Go ahead, hug a tree

After almost two decades of gardening our verdant half-acre in Corvallis, I’ve had to remove five dead or dying trees in the past two years. I have no hang-ups about using my chain saw for its intended purpose, but it’s still sad to see these old friends go: a gnarled coast pine growing too close to the house, a stately madrone that might have had too much water, a graceful vine maple that likely had too little, a spindly mountain ash muscled into submission by larger, taller neighbors, and a pink dogwood that never fulfilled its destiny of actually being pretty.

You only need to be in the
proximity of trees to gain
their health benefits--but go ahead
and hug one anyway

I have about 20 trees of various shapes and sizes remaining, including a 150-foot incense cedar that anchors my prayer garden with its striking, deeply furrowed trunk. The newest addition is a Shishigashira Japanese maple that I bought from a friend who has a boutique nursery specializing in unusual landscape trees. I handpicked this specimen for its curly leaves, highly layered look and brilliant scarlet fall foliage. Planting a tree and nurturing its early growth isn’t quite the same as parenthood, but it remains a solemn act of stewardship just the same.

I read recently that ancient bristlecone forests in North America are falling victim to a fungal disease spread by pine beetles. Many years ago I visited a grove of these trees in the White Mountains of southeastern California, and was awed by both their age and beauty. Each tree was arboreal sculpture, some with no more life than a few clusters of needles at the tips of contorted branches. To know that trees as old as the pyramids of Egypt are dying prematurely deserves some serious contemplation. I have also traveled through the Brazilian Amazon as a magazine reporter and seen trees spreading out to the horizon in all directions. In the Sierra Madre of Mexico, I witnessed old-growth Ponderosa pine forests being savaged by industrial logging financed by the World Bank. Ironically, in Oregon, where trees on public lands could actually be sustainably harvested to the economic benefit of all, they are left practically untouched.

I have an affinity for trees that’s unusual even for an Oregon native. I graduated with a minor in forestry from OSU, so I know something about the economic and recreational value of forests. Their importance to some of our most pressing environmental problems should also not be underestimated. We take them for granted, but they are a near miracle. In a bit of natural alchemy called photosynthesis, trees turn the insubstantiality of sunlight into food for insects and wildlife, and we use trees to create shade, beauty and wood for fuel, furniture and homes. One of the best things we can do to heal the earth while also serving humanity is to plant trees—en mass. It’s been said that the best time to plant a tree is 20 years ago. The second-best time? Today.

Leave it to the Japanese to popularize an esthetic practice involving trees that sounds a bit kooky but which caused The Ogler to sit up and take notice. In Japan, researchers have long studied what they call “forest bathing.” A long walk in the woods, they say, reduces the level of stress chemicals in the body and increases the killer T cells in the immune system, about which I’ve already written. Trees are known to release vast clouds of beneficial chemicals, some of which are anti-bacterial, anti-fungal and anti-viral. Among the many good reasons to spend time in the woods should be added the possibility that trees offer a yet unknown degree of protection against cancer. The shade they provide also protects us against damage caused by UV radiation that can lead to melanoma and other forms of skin cancer.

I’ve always believed that there was nothing wrong with being a tree hugger. Now I know for sure.

The good, the bad and the downright weird

When you have melanoma and end up spending most of a day with dozens of other people with melanoma, doctors who treat melanoma and scientists who investigate melanoma, it’s logical that a melanoma-fest should ensue. The melanoma patient symposium held Saturday at Fred Hutchinson Cancer Center in Seattle did not disappoint in this regard.

I learned a few things, I made some new friends, I had a few of my suspicions about the melanoma industrial complex confirmed, and I laughed at the occasional weirdness of it all.

This was my third time around at this annual event, which is underwritten and promoted by the Melanoma Research Foundation. The MRF is the oldest and largest patient advocacy organization in the melanoma world, as they like to remind everyone. I appreciate the trouble to which they go to provide these forums for folks like me who follow the science and clinical practice of melanoma therapy. Heck, they’re free and they never run out of coffee, so what's not to like? I always learn something useful, and I love being able to speak informally with luminaries. The program itself was wildly uneven in quality, as usual, but it helps to just hear the jargon, even when a speaker is a dud, and to learn how to correctly pronounce words like adjuvant and vitiligo.

