And don't come back

This is the day that the LORD has made;
    Let us rejoice and be glad in it!

- Psalm 118.24.

This time five years ago, I was receiving weekly doses of poison and daily radiation burns to my chest after being diagnosed with a rapidly growing malignant tumour just above my heart and invading my left bronchial tube. Today, I went into an oncologist's office and was told not to return, as five years of follow up is enough.

Although it is still possible for me to experience relapse, the chances are that any cancer now found in my body is more likely to be a new growth than a renewal of the one that was well on its way to killing me in 2006/07. I am obviously delighted to reach this milestone and continue to receive each day as a gift. I did not deserve to live, did not earn my reprieve, did not qualify for healing through the quality of my faith. Faced with a very rare form of cancer (numerous specialists have given me the impression that I'm one in a million), medical science took its best (highly educated) guess as to treatment and it worked beyond all expectations.

And so praise God for life, for health, for wonderful support from family, friends and even strangers, for medical specialists and all the care I have received over five years from dozens of healthcare professionals both in Oz and the UK and for public healthcare that has meant my total out of pocket expenses have been AUD $0 + GBP £0 for treatments that probably cost tens of thousands (thanks fellow tax-payers!).

Yet the experience continues to have its shadows. Given that the first side-effect mentioned on the consent forms I signed for both chemotherapy and radiotherapy is that those treatments are themselves carcinogenic, cancer is still quite likely to be part of my future, as is reduced life-expectancy. I am also aware of the costs the illness and treatment have brought to my health in other ways; being poisoned and burned are not generally conducive to good health (I've always thought that Nietzsche's boast that whatever did not kill him could only make him stronger was one of his sillier ones).

And I am not the same man I was. Being gravely sick has reconfigured my emotional and spiritual life, not to mention shaping my academic interests. For much of this I am grateful (and this is undoubtedly the true referent of Nietzsche's comment), especially for the reminder of my own frail mortality and the liberating realisation that survival is not our highest priority. These are important lessons that I hope always to keep close to hand. Has the experience also made me more pessimistic about our future prospects? Given that being ill significantly overlapped with the period during which I began investigating ecological and resources predicaments in greater depth, it is hard to tell whether the chicken or the egg came first.

The significance of my reaching this milestone was brought home powerfully to me a day or two ago when I came across the story of Kristian Anderson, a Sydney Christian man in his 30s with a wife and young kids, and who died from cancer two days ago. Kristian recorded more than two years of his physical, emotional and spiritual journey since diagnosis on a blog called How the Light Gets In (H/t Andrew Paterson). I ran out of tissues while reading it. I never met him, but I thank God for his life and witness, even amidst great darkness, and I pray for his widow and little boys.

Life is a precious gift. Let us rejoice in each day we receive.

On supporting a friend with cancer

After my own experiences of cancer diagnosis, treatment and remission, I more or less regularly receive requests from people whose friend, family member or colleague has just been diagnosed asking for advice on how they might best care for them. I thought I would post one of my answers (with permission) in case it is of some benefit to others.

Hi friend,

Good to hear from you, though sorry to hear about this news.

I guess the first thing I'd say, which may actually not sound very helpful at all, is that cancers are very different and the experiences of cancer patients even more diverse, so I would be quite hesitant to extrapolate too much from my own story.

Having said that, it is still possible to say a little more. Grief and suffering come in many forms (even in the same person) and bring with them various needs and opportunities. At times, silence is the best support; at others, the chance to talk to a sympathetic ear; at others, a word of comfort; at others, an act of silent service. In general, I guess I'd suggest that responsiveness is therefore key, being willing to play whatever role will be a blessing to those in need. While at times grief needs space, I suspect it rarely needs absence, so as a start, simply indicating your willingness to be there for them and to grieve with them is probably the best bet. If they have practical needs, then offers of help from trusted friends may well be appreciated (babysitting while parents go to some of the endless appointments these things seem to involve? Doing some housework? Frozen meals? The latter can probably be safely brought without being asked, as long as you stick to any known dietary requirements). Some people may find themselves with little energy for daily tasks like these. Others might throw themselves into them as a distraction and comfort.

Depending how wide and deep the pre-existing support networks of this family are, it may be that they are initially swamped with offers of help and sympathy. If you think this might be the case, you (or someone else) could perform the service of coordinating the practical support (putting together rosters for babysitting or frozen meals, etc.).

Don't neglect the partner of the patient, whose grief is double: grief for their partner's sake and for their own (potential) loss. And depending how old the kids are, they may need extra support from trusted family friends.

