Karen is continuing to do well and her spirits remain high but that is in spite of the fact that she feels, as she calls it “puny” all the time. She’s running a discomfort marathon of sorts, punctuated by intermittent obstacle courses of gagging and clogged drains. The gagging is due to the radiation causing her throat to become very sensitive and sore. The clogged drains are due to the chunks of hair that are falling out through the day. Through it all Karen continues to be as steady as ever. I catch myself shaking my head in amazement sometimes. I'm not so sure I'd be so steady.

I did take some pictures to try to give you all a better idea what Karen experiences each day.

This is a picture of Karen after she's just gotten suited up before treatment.

This is a picture right after Karen took a shot of "soothing citrus" chloraseptic to help sooth her throat. That turned out to be a bad idea. She hasn't done that since.

This is a picture of the radiation machine. the big arm actually swings around to shoot at different parts of the patients body.

This is a picture of Karen laying face down on the radiation machine. The techs are maching laser lights that are projected from the walls with tatoos on Karens back and with marks on Karen's helmet. In this picture you can see the helmet that is locked onto the table. There are marks on the helmet on masking tape that show you exactly where the radiation is projected. You can also see one of the lasers on the far wall that projects the lines onto her back thatthe techs use to line her up with the machine.

After the treatment yesterday I took Karen out to a matinee. We went to see “Stranger than Fiction”. It’s the new Will Farrell movie billed as a romantic comedy. I personally thought that the movie was great. The characters were very interesting, the plot was creative and captivating, and the themes that the movie explored were very appropriate to what we are experiencing right now. The movie dealt with the question of tragedy in life. It made me think again about how we try to make sense of suffering.

As we explain the pains and discomforts that Karen is experiencing I hope that you are all putting these things into context in at least two ways. The first is that it is important to see these things in contrast to what Christ had to suffer. What he suffered he did so willingly as a righteous man., What we suffer we do so as guilty men who in our hearts beat our chests and ask “why?!” deceiving ourselves that we deserve better than what we’re getting.

Secondly, we must appreciate that this pain and suffering is part of the great story of history that God is breathing out over time. All of its comedy as well as its tragedy are perfectly placed. He is the master author and we are the characters that he loves. That he loves his people means that the tragedy is not capricious, mean or pointless. That we are characters means that we are his creation and we are not privy to know all the reasons why he has written our particular parts the way he has. We can be confident, however, that for those who love him, when we are finally able to look back at the whole story we’ll see that each part of the plot was necessary to make it truly beautiful.

Again I saw something meaningless under the sun: There was a man all alone; he had neither son nor brother. There was no end to his toil, yet his eyes were not content with his wealth. "For whom am I toiling," he asked, "and why am I depriving myself of enjoyment?" This too is meaningless-- a miserable business! Two are better than one, because they have a good return for their work: If one falls down, his friend can help him up. But pity the man who falls and has no one to help him up! Also, if two lie down together, they will keep warm. But how can one keep warm alone? Though one may be overpowered, two can defend themselves. A cord of three strands is not quickly broken.
Ecclesiastes 4:7-12

I know that I've been slow to update the blog this week. Last week went quite well, but the past three days have really begun to show how progressively more difficult the radiation will be. One of the nurses compared radiation to a bruise that is hit each day. The first part of the treatment is not that noticeable but as the radiation continues to hit the tissue it becomes more and more sensitive and the effects become further pronounced.

While the Zofran has taken the bulk of the nausea away, this week nausea has continued to haunt her and she’s never felt quite right. That culminated last night in the sink (if you catch my not so subtle inference).

This morning she’s doing better in that regard, but the new symptom that popped up on Sunday was a chronic sore throat. This is not, as some of you may be guessing, a result of a suppressed immune system. In fact, the radiation should not (and has not to date) had any significant impact on her white blood cell count. The sore throat is due to the radiation being given to her spine that reaches through to the soft tissue in her throat and makes it feel like she has a perpetual cold.

