Future Looking Decision Making

Posted March 29, 2012 by brucebuchanan
Categories: cancer, chemotherapy, decision making

We have been on the market for a new van for a number of months.  The repairs on our old van were getting more frequent.  However, for us, the decision of which van to buy was not intuitive.  It would be a major expense, and we knew that we would have to live with the consequences of that decision for years.   Last Saturday we bought a new (to us) van in Pennsylvania.  We chose to buy it in Pennsylvania because it would not have been exposed to as much metal-eating salt as New York vehicles face each winter.   We looked seriously at about two dozen vans in the Lancaster area.  We considered their age, condition, features, mileage, economy, anticipated future repair costs, and price.  Ultimately, we decided on a 2006 Town and Country with 41,000 miles, but it wasn’t an easy decision.   It was complex; many interrelated factors had to be addressed.

Over the last month, we have also been addressing another complex, future looking decision about chemotherapy.  I had an uneasy feeling about the decision because chemotherapy is a process.  It is a long, demanding and debilitating “process”  (and I have a harder time with processes than events).  You don’t just receive anesthesia and wake up six hours later with it behind you.  Although I understand that chemo affects patients differently, NONE of its side effects were appealing to me.   In addition to chemo, we considered alternative approaches.  As we wrestled with this complex decision, we asked ourselves, “In which decision is it worse to be wrong?”[i]

Careful decision making is a task that I wanted to teach each of my sons as they were growing up.  In the year that each turned twelve years of age, I took them hiking.  Although we go on hikes from time to time as a family, this hike was intentionally chosen to include a mountain climb with a panoramic view from the top. At the top, I encouraged my sons to think of the view as the future. From the mountaintop you could take in not only the nearby hills, but also the distant valleys, and mountains.  As we looked out over the other mountains, hills, valleys and countryside, I challenged each of my sons to be a “mountain” man.  Not a “mountain man” in the sense of the hunters and trappers of the nineteenth century, but a “mountain” man, as opposed to a “valley” man.  I want my sons to be men who will consider the distant consequences of decisions they make in the present.  On the other hand, a man in the valley can only see what is immediately before him. If he makes decisions on the basis of his view, he will be shortsighted, only considering the immediate, the moment.

Future looking decision making is often involved when one is deciding whether or not to date someone seriously, or consider marriage, or adoption, or a home purchase, or a business venture.  Such decisions often weigh the long term, future benefit, versus the probable negative consequences or problems.  When we decided on the van, we tried to make our decision in terms of what would be best for our family over the long haul [no pun intended], and when we were weighing the decision on chemotherapy, we tried to evaluate the options in terms of their potential long term consequences.

It seems so natural to consider whether a car will meet our needs and will last into the future without needing expensive repairs,  or to consider whether option A versus option B is more probable to give us a longer life after cancer.  But future looking decision making really needs to be applied to the choices we make in the present for the distant, distant future.   Some people give more thought to their ride — which will likely be scrap metal in twenty five years — than they do to their eternal destiny.  It would be wise for them to consider the helping question, “In which decision is it worse to be wrong?”

“As it is appointed unto men once to die, but after this the judgment.”  Hebrews 9:27

Jesus said to him, “I am the way, and the truth, and the life. No one comes to the Father except through me.” John 14:6

_____________________


[i] Decision-wise, we decided to go ahead with chemotherapy, because based on my situation, chemo seemed to be the wisest choice, especially as we asked the question, “In which decision is it worse to be wrong?”  However, my future, medically speaking, or my life in general, is ultimately in God’s hands.  The outcome of the chemo, and my future life will all be up to Him.  Yesterday I had my first chemotherapy infusion at the Cancer Institute in Buffalo.  I am now back home and wearing a chemo infusion pump which will continue to dispense additional chemo agent into me today through tomorrow morning.  Then it will be disconnected and I will have about a week and a half off before I begin cycle number two of twelve two week cycles.