Again, depending how well you know them, then make your level and form of contact fit the relationship. If you are not close friends, then make contact through forms that can be ignored or noted and replied to later (email, letter, card, SMS). Only call if you know them well, because they might receiving a string of calls and probably don't want to be having the same conversation with dozens of people.

If my experience is anything to go by, they are likely to find themselves the target of more unsolicited advice than at any time outside of pregnancy. Although I know everyone meant well, I'd suggest keeping any crank miracle cures you've heard of or stories of amazing recoveries to yourself. It is actually not very encouraging to be told about someone's aunt who was cured simply by prayer and faith or someone's grandfather who drank only goji berry juice and lived to 100. Such stories are (a) irresponsible (I'm not a big fan of alternative medicine, nor of purely faith-based healing, for both scientific and theological reasons) and (b) sometimes contain an element of accusation in them ("if only you had enough faith, you too would be healed like my cousin").

Many cancer treatments become complex, and there is often a high volume of information to share with those concerned. One suggestion that a friend made to me (more unsolicited advice from a guy I didn't know well at the time, but of all that I received, almost the only piece of pure gold I got) was that it might be a good idea to set up a blog where interested family and friends can self-medicate on as much or as little information as they wish. This means that rather than having the same conversation fifty times after each appointment, I could simply write out a summary once and post it on the blog, then direct people to the blog. Mine is here (only updated very infrequently now).

I would also suggest keeping your theological comments minimal unless they raise it. I was probably unusual in that I'd just written my 4th year paper on suffering and the problem of evil just weeks before being diagnosed and so was (usually) quite happy to discuss theology with anyone who wanted. But not everyone is in that place, and for many, just retreating into survival mode is all they can handle for a while (once treatment started, my willingness to talk dropped rapidly as I just had little energy for anything).

I could write reams about my experiences of treatment, but here, the specifics of the cancer become most stark and what I say may bear little or no relevance to their situation.

They may or may not find it helpful to meet with other cancer patients, though I suspect that such groups will be available through the hospital, so you probably don't need to worry about that.

Finally, I'd suggest taking this tragedy as an opportunity to reflect upon your own mortality. Our society has hidden death and dying as far from view as possible and here is one place that the gospel truly does have good news (though not always easy news). Of all that I read, wrote and heard during the intense few months after diagnosis, the best was undoubtedly this talk by Stanley Hauerwas. It may or may not be appropriate to share with your friends (that is for you to judge), but it is almost certainly worth an hour of your time (if you can get past his braying cackle and Texan twang).

It hardly needs saying, but when words and wisdom falter, groans are also part of a faithful response to serious illness.

Grace & peace,
Byron

PS If you don't mind, I might post my reply (omitting your name and any other identifying details) on my blog since I have been asked this question quite a number of times (not that I mind being asked!) and putting it there will mean I can refer to it in future. Let me know if you'd rather I didn't.

Tattoos

As a bearer of three tattoos myself, I particularly enjoyed this xkcd. The extreme measures we take to address unrestrained growth in the body may be a good inspiration for tackling unrestrained growth in the body politic (or at least the body economic).

A sense of proportion

The problem is not capitalism.

It is not the exploitation of fossil fuels. It is neither corporations, nor government taxation and spending. It is not wealth. It is not political donations and special interest lobbying. It is not economic growth. It is not consumption (though consumerism is always wrong, no matter the ecological situation). It is none of these things per se. The problem is a loss of our sense of proportion. All these things may have their place in a healthy society. But we have lost a sense of their appropriate place and scale. We have taken good things and thought that by maximising them, then the common good would enlarge. We have thus enabled each of these things to become hideously deformed, metastasizing throughout the body politic at a pace and scale that threaten our collective life. We have taken certain goods and ideas and fashioned them into idols.

What horizon of reference can help us to regain our bearings and a feel for the relative weight of different claims upon our attention? When our actions and hubris have ballooned into reshaping the sky and oceans and earth, what backdrop can highlight our grotesque distortions of priority and probity? Against whom can we measure a life that is properly creaturely, aptly humble, truly human?

What good is Wall Street?

Much of what investment bankers do is socially worthless: "Why on earth should finance be the biggest and most highly paid industry when it’s just a utility, like sewage or gas. It is like a cancer that is growing to infinite size, until it takes over the entire body."