I was especially impressed by Dr. David Byrd, the program director and chief of surgical oncology at the Seattle Cancer Care Alliance, and Dr. Kim Margolin, a melanoma specialist at the Hutch. Both show a generosity of spirit that is rare in oncology. I asked Margolin after the morning session what she thought about Yervoy versus interleukin-2 for systemic treatment of advanced disease. She gave a straight, gracious response without a trace of the attitude I often get from smarty-pants doctors. This symposium is small enough you can sit with the experts at lunch, if you want, and pick their brains—and you don’t need to show proof of insurance for the opportunity.

It’s easy to make friends with people who share a disease like melanoma, as most of us are pretty compulsive about telling our stories. I recently made contact online with a woman about my age who is bright and articulate and whose experience with melanoma mirrors mine in certain ways. We met at the symposium and sat together. We share the conviction that you can’t always depend on medical professionals to act wisely on your behalf; you have to be your own advocate. And to be that, it helps to have the experience and insight of others who share your circumstances and against whom you can test your understanding of things. It was great to meet her and I hope we can be a support to each other.

I should add there is shared sorrow in hearing the particulars of someone else’s cancer journey. We all know that melanoma will deprive many of us of years of life; we just don’t know for certain who and how many. Some of the patient stories we heard at the symposium practically stopped my heart, and I realized anew how blessed I’ve been to have an indolent form of the disease.

The biggest disappointment of the day for me was the willingness of an academic dermatologist to give the tanning industry a pass for its complicity in the epidemic of skin cancer. Indoor tanning continues to grow in popularity and its business lobby seems fully up to the task of defusing the medical arguments against it. As evidence accumulates on the DNA damage caused by UV energy (both indoor and out), I think dermatologists have a moral obligation to act aggressively against it. I wish I had heard more passion from the speaker about this topic. A room full of people who spent too much time in the sun or in tanning booths was not the place to soft pedal an issue that needs immediate, aggressive action.

He's my hero, so please
don't desecrate his music

The weirdest moment came when the executive director of the MRF broke into song and belted out the Pete Seeger number, “Step By Step.” The point I think he was trying to make was that the fight against melanoma can be won in small increments and that, in fact, significant progress has been made. This is a message that would undoubtedly resonate at a fund-raising banquet, but seemed totally off-key delivered to people who may die before something comes along that might save them. Survival statistics for people with advanced melanoma remain dismal and it will probably be years before that changes. There’s an important distinction between being hopeful and making a PR pitch. I’ll believe we’re at a tipping point in curbing melanoma when we get past the sensational case studies and see some rigorous population-based statistics that prove it.

And the next time someone at a melanoma meeting is tempted to dip into the Pete Seeger song book, I dare them to go all the way and lead a sing-along version of “Guantanamera."

The fault, dear Brutus, is in our cells

A novel about two precocious teenagers dying of cancer is not the sort of book to which I’m typically drawn. In fact, with the exception of “A Wrinkle in Time,” I hadn’t read any young-adult fiction in years. But “The Fault in Our Stars” popped up on my amazon.com page a few weeks ago, so I decided to give it a go. Even though it’s “kid lit,” I was curious how a difficult topic like childhood cancer would be handled by what appeared to be a competent author (John Green).

Once I opened the book, I couldn’t put it down. This may be a book written for people decades younger than me, but I found Green’s voice to be compulsively readable. He has deftly mixed the profound with the quotidian in a beautiful story about two remarkable young people. Yes, there’s romance of the adolescent persuasion, but I liked the book instead for being so sweet, philosophical, funny and melancholy. This is no sappy “Love Story.”

