Editor’s Note:
Gavin Elbourne was a faithful member of Christ Church Cathedral and
of the Diocese of Montreal for about a quarter of a century. An active Lay Reader and
long time member of Synod, Gavin served his church and his community in numerous capacities
over the years, devoted to issues in leadership, church growth and development, spiritual
and social concerns. Gavin died on 29 September, 1997, of cancer. Excerpts from the
following sermon were read at his memorial service at Christ Church Cathedral on
4 October, 1997. Gavin preached this sermon in the same cathedral on 17 November, 1996.
It is offered here as a token of appreciation for a faithful member of the church, and in
the hope that Gavin's words will be of help and comfort to others facing serious illness.
May his soul, and the souls of all the departed, through the mercy of God, rest in peace.
“Therefore Choose Life”: Reflections on a First Year With Lung Cancer
Cancer is not easy to talk about. The word scares us, and with good reason. Almost everyone will
have at some time lost a family member or a friend to cancer, or will have had the joy of seeing
someone recover from it, or will have struggled with it themselves. I pray that my words may help.
The pulpit is not the place for a detailed medical history. However, in order for you to understand
the reflections which follow, I must start with a quick summary of what has been happening to me
during the past year. After that, my main reflections fall into three groups. The first I have labelled
"practical". The second and third I have called "spiritual issues" and "spiritual resources",
structuring them around a number of Bible quotations which have come to mean a lot to me.
2. The story so far...
It was slightly over a year ago that I was called to the hospital and told that I did indeed have a
malignant tumour in the tube leading to my right lung and that the lung was scarcely functional.
There were indications that the cancer had spread and I was told that if this was so the 5-year
survival rate was 10%. Later investigations showed that the cancer was indeed present in the
other lung, in some lymph glands and in 2 places in the bones. At that point (although I was not
told this at the time) if I had declined treatment the statistical life expectancy was apparently 4
months. In fact I began chemotherapy in January and am still having treatment about 3 weeks in
4. I was told that the probability that the cancer would respond to treatment was about 30%. It was
also made clear that the objective was not to cure me but to prolong my life. You can see now why
I believe that dealing with medical statistics is a major psychological issue. Anyway, the treatment
has so far shown results - the main tumour has shrunk by some 25%, my left lung is clear of
cancer, my breathing is fully restored and the bone lesions are showing reduced activity and have
not spread. So far then so good. This concludes the medical summary, and now let's turn to some
of the issues that are raised in my mind.
3. Practical issues
3.1 Who's in charge here?
Faced with the sort of diagnosis which I have described, it would be a weird person indeed who
did not feel a tiny bit discouraged. Yet strangely enough, as I sat there trying to ask intelligent
questions about the X-rays, I started getting an immensely strong message from my body - or (if
you prefer) from that part of me which is not under my conscious control. And the message was
"together we are going to fight this thing". This did not seem to be a conscious decision on my
part, but rather a piece of information that was being transmitted to my conscious mind now that I
had finally become sufficiently aware of the situation to hear what my body was saying.
The key point I want to make here is that the front line troops in the battle against disease are the
cells in our bodies, supported by those ancient body systems which have sustained our species
for millions of years, and which I have come to believe are in contact with spiritual reality in ways
which our conscious intelligence does not yet understand. Accordingly, everything else - our
conscious decisions, our medical treatments and our lifestyle - must be devoted to providing
resources to our body-systems so that we maximise their chances of success in that battle. We
do not need to agonise over possible outcomes, but only to ask what decisions need to be made
each day to support the troops. This is surely what Jesus meant by "Do not worry about
tomorrow... today's trouble is enough for today" (Matt 6:34). Overall responsibility for today's
decisions rests with us the patients and cannot be delegated to any outside authority, however
knowledgeable or benevolent. Hence our processional hymn today was "Fight the good fight".
3.2 Assessing your resources
The first question to ask is "what resources do I have?". Fortunately, you have many. You have
first your own body with its defence mechanisms, so it is essential to keep it well fed and rested
and freed as far as possible from unnecessary stress. Then you have the Canadian health
system, which I have every reason to believe is one of the best in the world. Then you have your
family and close friends, who invariably rally round in the most amazing way. You have all kinds of
books and practitioners of what get called "alternative therapies". There are support groups of
various kinds, if you can find them. And there is the enormous resource of the community of faith -
which is to say you guys - about which I will speak more later.
You need to develop a strategy for making the best use of these resources, and balancing it
against the time you must put into all the other things you want to accomplish while you have your
health and strength. If there is one criticism to make of our excellent public health system, it is that
it offers no help in this area of personal strategy development, but concentrates entirely on its core
functions of diagnosis and medical intervention. As far as I can tell, the church offers nothing in
this area either. So you finish up doing it with no outside help.
3.3 Diagnosis, prognosis and statistics.
Now we come to the issue of diagnosis, prognosis and medical statistics. It is easy to take a
cancer diagnosis as a death sentence, but that would be an error. A radiologist is not a judge, and
a diagnosis is simply the best interpretation which it is possible to make at a given time of a given
set of observations. We need the most accurate information available in order to plan our strategy.
