, and it will be for blood tests and a discussion.  If you read my last post (“An Itchy Loaf of Bread”) you have an idea of what body scans are like.  I’m supposed to have body scans at least twice a year for the rest of my life.  They won’t always be both CT and PET scans, but they will be one or the other.  The problem with both of these scans is that you are exposed to some kind of radiation, and I don’t like that.  So I asked Joe if there were any molecular tests that could be done instead, and he referred to something I asked him about the other time we talked:  Gene expression profiling.  He reiterated that although there are experimental studies doing gene expression profiling in follicular lymphoma patients, this kind of test is not yet ready for routine clinical use with this cancer.  It turns out that he does know of such a study, but I wouldn’t qualify for it because I haven’t yet had treatment and a recurrence.  It’s a great blessing that researchers continue to study disease, and perhaps in the next few years there will be a test available that is safer than PET and CT scans.  Joe also again told me that if at any point in this process I want a second opinion, then that would be fine with him.  I appreciate that.

The approach we are using (not treating it now but continuing to do tests) is called watchful waiting.  According to the Wikipedia article, this “is recommended in situations with a high likelihood of self-resolution, in situations where there is high uncertainty concerning the diagnosis, and in situations where the risks of intervention or therapy may outweigh the benefits.”  The last part applies to me:  Treating me now would be of very questionable value but would most certainly have negative impact on me.

Not everybody is familiar with using watchful waiting with cancer.  When I first discussed it with Stephen (my son), he said, “So is it like a rattle in an old car?”  If you’ve ever had an old car, then you may have had a rattle that just wouldn’t go away.  A sound like this can be safely ignored as long as it doesn’t indicate a problem that would negatively affect the occupants, other people, the functioning of the car, or other property.  However, you better pay attention if the sound of that rattle changes, because that could indicate impending doom.  I thought Stephen’s analogy was great, and so yesterday I ran it past Dr. Stephenson to see what he thought.  He asked for permission to use it with his other patients.  Knowing my son as I do, I told Joe that would be just fine.  So, at this point I’m thinking of my follicular lymphoma as a rattle in an old car.

I’ve been told that it isn’t a matter of if I will need treatment—it’s a matter of when.  At some point it is expected that my follicular lymphoma will go from low-grade to mid-grade and from stage IIA to a higher stage.  I am very thankful for modern medicine, and perhaps by the time my cancer worsens there will be treatments that are more effective than chemotherapy or radiation while also having far fewer adverse effects.  I am going to have to listen to this rattle, and Joe is going to listen to it every three months.  Of course, if I find another lump or something else suspicious, I will contact him immediately.

This is not how I expected to begin my 32^nd year of teaching.  How will this affect my wife and the rest of my family?  If there are grandchildren, will I know them?  Will they know me?  Before I saw my test results yesterday one of my students had sent me an email asking me a question.  After her signature she included a reference to the 62^nd chapter of the Psalms.  As I read it, verse five jumped out at me:

“My soul, wait thou only upon God; for my expectation is from Him.”

God has proven to me that He will not fail to provide those things that He has promised.  Why should I expect anything different now?  I must wait on Him for the right answers to my questions.

An Itchy Loaf of Bread

In preparation for the PET scan the nurse began injecting my arm with a solution of a glucose derivative that had been radioactively labeled with fluorine-18.  With a short half-life of only…wait, wait, this isn’t a chemistry class.  And then I began sipping a solution containing an organic iodine compound that would give better contrast to the images from the CT scans. It had an odd sort of “I’ve been cleaning up a dirty basement or garage” taste, and believe me, it won’t make it into the Coca-Cola Freestyle lineup.  After waiting for an hour so that my cells would absorb the PET chemical, I was ushered into the room housing the large cylindrical machine that would do both the CT and PET scans.

Another nice lady helped me climb onto a long, thin table with a pillow made of a cushioned U-shaped rigid frame. This would make it easy for even me to keep my head still.  She put a cushion under my calves so that everything would be positioned properly for the scans.  It also helped my formerly-broken-but-now-repaired-with-titanium-parts back feel comfortable, and I was thankful for that.  She hooked up my IV to a solution of another CT contrast dye and then a motor moved me into the machine.  The dye gave me a nice warm sensation through various parts of my body, particularly noticeable in my pelvic region.

