Early Christmas present

Hello All! Merry Christmas about a week early from the Clarks. I know that the posts are a bit more irregular in frequency lately, but that is simply because of two things. One, and I am sure you can all relate, it is BUSY right about now! And two, there's just not much happening medically for Dee Dee. She has mostly fully recovered from the surgery, with the exception being lingering soreness if direct pressure is applied to her left side. We cancelled one follow-up at Duke, just because there seemed no point in it until we decide what to do from a long-term, big decision standpoint.

I have spoken to the folks at Johns-Hopkins, and they affirm that both Duke and Mayo are logically, medically reasonable in their advice. Duke's surgical answer guarantees no cancer but lingering "yuckiness" (a highly sophisticated medical term, by the way); Mayo's means some long-term risk from leaving over twenty tumors in your stomach on purpose, but is reasonably safe with no yuckiness. Johns-Hopkins says that both make sense, and that neither clinic is giving strange advice. I have had one conversation with the doc at MD Anderson in Houston, Dr. James Yao, who is recognized as one of the nation's leading researchers for carcinoid cancer. He also says that sometimes they do the surgery, and sometimes not. He, too, says that both answers are valid. He is debating the need to see Dee Dee, versus just looking at her info and talking to me on the phone. We are leaning more and more toward the Mayo approach of life-long surveillance, probably twice a year for now, once a year down the road. We would do this at Mayo, simply because they are the ones who most earnestly believe it to be appropriate (my decision on that part of the plan).

Now on to the really important stuff. Today was one of the best days in our young church's life. We are less than nine years old, less than 150 people, and just a great community of members. We have this one family, fantastic couple with two girls. The dad, at age 40, became a Christian yesterday! Lots of cheers and tears in Ambassador Presbyterian today, and I am sure for a long time to come. He has loved his wife by attending faithfully with her all these years, as a show of support and respect. She has personified 1 Peter 3, by being a steadfast and godly wife, making the gospel attractive to her husband. PRAISE OUR GOD for His sovereign plan, for His choosing this man to reign in glory, for electing to save another who, like me, did not deserve it. PRAISE OUR GOD that none of us get what we deserve, that none of us can do anything worthy of His approval, but that we can be adopted by the King of all glory to be sons and daughters, full of His grace and receiving His mercy. Let us join with the angels, who are rejoicing for my friend tonight.

Well, there is nothing else that I can write about that warrants inclusion with a sinner being saved, so I'm gonna go to bed now. Take a moment to pray for that friend or family member who you used to pray for regularly, but time has dulled your sense of urgency. You know, that person who seems like a lost cause, that if you really could be honest with yourself, you're not even sure God can save, or wants to save. Time is nothing to our God; and His grace is irresistible. (And all my reformed brothers said, "Amen!")

Love, thanks, and prayers,

Tony

Now that we've calmed down....

Okay, yesterday was no fun. The results were good (the scan showed no new tumors, and the areas of concern were deemed "okay."). For that, we are very thankful. Now to the frustration.

It took a great deal of effort and aggravation to even get yesterday's test scheduled, because Duke insisted that once you have had a doctor do any type of "scope" procedure, no one but that doctor could ever do another scope. So, we had to coordinate her test yesterday with the doc who did her first scan at Duke, and that was tough. Finally, we got that scheduled, nearly three weeks after the initial order for the test (lots of other openings were available sooner, just not with her assigned doc). Then, we had to get the consultation with Dr. Bendell scheduled for after the scan; this was finally set up for Monday, 12/04.

We get to the pre-op area for prepping Dee Dee for the scan, and sure enough, her doc is NOT even in town. Instead, the doc is someone we could have had do the procedure two weeks ago. We maintained a sense of humor, and let it go. The procedure lasted about 50 minutes. Normally, the patient is sedated at the beginning, and wakes up after it is all over. They have a scope down the throat, into the stomach, and this scope is pretty large in diameter. Well, they did not give Dee Dee enough sedation, and she kept waking up during the procedure. She would try to tell them she needed more meds, and they just told her to be still, or to be patient, they were almost done, yada yada yada.

This started shortly after they started the procedure, and it hurt basically the whole time. When they got me to her after it was over, I thought I was going to have to restrain her she was so upset. The doc came and apologized, but that did not erase a pretty bad afternoon. Her throat was very sore the rest of the day yesterday, but today has just been "not normal."

Okay, the venting is over. We are very pleased at the results of the test, even if the test itself was tough. I already emailed the doc at Mayo, and he responded that this is further proof to him that we should not do the stomach surgery. At the very least, we are sure that we will not have any further procedures at Duke. The last 2-3 experiences have been....well, bad. From a scheduling standpoint, from a compassion standpoint, from a pain standpoint, they've just been bad. It seems as if in their desire to practice great medicine, they forgot to practice preat patient care. There's more involved than just the stomach; there is a whole person attached to that stomach! In their zeal to do surgery on her stomach, it feels to us as if they have forgotton to care for the woman. Oops, I think I vented some more!

Thank you all for praying about yesterday. The results were good, and we are grateful for that. Pray that we don't smack anyone at the last appointment on Monday. Also, we are going to at least talk to the folks at MD Anderson (a great cancer clinic in Houston); not sure yet if we are going to go for official consult, but may just talk to them about their philosophical approach to this condition. Pray that we would be wise about that as well, and that the path to doing either of those courses of action would be smooth.

This is Saturday night, so I pray that you have a blessed Lord's Day tomorrow.

Immortal, Invisible, God Only Wise

1. Immortal, invisible, God only wise,

In light inaccessible hid from our eyes,

Most blessed, most glorious, the Ancient of Days,

Almighty, victorious, Thy great name we praise.

2. Unresting, unhasting, and silent as light,

Nor wanting, nor wasting, Thou rulest in might;

Thy justice, like mountains, high soaring above

Thy clouds, which are fountains of goodness and love.

3. To all, life Thou givest, to both great and small;

In all life Thou livest, the true life of all;

We blossom and flourish as leaves on the tree,

And wither and perish - but naught changeth Thee.

4. Great Father of glory, pure Father of light,

Thine angels adore Thee, all veiling their sight;

All praise we would render; O help us to see

’Tis only the splendor of light hideth Thee!

Thanks-giving

Gobble Gobble! I finally remembered where our blog was, so I'm here to "post" again. Actually, I've just been slack/busy/waiting for new developments. There is still not much news to report, but I wanted to share a few things we are thankful for, as well as a brief medical update (which is at the end). I hope you all had a great Thanksgiving. How about you folks overseas? Did you do the whole Thanksgiving occasion?

Dee Dee and I have been married for almost twenty years. I am thankful for a godly wife, who loves our Lord, trusts His word, and lives it daily. I am thankful that she is still so good-looking, and that she somehow still thinks I'm okay as well. We are thankful for six great kids. Caleb turns 15 in a couple of days! They are all healthy and well, and we usually want to keep them (grin). We are thankful for a church where God's word is faithfully taught, where the people truly care for one another, and where our gifts are given opportunity to be used. We are thankful for extended family, that despite the normal peaks and valleys of lifelong relationships, are still strong, and in many ways more enjoyable than ever. We are thankful for many friends, who care enough to read stuff like this, to write, to pray, to cook, to love us after the manner of Christ, with grace and mercy. We are thankful for a great practice, with an understanding partner and his wife who care for us as we go through this; and with amazing patients who not only understand when I have to cancel, but many of whom are reading this blog and praying for us as well. We are above all, thankful for a God who is alive and well, active and strong; who is trustworthy; who is faithful to forgive; who never forsakes us even when we turn from him to chase our own idols.

We can just look back and see His providence and protection in so many ways! For example, God used Julius Erving (the basketball player) and J.I. Packer (the theologian) to bring Dee Dee and I together. Amazing! The list of health care issues that we have been through, and delivered from, is surprisingly long. It would take far too long to record them all, and to be honest I started to write some of them, but it just felt wrong. Suffice it to say, we have often been on the receiving end of the medical field!

On to the medicine. Dee Dee has the endoscopic ultrasound scheduled at Duke for this coming Friday, 12/01. Just getting this thing scheduled has been a royal pain, but it is finally almost here. She then has follow-up with Dr. Bendell on Monday the 4th. At that point, there will be no more medical testing or investigating to do; we will have all the information. It will only remain for us to decide. Neither of us wants her to have the stomach surgery, but we will if she needs it. The medical and scientific arguments espoused by both camps (Duke - do surgery; Mayo - no surgery) make remarkable sense.

Mayo says the cancer will never leave her stomach, and will never shorten her life. It will significantly inconvenience her life, but that is all. Duke says that may be true, and the science makes sense, but no one can guarantee that it will not spread. If Dee Dee is that ultra-rare patient (that Mayo says does not exist), then we will regret the decision not to do surgery. Once it has spread to another organ, it is treatable, but not curable. If we do the stomach surgery, then all agree it will be permanently cured. As Dee Dee puts it, Duke is "selling" life insurance.

However, the premium for this insurance is awfully high. Her weight would immediately drop to 90 pounds or less. She may need to be tube-fed for a period of weeks. It could take as much as a year for her weight to recover. It would take about the same length of time for her energy and strength to recover. She would run the risk of significant bone-density problems as a senior citizen because of the extended time of weight loss. It would make the normal living of life for her difficult for a season (homeschooling, teaching, mentoring, etc.). This is all separate from the other issue, the potential for the lifelong digestive problems. So again, we'll do it if she needs it, but man she really needs to need it! I don't think we will do it just out of fear, or from a sense of "What if...."

Certainly, we will not do surgery without another institution concurring with Duke. I have already talked a fair bit with Johns-Hopkins, and they approach this condition from a team format. One doc gathers all the info, then presents the case to an oncology board. They discuss it for an hour or two, then vote. Majority wins. Bottom line, they go about 60% of patients with surgery, and about 40% surveillance; a poor tie-breaker. Sloan-Kettering is very difficult, and will not talk with me on the phone. So, if we decide to go for another opinion, it will be to M.D. Anderson in Houston, TX. This is a great cancer clinic, and is the one our Aunt Jackie received care from during her battle with terminal cancer. We have not decided yet whether to go for another opinion or not. On many of the issues we have faced, I have decided for her/us. This issue is really one that gets to Dee Dee's peace of mind, so I am following her on this one.