Only when we know what we are confronting can we concentrate on actions rather than fears.
Now take the statement "There is a 10% chance of 5-year survival". Does it mean that you, the
individual patient have only one chance in ten of surviving? No it does not. Supposing you are told
that 90% of students fail a given exam, or that a group comprising 30% of the population commits
60% of the crimes. These are useful statistics if you are planning preparatory seminars or the
distribution of police resources, but they will never tell you whether a particular individual
committed a particular crime, or whether a specific student is properly prepared for the exam. As
patients, we have to ask "what is the behaviour of the people who survive and how can I maximise
my chances of being among them?". Once again, we are pushed towards action, not paralysis. A
very good book in this regard is Dr. Siegal's "Love, medicine and miracles".
Remember that statistics are always out of date. I was given my 10% figure in 1995. So the latest
year that it could have been based on was 1994. Since they are 5-year statistics, they can only
refer to people who began treatment in 1989. But the drugs which I am receiving did not exist in
1989, and at that time chemotherapy was so much more unpleasant that fewer people opted for it.
It is a perfectly rational assumption that cure rates will continue to edge up, and therefore that
future trends will continue to improve. So although we cannot ignore the story which statistics tell
us, we do not allow them to crush our spirit.
3.4 Dealing with hospitals
My final practical issue is dealing with hospitals. I am in the Montreal General Hospital twice a
week, and it is important to develop a strategy for optimizing that experience. I believe that the
simple solution is to regard a hospital as a community of human beings trying to do a job. Get to
know everyone's name, find out a bit about them without being nosy, and think of your visits as an
opportunity to go and see a group of friends. It is amazing how everyone will respond, and how
you will even come to look forward to your visits. And, of course, always take some work or a
good book for the principal hospital activity, which is sitting around waiting for something to
happen. But even waiting time can often be spent getting to know other patients and sometimes
encouraging them.
4. Spiritual issues
4.1 Vulnerability: "My strength is made perfect in weakness"
Now we turn to some of the Bible passages which I have found significant during this last year.
Start with St. Paul, speaking of his own affliction (2 Cor 12:5) "Three times I appealed to the Lord
about this, that it would leave me, but he said 'My grace is sufficient for you, for (my) power is
made perfect in weakness'." It is hard to accept that we are vulnerable, especially for those of us
who were brought up in a soldierly and hierarchical climate. Our egos feed on power, and yet
Paul's point seems to be that God can work best through us if we do not let our own power-issues
get in the way. So God gives us sharp reminders of how powerless we ultimately are. I do not say
I like this, but it does seem to be true. It drives us to realise, in the words of our offertory hymn,
that "All my hope on God is founded".
4.2 Why me?: "That the works of God might be made manifest in him"
Now Jesus (John 9:2) "As he walked along, he saw a man who had been blind from birth. His
disciples asked him 'Rabbi, who sinned, this man or his parents, that he was born blind?' Jesus
answered 'Neither this man nor his parents sinned - he was born blind so that God's works might
be revealed in him.'" This passage repays a great deal of thought. If there is one thing that the
New Testament authors are unanimous about, it is that illness is caused by evil spirits. Today we
would probably not use exactly that language, but the essential point is that illness is not sent by
God as a punishment, but is caused by hostile forces. It is therefore not a useful exercise to sit
around asking "why did God do this to me?" even if we all do it sometimes because it seems to be
human nature. Yet Jesus seems to be saying that even though illness is not sent by God, God
can work through the illness so that his love is demonstrated and in the end his purpose is not
frustrated. I find this both deep and scary, and yet in the end very powerful.
4.3 Uncertainty: "The day of the Lord will come like a thief in the night"
Now let's talk about uncertainty. There is a lot of uncertainty about cancer. Any examination, any
test may bring the news that the tide of battle has turned in the enemy's favour. You live, if not
with a 24-hour horizon, at least with a 3 to 6 month one. That is not easy, and may be what wears
a number of people down. There is no way of avoiding that uncertainty, and you simply have to
recognise it and press on. My way of coping is to set it in the context of a greater uncertainty,
since this whole universe is contingent, and has a limited future. At some point God will roll it up
into his larger kingdom, and none of us knows when that will be. As our second reading told us
"The day of the Lord will come like a thief in the night" (1 Thess 5:2) I do not say this in order to
incite us to stop contributing to our RRSPs, but to remind us that all our suffering has to be set in
that eternal context, where we will one day find out what it is that our particular set of experiences
in this life has been training us for. This is why we pray (every day in the Lord's prayer, and
specifically today in our gradual hymn) "Thy kingdom come. On bended knee the passing ages
pray".
5. Spiritual resources.
5.1 Personal prayer: "The very Spirit intercedes with sighs too deep for words"
In our final section, I turn to our spiritual resources, and obviously the first is prayer. There is a
passage in Paul which I had always found puzzling (Rom 8:26) "The very Spirit intercedes with
sighs too deep for words. And God who searches the heart, knows what is the mind of the Spirit."