“HOLD YOUR BREATH,” the machine commanded me in a stern male voice that probably came from some technical guy who hadn’t had any human contact for 6-12 months except through texting.  Deep breath, hold it.  I watched the top of the cylinder over me as the machine slowly sucked me into its bowels.  And then it stopped.  “BREATHE,” he ordered.  You don’t need to tell me that twice.  And my body moved back out.  “HOLD YOUR BREATH.”  I noticed that there were little labels in various places above me that said, “LASER APERTURE Do not stare into the beam.”  And they were all upside down!  That was annoying.  I’m pretty sure that these labels were there in order to warn Male Machine Man so that he wouldn’t harm himself while he was aligning the many parts in the scanner.  “BREATHE.”  Oh, yes, yes, yes, I will.  “HOLD YOUR BREATH.”  I had no idea that I could still hold my breath for such a long period of time.  And out my body went again.  “BREATHE.”  I was starting to feel like a large loaf of bread in an oven, with somebody pulling me out every now and then in order to see if I was done.

The nice lady disconnected my IV, had me put my arms by my sides, and then gently locked me in place with two huge pieces of Velcro so that I wouldn’t move.  I’m pretty sure that this is what the Inquisition would have been like if Spain had been more compassionate and politically correct.  And then the large EZ Bake oven started back up again, baking me one section at a time.  Thankfully MMM wasn’t barking orders at me anymore.

You can think about a lot of things during a 30-minute PET scan.  Things like, “If that smoke detector on the ceiling has americium in it, couldn’t that interfere with the scan?”  You notice the whirring of the machine, the sound of the HVAC system, the flow of air over your body, and the local country-western station that was being played in the background just quietly enough so that you couldn’t understand most of the words. It sounded something like somebody gargling with corned-beef hash.  And then the itching started.

The worst kind of itch is the one you can’t scratch.  During one of the times that my head and part of my torso were sticking out of the far end of the machine I suddenly developed an itch.  I didn’t know if it was due to the AC blowing on me or the result of a traitorous hair sticking me in the forehead.  Either way it didn’t matter–it just itched.  Helpfully the inquisitor had made sure that the strait jacket was snug.  I’m pretty sure that Houdini worked at a burger joint until one day during a PET scan he realized that he could scratch his head only if he could get out of the Velcro.  I manfully endured it, and in a few minutes it went away, shortly before the right edge of my right eye started itching.

And then there are the more serious thoughts. What would it be like to go through this alone?  What do people who don’t have relationships with God think about during PET scans?  In an email one of my sisters-in-Christ reminded me of Deuteronomy 33:27:  “The eternal God is your dwelling place, and underneath are the everlasting arms.”  Why wasn’t I worried about the outcome of these tests?  Why wasn’t I afraid?  I again heard the words of Christ, “I will never leave you nor forsake you.”  (Hebrews 13:5)  Although I was in the scanner, God was gently cradling me in His arms, comforting me.

Bone Marrow Needle Biopsies Are Fun!!

Nurse Practioner:  "Are you comfortable?"

Brian:  "As comfortable as a guy can be with two strange women looking at his rear end."

NP (cheerily):  "We've got two more coming!"

And they did.  So began my procedure today.  She then asked me what I do, and after I told her that I'm the chairman of the Chemistry Department at BJU she began to confess her historical experiences in chemistry courses (beginning with high school).  I absolved her of everything.

They swabbed me (well, part of me, anyway) with some kind of iodine solution, sprayed the target zone with something cold, stuck a needle in the bull’s-eye, and then injected me with lidocaine.  And I began thinking about the fact that lidocaine affects ion channels in neurons.  It was clear that the NP was teaching one of the other nurses how to do the anesthesia.  I felt considerably better after the NP told me that she would be the one to do the actual biopsy.

After the relevant portion of my rump was thoroughly numb, the NP inserted a needle and pushed it into my pelvis.  An odd feeling was followed by some pain as she aspirated bone marrow through the needle, which I'm pretty sure must have been at least 1-2 inches in diameter.  She said that I am "a giver," meaning that it was easy to get the bone marrow out.  There are some people where it's difficult to get it out and, well, I suppose they have to call Roto Rooter in assist.  It’s a little strange listening to four medical personnel discuss your procedure as they perform it while at the same time occasionally joining in the conversation.

She prepped some slides for pathology and then pushed the needle in deeper and aspirated some more.  Whew, we were finally done with the hard part.  The procedure wasn't really that painful: it was the idea of the thing that bothered me and gave me the willies.  She pulled the needle out, they bandaged me up (“keep it dry for 24 hours”), and helped me roll over and sit back up.  After getting off the table and standing up I thought I’d have a little fun and so I said, “I feel like I’m going to faint.”  Everyone became concerned.  They felt much better after I told them that I was kidding.