Her hair is still hanging on though. The only potential precursor to her losing her glory is that her scalp has started to feel tender and itchy.

So let’s sum up …

• Nausea
• Chills
• Fatigue
• Sore Throat
• Headache
• Dry Mouth
• Itchy and sensitive scalp
  

If I didn’t know better I’d diagnose her symptoms as the perfect storm of a flu, a cold and dandruff. At least this is all temporary.

There has been some good news this week. The 2nd opinion pathology report came back yesterday and the good news is that the Mayo Clinic pathologists concur that the cancer is indeed Tanycytic Ependymoma. We are thankful for that because it means that we are still dealing with a typically manageable cancer.

Also, Karen had her teeth cleaned recently because radiation can induce an environment conducive to cavity creation. I am proud to announce that she came away with a clean bill of dental health.

In the midst of the chronic discomfort that Karen is experiencing all of this is made bearable as we see God’s grace extended toward us daily in your love and generosity. Your love toward us was astounding when this all began happening, but more than two months later you continue to stand by us and it’s this consistent care that gives a fullness to the concept of “long-suffering.” Thank you all for your continued prayer and support.

“Oh give thanks to the Lord, call upon his name; Make known his deeds among the peoples. Sing to him, sing praises to Him; Speak of all His wonders. Glory in his holy name; let the heart of those who seek the Lord be glad”

1 Chronicles 16:8-10

There are many reasons for us “to give thanks to the Lord” not the least of which is that today was another good day for Karen. Compared to this past Thursday when the thought of six weeks full of days like that one was too much for Karen to bare, today was an utter joy.

In the passage above the Psalmist tells us to “make known his deeds among the peoples”. It’s natural for those who are familiar with the history of how God has been saving and protecting his people throughout history for grand images to come to mind when we think of “his deeds.” The parting of the Red Sea and Esther’s rescuing of Israel from holocaust are beautiful pictures of how God extends his grace to those he loves. The chief picture of God’s great love, of course, was demonstrated when he sent his only son to suffer the indignities of the cross and ultimately to die, not for his own sins, but for those for whom he loves.

It is interesting, however, that the “deeds” of God are not restricted to those of magnificent proportions. God is at the bottom of even the smallest of events that takes place. As the Psalmist says elsewhere:

“Where can I go from your spirit? Or where can I flee from your presence? If I
ascend to heaven you are there; If I make my bed in Sheol, behold you are there.
If I take the wings of the dawn, if I dwell in the remotest part of the sea,
even there Thy hand will lead me and thy right hand will lay hold of me.” Psalm
139:7-10.

I imagine that for some people the idea that we are unable to escape God’s hands might sound threatening or dangerous or like our rights to autonomy are somehow being violated. But for those who God has graciously called and who rest in Christ’s work on the cross, the idea that there is no place we can go to escape from God’s hands becomes a comfort. What child would want to run from the loving arms of a protecting father?

It is remarkable to consider that all the things God has done for Karen, though seemingly small in the grand sweep of history, are in reality some of the many wonderful deeds that the Psalmist commends us to “make known … among the peoples.”

“Let the heart of those who seek the Lord be glad”

The urgency of crisis has long since passed and has been replaced by the more subtle reminders that pop up at intervals throughout the day reminding us that life is moving forward but doesn’t look normal at all. The extremes of crisis make great fodder for writing and are also a sure fire remedy for writers block. Not long before Karen’s emergency I joked that the best artists are malcontent and deeply troubled. The tension in a life full of darkness and struggle tends to force one to confront the difficult subjects that the normal person rarely thinks about amidst the many distractions that lay within reach of the typical modern.

I don’t believe that I have ever been a malcontent and I don’t possess any allusions that this blog will find itself on a shelf next to any great author. I do, however, understand how a crisis can arouse in a person a sensitivity to these deeper themes. Now that the sense of crisis is gone, though, I find that the words don’t flow quite as easily.

