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Rejoicing in Lament
Wrestling with Incurable Cancer & Life in Christ
By J. Todd Billings
Brazos PressCopyright © 2015 J. Todd Billings
All rights reserved.
Walking in the Fog
A Narrowed Future or a Spacious Place?
"Get well soon! Jesus loves you! God is bigger than cancer!"
My tears started to flow as I read these words. They were from a fifteen-year-old girl with Down syndrome in my congregation. Less than a week earlier, the doctor spoke the diagnosis to me, about which he had no doubt: a cancer of the bone marrow, multiple myeloma—an incurable cancer, a fatal disease. I had been in a fog ever since. How was I to face each day when my future—which had seemed wide open—had suddenly narrowed? My "world" seemed to be caving in on itself with fog in each direction I turned, so that no light could shine in.
While I had received many cards in the previous days, this one was different. "God is bigger than cancer!" Yes. She did not say, "God will cure you of this cancer," or "God will suffer with you." God is bigger than cancer. The fog is thick, but God is bigger. My cancer story was already developing its own sense of drama. The sky was closing in, enveloping my whole world so that nothing else could creep in. But God's story, the drama of God's action in the world, was bigger. The girl in my church wasn't denying the fog or the loss but testifying to a God who was greater, the God made known in Jesus Christ, who shows us that "the light shines in the darkness, and the darkness did not overcome it" (John 1:5). In my tears, there was not only grief but also joy that in the body of Christ theological truths are not a commodity trafficked and controlled by professional theologians. God's story in Christ is bigger than my cancer story, period.
This book explores the way in which God, and the drama of his revelation in Christ, is bigger than my cancer story. The first six chapters build on one another in their reflection on God's story in relation to my cancer story. They do not give a sequential, month-by-month account, but offer different angles of vision into the reality of diagnosis and my first six months of chemotherapy In chapters 7 and 8, I continue the story of my cancer chronologically with my theological reflections during nearly a month in the hospital receiving a stem cell transplant. The final two chapters complete my theological reflections on God's story as I emerged from the transplant into a time of quarantine (because of a compromised immune system) and eventually returned to my "old" life, in a new way. This first chapter begins my telling of the cancer story and provides some initial biblical and theological reflections that will be explored further as the book moves into later chapters: how God's story relates to my cancer story; the Psalms as companions in our Christian pilgrimage; the meaning of life in Christ and God's final victory over death.
Living in the Fog: Sharing the Cancer Story and Moving into God's Story
God is bigger than cancer. Yet, from those early days in the fall of 2012, I sensed that my unfolding cancer story was not to be denied or repressed because of God's story, either. The news felt like a heavy burden. When I would see students and colleagues at the seminary where I work (Western Theological Seminary) and respond to their queries of "How are you?," any response I gave felt like a lie. My wife and I decided to share the news publicly—with no "secrets"—within two days of receiving the diagnosis. An emergency faculty meeting was called. No dry eyes. An announcement went out to the seminary community, the church, and friends on Facebook. For better or worse, my cancer journey was no longer just my own or that of my family. It was shared with our community.
There are risks with that kind of sharing, as cancer patients know. Our culture often suggests that we are "entitled" to a long, fulfilling life, and if that doesn't happen, there must be someone to sue, someone to blame. When the word "cancer" is spoken, looking to the future reveals only a fog of uncertainty It brings to mind a life that is spent in the process of dying—a casket waiting to be filled, with no politician to blame for it. In this state of affairs, people often don't know how to respond. Many simply said that I would be in their prayers. Some shared a Bible verse in encouragement. Some allowed the conversational habit of "free association" to hold sway, sharing about the last person they knew who died of cancer or of someone they knew who had a remarkable recovery from cancer. For the patient, the last approach tends to be the least helpful. And the more public the news is, the more frequently one will hear stories of others with the same cancer who died an early death, herbal remedies that one must try, or other less-than-helpful bits of advice.
Whether or not cancer patients intend to share their journey openly with others, they generally find that the cancer situation itself has put their lives into a fish bowl—for public viewing—whether they like it or not. "What were your most recent test results?" "What did the doctor say?" Those questions used to be for me and my family. Now, with a "terminal illness," they are relevant questions for all who care about my family and me. My body—its test results, its symptoms—has become a public spectacle, something for public commentary. Some things are kept private. But much that was formerly private is no longer so.