That’s one more thing off my bucket list, and I highly recommend that you add it to yours.

Testing the Teacher

I’d been thinking about my appointment today, praying about it, and praying for my oncologist.  He (Dr. Joe Stephenson of the Greenville Health System Oncology Institute) and I met for the first time today and we had a productive discussion.  He found it interesting that I’m the chairman of the Chemistry Department at BJU and thanked me for teaching all these years (now over 31).  I didn’t expect that, and it was very nice of him.

He said that my follicular lymphoma is “low-grade,” as opposed to mid- or high-grade.  This is good and bad.  It’s good because it appears to be slow-growing.  It’s bad because it’s considered to be incurable.  This doesn’t mean that I’m going to die soon, but it does mean that if it remains in the state it is in right now, then I’ll probably have to just live with it for the rest of my life.  But it should be medically manageable.  In other words, we’ll do what is called watchful waiting, which means we’ll watch it and respond to what we see.  Will I need chemotherapy now?  I don’t yet know.  Will I need it later?  That’ll be determined by watchful waiting.  Oh, and low-grade follicular lymphoma can progress to the other grades, and it can also turn into diffuse large B-cell lymphoma.  It doesn’t sound like watchful waiting is optional.

After reading and thinking about things, I went into this appointment convinced that we needed to do more testing, and in particular that a PET scan would be a very good idea.  Before I had a chance to bring this up, Joe said, “We need to do a PET scan.”  Thank you, Lord, for answering prayer in exacting detail.  He also said that we need to do a CT scan of my neck.  And a CT scan of my chest.  And a CT scan of my abdomen.  And a CT scan of my pelvis.  And a biopsy of the bone marrow in my pelvis.  OK, well, I did think we needed more testing.

The bone marrow biopsy will be done next Tuesday, and then all of the scans the next Tuesday after that.  Anybody that knows me very well has observed that I’m a fidgety kind of guy and that I rarely stay still at all, much less for long periods of time.  How in the world will I be able to stay still for several hours of scans?  I sure hope it’s not like the x-ray of my back and CT scan of my head when I broke my back in 2011.  This was the result of what I call The Fall of Brian (as opposed to A Lump of Brian, which as you know was recently removed).  Although I was loaded with morphine–no, make that really, really loaded with morphine–I was still in serious pain and fidgety.  And I wiggled, and they pulled the x-ray sensor out from under my back, checked it, came back and said, “We have to do it again. Try to stay still.”  And then they stuffed the sensor under my back again.  Excruciating pain, deep breath, try to stay still.  I think we did it one more time after that.  And then they did multiple CT scans on my head.  “Try to stay still.”  I hope I can.

Joe and I will discuss the results of all the tests on Friday, September 26, and then I’ll know if I need any chemotherapy.  Today he said that if chemo is necessary he expects it to not be the harshest kind.  That’s reassuring.  I wonder, what are the side effects of not-the-harshest-kind of chemotherapy?

It appears that I will be in this for the long run, something I never expected.  Over the last few weeks I have anchored my soul to the words given in Hebrews 13:5:

“I will never leave you nor forsake you.”

How precious those words are, particularly during difficult times.  No matter what happens, no matter where I am, I will never be alone.  God will be with me, as he is right now.  He continues to give me peace and comfort.  And the comfort continues:

We can confidently say,

“The Lord is my helper;

I will not fear;

what can man do to me?”

Facing the Unknown

I’ll be seeing an oncologist for the first time on Tuesday afternoon next week, and I have some questions.

How far has it spread?  Cancer cells are cells that are out of control and can potentially invade other parts of the body, a process known as metastasis.  They can wreak all sorts of havoc in the liver, lungs, bone marrow, brain, and other organs.  In my case Dr. Rob Brown expertly removed a cancerous lymph node measuring roughly 1.5” x 1” x 0.7” from my neck.  Normally a lymph node in the neck is about the size of a grain of rice.  I had figured that I might have a significant scar after the surgery and thought I might start the first day of class with something like, “Hi, I’m Dr. Vogt, your chemistry teacher. You can call me Dr. Scar.” Well, Dr. Brown did such an artful job that at this point it appears that the scar will look like a crease on my neck, which isn’t at all out of place on a 58-year old bloke.  For some reason Dr. Crease just doesn’t sound as cool as Dr. Scar.

