March 29, 2006 - Crucible of Hope

This evening I preside at Madeline’s funeral. She’s the church member in her fifties who died in hospice care several weeks ago, after a long struggle with ovarian cancer. The family decided to wait a couple of weeks until I was through my most recent chemo treatment, so I could conduct her service.

I remember when Madeline was first diagnosed. Her prognosis was not very encouraging, but she and her husband Dave stepped right up to the challenge, learned as much as they could about the disease and pursued aggressive treatment for as long as it seemed medically advisable to do so. I remember one night when they came into the Disciple Bible Study group I was teaching, and distributed educational materials about ovarian cancer to their fellow class members. They were on a mission that night: they wanted other women (and the men who love them) to know about the disease, and about the importance of early detection. It was just like Madeline – who combined deep caring for others with a no-nonsense, practical attitude – to do something like that.

Tonight I do feel well enough to conduct her service – but only just. A week after the most difficult of my chemo treatments so far, I don’t have a lot of stamina. It’s a good thing the funeral service is composed of a number of short segments. With Robin assisting me, I’m able to limit the time on my feet, and get through it without much difficulty.

Last week, when Dottie – my Presbyterian-minister colleague – stopped by to visit me during my chemo treatment, one of the pieces of advice she gave me was, “Don’t be a hero.” From her own experience as a cancer survivor – and perhaps knowing, also, that I’m the overly-conscientious type – she was encouraging me to take whatever time I need to get better, and let others handle my tasks at the church. I hear what she was saying, and I know I don’t absolutely need to be here tonight (Robin could very capably handle the service). Yet, in another sense, I do need to be here. What I need to do tonight is not something very many other people could do in my place. It’s a Cancer Underground sort of thing.

It’s hard to put into words, but I have a sense, tonight, that Madeline and I had a special connection because of our cancer. I choose to read these words from the letter to the Romans about suffering and endurance, because they somehow speak to our common experience:

“...we also boast in our sufferings, knowing that suffering produces endurance, and endurance produces character, and character produces hope, and hope does not disappoint us, because God’s love has been poured into our hearts through the Holy Spirit that has been given to us.” (Romans 5:3-5)

I haven’t figured out, in advance, exactly what to say about this passage, so I just wing it. I speak about sickness as a stern and demanding teacher. The lessons people like Madeline and me learn from our illness are not the sort that can be put into words. They have more to do with who we are becoming, as a result of the experience. The fact that Madeline is no longer a cancer survivor, while I still am, is incidental. Our faith assures us there is life after death, and that therefore this hope, born of endurance and character, carries us onward into the life to come.

The image that comes to my mind, as I think later about what sort of thing cancer teaches, is that of an Olympic skater. These athletes put themselves through years of demanding training, in order that they may become the sort of people they know they are meant to be. There are falls and injuries along the way. Sometimes the falls happen in competition, and that is painful to behold – but they get up and skate on. Maybe the most important trait these athletes need, in order to become champions, is this very ability to get up, again and again, after they have fallen.

One thing I find noteworthy about the Romans passage is that Paul does not seem to consider character to be a given. Most of us consider character to be the result of having come from a good family, having had the right upbringing, and so forth. But his is a more dynamic idea of character. It’s not anything we can take credit for. It’s what life makes of us, in the mysterious providence of God.

Back home after the service, Claire tells me my voice was not so strong as it usually is. She could see my physical weakness as I stood at the pulpit, and probably others could, too. Yet in another sense, I feel strong, stronger than I’ve ever been before. That’s all because of suffering, which produces endurance, character – and hope.

March 28, 2006 - Poster Child?

When I was a kid, the March of Dimes was a charity that sought to end polio (the fact that they started out soliciting dimes tells you how long they’ve been around). I was in elementary school when the oral form of the Salk polio vaccine came out. I can still remember the novel experience of my mother telling my brother, Jim, and me that it was time to drive downtown, so we could eat a sugar cube which contained the liquid vaccine. My mother, ever wary of our dental health, was not inclined to let us eat sugar cubes, so this jaunt seemed a truly noteworthy event. (Jim and I agreed that, if nothing else, the sugar cube sure beat a hypodermic needle.)

After the Salk vaccine, polio was more or less eradicated in short order. Rather than closing up shop, the March of Dimes cast around for a new mission. They settled on the worthy cause of preventing birth defects. From their polio-fighting days, they had learned the value of naming a “poster child” each year. This was generally a cute-looking pre-schooler, who could be portrayed on promotional posters wearing leg braces or using crutches. The purpose of the poster child was to get sympathetic donors to part with their dollars (the organization having long since left mere dimes behind). We used to see the poster children’s pictures on change canisters in stores. They always seemed a bit sad. I never dreamed I might be one.

Recently, I’ve agreed to become a poster child of sorts – at least for one particular project, the raising of money for lymphoma research. Dana, a member of our church who works for Genentech (the company that makes Rituxan, the lymphoma miracle drug I’m receiving), is quite attuned to the ongoing need for research funds. She suggested that the church organize a fund-raising walk to aid the Lymphoma Research Foundation. Tom (another church member who’s principal of the local elementary school), and Mandy (our youth director) have responded enthusiastically to the idea - although we’re hoping for participation from all ages, not just the youth group. As of today, we’ve got a date (Sunday evening, April 30th, a place (the Antrim School) and a gimmick to set the event apart (a night-time walk with participants carrying glow-sticks for the dramatic effect).

I take it as a gesture of personal support and empathy for my situation, and am glad to receive it in that spirit. I’ll plan to come to the event to give the walkers moral support, though I may not have energy for more than a symbolic walk around the school track.

Sure, I’ll be a poster child for a good cause...

March 27, 2006 - Cumulative

The word for the day is: cumulative.

