Thursday, January 26, 2023

Spiritual

The Spiritual dynamic is very real for anyone diagnosed with a malignant cancer, even (and maybe especially) us ordained ministers. We have dealt with tragic circumstances as much as anyone this side of medical personnel — maybe more. After 47 years of ordained ministry as a Senior Minister I have cried with/for more people than I can ever remember. Whether it is the death of a child or a 90 year old, there is always what Miguel de Unamuno called "the tragic sense of life" lurking in the shadows. In walking with parishioners during these times we are called to be the presence of God that comforts, strengthens and enables the family to move forward with their lives in due time. As a young minister I did not fully comprehend this, but the reality quickly set in. The reality is that grief and sorrow create sacred moments, deeply binding pastor and congregation together. I would not give them up for anything, but they are incredibly painful. In these moments we realize how feeble and helpless we are in the face of deep grief and tragedy.

The death of children is particularly difficult on families and all concerned. I've had more than one family look at me and ask “Why did God allow this to happen?" My answers usually revolved around not understanding all that God permits, but to somehow let God use this to draw us closer to God and to each other. As Carlyle Marney replied to John Claypool when he posed this question concerning the death of his daughter: "When we get to heaven God has a lot for which to answer; and God will want to answer because God understands what we do not."


At this point I must confess that the question of Evil, known in theology as the question of theodicy, is one to which I have never found a fully satisfactory answer: How/why does an all knowing, all good and all loving God allow evil in the world? The dilemma evil presents to us is harsh; logic demands that we make a choice as to the makeup of God: 

  • If God is all knowing then either God is not all loving or not all powerful. An all loving God could not allow evil to run rampant as it does. Should not an all powerful God would act to limit evil and it’s effects in the world?
  • Is God fully knowledgeable about the future as we claim? The elements of chance and choice seem to be an integral part of our universe; God seems to be limited to act as we would suppose God should/could.  

There are at least 2 dimensions to this question: the "Macro" and the "Micro." The Macro focuses on universal events, i.e., plagues, earthquakes, world wars, etc., massive events that cause the death of thousands if not millions. The Micro is about the individual person, i.e., why do “I” in particular suffer this particular disease or event? Is it all about chance? Fate? Are these events really the purview of divine design?


This question became vividly real to me in dealing with my diagnosis.  I blithely figured that since I had served God faithfully (I knew the sacrifices my family had made to do so) — I just knew that God would bless us with longevity, i.e., that we could see our grandchildren grow up to maturity. In reality I knew that there was never such a contract; I have seen too many ministers have tragic events to know that.  


However, we all tend to think that we're special, we're different, and God will bless us and protect us. Now I had to come face to face with the reality that even as a minister I am no different than any other human; subject to the same physical ailments as anyone else. I have known far more pastors who have died before the age of 80 than after; and I have no concrete data as to why. I suspect the stress of ministry may have something to do with our average mortality. (Or it could be potluck suppers with fried chicken and pecan pie!)


My personal sense of tragedy was put into its place by numerous encounters with persons suffering from cancers far worse than mine. On my first visit to the radiologist, while in the waiting room a young girl, probably about 18 or so, came out from treatment. She was rail thin, had no hair, and walked by without a word or a smile. Whatever cancer she had, it was far worse than mine. I looked up to the ceiling and said to God and myself, "No, I'm good. I'll soon be 72 and chances are I'll make it to 80+." 


Please hear me carefully: I am not minimizing my cancer. I am not excited about living a decade or so on the edge between remission and relapse, taking chemotherapy drugs and dealing with the side effects, etc. However, my life journey to this point has been one of joy and challenge, of growth on so many fronts that I cannot imagine going down any other path. Am I personally wealthy? Not even close! However, I am such a different person than when I entered ministry that I can barely remember that delusional young man! I have been blessed with a spouse who loves me (not as easy as I imagine) and has walked beside me even when she wondered what I was thinking or where I was going. We have been blessed with 2 sons, 2 daughters-in-law, and 4 grandchildren who are the joys of our lives. 