What we do with what we know: a story

A few years ago, I was diagnosed with cancer. It was not an easy cancer to explain to people, because, basically, the doctors hadn’t seen any cases quite like it before and could not identify precisely where it had started or what caused it. Since it was such a rare growth, they could also not give me a meaningful prognosis. The scans indicated that it was of a significant size, in a critical location and there was good reason to think it was probably growing quite rapidly. Their recommendations were that surgery would be almost impossible (one of them told me, “I’m not into killing my patients”), but that chemotherapy and/or radiotherapy might have some effect (one oncologist spoke of “curative doses” and another simply of reducing its size).

Now at this point, I had a variety of possible responses open to me. I could go and get further oncological opinions (I had already gone to three different hospitals and had multiple scans and a variety of tests).

I could have weighed up the probable side effects of treatment (quite a long list!) and decided that it was not worth it and tried to make the most of my remaining time, however long or short that turned out to be.

I could have heeded the many voices telling me that traditional medicine doesn’t know how to deal with cancer and that I needed various alternative treatments: homeopathy, acupuncture, meditation, herbal remedies, hypnosis, miracle diets and many more that were urged upon me by well-meaning contacts, often with powerful testimonials.

I could have listened to the Christian sisters and brothers who told me that I would be healed if I had faith, that God loves miracles and would preserve my life without treatment, that they had seen or been given amazing recoveries after prayer.

I could have embraced the cynical critiques of the medical system by noting that it is in doctors’ interests to keep me thinking that I am sick, that I need them, that I need their expensive and complicated treatments.

I could have gone onto Google and attempted my own re-diagnosis on the basis of extensive reading of the most popular sites, or by consulting the most helpful discussion boards.

Each of these options were being put forward by people who apparently desired good for me. Yet deciding to go ahead with the recommended treatment was a relatively easy conclusion for me. Despite its costs, I do not at all regret the decision and suspect there is a very good chance I would not be here today without the excellent treatment I received at the Royal Prince Alfred Hospital. Indeed, it has been three years today since I had my last radiotherapy dose, a few more days since my final round of chemo.

I’m sharing this story not for the sympathy vote, nor to celebrate an anniversary, and nor yet to ridicule the faith or intentions of those who urged me to avoid treatment. I share this story to raise the issue of the relation of knowledge to ethics. How does our knowledge of the world affect our obligations and opportunities to pursue good?

Many factors contributed to my decision to accept treatment, but significant amongst them was the considered advice of recognised experts in the field based on years of empirical research. I was not morally bound to follow this advice. The research has not been exhaustive. Not all the experts I saw recommended exactly the same treatment. My case involved some degree of novelty. Not all cancer treatment is as effective as mine has been so far. But I do believe I would have been both foolish and seriously at fault if I had simply ignored their advice, or acted as though the diagnosis must be wrong because I’ve heard of some misdiagnoses in the past, or if I had presumed that I would be alright because some tumours undergo spontaneous remission.

It would be no good to say that since the scriptures don’t tell me whether or not to trust doctors, then I have no reason to trust them. It would equally be no good to say that since the scriptures don’t tell me to have cancer treatment, then I was under no moral obligation to take the advice of the oncologists seriously.

Of course, receiving treatment in order to try to stay alive was neither my only nor my highest moral obligation. There are worse things than death. There are ways of staying alive that diminish the point of being alive. But all things considered, I believe there was a compelling moral case for me to accept the recommended treatment. I believe that not only was it possible to pursue this treatment without being distracted from more important things (like loving those around me and praising the wonders of the one who gives all life), but that the treatment was in fact a means to that end, keeping me alive for more service and song, and opening many opportunities to love and praise that I might otherwise not have had.

It may be obvious where I am going with this, but in case it is not let me spell it out. There is a large and diverse body of scientific experts with years in the field who point to widespread and growing empirical evidence of a critical diagnosis, which we cannot in good conscience ignore. They may offer a variety of different (even sometimes conflicting) advice on specific treatment, but it would be irresponsible to dismiss their warnings or to treat the situation as though it were nothing but a distraction from what is truly important.

Our knowledge of the world, though fallible and incomplete, is nonetheless sufficient to contribute to the moral deliberation of Christians. The evidence for alarming anthropogenic climate change is strong enough such that wilfully ignoring or burying the issue at this stage has become irresponsible. This is not a denial of sola scriptura nor to fall into legalism. Nor is it to say that climate change is the only or primary moral challenge of our day, or that all Christians ought to become climate change activists. And neither yet do I claim that Christians owe their allegiance to any particular mitigation strategy. But as one significant pastoral and social issue amongst others, and one linked to fears and guilt, to anger and confusion, to questions of greed and of faith, hope and love, addressing climate change Christianly is neither a luxury nor a distraction from the gospel.

On leaving the dying in the dark

I'm dying.