I read somewhere, a while back, that chemotherapy side effects are often cumulative – the longer one goes through this process, the longer they take to dissipate. This has certainly been true this time around.

I’ve written, before, about the prednisone rush. In previous cycles this has happened to me on the afternoon of the fourth and final day of taking these powerful steroid tablets. Symptoms include hot flashes, headache, nervous energy and a general emotional feeling that’s something like sitting behind the wheel of a car, flooring the accelerator and listening to the wheels spin. There’s a pervasive exhaustion that goes along with it, but it’s nothing a nap will fix. It’s hard to sleep at all, in fact, despite the run-down feeling.

This time around, the prednisone side effects began a day early, and they’re still with me now, a couple of days after taking my last pill. I’m profoundly tired of this unpleasant, jittery feeling, but this time it just won’t seem to go away.

This morning Claire happens to be home, and I suggest we go out for lunch. It’s a beautiful, spring day at the Jersey Shore, and I feel the need to get out of the house. We stop for a sandwich at a local seafood place, then head over to the boardwalk.

I quickly find that the prednisone rush isn’t the only chemotherapy side effect that’s cumulative. So is physical exhaustion. I find it hard to walk any distance at all along the boardwalk, without stopping to sit on a bench and catch my breath. I used to walk the whole mile-long length of the Point Pleasant Beach boardwalk for exercise, up and back, without thinking much about it – but the thought of that amount of walking seems completely impossible now. My progress these days is measured not in miles, but in feet.

I feel a sense of loss that doesn’t seem diminished by the thought that these side effects are likely only temporary. The fact is, right now I couldn’t walk the length of the boardwalk if I tried. I’ve lost that physical capability. I feel older than my years.

I’m dealing, now, with my fourth chemo treatment out of six. Emotionally, it’s a difficult spot to be in. I’m more than halfway through, but – knowing that the cumulative effects will only increase – it still seems like I’ve got a very long way to go.

Just keep putting one foot in front of the next. Take it slow. Stop and breathe, when you need to. It’s the only thing to do...

March 26, 2006 - Thinking About the Garden

"Thinking About the Garden"

I’m thinking today about the Garden
(which I suppose is a good thing,
because it means I’m not thinking
about the cancer).

The Garden
is a small plot of ground
off to the side of the Manse,
tucked between the concrete drive
and the gray-shingled house.
Each Spring about this time,
for each of the fifteen Springs we’ve lived here,
Jake, the Sexton,
has come, unasked,
gripping his Roto-Tiller’s handles,
to churn and turn
the clods for me,
so I could claim
my suburban squire’s privilege
of pressing a few tomato seedlings
into the moist earth,
and of savoring the distant hope
of a taste of vine-warm fruit
at some steamy summer cookout yet to come –
a cascade of sweet, red juice
“running down upon the beard,
on the beard of Aaron
running down over the collar of his robes.”


Jake’s retired now.
There is no more Sexton
(sorry, budget cutbacks).
We have a cleaning service
and a grounds service, too:
efficient,
economical,
anonymous.
(A pity.)

“Sexton,” propounds the Oxford Dictionary,
comes from sacristanus (Old Latin):
“A person responsible
for looking after a church,
its contents,
and the churchyard,
frequently acting as bell-ringer
and gravedigger.”
The sacristanus handles sacred things,
like clods of moist, brown earth.

We never did permit Jake to handle
the sterling silver trays of yeasty bread cubes,
nor the sweet, Presbyterian grape juice,
decanted from Dr. Welch’s bottle
into plastic cups.
He was a man of the earth,
with dirty hands to show for it.
Those tasks belong to the Deacons
in their proper Sunday suits and dresses:
they who ascend the hill of the Lord
with clean hands
and a pure heart
(or so goes the theory).

There is no sacristanus to churn the earth for me,
churn it like the waters of Bethesda’s pool,
so it may yield its increase.
(More’s the pity.)

One bright day,
slowly,
hoe in hand,
I will do it myself.

Indeed it is a good thing
that I am thinking about the Garden,
because it means I’m not thinking
about the cancer.

March 24, 2006 - Looking Sick

Yesterday my missing CT scan films finally arrived from Sloan-Kettering. This afternoon I notice them sitting by the front door, and I know Claire will be out for the rest of the afternoon doing hospice ministry, so I decide to drive them over to Ocean Medical Center myself.

It’s more tiring than I would have thought, just walking from the parking garage over to the main building. I go slow, huffing and puffing along the way. I have very little stamina for physical exercise. The only experience I have to compare this to was last spring, when I went out to a national Presbyterian pastors' retreat at the Snowbird ski resort in Utah. That place was around 8,000 feet above sea level. With the thinner air at that altitude, I had the unaccustomed experience of thinking consciously about my own breathing.

I find my way to the X-Ray File Room, which is where CT films are kept. A staff member from that department is coming out of a side door as I’m walking down the hall with my large envelope, and she asks me if I’m returning films. I say, yes I am, but also explain that Dr. Lerner wants me to ask her to pass on the word to the radiologist that these are now in, in case that doctor wants to make a supplementary report, based on the actual films (rather than just the narrative report from last fall). Evidently, there’s no release to sign, no form to fill out – so I just hand over the envelope. (All the films have my name on them, and the date, so there doesn’t seem to be much chance they’ll get lost – but the whole transaction still seems very informal, especially since it's happening out in the hallway.)

She says she’ll take care of it, and not to worry about it. She seems unusually solicitous, and it occurs to me that I may not look too good at the moment. I’m feeling tired, my eyes are glassy, and my complexion is probably closer to gray than any other color. She’s treating me like a sick person, I think to myself. Well, that’s what I am, especially just a couple of days after chemotherapy. Sometimes I forget that I don’t look the same as I always have.