Thank you all for persevering in prayer on our behalf. I'll try to write more regularly. Ya'll are great, and I thank God for each of you!

Tony

Oh, also I thank God for turkey and for oyster dressing. And for pecan pie. And naps. He didn't have to let us have any of those, ya know?

Wisdom

Psalm 111:10 - "The fear of the LORD is the beginning of wisdom; all those who
practice it have a good understanding. His praise endures forever!"

It seemed appropriate to start tonight's post with the topic of wisdom, because we sorely need it. Our appointment today with Dr. Bendell went fine, and we liked her well enough. She was very encouraging about the lymph node results, which actually weren't really even lymph in origin. She was encouraging that the long-term prognosis is very good. She was emphatic that the correct course of therapy is to do the stomach surgery to remove the antrum of the stomach.

Ugh.

(Heavy sigh)

So now we come to it, to the deciding point. Mayo says do not, under any circumstances, take out her antrum. In fact, I got an email from the doctor at Mayo last night reiterating that point (Dr. Thompson). The science behind this approach makes wonderful sense to the medical side of both of us. The desire to avoid major surgery, with a 6-9 month recovery, is obviously attractive. The avoidance of the risk of permanent side effects in her digestive system would be great.

At Duke, every doctor, physician's assistant, and nurse practitioner have all said to do the surgery. No exceptions. They have stopped just short of calling Mayo's "Surveillance Therapy" approach ridiculous and irresponsible, but they've come close. (Mayo, on the other hand, essentially called Duke's surgery approach barbaric and uneducated.) The reasoning behind Duke's approach is a bit more philosophical, and unfortunately for us, the folks who ultimately have to make this decision, it also makes absolutely perfect sense. Their reasoning is that she has cancer; it is confined to one location. If we do this surgery, the risk of further complications or spread are permanently eliminated. It is gone, won't come back, completely finished. She never worries about it again.

Also, and this is a part of medicine today, I am sure that everyone at Duke knows that if they recommend the surgery, there is no risk of me coming back 5-10 years from now with a team of lawyers because they failed to act and prevent the early death of my wife. If they go with surveillance, they are convinced that there is some risk of shortened life; why would we chance it, and why would they risk it legally? I just know that is part of their thinking.

Duke agrees that the risk of metastasis is very low, but refuses to say impossible. Mayo says they "think" it is impossible. Dr. Bendell said that if Dee Dee were 72, she would say not to do the surgery. But as young as Dee Dee is, it just doesn't make sense to leave the cancer inside her body when you have a guaranteed way to get it out forever, according to Dr. Bendell. By the way, Bendell is probably in her mid-thirties, female, and fairly thin (not as thin as Dee Dee, but slim). So, she fits the profile for higher risk of post-operative complications that Dee Dee would be at risk for. When asked today what she would do, Dr. Bendell did not hesitate: "I would have the surgery as soon as possible, and be done with it."

We told Dr. Bendell that we would take everything under advisement, but there was no way we were deciding this thing today. We got (more!) bloodwork done today - seven vials worth. They are scheduling the last study they want to do (Mayo agrees), an endoscopy with ultasound of the possible sub-surface tumors in the stomach. Then, we will talk a lot, pray even more, and decide what to do. Obviously, we don't get to simply refuse to decide; that then would be the decision to simply observe. We discussed, briefly, getting yet another opinion (from either Johns Hopkins or from MD Anderson in Houston); but to be honest, starting over at another center made us both feel a bit nauseous. We may revisit that idea later.

By the way, if we go with Mayo's approach, basically for the next several years Dee Dee would get endoscopy 3-4 times a year, CAT scan once a year, PET scan once a year, and octreatide once a year. After that, they would try to spread things out, assuming everything was holding stable. If the lesions grow in size or number, there is increased risk of internal bleeding. If they metastasize, there is risk of shortened life span. Obviously we can come back and do the surgery later, but with any cancer there is a "too late," although evidently that is a low (Duke) to no (Mayo) risk here. If we do the surgery, the cancer risk is gone, but there is between a 5% risk of the permanent digestive problems (per the surgeon, Dr. Pappas), to a 15% risk (per Bendell), to a 50% or greater risk (everyone at Mayo).

So we pray for wisdom. I pray for the courage to be a godly husband and lead my wife even in the scary times and the scary decisions. The Bible says that fear of the Lord is the beginning of wisdom. Proverbs 8:13 - "The fear of the LORD is hatred of evil. Pride and arrogance and the way of evil and perverted speech I hate." So, I pray that we would fear God more, in the correct and proper way. I pray that our reverence and awe and humility before His perfection and holiness would grow. I pray that we would be more convicted of our sinful nature, and of our specific sins, in light of His holiness. This is proper fear of God. And this will lead to greater wisdom. It is a mathematical certainty. Fear of the Lord is the beginning of wisdom.

People ask me if we want to flee, to just get away from this. No! I didn't ask for it, but I have asked God to take it from us. And He has repeatedly said, "NO." His answer, given that He has promised to only do good for us, is good enough. I will not deliberately try to avoid His plan. And by the way, I am not nearly brave enough, or good enough, on my own to stand up to this. It is Christ in me, it is the Holy Spirit comforting me, that enables me to talk about this candidly, to face it daily with sanity and some humor. Our younger kids sing, "My God is so big, so strong and so mighty, there's nothing my God cannot do." And while that does mean that He could take the cancer away, it seems in our case to mean that He can empower us to live as if Scripture is true, even when life circumstances turn scary and sad and hard.

That's really all I/we are doing: living daily as if the Bible is actually true. After all, we're Christians; shouldn't we live this way?

Tony

Proverbs 2:6-7 - "For the LORD gives wisdom; from His mouth come knowledge and understanding; He stores up sound wisdom for the upright; He is a shield to those who walk in integrity"

Proverbs 8:14 - "I have counsel and sound wisdom; I have insight; I have strength."

Final report on the "Lymph"

We had our appointment today with the thoracic folks at Duke. Basically, all GOOD NEWS! They said that she is healing as expected, and that her incisions are great. The pain, and more recent addition of significant burning, are normal and will pass over the next two-three weeks. The doctor said that you can tell a great deal about a person's overall health by how they do while under general anesthesia, and that Dee Dee is "the very picture of excellent cardiovascular health." One of the anesthesia docs commented that he needed to get on "whatever workout program this lady is on." That's my bride!

And best of all, the lymph was actually more of a blood vessel problem, totally benign, unrelated to the stomach in any sense of the word. It was large enough that they are glad to have it out, but suspect that it had been there for years. Amazing! The thymus gland was partially involved, and they removed part of it, but that, too, is no big deal. The thymus is hugely critical in developing immunities during the first decade of life, but by age twenty it begins to atrophy, and by now is mostly inert tissue. It has done its job, so it basically goes away over time. Again, we are fearfully and wonderfully made. If Darwin himself could see the human body with the level of medical and scientific knowledge that we have today, he would scoff at his own theory.

Thanks for continued praying, and meals, and notes and cards. She has never been a big fan of spending time on the phone, but she's even up for more calls and visits now. Thanks for your continued efforts to encourage her, and me, and all us Clarks!

Tony

One week post-op

Greetings! I know it has been a while since my last post, but that's simply because not much has changed. Basically, this has been a much more painful and slow surgery to recover from than we had anticipated, but she is getting better. Yesterday, for example, she had to leave church early because it just hurt too much to stay.

However, she is clearly better now than she was 2-3 days ago. That is how we have realized that we must think of this process: looking at several days for progress, not daily progress. This is not easy for two sinfully self-sufficient, strong "type A's" to readily accept. We are sort of wired to look at the new morning and compare it to last night. Or, for me to get home from work and want to know how much better she is than that morning. So, it seems, God intends to teach us patience through this process, among other things.

When Gabe was sick, exactly ten years ago, I remember saying that there are times that God shapes his children gently, with very fine sandpaper. There are other times that he is a sculptor, using chisels to knock off great pieces of sin. This is a new time of sculpting for us, and self-sufficiency and patience are two of the chunks getting leveled! Maybe if we'd learned those lessons well enough last time....

Now, I'm not saying that God has sent Dee Dee's cancer purely as discipline. He may very well have sent it simply to refine us, to strengthen our faith. However, His word is clear that he will also correct His children when they are in sinful patterns that they seem unaware of, or unwilling to repent of. Therefore, we would be remiss not to do some introspective soul-searching any time difficulties are sent our way. All opportunities to learn more of our sin, of our need for a savior, should be welcomed and vigorously pursued. This is one of those times, when we are driven back to Christ. We should be thankful when God, in His love and grace, works to get us back to the cross! This is the concept we see in so many Psalms, where He searches our hearts (Psalms 4:4, 7:9, 139:1, 139:23).

Some good news: the preliminary pathology results for the mass removed last week are that it is benign, and unrelated to the stomach cancer. We should get final results tomorrow at her appointment at Duke. So, the surgery was able to be done locally (not at Mayo); in the least invasive manner possible (no broken ribs or sternum sawed in half); with what appears to be the best pathology result possible. Praise God! The pain can wear your body down, but our hearts rejoice in the goodness of God.

Our upcoming schedule looks like surgery follow-up on Wednesday; and first official appointment with the medical GI oncologist at Duke on Thursday. She, we assume, will then schedule the remaining test to look at the sub-surface lesions in the stomach that were seen at Mayo, and then we will decide on further treatment.

I was thinking, how things that you would not really expect to minister to you during troubling times, actually end up being part of the key ways you are blessed. Now, I know you all will laugh at this, and say to yourselves that every Clark male would say the same thing, but food really has been that for us. Many have brought food, both for lunches and dinners. Thank you all! We know some very good cooks! It has been a blessing not to need to figure out menus, try to get them prepared, or just constantly go for take out. Thank you.

