What comes next? (11/13/24)

 This morning we are waiting to be called back for a Gamma Knife procedure in which six different metastatic brain lesions will be targeted with radiation. The procedure itself is extremely safe with almost zero risk of injury to the vital surrounding structures in the brain. That said, the safety profile is achieved through a strategy that essentially eliminates the risk of any movement during the treatment. Four screws are passed through a metal “head frame” and into the skull. The head frame is then locked into the Gama Knife table while the radiation is administered. For this, 1 mg Ativan will be given to reduce anxiety. We feel so blessed to be living in a time when this sort of technology exists for treating a part of the anatomy that is usually off limits to medical treatments due to the presence of the blood brain barrier. That said, I’m pretty sure when my grandchildren visit the Tower of London someday they will find this apparatus right next to the “scavenger’s daughter.”

This is our first time being treated at St. Mary’s Hospital, where I spent most of my waking hours during our three years in Rochester. One surprising discovery for me is how few memories I have of that time, even though it was less than ten years ago. I’ve often thought about how absurd it is that I tend to spend so much of my present worrying about a future that I want to control, even as that future is being swallowed up in a past that I quickly lose access to. Even as I am aware of this paradox, the complete uncertainty about what even the next few days will hold has been one of the most difficult parts of the cancer journey.

Thankfully, yesterday brought the first glimpses of what a hypothetical future might look like after we met with our rock star medical oncologist for the first time. Some of the biopsy results are still pending (PD-L1 which will tell us if immunotherapy is an option), but regardless of the findings it sounds like there is a fairly broad arsenal of weapons with which to target this malignancy. The good news about living in a time when drug discovery is occurring at such a fast pace is that management of Stage IV breast cancer is almost like an arms race between the scientists’ ability to identify new molecular targets and the cancer’s ability to mutate and evade. Although I find some encouragement in thinking about this situation in military terms, I’ve studied enough Sun Tzu to understand that we are very much “outgunned, outmanned, outnumbered, out planned.” Element of surprise: advantage cancer. Know your enemy: advantage cancer. Stay adaptable: advantage cancer. But Sun Tzu also said, “In the midst of chaos, there is opportunity.” I am reminded again of Genesis 37 when Joseph is thrown into a cistern by his brothers before being sold into slavery. These events took place in the city of Dothan, a location in the Samaria Hills of present-day Israel. God was present in that cistern even though there was no indication that this was the case. Dothan makes a second appearance in the Old Testament in 2 Kings 6, when the prophet Elisha is being hunted down by a Syrian posse.

 13 “Go, find out where he is,” the king ordered, “so I can send men and capture him.” The report came back: “He is in Dothan.” 14 Then he sent horses and chariots and a strong force there. They went by night and surrounded the city. 15 When the servant of the man of God got up and went out early the next morning, an army with horses and chariots had surrounded the city. “Oh no, my lord! What shall we do?” the servant asked. 16 “Don’t be afraid,” the prophet answered. “Those who are with us are more than those who are with them.” 17 And Elisha prayed, “Open his eyes, Lord, so that he may see.” Then the Lord opened the servant’s eyes, and he looked and saw the hills full of horses and chariots of fire all around Elisha.

Encirclement is the most dominant position an army can achieve in a military campaign. I think that we’re all feeling a degree of hopelessness in this situation. Wouldn’t it be great to have Elisha’s spiritual vision as we find ourselves completely surrounded? I pray that we can all find the courage that comes from having our eyes opened in this way so that we can prepare for this assault with the same confidence that Richard Winters exuded on the eve of the Ardennes Offensive in the HBO series “Band of Brothers:”

“We’re paratroopers, we’re supposed to be surrounded.”