Rearranging one's activities following a diagnosis of cancer

Recently, I read some notes that I had made when taking a transition assistance course for senior officers prior to retiring from the Navy. In those notes, I found a list of my hobbies: travel, an active lifestyle that included exercising several times per week and frequent walks with my wife, learning about and enjoying good food and wine, and reading.

This autumn, cancer has disrupted all four. My damaged vertebra, caused by my cancer leaching calcium from my spine, no longer permits travel or an active lifestyle. I have gone from comfortably walking ten miles to feeling tired after walking a half-mile. (At times, my oncologist (pro-walking) and my neurosurgeon (anti-walking to avoid damaging my spinal cord) have debated whether I should walk a half-mile.) I'm currently taking eleven different medications, each with its own schedule. Three are for chemotherapy; eight are for coping with side effects that the chemotherapy causes. Even reading is often difficult because the drugs have shortened my attention span, altered my moods, and, along with my injured spine, generally made sitting comfortably for an extended period time impossible.

Now that my cancer is approaching remission, some of my interest in food (but not in drink, interestingly) has returned. I continue to find dining in restaurants less attractive, perhaps because it tends to be less physically comfortable than eating at home. I still do not feel like traveling or leading the active a lifestyle that I led a year ago. I am reading more, though in much shorter sessions than prior to having cancer.

These four sets of activities were important factors in my wife deciding to live in Honolulu and to opt for a condominium in the heart of Honolulu. We had planned to travel less, taking a major trip biennially instead of annually. However, we had also intended occasional visits to the other Hawaiian islands, something that presently exceeds my physical abilities. In time, I hope that I shall at least have the strength and physical capacity to travel the relatively short distances to the other islands. Honolulu's climate is conducive to an active lifestyle. Similarly, I hope that when I have completed chemotherapy, dining in restaurants, savoring different cuisines, and exploring different drinks relaxing and pleasurable.

We chose our condominium because of its proximity to the airport; the building has amenities suitable for an active lifestyle (pool, tennis courts, etc.); lastly, the building is located within two blocks of a major beach park and a block from two major shopping areas, hundreds of restaurants, and otherwise supports a pedestrian lifestyle. Now I wonder whether a condominium in a less congested, less developed area of Oahu that offered a less pedestrian friendly lifestyle and fewer amenities might have been the better choice.

However, humans do well to make decisions based upon the best available information, recognizing that circumstances may change and that no amount of research will ever lead to making perfect decisions. Living in this condo does provide an incentive for doing everything I can to regain as much health as possible. I also know that is likely that I will predecease my wife and that we live in a location and with the possibility of enjoying the lifestyle that she prefers.

I also wonder how many of my hobbies I will be able to enjoy in the future and to what degree I will be able to pursue those hobbies. My cancer has been a catalyst for reexamining what I want to achieve in the remainder of my life: how I can best use and enjoy those years. My next Ethical Musings post explore those topics.

My 2016 Thanksgiving

This year Thanksgiving is special because my cancer has deepened my appreciation for life in several ways. One can give thanks to God (as I do) or to the family and friends with whom one shares mutual love and affection (as I recommended for non-believers in my previous Ethical Musings' post, Rethinking Thanksgiving). In either case, I hope that my thoughts on giving thanks will help you to give thanks for the good that you enjoy and that enriches your life.

First, the treatment of my multiple myeloma is progressing very well and I am nearing remission. I am grateful for all of the persons who made this possible: research scientists and their staffs; the healthcare personnel who administer the treatment to me in a highly professional manner complemented with personal caring; and the healthcare the nation provides to its military retirees.

Second, I am similarly grateful for the potential gains to my mobility, comfort, and decreased risk of some of vertebrae collapsing with subsequent irreversible damage to my spinal cord and the adverse effects that entails. The list of personnel involved in this is long, including radiologists, neurosurgeons, wound care specialists, interventionist radiologists, research scientists, and others.

Third, I am thankful to be part of an extended network of family and friends, especially friends and colleagues within the Anglican Communion worldwide and the Episcopal Church in the US. Prayers, best wishes, visits, and other forms of support have helped to buoy my spirit and to support the healing process. The best available scientific research suggests but does not prove that prayer is efficacious. I am especially thankful for my wife of 43 years. She entered into our marriage with no knowledge of what the future might hold. Nevertheless, she has willing supported me with unstinting encouragement, bravely facing she negative development, and willing providing care and assistance as I have needed.