Another unexpected blessing: When Gabe was ill, one of our dear friends really ministered to our hearts regularly. Doug and Susie then moved to Oklahoma (proving the depravity of man and that all sin and fall short!), and we have missed them ever since. As we have gone through this, I have missed Doug. I have missed his laugh, his genuine affection, and his ability to quickly connect to my own emotional state. Sunday afternoon, I got a call from this dear man telling me that he would be in my house in about 2 hours. What a treat! He was just in for a brief trip, knew of our situation, and came to spend a few minutes with us. It reminded me of .... the last time I approached this level of hurt/pain/ fear/helplessness, and how God used this brother to minister comfort and peace. In Is. 61, He promises to bring beauty from ashes; isn't it great when He let's us be a part of that process?

Tony

Praising Him for another day done

Don't you find, when you are sick or hurting, that you almost count the days? You know, for example, that the flu doesn't last forever. So, you count the hours, knowing that relief comes with time. In school they taught us that one of the most effective treatments in all of medicine is "tincture of time." Time alone will cure a lot of ills!

So today, no big events, unless you count a short walk down the street. Unless you count her fever breaking so that she did not have to be readmitted (this was a strong possibility last night at about 9-10 p.m. The magic number for re-admittance was 101.5; she got to 101.2). Unless you count no real nausea for the first time in 48 hours. Well, I'm counting all those things!!!

Yes, time is starting to mend Dee Dee's body from the insult of surgery. She is beginning to feel less sharp pain, and now has this more steady pain, less severe than yesterday. Yesterday the oxycodone narcotic pain meds didn't do a lot of good; today they are helping. These are great things!

She told me yesterday that if the full thoracotomy surgery, as originally proposed as likely to be necessary, actually did hurt a lot worse than this VATS surgery, then she would have opted to leave the tumor in there. My wife is pretty stoic, so I knew she was in a deep hole. Today she can see out of the hole. Thanks for praying.

Tony

Home now

Just a quick prayer request. I'm guessing that my dear bride came home too soon, because of concern for me and her children. Typical action of my servant-hearted wife, but she's in a lot more pain now that she cannot have the Toradol. Pray that this stage passes soon.

Thanks,

Tony

Going Home

We are waiting on the wheelchair folks to come and then we are headed home! Dee Dee had a tough time with pain and nausea from yesterday afternoon through the wee hours of the morning, but the nausea has greatly abated. She does have a fair bit of pain, but decided a couple of hours ago that she could rest in her own bed and deal with pain better than she could in the hospital bed. She will be on oxycodone for about a week, and can't drive until she finishes with that.

Thank you all for praying us through this. The doctors continue to be positive and encouraging, and we have a follow-up appointment with Dr. D'Amico's PA on 11/10/2006. We will probably hear about the pathology report sooner than that, at least we hope to!

In terms of visiting her at home, she is still weak and tired, so please hold off today (Tuesday). After that, maybe just call first, but I am sure she will enjoy (brief) visits. Thanks!

We are completely humbled and full of gratitude for the prayers and love of our family and friends during this. You are all loved and prayed for as well. Truly, we are of one body, and that has been evident to all during the past weeks. Thank you for your living testimony of God's grace and love.

Tony

Late night Monday

After today's earlier posting, things got ...interesting here. The anesthesia finished wearing off, and the pain came hard. There was a delay in getting the Toradol on board, so she had a solid hour or so of real pain. Then, as the pain began to lessen, she began to develop pretty significant nausea. It seems that my super-healthy wife is too fit!

The PA said that she is so thin that her body cannot tolerate much in the way of anesthesia; and since she is not prone to drunkenness or recreational drugs, she is not as able to handle narcotics. So, the morphine, which is necessary to handle the pain, causes the nausea. We have decided that we evidently need to go out drinking and clubbing every couple of weeks, just for preventive health care!

This has slowed things a fair bit. She has not been able to eat anything except jello, and that didn't, er, stay. They warned us that she is going to wake up tomorrow convinced that something is very wrong, because the pain is going to be huge. However, in 50% of patients, they rapidly improve and by lunch time or so feel up to going home. That is certainly our prayer!

Other adventures? How about a nurse giving a heparin injection in her stomach to prevent clots, only to realize as she finished that the needle had separated from the syringe, so an unknown amount of medicine spilled onto her bed. Should we give more? How much? Unreal.

This was an important day, and a very good day overall. We are thankful for all God's mercy today, and pray that it soon fades into the rear-view mirror of our lives.... Thanks.

Tony

Chest tubes suck....

....the fluid out of your chest, but they sure do hurt! What that obviously means is that Dee Dee is out of surgery, and is now in her room (3303).

Lots of praises today! The surgeon was able to remove the entire node, which he felt might actually have been more of the thymus gland than node, so he also removed a portion of the thymus (Not sure yet if there are any implications long-term from this). He was able to do the surgery with the least invasive type of surgery, just two incisions and no rib spreading. There were no "roots" or attachments from the tumor to surrounding tissue. He said that it did not look like carcinoid at all, and in fact looked like it would prove to be benign and unrelated to the stomach cancer. ALL GREAT ANSWERS TO MANY PRAYERS - THANK YOU ALL!

They did leave in a chest tube, to drain any blood or other fluids from her chest. It will stay in at least until tomorrow morning. It does cause a fair amount of pain, because as the PA said, "You have nice pink healthy lungs, with no room in your chest for things like a tube." A combination of the tube and the surgery are currently causing a fair amount of pain. She felt much better during the 1-2 hours after the surgery, until all the anesthesia wore off. She bottomed out from the pain at about 1:00 p.m. They have her on high doses of Toradol (non-steroidal anti-inflammatory) and morphine, whaich have started to help. They continue to hope that she will be discharged tomorrow, but Wednesday is a possibility.

Last night was a great time to pray together as a family, then individually with each child. Micah, who has not shown tremendous emotions with this thing up until now, could not stop crying; when the dam broke for that little 6-year-old heart, it broke hard. Josiah was the only one who seemed to have no fear, and acted like this was just a big adventure. Even though we left at 5:00 a.m., all the others got up with us this morning to kiss Mom good-bye. A sweet time for us! Thank you all for lifting my kids up as well.

It will take about a week to get the pathology report from the tumor today. After that, we will have an appointment with the digestive oncologist at Duke to decide on how to treat the stomach. If the pathology report is negative, which again is what the surgeon today thinks it will be, then we can probably go with the surveillance approach for the stomach. Our God is amazing! As the coach of the football team in the current movie "Facing the Giants" asks his team near the end of the movie, "What can't our God do?!"

Folks, what can't our God do?

Tony

"Twas the night before....

Hey everybody! Tomorrow is the big day, and it is with mixed emotions that it approaches. We are eager to have the surgery behind us, eager to have the lymph node out, eager to finally know the opponent we face... we are not looking forward to pain, to the hospital stay, to the finally knowing our opponent.

The surgery is scheduled for 7:00 a.m., and we have to be at the hospital at 5:30. It is a blessing to have the first surgical procedure of the day, for several reasons. It means less waiting time, where our minds drift "to the dark side," as my friend Dave put it. It means less likelihood of getting delayed, or even postponed. It increases the probability that Dee Dee will go home on Tuesday, just because it gives her a few more hours of recovery that day. The doctors say this surgery has a hospital stay of 1-3 days, but they believe that her excellent health and fitness will help her leave quickly. She cannot leave until the chest tube stops draining fluid, and until her pain is manageable by oral meds instead of IV meds.

The surgery is called a VATS procedure; a good web site is http://www.health.harvard.edu/fhg/diagnostics/thoracic/thoracic.shtml

Pray for the surgeons and anesthetists and nurses and PAs. Pray that the surgeon (D'Amico) is able to visualize the node, that it has no roots growing into surrounding tissue, and that it is small enough to remove without spreading ribs. Pray that her left lung re-inflates properly and quickly; and that her chest stops draining fluid quickly as well. Pray that her pain is minimal, and that they can do this with two incisions instead of three. Pray that the incisions heal well, with minimal scars.

Pray for us relationally as well. As the hour approaches, our tension has built, and neither of us is real friendly right now. There are short fuses in the Clark home, including the kiddos!

Many have offered help with logistics for home and children. Thank you! We are blown away by the outpouring of love and encouragement. One of the nice perks of living where you grew up is that we have family staying in the house while we are in the hospital, and after, so the child care is covered. Thanks to all who are helping taxi children to their classes and events. For meals, a great young lady at church has volunteered to coordinate this aspect. Her name is Christy Neal, and her phone # is 363-5441; email is nealcw@hotmail.com.

We cannot express our thankfulness and gratitude to you all. More, we cannot adequately express our thanks to God. We thank Him for being perfectly good, perfectly just, perfectly powerful, perfectly faithful. We thank Him for being a perfect Father. We thank Him for perfect mercy and grace. We thank Him for being Savior and God and King and Daddy!

One of our favorite worship groups to listen to is Indelible Grace. They take old hymns and make them new, and my favorite is "Whate'er My God Ordains Is Right" and some of its lyrics are:
1. Whate’er my God ordains is right
Holy His will abideth.
I will be still whate’er He does,
And follow where He guideth.
He is my God,
Though dark my road.
He holds me that I shall not fall
Wherefore to Him I leave it all.

4. What'er my God ordains is right,
Here shall my stand be taken.
Though sorrow, need, or death be mine,
Yet I am not forsaken.
My Father's care
Is round me there
He holds me that I shall not fall
And so to Him I leave it all.

And then, from one that our worship team chose to sing this morning, I suspect because someone wanted to see me cry and blubber so much that Micah was worried about his Daddy, "I Need Thee Every Hour":
2. I need Thee every hour,
in joy or pain;
Come quickly and abide,
or life is vain
I need Thee every hour,
teach me Thy will;
And Thy rich promises in me fulfill

(chorus) I need Thee, O I need Thee;
I need Thee every hour;
I need you Lord, O bless me now,
My Savior, I come to Thee.

We pray that He will teach us His will, and that we would truly leave it all to Him.

Thank you everyone, and I'll update tomorrow as I am able.