Sharing the cancer story, however, can also open the door for many blessings to flow. One blessing is that I have been able to explore—and bear witness to—the ways in which God's story intersects with the cancer story; how my cancer story is complicated and mysterious but not nearly as compelling as the mystery of God's love made known in Jesus Christ. This opportunity came with the initial announcement of my diagnosis, where—in all of the various venues—I included the following words from Question and Answer 1 of the Heidelberg Catechism: "What is your only comfort in life and in death? That I am not my own, but that I belong—in body and soul, in life and in death—to my faithful Savior Jesus Christ." Like the note from the fifteen-year-old girl in my church, it breaks through the fog of "terminal" and "incurable" and "cancer" by pointing us to the bedrock of what matters: that I belong, in life and in death, to Jesus Christ. My life is not my own.
This opportunity was soon amplified when I began to chronicle both stories on CarePages, a blog site for those who want to update family and friends as they struggle with illness. Within a week of my diagnosis, I started chemotherapy. There was a lot of medical information to be shared. The sharing of that information on an individual basis was laborious and intense. And overwhelming. I soon decided that starting a CarePages blog would be wise—to share the medical information to all who were interested, all who were praying. Moreover, it could be a forum for sharing the intersection of the two stories that I found myself in. In many ways, this book is an extension of that initial effort at sharing, exploring, and testifying to the way in which the drama of the Triune God intersects with my story of pain and disorientation due to cancer.
A Narrowed Future, a Spacious Place
Here is a section from my CarePages posted on October 11, 2012, which was about two weeks after the diagnosis. It gives a taste of the genuine lament and yet hope in and through Christ that later chapters will continue to explore.
In the months following, I would return to these themes again and again: a genuine lament and a genuine rejoicing in God's promises—promises that, as expressed in the Psalms, are the basis for praise, trust, and also complaint and lament; promises that find their fulfillment in Jesus Christ, and life in him by the Spirit. But this life in Christ, while abundant, cannot be measured by a life span.
A Shortened Life Span? The Ways of Cancer and of God
A week after the post above, I continued my CarePages reflections after attending a conference in Detroit focused on my cancer, multiple myeloma. The conference raised medical and theological questions: What will this cancer mean for how I view the future? Does God owe me a long life? What would it mean to say that abundant life in Christ cannot be constricted by the length of a life span?
This CarePages entry represents a kind of "first brush" with the existential and theological issues raised by the mixed blessing of a medical prognosis. In the prognosis process, it's hard not to be paralyzed by numbers. About fifteen years ago, the median life span for someone diagnosed with multiple myeloma was two to three years. Now, it is about double that. But what numbers apply to me, as an unusually young patient? It's really hard to tell. One doctor examined my medical results and sought to encourage me by suggesting that I had a good possibility of living longer than some other patients—I had a 50 percent chance of living ten years, he said. What does that mean? I'm either alive or dead. I can't be 50 percent alive, just as a woman cannot be 50 percent pregnant. How am I to think about or process such a number? (Later, another doctor thought that number was too pessimistic for my prognosis.)
My main oncologist tended to leave it more open ended. He would say, "Some patients live decades with multiple myeloma." No promises. But a possible hope. And my life span prospects depend, in his view, largely on the ongoing progress in research and treatment.
In seeking to find out more about the world of cancer, I read the Pulitzer Prize–winning book The Emperor of All Maladies by Siddhartha Mukherjee in the months following diagnosis. I found his assessment of multiple myeloma to be quite balanced and illuminating. On the one hand, "in the 1980s, multiple myeloma was treated by high doses of standard chemotherapy—old, hard-bitten drugs that typically decimated patients about as quickly as they decimated the cancer." These chemo drugs had not been developed specifically for myeloma, and the expected life spans were short. But improved treatments, through drugs developed specifically for the disease, have made a big difference. While "myeloma is still a fatal disease," the improvements have been substantial: "In 1971, about half of those diagnosed with multiple myeloma died within 24 months of diagnosis; the other half died by the tenth year." Yet "in 2008, about half of all Myeloma patients treated with the shifting armamentarium of new drugs will still be alive at five years. If the survival trends continue, the other half will continue to be alive well beyond ten years."
But what do these numbers mean? Even if I do live decades, the myeloma may still be chopping decades off of the life that I might have had without cancer. Of course, I never knew that I could or would live until my seventies or older; but often such an assumption is simply present in white, middle-class Western culture, and I had soaked it in. I found myself thinking about these numbers when playing with Neti—my beautiful three-year-old daughter adopted from Ethiopia. Would I see her into middle school? If I listen to the 50-percent-for-ten-years estimate, then that means I have a 50 percent chance to see her live to be thirteen. Wow. What would be my "chances" to see her graduate from high school? And what does "chance" have to do with it, anyway? Why, God, oh why, would you allow this for little Neti and her younger brother, Nathaniel? Rachel and I desired and prayed for children—and both Neti and Nathaniel came as incredible gifts, answers to prayer. Why would you take away their dad during their childhoods?