Is that a good thing, to be treated as a sick person? I’m not sure. On the one hand, the hospital staffer seems very kind, but on the other, I feel, in that moment, somehow set apart from the rest of the human race. I’m different, I think to myself. I look different, and this person is treating me differently.

Thinking back on the experience later, I wonder if that’s how older people feel. I’ve seen people fussing around and being solicitous of the elderly. At times I’ve done so myself. Those actions are of course well-meant, but I suppose that, from the standpoint of the recipient, they could unintentionally contribute to a sense of isolation.

File that one away as a lesson for the future, I think to myself. One more lesson from Cancer: that stern, master teacher.

March 22, 2006 - Chemo 4, and Some Good News

This morning at 9:30 Claire and I drive over to Dr. Lerner's office for my fourth chemotherapy treatment. I go in by myself first, to step onto the scale and then have my porta-cath flushed in preparation for the chemo drugs. At my request, Raquel, the nurse, uses a larger needle to access my porta-cath – I had problems with the smaller needle reaching the deeply-implanted device on a previous visit – but now it appears that the prior problem was due to post-surgical swelling, which has now resolved itself. A regular-sized needle would have done fine. Raquel consults with a couple of the other nurses, and they decide to go ahead and leave the larger needle in (rather than removing it and sticking me a second time), even though there's a risk of it catching on something and being pulled out. They put a thick wad of gauze under its protruding end to support it, and cover the whole arrangement with a lot of adhesive tape. It seems pretty secure. Raquel then draws my weekly blood sample through the porta-cath. With a plastic cylinder that looks like the fluid-reservoir of a hypodermic needle taped to my shirt, I go down the hall into an examining room, where Claire joins me.

Dr. Lerner comes in, greets us, and opens my file – which, I can see, is growing. It's now a couple of inches thick. First, the news we've been waiting for – and it's good news. The CT scan reveals that the mass in my abdomen has shrunk to about half its original size: from 93 square centimeters to about 45. This, says the doctor, is good progress. Evidently, the radiologist who read the scan was able to make this judgment using the narrative report from my original CT scan – although it would have been better to do a side-by-side comparison of the actual films. Dr. Lerner suggests that, when I do receive the original films back from Sloan-Kettering, I take them over to Ocean Medical Center with a request that the radiologist do a supplemental report.

Dr. Lerner's plan is to continue with the same chemotherapy regimen I've been undergoing, because clearly it's working. At the end of the sixth treatment, I'll have another CT scan – although he warns me that, because I have a large tumor, it may show some residual tissue remaining. Generally, this is fibrous, scar-like tissue, and not a threat – although he says he'll probably want to order another PET scan, just to make sure no "hot spots" show up.

Dr. Lerner does give us a new piece of information. He says there's a possibility that, once the chemo sessions are ended, I may need to have radiation treatments. This is sometimes done with patients like me, who have larger tumors that can be clearly targeted. I ask him about the duration of these treatments, and he says they would probably last for three or four weeks – a series of very brief, daily visits. Another doctor, a radiation oncologist, would determine the schedule and oversee the treatments. When I ask him about the other tumors that showed up on my previous PET scan, he doesn't use the word "tumors" in his response, but rather refers to them as "hot spots." Clearly, his main focus is on the large abdominal tumor; he'll check on the other areas at the time of my post-chemo PET scan.

My blood tests continue to look pretty good. My white cell count is a little below normal, but only slightly – and the Neulasta injection I'll get tomorrow should resolve that.

Dr. Lerner asks about side effects, and I tell him I've been having some trouble with nausea for several days after each chemo treatment – even with the Aloxi they've been giving me intravenously on treatment days, and with the Compazine tablets I've been taking as needed. I remind him that, on my last blood-test visit, Raquel (after checking with him) gave me some samples of Kytril, another anti-nausea drug. I've been holding onto these pills at home, so as to start taking them following this week's treatment. Dr. Lerner says that, besides the Kytril and the Aloxi, he'll prescribe another anti-nausea drug, a new one called Emend. He first asks me if I have a prescription plan – evidently, this drug is expensive. Raquel had asked me the same thing, a couple weeks before, about the Kytril – the samples were of course free, but she was thinking about subsequent prescriptions. What price comfort?

After concluding our time with Dr. Lerner, I walk with Claire to the other end of the building, where I take my seat in the same corner treatment room. Janet, my nurse for the day, begins the Benadryl drip, then the Rituxan not long after that. The medicine makes me drowsy, as it's done before, and I doze through most of the morning. Claire returns around noon, bringing my new Emend anti-nausea prescription – the first pill of which I need to start taking about an hour before I start on the CHOP chemo drugs (these don't start until I've finished the four- or five-hour Rituxan drip, so there's still time). I don't know what the original cost of the Emend prescription is, but our share, after the prescription plan kicked in, is about $85. This is for three pills.

A couple of friends stop by this afternoon, for surprise – and very welcome – visits. Dottie, a retired minister from our presbytery who's receiving treatment for ovarian cancer, stops by to offer encouragement and a prayer. Then, a little while after she leaves, Don – the member of our church who also has NHL – looks in. Both have been in today to see doctors from the same medical group, and ran into Claire in passing, so they realized I must be back here and stopped by to say hello. Both are well-known to the chemo nurses and very familiar with the whole treatment routine.

After my visitors leave, I watch a video I've brought along with me. In this age of DVDs, the video selection in our local Blockbuster store is getting sparse, but last night I did find a videocassette version of the 1998 Robin Williams film, Patch Adams. It's about an iconoclastic young doctor's journey through a rather traditional medical school, and how he manages to chart his own course – despite opposition from some hidebound professors – in the direction of a more holistic, personal way of treating patients. I had heard that the film – while based on a real person – is highly fictionalized. That's obvious from the script, some of which is just too unbelievable – typical Hollywood! But Robin Williams makes it entertaining, with his special blend of humor and compassion. The movie raises some provocative questions for modern medicine, which all too often treats patients as cases rather than people. (Not that I have any complaints about Dr. Lerner or his staff in that regard – they're very caring.)

