Waving the white flag

I needed a day like yesterday to be humbled and driven back to my knees before God. First, I had my first of 10 radiation sessions to treat the hot-dog-sized tumor in my spine. There is no pain from this mass nor from the treatment itself, but also no quick or easy relief. My legs are very weak. I use a cane now to get around the house, and if this nerve compression (Cauda Equina Syndrome) worsens, I could end up paraplegic. The radiation should eventually calm the nerves in the upper legs as they exit my spine, but there’s no guarantee it will. It’s very hard for me to accept this slow loss of mobility. I may take to a walker if I don’t soon regain muscular strength.

I also got an email from Dr. Curti yesterday stating that melanoma specialists at Fred Hutchinson Cancer Center in Seattle agreed with his plan for palliative radiation to the spine and did not think that gamma knife would benefit the brain for the reasons that were explained to me last week (e.g. since melanoma cells are traveling through the cerebral-spinal fluid, there will only be more deposits in the near term). In addition, the large area that needs to be treated with gamma knife would likely result in negative cognitive changes. Although another course of ipi or temozolomide chemotherapy could be offered, they have a low probability of response and a high probability of side effects. There appear to be no clinical trials of melanoma drugs on the West Coast for which I might be eligible.

When your medical history includes as many comebacks as mine has, it’s easy to imagine I must have another one in me. Realistically, I don’t. I believe I‘ve been tested this week: to resist the temptation to seek more curative treatment in the hope that I can yet beat melanoma. Almost every patient with advanced cancer will know what I mean by this. No matter how strong your character or religious convictions, it’s a brutal decision to finally wave the white flag. To say, “Enough. I’m done.” To know there’s no alternative to surrendering to the biological imperative that God has designed into our genes. To tell yourself, “Death is near.”

I have no particular sense of what I want my last days or weeks to look like. I’ve lived my bucket list—been everywhere I wanted to go and done all I needed to do. I’ve been blessed in life beyond measure, to which I hope this blog is testament. I now mostly want to be around family and friends, most of whom are fortuitously located nearby (two of them down a flight of stairs!). Should I regain strength in my legs, I hope to get back into more of God’s creation this spring and summer and to enjoy its pleasures. If I don’t, I have the consolation of the peace of Jesus, of prayer, of reading and of conversation with the people I love most. My days are full.

Having lived a good life, I pray to God that I would now die a good death. While I am staunchly pro-life, I am not equally anti-death. The devaluing of life at its end as at its conception is equally abhorrent. Assessing the value of life at its completion is different, however, than the same assessment at its beginning. Destroying life at its beginning rejects God’s sovereign arrangement in creating it, abandons hope in God’s sufficient grace and does not trust in God’s ability to care for what he creates.

Life’s sanctity, however, does not demand its preservation at all costs when a lifetime is fulfilled. Those Christians who say the sanctity of life requires us to use any medical means to stay alive contribute to our inability to routinely teach and practice dying well. Let it never be said about me that “I have fought the good fight” (2 Timothy 4:7), as this quote from the apostle Paul is typically misconstrued to be less about spiritual things than about trying every medical option to stay alive. My gradual dying has given me the advantage of advanced warning. I don’t want to squander the gift of generous time for end-of-life preparation than most people are given. In many respects, the last few years have been the most precious of my life. I’ve been able to accomplish what many people are not granted in a sudden death.

I met with a social-worker friend this afternoon to talk about hospice care and the choices to be made. It was a good exchange of practical information, but also a little surreal as Martha is someone with whom I've run many times in both formal events and just around the streets and trails of our neighborhood. I haven’t run in three months now and likely won’t again, which in itself is a small death. The process of gradually giving up things I love is sad, but clearly part of God’s plan. I take comfort in knowing that what I love most—my wife, my family and my friends—will be the last thing I see and am blessed by in this life. He leaves us with the best till the end.

If I can 1) glorify God by living a full life, 2) accept his plan for its end, 3) trust in continued life in Christ, and 4) know that that he will see me through from this world to the next, then I live contentedly and gratefully. I fear nothing.