Advertisements

Hospital Doors

Posted February 28, 2012 by brucebuchanan
Categories: living, providence, Uncategorized

On Wednesday, while waiting to leave the hospital for the drive home after surgery, I sat on a bench near the hospital doors and watched the many faces coming in.  I had come in through those doors a half dozen times in the previous month.  I reflected on the thoughts that had gone through my mind each time I had walked through those doors.  On December 27, right after my diagnosis, I wondered about this hospital, the doctor I was about to meet, and what she would say and find out about my cancer.  During one visit, because I had fasted in preparation for a procedure, I wondered how soon I could eat lunch and what I would like to eat when I could.  During another visit I tried to make sense out of the very conflicting results I was getting from various tests, and wondered what the doctor would find that day.  I was back a couple of other times too, but when I came through those doors on February 2, it was for the surgeon to perform a colectomy to remove the section of my colon where the cancerous ulcer was found.  In my heart, it was my desire for God to be glorified in my life that day, but I also wondered what this experience would entail for my family and me.

That Wednesday while I waited for my ride, I wondered about each of the faces coming through the doors.  Some were the faces of medical professionals, coming in for a day’s work.  Some were patients.  Some were volunteers.  Some were family members of patients.  Doctors with stethoscopes and briefcases walked in next to chemo patients wearing knit caps.  Volunteers hurried by husbands who were carefully pushing their wives in wheel chairs.

I also realized that for a moment in time, the hospital doors framed together strangers who knew nothing about each other.  As I looked at the faces walking by, I realized that they were not looking at each other.  They all were preoccupied.  They all were wrapped up in their own concerns, anxieties, plans and daydreams.  I realized that I had been equally oblivious of those who had walked through the doors beside me each of the previous times I had entered.

Life does the same thing.  It frames me together alongside strangers that I don’t even know.  I, in my own little world — they, in theirs.  In Matthew 5, Jesus presented the picture that His followers were to be influencing and providing light for their world.  I don’t naively believe that it is my responsibility to personally interact with “everyone” who “happens” to walk through doorways next to me.  But I am challenged to consider, when in a moment of time life “frames” me next to others:   “Do I, in that passing moment, pay attention to, or care, or speak to them about what is on their hearts?”  How many times am I “in my own little world,” thinking my own private thoughts, without a thought or a care for that other soul who God has providentially arranged to be right beside me?

Jesus said:  “You are the salt of the earth; but if the salt has become tasteless, how can it be made salty again? It is no longer good for anything, except to be thrown out and trampled under foot by men.  “You are the light of the world. A city set on a hill cannot be hidden; nor does anyone light a lamp and put it under a basket, but on the lampstand, and it gives light to all who are in the house. Let your light shine before men in such a way that they may see your good works, and glorify your Father who is in heaven.”  Matthew 5:13-16

Life Events versus Life Processes

Posted February 24, 2012 by brucebuchanan
Categories: living, Uncategorized

I want to thank all of you who were praying for me as I underwent surgery for colon cancer on Thursday, February 2 at Roswell Park Cancer Institute in Buffalo.  I was discharged on Tuesday, February 7 and went back for a follow up appointment on Friday, February 17.  I understand that medically speaking the surgeon believes he removed everything that he needed to in order to minimize the probability of the cancer spreading (i.e., part of my colon and the attending lymph nodes).  However, I realized that night after my surgery, and the next day, and the next, that although the surgery was behind me, there were definite “mile markers” which the doctors and nursing staff were looking for as they monitored my body’s recovery.  Colon resectioning was not as simple as cutting out a piece of PVC pipe, gluing the two ends together, and returning everything to “good to go” condition again.  I realized that every one of those “mile markers” were important.  Besides being mindful of the actual “plumbing” repair, the doctors and nurses were constantly watching for blood clots, increased temperature, swelling, blood pressure, nausea, etc.  Diet was restricted and only incrementally changed until eventually I was (more or less) back on a full diet again.  What struck me was that I went into the surgery thinking a great deal about the event of surgery, but not much about the process of recovery that would come afterward.

Events call attention to themselves.  They are often specific.  Unless they come as a result of an accident, they are often “planable.”   They can more or less be represented as “points in time.”  A person goes through an event, but then it is past, and he/she “moves on” with his/her life — even if the event was life changing.  But processes are different.  They tend to be ongoing.  They don’t have clear-cut points of termination.  They may be measured by various mile markers, but they have linear characteristics.  My surgery was an event.  It took place on February 2. But by that evening, the event of surgery was over, and I had entered the process of recovery.  Over the next three or four days the medical staff watched for various mile markers to indicate that the healing was progressing, but none of those markers were worth “writing” about.  Yet at every point, if the recovery hadn’t proceeded as it should have, there would have been a concern because something was wrong.