The two protagonists are 16-year-olds who meet at a cancer support group. Hazel Lancaster, the narrator, is living with terminal thyroid cancer that has ravaged her lungs enough to necessitate the use of an oxygen tank wherever she goes. It’s during a support meeting that she is introduced to Augustus Waters, a once-was sports jock who has lost a leg to a malignant bone tumor and who soon becomes the object of her affection.

“The Fault in Our Stars” is not just about cancer, as the characters themselves won’t allow for that. But Hazel and Augustus are both wise beyond their years because of a shared sense of mortality that is unheard of in the typical teenager. This is partly a literary conceit, but a plausible one in this case. I’ve seen how cancer can transform character in people I’ve known, making both young and old more reflective, more patient, more complicated and, sometimes, ennobling them in unexpected ways. It doesn’t always work out this way, but in Green’s hands, our two young characters find in each other the depth and significance that everyone else in their lives seem to lack.

Hazel and Augustus are not turned into heroes, other than maybe to each other. One of them dies, of course, which is how a novel about juvenile cancer was bound to end. It’s not a happy ending, either—not poetic or even somehow right. It left me empty, but all the more appreciative of the emotional restraint of the author. There is no false hope in this story. He lets a tragedy remain a tragedy.

Pale is the new tan

May is Melanoma Awareness Month, in case you need to be told. Most people reading The Ogler don’t. If you’re a regular visitor, you probably know more about melanoma than you ever thought possible. I’m glad to be of service.

There are a multitude of fundraisers and media campaigns in the offing. Most are aimed at making the public aware of the risks of excessive exposure to UV radiation and to hector people into having their skin checked if they notice anything suspicious (do you know the ABCDE Rule?). It’s an idealistic campaign, given that this is but one disease among many that clamor for our attention. I remain hopeful, however, that at least a few people who are oblivious to their risky behavior will take notice, get out of the sun and save themselves some major heartache.

Public awareness of melanoma is definitely on the rise, partly because of its growing incidence--especially among young women. In terms of new cases, melanoma is the fastest growing cancer in the U.S. If you’re looking for a trendy disease, this may be it. One popular cancer blog has titled itself, "Black is the new pink," as if we were in some sort of demented contest for attention with breast cancer (and its ubiquitous pink ribbons).

Too bad there wasn’t a Melanoma Awareness Month in 2005, which I figure is about when the mole on my leg took off and became the launching pad for the metastatic proliferation of my cancer. I had at least a couple of severe sunburns when I was young and then spent far too much time in the sun as an adult without sunscreen and often without even a hat. Somewhere along the line, one renegade melanocyte picked up a mutation and began to madly multiply.

Sad to say, I don’t remember the word “melanoma” ever being spoken to me until a dermatologist used the M-word in 2006 when he examined what by then was a deformed and ulcerated mole near my left knee. Had I paid serious attention to this mole a year earlier I might have had it removed before it could do me serious harm.

Melanoma is not totally preventable, but careful self-examination and a yearly skin check by a dermatologist should be a part of everyone’s healthcare regimen. If you’re a boomer as I am, it’s cumulative sun exposure over your whole life that is your single biggest risk factor. Just because you’ve wised up about the sun in recent years doesn’t mean you haven’t done genetic damage that could lead to melanoma later. And don’t expect your GP to bail you out; mine didn’t. I had my annual physical just days before I decided that I needed my wayward mole attended to and came back to him with the question, “Um, do you think there might be a problem here?”

So consider yourself warned: Left unattended, a bad mole can seriously screw up your life. When in doubt, check it out.

I’ll be posting this message on Facebook as my meager contribution to Melanoma Awareness Month. Anyone reckless enough to spend long hours in the sun this summer without protection--or, God forbid, frequent a tanning "salon"--might as well take up smoking and texting while driving. Just remember: Your tan won’t impress anyone at the morgue.

I won’t bother to argue the odds of something bad happening from an activity that feels as good as soaking in the radiant warmth of the sun. They may be low, but they aren’t negligible. The fact that what turns your skin brown can later turn it black should be knowledge enough that it’s not worth the risk. Should you see that public service slogan in coming days that “Pale is the new tan,” believe it.