My personal tragic sense of life focuses in that I wish to live and see my grandchildren mature, marry, and establish lives of their own. I am in the sunset years of life and other than this blip on the radar screen they are quite enjoyable and fulfilling. When the time comes for me to cross the River Jordan, I pray that I shall do so bolstered by the faith which has sustained me to this point.


Equating faith in God with financial success, personal well-being and/or longevity of life has always bothered me. What does this belief say to the millions of Christians around the world who live in virtually crisis situations, dealing with famine, starvation, viral disease and death on a daily basis? Does God love these any less than God loves us who live in relative wealth, peace and have full health care? I think not!


I fully reject any notion of the "prosperity gospel" — it is pure heresy. Faith in God is not a pathway to prosperity. I believe that one can serve God faithfully and the bottom will still fall out of your life for no real reason that you can discover. 


The uncertainty/unpredictability of human existence happens to us all; we really do “see through a veil darkly” in this world. I asked Dr. Hamza Hashmi, my incredibly brilliant oncologist, if my disease was due to genetics or lifestyle; he answered “probably neither.” I underwent genetic testing and I have none of the genes normally associated with a higher risk of cancer. For some unknown reason, I drew the card that said, “Multiple Myeloma.” 


We all know that having a lifestyle filled with bad habits will usually result in diseases and death. I’ve buried enough smokers who died in the 60’s to validate the statistics. However, that is not the only narrative. Bad things happen to people for no real reason other than that they just happen. This is life as we know it; there are no guarantees. 


Will God strengthen me and enable me to get through this? To be sure — God is my fortress and my rock. In my reflection about my situation I realized how fortunate I was to get to this age without any major diseases. My primary concern is not healing, though I would not turn that down. My focus is to deal with this disease in a strong and faithful manner, for my children and grandchildren are looking at me to see how I respond to this. Will I respond as a person of faith and trust in God as I have taught and preached for almost 50 years? Or, will I respond in depression, hopelessness and spend my last years "cursing God and waiting to die" as Job's wife suggested. My prayer is that I respond as Job: "Shall I accept good and not evil?" Or, as is said of Job, "In all that he did Job did not sin…" I will say more about this in the weeks to come. I’ve loved Job for decades!


While the “Micro” perspective makes Evil real at the personal level, the “Macro” is much more difficult to deal with from a theological perspective. Why would a loving God create a universe in which disease can run rampant? The dilemma for both perspectives is fairly easy to outline:

    • Christianity claims that God is omnipotent, omniscient, and omnipresent. We also claim that God is loving, compassionate, and just in all that God does.
    • If the first claim is true, then how can the second one be? How does a compassionate and loving God allow “Macro Evil” to not only exist, but to even run rampant?
    • Why did God not use God’s power to create a universe in which Evil is nonexistent? Does not the very presence of Evil call into question our beliefs concerning God’s omnipotence and/or God’s nature as loving and just?

In coming weeks I will deal with these issues in more depth. Suffice it to say that this question is one that has consumed me ever since I was a college student wrestling with the very idea of God. Wrestling with this question has not weakened, but deepened my faith in ways I never imagined!


The question of Evil raises moral issues not only about God, but also about us humans as moral creatures. Consider how many resources we humans dedicate to stopping/containing human pathogens. Billions of dollars were expended to contain Covid 19 — was this the best use of this money? A further moral question is should we try to do so? Plagues can be seen from one perspective as the way in which over-population was controlled for centuries. Is it really moral to stop human pathogens in a world where over-population is a definite problem? Would it not be in line with a utilitarian ethic (the greatest good for the greatest number) to allow the pathogen to wreak it’s havoc, knowing that after the plague has run its course those who survive will have a better life?


Should we “sacrifice” ¼ or 1/5 of the population to allow the survivors to thrive? (Dan Brown’s novel Inferno presents this dilemma in a very real and modern setting.) In reality is this not what transpired periodically through out human history? The Black Death (14th CE) killed about 200 million people — or about ½ of Europe before the cause was connected to rats coming from ships in port. The Flu Epidemic of 1918-20 claimed 50-100 million before weakening due to rising immunity. New World Smallpox (1520-early 1600’s) caused 25-55 million deaths, primarily among the Indigenous peoples who had no immunity to this disease brought by the Europeans. Covid 19 came to a more populous world but also one which had greater resources to fight it. Current statistics say that 6.8 million have died from Covid, although due to reporting coverup/failure deaths are thought to really be double that. 


