Again.

5 years and 8 months of being cancer free.

Eight months ago my clinical trial ended. The experimental agent that I was taking in conjunction with the chemo pill wasn’t going into production. In the options available to me, I chose to be done with treatment. No evidence of disease in 5 years felt like good enough reason to take a drug holiday. It was a lovely holiday. My body re-regulated in so many ways and I almost, almost, felt like maybe I could set cancer behind me.

My next scan was in November (my 30th PET scan!). It was good, but there were a couple small spots that lit up in my right lung – probably nothing, but a follow up CT scan was scheduled for February. I headed to Philly for the CT scan, went through the usual motions – train station to hospital, hospital to radiology, radiology to the lab, lab to oncology, oncology back to the train. I was headed home before the official radiology report, but with my oncologist saying that it all looked pretty good and stable to him, we sent all the texts – “Unremarkable!” “All clear!” “Good to go until the next scan in June!”

An hour after getting home, I got a phone call from my oncologist. “I wanted to give you a call before you saw the radiology report” he said. The radiology report which read “new and increased size in pulmonary nodules likely reflecting lymphoma.” Lots of potential explanations for this, he said. Could be a number of things, he said. Need to bump up the next scan and do more testing, he said. Likely reflecting lymphoma, it said.

My muscle memory for receiving unfavorable medical news was shockingly intact. I quickly strode through the five stages of grief. Nope, this isn’t happening. It may have taken that radiologist 15 year of schooling to be where they are, but clearly they don’t know my body and are just trying to find something – idiot. If I had just been exercising more or eating better or managing stress more effectively this wouldn’t be happening. Oh my gosh, is this happening? I think this might be happening. Ok, just focus on the next thing.

The next thing was a fairly new type of blood test that uses a cancer tissue sample to identify circulating tumor DNA in your blood. The hope was this would result something that might be helpful while I waited for my new PET scan date in April.

Oh the waiting.

There is just nothing quite like the slow anticipation of your whole world shifting. Dinner still needs to get made and laundry sorted. Work doesn’t slow down and relationships don’t get easier and dust still accumulates on every surface. And underneath all of it, a deep knowing that in a couple of weeks some pictures on a radiology image could unravel the messy ordinariness of it all.

As agonizing as the waiting feels, there is an equally intense feeling of dread when the time comes for the thing you’ve been waiting for. As my scan day neared, my brain kept trying to convince me to turn around and run or just sit down. If it doesn’t happen, then it can’t be real.

Scan day came and forward through the motions I went, because that’s what you do. You see the hard thing, the impossible thing. You feel the weight of it. The bigness of it. The fear of it. And you move forward anyway. Every time there is a call to be strong and courageous in scripture it’s during hard and impossible times because it is never meant to be done in your own strength. We can be strong and courageous even and especially when it’s all impossible because God is for us.

As I sat, heart beating quite a few ticks faster than the recommended BeeGees Stayin’ Alive pace, alert to every footstep passing by, I tried to imagine what the moment would be like when my doctor delivered the bad news. In the 8 years that I have been going to Penn, he has only ever had favorable news to offer me. Considering I started seeing him when I had cancer growing like dandelions in April and no options remaining for treatment, the bar started pretty low. But would it be the first thing he said? Would it hit like a sucker punch or land like a soft blow? Even then, it didn’t even seem a plausible option that he would have anything other than devastating news to offer me.

I was right.

And he delivered the devastation exactly like he has always delivered the unremarkable – with a sense of humanity and calm that slowed my heart. Immediately I felt less alone. Thank God for good doctors.

Not only had the spots in my lungs increased slightly in size since my CT scan in February, there was a new lesion in my abdomen that had cropped up that was concerning to him. “Is it -” “Lymphoma. Yes, I feel confident it is,” he finished my sentence and the air around me had just a little less oxygen in it. My blood test had also resulted that morning, just before my scan, showing that there was in fact circulating tumor DNA – minimal, but present.

I was scheduled a week later for a biopsy of my newest lymph node to turn against me. I knew going into it that this one was in a really tricky spot to access, tucked neatly behind my liver, next door to my pancreas and in the neighborhood of some critical vessels. I assumed that if I went to the hospital, got prepped and made it into a procedure room, that meant they had decided it was tricky, but possible. It turns out, that’s what the doctor thought too. Thirty minutes, lots of sedation meds, a few passes in and out of CT guidance and one large needle in my abdomen later, she stopped. “I’m just not able to reach the spot safely” she said.

And that was the end of my biopsy.

The doctor performing the biopsy – who comes off a little as the villain in this story, but was in fact as kind as she was capable – told Joe that she does thousands of these and this is only the second time she was unable to obtain a tissue sample. All of the emotional buildup. All of the planning. The time off of work. The early morning train ride. The prep. The hospital gown. The IV. The smells and sounds. Being there again. All of it. To turn around and leave five hours later no closer to knowing what is happening inside of my body than I had been the week before, left me feeling gutted.

Since failed biopsy day, I have spent time talking to my oncologist about next steps and treatment plans and all of the things I hoped I’d never have to discuss again. But this is where I am. It’s impossible and it’s heavy and I’m not carrying it alone.

Thank you for helping me shoulder this weight. Again. Thank you for interceding on my behalf. Again. Thank you for laughing with me and crying with me and reading exceedingly long updates about my journey. Again. The community around me is evidence of the goodness of the Lord.

I would have despaired unless I had believed that I would see the goodness of the Lord in the land of the living. Wait for the Lord; be strong and let your heart take courage and wait for the Lord
Psalm 27:13-14