Tony

A very long, very good day

Usually in a good story, the author doesn't give the ending until, well, the end. (Except in Pulp Fiction, or Reservoir Dogs, but that reference is probably just for a few, like Randy! I actually thought about naming each of the people we met with today Mr. White, Mr. Pink etc....) Well tonight, I'm giving the ending first. Today was a very good day! It was long, but there was nothing terribly painful or miserable about it, and the outcomes were better even than we had hoped.

We started at 10:30 a.m., and finished at 6:00 p.m. We actually spent 5 hours sitting in one exam room! We joked that for us lately, that might qualify as a date. (I then observed that the exam room door had a lock, but Dee Dee didn't think that was terribly funny.) Every 60-90 minutes someone else would come in and ask a bunch of questions, marvel that this young, fit woman had any serious health issues, and assure us that everything was going to be fine. We met with three docs before the end of the day. Dr. Garst was great; she just sat up on the exam table while we sat in the chairs, and talked. She was friendly, warm, and encouraging. She also said pretty quickly that she was the least important "doctor-piece" to the puzzle, because her specialty is lung cancer. She saw herself more as the facilitator/coordinator.

Dr. Garst then went and personally found a doc we had no appointment with whatsoever, but this was the doc that Garst felt would be the best one at Duke to help decide about the stomach, after the node has been dealt with. This was Dr. Johanna Bendell, a medical oncologist specializing in digestive cancer. She just stopped by to meet us, and couldn't really get into the medicine yet, but was also very engaging. Then (well, 60 minutes later) Dr. D'Amico's personal physician's assistant came in. He stayed for at least 45 minutes, and was fantastic. He connected with both of us, and you just felt a trust with him right away. Further in the conversation, he talked about his faith, and asked about ours! Every doc eventually picks up on the fact that we are in a medical profession; every Christian picks up on the fact that we are believers.

Here's where it starts to get medically great. Dr. D'Amico has invented a surgical technique that he is extremely confidant will allow him to get the entire node out with a much less invasive procedure. He will use a video-microscope and two small incisions (1-2 inches each) to get to the tumor. They will deflate her left lung for the surgery, re-inflating afterward. They will leave a drainage tube in her chest until it stops draining any fluid, about a day or so. She will be in the hospital for 1-3 days instead of 4-5 days with thoracotomy (the one we actually thought was the best option) or 2 weeks with the most serious approach. She will be on prescription pain meds for about a week, as opposed to a month the other way. He has done about 2500 of these surgeries, and feels almost certain this will work. Praise God! Finally, he is going to do this surgery at Duke on Monday, 10/30, which is much sooner than we had thought Duke's wheels would spin.

We still have some hurdles to clear. This whole thing is too big to finish all at once. That's the old metaphor, you can't eat an elephant at once, you have to eat a bite at a time. Today was a really good day for progress, for encouragement, and for basic good news. We still have to find out what the node actually is. We have to decide what to do about the stomach. Also, that was a second lesion lower in the chest, and we have to investigate that at some point. Today, they were not terribly worried about this smaller spot. We'll get to all those things, but for tonight we will sleep a bit better, and enjoy the good from today.

Thanks for praying today. "The prayers of a righteous man availeth much." We are grateful that the are hundreds of righteous men and women praying much, availing much, on our behalf. We are aware of people in Peru and Sweden, South Africa, Slovakia, and Germany, and all over the good ol' USA praying for us. Our prayer is that God would richly bless you as you walk this path with us. Thank you! Thank God!

Tony

For His Own Glory

I'm sorry that it has been a few days since the last post. Nothing has happened medically, and normal life has been pretty busy. However, with the time lapse, there's a lot on my mind, so this could spin into a long one (sorry Kim)!

Let's go medical first. If you remember, Dee Dee suffered a seizure in January this year. She awakened me at 4:30 in the morning with the seizure, and we spent the next two weeks getting her head scanned and tested in every imagineable way. Bottom line: no cause found, "pretend like it didn't happen." Well, I got to thinking that maybe this lymph node, because it presses against her phrenic nerve (the one that operates her left diaphragm, the muscle that makes your lungs work correctly), could it have initiated the seizure? I talked to her neurologist today, and he said that the lymph is almost certainly the cause of the seizure. However, my logic was off a bit; he thinks that because it is on the heart, it started an arrythmia that triggered the seizure. Either way, it is more evidence that the thing must be removed! Now, more than ever, we are opposed to the biopsy approach.

More medicine: we start tomorrow at 10:30 at Duke for (yet more) bloodwork. Then we meet with Dr. Jennifer Garst, the pulmonary oncologist. Here is where there is a huge praise! We have a friend at church who works at Duke Med. She knows Garst personally, and affirmed to us that she is a terrific doc, and a very nice person. Unfortunately, she is not a surgeon. She is a cancer doc, and maybe a biopsy doc. We were quite bummed, because that basically would have meant at least another week of waiting. Well, our friend told Garst our story, including Mayo's recommendation to skip the biopsy and just go straight to surgery. Garst responded with a recommendation on her favorite thoracic surgeon at Duke, and took it upon herself to get him to meet with us tomorrow as well. His name is Dr. Thomas D'Amico, and we meet with him whenever we finish with her. It may not seem like a huge deal, but I gotta tell you, for the Clarks right now there's not much that could have been better news. Our heartfelt thanks to Julia P. for helping us here! More, though, is our sincere thankfulness to God for orchestrating the daily events of our lives to accomplish his good purposes.

Last medical update for the day (hopefully many more tomorrow): I'd like to explain the surgery that was proposed at Mayo. If you take your left hand and make a fist, with the thumb pointing up, hold it in front of the middle of your chest. The fist is the heart, and the thumb is the aorta. Her node sits on top of the fist, leaned against the thumb. In front of the node is the phrenic nerve, that controls the diaphragm. To the right of the node (I think I'm correct here) is the nerve that controls her voice box. The danger of trying to biopsy is that one of those nerves could be accidentally damaged. So, the head thoracic surgeon at Mayo proposed to do a sugical procedure in which he makes a ~5 inch incision in her left side, probably breaks 2 ribs to gain access, and goes to the tumor that way. If he can adequately visualize the tumor/heart/aorta/nerves, he would remove the tumor in this fashion. This also would be dependant upon the tumor being "encapsulated" as opposed to a tumor that is "growing roots." If he cannot see well enough, or if it is rooted into the heart and aorta (like ivy growing on a wall), then he would change and make an ~8 inch incision in the center of her chest, saw through her sternum, and split open the ribcage to almost do open-heart surgery. The first surgery would hurt really badly for ~ 3 days, with hospitalization for 4-5 days. If he has to change gears, we are dramatically increasing the length of recovery.

Obviously we are praying for the least-invasive, lowest-risk surgery that will succeed. We pray that that docs at Duke agree with this approach, and that for a change the two sets of medical experts agree on the correct treatment. We pray that the lesser surgery will succeed. We already pray that her surgery would be without complication, that her life would be protected, her heart and aorta safe, and her nerves undamaged. We pray for a fast recovery, and that the pain would be less severe than they anticipate. We pray that we can do it at Duke, but if things just aren't "right" at Duke, we have decided that we would return to Mayo for the surgery. We pray that we leave Duke tomorrow with firm answers and dates.

Now on to non-medical. People have been graciously, wonderfully supportive in prayer, words, notes, and deeds since this started. We are blown away by the goodness and love of the body of Christ! One of the things that folks keep asking is, "I know how her health is, but how are you both doing otherwise?" I can honestly say that we are doing better than anything that makes good sense. I have yet to detect any anger or despair in either of us. There is no lack of faith; we are perfectly content to be in the center of His will and plan for our lives, and for our kids' lives. We are encouraged daily by His word, your prayers, and our love for one another. We are actually excited by the opportunity to parent our children through this time, because we know that it can be a time where God does amazing things in and for them, too. I told Caleb and Samara the other night that while Dee Dee and I don't want to "Waste her cancer" as Piper put it, our kids shouldn't waste their mom's cancer, either. This will be the seminal time in their adolescence that they will remember their parents actually living out their faith. For them, it may be the most visible time in which our faith was not just theoretical, but real. How great is it to be able to recognize that opportunity, not just have it lazily drift by? The heat of this moment forces us to recognize it, and for that we are thankful.

Don't get me wrong! There is certainly fear (of the surgery, of the pain, of the outcome, of all sorts of things); this is scary stuff. There are many sleepless nights; I haven't slept more than about 4 hours in a night since we found out she had cancer 6 weeks ago. There are more stress-related headaches than we usually have in a year. We wrestle with patience with our kids more, and I wrestle with patience with work issues more than usual. It is just that these things exist inside an over-arching awareness of the sovereignty of almighty God.

So why are we doing well? Why aren't we falling apart at the seams? How are we getting out of bed each day, instead of simply lying there holding each other? This is a living definition of faith. As Dee Dee told our small group Sunday night, faith is choosing to live as if the God of the Bible is real and His word is actually true, even when our emotions don't feel like it. When we do this, our hearts will follow our heads. What do our heads know to be true here? It is just this. God planned from before time that Dee Dee would have cancer in 2006 A.D. This has always been in His design for us, it is under His control, and it is not surprising Him nor stretching His ability to govern it. And because our Lord is also our Father, He loves us too much to let us get to this place unprepared! He not only planned the cancer, but He planned every event, every encounter, every relationship and conversation, even our childhood enjoyment of science which led to medical training, so that when we got here we would not drown. Not only will we get through it, we will triumph, because this is the God we serve.

Why is this so? FOR HIS OWN GLORY. Not for our own praise, but for His. Several have mentioned how amazed they are at our attitudes, or how proud they are of our strength. This is kind, and I thank you. I know the intent of the words, which is to encourage; it does! But remember, I will not boast in anything, save Christ at work in me. Trust me, Tony Clark is not man enough nor Christian warrior enough to handle Dee Dee having cancer and be anything but a babbling idiot. BUT, through Christ we are victorious; through Him we don't just get by, we excel. In Him we live, and move, and have our being. Not for our own glory, but for His.

