The Philippians 1 Dilemma

During a particularly dangerous time of imprisonment for the Apostle Paul, when it looked like his life could be over very soon, he wrote a fascinating letter to the church in Philippi. Early in the letter, he contemplates the possibilities of surviving or dying in this situation:

“Yes, and I will continue to rejoice, for I know that through your prayers and God’s provision of the Spirit of Jesus Christ what has happened to me will turn out for my deliverance. I eagerly expect and hope that I will in no way be ashamed, but will have sufficient courage so that now as always Christ will be exalted in my body, whether by life or by death. For to me, to live is Christ and to die is gain. If I am to go on living in the body, this will mean fruitful labor for me. Yet what shall I choose? I do not know! I am torn between the two: I desire to depart and be with Christ, which is better by far; but it is more necessary for you that I remain in the body. Convinced of this, I know that I will remain, and I will continue with all of you for your progress and joy in the faith, so that through my being with you again your boasting in Christ Jesus will abound on account of me.”

I think it’s an important passage for us to reflect on whenever we face deadly situations. It’s a passage that has come up in many conversations I’ve had over the past 10 months since I first got this cancer diagnosis. Paul highlights a crucial dynamic for the Christian. On one hand, there’s a part of us eagerly looking forward to our reward in Heaven, finally united with the One who loved us enough to die for us. On the other hand, we each have our important work here on earth to finish, and we don’t give up on it just because we hit a stretch of rocky road. No matter how deadly or impossible the peril, we remain until the work we were created to do is completed. Despite the hopelessness of his situation, Paul knew that he still had work to do on this earth, so it wasn’t his time to go quite yet.

Going into surgery this week, I think it’s a good time to look back on this last year, and share some of the thoughts I’ve had throughout it. Most of you know this is actually my second time dealing with a stage 4 cancer; the first time was when I was just 15 with non-Hodgkin’s lymphoma. Treatment for that was a full year of chemotherapy, and after that the cancer was completely gone. Doctors gave me a 75% chance of survival with my initial diagnosis back then; slightly better odds than we normally think of when we think of cancer.

So, on the one hand, a stage 4 cancer diagnosis doesn’t seem quite as impossible for me to beat having already gone through it once. However, this cancer is a little different. It’s a very rare form of small intestinal cancer, extremely aggressive and invasive. Generally it doesn’t respond to chemotherapy and people who are diagnosed with it in the condition I was back in June typically don’t survive for very long. For me, it had already spread to three different places in my intestines, to some lymph nodes, and several other spots around my abdomen, which was too much spread to try to address with surgery. In fact, my first instinct when I saw the histology report, before I even met with my oncologist, was that I should probably start figuring out how to say goodbye to people. I was actually thinking about putting together some kind of goodbye video and giving it to someone to hold on to just in case things went south really quickly.

Then after a few days of that mindset, something changed. I can’t really explain it, it wasn’t some new medical data I came across or new information or even meeting with my oncologist…I was just filled with a strong conviction that I wouldn’t need to be worrying about goodbyes any time soon. I knew how impossible the odds were of surviving this cancer (my PhD was in cancer diagnostics, after all). It just didn’t seem to matter anymore. It’s the Philippians 1 principle; it was necessary for me to remain, so remain I shall. The more I found people praying for me all over the world, the stronger my conviction felt. Whatever happened, I wouldn’t be needing that video.

And then I saw the hand of God working throughout treatment. Chemo treatment ended up being surprisingly easy, considering we were hitting me with the strongest regimen we could. Far from knocking me down for days after each treatment, I found myself largely unaffected by the typical chemotherapy side effects. For the most part I had my normal amount of energy, and really wasn’t inhibited by nausea. The pain from the cancer seemed to subside fairly quickly as well, suggesting a good response, and other than one brief stretch in the hospital in August following some kind of stomach virus infection I didn’t have any significant incidents throughout the course of treatment. After the first 4 treatments, we did a couple more scans to see how the cancer had responded, and surprisingly the response seemed pretty good; enough that my oncologist wanted to start touching base with a surgeon to shoot for some surgery after the treatment course was finished, with the goal of attempting to remove all the remaining cancer. I was pretty impressed with the development.

