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."