War and With

Dearest Friend,

This is one of those topics that I've floated with other people, but it doesn't seem to gain purchase.  Maybe there is a good reason for that. Maybe not. Don't care a great deal about why these days. Maybe this will touch something in you. Maybe it will not.

Before I begin, let’s be very clear. This is not a rant against the pharmaceutical industry. I am not railing against doctors or research scientists or hospitals or vaccines or our education system or insurance companies or health regulators, all of whom, I truly believe, are operating to the best of their ability within the constraints of our health care system. I’m actually grateful for all of those things. For all of them - except maybe the system in which they operate, a system which is perfectly designed for the results it is getting. But this isn’t about that either. That would be a rant, but I’ll save it for another day. Or maybe never.

Today, I’m just wondering out loud.

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I wonder if you have ever considered there might be a way to do medicine completely differently?  Have you ever noticed that most of western medicine seems to be based on a war metaphor? No. Seriously. Think about it.

Our bodies are invaded by cancer (or something) and western medicine directs all of its efforts to battling it. Destroying it. I am not suggesting this is always a bad idea, but I do wonder if we're missing something obvious.  Because not only does this approach often fail, it usually comes with significant risks to our own bodies, risks that we just sort of chalk up to the nature of warfare.

(Norm MacDonald got it.)

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Right after my brain surgery - surgery was the the first phase of the military campaign - I began six weeks of simultaneous radiation and chemotherapy. I don't know if I mentioned this before, but one day around week five, during a meeting with my oncologist I wondered aloud just how much damage the radiation was doing to my brain. The Nurse Practitioner didn't miss a beat. She said:

"Tons of damage, but rarely does someone in your position live long enough for that damage to manifest."

I am barely paraphrasing. Questionable bedside manner, to be sure. But I appreciated her candor. Seriously. I also lamented that I hadn’t asked that question earlier in the process. I doubt I would have done anything differently. But still.

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Last week I had to delay the next round of chemo because of the damage the previous eight rounds have inflicted on my bone marrow. My platelets have been low, and this time, my white cells dropped so low that starting the next chemo round on schedule would have risked serious infection. So we waited, retested, and resumed treatment when my body recovered a few days later. 

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I get that this is standard of care today. I get that there is benefit and I understand that, outside of grace, nothing comes for free. I understand that life expectancy has risen dramatically as a result of this approach to medicine. But I wonder if the cost/benefit balance might be a little off. Maybe this isn't as good a trade as we imagine, or maybe we haven’t fully measured the long-term costs of our aggression. We hear how many truly terrible diseases are more prevalent now than they once were, and I have heard some suggest this may be the result of our war on germs. I haven’t seen the data, and wouldn’t know what to do with it if I did. But the thought is compelling to me. I wonder if we are using our best weapons on the scouting party and leaving ourselves vulnerable to the main army. I wonder what we might find if we considered other approaches to treatment. Or at least a more nuanced one.

Suppose instead of insisting on complete destruction of the invader and accepting some collateral damage, we instead decided to declare a truce and looked for ways to coexist with disease. I’m not talking about unconditional surrender. I’m talking about harmony, and I'm serious. Suppose we searched for a way to allow cancer to live, but to allow it live in a way that doesn't kill its host (which is us after all). Find an alternative to killing ourselves in our attempts to kill the disease.

What might it mean to live in harmony with cancer?

I honestly don't think this is as crazy as it sounds, and perhaps this is precisely what eastern medicine does. I don't know.  But as I look around, coexistence seems to be the way of the universe.  Creatures compete to be sure, but they also live beside one another, occupy the same pond, nest in the same trees, fly in the same air. And it's hard for me to find examples in nature where a creature is so hell-bent on defeating an enemy that it is willing to give its own life in a perverse…

“…better we both should die than you, alone, should live,”

sort of arrangement. Actually, I can’t find any.

I prefer live-live to die-die, or even to live-die, and it seems that creation does as well. Of course, I do see examples of individuals willing to die so that others might live, but that is simply not the same thing. That is giving one's life in love for another. Not in fear of another. Not in hatred of another. Big, enormous, monumental difference, isn’t it?

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Some might counter that the nature of the universe is one of continual war between good and evil. Maybe so.

But if one believes, as I do, that God is omnipotent, one has to consider that it would not be too difficult for an absolutely sovereign God to destroy evil absolutely. Yet evil exists. I can’t for a second pretend to understand why a good God would allow evil to exist. That is so far above my pay-grade that I wouldn’t even dare to offer an explanation, (and as I’ve already noted, I don’t give all that much thought to why? anymore. For me, my why-obsession? was a personal highway to crazytown. I got off that highway a few exits back. I’m taking the back roads.)

But I can accept harmony as the nature of creation, and can wonder if there is something so important about living with, even with creatures whose very existences threaten our own, that a loving, sovereign God has painted his grand creation on a canvas of coexistence. Look closely. You cannot not see it. You might not notice it, but it seems literally to be everywhere you look - in the rain forests, on the high seas, in the dry deserts and in the night sky. I can wonder aloud if that same good and sovereign God might be inviting us to notice. Practically begging us to notice His creation as it is.

Just notice! You don’t have to explain it. Simply accept it. Maybe even mimic it.

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What will I do with these thoughts? From a medical standpoint, maybe I’ll talk to the NP in October. Maybe I’ll talk to the folks at UVa. Maybe not. I think I’ll just wait.

But today, and tomorrow and the day after that, I want to pay attention when my natural response is to declare war on something. To take a moment when I find myself assuming that something is a threat to be eliminated. Instead of striking out at it (or him or her), I hope to be more intentional and to take a breath and to pay closer attention to the perceived threat and wonder if there isn’t some space where we might sing together in harmony.

And in the days that follow, I hope to be more still and to notice. To be more still and to know. To be more still and to pay attention. Because, paying attention is the beginning of …

… well, you already know the rest.

Oremus,

C