Can I keep singing?

When evening came, Jesus was reclining at the table with the Twelve. And while they were eating, he said, "I tell you the truth, one of you will betray me." They were very sad and began to say to him one after the other, "Surely not I, Lord?" Jesus replied, "The one who has dipped his hand into the bowl with me will betray me. The Son of Man will go just as it is written about him. But woe to that man who betrays the Son of Man! It would be better for him if he had not been born." Then Judas, the one who would betray him, said, "Surely not I, Rabbi?" Jesus answered, "Yes, it is you." While they were eating, Jesus took bread, gave thanks and broke it, and gave it to his disciples, saying, "Take and eat; this is my body." Then he took the cup, gave thanks and offered it to them, saying, "Drink from it, all of you. This is my blood of the covenant, which is poured out for many for the forgiveness of sins. I tell you, I will not drink of this fruit of the vine from now on until that day when I drink it anew with you in my Father's kingdom."

When they had sung a hymn, they went out to the Mount of Olives. ~Matthew 26

The evening prior to His death. The long night lay before Him, He had beads of bloody sweat to be wrung from Him in His agony. What did He do, that very last night of normal? He reclined at a table with His friends. He helped them understand the suffering to come. And he sang. Jesus sang?!! I read that this morning in a little book I picked up for $2 at a used bookstore yesterday - "How to Meet Your Troubles", the slim brown volume is titled. I never noticed it before - but He did! The very last thing He did before walking to the garden was sing in worship.

I didn't feel like singing last night, when I typed up the words to this song - "How Can I Keep from Singing?". It has been ringing through my heart for days, as I practiced it for Sunday worship. But I just didn't have it in me last night to post these words...they seemed falsely joyful.

For eight weeks, something has been troubling me. I went to the doctor once and my vague symptoms were dismissed. Since then, they've worsened, and I took to doing a breast exam every day in the shower, looking for what I thought was an infection brewing. On Saturday, I found a small lump, like a pebble under my skin. I found it late at night, after finishing writing on a paper. Aaron was asleep, my mother was asleep. So I spent most of the night in prayer, and woke after just a few hours of sleep to go sing, play my harmonica, play the keys for worship at church on Sunday. Sunday afternoon, I was able to tell Aaron and my parents. We just accepted it. Okay, that's what we'll do next. Figure out this lump business. On Sunday night, again in the shower, I thought I found a larger lump, too.

I went to the midwife yesterday. She has been doing my physical for six years now. She found my thyroid cancer because of her carefulness and knowledge of my body's normal. I hoped she would say I was imagining things. Instead, she carefully measured the lumps - 1/2" for the small one; over 1" for the large one. (that's about the same size as my thyroid tumor when it was removed - between 4 and 5 centimeters) She checked her computer. With normal risk factors (mine are anything but) and only one of my symptoms, the risk of cancer is probably 15%. My own check, combining the three symptoms I have with my risk factors, is around 75%. Oddly enough, that cheers me - the more probably it seems, the less likely it will be true, in my experience so far. The less probable - well, then of course it will be! I know it doesn't sound logical, but it is a small comfort to me that all my previous experiences have gone this way.

Because of my risk and the other potential problems that could cause these particular symptoms, I am already scheduled to meet with a surgeon, regardless of the outcome of my diagnostic tests tomorrow ("smashogram" and level 2, high definition ultrasound). I will probably require surgical removal of the lumps, if nothing more. I will go to sleep knowing I am having lumps removed. They will test the lumps for cancer while I am still under anesthesia, and remove one or both of my breasts and lymph tissue if it is cancer. Going to sleep not knowing is one of the hardest parts of the trial for me to face again.

I don't know what to ask for. Instead, I am back to basics: praying the Lord's prayer. Give me the food I need today, Lord. Forgive me, I am weary. Thy kingdom come, Thy will be done, in my body as it is in your heaven. For thine is the kingdom and the glory forever and ever - so be it.

And yes. I will keep singing. I will keep praying. Words I wrote myself in long-ago days of trouble are echoing in my soul today.