Claire returns about 5:00, and we leave about 5:30 – after stopping on the way out to schedule my next several weeks of blood tests, and my next chemo treatment for April 12th.

March 20, 2006 - In Praise of DIY

When Claire and I were living in Scotland some years back, we’d occasionally come across a “DIY Store.” We soon learned the initials stand for “Do It Yourself.” A DIY Store is one that sells home-improvement and craft items, for the amateur carpenter, plumber, electrician or other tinkerer.

I’m learning that cancer treatment is, at least in part, a DIY enterprise. We’ve had a couple of experiences in recent weeks that have reinforced for us the value of remaining proactive and engaged with the whole treatment process.

The first incident occurred just after my last appointment with Dr. Lerner. The Doctor told us he wanted me to have a CT Scan in two to two-and-a-half weeks – allowing sufficient time for the results to get back to him prior to my fourth chemotherapy treatment (which is coming up this Wednesday). I could either call the hospital myself to schedule this test, he told me, or his office staff could do it.

I’ll let the office staff do it, I decided. They’re the pros at this: why not let them go through the process of contacting the hospital, and of getting pre-certification from my insurance company? Besides, a doctor’s office probably has more clout with the hospital authorities than a humble patient.

Wrong decision. There was some sort of communications breakdown. First, the request to schedule the test somehow got misfiled, and it wasn’t till a week later – after some prodding from me – that I finally got a call telling me when the test would be. It would be on Wednesday, March 22nd.

“It can’t possibly be that day,” I said to them. “That’s the day of my next chemo treatment, and Dr. Lerner wants to have the results by then, so he can make any medication-dosage adjustments that may be needed.”

“Well, the doctor’s written instructions say, ‘Schedule it in two to two-and-a-half weeks.’”

“That was two to two and a half weeks from my last appointment with him, not from the day when I called you back to say I hadn’t heard back yet.”

“I’ll check with the doctor, and get back to you.”

Well, someone did evidently check with the doctor, and sure enough, someone called back to tell me the test had finally been scheduled at the proper time – and just when I had been saying all along that it needed to be scheduled. I would have saved myself a whole lot of time and effort by calling to schedule the test myself, even if it meant making my own call to the insurance company for pre-certification. I’m learning that “DIY whenever you can” is a good, practical rule for the cancer survivor – and that’s exactly the rule I’ll follow in the future.

But the saga of the CT scan was not yet ended. A day or two after the test, I got a phone call from the file room at Ocean Medical Center. It seemed they couldn’t find my CT scan films from last fall, to which the radiologist wanted to compare my latest results. The last record they had was that the films had been sent to Memorial Sloan-Kettering Cancer Center in New York, for my consultation with Dr. Portlock.

I remembered receiving an envelope from Sloan-Kettering with some diagnostic films in it. I checked the envelope, and found that, while the PET scan and MUGA scan results were there, the CT scan results were not. A phone call to Sloan-Kettering resulted in a promise that they would send the CT scan films to me immediately, by overnight delivery. (Better have them sent here to me at home, I thought to myself; that way, I can be sure they arrive, then drive them over to the local hospital myself, rather than risking them getting lost somewhere along the way. DIY!)

As of this morning, I’ve still not received the CT scan films. I call Dr. Portlock’s office, only to learn that the person I talked to early last week is not in today, and all the information about the shipping of my scan results is in her computer. No one else has the password to get onto her computer. Could you call back tomorrow? OK, if I must.

I call Dr. Lerner’s office, to find out if there are any further developments with the radiologist. I haven’t heard a thing since the file room clerk called me last week. Was the radiologist able to analyze my most recent scan results, anyway, even without the earlier results? Was it possible, perhaps, to compare them with the PET scan films instead (which, after all, are supposed to display my tumors in even greater detail)? No one in the doctor’s office seems to know. They promise to check on it and get back to me. But by the end of the day, no one’s called back. I’ll call again first thing in the morning – but my fear is that all this effort to get the CT scan scheduled in time may be for naught, because of this comedy of errors involving multiple people.

It’s a complicated business, cancer treatment. I’m learning that it’s best to be as proactive as possible, to ask questions, to keep checking back. And even then, mistakes still happen.

DIY forever!

March 18, 2006 - Back in the Saddle

Today I’m back to preaching again – well, not actually preaching the sermon just yet, but writing it in preparation for tomorrow’s services. I’m halfway through the last (and best) of the three weeks following my most recent chemo treatment, so Robin and I figured this would be a good day to write me into the preaching schedule. I’ll probably feel tired standing there at the pulpit, especially during the second of our two morning services, but I think I can manage it.

I’m not going to preach about cancer. I don’t want cancer to define me as a preacher during this season of my illness – although, as I stand up there with my nearly-bald head, I’ll be under no illusions that my listeners won’t be thinking about it. But so what? As ol’ Popeye used to say, “I yam what I yam, and that’s all that I yam.”

I’m going to speak, instead, about mission. I’m concerned about some tendencies I see, both in our local church and in the larger Presbyterian Church, to hunker down and focus most of our resources locally in these times of financial strictures. We’re in danger of becoming parochial. There’s an increase in the sort of thinking that used to be a problem in the eighteenth and early nineteenth centuries, back when parishioners used to rent their pews through an annual subscription. When it came time to appeal for offerings for roof repairs, the snappy response is said to have come back, “Why should I give? It’s not raining over my pew!”

Anyway, I’m thinking it’s time for a gentle reminder that the church is bigger than the lot on which its building sits, and the church’s mission is larger than simply opening the doors and inviting people to come in.