Processes are harder to remember.  I would suggest that many who have lost loved ones have found sympathy and support at the time of the funeral, however they may not have received as much support as they went through the grieving process in the following days and weeks and months.   Events are “rememberable” by others, in that it may be easier for others to remember and express concern, offer prayers, or reach out to a person at an “event” time of his/her life, whether it is a surgical procedure, death, or accident.  But the process of building (or rebuilding) that comes afterward may be forgotten by those who were so supportive during the difficult moments of the event.

Two days after surgery I wrote:

“I am finding that it is harder for me to deal with the process than the event.  Surgery was a one time event.  I prayed for God’s will to be done and committed the outcome to Him.  The doctors started the anesthesia and my conscious involvement was over and done.  But recovery is not so simple.  Every day involves waiting, waiting for ‘things to happen,’ which are very important, but which may not happen as the doctors expect, hope and anticipate.  There are very few actions I can take to help the recovery process, but those actions cannot ensure results.”

I am thankful that God has facilitated my recovery, and I am thankful for my friends and family who continue to support me as I am in this recovery process.  They haven’t forgotten me now that the event of my surgery is past, but I would suggest that almost anyone who goes through a significant life event may also have an equally important process that follows.  Don’t forget about that person who just had surgery, or an accident, or the death of a loved one.  He/she may be going through a very significant process in his/her life, the outcome of any part thereof may be every bit as consequential as the event itself.

In the realm of Christian experience a parallel may be that there is often a great deal of focus on the event of a person turning to put his/her trust and belief in Jesus Christ.  That event, or experience, is highly valued and celebrated, and it should be.  However, there is also a process which ought to continue from that point into the future.  That person should continue to follow Jesus Christ as one of his disciples, or followers.  Following Jesus Christ is a process.  It is not just an event.

I am thankful that the writers of the New Testament encouraged the followers of Jesus Christ to be praying for one another.  I need that reminder.  I need to be reminded to pray for others, not just when they are going through significant events in their lives, but also as they go through the routine and seemingly mundane processes that make up our everyday existence.  I am thankful that my recovery has been “uneventful,” that there have not been any complications or problems, that the doctor and nurses gave me a “thumbs up” at my follow-up appointment a week ago (my body appears to be healing well, and no cancer was found in the numerous lymph nodes which were removed), but I realize that it is all because of God and what God was doing in the processes that were taking place in my body.  I will close by thanking all of you who were (and are) praying for me as I go through this process of recovery.  May I, by God’s grace, likewise be faithful in praying for you, as you go through various events and processes in your lives, as well.

Living Intentionally

Posted January 24, 2012 by brucebuchanan
Categories: living

Tags:

When I was first diagnosed with colon cancer five weeks ago, I wrote about how our lives, like roads, can have familiar and “predictable” sections.  But God, for His purposes, sometimes sends us off the predictable into the unfamiliar [ Detour Ahead, Exit Now ].    I’ve been on those “unfamiliar” roads the last five weeks and I have written about frustrations [ GPS is Spinning], and the challenges of unanswered questions [ Unanswered Questions  and Solving a Maze ].

Two weeks ago my ulcer, after being somewhat hard-to-find, was found again.  Then last Tuesday I met with the surgeon in Buffalo and we scheduled surgery for next Thursday, February 2, to remove the cancerous part of my colon .

In the last few weeks, my life has become very “intentional.”  I have been very selective of what I have done in my waking hours.  Because the doctors have told me that I will be “out of commission” for at least four weeks, I have wanted to finish up as many important partially completed projects as possible.  I have also wanted to get everything ready and scheduled for those who are going to be speaking in my behalf at my regular speaking engagements.  And I want to select and gather the various books that I hope to read while I am convalescing.  And since it is winter, and we live in upstate New York, I have wanted to make arrangements for our home and cars so that as much as I can, I will have everything in place for my wife and youngest son to be “ready” for whatever weather we receive in the month of February [both Patty and my son have now had, and passed, “snowblower lessons” 🙂 ; and for the first time in ??? years, our garage is cleaned out and there is actually room to park a vehicle inside(!)].  All of this has only come about by God’s grace and by my being very “intentional” in how I have used each day.