So as we were chatting at dinner tonight about how things are going I asked if she would say a few words to you all. So here goes.

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My dearest husband has made quite an impression on you all (and me too!) with his delightful writing abilities. Mine aren't nearly as entertaining, but here goes...

I am really grateful that the radiation treatment only takes between 10 and 20 minutes now, rather than the 30+ minutes during the 2 days of preparation that were so intense they left me in tears. It’s getting easier now to make it through the daily struggle because the time with my face smashed on the table has been getting shorter as the days go on. I work hard to keep my focus elsewhere during the radiation. By occasionally closing my jaw I can move the pressure on my face from one part to another. Swallowing is also difficult so as the machine moves from one field to another I do my best to swallow a bit.

I also try to make the time pass by counting during each portion of the radiation treatment. So far it appears that I can count to around 30 for each side of my head and around 60 for both the top and bottom of my spine.

The best part is that when it’s all over my forehead and cheeks have large unattractive red indentations that remain prominently displayed for about an hour afterward. Thankfully the office is filled with a delightful and loving group of doctors, nurses and technicians. Yesterday I was getting really anxious as we drove to the appointment. I thought for sure I’d need to take some anti-anxiety medicine in order to make it through, but surprisingly after I got to the radiation center the staff there were so loving I was able to make it through without drugs and it was the easiest time yet.

Overall I'm happy to say that today (Tuesday) is the first day since I started on Thursday that I haven't been feeling pretty yucky. I can only hope that each of the next several days are like today...I want to let you all know how amazed I am by your devotion, prayers and generosity. Endless thank yous to you all!

Today was Karen's first radiation treatment. The actual treatment went much better than the planning session yesterday. The primary reason for this was that it was much shorter.

Karen decided not to use the anti anxiety meds that the doctor had recommended that she try because she really wasn’t anxious about the procedure and it hadn’t helped the day before. Instead she tried a Vicadin to try to cut the pain a bit. In the end she doesn't think the vicadin helped so my guess is that tomorrow she'll be goin' hippie and not using any drugs at all. Actually, I guess that means that she'd be goin' anti hippie ... now I'm confused. Do hippies use drugs or not? Do they avoid legal drugs and only use illicit substances? Maybe they avoid drugs developed by corporations and stick to cottage industry “remedies.” In any case, since tomorrow’s procedure should be even shorter she doesn’t think she’ll need anything for the pain.

Unfortunately, a few hours after we got back from the hospital Karen started feeling really nauseous and got progressively worse as the day dragged on. She got many of the symptoms of a flu: vomiting, headache, chills, fatigue etc. When things didn’t get better on their own I called the radiation folks and asked them what we should do. They were really great and got a prescription sent over right away to our pharmacist. The good news is that the stuff that they prescribed is the best anti nausea medicine available today and that it worked really well. The bad news is that they only prescribe 2 pills at a time and the cost for each pill could provide your local yuppie (not to be confused with hippie) with fresh brewed Starbucks for about five weeks. (No joke).

I have to say, that at least for tonight it was worth the cost. Karen almost immediately felt better and as of about two minutes ago only had a light headache. She even ate the grilled cheese sandwiches I made for dinner! If that isn’t evidence of her dramatic turn around then I don’t know what would be. :)

As always thank you for your continued prayers.

But because of his great love for us, God, who is rich in mercy, made us alive with Christ even when we were dead in transgressions--it is by grace you have been saved. And God raised us up with Christ and seated us with him in the heavenly realms in Christ Jesus, in order that in the coming ages he might show the incomparable riches of his grace, expressed in his kindness to us in Christ Jesus.
Ephesians 2:4-7

I’ve been told that many of you have been tapping your fingers impatiently on your desks waiting for an update on Karen. I am sorry to have waited so long but a lot happened this week and so I wanted to wait until we got to the end of it to let you all know what is going on.