Sometimes, raising topics like that as a traditional preacher, I feel a bit like a dinosaur. When I was in seminary, there were some who were eagerly writing the obituary of the traditional sermon. We were all being encouraged to preach first-person sermons (dramatic monologues in which we took on the role of a biblical character) or dialogue sermons (a sort of ecclesiastical tag team involving two preachers). Thankfully, those innovations never really took hold. In seminaries today, they’re still saying the traditional sermon is on life-support, but they’re encouraging us preachers, instead, to wire our sanctuaries for light and sound, and accompany our talks with Power Point presentations and video clips. This is in order to reach the younger generations who are more visual, and have supposedly lost the ability to sit and listen to anything longer than the interval of time between TV commercials, unless they also have something to look at.


I don’t think we’ll ever return to the days when people used to line up around the block to hear Harry Emerson Fosdick preach forty-minute sermons, or when the major newspapers used to run Monday-morning summaries of the previous day’s pulpiteering. But I wouldn’t want to mutter “ashes to ashes, dust to dust” over the traditional sermon, either. It’s proven remarkably durable over the years, despite each generation’s attempt to replace it with something else.

Yesterday’s New York Times had a couple of articles that got me to thinking about this whole business of preaching. One article notes that Protestant theological seminaries continue to be filled with students, but that (1) these are mostly mature students, and (2) comparatively few of the younger students are interested in becoming pastors of churches after they graduate. (This is nothing new to me; I could see these trends beginning more than fifteen years ago, back when I was a seminary admissions director – but it seems somehow significant that the Times has discovered these factoids and deemed them worthy of publication.) The second article, from the same issue of the same newspaper, focuses on how the spoken word is becoming trendy again, and how public lectures on a variety of topics are becoming some of the hottest tickets in the Big Apple (Neela Banerjee, “Students Flock to Seminaries, but Fewer See Pulpit in Future,” and Dinitia Smith, “In the Age of the Overamplified, a Resurgence for the Humble Lecture,” both articles in the New York Times, March 17, 2006).

If there’s anything to this trend of rejecting high-tech glitz and returning to the simplicity of the talking head, then perhaps the churches that are so eagerly jumping on the bandwagon of rear-projection screens and computer animations have hurled themselves into a Keystone Cops car that’s careening off in precisely the wrong direction. For who has been offering “the humble lecture” longer than Protestant preachers? (I’d like to think we do it well, but that’s for our listeners to decide.) Far be it for the Times writer to think in such terms, however; her range of vision is limited to public library and museum programs.

I still think there’s a place for the traditional sermon in our wired world. There’s something real, and authentically human, about people talking to other people, with no more electronic assistance than perhaps a microphone. Garrison Keillor has reminded us, through thirty years of immensely popular Prairie Home Companion broadcasts, that radio can still be more than either an endless parade of vacuous top-40 tunes or a killing field for victims of right-wing talk-radio hosts. His Lake Wobegon tales teach us there’s still such a thing as the human imagination, and that it can be accessed through the ears as well as the eyes.

So, enough blogging for today. Off I go to write the sermon...

March 17, 2006 - Death of a Poet

Surfing the net today, I happen to read of the death of a poet, a man named Ken Brewer. He held the rare distinction of being poet laureate of the State of Utah. He spent his life teaching others how to write, and in his later years he took on the poet laureate mantle with gusto, driving all over that sparsely-populated desert state to read poetry to groups large and small.

Ken Brewer died on Wednesday at the age of 64. The cause? Pancreatic cancer, with which he was diagnosed only last June. Evidently, his response to the news that he had this deadliest, most incurable of cancers was to take up his pen and write. He spent the last months of his life writing poetry at a rate he described as a “fever pitch.” Ironically, after a lifetime of writing poetry, it is these death poems – written, I suppose, in the spirit of Dylan Thomas, who himself advised poets to "rage, rage against the dying of the light" – that have given Ken Brewer his fifteen minutes of fame. I think, from what little I’ve seen of his work, that he deserves a good deal more fame than that – but we’ll see if the world accords him more than passing notice.

I haven’t heard of Brewer’s work before – and, in fact, as with too many poets, it seems that most of his books are out of print. It’s also frustratingly hard to find any of his poetry online – just snippets here and there.

I do discover a feature story that CBS News did on him back in December. It includes a couple of video clips of him reading his poetry. One of the poems he read to the television camera I decide to write down. Here it is (although, because I’ve transcribed it from oral form, the punctuation and line breaks may not be quite as the poet intended):

“The Measure”
by Kenneth Brewer

I measure my life in friends
and I am humbled by the numbers,
the quality,
the style, path, policy and grace.
I measure my life in days
when friends write,
when we converse as they sit by my bed,
read poems and listen.
I measure my life in family
who speak through tears,
who serve me meals on a wicker tray,
who pray and love and float.
I measure my life in pine siskens
who entertain me in feeders outside my window,
and Gus, the schnauzer,
who curls next to me in bed.
I measure my life in friends
who do not know my sins,
who hug my shrunken body,
who break open my heart with words.
I measure my life in cancer
that has taught me how to measure my life.

He’s right about that. Cancer – for those of us who have it – does have a way of teaching us how to measure our lives. I suppose that many of those, like Ken Brewer, who are unfortunate enough to have one of the deadliest types of cancer, achieve a certain clarity of purpose right quickly. They have heard their doctor soberly say, “Go put your affairs in order.” And so they do. If the person is a poet, then that may mean, “Go write more poems.”

