by John Creasey
And not one of them will fall to the ground apart from your Father.
But even the hairs of your head are all numbered.
Fear not therefore; you are of more value than many sparrows.
~ Matthew 10:29–31
It is one year ago today the Enemy Cancer’s behind the lines infiltration was discovered. One year ago that friendly forces launched an all out counter attack designed to destroy the Enemy. One year during which Dixie’s body has been a battlefield for Good vs. Bad cellular warfare.
One year in which my heart has broken a little more each day.
Tuesday. We return to UWMC for a visit with Dr. Park, still the soft-spoken youngish gentleman we have grown to respect and in whom Dixie has great confidence. We are joined in the small examination room by a resident physician. We crowd in together as Dr. Park brings up pictures of Dixie’s most recent CT scans on the computer screen, explaining in detail what we are seeing.
The spots we observe in the lungs appear to have responded to the chemotherapy for now, but the target of immediate concern is still the liver where the original pancreatic tumor has metastasized. The reason we are here today is to discuss options for the next battle strategies, 1) surgically burning the mass (now 2.4 cm or approximately one inch in size) clearly visible in the scans, or 2) taking the route of proton therapy. I watch and listen while Dr. Park patiently goes over the pros and cons of both procedures with Dixie and then makes his recommendation.
I know Proton therapy is not Dixie’s first choice. We have discussed this numerous times. But her countenance expresses clear relief at hearing Dr. Park’s recommendation. She trusts him and his argument in favor of proton therapy has made good sense to her. There are no guarantees of success, but the percentages are favorable for a good outcome with far fewer side effects. This is it then.
On Thursday of next week, we will make an early morning stop at SCCA to replace a lost power port identity card. Then it’s on to UWMC for a 9 o’clock blood draw, a stop at the admitting office, and then to F1 and Radiation where the surgical insertion of tiny seeds around the tumor attached to the liver will take place. This procedure and follow-up will keep us here the rest of the day. It is the essential first step in Dixie’s proton therapy procedure. Nothing comes easy.
And so the battle continues. A year ago, we did not get one another Valentine cards. It was not high on our list of priorities that day. And this year, I forgot to even get cards for our kids. It is something that has never been on my to-do list in the past. Dixie takes care of these things. So my apologies to all. Sorry, kids. And best wishes to everyone. Happy Valentine’s Day. You are special. You are loved. Really.
46
Our Family in Christ
“If God is our father, the church is our mother.” The words are those of the Swiss Reformer John Calvin . . . It is impossible, unnecessary, and undesirable to be a Christian all by yourself as it is to be a newborn baby all by yourself.
~ N.T. Wright
Thursday 19 February. I awaken Dixie at 4:30 for a small portion of yogurt, water for MEDS, and black coffee. She is not permitted to eat anything solid after 5 o’clock until the surgical procedure later this morning is completed. We arrive at UWMC AT 8:45, for blood draw and admitting, then to F2 and Radiology. After the extensive prep, I kiss her lightly and watch as she is rolled away to the procedure room. It is 12:40 when I accompany her to F4 East Tower where she will remain under observation until 5 o’clock.
I make a latté run for her while she orders a sandwich and snicker doodle cookie and some apple juice. The Plaza Café on F1 is considerably larger than SCCA’s Red Brick, and with many more choices. Life is good. The next few hours are spent reading and dozing. At 4:45 she is released, fifteen minutes early. I want to wheelchair her to parking, but she refuses; and so we make the long F3 walk to Pavilion parking slowly, recover our car and make our way back across the Lake Washington to Bellevue and home. It’s been a long, arduous, but successful day.
The tumor was located by ultrasound and then the skin pierced twice to accommodate the placement of two soft tissue gold fiducial markers in the liver near the mass. The markers will enhance accuracy and efficiency during proton therapy, providing real-time accurate localization of the treatment volumes. These are essential, we are told, whenever the target may move during and between treatments relative to external skin markings.
Next week we will return to the Proton Therapy Center in north Seattle to see what is ahead. We have been told 10–15 treatments will take place, but don’t know yet exactly when these will begin, how many for sure, and with what frequency. We are grateful for these good people and their skills, the futuristic equipment, the caring attitudes we meet every day, and that it all exists within a few miles of our home. And most of all we are grateful for our family. Our extended family, yes, but also the family, the community we enjoy in Christ.
Now you are the body of Christ and individually members of it. ~ 1 Corinthians 12:27
Life stories are celebrated in the gifts of Word and sacrament, in birth and health, in illness and death. Our new lives, our redeemed lives began in Christ and the church. A small church in a farming/ranching community is where I made a serious life commitment to Jesus and was baptized. For Dixie, it was a church body formed in a large city nearly two thousand miles from my hometown. Church communities very different, very distant. What are the chances we would ever meet?
Dixie and I have served three churches in our lifetimes. Though I’ve not kept an accurate count, I’ve preached in more than 200 other churches, plus youth camps, radio, television, marriage seminars, seminary classes and church conferences. Dixie has been at my side, teaching and speaking on many of these occasions. Three churches plus. Weddings. Funerals. Infant dedications. Baptisms. Christ and his community. Our family!