On Wednesday we went to the initial consult with the radiation oncologist in Walnut Creek (John Muir Medical Center) where Karen will be getting her radiation treatments. This location is much closer to us than UCSF and was highly recommended by the team in San Francisco. Our radiation oncologist there has been in the business for decades and is very experienced and self described as “pedantic.” He said this is a good trait in a radiation oncologist considering he’s going to be pointing radiation at Karen’s head and spine and could paralyze her if he doesn’t pedantically plan the dosage and angles.

This appointment, as most are, was punctuated by many periods of waiting. As I’d forgotten to bring some reading material I was entertained as we moved from room to room by the different reading material that was made available in the form of thousands of magazines. As we entered another waiting area I reached over and started rummaging through one of the stacks. I quickly passed over “Vogue” and “Bay Area Mother” and picked up “The Economist.”

On of the articles that caught my eye (to no one’s surprise) was a feature on a very successful executive who had been diagnosed with terminal cancer and who, together with his wife, co-authored a book about his experiences over the next 6 months until his death. I’ll admit that I didn’t have the opportunity to read the whole article, but what I did read got me to thinking. This admittedly successful man handled his cancer and his imminent death with what anyone would call a kind of calm and purpose. However, I was primarily interested in how this man turned to meditation as a means of calming himself and remaining focused as he entered his last days of life.

This interested me because it got me to thinking about how Karen has viewed her “spirituality” in the context of her cancer. Meditation, as I understand it is practiced by most westerners today, is primarily about clearing ones mind and focusing one’s attention on a specific thought. I asked myself, “what was this man focusing his attention on? Did the object of his meditation really matter? Was all that mattered that he found it helpful? How does his experience in turning to meditation compare and contrast with how Karen is dealing with her own cancer?”

These series of questions reminded me of something I wrote early on in the blog as I wrote about faith. I talked about how the most vital part of faith is what you are placing your faith in. As I read about how this very successful, driven, thoughtful executive turned to meditation the fundamental question remained the same. What was he meditating ON? What was the object of his meditation?

John Calvin talks about something similar in his Institutes. In chapter 4 he is discussing how the natural and inescapable nature of man is to smother and corrupt their knowledge of God. Unless God reaches down, interferes in our lives, and changes our hearts, no one would want to seek after God to discover who he is as he has revealed HIMSELF. In this context he writes:

“Indeed, vanity joined with pride can be detected in the fact that, in seeking God, miserable men do not rise above themselves as they should, but measure him by the yardstick of their own carnal stupidity, and neglect sound investigation; thus out of curiosity they fly off into empty speculation.

They do not apprehend God as he offers HIMSELF, but imagine him as they have fashioned him in their own presumption.

When this gulf opens, whatever direction they move their feet they cannot but plunge headlong into ruin. Indeed, whatever afterwards they attempt by way of worship or service of God, they cannot bring as tribute to HIM, for they are worshiping not God but a figment and dream of their own heart.”

As I think about the many things God has done for our family I am utterly speechless. By his grace he has showered his mercy on our family and opened our eyes that we might see him as he has revealed himself. Karen and I thank him that he is continuing to wash away the residue of our own presumption, speculation and stupidity. We know that he is using this time of struggle as a means of refining us so that as we meditate on his word, THE Word, our meditation has the express purpose of bringing into more vivid focus the awesome character of our saving God.

When the doctor finally met us in the conference room, most of the information he gave us was basically the same as what the radiation oncologist in SF gave us. It was interesting, though, to see the nuances of difference in the way he presented the info and what bits he gave us that the other specialist didn’t. I also cracked a smile when toward the end of the meeting he asked us if his plan was different in any way than what would have been prescribed at UCSF. I guess I shouldn’t be surprised at this friendly professional comparison. All in all the meeting went well and Karen was in good spirits.Thursday we drove to San Francisco (UCSF) to have a CaT scan done of Karen's chest, abdomen and pelvis. Our Neuro Oncologist ordered up this CaT scan as a conservative precaution to make sure that the cancer had not spread to the rest of Karen’s body. The CaT scan was a totally different experience than the MRI. It was extremely fast and she didn’t even have to disrobe. I don’t think she was in the machine more than 10 minutes from start to finish. The good news is that we got a call from the doctor yesterday and after reviewing the CaT scans there does not appear to be any cancer in her body except for her brain and spine. No surprises there.