In reading a news article about him, I discover another thing Ken Brewer said, something he had learned about cancer:

“Brewer experienced an evolution of language as he wrote about cancer. He noticed all the ‘military terms,’ such as ‘fight, battle, kill,’ and he used those in his early poems. But gradually he came to feel that he should talk about cancer in a different way. ‘It’s your cancer – a house guest who stays longer than you wanted him to. You kill your spirit when you use military language. There are other parts of you that need to be healed. I focus now on spiritual healing.’”

(Dennis Lythgoe, “Utah Poet Writes at a Fever Pitch,” Deseret Morning News, December 18, 2005)

I’ve been using that military language some, in talking about my own cancer. It’s hard not to. A lot of the stuff written about cancer treatment – the “War on Cancer” – does talk about “attacking” the malignant cells, about “killing”them. I’ve heard Rituxan, the medicine I’m taking, described as a “smart bomb” that goes right to the cancer cells and obliterates them. There’s a sort of righteous rage behind that choice of words (“Yes, officer, I confess: I killed that cancer cell, but you have to understand, I did it in self-defense”).

Ken Brewer figured out, over time, that the military language wasn’t doing him any good. Cancer, after all, is not some foreign microbe that infiltrates our bodies and sets up housekeeping like an unwelcome squatter. Cancer is our bodies. It is our very own cells, whose mutinous growth has been mapped out in advance by rebel strands of our own DNA. Certain cancers, it seems, are pre-programmed into our bodies at birth. If we live long enough, eventually our genetic code will trigger the mutation, and the disease will be off and running.

So does it make sense to speak of “killing” the cancer, to blow those errant cells to smithereens? I’m not sure it does – as emotionally satisfying as it may seem, at times, to vent our anger in such a way. If what I’ve learned about lymphoma is correct, then I’m probably going to have the disease the rest of my life. It’s part of me, and always will be. If Ken Brewer’s right, then maybe I need to embrace it – although I suppose that embrace could be a wrestler’s grip, like Jacob’s at the fords of the Jabbok:

“Jacob was left alone; and a man wrestled with him until daybreak. When the man saw that he did not prevail against Jacob, he struck him on the hip socket; and Jacob’s hip was put out of joint as he wrestled with him. Then he said, ‘Let me go, for the day is breaking.’ But Jacob said, ‘I will not let you go, unless you bless me.’” (Genesis 32:24-26)

Genesis portrays the solitary figure of Jacob, silhouetted against the rising sun, limping away from that mysterious encounter – but the wiser for it. Cancer may indeed leave us limping, but if we’re canny and persistent, perhaps we can wrestle a blessing out of it after all.

March 14, 2006 - Historical Artifact

This morning I’m walking down the street in my neighborhood, when I pass a snazzy, purple Volkswagen Beetle parked along the street. I’m admiring the car’s immaculate paint job when I notice a word at the bottom of the New Jersey license plate. It says, “Historic.”

Now wait a minute! A Volkswagen Beetle – historic? But evidently it is, nowadays.

Suddenly, I’m feeling my age. Our family had a Beetle when I was a kid. Priced as a bargain vehicle, it was the only set of wheels we could afford, when it came time to buy a second car for my mother to drive. That blue Beetle became the suburban chariot that schlepped my brothers and me to all our after-school events, Scout meetings and such.

The Volkswagen was a novelty to my friends. A sure-fire way to impress them was to borrow the car keys from Mom, then take them out into the driveway and open up the front and rear hatches: showing them the engine in the back and the trunk in the front.

Sometimes, on really cold days, the thing wouldn’t start. Then, we’d have to push it down the driveway into the street (it wasn’t very heavy, as cars go), and point it down the hill. We’d hop in, and my mother would then take her foot off the brake and let it roll rapidly downward, popping the clutch to start the thing – all of which we hoped would happen before we rolled out into heavy traffic on Washington Street. For a kid of 11 or 12, it didn’t get much better than that.

This car was part of my growing up. It can’t be a classic already. It just can’t.

But it is. Tempus fugit.

“For all our days pass away under your wrath;
our years come to an end like a sigh.
The days of our life are seventy years,
or perhaps eighty, if we are strong;
even then their span is only toil and trouble;
they are soon gone, and we fly away....
So teach us to count our days
that we may gain a wise heart.”
(Psalm 90:9-10, 12)

“Counting our days” was what passed for wisdom in the world of the Hebrew Bible. When they counted their days, those ancient Hebrews came up with the proverbial “threescore years and ten” – seventy, in other words – as the normal upper limit on human life. A very few might live on to eighty (if they were strong), but this was considered exceptional.

If all goes well with my CT Scans (the one I had done yesterday, and the one I’ll have in mid-May, following my sixth chemo treatment), I’ll be in remission by the time I turn 50 in October. That will give me twenty more years until I hit the threescore-years-and-ten – although, as we all know, people in our culture with access to good nutrition and medical care can ordinarily expect to live a good deal longer than that.

Assuming I do make it into remission – as Dr. Lerner seems confident I will – how long will it last? Could I be doing this chemotherapy thing again in another five years? Another ten? Will chemo even be the treatment of choice at that time (considering how rapidly the scientists are making new discoveries)? Maybe, when and if the cancer comes back, I’ll be receiving vaccine therapy instead (like the experimental protocol the folks at Sloan-Kettering wanted me to receive as a clinical trial – before the revised grading of my cancer disqualified me). Maybe I’ll have a stem-cell transplant. Maybe there will be some new treatment no one’s even thought of yet.

It all seems so hypothetical. Before getting cancer, I would have routinely expected to live into my eighties or nineties. I still might – but there seem to be so many more factors, now, that could affect my lifespan.

“Counting my days” doesn’t seem so wise, after all. When I see a purple Volkswagen Beetle on the street, I should probably just enjoy it for what it is, in the here and now.

Now that’s wisdom.

