A Minor Setback

Eva continues to proceed through the treatment cycle called Interim Maintenance I. The plan calls for doses every ten days instead of the weekly treatments she has had since the beginning. We have enjoyed the slower pace of this cycle. Eva didn’t have to go to the clinic at all last week, and her blood counts numbers at her most recent clinic were so good that the nurse commented we could probably get outside with her if we wanted to. We took advantage of the opportunity and during the week we paid a visit to Joshua Tree National Park for a nature walk and the San Diego Botanic Gardens for some more exploring. It was a nice week and felt like a welcome return to normalcy.

This week was to start with a Monday dose of vincristine and methotrexate. Audra took Eva to the clinic instead of me because of my travel plans for an upcoming meeting. The clinic didn’t go as planned. Eva’s ANC (a number that reflects the strength of her body’s ability to provide an initial fight against infection) was about 480—the lowest we have yet seen it, and below the threshold required for her to receive her prescribed dosage. Not only that, since she is below 500 any fever would require mandatory hospitalization as a precaution.

As Audra kept me posted on the news via iMessage the old fears came rushing back along with the angry sense of uncertainty. This is the emotional whiplash other cancer survivors have told us about. One day the condition suffocates, the next it pierces—either way it’s uncomfortable. I’m actually writing this post on a flight east. The last time I made this trip I had to rush home to discover my daughter had leukemia. This time I will anxiously watch and pray that Eva’s immune system stays strong.

The doctors and nurses assured us that nothing about Eva’s numbers are a genuine concern to them. They see this all the time, especially when children start receiving methotrexate. Apparently that particular drug hits ANC counts pretty hard. The plan is to have Eva lay low and let her body recover a bit before another clinic appointment on Thursday. If her counts are still low they will administer only the vincristine and delay the methotrexate further.

I’ve titled this post “A Minor Setback,” because that’s what it seems to be. Her leukemia is not back, nothing like that at all. This is part and parcel of chemotherapy. Eva’s body has so far handled treatment so well that I had forgotten just how rigorous chemotherapy is. Today was a jolting reminder that what Eva’s doing isn’t easy, even if the whole process is starting to feel routine.

In the end, I’m glad for this little reminder. It’s a gentle prod from God to keep in mind the values that have short half-lives when life goes well. Gentleness, kindness, patience, love—these gifts radiate when we bear the cross, but when the weight of the cross is lifted they seem to dissipate. Tempers flare, patience runs thins, love that reconciles is replaced with anger that nurses grudges.

Thanks be to God for the cross of Christ! The Son of God stretched out his hands to die for the sins of the world and remove from all who believe in him and him alone the genuine threat of an eternity worse than annihilation—an eternity of existence without no gentleness, with no kindness, no patience, no love. Jesus was roughly beaten that we might have God’s gentleness, Jesus was roundly insulted that we might have God’s praise, Jesus was rushed to injustice that we might have God’s righteousness forever, Jesus sank into a hellish sea of hate that we might sail on the winds of his love.

His cross has pardoned me for my flaring temper, my thin patience, my grudging anger—for all my sins. Now the cross that sets me free also shapes me. He presses it into my life by the work of the Holy Spirit. His gifts radiate once more. He loves me. He loves my family. He loves Eva. And if he has done so much to bring us these gifts then he will surely not fail to bring them to everlasting fulfillment.

Considering our circumstances

Tonight concluded the “Consolidation” phase of Eva’s leukemia treatment when she swallowed her final dose of oral chemotherapy. Tomorrow I will take her down to the clinic at Rady Children’s Hospital for a routine draw of blood. If her blood counts look good (and we expect they will), she will begin the next phase of her treatment on Wednesday, January 18. That phase is called ”Interim Maintenance I.” I have described the nature of these therapies in a previous post.

People ask how we’ve been doing during these last few weeks. My answer is usually something like, “We’re doing alright, considering the circumstances.” That reply doesn’t really say much because there doesn’t seem much to say. The immediate crisis of a life-threatening diagnosis has been replaced with what seems banal by contrast—changing diapers, cutting pills, and mediating arguments. To borrow biblical language, things are neither hot nor cold, but lukewarm—spitting temperature.

Each phase of Eva’s treatment has begun with a doctor handing us a list of drugs and their most common side effects. We are thankful that Eva has been spared virtually everything on those lists, but we are learning about the side effects you can’t quite quantify on paper.

Perhaps it has been cabin fever from the frequent rain (which we need), or perhaps it has been the frustration from my stubborn cold (which we don’t need), but for whatever the reason there has been a certain pall over us lately. We’re tied pretty tightly to the house, disallowed for medical reasons from the places we once frequented. Things that were always “yes” have turned to “no.” Tactics that formerly turned the tide of a day breaking bad are either impossible or ineffective. The generous amount of patience that the crisis had generated in me has all but dissipated and I don’t like the way that feels. Bad days often tally into worse weeks. These days there is no single setback, no definitive burden that defines our story, just the background noise of daily cares. We’re in “maintenance,” which is about as boring a category there is. We’re stuck in the middle—not in danger, but not out of it either.

I trust this is what it’s like to climb out of the valley of the shadow of death. Things are warming up, but the chill remains. The crest is ahead, but there’s still a good piece left to travel. And walking ahead of us is a Shepherd. In his hands are the rod that guides and the staff that comforts. In his hands are the nail–scars that testify to the truth that he has walked this path before us and did so for our eternal benefit. We fix our eyes on him. For the joy set before him he endured the cross, scorning its shame, and sat down at the right hand of the throne of God. We consider him who endured…so that we will not grow weary and lose heart (Hebrews 12:2-3).

So, considering our circumstances, we’re doing alright. But considering our Savior, we couldn’t be better.