Perhaps you are one of these we have met only once. Others many times over. Some have long since made the final turn, crossing the finish line of their sacred journeys. Many we’ve simply lost track of through the years. Some we’ve known only through notes or letters or brief conversations. Still others have come back to us in this past year of shadows; old friends and brand new, again and again, with prayers and encouraging words. The physical body is an amazing thing. The body of Christ more amazing still!
Who could have known so long ago that two scared kids, with no real idea of what was ahead, were about to experience such holy adventures as these?
Actually there is One who knew right from the start.
And all he said was, “Follow me.”
I tread no path in life to Him unknown;
I lift no burden, bear no pain, alone;
My soul a calm, sure hiding place has found;
The everlasting arms my life surround.
~ from “God, Thou Art Love,” Robert Browning
47
Don’t Breathe
When I am afraid, I put my trust in you. ~ Psalm 56:3
It has been four weeks since Dixie’s last chemotherapy infusion treatment. She is feeling considerably better as a result. It was 19 February, when doctors planted the two permanent gold markers into her liver at the site of the tumor. I know diamonds are a girl’s best friend, but in this case gold will have to do. It was the first step in proton radiation therapy.
On Thursday this week, Michele joins us for the afternoon at the UW/SCCA Northwest Hospital campus, site of the Proton Therapy Center. We meet again with Dr. A and go over what will happen today. Eventually a technician comes and invites Dixie to follow her into one of the therapy treatment rooms where she is introduced to her team members.
After a few minutes of becoming comfortable with one another, she is placed on a hard-surface table and instructed to move her hands and arms into the surrender position while her pelvis area is locked in so she cannot move. This will be her position during actual radiation treatments. She remains this way without moving for the next two hours while her team works with her.<
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They find her earlier set of tattoo markers and proceed to add some new ones. I think this would be a great time to get a heart shaped tattoo with an arrow through it and “I love Ward” across it in script lettering. I’ve suggested this at other times so I don’t bother saying anything now. The answer would be the same. She doesn’t love me that much.
A breathing coach teaches her how to hold her breath while radiation is administered. Dr. A stops by to assure her that he will be here with the team throughout this prep session. He retires to the control room to watch over the technicians as they work. The precise measurements must be set in advance of the real deal. Dr. A tells us later that she did well, “like a swimmer.” Much better than many of his patients. Of course she did.
She is given a handheld control with a thumb button. A mask is placed over her nose and mouth so when the technician chooses, air is removed and she is no longer able to breathe (this process is not for the faint of heart!). She holds it first for 15, then 20, 25, and 30 seconds. Each breath-hold graduation is done five times so it takes awhile. As long as she presses down on the thumb button she’s okay. If something happens or there is a glitch of any kind and she needs help, the button is released (that is if she remembers to remove her thumb) and help is on the way.
The breathing coach and two others are in the room with her while she is training. During regular treatments she will be alone. On this first dry run, there are several technicians and others who are also in the control room observing the process with Dr. A. Since UWMC is a teaching hospital everyone is interested in what is going on. Once she and everyone else are confident she can do the treatment format successfully, she undergoes yet another CT scan. Dixie says if cancer doesn’t get her, the X-rays may do the job. She has had a lot of them for sure.
Our hope is that the treatment will kill this specific Enemy Cancer mass. It will be a great victory for Dixie and for us all.
48
It Takes a Village!
Lord, my fervent prayer today is, let me touch people in a way that you can bless, or change, or draw them to yourself. Amen. ~ DLT diary, September 1990
In Dixie’s first full year of battling cancer, we guesstimate she has been served by over two hundred dedicated men and women in the medical field who are directly or indirectly part of Bellevue’s Overlake Medical Center (OMC), the University of Washington Medical Center (UWMC), and the Seattle Cancer Care Alliance (SCCA), also part of the Fred Hutchinson Cancer Research Center. Now we add the Proton Therapy Center team.
Monday 2 March. We are back at UWMC for another body scan. As Dixie is leaving, she is given a dated yellow card with her name and birthdate and the words, “This patient had a nuclear medicine procedure and may still have small amounts of radiation capable of detection. This amount of radiation poses no danger to the public . . . ” She is advised that these small amounts will slowly disappear over the next three days. We decide it gives the song, “You Light Up My Life,” an entirely new meaning.
On another morning, Katy comes to hang out with Gramma. Any day now she will deliver our second great-grandson. Needless to say, excitement abounds.
Thursday. We are carving out new frontiers in Dixie’s treatment program. Early this Thursday we are called back to the Proton Therapy Center (PTC) and informed something is showing wrong from her final scan and trial run the day before. She has to be retested. After several anxious moments it is determined the problem is with the machine, not Dixie. Testing with a new machine brings the expected results. The green light is given. After all this, finally, it’s a go!
This evening at 7 o’clock, Randal, a member of her tech team, comes to escort her to the changing area and Treatment Room 3. Michele and I settle in near the fireplace in the large and comfortable waiting area as Dixie begins her first real proton radiation treatment. The safety margin sought for in this treatment is impressive and a bit daunting. There is zero margin for error when one steps back and thinks of what is being undertaken.
