Lessons from the Fire: Society of Clinical Oncology

Jason Micheli —  May 22, 2018 — 5 Comments

Earlier this month I was the closing speaker at the Society of Clinical Oncology conference in Tampa. You know the medical community is starving for shits and giggles when they request a man of the cloth to close them out. To play on the humorlessness of the atmosphere and to puncture a secular crowd’s assumptions about a preacher I wore my collar and began with a swear word.

If that makes you nervous, concerned, or ashamed of me as a pastor…you should know A) it was what they asked me to do- be funny- and B)  it killed at the conference.

They all fell apart and then I had their attention so as to sneak up on them with some Gospel. That’s just my FYI for what follows, a little peak at the method behind the immaturity.

Here it is:

    Hi.

    My name is Reverend Jason Micheli, and I was invited to this event this afternoon in order to ask you to accept Jesus Christ into your heart as your personal Lord and Savior.

     Don’t worry, I’m just fucking with you.

Okay, before I continue…unless you’re looking at porn or are shopping in Amazon for my book, Cancer is Funny, ya’ll are going to have to put your devices down. I normally only experience this level of distraction and inattention in the bedroom.

Just kidding.

But not really.

     A little over a year ago, my wife, Ali, my mother, and I were sitting shoulder-to-shoulder in the mauve exam room where Dr. D______ had just handed me the results of my latest PET scan.

     My wife blushed before she even had a grip on the sheet of paper the doctor had handed her. ‘Oh my,’ she gasped, covering her mouth like she’d spilled a secret, ‘that’s…umm…thorough.’

     My mom read the impenetrable written summary of the findings while Ali and I looked over the scan’s snapshots of my body, which included, to my surprise, the positronic outline of my man-parts.

     My wife blushed and laughed while I silently congratulated myself for appearing so ample in the pictures. Suddenly cancer, for giving me this shot to my self-image, didn’t seem so bad.

     ‘Let me see it,’ my mom reached her hand out and, reflexively, I reached mine out to cover the naughty bits in the images. ‘I’ve seen it all before,’ she said rolling her eyes and grinning.

     ‘Well, a lot’s changed in 35 years,’ I said.

     I’d finished my 8th round of chemo 7 weeks earlier, about a year after getting a call from a GI doctor who started by asking me if I was sitting down. I’d been getting these double-over stomach pains for months. The following day I was waking up from emergency abdominal surgery to my wife kissing my forehead and telling me they’d taken an 11×11 inch tumor from my intestine and that I likely had something called Mantle Cell.

     I’d staggered across chemo’s finish line like a runner who hadn’t practiced on enough hills. My anemia had worsened and, with it, my constant dizziness. I’d passed out trying to do sit-ups at the gym, and I’d collapsed standing in the sun at the papal mass in DC. My hands and legs were bruised from my low platelet count, which had never really recovered after my 6th and 7th rounds. And my chest port had gotten infected, turning my chest a furious, crusty red. What’s more, the antibiotics the doctor gave me to stem the infection had induced an allergic reaction so in the days before my final round the same nurse who’d installed the port scrubbed my infected chest with alcohol and a wire brush and then, in one long painful motion, ripped the port out of my chest like he was starting a push mower.

     ‘So…other than my johnson, what am I looking at?’ I asked, holding the PET scan in my hand. The words, I noticed, quivered against my bated breath.

    ‘You’re as clear as a bell, my friend,’ Dr D____ said, punctuating the news with a warm, knowing smile. ‘All the tumors you’d had all over you,’ he gestured to the spots with his pen, ‘are completely gone.’

     None of us shouted hallelujah.

———————-

     The chemo had killed off the cancer in my body, but we all knew I still had Mantle Cell percolating in my bone marrow, which, in the absence of the chemo poison, would soon-to-eventually return lumps and masses throughout my lymph system.

     So no one shouted ‘Praise God!’ We didn’t receive the PET scan as a miracle, but we did breath easier than we had in almost a year. The scan wasn’t unfettered good news, but it was as good as we could’ve hoped.