T cell in a murderous mood

The human body is an amazing instrument that has the ability to heal itself from a variety of maladies, including cancer. One of the tools the immune system uses is called a killer T cell, which is depicted in this astonishing video made by scientists at Cambridge University. You need to watch this minute-long clip in order to believe me when I say your immune system has probably saved your life countless times over.

If you ignored my suggestion, what you’ve missed is a time-lapse movie of a T cell (10 microns in length) attacking a tumor cell. This aggressor, which is a specialized type of white blood cell, secretes a toxic enzyme that quickly causes the tumor cell to die—a process called apoptosis. T cells are highly efficient killers—like a “smart-bomb” of the body. Researchers are striving to better understand these cells so they can gain control of them to create new treatments for certain types of cancer.

The immune system protects us not only against cancer but also against billions of bacteria, viruses and parasites. Most of us have no reason to reflect on the fact that while we hang out with friends, watch TV or mow the lawn, the immune system inside our bodies is on constant high alert, attacking harmful organisms at the first sign of their invasion. We can’t see this or feel it. If someone hadn’t created this video via electron microscopy, the idea of my immune system responding to a cancer threat would have remained a remote abstraction.

What the video’s producers fail to note is that the immune system, unfortunately, often fails to identify malignant cells as invading enemies. Cancer cells are given a pass since they’re not foreign to the body as, say, a cold virus is. When people with advanced melanoma undergo immunotherapy, the drugs we’re given are designed to tweak our immune system’s response to cancer. Strenuous exercise is also believed to be an immunostimulant. When I run I sometimes play a video loop in my brain of these killer T cells wreaking havoc on melanoma cells they chase down and eviscerate.

Visualization is a largely discredited form of cancer therapy, buy by retaining the mental image of T cells at work, I'm better able to understand what is likely the preeminent means by which my body staves off cancer. When I pray for a miracle of healing, this is the miracle I have in mind. I pray that my body does what it's designed to do. Seeing with my own eyes the haunting beauty of my immune system in action is, for me, really powerful medicine.

Stephen Jay Gould and the long tail

When my melanoma went metastatic more than two years ago, I didn’t need my oncologist to tell me how long patients like me typically lived. I already knew, and it wasn’t much. He told me anyway, probably figuring this was part of his job: to keep things real. I don’t recall whether I shrugged or slumped. What I do remember is booking a flight to Kauai within days, figuring he might be right. Ellen and I went on an adventure that we feared might be our last together.

Gould's famous essay has
become a source of comfort
for many cancer patients,
deservedly or not.

I’ve since blown past the AJCC averages, which has been a pleasant surprise. I may not have beaten the cancer and likely never will, in the sense that recurrence is an ever-present reality. But my short-term survival is no longer in doubt. I have adopted an attitude these days that either the cancer will come back or it won’t. For someone as quantitatively oriented as I am, this is something of a breakthrough. I’ve thrown out the stats charts.

Probabilities are still in play, of course. The data collected by cancer centers across the country form a database that’s hard to argue logically against. I suspect that both my surgeon and my oncologist could tell me from experience how much longer they think I might live, and what disease progression looks like for an outlier like myself. My case is not unprecedented. But I haven’t brought any of this stuff up with them for months, and remain disinclined to do so.

In his 1985 essay, “The Median Isn’t the Message” the renowned paleontologist Stephen Jay Gould described the solace he felt after he learned he had a deadly cancer when he saw in the statistics that a few people actually lived a very long time, even though most with his diagnosis succumbed rapidly.

He decided at that moment to be one of the rare ones; put scientifically, he planned to be in the tail of the distribution. It’s a remarkable essay by one of the great scientists and science writers of our era. And he was prescient. Gould lived another 17 years after publishing it. He beat the odds.