This cancer was ordained by our Father for our good and His glory. And that is true, no matter the medical outcome from this whole thing. We pray that He will allow this cup to pass, that her health will be restored quickly, and that we soon we are looking back on this time as a closed chapter. But no matter what cup He has for us, we will drink deeply. To do otherwise would be to deny that He is good, to deny that His promises to perfectly love and to always do the best thing for His children are false, to call Him a liar. Our God is true, and trustworthy, and gracious to His chosen people. Never let us doubt the goodness of God!

Finally, I just wanted to mention one of the ways that God has sustained us. Exactly ten years ago our infant son was lying in a hospital bed, desperately ill. The medical team told us that he had about 24 hours before he would slip into a coma, and another 24-36 hours before he would die. He was the third patient in medical literature to have his specific diagnosis, and the first to recover. Today, our faith is strengthened every time we look at 10-year-old Gabe. He is healthy, and sweet, and kind, and bright. He is insightful, loves deeply, trusts God, and thinks the world of his siblings. He is funny, plays drums, is easily distracted, and hates clowns and pigs. In short, Gabe is your classic boy. Every time we look at him, we are confronted with living, breathing proof that our God is able to do whatever he chooses, whenever He chooses, however He chooses. How could I doubt this same God now? If I look at Dee Dee and begin to lose faith, all I have to do is look at Gabe and my heart rejoices.

So, thank you God for being miraculous. Thank you friends and family for being earnest and faithful in your prayers and support. We look forward to seeing the miracles that He works in this time, and to rejoicing with you as He does. I will update everyone tomorrow after we find out more.

Tony

Coming home, many questions

We are in Minneapolis, just waiting until time to head for the airport now. We just had a long talk about the whole trip, trying to summarize things while they are still fresh, making sure we are together in our thoughts and feelings.

Sadly, we are coming home with more questions than we had before. The two centers are absolutely of different opinions on the stomach; Duke still wants to do the stomach surgery, and Mayo still says the stomach is safe. We don't know what the lymph node is. There is one radiology report that suggests that there is a second, smaller lesion about 6 inches lower than the big lymph, but we are not sure if that is just a poorly worded reference to the big lesion, or actually is a second lesion. It comes from the PET scan, but does not show up on the xray or CT; the big one shows on CT and octreatide, but not on PET.

The last time we talked to Duke, they still want to try to biopsy the node. The folks up here feel that would be a waste of time, and putting Dee Dee at risks that she does not need to undergo. Duke's point is that a biopsy carries less risk than surgery, less pain, and might allow her to skip the surgery altogether. Mayo's point is that the thing is too big to leave in there, no matter what it is, so skip the biopsy with its risks, and just get it out. All agree that it is most likely cancer, but until we get it under a microscope we will not know what type.

(By the way, as I write about my wife and cancer and surgery and risks, I still feel a lot like getting sick. It is a very schizophrenic feeling, letting the medical part of my brain relay facts, while all other parts of me want to scream and run around in circles!)

Emotionally, Dee Dee is very low. She is feeling some sense of failure and guilt because of not getting it done while here, allowing the questions to remain. She is flat out scared of the answers. Not in a weak, immature Christian way; more like a "I am not afraid to die, but I want to watch my children grow up, and I want them to be with me as they do; I don't want my husband to suffer through that now." I think that a big part of her hesitation at doing it here was the real possibility that she could have had a serious problem secondary to surgery here, and her children not able to come to her in time, and her husband going through it alone.

I keep assuring her that we made the right decision, and that it was not hers to make but mine. I still believe it was the right decision, and we will simply plan to get the answers to these questions back home. It will just take a bit longer. Pray for her mind and emotions as much as you do her health. Our adversary is working overtime on her mind right now. Pray that I am able to understand and empathize, to connect in the ways she needs me to connect.
Pray also that things could happen quickly at Duke, and that at least on the node they would be in agreement.

Thank you all for your encouraging words. We read them together often. Thank you for your physical aid as well. Thank you for praying; we know that we are covered in the prayers of our brothers and sisters, co-laborers in the Kingdom, joint heirs with Christ. We know that we are being prayed for by our great High Priest, who longs to intercede on our behalf. These are the things that are true, and praiseworthy, and commendable. Praise God for them, and for you.

Tony

Tuesday night

Hey folks. I don't really know how to write this one, because I am not really sure how to summarize today. First, some praises. Dee Dee definitely felt better today, and was able to get the octreatide scan done today. She thought of my brother during the scan, because Randy is fairly claustrophobic and this one lasted three hours, with her in a device that was inches from her face the whole time. The results basically confirmed....everything we already knew. She has stomach things and a lymph thing.

We met with the surgeons this afternoon. The stomach surgeon adamantly insists that the stomach tumors are not that big a deal. He wants to watch them every year, essentially forever, but that is all he wants to do.

I think we started to feel a little too happy, because when the chest surgeon came in his news was more than a little deflating. He looked at everything, and said, "That node is no good, and has to come out." He feels that it is as large as an egg. He discussed the possibilities, and while he felt that it was most likely carcinoid, it could be a lot of other things. On that list are breast cancer, lung cancer, and lymphatic cancer.

He wanted to do the surgery tomorrow. This would be a major surgery, with a lot of pain and a fair bit of risk, because it is in contact with two very important nerves (one to her vocal cords, one to her diaphragm, which controls breathing), and it is adjacent to her aorta and her heart. If it is cancerous, then it may be difficult to remove because it will be "attached" to everything it touches. She will be in the hospital for 3-5 days, with a lot of pain. She will have a drainage tube in her side, and until it stops draining she can't leave.

Because of the time of day, we had about 30 minutes to decide. We prayed, cried, and talked. Medically, it made sense to do it here. It is the fastest way to find out the answer; it guarantees that the same pathologist would look at both the stomach tumor slides and the lymph slides; we really liked the stomach guy here (Thompson); lots of reasons.

We decided to come home. If everything goes well, she preferred to have it done at home, where we have friends and family. More, though, we didn't prepare emotionally for major surgery. We didn't feel that we had adequately prepared our kids for Mom having that level of surgery. Bottom line, Dee Dee needed one more very special hug with her kids before a surgery that big. She told me she would follow my decision, but I could see in her eyes and hear in her voice that the thought of doing the surgery tomorrow was hurting her deeply. In the end, that was all I needed; we are coming home. We'll meet with the Duke surgeon next week on Thursday, and have surgery sometime after that.

So all the medicine here is done now. Our flight is not until Thursday, so we will try to fill the hours until then. There is not a lot of site-seeing to do here in beautiful Rochester, MN. We will continue to praise Him for His mercy, and His goodness. We will continue to trust Him as our Father who loves us perfectly. We will count the hours until we finally know what the node is all about. We pray that it might still be something other than cancer, and that she would not need more surgery or chemo/radiation. Thank you for your prayers and love over the past month (which, by the way, has actually lasted about 6-7 years), and especially these last few days.

Tony

Pray tonight!

Just a quick note, please pray for her tonight. She is really pretty sick, and has been since this morning's procedure. She hasn't been able to eat, and just hurts. Lots of nausea. Minnesota may be a perfectly wonderful place, but right now we're not big fans.

She needs to not be sick for a few hours; she needs to not hurt; she needs to be able to sleep; and tomorrow she needs to be able to keep food down.

Also, she had to drink some fairly nasty medication tonight for tomorrow's test, and was unable to keep it down. Please pray that she is able to get the test done tomorrow despite that difficulty.

Thanks,

Tony

Quick progress report

It is now 2:45 local time, and I just wanted to give a brief update. The long day is close to being over.

Dee Dee was quite ill after the morning procedures. We had to stop several times as I wheeled her through the hallways. This is a HUGE place! She has just, in the last hour, started feeling okay. She has been able to keep down some dry toast and ginger ale, which is progress.

She had the octreatide radioactive dye injection at 11:30, and the scan is set for 3:30. She will be re-scanned tomorrow at 8:00 a.m., but no new injection is needed. We meet with Dr. Thompson at 2:00 tomorrow, as well as with a thoracic surgeon (same time) to discuss not only the stomach but also the lymph node.

Please pray that Dee Dee feels well enough to eat when we finish the scan today; she has to stop eating at 7:00 tonight for the scan tomorrow a.m. Thankfully, she can eat a light breakfast tomorrow before the scan, but right now she's nearing 20+ hours with lots of medical procedures and no real food. Also, I feel guilty chowing down in front of her while she's too nauseous to eat; really, it becomes a prayer for me as much as her! (Grin)

Tony

So far today (now 9:30 a.m.)

We made it to the bus at 6:30 without too much trouble, found the "Alfred" building at St. Mary's Hospital by 6:50, then waited until 8:00 to go back. I guess if a one-hour wait is the longest we have, that won't be too bad!

Dr. DeViggio is her endoscopy doc. She is having the procedure right now; they allowed me to go back into the room during the procedure to observe and to begin the dialogue. I have been present for all of our kids' deliveries, seen my wife's "insides" several times during C-sections. I have dissected cadavers. This was...different. Fascinating, and scary. I tried to be intelligent, but probably asked fairly standard, not-too-bright questions. They were at 21 tumors and counting when my presence in the room was evidently no longer useful. Most were very small and soft. He clipped many of them, and cauterized the spots. Some were larger, and about 6 were, in his words, "big." He resected most of them, and cauterized the sites to stop the bleeding.

He will study the tumors under microscope, but was unwilling to offer any early indication as to the early Mayo version of a diagnosis. They will have the microscopic results before our appointment with Dr. Thompson tomorrow at 2:00. Next up today is blood work, then day one of the octreotide scan.

Thanks for your prayers. It is nice hearing from everyone, especially some of you folks we don't get to see or talk with as much as we would wish.

More later,

Tony

Here in Minnesota

Well, after a day of traveling, we made it to our hotel in Rochester tonight at 7:15 local time. Tired, hungry, glad to be out of airports. It was, to say the least, a weird day.

