September 4, 2006 - Cancer and Wholeness

One of the most frustrating aspects of civilization's war against terrorism is that the adversaries are so hard to find. Something similar is true of cancer: it's only in certain circumstances that the enemy is clearly defined, and can be efficiently removed with a "surgical strike." More often than not, malignant cells linger, even after the scalpel's intervention. Grueling "therapies" – chemical, radiological – put the patient through hell, for a still-inconclusive outcome. But that should come as no surprise. "War is hell," said the infamous General Sherman, recalling the plumes of black smoke rising over the rooftops of Atlanta.

Yet, there's something about the military metaphor, applied to cancer, that doesn't quite fit. Cancerous cells are not some foreign invader: a band of terrorist commandos who slip across the border on forged passports, to blow themselves up, and us along with them. Cancer cells spring from our own loins. They arise from out of our own bodies, the result of genetic mutations that, despite science's best efforts, are still only dimly understood. If the terrorist metaphor applies at all, it's Timothy McVeigh and the Federal Building in Oklahoma City, not al-Qaeda and 9/11. We cancer survivors have met the enemy, and he is us.

I've quoted before from a little book of devotions called Now That I Have Cancer, I Am Whole, by John Robert McFarland (Andrews and McMeel, 1993). McFarland is a Methodist minister and colon-cancer survivor. Suzanne, a minister-colleague of mine and a friend of McFarland's, gave the book to me not long after I was diagnosed. Here's what he has to say about cancer and wholeness:

"In trying to beat cancer... I am competing against myself. Cancer is a part of me, so if I win, I also lose. Getting whole, getting well, has to do with oneness. It's not a matter of right or wrong, victory or defeat, not even life or death. It is life vs. nonlife. If I experience wholeness in life, death is not a defeat. If I experience fragmentation in life, then life is not a victory.

The goal, the sense of purpose, is not so much getting cured, beating the cancer, continuing to live. The goal is wholeness itself, being a full and complete person. That is adequate purpose. In fact, it is the only worthy purpose of life. I don't have to make some great achievement, do some mighty work, to justify my existence. Being a whole person is the purpose for our being.

There is no single road to wellness. Getting well and being well is taking an interlocking network of highways that lead to the one, central junction of wholeness" (p. 48).

I’ve been thinking about my PET Scan report, that – as I read the medical jargon, anyway – indicates no sign of malignancy. That’s good news, something to celebrate. Yet, I also know, from my reading about Non-Hodgkin Lymphoma, that oncologists generally prefer to use the word “remission,” rather than “cure,” when talking about this kind of cancer.

It takes millions of malignant cells to create even the tiniest “hot spot” on the PET Scan film. That means hundreds of thousands of those cells could still be holed up in some dark, Tora-Bora cave within my body, subsisting below the radar of even the most sophisticated medical test – and the doctors know it. Even if the chemotherapy drugs and the Rituxan have wiped out every last malignant cell in my body, there’s nothing to stop some normal cell from going through the same mutation, starting the process all over again. If lymphoma’s plan of attack is coded into my DNA – as is entirely possible, and even likely – then who can prevent its return? There’s not a lot of closure, in treating NHL.

Evidently, that's true of some other forms of cancer, as well, as McFarland observes:

"Cure is an end-result concept. Wellness, health, healing, wholeness – these are process, each-moment-at-a-time concepts. I don't just want to be cured, to reach the end of one road. I want to be whole for each moment of all my life, whether my days are few or many" (p. 49).

I’m beginning to realize that this is the road map for my future. It’s always been the road map – indeed, it is for all of us – but the cancer experience reveals it with particular clarity.


You can’t wage war against cancer, any more than you can wage war against terrorism (as our nation is slowly learning). There are certain battles you can fight, but there’s no final resolution. The solution lies somewhere else. It lies within ourselves – where, by the grace of God, we may one day receive the wisdom to find it.

September 1, 2006 - An Encouraging-Sounding Report

This afternoon I go to Atlantic Medical Imaging for more scans – CT scans of the abdomen and pelvis, to be exact. Joanne from Dr. Lerner’s office phoned me yesterday, to say the doctor wants CT scans, in addition to the PET/CT fusion. She explained that the amount of detail visible on the fusion scan is not as great as he prefers to see.

Joanne managed to get the scan scheduled for the very next day – today – and got immediate pre-certification from my medical insurance. Because I’ve just had a CT scan of the lung on Monday (along the with PET/CT fusion), I don’t need to have that one re-done. Just the abdomen and pelvis.

Today’s scans go smoothly enough – drink the contrast fluid ahead of time, get poked in the arm for the IV contrast infusion, lie down on the table with arms over my head, hold my breath when the disembodied machine-voice tells me to – the usual.

As I’m talking to Kathy, the technician, I explain about the call from Dr. Lerner’s office, and how it happens that I’ve come in so soon again. I ask her if it’s a common thing for doctors to want a CT scan in addition to the PET/CT fusion, and she says it is. Some doctors will wait to see the report from the fusion scan before deciding they want the supplementary CT scans, while others routinely order both at the same time.

Reading between the lines of my question, Kathy tells me the narrative report from Monday’s scans is in my file, and offers to make me a copy of it. Sitting in my car in the parking lot after the test is finished, I wade through the medical jargon, and come upon these words:

“There is no abnormal hypermetabolic activity in the neck, skull base, abdomen, pelvis or upper thighs.” Towards the end, in the summary, the pathologist repeats, “No hypermetabolic activity to suggest pathologic lymphadenopathy in the neck, chest, abdomen or pelvis.”

Although I’ll have to wait for Dr. Lerner to confirm this when I see him this coming Wednesday afternoon, this sounds like good news to me.

As for the spot on the lung, there’s still something there, but it appears to be a bit smaller than whatever it was that showed up in May. It also appears to be of a non-cancerous nature.

From the narrative report of this past Monday’s CT scan:

“The centimeter sized nodule of interest is seen in the right middle lobe on the prior study. On today’s study, this area has an appearance more suggestive of scarring and is not hypermetabolic. This area also appears smaller on today’s study.... There is a triangular area of interstitial disease in a small portion of the superior segment of the right lower lobe... There is an area of scarring in the right middle lung. Just posterior to this, there is a tiny, triangle-appearing nodule approximately 2 mm also likely reflecting scarring. I do not see a centimeter sized nodule as was described on the prior reports within the right middle lobe.”

From the summary: “On PET/CT scan, also performed today, there is an area of hypermetabolic activity in the superior segment of the right lower lung corresponding to an area of interstitial lung disease on the chest CT. I would favor this to reflect an inflammatory or infectious etiology...”

Bottom line? As I read the medical jargon – and, again, I’ll have to wait to hear from Dr. Lerner for the final word – it looks like the lung abnormalities are scar tissue, from some past or present lung infection of as-yet-unknown origin.

It will be a lot easier to wait for Wednesday’s appointment, having read the encouraging-sounding PET/CT fusion report.