Fourth, I daily appreciate living on a beautiful, semi-tropical island in a very comfortable condo and having the resources to pay for both daily expenses and any costs we incur because of my disease or treatments. In other words, I daily recognize the importance of protecting the environment and the benefits of living in harmony with nature.

For these things, I give thanks to God and to the people involved.

I pray that all of you and your loved ones will have a blessed Thanksgiving.

Rethinking Thanksgiving

The historical roots – at least the mythical if not the factual version – of the Thanksgiving holiday in the US are widely known. Pilgrims fleeing religious persecution in England immigrated to the rocky shores of what would become Massachusetts. These pilgrims would not have survived without the assistance, especially gifts of food and agricultural instruction, which they received from the natives. Thanksgiving for these pilgrims, as for many in subsequent observances of the holiday, believed their perceived blessings to be God's gifts.

Today, describing our perceived blessings as God's gifts increasingly rings hollow among believers in God, agnostics, and atheists. Scripture reminds us that the rain falls indiscriminately on both the just and the unjust. That is, good and bad things happen to everyone and are not special blessings intended for a select few. We more accurately attribute the pilgrims' perceived blessing of a bountiful harvest to help from their neighbors than to God's direct intervention.

More broadly, belief that God is responsible for everything that happens is diminishing among believers and rejected in principle by atheists. For example, positing God's direct control of everything that occurs problematically makes God responsible for evil as well as good. In short, Thanksgiving's underlying premise that the good things we enjoy in life come from God whom we rightly thank for blessing us is increasingly suspect if not dismissed as erroneous.

Concurrently, the continuing urbanization of the US population distances people from having a personal appreciation for Thanksgiving as a harvest festival.

Yet, in spite of the erosion of the historical reasons for celebrating Thanksgiving, the feast remains popular. Attendance at religious and communal Thanksgiving services has precipitously declined as have the number of people who self-identify as religious. Nevertheless, families and friends persist in gathering annually at Thanksgiving, often travelling great distances at considerable cost to attend.

Thus, Thanksgiving is a feast that invites rethinking. Proposed below are an alternative reason to give thanks to one another if not to God and an ethical imperative that observing the feast of Thanksgiving can strengthen.

First, give thanks to those we love and those who love us. These relationships give life meaning. Believers appropriately include God among those we love and those who love us. Believers and non-believers appropriately express their gratitude to family and friends whom they love and by whom they are loved. Important expressions of gratitude include spending time together, sharing a special, festive meal together, and verbalizing why a mutual relationship is life enhancing. Observing Thanksgiving celebrations over the last several decades suggests that numerous people have already shifted from a theocentric feast to a feast that celebrates the important persons in their lives.

Second, reinterpret Thanksgiving's traditional harvest imagery in terms of contemporary ecological concerns. Thanksgiving is an excellent opportunity to renew our commitment to caring for the earth and most life forms that dwell on the earth. Giving thanks for most life forms is more honest than giving thanks for all life forms, e.g., I personally find it impossible to give thanks for mutant cells that cause cancer, bacteria and viruses that cause severe suffering or death, etc.

The Church as well as the US presently lack an annual, widely observed festival focused on ecological concerns. Although Earth Day has gained some traction, it falls far short of Thanksgiving's enduring popularity. Reinterpreting Thanksgiving in ecological terms is an excellent opportunity to heighten awareness and to strengthen our commitment to safeguarding the earth and most of its life forms. Ideally, families and friends who gather to share a Thanksgiving meal might develop a new tradition of engaging in an ecological action in addition to current traditions of watching televised parades and football games, playing pickup football games, and shopping.

These two reasons for rethinking Thanksgiving broadly overlap. Illustratively, a prime reason for protecting the environment is to preserve opportunities for future generations to live rich, fulfilling lives.

Rethinking Thanksgiving will require the Church to rework its Thanksgiving liturgies and observances to emphasize giving thanks to those we love, receiving thanks from those who love us, and living as stewards responsible for caring for creation. Rethinking Thanksgiving will better align the feast with what is already occurring while preserving links to the holiday's historical origins.