     ‘What the scan doesn’t show,’ Dr. D____ said, scooting the little round stool closer to us, ‘’remember what we discussed- what the scan doesn’t show is the level of activity of Mantle Cell in your marrow. We’ll need to do a bone marrow biopsy for that.’

     The reality that the cloud of cancer would never be completely removed from my body or our lives reasserted itself and hung over us. We nodded. My mom wiped a tear threatening in the corner of her eye.

     ‘Knowing the level of activity in your marrow will help us to gauge how we approach your maintenance chemo over the coming years.’

     Dr. D___ offered us, each in turn, the same reassuring smile before explaining the bone marrow biopsy to us. On the back of a ‘Life with Cancer’ newsletter, he sketched what looked like a molar- it was supposed to be my hip.

     Dental work, I started to suspect in that moment, might be preferable. Next to the tooth that was my hip, he drew what looked like a long syringe. The needle, I noted, was nearly twice as large as the picture of my hip.

     ‘Is that to scale?’ I asked, swallowing hard. He didn’t catch my meaning.

     ‘We’ll do it here in the exam room, won’t take long. We’ll drill down into the center of your hip bone and extract a couple of vials of marrow.’

     ‘Come again?’ I asked and maybe (my wife says no) passed out momentarily. He thought I hadn’t heard him. He pointed to the cartoon and repeated himself: ‘We’ll drill down into the center of your hip bone and extract a couple of vials of marrow.’

     ‘Did you say drill?!’ I asked and, I could see from my reflection in the glass of the flower print frame opposite me, blanched.

     ‘Yes, drill’ he said, oblivious.

     ‘And am I, like, awake during this drilling?’

     ‘Yes, but you needn’t worry. You’ll feel only a quick, momentary discomfort.’

I nodded, calming down.

     ‘I always heard it was a terrible, godawful pain,’ my mother, the nurse, added flatly.

     ‘Well, I do plan on giving you a prescription for oxycontin to take before you come in that morning.’

     ‘Oxycontin? I thought you said it would be only a momentary discomfort?’

     He didn’t reply.

     ‘Can I just go back to having cancer?’

     He slowly drew a smile across his face and then threw his head back in what seems now with hindsight less a hearty and more a diabolical laugh.

————————-

     I returned a week later for the bone marrow biopsy.

     I held out my arm for the lab nurse to draw my blood work. ‘I almost didn’t recognize you,’ she said, sliding the needle into me seamlessly, ‘Your hair’s growing back.’

     I brushed my goatee with my free hand. ‘Everyone said chemo might change the color of my hair. White wasn’t what I had in mind.’

     ‘It makes you look more distinguished,’ she needled, ‘Looking distinguished is better than, you know, looking like you’re dying.’

     ‘Gee, thanks,’ I flexed my hand as she pulled the needle out and looked up at Judge Judy playing on the TV on the infusion center wall.

     And, just as an aside, I don’t know if it’s standard medical practice to play crap TV in the cancer ward (Judge Judy, Jerry Springer etc.), but we patients love it. Show us all the paternity tests, baby-mommas, and petty lawsuits you can find- it feels great to have cancer and know there’s at least some one out there who’s life is crappier than your own.

     The nurse drew the needle out.

     ’It looks like I’ll be back with you for your biopsy today.’

     ‘Awesome,’ I said and then shared with her how Dr. D____ had described it as a momentary discomfort only then to prescribe a dangerous opiate normally associated with right wing radio hosts and gin-slinging country club wives. She smiled like a preschool teacher. ‘You took it though, right?’ looking at me, suddenly sober.

     ‘I didn’t even fill it,’ I said, ‘I forgot.’

     ‘This should be…memorable,’ she said, putting a cotton swab and tape over the puncture in my arm.

     ‘For you or for me?’ I asked, the fear like diarrhea bubbling in my gut. ‘Both,’ she was back to smiling.

     ‘What’s it feel like?’

     She was putting labels on my vials of blood. ‘Some people scream.’

     ‘Some? What about the others?’

     ‘They usually pass out.’

     ‘But what does it feel like? There’s no nerves inside the bone there so it can’t hurt, right?’