Let's face it: we all are. There's no avoiding it and denial can only get you so far. Although I was quite sick a year or two ago, and there are no new developments (which would be posted here if there were any), I have been reminded of my mortality again recently when I was bedridden by a nasty 'flu while travelling. It was not fun. But while I lay there alternatively shivering and sweating, I thought about hospitals and sickness, doctors and families, diagnoses and prognoses. And about how the patient is often the last one to know that he is dying. Or so everyone thinks and so everyone conspires to keep it thus.

But I think that's a profound disservice. Why do we think that it would be such a bad thing to know that your own death is imminent? It assumes that the worst thing would be to be dying and to know it. It assumes that the patient is unwilling or incapable of facing his own death and must be treated again like a child whose parents spell out words over his head. Except in this case, rather than the parents spelling L-O-L-L-Y or B-E-D-T-I-M-E, it is the children spelling T-E-R-M-I-N-A-L or T-H-R-E-E-M-O-N-T-H-S.

Although death is not a party, not a cause for celebration or an irrelevance, neither is death the worst possible thing. There are things worse than death. In fact, since Christ has defeated death, we can now face death without fear. Not just the knowledge that one day I, like everyone else, will die, but even the news that death is imminent need not destroy our enjoyment of life or the pursuit of delight in service. Death, the defeated enemy, can be faced and even accepted. Its sting has been removed.

And so there is no need to keep for a conspiracy of the healthy in order to keep the dying in the dark about the their own death. All of us who live in the shadow of death can open our eyes and see the glow of the coming dawn.

One year on

On this day last year (at about this time), I was diagnosed with cancer, specifically a squameous cell carcinoma of the upper aero-digestive tract (though it took a few weeks to get this specific). I first mentioned this (with more details) back here and set up another blog to keep those interested updated.

I thank God for many things: that I'm still alive (it really wasn't looking good for the first few weeks); for the love and support (and generosity) of so many people over the last year, particularly my wife Jessica; for a wonderful (basically) free public medical system in Australia; for my gradually returning voice; for being able to share my experience with others; and for the chance to reflect with a little more depth and urgency upon death, fear and hope (amongst other things); and for new birth into a living hope, which gives us so much to live for now.

Ten years on
In other news today, Australia has finally ratified the Kyoto protocol, almost a decade after signing it. This was a good first step for Mr Rudd after being sworn in as Australia's 26th Prime Minister yesterday: may there be many more.

Ninety-four years on
And yesterday (2nd December GMT), noted British theologian T. F. Torrance died old and full of years at the age of ninety-four. Torrance's The Trinitarian Faith helped deepen my understanding and worship of Father, Son and Spirit, and along the way undid many prejudices I held against the Nicene Creed. May he rest until resurrection.

Cancer (hasn't) killed the radio star

Sorry for the title, but Jessica and I will be interviewed by Bishop Robert Forsyth on 2CH (1170 on the AM dial) at 10 pm Sunday night (after the news). We'll be talking about our experiences of sickness and hope over the last six months or so. Can't say I've ever listened to that station myself (I rarely listen to any radio), but in case you're not already sick of hearing me talk about being sick, then this is another chance.

UPDATE: For those out of Sydney, you can listen online. H/T Jason Goroncy.

Before and after

Here are some before and after shots of my tumour for those who might be interested. I suddenly realised I'd never put these up.

Thanksgiving reflection

On Saturday morning I went to a service of thanksgiving with a small gang of about 140 family and friends in order to praise God for his goodness. It was a wonderful morning. Giving thanks together is a privilege and a joy. A few people described it as an anti-funeral. Towards the end of the service, everyone had a chance to reflect on God's goodness and write a brief prayer of thanks onto a small card, which was then pinned onto a banner Jess and Bill made and which now hangs on our wall.

Thanks to everyone who helped make the morning happen. It was (yet another) delightful gift. Speaking of which, our rector Tim surprised us at the end of the service by getting us up and giving us a gift from the All Souls community - time off and some extra money for a holiday! Details are still being worked out...

I have posted the text of my reflection at the service here. Regular readers will recognise many of the ideas from recent posts.
First picture by HCS, taken just after the service ended.

Thanksgiving reminder

Tomorrow, 10 am
All Souls, Leichhardt
A service of thanksgiving in response to getting the all-clear
All welcome
More details here

Let the little children come to...

...someone else. Jesus preferably.

Yesterday morning, I spent two hours teaching four classes of school Scripture to six to twelve year olds.

Last night, I spent two hours with Dr Matheson Russell teaching a CASE course on the problem of evil to about twenty adults.