Usually, Dee Dee and I enjoy travelling. We enjoy flying, we enjoy the anticipation of the trip, we enjoy experiencing a new place. Today, really yesterday as well, it was like we kept trying to summon up any sense of anticipation or enjoyment at the prospect of new things. We tried, but without success. The closer we got to Mayo, the less enjoyable the whole thing became. I think the reality of everything, yet again, hit as we started seeing highway signs for "Mayo Clinic."

It was sad to leave this morning as our children headed off to church with their grandmother, Memaw. We miss them, and are praying for them. Thank you for doing the same.

We have had times today when we laughed. God has continued to provide moments along the way when our love for one another has shined. He has given moments of laughter, and normalcy. We are genuinely touched by the number of people loving us and praying for us, and encouraging us.

We start tomorrow at 7:00 at St. Mary's Hospital, and adjunct hospital affiliated with Mayo. Bus leaves at 6:30, so we need to hit the sack. I'll write again soon.

Tony

PET scan results

Okay, the radiologist report came in today. "Suspicious for metastatic carcinoid." We are to meet with a pulmonary oncologist, Dr. Jennifer Garst, whenever we can get it scheduled. They tried to set it up for next week, but obviously we will be in Minnesota and unable to make that work. She is the doc who Duke wants to perform the biopsy. They still haven't decided how best to get to the node, but the two leading candidates are to either make in incision in Dee Dee's neck and go down from there, or to make a larger incision between two ribs and go that route.

Even though the PET scan result is not necessarily a new thing, and there is good news (no other tumors, no other lymph nodes involved), it still brings a touch of sadness. As Dee Dee said, we know that God could take this away, and every test or scan that is done confirms that He wants it to stay, at least for now. It is tough to fight the hope, each time, that it will just be....gone. We continue to pray as Christ prayed in the garden, that if it be His will that this cup would pass. The sadness is that with each test result comes confirmation that in fact He wants us to drink from the cup.

Dee Dee went to bed early tonight, and friends stopped by to pray with us, after she was asleep. As Marty prayed, he quoted Philippians 4:8, a familiar passage to many. However, I had never thought of that passage in this light, so my thanks to Marty and Angela for their visit and their prayers; they are a representation of the real efforts being made on our behalf, by more people than we even know of, efforts of love and grace and prayer. Thank you all.


Philippians 4:7-9

"And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus. Finally, brothers, whatever is true, whatever is honorable, whatever is just, whatever is pure, whatever is lovely, whatever is commendable, if there is any excellence, if there is anything worthy of praise, think about these things. What you have learned and received and heard and seen in me--practice these things, and the God of peace will be with you."

So, tonight I pray that cancer will not prevent us from thinking on whatever things are true, and pure, and lovely; whatever things are excellent and worthy of praise. God is still the God of love, and peace, and mercy. He is still Abba Father, a loving Daddy who longs to hold His children and give comfort and grace.

We will pray that this cup passes, but more, we will pray that His will is done. We will pray that we learn great things of our God in this, and that He is poured into our kids through this. We will pray, not that He is glorified despite the cancer, but BECAUSE of cancer. We will pray!

Tony

No news, sort of

Well, no news today from the radiologist or oncologist concerning yesterday's PET scan. Hopefully we will hear tomorrow. I plan to ask the surgeon when he anticipates doing the lymph node procedure as well, to try to get the wheels turning on getting that scheduled. He only does surgery on Fridays, so if he is the guy, it will not be done until 10/27, with results the following week. Yuck.

Also, my wife has officially asked that the shackles be removed, and that the phone re-enter the life of the Clarks! She has had enough time to get past the shock, the stage where you feel like you can't talk about things because you don't know how to think yet. She says that in the past ten years, our phone has never been this silent, nor our doorbell so quiet. So, over the next few days, if you would like to call, please feel encouraged to do so. Ya'll have been great at respecting her, and our, need for some quiet. The cards and emails have been a blessing. Please don't stop those! But, I think there is opportunity now to let your voice provide some nourishment as well. I have seen her blessed while a friend was praying for her on the phone; more of that cannot be bad, right?

Tony

Quick Update

In honor of my dear sister, tonight's update will be brief (grin)! Thank you all for praying for today's test; Dee Dee tolerated the procedure well. She strongly dislikes drinking the radioactive contrast, but otherwise has fared pretty well today.

The test took about three hours to complete, but we did not learn anything today. The radiologist should read it tomorrow, and we should hear tomorrow or Wednesday. It has as a primary goal the establishment of the appropriate route or procedure to use in getting that doggone lymph node dealt with. It will also, as a side benefit, confirm that there are no tumors anywhere else.

So, we wait. The waiting, the not knowing with any certainty the full scope of things, is officially growing old. I think that is more draining for Dee Dee than anything else; she is ready to tackle anything, but let's please nail down exactly what it is we are tackling!

Everything for the Mayo trip is set. We have childcare arranged; a wonderful young couple, who know our kids well, is staying here at the house basically the whole time. Dee Dee's mom is staying until they get here Sunday night. Thank you all for your offers of help!

So, thanks again for praying for today. We will keep you informed as things happen, or needs arise, or I just need to vent, or whatever.

Tony

Brief Note

This will be brief, or at least as brief as I am able; those who know me well know that brief is a stretch for me! One housekeeping issue: we are getting a bit of spam on the comments, so I have added the "word verification" feature for comments. Sorry about that, and thank you all for your continued written (notes, cards, emails) encouragement.

On to the medicine. I talked to Pappas at Duke yesterday. He had shown Dee Dee's CAT scan and x-rays to about 6-7 docs at Duke. They all agreed that the lymph node must be addressed, but could not reach any consensus on how to get to it. It is adjacent to her aorta, and they simply disagree as to the best physical technique to get it. So, they decided that they will not do anything until she has had the octreatide scan and a PET scan. (For more info on the PET, this is a very good web site: http://www.radiologyinfo.org/en/info.cfm?pg=pet&bhcp=1)

The PET is scheduled at Duke for Monday at 2:30, and will last about 3 hours. The octreatide is at Mayo on the following Monday, 10/16. I don't know if the biopsy will be done at Mayo, or back here at Duke when we return.

This continues to be a tough time for myself and my sweet bride. The issue of the node has weighed heavily on her heart since the day they told us about it, and the extra difficulty getting to it, the number of docs looking at it, as well as the delays in finding out the answer are all contributing to the general sense of unease. Please continue to pray that it is a medical "red herring," and not of any real importance.

More later,

Tony

No wonder it's tough to love doctors!

Well, I wrote a post earlier this evening, and went to officially put it on the blog, and it totally disappeared. It was not a nice post, not upbeat, not encouraging, and I think God wanted me to meditate on Him a bit longer before I wrote anything for public consumption!

Today was, to be blunt, a bad day. The whole point of the day, medically, was to do an endoscopy and obtain a biopsy of the lymph node via the esophagus (we were wrong yesterday when we both thought it was via the trachea). We arrived at Duke at 9:15 this morning, they started at 10:30, called me back at noon. She began coming out of anesthesia at 12:15, doc came in at 12:30 or so. "We did the endoscopy, but despite all our efforts were unable to obtain a biopsy." I was shocked, did not know how to react, decided against anger (barely). They advised going home and waiting for Dr. Pappas to call sometime this week with the next, as yet undetermined, procedure time. So, my heart hurt for my wife who had undergone this procedure that while not painful, is uncomfortable and leaves her feeling pretty lousy for a day or so, to no real benefit.

I insisted that they page Pappas before we left. So, we left Dee Dee's I.V. in, etc., in the hope of doing the next thing while we were already there. He called back, and said to hustle over to try to get the octreatide scan today. We went to that area, waited 2 hours, then were told that it could not be done at all today, and that in fact it couldn't be done for a bit over 2 weeks!

Driving home, there was not a lot of conversation. We were both sort of empty, very disappointed. Dee Dee handled it best, and reminded me several times that our times are His, that the courses of our days are in His hands. I called Pappas, and he returned the call a bit after we arrived home. He said he was not shocked that the procedure did not work, and that the node was just too far from the esophagus to reach it safely via that route. He is going to have the pulmonary specialists look at the CAT scan to determine which route will work, and hopefully get that done this week. The options are an incision in her neck, or a larger incision between two ribs.

He also still wants to get the octreatide scan, and will try to get it scheduled sooner than 10/18. By the way, we found out today that this is a 2-day scan. No hospital stay, but back to Duke two days in a row for scanning.

I then called the doc at Mayo who will actually be taking care of us while in Minnesota. This was the first time I have talked with him (he called me back during Caleb's baseball game, while I was coaching and Caleb was pitching!). His name is Geoff Thompson. He wants us to go ahead with lymph biopsy here, agreeing that a 4 cm lymph is unusual, and must be evaluated. He reiterated that he doubts it is carcinoid, but that the size mandates attention. After talking, we agreed upon travel dates, and I have booked flights and hotel for Rochester, MN. Thank God for many things, including Priceline.com! Tickets were all listing for over $1000 per person, and we got them on priceline for $300 a person. Whew! I had to remind Dee Dee that just like our time is His, so is our money. If He chooses to have us spend it on plane tix and hotels in MN, that is His prerogative.

The other significant news from my conversation with Thompson is that he basically said that he was going to absolutely disagree with Pappas. He said that he NEVER takes out any part of a woman's stomach unless it is completely unavoidable. "There is no possible way that I would allow this procedure to be done on my wife. Period." He said that we would be taking a woman who is essentially without symptoms, and "sentencing her to a life of daily symptoms, where she would never again feel normal and good." He wants to look at everything himself, and repeat a few tests (octreatide scan, endoscopy, remove the larger tumors in their entirety), but if all the info we have been given so far is correct, he will simply advocate lifelong monitoring, choosing to leave the cancer in place.

This, my friends, has been the weirdest day of the whole event. We had things done that produced no knowledge, and now have two docs from the #1 cancer center in the US (Mayo) and #4 cancer center in the US (Duke) completely disagreeing. To be honest, I have no idea what to think, how to process this information. I appreciate your prayers for wisdom and discernment at this point. We will not do the octreatide scan here and at Mayo, so we will just do it at Mayo. We fly to MN on Sunday 10/15, and return on Thursday 10/19. That gives them 3 full days to test/poke/prod and talk. As I learn more about his reasons for non-surgical treatment, I will let you know. Also, when we know the time of the biopsy round #2, I will post that.

