The past week has been a whirlwind of activity. Because it's so hard to keep everything straight, I'm going to write this entry almost as a timeline so it's easier for me to write and for you to follow.

Sunday, April 2
My parents arrived from Washington State for a short visit. They always claim they come to see Melissa and me as well, but we know full well that their only grandchildren, Matthew and Raegann, are the real draw.

Monday, April 3
The family spent a relaxing day around the house, with the kids enjoying so much having two extra playmates to entertain them. The abdominal bloating caused by suspected stool blockage continued to grow slightly, but it remained only a minor inconvenience. It was not a complete blockage, and so although I needed to eat and drink slowly, I just continued to deal with the problem, hoping that as I reduced my use of narcotic pain-killers, the normal bowel function would slowly return.

Tuesday, April 4
I woke up at my usual time, showered, and got ready to teach my classes. At this point, the abdominal bloating had become so pronounced and tight that it was making it hard for me to walk upright normally. I was able to borrow a walker from my mother-in-law that made it much easier for me to get to my car and into SB Hall, where my office and classroom are located. Because of the counter indications for some of the medications I was taking at the time, I was unable to drive myself to campus, so my dad was kind enough to take on the role of chauffeur. 

I arrived on campus, set up my classroom for BUS 3306: Business Communication, and completed the first 80 minute class section with some mild abdominal discomfort and some difficulty breathing because my abdominal cavity was so swollen that it left little room for lung expansion. As I dismissed my 9:30-10:50AM class, the abdominal pain suddenly took a turn for the worse, and I knew I wouldn't be able to make it through a second class. I packed up my things as my students entered the classroom, and once everyone arrived, quickly apologized for the late cancellation, but informed the students that I was experiencing too much pain to conduct the class section and that I would be in touch via email with assignments for the day.

As the students left the classroom, my dad and I made it back to my office where I picked up the walker and began the now seemingly miles-long trek to my parked car. Dad drove us back home as quickly as he could safely do, and I texted Melissa to tell her that I needed to go to the hospital. Previously, my oncologist had instructed me that if the abdominal swelling became much worse, I should call him and he would admit me to the hospital. Melissa quickly called my doctor, explained the situation, and we went directly to the emergency room at Baylor, Scott, & White Hospital in Irving, where I was admitted.

She loves me, even with my naso-gastric tube

Eventually, a naso-gastric tube was placed down my nose into my stomach to begin slowly suctioning away fluid from my abdomen as a way of reducing the pressure. Slowly, this process did relieve much of the pressure in my abdomen, and x-rays revealed continued blockage in my intestines, so I was given some shots directly into my stomach to stimulate the intestinal peristalsis and allow some movement to occur. This process was successful, to a point, but the blockage was not completely cleared, although the swelling in my abdomen did go down by more than 50% and the discomfort was drastically reduced.

My first night in the hospital was one of the worst nights of my life. For the previous two weeks or so, the tumors in my psoas (back) muscles and the tumors pressing on my spinal cord have been causing pretty intense pain whenever I attempt to lie flat (you'll remember the problems with the CT scans from the last post). I had been sleeping in a recliner for at least 12 days by the time I was admitted to the hospital. My problem with the hospital bed was that, as adjustable as it was, it could not adjust to a position that my back and neck could tolerate. Throughout the night, my pain grew worse and worse due to the position my back and neck were being forced into by the hospital bed. Eventually, I was hooked up to an IV pump with Dilaudid (a stronger-than-morphine narcotic painkiller), and for much of the night I had my phone timer set to beep every 10 minutes to remind myself that I could take another dose. At home, my typical treatment for the cancer-caused lower back pain would  be to take a scalding hot shower that would relax the muscles and allow me to sleep peacefully in my recliner for several more hours. Unfortunately, hospital showers seem to lack a "HOT position on the dial; instead, they move between "freezing cold" and "slightly warmer than dog spit." Adding insult to injury, the irony was that the vast majority of the pain I was experiencing was due to the hospital bed, not due to my cancer.

The next day, my oncologist arrived at the hospital to check on me, and suggested that I consider hospice care. It was his opinion that the only way I could be even remotely comfortable at home would be by having access to an intravenous pain pump, and I would only be able to get access to one of those at home through a hospice organization. At a later point, in the hall, Melissa candidly asked my oncologist what he thought my prognosis was. His honest opinion was that I probably have days or weeks to live, and the best course of action would be to take me home and make me as comfortable as possible so I could spend whatever time I have left with my family.

With this knowledge, I called my direct supervisor at University of Dallas and regrettably informed him that a sudden negative turn of events related to my cancer necessitated that I go on immediate medical leave from the University. It was one of the hardest phone calls I've ever had to make - aside from being with my family, teaching is the activity that has brought me more joy and fulfillment than anything else I have ever done.