Lord, lead me safely through the path of today,
Reach down and rescue me from hate and from pain,
Set Your laws before me, That I may have a lamp for my feet,
O Lord, guide me.
In this place,
Surrounded by a thousand fears,
Temptation and weakness,
Hatred and lies,
He promised me faithfulness, integrity,
A way that is perfect, a light for my life.
~"Guide" from Psalm 18, 10/02/98

I struggle, God,
You hold me up, I stand.
In your all-surpassing power, not my strength.
When trouble overcomes me, I turn my eyes to You.
For though I may crumble, You endure.
I do not lose heart,
I do not lose faith.
Your promise is my hope, day by day.
I fix my gaze on You, I am renewed.
~"Renewed", 2001

I can sing when I lose my step

And fall down again

I can sing 'cause You pick me up

Sing 'cause You're there

I can sing 'cause You hear me, Lord

When I call to You in prayer

I can sing with my last breath

Sing for I know

That I'll sing with the angels

And the saints around the throne

~ How Can I Keep from Singing,

sung with beauty by the random self-deprecating guy, below,

and words by Chris Tomlin (2006) and Robert Lowry (1860)

I must decrease...

...He must increase. No one can receive a single thing unless it's given to him from heaven." (John 3:27 & 30)

Statistics are something most cancer patients avoid like the plague. I remember back to last September, when I met with the oncologist at Mayo for the first time post-surgery. At that time, I was quoted a MACIS score of 3.97 and 5-year survival odds of 97%. In October, when I met with the local oncologist I am now seeing, with new pathology results in hand, my MACIS score was re-calculated to be 4.97, and my 5-year survival odds plummeted to 89%, with 10-year survival odds of 77%. No one likes to hear that, by age 39, there is a 33% chance that one might be dead from a supposedly "good" cancer. It's not something I've talked a whole lot about. Mostly because I lost all faith in statistics after observing how physicians sometimes twisted them to coerce patients into treatment plans that they otherwise might never have chosen.

The good news in all this talk of surviving or dying is that my survival "odds" have just taken a giant leap for the better. As humans, we constantly strive to force God's hand...or, at the very least, get Him to tip His cosmic knowledge our direction so we can get a sneak peek at what is to come for us and those we love. My odds have jumped from 89% at 5 years to 97%, and remain high through the 30 year mark. It is difficult for me to know how to react. My first reaction is praise and rejoicing, which God says should be my first response to everything (in everything give thanks: for this is the will of God in Christ Jesus concerning you. ~ I Thessalonians 5:18). And then my mind says, well, there was a 3% chance that it would be cancer when they first found the lump. Then there was a 3% chance that it would be malignant. Then there was less than 1% chance that it would have exploded from it's capsule and invaded my blood stream. The only positive light: there was less than 3% chance that the I-131 would work so quickly and completely when my thyroglobulin levels came back positive last November. So now there's a 3% chance it will kill me. Yep, I still have no idea what to make of this statistic.

So I am just reporting it to you, dear reader. As it was reported to me. I don't know how to respond to it. I think I will just leave it be, a neutral fact without much meaning. But at least a more positive fact than the one I was given in November.

Look, ma, my robe isn't even scorched!

The king's command was so urgent and the furnace so hot that the flames of the fire killed the soldiers who took up Shadrach, Meshach and Abednego, and these three men, firmly tied, fell into the blazing furnace. Then King Nebuchadnezzar leaped to his feet in amazement and asked his advisers, "Weren't there three men that we tied up and threw into the fire?" They replied, "Certainly, O king." He said, "Look! I see four men walking around in the fire, unbound and unharmed, and the fourth looks like a son of the gods." Nebuchadnezzar then approached the opening of the blazing furnace and shouted, "Shadrach, Meshach and Abednego, servants of the Most High God, come out! Come here!"

So Shadrach, Meshach and Abednego came out of the fire, and the satraps, prefects, governors and royal advisers crowded around them. They saw that the fire had not harmed their bodies, nor was a hair of their heads singed; their robes were not scorched, and there was no smell of fire on them. Then Nebuchadnezzar said, "Praise be to the God of Shadrach, Meshach and Abednego, who has sent his angel and rescued his servants!" (Daniel 3:22-28)

I understand this story in a more personal way than ever before. What do you think the mindset of these men was as they approached the furnace, so hot that the flames killed their escorts before they even reached the edge? I doubt it was complete, unwavering faith in their deliverance! Why would God, who also receives glory when His faithful followers die rather than renounce Him, choose to save these three men? I imagine they walked into the flames saying a prayer for courage as they faced certain, painful death...and a quick reunion with their friends and family in heaven! And so I faced cancer. Not certain death, but certain uncertainty. I faced it with the possibility that God would take me from a young family, that I and these dear children and rock of a husband would be living proof that you can serve God through sorrow and worship Him in your deepest pit of distress.