March 13, 2006 - Breathing Lessons

Unless we’ve got some sort of respiratory problem, most of us spend little or no time each day thinking about our breathing. It’s one of the body’s “autonomic” functions – breathing happens automatically, whether we’re thinking about it or not.

On two different occasions today, my attention is focused on my own breathing. Those two circumstances are as different as different can be.

The first takes place this afternoon at Ocean Medical Center (Brick Hospital), where I’ve gone for a CT Scan. I’m halfway through my chemo treatments, so this is the mid-point check on how much my tumors have diminished in size. It will be several days before I hear the results from Dr. Lerner.

I’ve been through this procedure before. Drink a banana-flavored pseudo-milkshake: half of it three hours before the test, the rest of it moments before. Then, lie down on a narrow gurney, feet pointing in the direction of the large, white donut that is the CT Scan machine. Extend an arm, for it to be pierced with a special IV needle, so the contrast dye can be injected moments before the test. Now, hands over your head, and do what the machine tells you.


The machine? Yes, the machine. A disembodied, robotic voice repeats this three-part command a dozen or so times, as a whirring electric engine moves my body jerkily through the donut: “Breathe in. Hold it. Breathe.” For this scan of my chest and abdomen, my belly must be absolutely still at the critical moments – not rising and falling as it does with normal breathing.

Each time the robotic voice says, “Breathe in,” I fill my lungs with air – not too much, because I might hyperventilate, but a larger-than-normal breath all the same. Then I have to hold that breath a little longer than feels comfortable, before abruptly, almost explosively expelling it on the “Breathe” command. Despite all this deep breathing, there’s a breathless feeling about it all. As familiar as we all are with the act of breathing, it feels unnatural to breathe on command.

The second occasion I have to reflect on my breathing is this evening, at our church’s informal healing service. It’s a peaceful, restful setting. The sanctuary lights are dimmed, with candles flickering on the communion table. Gentle, Taizé music is playing softly over the sound system. There are periods of silence, during which the other worshipers and I sit quietly.

In such a setting, it’s natural to become aware of one’s own breathing. It’s a time-honored meditation technique, in fact, to reflect on one’s own breathing – and perhaps to utter a simple, rote prayer on the “in” breath and another on the “out” breath. I don’t whisper any such prayer tonight, but I do focus on my breathing – and the more I do, the more relaxed I feel. By the time some of us – myself included – come forward for prayer and the laying on of hands, I’m feeling relaxed indeed, and at peace.

There’s quite a contrast between this day’s two experiences of intentional breathing. Each, in its own way, is supposed to make me well. Yet the first increases my anxiety, while the second makes me feel at peace. I’m not suggesting that CT Scans be conducted any differently – there are good medical reasons why it’s best to hold one’s breath while the pictures are being taken. I’m just observing an interesting contrast between the two.

This contrast seems symbolic of these two ways of healing that are meant to be complementary: the clinical and the spiritual. A truly holistic treatment, for cancer or any other disorder, must include something of both.

Breathe in... breathe out. It’s the ceaseless rhythm of life.

March 10, 2006 - Death Be Not Proud

Yesterday and today I’m dealing with death – not my own, but other people’s.

While that statement may sound unusual, to me it’s commonplace enough. I’m a minister. That’s what I do.


Yesterday evening, Claire and I went to the funeral home to see Gwen, a member of our church who just lost her husband, Jack, to old age and Alzheimer’s Disease. Robin, our associate pastor, is scheduled to conduct his funeral service, but I felt well enough last evening to go pay my respects, and so I did. It’s a familiar-enough routine: enter the funeral home, greet the funeral directors on the way in (I see a lot of them in my line of work), walk into the room with the open casket over against one wall, and make my way through the crowd of friends and family to find the little cluster of those who are most closely touched by this death.

They don’t teach you in seminary what to say in such situations. I’ve long since learned that what you say isn’t so important anyway. It’s being there. There are heavily symbolic aspects to my role as a pastor, and this is one. When I’m in a room, the church is there too. Some would go further and say that when I’m there, God is there. Although I’d never be so theologically arrogant as to claim that God somehow rides in on my coattails, I’ve become used to the fact that there’s a symbolic aspect to this work. It’s a matter of representation. Just as salespeople out on the road represent their companies, so my presence represents God in times such as this.

Gwen was glad to see us. We stood with her by the casket and marveled at this wonder of a human body that once had been animate, but now lay cold and still. The face – assisted by the mortician’s skilled labors – was an excellent likeness. Jack had been in declining health, both mentally and physically, for years – but last night there was no sign of it. He looked like himself, as we all remembered him from better days. To Gwen, who had been so devoted to him, that was a blessing beyond words.

This morning I meet for an hour or so with David and Lauren, who have just lost their wife and mother, Madeline, to ovarian cancer. She was in her fifties – too young, anyone would agree. I’m planning to conduct her memorial service in a few weeks (which we think we’ve timed right, in between my chemo treatments). We sit, the three of us, in my study at the church, mostly sharing stories. I’ve found that’s the most helpful thing to do in such a situation. The stories somehow conjure the person in our minds, so we can – when the time is right – say farewell.

Dave and Lauren had ample opportunity to say farewell to Madeline. With the slow progression of her disease, they knew she was dying. So did she. She talked about it freely. My last conversation with her was on the phone, at a time when I was too sick to leave the house (though Robin went over the next day and brought her communion). In the end, it was only a matter of time, until the family dared whisper the wish that finally comes to so many hospice rooms, the wish that it would soon be over.

As hard as it may be for those who have not lived through this kind of protracted bereavement to understand, this can be the most loving wish imaginable. The family have been journeying with their loved one through the sort of reverse pregnancy that is dying, and they’ve come to the point where they wish this new reality would be born: this new life that we believe begins at the instant of death, but whose details we cannot imagine until we ourselves experience it. When a baby is born, the pre-birth existence in the womb remains a dark mystery. Similarly, when a person dies, the life that awaits beyond this one is swathed in mystery. We stand, as family and friends and church, at the edge of that sweet but mysterious darkness, and our job is let go, to release the grip on the hand, to say it’s OK, you can go, it’s all right, we’ll all be all right.