Thoughts on Trump's electoral victory

Donald Trump achieved an amazing, unpredicted upset to win election as the next President of the United States. What does his victory portend for life in the US, for the future of the US, and for the world?

First, the conciliatory, unifying themes that Trump, Clinton, and Obama adopted in their post-election remarks are encouraging. Democracy entails living with outcomes not of our own choosing and while far from perfect is the best form of government known to humans. I personally wish that the energy devoted to protesting Trump's victory had been expended in working for a Clinton win. But to refuse to accept Trump as President of all US citizens and of the whole nation invites more problems than it resolves. Insisting on the dignity and right of all persons to equal respect and treatment represents a more constructive agenda and one that is likely to resonate with Trump's family if not the President-elect.

Second, Trump has provided few specifics about policies and programs that he intends his administration to adopt. He has also repeatedly moved from extreme positions toward more moderate positions, that is, he is a pragmatist more than an ideologue. Some of this pragmatism will, I suspect, be evident in differences between positions held by hard-right GOP House members, the more divided Senate in which Democrats by filibustering can wield significant power, and Trump's administration.

Trump's vagueness about his goals, his pragmatism, and his ability to shift positions may have some positive aspects. Illustratively, a Trump presidency may be the catalyst for returning to a stronger federalist system. For example, instead of attempting to centralize education standards states may have more latitude in adopting their own standards. One historic advantage of federalism that has long appealed to me is that when uncertainty obscures clarity about the best policies, practices, or programs allowing states to experiment provides fifty "labs" for testing various approaches. Contrary to single-issue politics and advocates, identifying best policies, practices, and programs is often a lengthy, difficult endeavor.

Third, Trump's lack of foreign policy knowledge and experience, a weakness that attracted repeated attention during the extended campaign, greatly concerns me. Like Trump, I favor rarely using US military power abroad. US intentions for its interventions are generally laudable. Unfortunately, often nobody, including US decision makers, has sufficient knowledge to predict the consequences of such interventions accurately. Sometimes an intervention ends in disaster (Vietnam), achieves short-term goals yet fails to achieve long-term stability (Afghanistan), or results in a less stable, less secure, less advantageous for the US outcome (Iraq).

Trump is not the first US president in recent history to lack significant foreign policy knowledge and experience. Hopefully, Trump will surround himself with competent advisors and quickly come up to speed on dealing with foreign policy.

Reviewing this post in a couple of years, I would not be surprised to discover that my optimism was unwarranted. Divisions within the US are deep, e.g., the chasm between the wealthiest 1% of the poorest 50%. Rapid change (though much of it is for the good in my estimation) has challenged people to adapt to a society with which they feel out of step. Globalization, economic shifts toward services and content instead of things, and greater justice for all are irreversible trends. Nevertheless, the rapid pace of change too often has been an excuse for treating persons who have not adapted to the changes, for whatever reason, as social misfits and inferiors, moves clearly incompatible with according all persons equal dignity and respect. And continued US hegemony as the world's only superpower is far from assured regardless of who is president or policies the US implements.

However, at this moment when the US is poised on the cusp of a new presidential administration, optimism is likely to produce results that are more positive by seeking to make the best of a potentially very problematic electoral outcome than is pessimism. 

Death and dying

On Tuesday, November 8, Colorado voters approved a measure legalizing assisted suicide, following the lead of Oregon, Vermont, Washington, and a couple of other states in taking this step.

A century ago, dying was generally an event or a very quick process. Today, dying is more often a lengthy process than an event. Life support measures such as respirators, intravenous feeding, and hydration can frequently sustain the mechanics of life for long periods, preserving the appearance of life in what is known as a persistent vegetative state (PVS). Medical treatment can concurrently prevent the person dying from a growing array of previously life-threatening diseases and injuries. (For a fuller, clearer exposition of this change, read Haider Javed Warraich's "On Assisted Suicide, Going Beyond ‘Do No Harm’", New York Times, November 4, 2016 at http://nyti.ms/2eaeL36.)

In one case that received much media attention, a Florida woman, Karen Ann Quinlan, was kept in a PVS at the insistence of her family of origin and contrary to the wishes of her husband, her legal next of kin. When the courts finally ended the standoff, siding with Quinlan's husband, an autopsy revealed that her brain had suffered considerable deterioration even though the rest of her body gave the appearance of being alive.