I can hear the screams emitting from the readers now that there is no way on earth we should just step back and let these epidemics take their toll. I agree, I find this personally repulsive as well, but we must ask ourselves why we would believe this? Where does this value regarding human life originate? Why are we humans more important than the rest of life? Personally, my value comes from my faith, especially the Hebrew Scriptures with their beautiful account of creation and fall found in Genesis 1-3. I profess an ethic which says that every human being, regardless of any characteristics or differences, bears the imago dei and is of ultimate worth and value. The person with severe physical or intellectual differences bears just as much the image of God as does the brilliant scientist.

 

This ethical belief that all are of equal worth and value requires that we who have the financial/scientific resources exercise our power in such a way as to minimize the impact of “Macro Evil” in our world. Either we all are created imago dei, or none of us are. We cannot pick and choose, trying to decide who is of more value or worth. While the life of a Nobel scientist on the surface may seem to be of greater value than mine, who really knows? How does God value life, anyway? Jesus told us: “Are not two sparrows sold for a cent? And yet not one of them will fall to the ground apart from your Father. But the very hairs of your head are all numbered. So do not fear; you are more valuable than many sparrows.” Matthew 7: 29-31. We are each and every one of us valuable to God. 


Let’s take a step back to our original question: Why did/does God allow Evil — Micro or Macro? The truth: I have many more questions than answers. I have developed a personal theology which speaks to God’s self-limitation so that we humans might have to face the consequences of our ethical decisions. Our decisions do matter, to us and to others. God’s self-limitations so structured our universe that we would have to make ethical choices, i.e., we must decide whether or not to partake of the forbidden fruit. Each of us must make that decision; we cannot pass it on to another person — as Adam tried when he blamed God and Eve: “the woman whom you gave to be with me, she gave me of the fruit and I ate.”   Or, as another ethicist put it: “I am not responsible for being here; but, being here, I am responsible.”


My personal belief is that God has so structured this world that we are called to live in partnership with God, living by the values and ethical norms found in Holy Scripture and ultimately in the person of Jesus Christ. In this partnership we are called to be re-creating what Scripture calls the “Kingdom of God.” Whether this Kingdom is to re-created here (N.T. Wright) or in another dimension of time and space (heaven) I do not know. I do believe that in our lives we are to be engaged in building the Kingdom in this world, right here where we live, in anticipation of the fulfillment of the Kingdom. When we live by the ethics of our Lord — something that is much harder that we wish to admit -- we are bringing into life in some small, albeit imperfect way, the reality of the Kingdom. God cannot do this alone in this world, but requires the partnership of those who “obey him” to bring this about. ("Not everyone who says to me 'Lord, Lord,' will enter the kingdom of heaven, but only the one who does the will of my Father in heaven. Matthew 7: 21.)


One final thought before I close: what sustains my faith so that I can ask these questions are not the answers of theologian or philosophers, but those of Holy Scripture and of hymns. I so miss going to church and singing the hymns of faith. I’ve discovered that Baptists and Presbyterians sing out of the same hymnal — metaphorically speaking, of course! We sing our faith more than we know. When I ask a person to name their favorite hymns, I will soon understand the substance of their personal faith. What is an intellectual exercise to the academician is a question of life and death to the person facing the reality of Evil. We are finite human beings trying to understand the infinite — an impossibility in any full sense of knowledge. In that moment when belief comes up against these limits, we are called upon to take our stance — faith or disbelief? Will I trust that the faith which has sustained me to this point will sustain me through death and into the life to come? 


What matters at this stage is not the academic, but the personal question: upon whom am I relying as I journey these last years of existence? A couple of verses from “How Firm a Foundation” (one of my 2 dozen favorite hymns) provides the answer to Micro Evil far better than I can frame:


When through fiery trials thy pathway shall lie,

My grace, all sufficient, shall be thy supply;

The flame shall not hurt thee, I only design

Thy dross to consume and thy gold to refine.