What’s surprising about this is that a MacArthur Foundation “genius” like him would choose to actively delude himself. He had no scientific basis on which to conclude he would survive; he simply declared that he would. Writing on his cancer blog at nytimes.com, Dr. Peter B. Bach has said this about Gould: “Only in Lake Wobegone can everyone be reliably above average, and there’s merit to being realistic.” Bach thinks that “hoping for the best” is a dumb plan for a cancer patient, which in his case involves the care of a wife with advanced breast cancer. He’s clearly a numbers guy, like I used to be.

As did Gould, I’m living in the long tail. I didn’t get there by any special merit and I don’t wear rose-colored glasses. I don’t believe in magic. Some people with metastatic melanoma live more than five years after their diagnosis, and a few even make it to 10. There are a handful who, having been treated with interleukin-2, have been declared “cured.” I’m at 28 months and counting. I will either remain NED or I won’t. It’s nice to have something so simple to believe in.

The choices I make in life are informed by my health status, but not dictated by it. I remain as fully aware of my own existence as a person can be, and am blessed for it. My days are filled with joy. Cancer survival statistics, on the other hand, are stone cold and over time unmercifully accurate. No one knows which side of the ledger one is on at any given moment, however. For now, I’m alive and well and happily deluded. I am free from slavish devotion to mere numbers. Stephen Jay Gould is my inspiration for living in the long tail.

Spitting into the wind

Rising healthcare costs are busting the federal budget, to say nothing of family budgets for anyone who’s privately insured, as we are. Policymakers and healthcare leaders have spent decades trying to figure out what to do about this mess—to no avail. No one knows what it really costs to deliver care to individual patients, much less how those costs compare to the outcomes achieved.

Because healthcare charges and reimbursements are disconnected from what they actually cost, some procedures are reimbursed very generously, while others are priced below their actual cost or not reimbursed at all. This leads many providers to expand into well-reimbursed procedures, like knee and hip replacements or high-end imaging, like PET and MRI. At the same time, critical services like primary and preventive care are reimbursed poorly.

My point: A lot of expensive medical care could be avoided and vast sums of money saved if gatekeeper physicians and nurses, and the simple procedures they order, were better reimbursed.

Regardless of whether they’re necessary to make their patients well, hospitals and doctors are paid handsomely to perform lots of sophisticated procedures and tests. Providers who excel and achieve better outcomes with fewer visits, procedures and complications are penalized by being paid less. If you doubt me about this, ask your pediatrician or family practice doc what they think.

As patients, it’s rarely in our financial interests to question the system. If you have a job and have employer-funded insurance, you’re still largely insulated from the absurdities of a system that encourages consumption of often needless healthcare. Because I’m not, I occasionally spar with the powers that be—mostly for my own amusement. On rare occasions, I win.

My most recent interaction could be called a draw. At a surgery a few weeks ago, I had three subcutaneous mets surgically removed by my oncologist. Like previous surgeries, the procedures were fairly simple and uneventful. As is my habit, I asked to see the tumors after they’d been dropped into small containers of formalin and before being sent to the path lab for analysis. I thought on this occasion to ask my surgeon, “We’ve been through this drill before. Since we both know they’re cancer, what’s the point of sending them to the lab?”

 I don’t recall exactly how Dr. V responded, but he overruled my objection. I didn’t protest. The cost of the lab work quite honesty wasn’t on my mind. It’s just that I’ve developed an amateur, but fairly refined sense for what metastatic melanoma looks like. I figured there wasn’t much the pathologist could tell us that would remotely affect my present or future oncologic care.

A few days later, my surgeon called to report the obvious: all three samples were positive for melanoma. No surprise there.

I received a statement from OHSU last week that breathed new life into this story. The $900 I was billed for pathology (technical component only) was disturbing enough, but what bothered me most was this charge being about three times more (per met) than my two previous, nearly identical surgeries. I checked the CPT codes on my insurance statements for those dates and found that they were at variance with my current bill. I called my insurance company (Regence BlueCross BlueShield) and the claims representative with whom I spoke seemed unperturbed by this observation. She assumed there was some added complexity to the most recent path samples, and declared everything good. OHSU’s charges were indeed correct based on the code provided.

