Chemo Continues - For Now

Today we had a routine appointment with Yvonne's neuroncologist at London Regional Cancer Program (Victoria Hospital). He noticed Yvonne's poorer condition -- not able to lift her left leg when he asked her; although I was surprised she was able to still hold out her arms reasonably well and squeeze his hands when directed. Her bloodwork showed her platelets (which sometimes in the past have taken a hit with the Temodal chemotherapy) were staying up, which is good. I noted a significant amount of her hair has come out in the past few weeks when I comb it each morning, after the radiation was completed May 14.

At first Dr. Macdonald seemed to be questioning whether the chemotherapy was doing much good. I countered that it's difficult to say when we can't tell how much worse she would have been if she had not been receiving chemo! Later I admitted that, although we don't have those results, as neuroncologist he does see a lot of patients that are likely similar to Yvonne, and I asked how she compared to them. He said, on that basis, if the chemo had been shrinking the tumour significantly, he would have expected her to be resuming her former functioning. I suppose an example would be reading aloud for him the sign on the door as she was able to do April 13, and certainly could NOT do today.

In the end, he relented and approved continuation of the chemo at least until her upcoming MRI July 9. That day he plans for us to stop in so we can see the resulting images (the radiologist report won't be ready until at least a day after).

He also approved an increase in the steroid Yvonne is taking (dexamethasone) which helps reduce swelling inside the brain (although it results in a puffy face). We had been tapering off it from the initial 16 mg/day to current 4 mg/day, but she is going back up to 12 mg/day in hopes this will help her functioning.

There was a bit of discussion about whether she should be going into the hospital in near future, and whether a "DNR" (Do Not Resuscitate) order would be appropriate. I explained I had been reluctant to put this in place as she had been still relatively functional until a couple of weeks ago. The nurse questioned me about it again Wednesday. I had a discussion with a fellow pastor this week, who was of the opinion it is probably the compassionate approach at this point. A "DNR" would need to be in place if I am to arrange an "EDITH". Yes Edith was actually Yvonne's maternal grandmother's name! (incorporated into our daughter Meredith's name) But this "EDITH" is short for "Expected Death In The Home" and means if Yvonne died at home, we wouldn't have to call 911 emergency services; procedures would be handled quietly through the visiting nursing service already in place. I like the low-key aspect of an EDITH, but had not yet mentally or emotionally crossed the bridge of the DNR order it would necessitate.

I realize from a point of view of individual "quality of life", Yvonne's state is diminishing significantly. However I also see it as a 'system' issue, not just the 'individual' one. She has a generous team of volunteers who have been lavishing love upon her with their time and their tasty cooking. Our children have started a Whatsapp Group called "Hi Mum!" in which they and the grandchildren have been submitting videos on a more or less daily rotating basis for Yvonne to watch (and she does enjoy watching them). From a Biblical viewpoint, as her husband I am "one flesh" with her (Genesis 2:24; Matthew 19:6) so I too am part of the equation. To evaluate "quality of life" solely from an individual point of view seems shortsighted; Yvonne is part of many overlapping circles of significant caring, mutually-enriching, relationship.

Late this afternoon, the Occupational Therapist stopped by in response to a report issued through our PSW (Personal Support Worker) network. Wednesday "W" the PSW was escorting Yvonne from her recliner to the washroom with the walker when Yvonne's legs collapsed under her. "W" called me at work and I came home a bit early to help get Yvonne up off the floor and into bed. "W" said the time was probably coming when more equipment would be needed in order for them to do their job safely. So the Occupational Therapist today agreed and we are looking into: a "sit-to-stand lift" (example), a hospital bed (saves PSW's back when doing personal care, and our present bed doesn't have clearance for the sit-to-stand lift underneath), and a commode chair (our ensuite bathroom is pretty tiny to try to get equipment like a lift or transfer chair into).

Thanks everyone for taking time to follow Yvonne's progress, for your prayers, and support!

“Doubting Affliction’s Design”

(Column for "From the Minister's Study" in North Huron's The Citizen newspaper)

            Driving to work after leaving my wife in the capable supervision of a Huron Hospice volunteer, my attention was arrested by the podcast speaker’s statement: “God designs all the afflictions of the godly for the increase of their everlasting joy.” What?! God actually intends or designs afflictions for those who are His? This goes against the tendency of many faithful to try to absolve God of any responsibility for bad things that happen; we instead prefer to blame our woes on attacks from Satan.

            The problem of pain and suffering has added poignancy for me recently since my wife’s brain tumour, 15 years after her initial lobectomy, returned with a vengeance between her routine November 2017 and March 2018  MRI scans. Measuring 22 mm and upgraded to an aggressive Grade 4 category, it prompted the neuroncologist to say she was now “probably palliative” – the end of the line was coming into view. Nevertheless, the neuroncologist and radiologist both approved further treatment to stave off progression of the disease, so my wife has received the benefit of further radiation and chemotherapy.