     She was, I could tell, thinking about something, remembering. She chuckled to herself softly, glanced over into the lab to see if her supervisor was listening and then said: ‘This one guy- he said it felt like a Harry Potter Dementor sucking his soul out of his ass.’

     I’m not sure why but that struck me as probably the most terrifying thing she could’ve said.

     She led me down the hallway and into the exam room. She feigned casualness, like we were on our first date and she’d just invited me upstairs to her place for a drink. ‘So…you can pull your pants down and lay on the table.’

     ‘Is there, like, a gown I should put on?’

     ‘No need.’

     ‘No need for you or for me?’ No response. ‘Where’s Dr. D___?’ I asked.

     ‘He’ll be along in a few minutes.’

     ‘You just need me to fold the waist of my pants down like this, right?’ I asked slash prayed, pointing to the top of my hip bone underneath my belt.

     ‘No, pull them all the way down past your butt.’

     Cancer is the gift that keeps on giving.

     ‘Jesus, you all ought to give me my copay back. You’re lucky my butt hair hasn’t grown back yet,’ I lamely tried to dispel the awkwardness palpable in the room, ‘otherwise you’d need to bring a Bobcat in here.’

     She was arranging glass specimen slides onto a metal tray. ‘Lucky is exactly  what I was just thinking’ she smirked.

    Without Dr. D_____ there I thought I should keep standing there, talking and chit-chatting with her, even if my butt was hanging out my pants, but with her eyebrows she motioned for me to lay down on my belly on the butcher paper covered exam table.

     With my face to the wall and my back to the room and my stubble-covered butt under the florescent lights, I hugged the institutional pillow like a girl on the cover of a Babysitters Club book and wished that I’d taken the oxycontin, to numb me to this if not to what was to follow. Maybe too the oxycontin would’ve made the time pass faster because Dr. D____ didn’t show for another 20 minutes. My butt started to get cold.

     ‘Do you have plans for Christmas?’ I asked the nurse. I thought about grabbing my cheeks and having my rear-end do the talking like Jim Carrey in Ace Ventura but somehow that didn’t seem ridiculous enough for the moment. She told me about her plans to visit her grandpa and from there we moved to swap dinner recipes, whether a smoked or fried turkey was superior, the merits of the new Star Wars film and the offseason signings of the Washington Nationals. I found myself wondering if she was making eye contact with me while we chatted.

     After a while a lull came to our conversation and she grew quiet. ‘What are you doing back there? I asked.

     ‘Taking a picture,’ she said in a deadpan tone of voice.

     ‘What?!’

     ‘You haven’t seen it? We keep a cork board in the lab of the best ones. You should feel flattered.’

     After a long pregnant pause, she added: ‘Just kidding.’

     ‘Which part are you kidding about?’ I asked, ‘the taking the picture part or how I should feel flattered?’

     She snorted as Dr. D____ finally knocked and rushed in. ‘Ah Jason, you look well.’

     He said.

     To my rear end.

———————

     He began by feeling around on the top of my hip bone, pressing down on me with his thumb the way I do to check the doneness of a steak. What felt like bee stings followed. ‘Just numbing the site,’ he said from behind me. Next he asked the question to which no could be the only honest answer: ‘Ready?’

     I squeezed the corners of the mattress. He pressed his large left hand on my back, in between my shoulder blades, pushing down on me, and grabbed a screw-shaped needle big enough to throw light off the corner of my eye. Were it not for the American Medical Association, I thought, this would violate the Geneva Conventions.

     I lay my head to the side, looking away from him.

     ‘You’re going to feel a little bit of pressure,’ he said euphemistically as he started to twist the needle down into my bone.

     ‘How was your Thanksgiving?’ he asked.

    ‘Fine,’ I grunted.

    ‘Did you travel?’

     ‘We went to my in-laws,’ I inhaled quickly and breathed out through my teeth, ‘in Georgia.’

    ‘Outstanding!’ he announced as bore down with his brace hand onto my upper back, trying to get more leverage. ‘Did you fly?’

    ‘No,’ we drove.

     ‘Oh my goodness!’ he said.

     ‘Oh my goodness is what I was just thinking.’ I heard the nurse giggle from somewhere behind my behind.