Recently, however, I have thought a lot about “intentionality,” and about how we can be very motivated and intentional when we have a project deadline, a test, houseguests coming, or a vacation.  I can also imagine that a person with an awareness that he has a terminal disease, and probably limited time on earth, can also be very “intentional” in how he uses his available strength and days.  We prioritize that which is important, which we must “get done,” when we have limited time.  Several verses in Scripture have come to my mind.

James writes: “For what is your life? It is even a vapour, that appeareth for a little time, and then vanisheth away.”  (James 4:14)

In this passage I am reminded that all of our days are unpredictable. Therefore we shouldn’t presume to have or take any present or future day “for granted” – whether or not we have an upcoming “deadline.”   We may not have a tomorrow.

Paul writes:  I [appeal to] you therefore, brethren, by the mercies of God, that ye present your bodies [as] a living sacrifice, holy, acceptable unto God, which is your reasonable service.”   (Romans 12:1)

Paul reminds me that I am to be making conscious choices to present myself to God in ways that are acceptable to Him.  This applies every day, not just when I am highly motivated to accomplish some goals, or when I see my time “running out.”  All of my life is to be lived in such a way as to be pleasing in God’s eyes.

Jesus says:  “Therefore I say unto you, be not anxious for your life, what ye shall eat, or what ye shall drink; nor yet for your body, what ye shall put on. Is not the life more than the food, and the body than the raiment? Behold the birds of the heaven, that they sow not, neither do they reap, nor gather into barns; and your heavenly Father feedeth them. Are not ye of much more value then they? And which of you by being anxious can add one cubit unto the measure of his life? And why are ye anxious concerning raiment? Consider the lilies of the field, how they grow; they toil not, neither do they spin: yet I say unto you, that even Solomon in all his glory was not arrayed like one of these. But if God doth so clothe the grass of the field, which to-day is, and to-morrow is cast into the oven, shall he not much more clothe you, O ye of little faith?”  (Matthew 6:25-30)

Solomon writes:  “Let us hear the conclusion of the whole matter: Fear God, and keep his commandments: for this is the whole duty of man. For God shall bring every work into judgment, with every secret thing, whether it be good, or whether it be evil.”  (Ecclesiastes 12:13-14)

I am here reminded that while Jesus tells me that I am not to be driven by anxious worry, Solomon reminds me that ultimately it does matter how I live.

And so I am reproved, that while I have been motivated to live very purposefully, very intentionally, these last few weeks, and I have genuinely wanted God to use my present experience with cancer for His purposes, I really need to live purposefully, “intentionally,” in a way that is acceptable in God’s eyes, every day, not just when I’m staring at foreshortened days, an imminent challenge, a trial, a deadline, or an ordeal.

Solving a Maze

Posted January 16, 2012 by brucebuchanan
Categories: cancer, decision making, providence, sovereignty, Uncategorized

Tags: , , ,

The last couple of weeks have been interesting.  It has been very much like trying to figure out a maze on paper.  With a pencil one tries different paths and then finds that one after another, each path seems to be taking you to a desired end, but instead leads you to the same place, a dead-end.  In diagnosing medical conditions, doctors need to rule out improbable causes from probable ones.  It is interesting when you are the patient.  Each test could lead to an answer to the puzzle of what’s wrong with you.  As you go through each test you weigh all the “what ifs,” both good and bad, for what that test could reveal.  You don’t want to become too “invested” in the results of any particular test because you know that another test could invalidate any earlier conclusions.  This is the maze that I have been living for the last couple of weeks.