I know which age group I prefer teaching. Scripture is a wonderful opportunity and kids are so often delightful, but putting twenty-odd together and letting them loose on me without much of a voice (or much experience, training or skill in dealing with primary and infants kids) is a recipe for general mayhem. I'd like to improve, but I'd also like to encourage those with an existing passion (and/or training) to get involved too (or simply instead!).

As for the CASE course, it's not too late to join. We had a great time last night, and there's still three more weeks to go. Thanks to SydneyAnglicans.net for some free advertising.

Thanksgiving service

Give thanks to the LORD for he is good;
His steadfast love endures forever!

- Psalm 136.1

Personal update and an invitation
We've now had a week or so for the good news of the latest scan to sink in. After initially finding ourselves exhausted and relieved, we're now starting to look ahead to a life of new and renewed possibilities. Before we get there, however, it is appropriate to mark this point in our journey with gratitude for God's goodness to us through so many people. And so we would like to invite you to a special service of thanksgiving.

Saturday May 19th, 10am
All Souls Anglican Church, Leichhardt (cnr Norton & Marion Streets)
Morning tea will be provided following the service.
RSVP would be appreciated. All welcome.

From here, I will continue to have scans every few months for at least two years. I will post any further updates on my health blog. Thank you for your support, prayers, love and generosity. God has blessed us so much through you all.

We've been reminded that life is so much more than the abundance of possessions, as Jesus says - indeed, it is more than the abundance of health. Our society often seems obsessed with health; could this be an expression of a deep fear of death? Our hope is not simply to avoid dying for a little longer (as good as that is!), but for death itself to be overthrown in resurrection.

May God fill you with hope and joy because Jesus is risen, and so the end of death has begun.

In praise of... God!

There are many things, great and small, worth praising God for. I was given one more yesterday. For those who have been following the dramas in my life over the last few months, you might be interested to read this.

Indeed, in our hearts we felt the sentence of death. But this happened that we might not rely on ourselves but on God, who raises the dead. He has delivered us from such a deadly peril, and he will deliver us. On him we have set our hope that he will continue to deliver us, as you help us by your prayers. Then many will give thanks on our behalf for the gracious favor granted us in answer to the prayers of many.

- 2 Corinthians 1.9-11

Thanks Naomi for this pasage.Series so far: I; II; III; IV; V; VI; VII; VIII; IX; X.

Update

I've now finished my two lectures at CASE (one on the Trinity and one on revelation), though in May I'll be teaching a short course with Matheson on the problem of evil. More details to come. Sorry for not advertising the two lectures I just finished, but I'm pretty sure you can download them from the CASE website if you're very keen.

Tomorrow I have my first post-treatment scan.* For the last month I've been recovering from the side-effects of treatment (and while still not 100%, I'm past half-way), but so far we haven't really known how effective the treatment has been. Tomorrow's CT scan will give half the picture, and then I have another scan (a PET scan) in another month to get a better idea. Usually I keep these updates for my other blog, but tomorrow will be something of a milestone, so I thought I'd mention it again here. I plan on writing another update email (which I will post on my other blog) either tomorrow evening or Thursday.
*For those who might have joined recently, see this post and my other blog.

UPDATE: The scan on Wednesday was good.

Apology

Posting has been less regular recently, as I have been very tired and also had a brief stay in hospital. I have many posts planned and a few guest posts to write. I hope to get to them all in due time.

In praise of... endings

All good things must come to to end.

It's a lie, of course. The Father's steadfast love endures forever; Jesus' blood never fails; the new age of the Spirit will never wear out.

But it is good that some things do come to an end, even where they were good. For me, I'm thankful that this morning was my final session of radiotherapy. After 33 days of treatment, it's great to have reached the end of this treatment cycle and get a chance to recover before having more scans in a month or two to see how it's all gone. For more details and some pictures, see here.
Series so far: I; II; III; IV; V; VI; VII; VIII; IX; X.

Second last chemo

Yesterday, I had my second last chemotherapy (if you didn't realise I had cancer, see here for the story). Things seem to be going quite well although definitive scans won't happen for about another six weeks in order to give radiotherapy more time to work. My main side-effect continues to be tiredness. I have posted a few more updates (and pictures) over here, and hope to continue answering FAQs, although this has been slow.

In other news, Lindbeck arrived yesterday - a heartwarming gift upon my return from hospital!
Photo by JKS.

Health updates: new blog

For those who might be interested, I am in the process of setting up a second blog to answer various frequently asked questions about my life with cancer and its treatments, as well as post updates. It can be found here. I will continue to expand the FAQs over the coming days and weeks.