     ‘How long did that take on the road?’ he wondered as I wondered when the needle would pop out the other side and through my belly button.

     ’12 hours’ I answered through a grimace.

     ‘What kind of car do you drive?’

     ‘A bronco but we took my wife’s Subaru.’ I was biting at the pillow now and sweating. I was soaking wet as I imagine all torture victims get.

     ‘Does it good gas mileage?’

     Are you freaking serious? I thought. Let’s get this done.

     ‘You’ve got strong bones.’ He was grunting now. Serves him right, I thought.

     ‘That’s probably because I breast fed until I was 12.’ I heard her giggle again. He did too.

     ‘Sorry,’ he said, ‘I need to take a break.’ He wiped his forehead with his sleeve. He was covered in sweat too. The nurse squirted some water into his mouth like he was a fighter and she was his cut man and we were still in the early rounds.

     ‘By all means, take your time. It’s not like I’m laying here with a spear screwed down into my ass.’

      ‘I’m a briefs man myself,’ he declared offhandedly, apparently staring at my boxers pulled down around my knees.

     ‘I wore my favorite pair just for you,’ I said.

     After he spelled himself a rest, he twisted and screwed some more. Soon after, he told me he was ‘in’ and I then felt a tapping in the middle of me as though he were hammering on the needle with a rubber mallet. I was afraid to ask about it.

     ‘Okay, are you ready?’ he asked.

     ‘Ready? There’s more?!’

     ‘I’m going to draw the marrow out now. This might feel a bit queer.’

     Queer? I thought. Queer is listening to Wham’s Make It Big album while drinking orange mocha frappachinos.

     ‘Here we go’ he said like Gene Wilder on the psychedelic chocolate river boat.

     Just then it felt like a cord was being pulled deep inside me. I could feel it inside my bones, from my heel all the way up my spine. My legs both kicked involuntarily, like I was a corpse with a last bit of life in me. I blinked wide from the shock of it and tried, hard, not to cry out.

     It wasn’t pain, not exactly, but it was a feeling I never wanted to feel again. It felt, well, it felt exactly like a Harry Potter Dementor sucking my soul out of me through my rear end.

     ‘Good,’ he said, ‘now only 2 maybe 3 more times.’ I swear I smelled sulfur then and heard a maniacal laugh.

     When he finished, I stood up from the exam table, too tired even to pull my pants up. ‘You were right about that Harry Potter thing’ I said to the nurse breathlessly.

     “And you were right about having a cute butt,” she said winking.

     I was so sweaty that pieces of butcher paper were stuck all over my arms and face, like I’d just had the worst shaving accident in history. ‘Wow,’ I said with astonished eyebrows, ‘that was the perfect way to cap off my year with cancer.’

     He patted me on the shoulder. ‘You’ve been through the fire, Jason. You’ve been through the fire.’

     I pulled my pants up.

     ‘Just like Shadrach, Meshach, and Abednego,’ I joked.

     ‘Well, let’s hope there’s no lion’s den in store for you’ he said, patting me again on the back.

———————-

     If you never flannel-graphed it as a kid in Sunday School, then you should have learned it in Oncology 101. It is, I think, a cancer story.

     In the story, told in the Old Testament book of Daniel, 3 Jewish civil servants are denounced by Nebuchadnezzar the pagan King of Babylon, condemned for refusing to submit to the gods of Babylon and, by implication, for refusing to submit to the authority of Nebuchadnezzar.

     The king orders the 3 Jews, Shadrach, Meshach, and Abednego, gagged, bound, and cast into a fiery furnace but not before the king instructs his men to crank the oven up to 7 times its normal heat.

     Since I’m a preacher I should pause there to point out for you that 7 is the biblical number for perfection or completeness and, thus, it’s a number that portends the presence of God.

     The furnace gets so hot that the heat obliterates the guards who come close enough to the fire to toss the prisoners inside. Not so Shadrach, Meshach, and Abednego.

     According to the author of Daniel, King Nebuchadnezzar and his courtiers can see Shadrach, Meshach, and Abednego in the fiery furnace, walking around, unbound and unburned as though they’re sailing toy boats in central park.