Now I have emerged from the other side of my personal furnace. I walked through the furnace accompanied by an angel. I felt the love of God poured out on my life in a new way. I prayed for courage...and what I received - at least for the moment - is healing and protection. The fire didn't harm my body, didn't scorch my robe, and there is no smell of smoke on me. Negative labs. Unheard of. To go from positive for cancer to absolutely no sign of cancer using only a minimal dose of the required treatment. Facing vascular invasion, potential distant metastases, positive antibodies and thyroglobulin levels to...nothing. To be the one who is rescued!

And how do I look into the faces of dear friends and loved ones who are not be rescued, but rather are joining...or have already joined...the martyrs of old? How do I continue to minister to those who fight and lose, when God chose to heal me? New questions emerge where old ones have finally received an answer. I love that - and find it frustrating, all at once. The Christian walk is never to a destination - not an earthly one. It is a winding path fraught with difficulty, side by side with unexpected beauty. Once again, I've rounded an unexpected curve, only to find just a short stretch of the path visible in front of me. No long straight stretches to spin my wheels on. This trial, if I am to use it best, still requires careful navigation. Let me not fall victim to a prosperity gospel that preaches constant and instantaneous deliverance. Let me not see healing as overly causal.

Above all, let me find the best way, in this, too, to give Him all the glory, and all the honor and all the praise.

when I think about the Lord
how He saved, how He raised me
how He filled me with the Holy Ghost
how He healed me to the uttermost
when I think about the Lord
how He picked me up
turned me around
how He set my feet
on solid ground

it makes me want to shout
hallelujah! thank you, Jesus!
Lord, you're worthy
of all the glory, and all the honor
and all the praise!
Hallelujah! thank you, Jesus!
Lord, you're worthy
of all the glory, and all the honor
and all the praise!
(Ephesians 2:4-7, II Corinthians 5:17)
When I Think About the Lord, James Huey

New growth on old branches

My days have been the giant evaporator, boiling down my sap to a pleasant sweet finish today. My scan is clean. My lab tests wonderfully, miraculously, are undetectable! The oncologist said this almost never happens. That I should have low values for that particular lab test, but never undetectable.

For the first time since last June, unbridled joy. Unchecked celebration. Awe-struck, falling on our knees in praise. Why would God do this - for us? Why this sudden mercy?

On Saturday, back to my nest of babies. News doors flying open in front of our family. I can nurse again. I could cuddle a new baby. I can sing, and dance. I don't need another scan until December, and this time it will be much less invasive, with no hormone withdrawal beforehand. The sweet bliss as I resume old duties and contemplate new ones. Striving to remember all these lessons, integrate them into the very fiber of my being so that I am never, ever the same.

Still three years until I am in remission. But I can say, assuredly, that I have no active cancer now. Sweet Savior who bends His knee to tend to me! What a privilege to walk my road today, dumbfounded. Speechless. Opening up like a crocus to the first promising warm breeze of spring. I have walked through my winter and now I will revel in the thaw.

My heart is steadfast, O God,
my heart is steadfast!
I will sing and make melody!
Awake, my glory!
Awake, O harp and lyre!
I will awake the dawn!
I will give thanks to you, O Lord, among the peoples;
I will sing praises to you among the nations.
For your steadfast love is great to the heavens,
your faithfulness to the clouds.

Be exalted, O God, above the heavens!
Let your glory be over all the earth!

~ Psalm 57

A different path

Thy word is a lamp unto my feet, and a light unto my path. (Psalm 119:105)

There isn't much that is clear about my situation. At least, that's how I often feel as I muddle through the haze of days of hypothyroidism, medication withdrawal, myriad decisions about which diet to follow, and which set of recommendations regarding radiation precautions post-scan dose and post-treatment dose. What I know is this: I have a rare variant form of thyroid cancer that requires different follow-up and treatment than the more "standard" (papillary or follicular) varieties. I know that I will be having frequent scans over the next 3-5 years. I know that I am at high risk for recurrence, and those 3-5 years may stretch into 20 years of careful treatment and follow-up. I also know that I have 4 small children at home, 5 and under, none of whom understand the concept of 3 feet from Mama, nor what it means when they suddenly can't cosleep with me after years of open access to my bed and bedroom. I know I am in close proximity to my children more (perhaps up to 20-some hours a day more!) than a mother who makes different choices, such as working outside the home or sleeping in a different room than her children. I know I would have difficulty not licking their spoons, or holding them in my arms, or kissing them goodnight - even though I am mature enough to understand the 3 foot rule and how radiation is transmitted through my saliva and sweat! I know that I must carefully weigh not only the physical impact of my decisions, but also the emotional and psychological impact. My children need to trust me when I say I am coming home. They need to trust that I will not leave again as soon as I get home. So I stay away - perhaps longer than necessary - to avoid a second separation. Why put them through that, when they are going through so much already? Why ask them not to hug me when I am home, when that is the deepest urge in their little beings?