            Still, there have been disturbing signs: her inability to communicate more than an occasional dubious “yes” or “no”; her lack of balance, resulting in numerous falls; and just this past Sunday while standing to sing at church, her legs had given out on her, requiring other members of the congregation to assist me getting her back into her chair. Prospects were not bright.

            A natural and even logical response might be to become angry and bitter, blaming fate for this preempting of what are normally hoped to be happier, ‘golden’, more relaxed, retirement years. All but one of our dozen grandchildren are just ten years old or under! One begins to survey wistfully the social media posts of colleagues who are jetting off to exotic tourist spots at this stage of life.

            Disease and affliction can prompt angry reactions. One friend posted on social media the news of a young twentysomething mother of four who suddenly found out she had a brain tumour. At the end of the post, amongst various other hashtags, was included the increasingly popular expletive, “#f---cancer”. Is that the most profound thing we can say when circumstances take a nosedive for us? Do we have a right, is our cause just, to lash out angrily when it becomes apparent our life may be terminated unexpectedly prematurely and painfully?

            This makes the statement by the podcast speaker, John Piper, all the more startling... “God designs all the afflictions of the godly for the increase of their everlasting joy.” Piper wasdefending his portrayal of New England Puritan theologian Jonathan Edwards as a Christian hedonist. Piper went on to paraphrase Edwards’ sentiment thus: “In other words, the only troubles that God permits in the lives of his children are those that will bring more pleasure than trouble with them — when all things are considered.” This would make it more palatable to speak of God ‘designing’ afflictions for our joy’s increase, if it can be shown that they will make our end-state ultimately more joyful. The troubles will be worth it.

            To back up this assertion, Piper notes Edwards cites four Biblical references: #1 “Blessed are you when others revile you and persecute you and utter all kinds of evil against you falsely on my account. Rejoice and be glad, for your reward is great in heaven.” (Matthew 5:11–12) #2 “Count it all joy, my brothers, when you meet trials of various kinds, for you know that the testing of your faith produces steadfastness.” (James 1:2–3) #3 “Then they left the presence of the council, rejoicing that they were counted worthy to suffer dishonour for the name.” (Acts 5:41) #4 “You joyfully accepted the plundering of your property, since you knew that you yourselves had a better possession and an abiding one.” (Hebrews 10:34)

            References 1, 3, and 4 seem to be more in the context of blatant persecution rather than suffering in general. Still, there are some relevant inductions that can be made. There is a reward in heaven that corresponds to our difficulties on earth. It is possible to rejoice despite suffering, when the connection can be made between our suffering and the honour of Christ’s name. And, a “better” and abiding possession awaits believers in the next life, even if this present earthly one comes up short.

            To me, it seems the quotation from James (#2) is most broadly applicable to our troubles in general. God allows us to experience trials so that our faith can be tested, it proves itself to be “the real McCoy” – and this testing produces steadfastness, un-rockability of conviction. A similar thought is found in Hebrews 12: “Endure hardship as discipline... God disciplines us for our good, that we may share in His holiness. No discipline seems pleasant at the time, but painful. Later on, however, it produces a harvest of righteousness and peace for those who have been trained by it.” (Heb 12:7a,10b-11) God has designed trials to produce the end result of holiness and righteousness. He’s grooming us to reflect His character, rather than just for our comfort.

            The Lord Jesus expressed something similar when describing God’s overall growth plan for us using the familiar metaphor of a grape vine and its branches. Not only do we need to remain connected to Christ as the ‘vine’ and source of sustenance; we need to be prepared to accept the ‘pruning’ of the Divine Gardener. “...Every branch that does bear fruit He prunes so that it will be even more fruitful... This is to my Father’s glory, that you bear much fruit, showing yourselves to be my disciples.” (John 15:2b,8) There are no shortcuts to fruitfulness! Our steadfast trust in our Sovereign God in the face of hardship, convinced that He knows what He’s doing despite all appearances to the contrary, brings honour and glory to God.

            Another Scripture promise I cling to in this regard comes from one of the apostles who suffered most severely, Paul, who wrote: “Praise be to the God and Father of our Lord Jesus Christ, the Father of compassion and the God of all comfort, who comforts us in all our troubles, so that we can comfort those in any trouble with the comfort we ourselves have received from God.” (2Cor. 1:3-4) Here, troubles not only provide an opportunity for God to show us His Holy Spirit is indeed the Comforter; troubles also provide the Body of the church a chance to practice sharing comfort with others.

            During my wife’s illness, we have been blessed by many volunteers delivering meals and taking time to visit with her while I carry on my employment duties. Then one day this past week, a couple of dozen workers showed up to spend several hours grooming our flowerbeds and generally improving our yard, making a startling improvement in its appearance. Several remarked what a good time they had doing it, too. So hardships and afflictions not only give the individual a chance to grow spiritually: they provide the faith community a platform from which to show forth God’s lovingkindness in a tangible way. Sounds like something He might have designed for our good and His glory!