Many paths have been tested; but the results have been inconclusive.  After my colon cancer was diagnosed on December 15 I had a CT scan to see if the cancer had spread to other organs.  Good news, it hadn’t.  Then a second pathologist interpreted the biopsy.  Bad news, confirmed, it was cancerous.  Then I was given a blood test to see if there were any indications of cancer.  Good news, there weren’t.  Then I had another (abbreviated) colonoscopy. Good news(?), the ulcer was not found.  Then a PET scan.  Good news, no cancer found.  Then I was given a DNA test to see if the biopsy was someone else’s.  It was mine.  The sequencing of all these tests was giving the impression that there definitely was cancer in my colon on the day of colonoscopy #1 (December 13), but the cancer seemed to be off the radar from then on.

With each test, I couldn’t help but “imagine” what results (a) versus (b) could mean.  Naturally I was thankful for every result that indicated “no cancer.” But the seeming contradiction between the initial diagnosis and the follow-up tests was hard to reconcile.  On December 15 I became aware that God telling me it was time for a detour from the predictable (see “Detour Ahead, Exit Now,” below).  My mind was racing, thinking of all the ways my life could go with a cancer diagnosis – Metastasis? Chemo? Radiation? Surgery? Numbered Days?

First I wondered about metastasis and very numbered days, then I wondered about errors, “Whose biopsy was it?”  “Did the doctor make an error? Or the lab?” Then I wondered if God might have healed the cancer.  The result of every test could have been (a) versus (b) and it was hard to not reach premature conclusions whenever a test result came back.  I was wrestling with the questions, “God, what are you doing?”  “What’s going on?”  “God, have You, in fact, healed me? Or have You not, and would I be foolish not to pursue the recommended medical advice?”  “Or if God really had healed me, would I be foolish to let them remove one side of my colon, as a precaution, ‘just to be sure?’”  [I certainly didn’t like the last idea at all!]

I knew that when King Nebuchadnezzar threatened Shadrach, Meshach, and Abed-nego with death they acknowledged that God could deliver them miraculously, if He would so choose, but they didn’t know if God would (Daniel 3:17).  Similarly, I knew that God could have healed my cancer after it was first diagnosed, if He wanted to, but I didn’t know if He had.  Many people were praying for me, and I would imagine that some were praying for God to heal me.  However, from the beginning of this journey it has been my prayer that God would do according to his will with the result, not necessarily of my healing, but rather with the result that He would be the most glorified by what He would choose to do in my life.

I knew that the Bible recorded that God used hardship in the lives of many of his servants for his purposes, even though his purpose was often hidden from the view of the particular servant.  I wondered what God was going to do in my life.  Would I know his purposes?  I had many questions, and no idea of what the doctors were going to conclude, or if God was doing something miraculous, or where God was leading.

However, last Friday (January 13) I had colonoscopy #3.  It was a full colonoscopy, and myRoswellParkdoctor was able to find the ulcer this time.  After the procedure she said, “I found it, it is small, and that is good – but it needs to come out.”  Then, all of a sudden, it became clear to me that the other “paths” in the maze, some of which had appeared to be very appealing, were dead-ends.  God now seems to be showing me, “This is the way, walk in it.”  So, in this I will rejoice and continue to pray that God will do what He will so that He might be the most glorified.

“Yet I will rejoice in the LORD, I will joy in the God of my salvation.”

Habakkuk 3:18

Decision Helping Questions

Posted January 8, 2012 by brucebuchanan
Categories: cancer, decision making

Tags: ,

It is now expected that the results from a DNA test on my biopsy will be back the first of next week.  Until then I am in a waiting pattern.  When the results come back it is possible that I will be faced with a difficult medical decision with no clear-cut obvious direction to go.  A couple of times I have asked a wise friend for suggestions of questions to ask doctors at difficult decision points, such as this.  The questions that have been suggested to me have been very helpful and I have decided to share them.  I have reworded them so that they all refer to a “treatment” or “procedure.”  This could be major or minor, in-patient or out-patient surgery, or some other treatment plan.  Feel free to use one or more of these as a starting point if you have to talk to a doctor about a difficult medical decision for yourself or a loved one.

As a pastor I have met with many families who have had loved ones facing decisions about medical procedures and treatment plans.  Sometimes the families have been well informed of their options, sometimes they have not.  Some have done exactly what the doctor has recommended; some have explored other possibilities, and taken slightly different routes.  Neither is necessarily right or wrong.  I know that I want to be as well informed as I can be before I make major medical decisions.  I certainly want to encourage others to be as well informed as they can be too before making (sometimes) irreversible decisions.