We all have a different path to trod. Why does mine include cancer? Why does my particular nuclear medicine physician suggest very strict precautions for me when his colleague might suggest very different precautions for the next patient? I don't know, no more than I understand why God blessed me with beautiful children or the ability to be a stay-at-home mom.

Doubts enter in whenever we let them, don't they? Satan is always ready with self-doubt proferred, whenever we are least ready. I must stand firm on what I do know, and shut my ears and eyes to the doubts that plague me and the questions I can't answer. I recorded a hymn for my children to listen to today, and it captures the resolve of my heart perfectly.

All the way my Saviour leads me;
What have I to ask beside?
Can I doubt His tender mercy,
Who through life has been my Guide?
Heavenly peace, divinest comfort,
Here by faith in Him to dwell!
For I know, whate'er befall me,
Jesus doeth all things well.
~ Fanny J. Crosby, All the Way My Savior Leads Me

The road so far

I've been walking the cancer road for 9 months now. The time it would take to grow a healthy baby in my womb. Along the way, I've begun to recognize a peculiar ebb and flow: tension and anxiety, followed by a season of peace and tranquility and yet ravenous consumption of every minute blessing in my life unlike seasons that have ever gone before.
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Diagnosis: stress and heartache, fear. I felt like I was standing in front of a full-length mirror for the first time in a decade. Scrutinizing myself, and particularly my soul. Unprepared for what I saw in my reflection, but gritting my teeth and examining it nonetheless.

After surgery: descending into a new reality. Coming to grips with a different life and molding new expectations. Turning my back on the past and embracing the future, it's myriad delights and sorrows. Feeling the gut-wrenching bitter and the mouth-tingling sweet that is watching a life fly by in a series of moments I wish I could bottle up and live in forever. Thinking about tomorrow...but yet never thinking about 3 months from now. I packed my full-length mirror away.

Treatment: My hands pierced the icy water of the deep end of this pool of suffering as I cleaved the water's surface, a fearless and determined dart of humanity diving head first and headlong into whatever lies below the surface. I kicked my legs furiously and reached the bottom. I laid there, in the deep, feeling the burn of my lungs echoing the cry of my heart. Memorizing the grains of gravel that etched my back and scarred me forever.

Home again: in a bubble of release, the pressure in my chest just shy of explosion, my face broke the surface, following my hands as I emerged from the dark deep to feel the sun on my face again. Delight, awe, gratitude, rediscovery, regrowth. I didn't look below the surface for a long time. I reveled in denial. I put on optimism like a familiar cloak, not even pausing to examine it's threads.

Next scan: I stood on the diving board for long moments as the clock ticked audibly beside me. I knew the depths. I remember the gravel in the bottom. I remember the darkness. I don't want to return. I walk away, and revel in denial for a few more days.
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Preparations unmade, days uncharted. It stretches before me like the abyss it is...parts of it known, previously discovered; yet it's length and breadth unknowable. I teeter on the edge and plan about planning. But the details elude me. I revel instead in companions, friends, family, sights, sounds, smells, experiences. Real life, not details of a life yet to be lived. I don't want to live it. It's almost as if I believe that it won't come to pass if I don't turn to face it.

So this week, I turn to face it. I consider what I must lose; I problem-solve so that I lose least, and gain something. (Anyone who does not take his cross and follow me is not worthy of me. Whoever finds his life will lose it, and whoever loses his life for my sake will find it. ~Matt. 10:38-39) I go on the strict diet, I make all the logistical plans, I cook ahead for my family, I wrap gifts for each of the 19 days I may be gone this time around, for each child. In every act of preparation, I have that old familiar choice: to grit my teeth and survive; or to find a way to cherish and believe and grow because of the pain I am facing, knowing.

This verse has played in my head all day: From the fullness of his grace we have all received one blessing after another. (John 1:16)

And this song, which has become an anthem for this season in my life:

Evermore my heart, my heart will say
Above all, I live for Your glory
Even if my world falls I will say
Above all, I live for Your glory
~ Hillsong, Evermore

Final pathology report

This morning, my oncologist's nurse called me with the final pathology report from the University of Pennsylvania. She was kind enough to read it to me. It states that there is a "focus of probable vascular invasion that cannot be completely confirmed due to specimen quality". This means there is an area where my tumor seems to have invaded the bloodstream, although the pathologist couldn't say for absolutely certain as the tumor sample is not of high enough quality (probably due to normal breakdown in storage).