Having been diagnosed with a specific fatal disease (life itself is eventually fatal, always ending in death), the shift from dying as an even to dying as a process, debates about assisted suicide, and the use of heroic measures to sustain life, or at least the appearance of life, prompt several thoughts and feelings.

First, I don't think that I fear death. I don't fear falling asleep at night; death, at its worst, may be the permanent loss of consciousness, not unlike falling asleep permanently. And optimally, death is just another waypoint on a journey to an even richer, more abundant form of life. Still, I'm in no rush to die, continuing to enjoy much of life, and eagerly looking forward to my cancer going into remission sometime in the next few months.

Second, I have no desire to remain in a PVS or to suffer uncontrollable pain from an agonizingly slow death. Although pain may be a precursor to something good (e.g., medical treatment and natural healing processes may cause pain, but that pain is incidental to the healing process), pain per se is never a good.

Third, existing (perhaps better described as subsisting) in endless pain with no hope of healing and no hope of leading a fuller life is not a good. Only the individual who lives in severe, unending pain – in consultation with loved ones and healthcare providers – is in a position to decide whether any continuing enjoyment of life outweighs the pain. Depression, a frequent side effect of long-term serious disease or suffering, can wrongly skew that judgment. This justifies the stipulation that decisions about treatment be made in consultation with loved ones and healthcare providers.

Fourth, a dying person may not be able to make healthcare decisions in a timely manner, e.g., being in a coma. Consequently, everyone should think about this set of problems, consult with loved ones, and then prepare an advanced healthcare directive and other requisite documents to ensure that their desires are honored if and when necessary.

Sickness unto Death?

The word crisis appears only once in the New Revised Standard Version of the Bible (1 Corinthians 7:26). That is one more time than I had guessed. Paul justifies advising the unmarried and widowed to remain celibate and unmarried in view of the impending crisis that will occur when Christ makes his anticipated eschatological appearance.

Etymologically, the English word crisis comes from the Greek noun krisis, which means decision, and from the Greek verb krinein, to decide. The Concise Oxford English Dictionary defines a crisis as a "time of intense difficulty or danger" or "the turning point of a disease when an important change takes place, indicating either recovery or death."

Organized religion in general and the Christian Church in particular face an existential crisis that threatens their continued existence. Symptoms of the present crisis include continuing numerical decline, growing numbers of people who find any religious faith or spirituality incompatible with a scientific worldview, and an increasingly widespread, unthinking individual dismissal of religion as mere superstition.

The Church's current existential crisis is clearly not identical with what Paul perceived to be the impending crisis. However, there are at least three important commonalities. First, new wine still requires new wineskins. Verbalizing religious experience and meaning requires constant repackaging, preserving a healthy tension with secularism, yet affirming God's continuing love and action in the midst of a broken, hurting world. Second, new wine distributed in new wineskins must offer a credible hope for creation's renewal and completion. Third, offering new wine today as in Paul's day calls for personal decisions to accept or reject it.

This existential crisis plays out on three levels, each progressively smaller and more personal than the previous but each an essential element of the whole. Most broadly, the crisis is evident in the global competition of institutions and ideas. On this level, the Roman Catholic Church under Pope Francis' leadership strives to keep the old wineskins, trying to soften their rigidity and enhance their appeal by using gentler, less judgmental language. At the other extreme, progressive Christians, sometimes accused of being atheists, struggle to identify new wineskins to hold new wine palatable to this new age while preserving the vital, transformative essence of religion and spirituality.

Unsurprisingly, the Church (including The Episcopal Church (TEC)) has experienced the most difficulty in playing on this broadest of levels. Our Presiding Bishop, the Most Rev. Michael Curry, with his emphases on taking the gospel to people rather than waiting for people to come to church and on making Jesus intelligible in the twenty-first century represents an effort to play on this level. However, the work of repackaging God's gift of new wine in new wineskins has proven problematic. The writings of progressive Christians such as Bishop Spong and David Ray Griffin (especially in his book, Panentheism and Scientific Naturalism) have often evoked more angry misunderstanding than appreciation.