Though Wednesday and Thursday were filled with lot’s of doctors and nurses they were both pretty easy days. Friday’s appointment was of quite a different character. We went back to John Muir for the radiation "planning session." This became another one of those moments that drives reality home regarding how hard the next 6 weeks are going to be.

The purpose of this appointment was to get her body oriented in the machine. They had her lay face down on the bed of the radiation machine with her face pressed against an apparatus used to hold her head still. A plastic mold was form fitted to the back of her head to additionally secure her body from moving. Her head, was thus, squeezed in a kind of vice grip.

Unfortunately this important and necessary apparatus used to prevent her from moving, squeezed her face so hard that it was almost unbearable. It was all she could do to keep from breaking down into tears because of the pain. The physical pain was only made worse by the mental strain of trying desperately not to cry for fear that if she did she’d move and mess the process up and she’d have to stay trapped in this device longer. So Karen fought back the tears and tried her best to bear up under the pain.

I had no idea this was going on in the room next door. I was content to have my attention bounce back and forth between my book on President Andrew Jackson, the “Today show” that was playing on the TV above me, and the small sea of seemingly happy cancer patients that surrounded me. I was not all that concerned that Karen would be in discomfort because every indication we’d been given up to this point was that the process would be painless.

Apparently the pain that Karen experienced is unusual. The technicians explained that it was due to the fact that she has so little “padding” on her body. The technicians tried to encourage her by praising her for how easy it was for them to “find her spine.” I guess the obesity epidemic in the U.S. has real implications on the ability of radiation technicians to efficiently do their job. So as the moments elapsed Karen tried desperately to control her emotions. As the process came to an end Karen finally broke down into tears as the technicians informed her that though the future sessions would be shorter, that if the first session was painful they would all be just as painful.

As I looked up from my book and saw her walking toward me the first thing I noticed as she entered the waiting room was how pink and puffy her face looked. I furrowed my brows quizzically trying to process what that actually indicated. Had she simply fallen asleep or had she been crying? Then I noticed her eyes. It wasn’t really the fact that they too were pink and puffy that clued me in. Honestly, they acted for a moment like the proverbial “windows into the soul” I could just tell as I looked into them that something was really not right.

The pain had triggered the weight of reality to further press down on her and this produced more tears, I think, than the pain did. Waves of emotion passed over her throughout the rest of the appointment but the storm did calm as the day progressed. Mike and Michelle flew in that morning to spend the weekend with us and their arrival provided the perfect distraction to help Karen put the morning behind her.

Before we left the appointment, our doctor informed us that next Wednesday will be the follow-up planning session. This will entail Karen laying on that same contraption while they take Xrays of the exact locations on her brain and spine that will be radiated. This is a dry run that will allow the doctor to see the precise location where the radiation will go. He’ll be able to further refine the radiation plan including dosage and angles to make sure the plan is perfect before they actually start the radiation treatments the next day. Please pray that this goes quickly because it could drag on and every moment in that contraption is truly agonizing.

Also, as I mentioned in a previous blog entry, our oncologist is having the pathology of the tumor reviewed again. He wants a second opinion to confirm tanacytic ependymoma. Thus he has sent the sample away to Mayo Clinic to be reviewed by a totally new set of pathologists. We won’t hear back on this for about another two weeks.

In the mean time, as Karen begins radiation next week, we ask that you continue to pray for Karen. Please pray for the pain she experienced while being strapped down, for effectiveness of the treatments and for no long term side effects.