I thought images might help you understand what's going on with my cancer. Sometimes it helps to have a visual so that the implications of these nuances of diagnosis can be better understood.

This is what normal thyroid tissue looks like under a microscope. Notice how organized and well defined the little capsules of thyroid tissue are:


Now here is what papillary carcinoma, follicular variant looks like under the microscope. Notice how poor the organization is. The cells all look a little different and they interact differently. They don't have much "respect" for the cell next to them.

This is what "capsular invasion" looks like under a microscope. The tumor is on the right, and you can plainly see how a "mushroom" of cancerous cells has broken through the membrane surrounding the tumor and is starting to compress the normal tissue along the left side of the image.


This is what it looks like when a tumor invades the bloodstream. Notice the round follicles of cancerous tissue in the white space of the blood vessel:

Today I am thanking the Lord that I do not have the much more dangerous medullary or anaplastic types of thyroid cancer. I am praying the pathologist is wrong and there has been no vascular invasion. Today is my "cancer day" of the week. In order to preserve my hope and faith, I set aside one day a week to deal with cancer: make appointments, talk to doctors, do research online and review and organize information for upcoming visits. I can't stand to do it piece-meal, with a little bit every day. It is better to let it completely fill one day, and save the others for more enjoyable pursuits. So today I read, learn, talk about cancer; today I am a cancer patient. So that tomorrow I can be a mom, wife, daughter, friend again! With joy.

Hiding in the numbers

I spent yesterday trying to gather information from various doctors about my latest medical tests. I was unable to get anyone to read me the final pathology report on my tumor, which was exceedingly frustrating. I did manage to get ahold of a sympathetic nurse who read to me from my electronic health record, although she didn't have much to offer in terms of interpretation. I gleaned a little information from this: several blood tests that have been normal since my surgery in June are now abnormal. I have tumor markers present in my bloodstream and also a positive thyroglobulin value. Both tests were drawn just prior to my radioactive iodine, which yields a ray of hope that the iodine may have destroyed the active cancer that was brewing in my body at that time.

The tumor marker test looks for cancerous genetic material in my blood stream. The bad news is that only tumors that have access to blood supply can be tested for in this way. Recurrent tumor markers are associated with malignant metastasis (dangerous spread) in over 90% of patients with papillary carcinoma. A positive value for this test indicates aggressive disease rather than the slow-growing cancer that I have been told to expect.

The thyroglobulin test is less clear-cut. It could indicate that the remaining thyroid remnant in my throat was functioning somewhat. However, in combination with the tumor marker test, it can be used to indicate recurrent or metastatic disease. But this test is generally less compelling than the last test.

If you've been reading here for any length of time, you know I normally don't coldly report on lab tests and statistical risk. Today I hide in the numbers. My family is circled close in a spiritual and emotional sense; circling our wagons. Consternation, fear, sorrow, remorse. Emotions are running high. I will write more when I have the heart to.

Details

I want to clarify the details of the "non-news" I received from my doctor today. I got more information from my husband, who has permission to view my electronic medical record. Slides of tumor samples were sent to Pennsylvania in the end of November, and the analysis of those samples revealed more invasion of the capsule (the membrane that surrounds the tumor and protects healthy tissue) and an area suspicious for blood vessel invasion. What this means, in plain English, is that my chances of tumor spread to distant parts of my body just went up. After analyzing these samples, the pathologist requested that my entire tumor be sent to her for a more detailed analysis. As someone with medical background, my heart skips a beat when I hear things like this. In my experience, this means bad news 9 times out of 10. The final report of her analysis of my tumor in it's entirety is what my doctor didn't feel comfortable sharing today. And that is what has me on the edge of my seat, waiting for more news.

Tonight I am resting in the bone-weary pre-Christmas state following a long day of bustle. Baking, cooking, wrapping, making gifts, cleaning, and packing for several holiday car trips with four kids has filled my plate already, even without these latest events! I am headed to bed - shortly before 1 a.m., which is record time for the week before Christmas!

Praise:

• Aaron got Christmas Eve off unexpectedly!
• I get to play in the church band for the Christmas Eve service tomorrow - and I can SING! God gave me my voice back, and I am excited to use it!
• Healthy, happy children
• White blanket of fresh snow for Christmas
• Family, friends, food, beer, wine, presents, laughter...

Pray:

• Spirits peaceful, resting on God during this time when worry creeps in (especially for Aaron and I and my parents and other family members)
• Our neighbors who lost their daughter today, the day before Christmas Eve
• My children, that this worry over cancer wouldn't touch them too deeply this Christmas season