When that fierce intimacy is ended, I come in, and help everyone sort out what has just happened. I ask questions, I listen to stories, I hand over the kleenex box, I write down those things that will become part of the funeral service. Again, my role is largely symbolic. The family has not come to see me; they have come hoping to see God. They yearn to be assured that God was there, too, in that sickroom, and they yearn to be assured God is with them still, as they prepare for one of life’s most difficult roles, that of bereavement. There’s not much more I really have to do than that – just be there, listen, let them talk as they have the need, and hope that my presence somehow speaks to them of God’s far more significant presence.

If truth be told, I feel like a pretty poor stand-in for God much of the time (and I know most of my ministerial colleagues feel the same way). But it’s not about us. It’s about God, and the fact that God somehow uses this frail human institution called the church, and its even frailer representatives called ministers, to remind people how much they are loved.

Poet and undertaker Thomas Lynch reflects on people like me, and what we do:

"Uncles find nickels behind our ears. Magicians pull rabbits from out of hats. Any good talker can preach pie in the sky or break out the warm fuzzies when the time is right. But only by faith do the dead arise and walk among us or speak to us in our soul's dark nights.

So rabbi and preacher, pooh-bah and high priest do well to understand the deadly pretext of their vocation. But for our mortality there'd be no need for churches, mosques, temples, or synagogues. Those clerics who regard funerals as so much fuss and bother, a waste of time better spent in prayer, a waste of money better spent on stained glass or bell towers, should not wonder for whom the bell tolls. They may have heard the call but they've missed the point. The afterlife begins to make the most sense after life – when someone we love is dead on the premises. The bon vivant abob in his hot tub needs heaven like another belly button. Faith is for the heartbroken, the embittered, the doubting, and the dead. And funerals are the venues at which such folks gather.” (Thomas Lynch, The Undertaking, Penguin, 1997, pp. 80-81.)

After more than twenty years of doing this, I think I do understand what Lynch calls “the deadly pretext of my vocation.” I’m learning that the fact that I have a disease that could kill me doesn’t make a bit of difference. We’re all going to die. Some do it sooner than others, but eternity has the same duration, regardless. While I have breath, I continue to feel privileged to be welcomed into that intimate place where family members confront their deepest griefs and fears, hold tight to one another for comfort – and look for God to show up, somehow, just beyond their peripheral vision... as I walk into a room, bald head and all.

Another Birthday Party

We celebrated Miki and Jeansie's birthdays on Sunday. We had some fun using three candles to honor both of their ages!


600mm lens at f/4.0 of my love and guiding light!


Sharon having fun with Jack and Kayla


Sharon and Evan


Evan shows his "Guns" to Jack and Yuta


Dad helping Jack dress after an hour in the spa


What a smile!

March 8, 2006 - By the Inlet

This afternoon, after I go for my weekly blood test – my counts are just fine, by the way – Claire and I drive down to the ocean and go for a walk on the beach. It’s a crisp, cold day – and pretty windy, besides – but the sun is bright, and the sea is lovely. I’ve always liked going down to the ocean in the off-season – a memory that goes back to my early years, growing up here on the Jersey Shore – though it seems we rarely get down there anymore. Our little town of Point Pleasant Beach gets inundated with visitors in July and August, so much so that it hardly seems to be our town anymore. Go down to the beach in these winter months, though, and you may only have to share it with the seagulls. That’s the way it is today: blessedly deserted.

We don’t stay long. The wind is just a bit too cold for comfort, and besides, my stamina for any kind of exercise is nearly non-existent. We drive over to the nearby 7-Eleven, pick up a couple of hot chocolates, then head over and park by the Manasquan Inlet.

The Inlet is part of the Inland Waterway, a major navigation route for small boats. It’s actually the mouth of the Manasquan River, but the Point Pleasant Canal empties into it about a mile upriver. This means the mouth of the river serves as the Canal’s outlet to the ocean – the only way into or out of the northern part of Barnegat Bay. At certain times of year, you can sit by the Inlet and watch a constant parade of boats, both recreational and commercial fishing vessels, chugging through this narrow channel between the concrete sea-walls. The lore among local pastors is that this is where our parishioners go when they’re playing hooky from church on Sunday morning: they sit in their cars by the Inlet, with bagels and the New York Times. At this late-afternoon hour, though, the prime parking spaces in the Inlet lot are only about one-third filled. As for the Inlet itself, the only marine traffic we see is one small Coast Guard boat, which makes the passage out into the ocean as we watch.

Then we see it, poking up through the surface of the water. At first we mistake it for a sea bird, but the outline is just too distinctive. We’ve seen that dark silhouette plenty of times along the Scottish coast (and even photographed it), but rarely are we so lucky as to see one here. It’s a seal – treading water right there in the middle of the Inlet, as plain as day. After a few moments of looking around (probably enjoying the good fortune of being able to take a long, leisurely look, with no boats to cause interruption), the seal submerges, and we see it no more.

It’s a special showing the Universe appears to have arranged, just for us. The people sitting in the other cars in the lot would have had to be looking at that particular patch of water at just the right time, in order to see it. The seal is a reminder to us that there’s a whole world out there we rarely even think about, so wrapped up are we in the sheer daily-ness of living. Beneath the waves, the seals slice through the black water, doing their barrel rolls and loop-de-loops, living their feckless, fishing life. This afternoon, for ever so brief an instant, we have come into contact with their world.

Note to self: go down to the Inlet more often. It’s good therapy.