Wednesday, April 5
My doctor recommended that I stay a second night in the hospital with the nasal-gastric tube draining my abdomen and so I would continue with access to the pain pump. This second night in the hospital was, without question, the worst night of my life. Again, the positioning of the bed wrought havoc on my back and neck muscles, so most of the night was spent rotating every five minutes between an electric heating pad, bags of ice, and an electric massager, trying to find enough comfort to sleep, even for a few minutes. My heroic father, who stayed both nights with me in the hospital, must have spent at least six hours between the two nights massaging my back and neck with the electric massager, filling bags with ice, moving around the heating pad, or reminding me to again punch the button on my Dilaudid IV drip. And again, the worst part of this was that the vast majority of the pain I was experiencing was due to the bed, not due to the pain caused by my cancer tumors. Eventually, I ended up getting about 2.5 hours of uninterrupted sleep late in the morning by sitting upright in the visitor chair with pillows tucked behind me, sitting on a pillow, and with my feet propped up in the lowest drawer of the night stand, used as a footrest.

During the day of April 5, Melissa contacted my radiation oncologist at UT Southwestern to see if there was any possibility of trying to get a single radiation treatment that migth be able to reduce my back pain enough to be able to lie flat for the CT scan so that the additional palliative radiation treatments could be completed, potentially improving my quality of life. She discussed this option with my medical oncologist, who discouraged this plan, believing that it would needlessly take me away from my IV pain medication drip, and potentially send me into a pain spiral that would be difficult to recover from. Melissa continued her discussions with my radiation oncologist, and he firmly believed that if the first palliative treatment session could be completed, it could drastically reduce my pain and potentially open up the possibility of completing the full 8-session treatment. As we discussed it, Melissa and I wanted to give our God as many opportunities as possible to grant us the healing miracle we have been so desperately praying for, so we decided to try to complete the radiation treatment. (You'll remember from my last blog post that this was the treatment I was not able to complete due to being unable to lie flat enough on the CT machine table). 

Around 11PM on April 5, Melissa returned to the hospital where I was staying and made plans with all of the nurses on duty to ensure that I could be discharged no later than 6:30AM the following morning.

Thursday, April 6
If you've ever tried to get discharged from a hospital, you know what a nightmare it can be. "Just a few more minutes" often becomes hours, days, or weeks. I think that the nursing staff was a bit afraid of Melissa after her meeting with them at 11PM the night before, as much to my surprise and delight, the charge nurse entered my room at 6:22 with discharge papers that were pre-filled, and she requested only my signature twice and my initials once. An orderly wheeled me to the car where Melissa was waiting to pick me up, and we drove the two blocks back to our house where I took a glorious scalding hot shower which relaxed the muscles in my neck and back to a state of comfort that they had not experienced since my hospital admission. After my shower, I quickly dressed, and we made the drive to the newly opened UT Southwestern Radiation Oncology facility in Dallas. During the trip, my back muscles, so badly abused from the two nights in the hospital bed, began to seize up again, and we began to worry that I wouldn't be able to complete the treatment.

As soon as we arrived, we talked to my radiation oncologist's nurse practitioner about the state of my back muscles. She grabbed two chemical heating pads, which we started up, but they were unable to provide anything near the heat output that would be needed to soothe my back. As there was still a little time until my scheduled procedure, Melissa elected to drive back to our house to pick up our electric heating pad, hoping that the morning traffic (it was now about 8:35AM) would not prevent her from returning in time to be of use.

Shortly after Melissa left, a team of three nurses and technicians arrived to prepare me for the initial CT scan upon which the first palliative radiation treatment would be based. I was taken in to a prep room where an IV line was placed to allow iodine-based contrast to be run through my veins to make it easier to identify structures within the body. I was placed on the CT machine and several new techs appeared who began the process of carefully packing by body into the specialized materials that would ensure the exact same position of all of my parts could be duplicated in the radiation machine. Typically, this procedure is fairly simple; patients who can lie flat on their back do so, and then the adjustable beanbag-like wedges and pillows are placed around the body and filled or deflated as necessary to ensure precise positioning and the inability to move.

Thankfully, this team understood that this was my second try for this CT scan and radiation treatment, and that lying flat on the table was not an option. Several additional technicians, nurses, and physicians appeared, and all of them stood around the table building a platform for me at the lowest possible angle that I could tolderate for the 15-20 minutes it would take to complete the needed scans. Shortly after this process started, Melissa returned with the heating pad, and it was placed inside my CT cocoon to further allow my muscles to soften. Once the positioning bags had all been placed, the final check was run where the table was turned on to run me through the tube of the CT scanner. 

My feet entered the tube without any problems, then my chest, and when we finally came to my head, I was approximately 1.5 inches too tall to fit into the tube. In spite of all of the work of the team, we had come to a fail state that seemed insurmountable. I simplly couldn't lie flat enough to get into the CT machine. My radiation oncologist seemed unperturbed by the situation. He ordered everyone to move me from the table and take me into the next room with the radiation delivery machine. Although this device was primarily used for delivering the radiation, it also had the capability to complete CT scans, used to match initial CT scans with the tumors seen during the radiation delivery. Importantly, this machine lacked a tube, and was instead a large table with nothing around it except the flat delivery surface that actually shoots that radiation beams into the patient.