The middle level consists of the Church through its institutional structures (dioceses, congregations, and other structures) addressing contemporary crises. TEC has made tremendous institutional progress in becoming more inclusive. For example, gender and race are no longer formal barriers to becoming a leader and we celebrate marriage as the union of two people regardless of their gender or gender orientation. Moreover, TEC has responded promptly and decisively to some crises in remarkably positive, caring, and effective ways. Illustratively, I recall the post 9/11 100 days of mission coordinated by Bishop George Packard to the firefighters, police, mortuary staffs, construction crews, and other emergency personnel working at the pile that had been the World Trade Center.

At other times, the Church has responded ineffectually, if at all. At one extreme, some congregations create the hopefully unintended impression that TEC is a denomination of causes championed by disparate groups loosely linked only by their common commitment to Sunday's Eucharist. At the other extreme, visitors to some congregations live a version of Christianity more akin to escapism than to incarnation, gathering to celebrate a disembodied gospel, detached from current events. Institutional maintenance too frequently becomes the goal, rather than the institution representing a means for good decisions and cooperative action focused on bringing life out of death.

The last and most intimate level on which the Christian drama plays is that of an individual's life and spiritual journey. Again, TEC's scorecard is decidedly mixed. We Episcopalians have a well-deserved reputation for pastoral sensitivity, care, and being nonjudgmental. On the other hand, we touch too few lives because we concentrate on the needs of members of our congregations, rely too heavily upon our clergy for crisis response ministry, and sometimes find living and ministering through the duration of someone's extended crisis difficult.

James L. Griffith and Melissa Elliott Griffith in Encountering the Sacred in Psychotherapy (New York: Guilford Press, 2002, p. 268) helpfully charted existential crisis states that render a person vulnerable or resilient to illness:

States of Vulnerability	States of Resilience
Despair	Hope
Helplessness	Agency
Meaninglessness	Purpose
Isolation	Communion
Resentment	Gratitude
Sorrow	Joy

The Sickness Unto Death is Soren Kierkegaard's 1849 existential analysis of why death for Christians is not the end but simply another waypoint on the journey to eternal life. We may disagree with Kierkegaard that this sickness always shows itself as despair. As the Griffiths suggest, the sickness may have many forms and names. However, I find the title of his book an apt description of a crisis' potential catalytic power changing death unto life. With God's assistance, quality pastoral care intentionally aims to facilitate that transformation.

David Brooks, the popular New York Times' columnist, believes that there is "a pervasive cosmic unease, the anxiety that [people] don't quite understand the meaning of life, or have not surrendered to some all encompassing commitment that would bring coherence and peace." ("The Epidemic of Worry," October 25, 2016, accessed at http://nyti.ms/2eAgY7w)

Crises are opportunities for Christians, our institutional structures, and the global Church to address the cosmic unease that Brooks recognized. I see encouraging signs of hope, but am far from sanguine about the journey ahead. Instead of investing our collective and institutional energy and resources in preserving the status quo and our individual energy and resources in attempting to overcome the fears and anxiety that the sickness unto death causes, we might do better to reimagine the sickness unto death as the sickness that leads to life abundant. 

Lessons from cancer

My fight against cancer has taught, or re-taught, me several lessons.

First, science is vitally important. Without scientific advances achieved in the last fifty years, I would be dead today. Science has bought me precious additional years of life. More than ever, I am convinced that competitively juxtaposing science and religion in a win-lose contest is wrong. Truth and reality are singular, i.e., science and religion offer different views of the one reality but are ultimately, when rightly understood, compatible.

Second, receiving grace – whether through the professional skill of healthcare providers, the prayers of strangers, or the kindness and love of persons whose life had previously intersected with mine – is transformative. For one who is accustomed to giving rather than to receiving grace, this has been an important reminder that everyone needs grace, true grace is unsolicited and free, and that grace is ultimately a window through which divine light shines.

Third, life's richness and meaning is indissolubly linked to our relationships with other people. I have found that one of the most difficult aspects of hospitalization and then chemotherapy is lacking the energy to spend time with others. As I begin to regain strength and energy, I cherish my interactions with other people. A corollary of this lesson is that opportunities to touch other lives may occur not in the first moments of crisis, but in the longer, more arduous journey that lies on the other side of that crisis.

I look forward to learning more in the future.