I then emailed my surgeon, who to his credit is good about reading and responding to the occasional message I send him (unreimbursed care, I figure). I asked him specifically about the CPT codes and why they were divergent. His answer: All tissue samples suspected of being malignant are sent for path because OHSU is an NCI cancer center and thus obligated to test them all. He added that not everything that looks like a met is a met, and that he couldn’t remember ever not sending something that could be malignant to path.

I have no interest in challenging Dr. V's clinical judgment, but I remain in the dark about the CPT codes. I don’t understand code nomenclature and I know there’s arcane science behind what codes are assigned to specific procedures. It’s also possible that this was a matter of something simply being coded incorrectly. Mistakes happen, though not often admitted to, by people who are justifiably afraid of being sued. I don’t intend to press my doc on this matter but I'd love see a little more candor.

What bothers me the most about this matter is that nothing changes, nor had any chance of being changed, by some lab technician presumably conducting an added level of investigation of my samples. She or he simply sliced and diced them differently. Given that they were conspicuously malignant, there really wasn’t any worse news I could have learned. Even if the “mets” had miraculously all come back negative for melanoma, nothing in my life would change. I’d still be stage IV, I’d be watching for the appearance of new mets under my skin, and I’d be checking in again with my surgeon if and when something shows up. This is simply one small drop of medical overkill in a veritable sea of excess. Everyone involved in my follow-up to the $900 bill has given it a collective shrug. If I’m not hurt by it—other than financially—why should it matter?

In fairness, I should mention that the charge may eventually be reduced. Dr. V copied his nonresponse response to the chair of surgical pathology at OHSU, who cc’d it to her department’s billing and coding expert. It’s possible that my charge may yet be adjusted. I would appreciate that, but would equally like to know what actually happened here. Why were the samples coded differently after very similar surgeries? Is the system really that loosey-goosey? Does anyone ever get audited about this stuff? What is the NCI’s reason for requiring that everything cut out of cancer patients go to path?

I’m bothered a lot by the excessive cost of healthcare and by cavalier attitudes towards the system’s profligacy. I wage these quixotic raids not (just) because I’m a crank but because I figure if more of us did so, it might make a difference. I don’t wish the kind of insurance we have on anyone, other than perhaps the totally uninsured, who might actually appreciate it. It’s because my wife and I have considerable financial exposure that taking the time and effort to ask questions about our care makes sense. I’m looking less for charity than for answers, and ultimately for the sort of accountability that is grossly lacking in much of the healthcare we all receive.

Living in the light of resurrection

“Abba, Father, everything is possible for you. Take this cup from me. Yet not what I will, but what you will.” (Mark 14:36)

There is no explaining away the fear of death. Philosophers, theologians and pop psychologists have all tried, but the fear persists unabated. Its presence is dark, mysterious and utterly personal.

For some, death is an obscenity and they’re at a loss to even consider its possibility. For the fortunate few, the fear of death eventually loses its sting. I’ve observed this myself in some elderly people I’ve known and in a younger friend with cancer who approached his death with peace and equanimity. I’m in the muddled middle on this one, as mentioned in the previous post. I am not afraid of weighty reflection on my eventual demise, but I’m not at ease with it either. I worry that the conflict that smolders within me compromises my ability to make right decisions about how I respond to and treat my cancer. I feel simultaneously the push and pull between letting God’s will for my life to be exercised freely and seeking medical intervention for what appears to be an incurable but treatable disease.

The question that was posed in my previous post—Why keep going back for more care when I feel so conflicted about it?—is not likely to be resolved by my writing about it. This is one occasion when my mind simply cannot plumb the depths of my soul. I am like most people in that I possess a passionate love of life, and I don’t want it thwarted by disappointment, pain and death. My earthy nature is not easily managed…and yet I try.