Tough day, and not a lot of medical progress. Difficult day emotionally for us both. Certainly it was a day that we were glad to see end. Actually it ends two tough days. Yesterday we had two different families that had memorial services for their sweet boys; one lost their son during pregnancy, and another lost their son one day shy of his 9th birthday. A family member/friend of ours had lumpectomy today. Lots of opportunities for God's grace! The good news? His mercies are new EVERY morning, and tomorrow morning is never more than a few hours away.

Tony

News from Duke

Well, we had our first visit at Duke today, with Dr. Pappas. He did not really have any surprising news or thoughts, but we do have a clearer picture of the scenario.

First of all, he does not think the lymph node is going to be carcinoid. As he put it, "People either get respiratory carcinoid, or digestive carcinoid, but almost never both." However, that node is significantly larger than normal, so it has to be checked out. As he also said, "This cancer is rare enough that even though I see about as much of it as anyone, I average about one a year." That means you check everything out, no matter how remote the risk.

So, Tuesday we go back to Duke for a lymph node biopsy. This node is directly beside her airway in the left side of her chest, so they are going to do endoscopy with a biopsy probe attached to the scope. When they get to the level of the node, they will punch a hole through the airway wall and gather the biopsy of the node. The airway will self-seal, and that's it. It will take 2-3 days for the result.

If it is not carcinoid, then he wants to proceed with surgery in the next few weeks. If everyone is shocked, and it were to be carcinoid, then we start looking at traditional cancer issues, and chemo/radiation/surgery all come into play.

Bottom line, Pappas believes that these are gastrin-produced carcinoid tumors, and that ultimately the cure is removal of the gastrin. Why does she have so much gastrin? The cells in the stomach that allow someone to absorb B12 through the gut are the same ones that inhibit gastrin. In a patient with pernicious anemia, like Dee Dee, these cells don't work. So the gastrin is produced unchecked. Because the tumors are secondary to the gastrin, if you remove the gastrin the tumors shrivel and go away.

So, the surgery he proposes is to remove the lower third of her stomach, called the antrum. Remember, the tumors are in the upper stomach, so he is saying to simply leave them alone. Gotta tell you, it feels weird to intentionally leave the tumors inside! He also said that because this is so uncommon, there is no single definitive treatment option. He thinks there is a reasonable chance that the folks at Mayo may give different advice, just because there are so few cases of this that there are no real clinical studies for everyone to agree upon.

So please pray for several things:
* Dee Dee as she has this biopsy/endoscopy procedure today
* Healthy lymph node, and that we would learn this quickly
* Continue to pray for the trip to Mayo, and really that the docs there would be in agreement with the docs here
* For our courage and strength. There is something hard about meeting the cancer docs and surgeons that propose to remove part of your stomach. It isn't new revelation, because obviously Dee Dee has known that this was coming. It is just the hard reality of it all coming into plain view.

Thanks to you all, and we'll update later.

Tony

Piper, Powlison, on valuing cancer

Friends,

Here's a quick overview of the last 3 weeks in the Clark house. This is a lead-up to the article that I am going to post at the end of my entry. A bit over three weeks ago, Samara had to be rushed to the E.R. with severe allergic reaction to an unknown airborne allergen, with her airway closing off. She now carries an epi-pen and rescue breather everywhere she goes. Then we found out about the "lumps" in Dee Dee's stomach. Then someone stole my credit card #, and began using it (thankfully a vendor became suspicious and alerted me fairly quickly). Then the biopsies came back as cancer. Then, Thursday, I was told that I needed surgery on my shoulder for several bone spurs and rotator cuff problems. Mercy!

So here's the reason for the synopsis. They are all intentional parts of God's perfect plan for the blessing of His beloved children and the good of His kingdom. There is no accident here, there is no part that falls outside His divine will and decree. So, if that is the case, why? Why us, why now? We may never know all of the answers, but that's okay, we don't need to.

Many of you may have already read John Piper's classic letter that he wrote on the eve of his surgery for prostate cancer earlier this year. For those who don't know Piper, he is a pastor of a large Reformed Baptist church in Minnesota. He is also a wonderful author, and some of his books are Clark favorites. What I had not realized (thanks to Gail O. for pointing this one out to me!) was that shortly after he wrote this letter, a fellow in PA named Dave Powlison was also diagnosed with prostate cancer, and wrote a companion article to Piper's original. Powlison was at New Life church while we were there back in optometry school. This is the approach we should have toward not just the biggees like cancer, but to all the mundane trials and difficulties of life. His letter is entitled "Don't Waste Your Cancer," and you could substitute almost any other word for cancer. Don't waste your shoulder pain; don't waste having your credit card stolen; don't waste the many aspects of raising children, or of dealing with traffic, or anything at all!

Anyhow, Piper and Powlison say it all better than I do, so here ya go. Enjoy! Piper's words are in blue, Powlison's are in red.

Tony
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Don’t Waste Your Cancer
by John Piper
February 15, 2006

I write this on the eve of prostate surgery. I believe in God’s power to heal—by miracle and by medicine. I believe it is right and good to pray for both kinds of healing. Cancer is not wasted when it is healed by God. He gets the glory and that is why cancer exists. So not to pray for healing may waste your cancer. But healing is not God’s plan for everyone. And there are many other ways to waste your cancer. I am praying for myself and for you that we will not waste this pain.

David Powlison’s reflections on John Piper’s words were added on the morning after receiving news that I also have been diagnosed with prostate cancer (March 3, 2006). In each case, the main point and first paragraph is his; the second paragraph under each point is mine.

1. You will waste your cancer if you do not believe it is designed for you by God. It will not do to say that God only uses our cancer but does not design it. What God permits, he permits for a reason. And that reason is his design. If God foresees molecular developments becoming cancer, he can stop it or not. If he does not, he has a purpose. Since he is infinitely wise, it is right to call this purpose a design. Satan is real and causes many pleasures and pains. But he is not ultimate. So when he strikes Job with boils (Job 2:7), Job attributes it ultimately to God (2:10) and the inspired writer agrees: “They . . . comforted him for all the evil that the Lord had brought upon him” (Job 42:11). If you don’t believe your cancer is designed for you by God, you will waste it.
Recognizing his designing hand does not make you stoic or dishonest or artificially buoyant. Instead, the reality of God’s design elicits and channels your honest outcry to your one true Savior. God’s design invites honest speech, rather than silencing us into resignation. Consider the honesty of the Psalms, of King Hezekiah (Isaiah 38), of Habakkuk 3. These people are bluntly, believingly honest because they know that God is God and set their hopes in him. Psalm 28 teaches you passionate, direct prayer to God. He must hear you. He will hear you. He will continue to work in you and your situation. This outcry comes from your sense of need for help (28:1-2). Then name your particular troubles to God (28:3-5). You are free to personalize with your own particulars. Often in life’s ‘various trials’ (James 1:2), what you face does not exactly map on to the particulars that David or Jesus faced – but the dynamic of faith is the same. Having cast your cares on him who cares for you, then voice your joy (28:6-7): the God-given peace that is beyond understanding. Finally, because faith always works out into love, your personal need and joy will branch out into loving concern for others (28:8-9). Illness can sharpen your awareness of how thoroughly God has already and always been at work in every detail of your life.

2. You will waste your cancer if you believe it is a curse and not a gift. “There is therefore now no condemnation for those who are in Christ Jesus” (Romans 8:1). “Christ redeemed us from the curse of the law by becoming a curse for us” (Galatians 3:13). “There is no enchantment against Jacob, no divination against Israel” (Numbers 23:23). “The Lord God is a sun and shield; the Lord bestows favor and honor. No good thing does he withhold from those who walk uprightly” (Psalm 84:11).
The blessing comes in what God does for us, with us, through us. He brings his great and merciful redemption onto the stage of the curse. Your cancer, in itself, is one of those 10,000 ‘shadows of death’ (Psalm 23:4) that come upon each of us: all the threats, losses, pains, incompletion, disappointment, evils. But in his beloved children, our Father works a most kind good through our most grievous losses: sometimes healing and restoring the body (temporarily, until the resurrection of the dead to eternal life), always sustaining and teaching us that we might know and love him more simply. In the testing ground of evils, your faith becomes deep and real, and your love becomes purposeful and wise: James 1:2-5, 1 Peter 1:3-9, Romans 5:1-5, Romans 8:18-39.

3. You will waste your cancer if you seek comfort from your odds rather than from your God.
The design of God in your cancer is not to train you in the rationalistic, human calculation of odds. The world gets comfort from their odds. Not Christians. Some count their chariots (percentages of survival) and some count their horses (side effects of treatment), but we trust in the name of the Lord our God (Psalm 20:7). God’s design is clear from 2 Corinthians 1:9, “We felt that we had received the sentence of death. But that was to make us rely not on ourselves but on God who raises the dead.” The aim of God in your cancer (among a thousand other good things) is to knock props out from under our hearts so that we rely utterly on him.
God himself is your comfort. He gives himself. The hymn “Be Still My Soul” (by Katerina von Schlegel) reckons the odds the right way: we are 100% certain to suffer, and Christ is 100% certain to meet us, to come for us, comfort us, and restore love’s purest joys. The hymn “How Firm a Foundation” reckons the odds the same way: you are 100% certain to pass through grave distresses, and your Savior is 100% certain to “be with you, your troubles to bless, and sanctify to you your deepest distress.” With God, you aren’t playing percentages, but living within certainties.