Regarding the current situation:

  • You may want to begin your discussion with your doctor by saying something like:  “I hope to learn from you my medical condition and its prognosis, along with all the possible treatment choices and your recommendations for which of them to do and in what order.”
  • “Do you already have all the information you need to make those determinations, or will you want any other tests?”
  • When the doctor discusses your prognosis, both in terms of the underlying disease and in terms of specific courses of action, ask him/her to please put numbers on the probabilities.*
  • “What are the risks, statistically, if I do have the treatment you are recommending?”
  • “What is the range of effects I might experience if I don’t have the recommended treatment?”
  • “What are the treatment alternatives, and their respective risks?”
  • “What might happen if I don’t do anything?”
  • “What are the risks, statistically, if I don’t do anything?”
  • “When and how might I become aware of physical effects?”
  • “If you do the recommended surgery (or procedure), what are the possible ‘surprises’ you might find, and their probability?”
  • Before any surgery or extensive treatment program it is often considered to be wise to get a second opinion from a specialist not affiliated with your doctor (in other words, not his/her partner, or in the same medical group).
  • Your meeting may end with your being faced with a decision on what to do and where to do it.  It may be helpful to make it a rule to try to never make medical decisions without having a chance to talk privately, without medical personnel present, with your spouse or other family member(s), or close friend(s).  Where possible, it would be good to have at least an overnight period to discuss and ponder, but that can’t always happen.  You almost always can go into another room with your spouse or family members or friend and talk (and pray) privately and then come back and give your answer.
  • A question to ask yourself:  “In which decision is it worse to be wrong?”

Regarding post-treatment:

  • “What effect will this procedure have on my future overall medical condition?”
  • “What effect will this procedure have on my lifestyle (for example: diet, exercise, mobility, health, etc.)?”
  • To the doctor:  “Based on your experience, do you already know what the probability is that I will be needing any particular treatment following the surgery (e.g. chemo, radiation, physical therapy, etc.)?”
  • To the doctor:  “What, if anything, can you tell me now about those post-surgical treatments and their impact, frequency, duration?”

Neither I, nor the person who gave me these suggestions, is licensed to practice medicine.  Hopefully these questions will help you get helpful information for your decision making process from those who are.

“The fear of the LORD is the beginning of knowledge: but fools despise wisdom and instruction.”
Proverbs 1:7


*  Please note that statistical probabilities are never “guarantees.”  In asking doctors about statistical probabilities you must understand that no doctor can guarantee any particular outcome and any statistical probability could be way off in any individual situation.  You must carefully weigh the answers you receive against ALL of the other options.

Joni Eareckson Tada

Posted January 3, 2012 by brucebuchanan
Categories: cancer, providence, sovereignty, Uncategorized

Tags: , ,

When I do aerobic exercises at the gym I usually listen to an MP3 of some conference lecture, or occasionally I read magazine or journal articles. When I went to the gym today I wanted to be sure that I could hear my cell phone if I got a call from a doctor or the mechanic who was working on my car. Consequently, instead of the iPod, I pulled a couple of magazines out of my gym bag before heading to the stair-step machine. It has been quite a few months since I’ve read any articles. The magazine I “happened” to pick up was the October 2010 issue of Christianity Today. It had been left folded open to pages 30-31. As I glanced down I saw that the article title was, “Something Greater Than Healing,” an interview with Joni Eareckson Tada.

In 1967, at age 17, Joni was severely paralyzed in a diving accident and has been living with quadriplegia ever since. For the past ten years she has been living with chronic pain. Last year, at age 60, a month before the article was written, she was diagnosed with breast cancer. Today, January 3, 2012, I appreciated all of what Joni had to say in a way that I wouldn’t have a month ago. Here are some excerpts from the interview.

——————————————————————————————–

CT: How has your perspective on suffering and healing changed since your breast cancer diagnosis?

Thankfully, it hasn’t changed at all. You examine Scripture again and follow every passage regarding healing. I did that with my quadriplegia, and I did that again 10 years ago, when I embarked on a whole new life of chronic pain. Just a month ago, getting diagnosed Read the rest of this post »