Tuesday, October 05, 2010

Living with a grim prognosis

I had my operation at Singapore General Hospital (SGH) on 9 Sep'10 to remove my primary tumour and right kidney. I was so weak after the operation that I had to depend on others for shower in the next two days, and to get up from my bed on my own in the next four days. I had almost no abdominal muscle at all in the one week after the operation. I had to live with the pain and woke up almost every night in the next three weeks. However, I am slowly regaining my strength with each passing week. I went back to SGH to remove the twenty-nine staples across my abdomen on 1 Oct'10, as well as to consult my urologist on my prognosis. My urologist, Prof. Christopher Cheng, advised me of three possible scenarios:

1) My remaining cancerous cells are confined within the lymph nodes on my neck, and the chemotherapy will shrink them and will make it safe enough for a surgery to remove them next year. This is the best case scenario, but not likely to happen.

2) There are cancerous cells lurking in the rest of my lymph nodes and they do not respond to the chemo and will invade the other organs in my body. This is the worst case scenario, but not likely to happen too.

3) The cancerous cells will react to the drug used in chemo and shrink. However, after the end of chemo, they will grow back again. Then a second type of drug will be employed to shrink these cells as they might be immune to the first drug. I will also be considered for clinical trial. This process will repeat until the type of drugs are exhausted. This method will probably prolong my life for one year to one year and a half, and is the most likely scenario.

He also shared with me some cases which are out of the ordinary. He has a kidney cancer patient who ought to have died ten years ago but is living well today. He has another kidney cancer patient who did not have recurrent symptom in the last fifteen years until recently when the dormant kidney cancerous cells spread to the nose. From Western medicine point of view, if a patient has survived beyond five years, the cancer is considered 99% cured. If beyond ten years, he/she is considered 99.9% cured. His general advice for me is to stay optimistic and to pray hard, for my future is still unknown despite of the statistics. His prognosis for me is similar to the specialists' whom I consulted at Massachusetts General Hospital two months ago. The good news is that my operation has removed up to 90% of my tumour load, and I am recovering well. Prof. Bin-Tean Teh is using with my tumour tissue to cultivate cell-line to test for drug reaction. I was told by Prof. Cheng that this is a patented technique which is not available at Mass General Hosp yet. Sound like I came back to Singapore at the right time. I had also donated my blood for other cancer research projects.

Ever since I have been informed that my kidney cancer is hereditary in nature, I started asking God "why me?" It took me some time to absorb the fact that I am a high risk cancer patient, which means and no matter what I did in the past, I am still more likely to develop cancer. It also occurred to me there are countless victims who suffered or are suffering for no apparent reason. The Hong Kong hostages killed in Manila two months back were innocent victims. The Polish tourists who died two weeks ago on their way back from Germany when their bus crashed were also innocent victims. The flood victims suffering in Pakistan are innocent too. So are those who are born handicapped and challenged in one way or another. I am not able to comprehend why Jesus says "Neither this man nor his parents sinned; he was born blind so that God’s works might be revealed in him" in John 9:3. How are God's works manifested in people who suffered for no apparent reason? I once thought I knew the answer until I myself am struck with cancer. I once assumed that God's works would be manifested through the response of others. Now, I no longer find this assumption adequate. I was struggling hard with this question again until I came across Eugene Peterson's introduction to the book of Job in his translated Bible (I still struggle but with less intensity). Below are three paragraphs which are particularly helpful to me:

... the ironic fact of the matter is that more often than not, people do not suffer less when they are committed to following God, but more. When these people go through suffering, their lives are often transformed, deepened, marked with beauty and holiness, in remarkable ways that could never have been anticipated before the suffering.

... sometimes it's hard to know just how to follow Job's lead when we feel so alone in our suffering, unsure of what God wants us to do. What we must realize during those times of darkness is that the God who appeared to Job in the whirlwind is calling out to all of us. Although God may not appear to us in a vision, he makes himself known to us in all the many ways that he describes to Job—from the macro to the micro, from the wonders of the galaxies to the little things we take for granted. He is the Creator of the unfathomable universe all around us—and he is also the Creator of the universe inside of us. And so we gain hope—not from the darkness of our suffering, not from pat answers in books, but from the God who sees our suffering and shares our pain.

... Every time we let Job give voice to our own questions, our suffering gains in dignity and we are brought a step closer to the threshold of the voice and mystery of God. Every time we persist with Job in rejecting the quick-fix counsel of people who see us and hear us but do not understand us, we deepen our availability and openness to the revelation that comes only out of the tempest ... We realize that suffering calls our lives into question, not God's. The tables are turned: God-Alive is present to us. God is speaking to us. And so Job's experience is confirmed and repeated once again in our suffering and our vulnerable humanity. (Eugene Peterson, THE MESSAGE REMIX: The Bible in Contemporary Language. 2006. pp. 651-2).

Eugene Peterson does not answer why one suffers but at least through his passage, I am able to imagine a God who not only sees our suffering, but shares our pain. Suffering can be dignified and creates a space for God to speak to me existentially. I pray that I could experience God speaking to me once again in the midst of my own pain and suffering, even though I may not know why I inherit a defective gene. I do not know why I am struck with cancer at a young age and before I could continue on with my second Master degree in theology, but I am comforted knowing that God shares my pain and suffering. I am also comforted to be surrounded by people called to be the church, who are also called to be Christ's witness till the end of time. There are so many unknowns, including why Senior Minister of State for Foreign Affairs Dr Balaji Sadasivan died of colon cancer at the age of 55 last week, but to live in the unknown and to trust that God is walking with me is a walk of faith.

I have been asked hypothetically many times what I would do if Jesus Christ were to return tonight: I would continue to live the same way I am living now. Now, I am living with another set of question: If Christ were to return any time, and I have one more year to live, how would I live? I would like to spend time with my family members, read theological books and to take local theological class if possible, correspond through email, update my blog, worship together with my brothers and sisters, enjoy fellowship together, and to continue staying hopeful that I will be physically healed, whether through chemotherapy, Chinese herbs or natural juices. I will also continue to keep you posted on my medical condition. My appointment with my oncologist at National Cancer Centre to discuss my chemo plan is on 18 Oct (Mon).

Lastly, there are three video clips in Mandarin on Youtube about a Taiwanese neurosurgeon who was diagnosed with Stage 3 colon cancer eight years ago, was told he would not live more than three years, and is still alive and well today. I am learning to live with the gift of living in the unknown.

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