This being Holy Week, I’m spending time considering once again the passion of Jesus Christ. I have read closely the gospel passages of Jesus in the Garden of Gethsemane. It was there, immediately before he was handed over to the Roman authorities, that Jesus agonized for hours over his fate. This is the only occasion in his life that we observe Jesus to be afraid of anything. He gave God one last chance to change his mind about his plan for salvation. Jesus may well have been afraid of death and dying at this moment, but his physical suffering was subsumed by fear of separation—however temporary—from his Father. This was the thought that caused him to literally sweat blood. His fear bordered on terror.

The cup from which Jesus must drink is not just his own sorrow but the sorrow of the whole human race. It is a cup full of physical, mental and spiritual anguish. It is the cup of starvation, torture, loneliness, bitterness, rejection, abandonment and despair. It is the cup that the prophet Isaiah called “the cup of God’s wrath.” It’s no wonder that even Jesus recoiled from it.

Dietrich Bonhoeffer came to understand in his own life and death what it meant to drink this cup to the dregs. The German Lutheran theologian and pastor has poignantly written that because of our spiritual shortsightedness, we tend to pay more attention to dying than to death.

“We’re more concerned to get over the act of dying than to overcome death. Socrates mastered the art of dying; Christ overcame death as the last enemy. There is a real difference between the two things; the one is within the scope of human possibilities, the other means resurrection,” Bonhoeffer wrote.

For the Christian, death is not an end but a beginning. This is what we celebrate on Easter morning. After his agony in the garden, Jesus went on to suffer one of the cruelest, most humiliating deaths recorded in human history, and to die broken and defeated. The light of the world was extinguished. Darkness overcame the face of the earth. But then…resurrection! God made good on his pledge of victory over death. Christ is risen, and new life reigns.

So what does all this mean for me? Merely everything, especially as it relates to my fear of death. It is faith in the bodily resurrection of Jesus that gives shape and meaning to the rest of the story of God’s ultimate purposes for creation. It is in the resurrection that I find real hope. After a bodily death Jesus experienced bodily life, and will live in human form for all eternity. And here’s the real mind-blower: so will I. Regardless of the time, place and reason, my death will not be the end of me. In God’s good time, I will be raised from the grave and will live again incorruptibly in bodily form. Rather than giving up on me and all those who come to know and love him, God will remake us all. What amazing grace.

This is a robust, orthodox understanding of what the resurrection of Christ represents. My faith in this Biblical narrative comes naturally. If so, then why should anyone—say me, in particular—ever choose to doubt the promises made to us in Scripture? Why should I persist in, much less admit to my fear of death? What’s with all that?

Indeed. About the best I can say in my defense is that I am weak. And I am weakest when I am most absorbed in the potentialities of medicine.

Having worked as a medical journalist for many years, I know something about its seductive power. In the absence of a religious worldview, there’s no reason not to make an idol of medicine. The consumption of medical care in this country is seemingly unquenchable because of the faith we have placed in it and the ministrations of its priesthood. Medicine is an idol because it appears to have the power to confer immortality. It ascribes to itself spiritual qualities--most notably hope--that belong to God alone. It is a value system that is fundamentally at odds with the values of God’s kingdom.

This clash is not absolute, however. I would never argue that vaccinations for children are wrong or refuse an annual physical with my GP. Much of healthcare is a great blessing. On my cancer journey, I’ve returned for care repeatedly because my doctors have something valuable to offer, however imperfectly they may provide it. It would be foolhardy for me to not have metastases surgically removed as an outpatient, for example. More problematic have been the radiation and immunotherapy regimens I’ve endured, and may face again. I don’t expect to avoid the moral and spiritual conundrum of healthcare decision-making in the future. If we live long enough, none of us will.

Because I possess an Easter faith, I am not captive to my fear of death. I am delivered from it even when it has me in its grip. I look to Jesus in the garden and am reminded that my dread is not unnatural nor more than I can bear. God will take care of things, however much I doubt that at times. I know him to be trustworthy. The same cannot be said for all things medical. There will always be ambiguity, error and carelessness in how it is administered. But medicine, too, is under the sovereign rule of the one sometimes known as the Great Physician. He is the King, the lover of my soul and the comforter of all my grief. It is in the light of his resurrection that I live today and into all eternity.