My cancer is in my lymph system, which circulates a clear fluid similar to blood plasma throughout the body.  The lymph system is an important part of our immune system.  Lymphocytes are white blood cells and in the lymph system they are located primarily in lymph nodes, but lymphocytes also circulate through the lymph system.  I have cancerous lymphocytes (hence the term lymphoma), and so it seems like some of those cancer cells must be circulating throughout my system.  Are there any other cancerous lymph nodes?  Not that we know of.  Will we find out?  I hope so.  I read the printed pathology report I got on Wednesday and it indicates that the particular kind of B cell non-Hodgkin’s lymphoma I have is called follicular lymphoma.  Of course follicular lymphoma is bad, but it actually has one trait that is good. You can look it up on Wikipedia if you’re interested.

How will the treatments affect me?  I assume that the oncologist will discuss chemotherapy and radiation with me, but of course I don’t yet know what treatments will be appropriate.  Radiation damages the skin in the area that it is administered and can result in blistering and, since the problem is near my throat, potential difficulty swallowing.  I hope it wouldn’t affect my larynx, because a lot of what I do in life requires me to speak.  Chemotherapy has a well-deserved reputation of causing serious side effects.  I rather doubt that I’ll look good without any hair, and so perhaps I’ll start a hat collection of some sort if that happens.  Then there’s the possibility of neuropathy, where the chemo treatments damage nerves and can lead to pain and numbness and can, for example, make it very difficult to walk.  Nausea is never fun, but there are drugs to help deal with that.  Being extremely fatigued is not fun, and it will also make it difficult to teach.  In college we don’t just call for a substitute. Who will take my teaching responsibilities if I can’t do it myself?  Thankfully I have very supportive colleagues who have already volunteered to help.  There is that one course, though, for which I’m the only person on campus qualified to teach.  What will happen there?  Who will cover my responsibilities as the chairman of my department?  One of my colleagues has agreed to do so.  Oh, boy, I work with wonderful people.  Who will cover my program coordinator job?  I’m the only academic advisor for one of the degree programs offered by my department, and I’m the only person that has ever advised students in this major.  Who will advise these students?  Oh, wait.  I’m also a husband, a father, a Sunday School teacher, an elder at my church, and co-owner of The Vogt Estate.  To what extent will I be able to fulfill these responsibilities?

Will I survive?  Survival statistics are just that, just numbers.  They are very helpful when describing large numbers of patients, but they don’t always apply to individuals.  The average U.S. adult male has a waist size of 39 inches, but there are lots of American men with waists of much different size (just look around the next time you’re in Walmart or McDonald’s).  Similarly, cancer patient survival rates are averages and don’t necessarily pertain to a given individual.  Here’s a similar example.  When my mother had heart bypass surgery in 1997, we were told that 97-98% of such patients survive.  She was in the other 2-3%.  So, although statistics may be helpful in making one feel better in a broad sense, one shouldn’t treat them as though they are accurate predictions of some sort.  The fact of the matter is, I don’t know how this is going to turn out.  My surgeon doesn’t know.  Doubtless my oncologist has experience, statistics, and reasonable expectations.  But he won’t know how this will turn out, either.

There’s enough here for me to spend a lot of time consumed by worry and fear, and I haven’t even mentioned everything that I’ve thought about.  How in the world am I supposed to deal with this?

Some of Christ’s most beloved words are recorded in Matthew 11:28-30:

Come to me, all who labor and are heavy laden, and I will give you rest.

Take my yoke upon you, and learn from me, for I am gentle and lowly in heart, and you will find rest for your souls.

For my yoke is easy, and my burden is light.

I need this kind of rest, rest for my soul that rejuvenates me.  Without it I’ll be faced with unrelenting turmoil, and it could wear me out mentally, emotionally, and physically.  But this peace has a condition attached to it:  In order to get it, I must go to him and agree to have his yoke placed upon me.  A yoke is a wooden contraption used to connect two oxen for plowing a field, and here Christ uses the term figuratively.  He means that I must willingly embrace his commandments and obey them.  All of them.  I must give myself and my life to him.  He promises that in return he will deal kindly and graciously with me (my yoke is easy) and that the tasks he chooses for me will be light.  He will also give me refreshing, calm, quiet, rest in my soul.

Many years ago I took Christ’s yoke upon me, and after being diagnosed with cancer I examined myself and reaffirmed my commitment to him and his purpose.  A lot of people have been praying for me, and I am very thankful for that.  Christ is honoring his promise to me and he is answering the prayers of his people.  Most of the time since my diagnosis I have been filled with peace.  Yes, there are times of struggle.  For example, one evening last week about an hour before I went to bed I had a terrible struggle with fear.  I discussed it with God and it evaporated before I went to bed.  Most of the time I feel like I’m sitting in a river of peace, with peace sloshing around and over me in endless supply, and I can drink as much of it as I want anytime I feel like it.  This is not me gutting it out or deluding myself, nor is it the result of any medications or the placebo effect:  This is God keeping his promise and giving me rest in my soul.  This is the way to face the unknown.