     What’s more surprising, the bystanders report seeing a fourth person there in the fire. Shadrach, Meshach, Abednego and who exactly?

     The story in Daniel ends with a typical Old Testament flourish when King Nebuchadnezzar, having brought Shadrach, Meshach, and Abednego out of the fire, unsinged, throws off his former affections and declares: ‘…there is no other god who is able to deliver in this way!’

     Daniel ends the story with an affirmation, but I think the story about the fire should instead end with a question. Did Shadrach, Meshach, and Abednego know they weren’t alone in the fire? Did they see that fourth companion?

     Certainly, they know they’re alive when they’d expected a death sentence. That much is obvious. They know they’ve been delivered from the fire. The king makes that clear. But did they know they hadn’t been alone in the fire?

     Daniel reports the king and his court saw a fourth person with them in the fire, but Daniel doesn’t say if the sufferers themselves, Shadrach, Meshach, and Abednego, saw him too.

     My guess- they did not.

     Had Shadrach, Meshach, and Abednego known they weren’t alone in the fire, had they seen and felt God’s presence there with them amidst the fire, they wouldn’t have wanted to leave it.

———————-

     That’s the first observation I wanted to make for you all today about the fire called cancer you all work to extinguish.

     While I’ve not been burned or singed by flames, I do have the belly scars and the needle marks and the monthly nausea and the weekly panic attacks and the medical bills to prove to you that I’ve been in the fire.

     And as a pastor, not just a patient- as someone who has buried somewhere north of 500 people and buried kids by the baker’s dozen- I’ve peered into the fire too.

     Here’s what Jason the Patient learned about the fire that Jason the Pastor didn’t appreciate and maybe what Jason the Physician (if I hadn’t disappointed my grandpa and gone into the Church) wouldn’t realize either.

     Jesus says that those who would have their lives saved must first discover their lives lost. Just as learning I had Mantle Cell meant mourning the loss of the life I had and the loss of the future I’d envisioned, so too- paradoxically- finding out that I wasn’t going to die (yet) meant mourning the loss of the life I’d found in cancer.

     This surprised me-

     As much as I wanted the nightmare called cancer to be over, I found a part of me grieving the news that I would (sort of) get my life back. I found myself grieving the life I’d learned to enjoy with cancer.

     What I had happened upon, without knowing it, is what Martin Luther termed a theology of the cross. Bear with me now- a theology of the cross is shorthand for how the God who condescended to meet us in the crucified Jesus never chooses any other means to meet us than condescension into suffering.

     As Old Testament scholar, Chad Bird, writes: “The glory of God is camouflaged by humility and suffering, for our God likes to hide himself beneath his opposite.”

     Bird just puts more politely what Luther wrote in his Heidelberg Disputation where Luther said that Jesus Christ meets us so far down in the muck and mire of our lives that his skin smokes hot; that is, God condescends to meet us not as a needless accessory in the pristine and happy parts of our lives but in the steaming piles of you-know-what in our lives.

    Shit happens we say, but a theology of the cross says wherever shit happens God happens too.

     Don’t worry.

     Like I said, I’m not trying to convert you, but I’ll glad take up an offering.

     You don’t need to buy into Christian theology to grasp the point, to see how Luther names in Christian terms a general experience that just is existentially and spiritually true for a lot of your patients.

     Call it God, the Divine, Enlightenment, Meaning, Grace- what have you, but for a lot of the people for whom you care they have found it in their experience of suffering with cancer.

    It’s odd-

    Everyone assumes the fire (suffering) leads you to closer to God, but seldom do we stop to think that exiting that experience of suffering will be its own kind of suffering.

     A loss to be mourned (of all things).

     Where before you grieved the life you had and the future you thought you’d have, now you grieve the loss of the spiritual and emotional vitality that suffering brought into your life which, presumably, healing will take away from your life, leaving you like the wise men in the nativity story to return home by a different path than you’d prefer.

     If God was most with me in the fire, what would happen, I wondered, when I was delivered from the furnace? If cancer, in other words, proved the means by which God became a deeper reality in my heart, then what would happen to my faith when or if my cancer was gone?