4. You will waste your cancer if you refuse to think about death. We will all die, if Jesus postpones his return. Not to think about what it will be like to leave this life and meet God is folly. Ecclesiastes 7:2 says, “It is better to go to the house of mourning [a funeral] than to go to the house of feasting, for this is the end of all mankind, and the living will lay it to heart.” How can you lay it to heart if you won’t think about it? Psalm 90:12 says, “Teach us to number our days that we may get a heart of wisdom.” Numbering your days means thinking about how few there are and that they will end. How will you get a heart of wisdom if you refuse to think about this? What a waste, if we do not think about death.
Paul describes the Holy Spirit is the unseen, inner ‘downpayment’ on the certainty of life. By faith, the Lord gives a sweet taste of the face-to-face reality of eternal life in the presence of our God and Christ. We might also say that cancer is one ‘downpayment’ on inevitable death, giving one bad taste of the reality of of our mortality. Cancer is a signpost pointing to something far bigger: the last enemy that you must face. But Christ has defeated this last enemy: 1 Corinthians 15. Death is swallowed up in victory. Cancer is merely one of the enemy’s scouting parties, out on patrol. It has no final power if you are a child of the resurrection, so you can look it in the eye.

5. You will waste your cancer if you think that “beating” cancer means staying alive rather than cherishing Christ. Satan’s and God’s designs in your cancer are not the same. Satan designs to destroy your love for Christ. God designs to deepen your love for Christ. Cancer does not win if you die. It wins if you fail to cherish Christ. God’s design is to wean you off the breast of the world and feast you on the sufficiency of Christ. It is meant to help you say and feel, “I count everything as loss because of the surpassing worth of knowing Christ Jesus my Lord.” And to know that therefore, “To live is Christ, and to die is gain” (Philippians 3:8; 1:21).
Cherishing Christ expresses the two core activities of faith: dire need and utter joy. Many psalms cry out in a ‘minor key’: we cherish our Savior by needing him to save us from real troubles, real sins, real sufferings, real anguish. Many psalms sing out in a ‘major key’: we cherish our Savior by delighting in him, loving him, thanking him for all his benefits to us, rejoicing that his salvation is the weightiest thing in the world and that he gets last say. And many psalms start out in one key and end up in the other. Cherishing Christ is not monochromatic; you live the whole spectrum of human experience with him. To ‘beat’ cancer is to live knowing how your Father has compassion on his beloved child, because he knows your frame, that you are but dust. Jesus Christ is the way, the truth, and the life. To live is to know him, whom to know is to love.

6. You will waste your cancer if you spend too much time reading about cancer and not enough time reading about God. It is not wrong to know about cancer. Ignorance is not a virtue. But the lure to know more and more and the lack of zeal to know God more and more is symptomatic of unbelief. Cancer is meant to waken us to the reality of God. It is meant to put feeling and force behind the command, “Let us know; let us press on to know the Lord” (Hosea 6:3). It is meant to waken us to the truth of Daniel 11:32, “The people who know their God shall stand firm and take action.” It is meant to make unshakable, indestructible oak trees out of us: “His delight is in the law of the Lord, and on his law he meditates day and night. He is like a tree planted by streams of water that yields its fruit in its season, and its leaf does not wither. In all that he does, he prospers” (Psalm 1:2). What a waste of cancer if we read day and night about cancer and not about God.
What is so for your reading is also true for your conversations with others. Other people will often express their care and concern by inquiring about your health. That’s good, but the conversation easily gets stuck there. So tell them openly about your sickness, seeking their prayers and counsel, but then change the direction of the conversation by telling them what your God is doing to faithfully sustain you with 10,000 mercies. Robert Murray McCheyne wisely said, “For every one look at your sins, take ten looks at Christ.” He was countering our tendency to reverse that 10:1 ratio by brooding over our failings and forgetting the Lord of mercy. What McCheyne says about our sins we can also apply to our sufferings. For every one sentence you say to others about your cancer, say ten sentences about your God, and your hope, and what he is teaching you, and the small blessings of each day. For every hour you spend researching or discussing your cancer, spend 10 hours researching and discussing and serving your Lord. Relate all that you are learning about cancer back to him and his purposes, and you won’t become obsessed.

7. You will waste your cancer if you let it drive you into solitude instead of deepen your relationships with manifest affection. When Epaphroditus brought the gifts to Paul sent by the Philippian church he became ill and almost died. Paul tells the Philippians, “He has been longing for you all and has been distressed because you heard that he was ill” (Philippians 2:26-27). What an amazing response! It does not say they were distressed that he was ill, but that he was distressed because they heard he was ill. That is the kind of heart God is aiming to create with cancer: a deeply affectionate, caring heart for people. Don’t waste your cancer by retreating into yourself.
Our culture is terrified of facing death. It is obsessed with medicine. It idolizes youth, health and energy. It tries to hide any signs of weakness or imperfection. You will bring huge blessing to others by living openly, believingly and lovingly within your weaknesses. Paradoxically, moving out into relationships when you are hurting and weak will actually strengthen others. ‘One anothering’ is a two-way street of generous giving and grateful receiving. Your need gives others an opportunity to love. And since love is always God’s highest purpose in you, too, you will learn his finest and most joyous lessons as you find small ways to express concern for others even when you are most weak. A great, life-threatening weakness can prove amazingly freeing. Nothing is left for you to do except to be loved by God and others, and to love God and others.

8. You will waste your cancer if you grieve as those who have no hope. Paul used this phrase in relation to those whose loved ones had died: “We do not want you to be uninformed, brothers, about those who are asleep, that you may not grieve as others do who have no hope” (1 Thessalonians 4:13). There is a grief at death. Even for the believer who dies, there is temporary loss—loss of body, and loss of loved ones here, and loss of earthly ministry. But the grief is different—it is permeated with hope. “We would rather be away from the body and at home with the Lord” (2 Corinthians 5:8). Don’t waste your cancer grieving as those who don’t have this hope.
Show the world this different way of grieving. Paul said that he would have had “grief upon grief” if his friend Epaphroditus had died. He had been grieving, feeling the painful weight of his friend’s illness. He would have doubly grieved if his friend had died. But this loving, honest, God-oriented grief coexisted with “rejoice always” and “the peace of God that passes understanding” and “showing a genuine concern for your welfare.” How on earth can heartache coexist with love, joy, peace, and an indestructible sense of life purpose? In the inner logic of faith, this makes perfect sense. In fact, because you have hope, you may feel the sufferings of this life more keenly: grief upon grief. In contrast, the grieving that has no hope often chooses denial or escape or busyness because it can’t face reality without becoming distraught. In Christ, you know what’s at stake, and so you keenly feel the wrong of this fallen world. You don’t take pain and death for granted. You love what is good, and hate what is evil. After all, you follow in the image of “a man of sorrows, acquainted with grief.” But this Jesus chose his cross willingly “for the joy set before him.” He lived and died in hopes that all come true. His pain was not muted by denial or medication, nor was it tainted with despair, fear, or thrashing about for any straw of hope that might change his circumstances. Jesus’ final promises overflow with the gladness of solid hope amid sorrows: “My joy will be in you, and your joy will be made full. Your grief will be turned to joy. No one will take your joy away from you. Ask, and you will receive, so that your joy will be made full. These things I speak in the world, so that they may have my joy made full in themselves” (selection from John 15-17).

9. You will waste your cancer if you treat sin as casually as before. Are your besetting sins as attractive as they were before you had cancer? If so you are wasting your cancer. Cancer is designed to destroy the appetite for sin. Pride, greed, lust, hatred, unforgiveness, impatience, laziness, procrastination—all these are the adversaries that cancer is meant to attack. Don’t just think of battling against cancer. Also think of battling with cancer. All these things are worse enemies than cancer. Don’t waste the power of cancer to crush these foes. Let the presence of eternity make the sins of time look as futile as they really are. “What does it profit a man if he gains the whole world and loses or forfeits himself?” (Luke 9:25).
Suffering really is meant to wean you from sin and strengthen your faith. If you are God-less, then suffering magnifies sin. Will you become more bitter, despairing, addictive, fearful, frenzied, avoidant, sentimental, godless in how you go about life? Will you pretend it’s business as usual? Will you come to terms with death, on your terms? But if you are God’s, then suffering in Christ’s hands will change you, always slowly, sometimes quickly. You come to terms with life and death on his terms. He will gentle you, purify you, cleanse you of vanities. He will make you need him and love him. He rearranges your priorities, so first things come first more often. He will walk with you. Of course you’ll fail at times, perhaps seized by irritability or brooding, escapism or fears. But he will always pick you up when you stumble. Your inner enemy – a moral cancer 10,000 times more deadly than your physical cancer – will be dying as you continue seeking and finding your Savior: “For your name’s sake, O Lord, pardon my iniquity, for it is very great. Who is the man who fears the Lord? He will instruct him in the way he should choose” (Psalm 25).

10. You will waste your cancer if you fail to use it as a means of witness to the truth and glory of Christ. Christians are never anywhere by divine accident. There are reasons for why we wind up where we do. Consider what Jesus said about painful, unplanned circumstances: “They will lay their hands on you and persecute you, delivering you up to the synagogues and prisons, and you will be brought before kings and governors for my name’s sake. This will be your opportunity to bear witness” (Luke 21:12 -13). So it is with cancer. This will be an opportunity to bear witness. Christ is infinitely worthy. Here is a golden opportunity to show that he is worth more than life. Don’t waste it.
Jesus is your life. He is the man before whom every knee will bow. He has defeated death once for all. He will finish what he has begun. Let your light so shine as you live in him, by him, through him, for him. One of the church’s ancient hymns puts it this way: “Christ be with me, Christ within me, Christ behind me, Christ before me, Christ beside me, Christ to win me, Christ to comfort and restore me, Christ beneath me, Christ above me, Christ in quiet, Christ in danger, Christ in hearts of all that love me, Christ in mouth of friend and stranger” (from “I bind unto myself the name”). In your cancer, you will need your brothers and sisters to witness to the truth and glory of Christ, to walk with you, to live out their faith beside you, to love you. And you can do same with them and with all others, becoming the heart that loves with the love of Christ, the mouth filled with hope to both friends and strangers.

Remember you are not left alone. You will have the help you need. “My God will supply every need of yours according to his riches in glory in Christ Jesus” (Philippians 4:19).
Pastor John
www.desiringGod.org.