Discovery

During the latter third of the winter/spring semester of the 2013-14 academic year there were many mornings when I woke up feeling sick, something like the onset of nausea, although I never got completely nauseated.  I attributed this simply to it being a very stressful semester.  Was this an early sign of cancer?  It's possible, I suppose, but I don't know and I don't know of any way to know.  Try saying that five times rapidly.

At the end of the school year and into the first part of the summer I experienced extreme fatigue for about six weeks.  I went to the doctor and we did a bunch of blood tests and everything we checked came back normal (except for one number that was such a teensy bit above normal that it was safe to ignore).  We concluded that it was simply the accumulation of fatigue and that it would be resolved with adequate rest.  I made a solo trip to visit some friends in Florida to do some saltwater fishing—this was great fun even though the fishing was so-so—and within a week or so of returning my fatigue disappeared.  Problem resolved.  Or was it?  Hmmm, I do wonder if the fatigue was a warning sign.

While I was in Florida staying at my friends' house I used a bathroom with a skylight.  One very bright day the sun was shining through the skylight and I saw a lump on the right side of my neck.  Difficult to measure, but it looked roughly oblong and perhaps about one inch wide by about two inches long.  It was easy to see from the right angle, and I wonder how long it had been there.  No tenderness, no fever.  Feeling just fine except there was a big lump staring at me in the mirror.  What would you think if it were you?

I was quite disturbed and immediately called my doctor's office in Greenville.  "Can you come in tomorrow?  No, I'm in Florida."  I exercised my will and read some thoughts and scripture from a devotional book that some friends at church had given me for my birthday.  And I talked with the Lord.  God immediately started to give me grace to deal with it.  I explained the situation to Carla and saw my doctor the following Monday after I got back.

One theory was that it might be an infection, and so I took an antibiotic for 10 days.  No change.  Could I have had mononucleosis and the lump was residual from that?  One more blood test.  Nope, it wasn't mono, either.  Next I went to a surgeon who checked me out and discussed things with me.  We then did a chest X-ray, a CT scan, and yet another blood test.  It was during these tests that a woman at the medical testing facility thought—very seriously, actually thought—that I was the inspiration for some show named Breaking Bad.  That's another story (and a quite funny one, I think), and if you're interested you can find it on my Facebook.  All of these things came back normal, and I was referred to an ear/nose/throat doctor, or ENT.

He did some ultrasound and a needle biopsy (fine needle aspiration, if you want the technical term) which came back showing no malignancy.  The ENT recommended taking it out regardless, which he did last Monday (August 18) at Greenville Memorial Hospital.  I was thankful to go home that night and I missed only three days of faculty in-service at BJU.  He told Carla that the tissue mass didn't look completely normal but not completely abnormal, either.  Translation:  It was something between "everything is OK" and "it's all cancer."  That Wednesday the ENT called me with the pathology report.  I have B cell non-Hodgkin's lymphoma.  In other words, cancer.

Several weeks earlier while contemplating the challenges of the upcoming school year the Lord had impressed on my heart part of II Chronicles 5:13 (ESV):  "For he is good, for his steadfast love [or mercy KJV or loving-kindness Darby] endures forever."  This is just as true now as it was a few weeks ago.  God is giving me the grace that I need, and He is going to use this in my life and in the lives of others.  I've been prioritizing things at school and at home and am trying to prepare for the worst while hoping for the best.  It's become clear that I'm going to have to work at not thinking about it too much of the time.  Some of you know that I have a somewhat fragile sleep schedule, and I didn't sleep too well last week.  This is a good time to remember that on more than one occasion Jesus was troubled in His spirit (see John 11 and 13).

Non-Hodgkin's lymphoma (NHL) is a cancer that starts in lymphocytes, which are a category of white blood cells.  I'm not an expert in this disease and have no desire to become one, and so I'm not in a position to answer a lot of questions about it.  If you're interested in reading about it, the American Cancer Society has a good description of NHL.  My cancer is B cell NHL.  B cells make antibodies, and there are lots of kinds of B cell non-Hodgkin's lymphoma:  I don't yet know which type I have.  I'll be seeing an oncologist on Tuesday, September 9, and I don't know what we'll do first.  I'll keep you posted.