     It’s the conceit of so many bad spy movies, the counter-intuitive bond between captive and captor forged by the intimacy of their shared scare.

     Cancer was Robert Redford to my Faye Dunaway. Cancer, like a villain, had made me a prisoner to my own body, but it had made me different too, had brought God closer to me, even if I often required the testimony of others to believe it.

     And now, as I waited for the results of my bone marrow biopsy, I suffered something like Stockholm Syndrome. I feared being free. Losing cancer would mean losing the immediacy of God I had experienced with cancer in a way unlike any other.

     Once they heard Nebuchadnezzar’s testimony about God being right there with them, close enough to touch and feel, I bet, some part of Shadrach, Meshach, and Abednego secretly missed the fiery furnace.

     To put it less homiletically, so much of the spirituality I have found encouraged by the medical system is transactional; in that, it was recommended to me for its utility in the healing process.

     Mindfulness practices, prayer, and even Buddhist meditation were suggested to me by licensed clinical social workers as techniques to help me cope with my suffering and to better my odds at surviving my suffering.

     All well and good but those who recommend such practices should be prepared for the possibility that such practices are not just helpful but true; that is, such practices just might inject into a person’s life a new treasure they do not want to relinquish yet do not know how to possess in the context of their old healthy life.

     Which is to say, practically-speaking, the exit out of cancer can be a more ambivalent experience for some people than you all, who are so determined to get us through it alive, may realize.

     The exit from cancer, in other words, should be stewarded with the same pastoral sensitivity as marks the entry into cancer.

     And this isn’t just a God-thing people.

     In the fire, I discovered a vulnerability (indeed I had no choice) which I believe opened me up to a new-found awareness of the divine, yet this same experience of vulnerability peeled away so many levels of protection and pretense, it pulled off so many of my masks, I was left with a marriage that was more real and intense than in any of the 15 years which preceded it.

     What prompts husbands and wives in the fire of cancer to make bucket lists is not the anticipation of the healthy future to come; it’s the passionate fire they feel for one another in the fire where, maybe for the first time, all their disguises have been burnt away.

     Why do I bother to mention this to you all? I mean, this isn’t a religious conference or even a marriage conference.

     I bring this to you because I believe what lay behind the newfound intensity I discovered in both my relationship with God and my relationship with my wife was the experience of absolute naked and terrifying vulnerability into which cancer had delivered me.

     I’ve seen this before as a pastor. I just couldn’t name it until I’d been a patient.

     There’s a reason so many men in the fire of cancer fall in love with their nurses and doctors.

     It’s because cancer just may be the first time in their lives men (especially men) have been truly vulnerable before another human being, including even their spouses, making their relationship with their nurses and doctors more authentic than many of their other relationships, including even their spouses.

     Obviously, this is a potential danger, but after 2 plus years living with Mantle Cell I’ve observed that you all as a guild have got precautions down solid.

     I mean, I can’t count how many times you’ve made me recite my birthday and read my name off of bags of chemo-poison. You’ve got the precautions down, solid.

     So I don’t want you to dwell on the potential danger posed by patients’ pregnant vulnerability, I instead want to call attention to the potential gift you have to give them by recognizing and rewarding it.

     Hell, I know there are insurance people here and I shouldn’t talk smack about insurance companies, but stewarding a patient’s virgin vulnerability could be the only free gift they receive in the fire called cancer. I mean, even those stupid socks with the tread on the bottom cost me $50.

     Your response to a patient’s newfound vulnerability is great and free gift you have to give them.

     In the Church, we call such a free gift grace and we believe it’s the means by which Meaning with a capital M heals us of ailments drugs cannot cure.

     And such grace is the medicine you dispense whenever you bother to touch a patient, not out of need or haste but gentleness and compassion.

     Such grace is the medicine you give when you ask a patient not for a one-size-fits-all, on a scale of 1-10, number to gauge their pain but ask instead for a story, a memory, that conjures how they feel.

     Speaking of feelings, you give this gift called grace whenever you take the time to ask a patient not how they feel but are your feelings- because my whole point in bringing this word vulnerability to you is that you may be the first person with whom they’ve ever truthfully shared their feelings.