The soul that on Jesus hath leaned for repose, 

I will not, I will not, desert to his foes;

That soul, though all hell shall endeavor to shake,

I’ll never, no never, no never forsake.

More to come…comments welcomed…prayers requested! 

Thursday, January 19, 2023

Personal

One of the aspects of having a malignant cancer is that you look at life so much differently. I will talk about the spiritual aspects later, but do want to say that my “sense of invincibility” is long gone, not to mention the “illusion of control.” I've had my share of orthopedic events:  shoulder surgeries, meniscus scoped, achilles heel issues, but nothing life threatening. Most of my wounds have been self-inflicted! The most difficult personal aspect to date is that I've always been on the other side of the bed, i.e., the one helping others to cope. Now I'm the one with the manageable but incurable disease. Now I'm one of the thousands  who go every week to have blood tested and receive chemotherapy.  When I sit in the blood testing waiting room @ MUSC, I look around at all the people there with the same or similar diseases.  The kindness/sense of community that permeates the room is encouraging, deriving from the reality that we are fighting similar battles. Perhaps if all of us in our world would work with the image that we are all battling the same "cancer" we would be much kinder to one another!


In retirement I enjoyed walking 18 holes of golf 2-3 times per week, as well as hitting balls the other days when weather permits. I've always enjoyed the golf  for the variety of its challenges as well as the beauty of being outdoors in nature. From March  2021 to January of 2022 I was unable to play as I was recovering from spinal fusion surgery and rehabbing my spine. I mistakenly assumed that I would be able to play by July; that was a laugh. My physical therapist released me in November to start chipping and putting.  When I returned to playing  in January, 2022, I tried to walk 18 holes (with my electric bag cart) but could not do so without total fatigue. So I returned to riding in a cart and walking at home to build up stamina. 


When I received the news in October 2022 that MM had progressed, my hematologist Dr. Hashmi said that I had to stop playing golf when I started treatments due to the fragility of my spine and other bones from both the disease and the treatments. So, once more I find myself unable to enjoy what has been a valued part of my life. My son Eddie did take me to play the noted East Lake course in Atlanta; my last round of the year.  I am hoping & praying that I will be strong enough by May to start hitting balls again. 


Debby has been wonderfully supportive and encouraging through all of this.  She will not let me feel sorry for myself and has noted that I've tended to become reclusive and maybe even a little depressed. I don't know what I would have done without her and I am sure that taking care of me is not something she bargained for some 47 years ago!  


Honesty and confession have been the greatest aids to me in my personal battle. There is something empowering about saying “I don’t like this” and then adding “but I am not about to let it beat me!”  I often laughed at the saying, “What doesn’t kill you will make you stronger.” Now I believe it fully, for personal growth and development come through challenge, not ease.


Quite honestly, I miss the exercise of walking, light workouts with stretching, and golf. These kept the endorphins flowing in my brain, not to mention keeping me in better physical condition. I walk some, but even going a mile with our dog is strenuous.  This will get worse before it gets better, but I’ve accepted that and am ready to get to the other side of the transplant and on to recovery. I am continually reminded that life is about the journey as much as the destination. I try to enjoy the journey even when I have to go on detours! 


I have read some, but not that much in these days.  I find it harder to concentrate on the good works of history and philosophy, etc. The omnipresent “spy” novels are all about the same — entertaining but you know the plot! My former professor, Dr. Wayne Flynt, has recently published a wonderful book, “Afternoons with Harper Lee.”  A warm and personal look at this very private and even reclusive author, I recommend it fully. Dr. Flynt is a rare combination of intellectual acumen and deeply held religious beliefs. You will not be disappointed and will gain a new appreciation for Ms. Lee and her fierce independence.


So, the wheels on the bus go round and round…keep me in your prayers (please) and next week we’ll take a stab at some of the spiritual thoughts and feelings that flood my meager brain these days.

