Protect Your Spirit

"The spirit of a man will sustain his infirmity; but a wounded spirit who can bear?" -Prov 18:14

High-Level Process Update

The port placement was done this past Tuesday, and we met with Dr. Yi, famed surgeon specializing in cancer patients. He expected that I will get a bowel obstruction at some point in the next few months during chemo, so he strongly suggested surgery first to perform a colostomy and avoid this risk. After discussing further with Dr. Yang yesterday, the probability and severity of this situation seems less of an issue, so I have decided not to elect for surgery first. But, as such, Dr. Yang recommends taking the first chemo dose ASAP, which will be tomorrow (Saturday).

Also the liver biopsy came back confirming colon cancer cells, which is what everyone already expected - "extensive metastatic disease" is the way the reports expressed it.

Why Take Risk and Decline Surgery?

As much as I hated the idea, I understood Dr. Yi's reasoning and was prepared to proceed accordingly. But a subsequent meeting with Dr. Yang yesterday afternoon shed a somewhat different light on the situation and changed my mind. He was much less pessimistic about the probability and the gravity of an obstruction. He and the other two women in the room (navigator, dietitian) could only recall a small number of cases over the past several years where a colostomy became necessary due to an obstruction AFTER starting chemo. Their experience was that, contrary to Dr. Yi's prediction, most patients enjoyed a shrinking of the primary colon mass soon after initiating chemo.

I realize Dr. Yi is highly credible, but my reasoning is that he primarily sees the patients requiring surgery, and is not exposed to the full population including similar patients who do not. In contrast, Dr. Yang and associates realize that Dr. Yi's surgery patients are a small percentage of the whole.

One other minor factor is that Dr. Yi did not express much optimism about reversing the colostomy in the future. If the primary mass in my case had not invaded surrounding tissues, he would have tried to remove it during surgery. But if so, the mass would have to stay. Also, he could not tell how far down into the rectum area the mass extended until surgery, which would also govern removability and/or future reversibility. For what it's worth, Dr. Yang has experienced Dr. Yi's reluctance to reverse colostomies in other patients as well.

The key point I heard from Dr. Yang was that it was not stupid to skip the surgery, based on experience of many other patients. This was important to me, because of a principle of our faith: Do not tempt God. If I am not tempting God, I will tolerate some level of risk. 

The classic example of this is when Satan took Jesus to the pinnacle of the temple and prompted Him to jump off, and thus prove He was the son of God when the angels would save him (according to the promise in Ps 91). Jesus answered with this scriptural principle: Thou shalt not tempt the Lord thy God. Meaning, Jesus was expected to take the stairs down from the pinnacle - It would have been sin to jump off, because there was another significantly lower-risk option available. Jumping off would mean certain death without the presumed angel to catch Him.

I have belabored this point about tempting God because it applies to so many decisions involving risk - medical or otherwise. If we have two choices with significantly different risk profiles (considering probability and gravity), God expects us to take the lower risk. But this is not an absolute rule. A choice that tempts God must be an unreasonable risk, such as jumping off the pinnacle of the temple. Thus it is not necessary in God's sight to make choices with an absolute minimization of all risk.

Some of you might remember a sermonette from about 5 years ago that I entitled "Tempting God or Leap of Faith", in which I presented the dilemma Ezra had when transporting a gargantuan amount of gold and silver from Babylon to Jerusalem for the rebuilding of the city. Should he ask for armed escorts from the king, or not? He had just told the king that the Lord blesses and protects His children, so he was embarrassed to then ask him for soldiers. He and his cohorts were not totally sure if they were tempting God by proceeding in their journey unarmed, so they fasted and prayed first. Then they set off on their ~4-month journey sans armed escorts and the Lord protected them, no problem.

Prognosis

I realize neither God nor natural reality operate according to averages. The meaning of an average is that there are some numbers higher and some numbers lower, perhaps significantly so. So when we talk about life expectancy, there is some large probability distribution around whatever the median would be. I think it would be something like a Weibull distribution, but it has been a long time since I had statistics. Almost no one dies in the first couple of months after diagnosis, but a few live for decades. A predicted median in a case like mine, according to Dr. Yang's experience, might be 2.5 to 3 years (but remember I am not even 40 years old, otherwise healthy, and I love God). Nevertheless, this helps me quite a bit in terms of choosing how to invest my time.

Protect Your Spirit

It's also true that I simply do not want a colostomy. I just don't. I know this feeling is not logical, but there is another component at play: the human spirit. I believe Dr. Yang picked up on this in our lengthy discussion... I think he could see that an unnecessary colostomy would wound or break my spirit to a degree, which could be detrimental to my longevity or quality of the time I have left. 

The text opening this post is very important, and there are other passages teaching this point as well. If you maintain faith, hope, cheer, and courage, your spirit can carry you through massive tragedies and difficulties. If you have a wounded or broken spirit, you're done.

Will I end up in the ER with an emergency surgery? Maybe. If I have to do it I will, and I will be thankful for it. But I don't think we're there yet. I am just not ready to make such a big semi-permanent change to my anatomy. 

The spirit of a man will sustain his infirmity. Whatever you face, protect your spirit.