With the positive response to chemotherapy and the fact that my body wasn’t really being significantly by treatment, we went ahead and pushed the 8 treatment cycles all the way up to 12, to see how much we could shrink the cancer ahead of surgery. And again, it really wasn’t until the last treatment or two that I started to feel some of the side effects from the chemotherapy. Going into January, things were looking pretty good, with the goal of doing a scan after my last treatment and planning to schedule surgery sometime early February, to give my body a month to recover from chemotherapy.

Unfortunately, that’s when things got a little disorganized. My last treatment was January 7th, but I wasn’t able to get the scan in until the 25th. The scan results looked good according to my oncologist, showing the cancer had continued to respond, but then it was a week and a half until I heard from the surgeon. Because of some of the lymph nodes that were involved, she told me it wouldn’t be possible to remove all the cancer, although she’d be willing to give surgery a shot anyway to see what could be possible, aiming for some time in February. After two weeks waiting to hear about confirming a surgery date, a friend found the number for the surgery scheduling office for me, so I called in to ask what was taking so long to schedule me in. It seems I had simply fallen through the cracks, and now the earliest surgery data available was March 8th, a full month after I was originally imagining us doing the surgery.

Already putting chemotherapy on hold for surgery for such an aggressive cancer was a gamble, and I knew it. I had been willing to take that gamble when I thought there was a possibility we could remove all the cancer, assuming we would schedule the surgery relatively quickly. Had I known that surgery wouldn’t be scheduled for two months and even at its best the surgeon wasn’t expecting to be able to remove everything, I probably wouldn’t have taken that gamble, but either way this is the place God has brought us to now. No sense in second guessing decisions at this point.

We go into this surgery Tuesday with a lot of unknowns. Because this is an invasive cancer, it doesn’t always show up well on scans, so we don’t know if the recent scan results represent an accurate picture of what we’ll find when we open me up. We know the worst spot is in one area of my small intestine; that’s the part that brought me in to the hospital with an obstruction two weeks ago. Given how aggressive we know this cancer to be, the doctors took this obstruction as a sign that the cancer had just grown back too much in the short time I had been off chemo, and even though they were willing to keep the March 8th surgery date on the books, there didn’t seem to be much confidence that surgery would help me at that point. Once these cancers get to the point of causing obstructions like this, there aren’t a lot of great options. You can’t resume chemotherapy while you have an intestinal obstruction, and the more intensive the surgery ends up being the longer you need to wait to try to resume chemotherapy, which just gives the remaining cancer that much more opportunity to grow back.

Then another twist came when the obstruction seemed to at least partly resolved itself on its own after a week in the hospital…as if either the obstruction wasn’t entirely caused by the cancer or that the cancer has somehow shrunk all on its own, adding to the questions this week. I’m still in some discomfort, but the fact that I don’t seem to be as bad now as I was two weeks ago is very interesting. There were actually several points during the first week in the hospital where I thought things were too bad to recover from, but each time we got a big prayer group together in respond and the situation turned around the next day. It seems God wants to be teaching us something about prayer during this time.

This has been a difficult battle up until this point, but it’s a battle worth fighting. Of course as Christians, our mindset in the battle of life and death is a little different. I see a lot of people fighting battles dominated by fear; it’s a fear of death that motivates them. I remember reading about wealthy people spending hundreds of thousands of dollars to cryofreeze themselves in the hopes that they could be thawed out some time in the distant future after we’ve discovered a cure for death or something…or at least a cure for whatever terminal illness they possibly have. The reality that no matter what you do to try to delay it, we’re all going to face death at some point in our lives. These bodies aren’t immortal.

The Christian fights for life for a different reason. A common question to arise in light of Heaven is whether we even want to continue to be on this earth at all. If Heaven is so much better, why stick around after you find salvation? We look forward to the day when we will be free of death and disease and the curse of sin in this world. Yet we also know that life is a precious gift from God, and shouldn’t be discarded carelessly. The people and relationships in our lives are also precious gifts from God…even the ones that are difficult to love. And precious things are worth fighting for.

As Paul fought to be reunited with those whose lives he had impacted, so he could continue to feed into them, we also fight to continue the work we’ve been tasked with. There’s pain in the fight, but there’s joy in the victories, and joy in knowing the work isn’t in vain. So let’s see what comes of the surgery this week, and see where God takes us next.