And so it begins with yet another medical team at the Proton Therapy Center, where the motto is “It’s About Beating Cancer Today. And Every Day After That.”
Dr. A heads the team. He is an Associate Professor of Radiation Oncology at the University of Washington, a board-certified radiation oncologist with expertise in proton therapy, specializing in gastrointestinal cancers, including liver, pancreas and rectal cancers. Zippy is the Care Team Nurse. Other Treatment Team Assistants help Dixie prepare for each session. Radiation Therapists make sure she is positioned properly for her treatment sessions. The same team works with her through every treatment.
Once her clothing is changed, she is placed on a hard table and positioned precisely for the proton beams. Hands over her head in surrender mode. A device to clamp her nasal passages shut. A snorkel tube inserted into her mouth with air flowing through. When everything is ready, a few short breaths to fill her lungs, then the air is shut off. She holds her breath for 30 seconds during the beam shots. Relax. Don’t panic. Six times altogether, remaining in the same posture, with intermittent changes of table position. The entire first time process takes two hours.
Many are involved in Dixie’s treatment program. The Intake Team coordinates the exchange of records, collects information for evaluating her case, and schedules consultations. A Financial Counselor assists with payment and insurance issues. The Patient Services Team greets us with each visit to the Center. Medical Physicists deliver the radiation and monitor equipment and therapy procedures.
Dosimetrists collaborate with Dr. A to prepare the treatment plan specific to her situation. They calculate the angles and doses of proton energy required to treat the targeted tumor, while ensuring healthy tissue is exposed to as little radiation as possible.
Machinists create a custom mold that matches the shape and form of Dixie’s tumor. During treatment, protons are delivered through this mold to guide the exact therapy delivery. Engineers make sure the equipment and systems needed to produce the proton beam are finely tuned. Facilities Staff maintains the building, ensuring it is clean and safe for the patients.
Last, but definitely not the least, are our many friends who continue to offer comments, cards, emails, letters, telephone calls and text messages, meals to feed us, even make long distance trips to visit us, and bend the ear of God so many times in prayers for us.
It really does take a village to fight Enemy Cancer!
49
“Beam Me up, Scotty”
What terrifying teachers we are for that part of creation which loves its eternally childish state. ~ Rainer Maria Rilke / Sonnets to Orpheus II:14
You and I are not the first to face the challenges of aging, but at some point we do each face them ourselves for the first time. It is new territory, much of it seems uncharted, some might even view it as the holy wild. So it’s good to learn from others in the wilderness.
We listen to children describe what (they think) it is like for their aging parents. We read the not-always-so-accurate wisdom of gerontologists, many of whom have yet to begin journeying through this new territory themselves. But there is nothing like living the adventure. Aging is not an accident. The late Dr James Hillman left us much to consider in his view of the purpose of aging. “The last years,” he said, “confirm and fulfill character.”
This is another BIG transition week for us.
Our first visit to the Proton Therapy Center was on 05 February. More visits have followed, including the surgical procedure placing the gold markers on the liver at each side of Dixie’s bad-boy tumor that so far has been unresponsive to chemotherapy.
Wednesday 11 March. Over a month after our initial PTC visit, the first treatment takes place and every weeknight following. On Thursday last we attend the 2nd Anniversary Celebration of the Center, learning more about how the beam works. It has a Star Wars kind of feel to it. Patients, families and invited guests attend and are treated to a behind
the scenes tour of the treatment rooms and machine shop, the cyclotron and control centers. Just about everything is on display. It is an engineering and medical science marvel.
Friday 27 March. Our second great-grandson, Finnigan Michael, decides to break out into this brave new world at about the noon hour. His brother, Corbin, and parents, Katy and Geoff Peterson are excited, to say the least. Michele and GG are there to witness his birth. Grandparents and great-grandparents are happy, too!
Wednesday 1 April. Graduation Day. The PTC staff holds a luncheon for nine graduates who are completing their therapy. Dixie is one of the nine. Each patient is given a beautiful PTC Medallion. On it is engraved a personal number to honor their brave participation in warring against their respective cancers. Dixie is #429 of the now 450 patients having begun or completed their treatment at the Center these last two years. And tonight, eight weeks after our first introduction to proton therapy, Dixie successfully completes her final treatment.
22 A proton therapy treatment bay
In the process she has become her team’s breath-holding star. Most of the patients cannot hold their breath 30 seconds and so require additional help. She holds hers for a minimum 30 seconds at least eight times each night while lying prone on a flat hard surface as the team takes her through the 1 to 1–1/2-hour procedure. After witnessing Dixie’s success from the first night, the team members all try holding their breath. Their best time is 26 seconds.
They decide Dixie must be an excellent swimmer. She says, “No, it’s not that. It’s just that I’ve been married to Ward for almost 59 years and I’ve learned to hold my breath a lot during that time . . . to say nothing about holding my tongue!” A true PTC celeb!
Tonight we are tired, but thankful we will not be crossing the SR 520 bridge into Seattle again until Monday morning. On Monday we return to SCCA for a new blood draw and to discuss next steps with Dr. Chiorean (I still do not call her Gabriela, much less Gabby).