Lament and the Victory of God over Death
While I seek to affirm the biblical truth that God is not my debtor and does not owe me a long life, my sense of lament becomes acute when I consider my young children in particular. My death would not just be a loss for me and for my wife, Rachel. It would be a tremendous loss for my young children.
Scripture does not say God owes us a long life. But paradoxically, this does not mean that we accept suffering and death with a stoic fatalism. Instead, God's people lament. In the Old Testament, not just the prospect of death but a death in the "middle" of one's years is seen as a particular cause for lament. Biblical scholars have long noted that the belief in a resurrection after death—explicit in passages of a late date such as Daniel 12—was gradual in its development in the Old Testament. Yet Jon Levenson has recently argued that passages like Daniel 12 have deep roots and resonance with many other, earlier parts of the Old Testament: for death—particularly premature or early death—is in tension with the fact that "God promises, offers, and prefers life and saves his people from annihilation." Thus, while the psalmist does not assume an afterlife when he says, "The dead do not praise the LORD, nor do any that go down into silence" (115:17), nevertheless an early death is grounds for protest and lament: "He [the Lord] has broken my strength in midcourse; he has shortened my days. 'O my God,' I say, 'do not take me away at the midpoint of my life, you whose years endure throughout all generations'" (Ps. 102:23–24). The psalmist adds to this plea by noting that God has many years—implicitly suggesting he could spare some more for his servant. "Long ago you laid the foundation of the earth, and the heavens are the work of your hands. They will perish, but you endure; they will all wear out like a garment. You change them like clothing, and they pass away; but you are the same, and your years have no end" (102:25–27). This is praise to the eternal, but also a lament, from one who faces death "at the midpoint of my life."
One finds a similar lament and protest in the book of Isaiah, when Hezekiah—ill to the point of death—"wept bitterly" (38:3) and lamented to the Lord that "in the middle of my days I must depart" (38:10 ESV). There was an offense, a cause for lament and complaint, in being taken from life in the "middle" of one's days.
In the unfolding of God's revelation through Scripture, death itself comes to be seen as God's enemy—contrary to God's desire and promise of life for his people. In the Old Testament, this is apparent in Daniel 12, in which God's people will be "delivered" when they "awake" from their "sleep in the dust of the earth" (vv. 1–2). In the New Testament, this testimony to God's victory over death is widespread and emphatic in light of Jesus Christ. In his marvelous chapter on the resurrection in 1 Corinthians 15, Paul speaks about how Christ's death and resurrection brings victory over death, for Christ's resurrection is the "first fruits, then at his coming those who belong to Christ" (v. 23). For at "the end," the Triune God's rule over "every authority and power" (v. 24) will be complete. "For he must reign until he has put all his enemies under his feet. The last enemy to be destroyed is death" (vv. 25–26).
Thus, in the testimony of Daniel and the apostle Paul, it is not just "premature death" but death itself—as that which would limit the life God shares with his people—that will be defeated. It is the final enemy. But in the meantime, here in a land in which war, poverty, cancer, and disease take the lives of mortals like you and me, death is still a present enemy. It doesn't seem to make much sense when it comes. At times, death comes to a child from cancer; at times, death comes to those who seem to be in the wrong place at the wrong time, as with those who perished from the Boston Marathon bombing (April 2013); at times, death comes to a ninety-five-year-old whose spouse has passed on after struggling with illness for years. In this final case, for the family, it may feel like death itself is a kind of grace—after a long life, when each breath becomes a burden, a struggle. But still, even then, death is an enemy. It must be overcome if we are to experience the life with God that God himself desires for his people. As John's vision of the heavenly Jerusalem indicates, God's repeated promise that "I will be their God and they will be my people" needs to overcome death in order to have its ultimate fulfillment. For then "He will dwell with them; they will be his peoples, and God himself will be with them" (Rev. 21:3). For "to the thirsty I will give water as a gift from the spring of the water of life" (v. 6).
Excerpted from Rejoicing in Lament by J. Todd Billings. Copyright © 2015 J. Todd Billings. Excerpted by permission of Brazos Press.
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