Friday, January 13, 2023

My Journey with Multiple Myeloma

 Many friends have asked me about both my disease, my prognosis and for updates. I'm taking a cue from a friend and fellow minister, Dr. Guy Sayles, who has been dealing with MM for over 8 years. I will be writing here once a week or so, depending on what's going on with me.  This journal will be a combination of medical updates, personal thoughts and even some realistic spiritual struggles. My hope/intent/prayer is that this journal will help others dealing with medical/personal/spiritual issues to gain some courage to face them as well.

If one "must" have a blood cancer, Multiple Myeloma is one you would pick. Though incurable, MM usually can be put into remission for a significant period of time. From talking with and reading the accounts of others life from this point forward will probably be about remission and relapse. I just hope and pray the former times far exceed the latter. However, there are no guarantees. We do know that the human body eventually wears out and dies. Even in Hunza Land, where people regularly live to 120 or more, they all die. 

To begin with I will share three aspects of my current status: Medical Prognosis; Personal and then Spiritual. These will be placed on my Blog — Dr. Bob’s Blog — where once upon a time I posted sermons. 

Medical Prognosis

For several years I had been 'afflicted" by lower back issues -- not uncommon for golfers as they age. In the spring of 2020 the issues grew more severe. An MRI revealed arthritis in the lower spine. I underwent Physical Therapy (helped some) and bought a back brace to wear during golf. However, my back continued to hurt with pain running down my legs. In December of 2020 I fell while playing kickball with my grandchildren -- trying to score!!! I felt tremendous pain even while wearing the back brace. I went to see my Physical Therapist the next week and she put me into orbit with the slightest touch on my back. My Internist immediately scheduled both an MRI and an appointment with a top spine surgeon at MUSC, Dr. Bruce Frankel. His PA met with me after the MRI, took my history, and said that I had to meet with Dr. Frankel himself as there were some irregularities that they did not like. This happened the next day; Dr. Frankel informed me that I had a compression fracture of the L4 vertebrae. This fracture, plus some slightly elevated proteins noted a couple of months prior by my Internist Dr. John McGough, raised the prospect of a plasmacytoma, or plasma tumor of the L4. Dr. Frankel scheduled surgery in 2 weeks, while also informing me that this tumor is usually a forerunner of Multiple Myeloma and that he would call in the MUSC specialist for this cancer, Dr. Hamza Hashmi. 

Spinal fusion surgery in April of 2021 was successful and the plasmacytoma was confirmed. Dr. Hashmi informed me that I did not have full blown MM, as my plasma cells were below the 10% figure. The “Multiple” term refers to more than  single a source of plasma cells; though there was another spot which glowed in the PT/CAT scan, it was nothing very large. I had 25 sessions of radiation therapy in May-June of 2021 under the guide of Dr. Bradley Cooper, MUSC. After these sessions all seemed good as the blood work was excellent and the cancer markers reduced to normal. I was released to continue PT and having quarterly blood work and scans. We knew MM would come back, but hoped that it would be 5 years or so. My condition rapidly improved and by October, 2021 I was back tormenting my friends on the golf course. In December, 2021 Debby and I went to Paris and took a Viking River Cruise down the Seine to Normandy and back to  celebrate both our 45th wedding anniversary the year before as well as my 70th birthday — both events delayed for 1 year by Covid.

Quarterly scans and blood work all looked good; though a couple of markers were tending up rather than down, they were not that concerning to the doctor. The 1st week of April, 2022 we went on a 15 day Viking Ocean cruise: flying from Atlanta to Madrid, then after a couple of days on to Barcelona via a Bullet Train, boarding our ship there and cruising the western Mediterranean through the Straits of Gibraltar and then on to Portugal, France, England, Belgium, and finally Norway. Despite one day of rough weather in the Atlantic we had a great and memorable time. We came home and continued on with life as usual.