     Made vulnerable by cancer, you’re in a position to give them grace, and the human community will be a bit better healed for you having done so.

———————-

      And that brings me to second point.

     Not to beat you over the head with the G word, but I figure you should’ve known what you were getting by inviting a guy with a collar to your gig.

     If God is to be found in the fire called cancer, then the spit and hiss of suffering’s flames will be occasioned not by mourning but by mirth, not by tears and crying (though, of course those) but by laughter.

     When you have cancer, you realize how everyone wants to use it as an excuse to drill down into the existential.

‘How has cancer deepened your faith?’

‘Have you grown closer to God in your suffering?’

     True, my line of work tends to invite such conversation but, talking with other patients, these kinds of questions are par for the cancer course.

     Even when the question is phrased in the negative, as in ‘How has struggling with cancer challenged your faith in God?’ the premise still connects the experience of suffering with an experience of God.

     Implicit in such questions is an assumption first asserted by John Chrysostom, a 4th century Church Father, who said that ‘tears bind us to God not laughter.’

     As a patient I discovered what I hadn’t known as a pastor; namely, EVERYONE assumes that the experience of suffering leads the sufferer closer to Enlightenment, Meaning, the Divine, a deeper or higher spiritual plane.

     Yet, as unexamined as it is, such an assumption necessarily identifies the Divine with Suffering and, just as a matter of freshman philosophy, this doesn’t hold water.

     Pierre Teilhard de Chardin, a French philosopher and priest from the 20th century, posited, as a sort of first principle, that ‘joy is the most infallible sign of the presence of God.’

     Everyone assumes suffering leads one closer to God but if God is Joy, then one can’t rightly be said to have grown closer to God, through suffering or any other means, without a marked increase in joy, and with joy comes laughter.

     As a clergyman I know from gravesides how quickly bone-wracking sobs can turn to belly-laughs, but the same should be true of the cancer ward too.

     If the philosophers who theorize about comedy are correct, if comedy is what comes from the collision of Lack and Excess then there is no funnier place than the infusion center where the bag of meds you hope will save your life comes with the label: “Warning: May Cause Leukemia.”

     To be an institution even more humorless than the Church is a great achievement, but I must say you all give us a run for our money.

     Martin Luther said his theology of the cross frees us to call things as they are, and that’s the sort of funny I commend you all to find and name when you do find it.

     Part of respecting your patient’s vulnerability is naming the absurdity that is so much of the experience of cancer and being willing to accompany them into that absurdity by means of your mirth and laughter.

     Don’t tell the healthcare industry but not one of us is getting out of life alive. We’re all terminal cases so you’re as qualified as your patient to share in a little gallows humor, for such humor is a way of treating them not as your patient but as your fellow terminally-ill, human.

     If Meaning with a capital M is joy then such moments are not just healing- and they are- they’re holy.

     Or, I believe, they’re the former because they are the latter.

     I’m grateful for the nurse who joked about my cute butt, for the Muslim nurse who picked me up off the bathroom floor in the name of Middle East Peace, for the nurse who asked if I’d prefer to watch Breaking Bad in the infusion center instead of Judge Judy, and for my oncologist who joked about the shorthand ‘dex’ for dexamethesone on my chemo calendar- ‘that’s a cursive s not a d,’ he said, ‘you better tell your wife to limber up.’

    “I appreciate the prescription, doc, but your other drugs have benched little Jason.”

———————-

     Speaking of my manhood, that brings me to my last observation for you all today.

     As a pastor, over the years I’ve had the occasion to counsel a number of women going through cancer, particularly breast cancer, so I was aware how alopecia and mastectomies can frustrate a woman’s self-image.

     But no one warned me about what cancer does to man’s sense of his manhood.

     I didn’t just discover things in the fire. The fire burnt away things too.

     The drugs that made it hard to keep food down made it impossible for me to get it up; meanwhile, weight loss and beard loss and chemo glow conspired to make me look sufficiently feminine as to be confused for a woman on several stocking-capped occasions.

     On one of the miraculous nights when my equipment seemed ready to cooperate with my tender intentions, my amour foundered against my anemia, sending my heart racing and my head spinning; so that, in the end the only romance I could muster was to be held and consoled over my premature dejection.