The team (now approaching nearly 20 individuals) placed me on the table at a much more comfortable angle (nearly sitting up this time), and again began packing me in to ensure that I couldn't move. Over the next 28 minutes, CT scans were completed, a treatment plan was developed and programmed, and I received the first palliative radiation treatment that I so desperately needed if I was to have any chance of completing the full 8-course treatment. I've never worked with a better team of doctors who were more committed to doing whatever was necessary for their patient. I didn't know it at the time, but my radiation oncologist, it turns out, is one of the best in the country, and is the Department Chair at UT Southwestern. In my view, he earns every penny of his $439,000 annual salary.

Following the radiation treatment, Melissa drove me home, and I spent most of the day relaxing, taking hot showers as needed, and spending time with my family. The fear of my medical oncologist that I would be unable to control my pain at home using only oral medications turned out to be unfounded, as once I was able to take showers and sleep in my recliner again, I was able to cut my intake of narcotic painkillers by more than half. As you might imagine, after spending two night in the hospital with very little sleep, I spent much of the rest of that afternoon sleeping. Around 3pm I woke up, but stayed sitting in my recliner, as I could hear Melissa on the phone with someone walking down the hall toward our bedroom. She opened the door a crack, saw that I was awake, and told the person on the line that I was avaialbe to talk. She placed the phone on speaker, and I was greeted by Dean Brett J. L. Landry, Dean of the Satish & Yasmin Gupta College of Business; Greg Bell, Associate Dean of Faculty Affairs for the COB, and Sheila Howard, Assistant Dean for Undergraduate Business Programs. Dean Landry didn't waste much time, but he told me that they had just been in a meeting with University President Keefe, and a scholarship had been set up for my children, Matthew and Raegann, which would cover 100% of their tuition and fees at the University of Dallas whenever they were ready to matriculate. Talk about working for an employer that values its people and practices the values it teaches within its classrooms! Melissa and I were completely overwhelmed at this gesture and how amazing this was, given the near immediate prospects of her becoming a single mother with two very young children.

Friday, April 7
This ended up being a day to again relax and simply try to recover from the two days of torture that my back and neck had experienced at the hands of the hospital bed. At 2:00PM, I felt well enough to attend a Rosary service at University of Dallas' Chapel of the Incarnation that students had organized to pray for my healing and comfort during this time. The service was an emotional one for me. First, I was astonished by the number of students, faculty, and staff who showed up for the service. I felt like George Bailey from the classic Christmas movie It's a Wonderful Life as he has the opportunity to attend his own funeral. I had the chance to talk with so many students and hear stories about how my class or something I had said to them in conversation at some point had had an impact on them. I was a blubbering mess by the end of the service, when students and faculty alike lined up to have a chance to talk to me. I had the chance to tell each of them that I'm not giving up. Jesus' short ministry on earth was marked by a whole lot of healing; that same Jesus now sits at the right hand of the Father in heaven and He is more than able to heal me, even as advanced as my disease has become.

I do not presume to know that He will heal me. The likely course of events is that this cancer will continue to spread through my body leading to multiple organ failure and my ultimate death. It will likely come sooner rather than later. But I promised my wife and my sweet baby girl Raegann and my tenacious little boy Matthew that I would never give up. That I will fight this awful disease for as long as I can, and that I will continue to beg God for a miracle of healing every day that I have breath.

And so I continue to do so - multiple times, every day: "Jesus - I know that you have the power to heal me. I ask that you will."

I am so grateful for the hundreds, maybe even thousands of you who are so earnestly praying for this miracle on my behalf as well. Live or die, I have become a better husband, a better father, and a better follower of Christ through this ordeal.

We continue to covet your prayers in these specific ways:

• That the palliative radiation treatment I received last week will be enough to allow me to lie flat and complete the full scheduled 8 rounds of radiation treatment.
• That the lowered dosages of narcotic painkillers will allow my bowel functions to return to normal and reduce the pain and discomfort from my abdominal distension.
• That the radiation treatment will be successful at shrinking the tumors that are attacking my back muscles and my spinal column, making it difficult for me to walk and necessitating the use of a wheelchair for all but the shortest trips.
• For my beautiful wife, Melissa, as she remains, in my eyes, caretaker of the century - constantly looking after my needs ahead of all others.
• For a miracle of complete healing. I believe that God has the power to heal me. Please pray with me that He sees fit to do so. I do so want to see my children grow up, and to have the opportunity to teach many more generations of students like those from University of Dallas who I have grown to love so much.

As of now, while we have selected a hospice care provider, I have not officially entered hospice care. There are some treatments, including radiation, chemotherapy, and immunotherapy, that hospice providers consider to be more than palliative, and so they disallow patients who are pursuing those treatments from receiving hospice services. So long as we are able to manage my pain at home with oral medications, we plan to aggressively take whatever actions we can to stave off this cancer. At this time, this will likely include completion of the palliative radiation treatments and beginning a course of immunotherapy to see if anything can be done to slow down my incredibly aggressive and treatment-resistant tumors.

So sorry for the length of this post - there was a lot to cover. Thank you for all of you who read it, or at least skipped to the bottom to say a prayer for us.