In June and again in September of 2022 I had more blood tests and scans. This last time the results were not as positive, though the markers were not that much higher, save for a kappa/lamda figure and Monoclonal protein spike. Dr. Hashmi told me that I was positive for Multiple Myeloma; he suspected it was hiding in my  bone marrow & bones — that he wanted to attack it before it grew worse. We both agreed and he explained that I would have chemotherapy for about 12 weeks — both daily at home and weekly outpatient at the hospital. At the end of these treatments he would talk to us about an Autologous Stem Cell/Bone Marrow transplant. In a few weeks we began that schedule and are just now completing 9 weeks.  I have 3 more to go and will be finished on February 1st.

Several people have asked why I did not go somewhere for a second opinion. Two basic reasons:

    a. I have a sister who is a retired Hematologist/Oncologist and though she no longer practices she is familiar with Multiple Myeloma and knows the basic protocols. Her statement, "This is not an exotic cancer and a good H/O can handle this." When I told her that Dr. Hashmi specialized in MM and does clinical trials, etc., then she confirmed that I was in the right place. 

    b. Dr. Hashmi's credentials and ability to focus on MM made going elsewhere non-essential. I would not travel elsewhere to be treated when I have a top flight cancer hospital, the Hollings Cancer Center of MUSC, 12 miles downtown — it is ranked in the top 10% of all cancer treatment facilities in the US. Through the Leukemia and Lymphoma Society information is available online as to the latest treatments. What I am receiving is the standard of care for MM in its early stages. I also have a childhood friend, whose wife has been dealing with MM for 2 years. They travel every six months to the University of Arkansas Medical Center in Little Rock which has a noted MM treatment facility. My treatment protocol is the same as hers, which again reinforced our decision.

At this stage chemotherapy consists of 4 main drugs: weekly injections of Velcade & Darzalex Pro, a weekly oral intake of Dexamethasone and a daily regimen of Revlimid — 14 days on and then 7 days off. There are also the usual supportive medications to reduce side effects: Oyster Calcium pills (and a shot of Xgeva monthly;) Acyclovir — to prevent shingles; and various others such as Benadryl, Tylenol, etc. Though this sounds like a lot, it is really mild compared to what other cancers require. Every Wednesday I spend 3-4 hours @ MUSC Hollings Cancer Center having blood drawn and analyzed and getting my shots. BTW, MUSC has the best technicians, nurses and staff that I have ever experienced. All their patients are hurting at one level or another, and they are nothing but kind, calm, caring and informative. 

On January 11th, 2023 I had full blood work and met with Dr. Hashmi and Dr. James Davis, head Pharmacist @ Hollings Cancer Center. After this final round of chemo I will be having an incredible number of tests to ensure my body is up to this. Then in mid-February the doctors will harvest my own stem cells, freeze them, and then reintroduce them in mid-March; this is called an “Autologous Stem Cell/Bone Marrow Transplant.” If all goes well the next year will be spent rebuilding bone marrow and my immune system. I must receive  again all the vaccinations I have ever been given — even measles and mumps!

The greatest danger at this stage with MM is not as much dying from the disease as it is dying from a secondary infection. I wear a KN 95 mask everywhere I go, as does Debby. Dr. Hashmi warned her not to go out and catch something and the infect me! In fact, at this stage the most challenging aspect of treatment is not so much the chemo, though that is no fun, but rather being quarantined from people. (Fatigue is a close second!)  We miss our church and SS Class — the ministers and members at Westminster Presbyterian have been wonderfully supportive — but we are confined at this point to watching worship online every Sunday.  It is not the same, but it is better than nothing. 

Side effects are very mild compared to other cancer treatments: fatigue, neuropathy on the bottom of my feet, occasional stumbling, blotches on my skin from the injections in the abdomen area, and the usual “chemo gut” — I’ll just leave that right there. My body has really tolerated these drugs very well.

So, that's the medical picture, or almost all of it. On November 9th Debby had a total shoulder replacement while I had my second round of chemotherapy. I dropped her off at an adjoining hospital and picked her up 2 days later; due to Covid and/or my being immunocompromised I could not go stay with her.  She has done amazingly well and is almost through with her PT. She is quite the trooper, I must say. 

From what I have gathered my case is fairly normal, especially considering we caught it very early. The moral of this part of the narrative: play kickball with your grandchildren and if you break your back you will be blessed.