     I cried, which only left me feeling even less of a man. I even had a hard time with that most mythic of masculine activities, tossing a baseball to my boys.

     No one bothered to prepare me for what cancer would do to my masculinity, not even the 100 Questions and Answers about Lymphoma booklet my oncologist’s office gave me, was how my cancer would mess with my sense of myself as a man.

     No doctor warned me about it and no clinical social worker asked to talk with me about it.

     This is why I think it’s doubly damaging when patients experience the healthcare system as treating them in a dehumanizing fashion. Cancer, after all, has already made them feel, if not less than human then certainly less their former selves. Cancer not only makes you look bad, sick all the time, it leaves you looking vague. Neutered of your former self. Feeling disgraced.

     The more I grieved the loss of my manhood, the more I sought refuge from my shame in the belief that had made me a Christian in the first place.

     The doctrine of incarnation- the proper name for the festival we call Christmas when, we believe, God takes a body in Jesus.

     I close with the incarnation not to bludgeon you with the G-word, but to give you all the thanks I feel more deeply than even a preacher can convey.

     You see, Christians believe ‘incarnation’ names not only a flesh and blood body born in Bethlehem but a mystical Body, what St. Paul calls the Mystery of Christ.

     You can think of it as the Mystery of Meaning with a Capital M, and this mystical Body Paul says is present in each of us and is extended through each of us.

     And this is important because it’s this Mystery of Meaning with a Capital M that Paul has in mind when he writes that cliched verse you may have heard before “I can do all things through Christ…”

     You can be sure you’re patients have been sent a card with that verse on it, but what Paul has in mind isn’t how the cliche is usually received in its Hallmark fashion.

     He doesn’t mean ‘I can do all things because of my belief in Christ…’ He doesn’t mean ‘I can endure all things through my faith in Christ…’ And he doesn’t mean ‘I can do anything by the power of my spiritual practices or self-will…’

     No, instead, Paul’s talking about the Body of Christ, the mystical Body, the mystery of Meaning with a capital M.

     Which includes you all, whether you’re religious or not.

     And let’s put it in the negative- to make the point sharper:

     I couldn’t have done it without you. We can’t do it without you.

     For what you do for patients like me- for your compassion and care, for your humor and your patience with your patients’ humor, for your calling it like it is and not BS-ing the bad news, for sharing in our suffering and asking for more than where we fall on a scale of 1-10, for taking the time to ask about our kids and our work, the time to touch us (and touch us gently) because every patient can feel the difference between a compassionate needle prick and a coarse and hurried one.

     For dealing with insurance companies on our behalf!

     For helping us heal with grace and humor and for helping us die with dignity.

     Thank you.

     I couldn’t have done it without you. We can’t do it without you.

    And there’s the irony for all of you whose sphincters might have gotten twisted in a pinch over all my God-talk today…as much as me, you all are the ones with a holy vocation.

 

 

 

Jason Micheli

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5 responses to Lessons from the Fire: Society of Clinical Oncology

  1. Wow. You DID kill it!

  2. Jeff VanOsdol May 23, 2018 at 8:31 AM

    Jason,

    You’re a better Lutheran than most of the Lutherans I know (I mean that as a compliment). You invoked my guys: Chad Bird, Luther…oh, and Jesus. Grace, Incarnation, Vocation: it’s all there. I wiped tears, I laughed out loud, I looked up French philosophers. What a touching travelogue of your journey, with a tip of the cap to those in the healing arts. That was no sneaking-up-on-them-with-the-Gospel, that was a lavish Broadway production of Gospel. Bravo. The almighty and merciful Lord, the Father, the (+) Son, and the Holy Spirit, bless and preserve you.

    Jeff

    Rev. Jeff VanOsdol
    Immanuel Lutheran Church
    Simpsonville, South Carolina

  3. Brilliant, thank you for this.

  4. You are amazing! Being a cancer survivor (overcomer!), you made every point so well, and expressed every feeling I ever had, although I never could have said it so well. I imagine those doctors are still picking themselves up off the floor!

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