Now it makes sense to me. I mentioned just now that the body seems to be in direct touch with
the spiritual. When I first had my diagnosis, and particularly up to the time that my tumour began
shrinking, I can only say that deeply felt prayer seemed to burst up out of my body without any
conscious initiative on my part. As it flashed by, so to speak, I tried to attach words to it, but I knew
that it was not really verbal. May it not be some such experience that Paul is referring to? I find
now that my body is often (if you will allow the word) nagging me to pray - saying in effect "come
on, get down to it, I need help". I have tried using Our Lord's Gethsemane prayer, but I find it
appallingly difficult. It needs more objectivity than I am capable of. I find my prayers coming to rest
in the verse we use in Compline "Into thy hands I commend my spirit, for thou hast redeemed me,
O Lord thou God of truth". Our communion hymn "What a friend we have in Jesus" was chosen to
help us articulate the value of prayer.
5.2 Public prayer: "Pray for one another, so that you may be healed"
When we turn to public prayer, I used to wonder about the value of our intercession list. Not any
more. I cannot describe the sense of comfort and strengthening which comes over you when you
hear your name being prayed for, and when people tell you that their parish, or their prayer group
is holding you before the Lord. The Bible says clearly (James 5:16) "Confess your sins to one
another; and pray for one another, so that you may be healed." The direct link between prayer and
healing will never be provable, but you have only to think of the recovery of Bill Derby to believe
that if there is no link we have seen some pretty strange coincidences. I would like to say a most
profound "thank you" to all those who have told me they are praying for me, and to ask you never
to give up.
Saint James also commends to us (James 5:14) the anointing of the sick with oil and prayer.
I have benefited from this, and found it helpful, though not overwhelmingly moving. But we do it
very quietly on a Wednesday. Might it not make sense to make unction and the laying of hands on
the sick part of our main Sunday gathering, as a number of parishes do? Maybe I could
commend that thought to your reflection.
5.3 Community support: "Encourage one another and build one another up"
Back now to today's second reading (1 Thess 5:11) "Encourage one another, and build up one
another, as indeed you are doing." If I tried to find one verse which sums up what a Christian
community is about, this would be it. I have been moved to tears by the cards, the letters, the
flowers, the books, the gramophone records, the words of encouragement, the lifts to the hospital
and the anonymous pots of jam that I have received from so many people here present. All this is
part of building each other up - not simply by passing gestures, but by helping each other come to
terms with reality in the most positive, balanced and growth-producing way.
5.4 Heavenly support: "So great a cloud of witnesses"
There is more. As citizens of God's kingdom, we are supported and surrounded by those who
have gone before. Today, for example, we remember Saint Hilda, one of the great women of
ecclesia anglicana, an abbess who ruled communities of male and female monks, as was normal
among Northern Anglo-Saxons at the time, and whose abbey of Whitby was chosen in the year
664 to host the conference that brought together the Celtic and Roman wings of our church. She
prays for us, as does all that cloud of witnesses which inspires us to "run with patience the race
that is set before us." (Hebrews 12:1)
5.5 Commitment: "Therefore choose life"
To sum all this up, there is one verse which has come to seem inscribed before me in letters of
fire (Deut 30:19) "This day I have set before you life and death, blessing and cursing. Therefore
choose life." Whether we bless or curse, whether we fight or surrender, whether we hope
or despair, these are choices that we make. You cannot choose your moment of passing from this
world, but you can choose whether it is to be an end or a beginning. Therefore, choose life.
You need to develop a strategy for making the best use of these resources, and balancing it
against the time you must put into all the other things you want to accomplish while you have your
health and strength. If there is one criticism to make of our excellent public health system, it is that
it offers no help in this area of personal strategy development, but concentrates entirely on its core
functions of diagnosis and medical intervention. As far as I can tell, the church offers nothing in
this area either. So you finish up doing it with no outside help.
Now Jesus (John 9:2) "As he walked along, he saw a man who had been blind from birth. His
disciples asked him 'Rabbi, who sinned, this man or his parents, that he was born blind?' Jesus
answered 'Neither this man nor his parents sinned - he was born blind so that God's works might
be revealed in him.'" This passage repays a great deal of thought. If there is one thing that the
New Testament authors are unanimous about, it is that illness is caused by evil spirits. Today we
would probably not use exactly that language, but the essential point is that illness is not sent by
God as a punishment, but is caused by hostile forces. It is therefore not a useful exercise to sit
around asking "why did God do this to me?" even if we all do it sometimes because it seems to be
human nature. Yet Jesus seems to be saying that even though illness is not sent by God, God
can work through the illness so that his love is demonstrated and in the end his purpose is not
frustrated. I find this both deep and scary, and yet in the end very powerful.
In our final section, I turn to our spiritual resources, and obviously the first is prayer. There is a
passage in Paul which I had always found puzzling (Rom 8:26) "The very Spirit intercedes with
sighs too deep for words. And God who searches the heart, knows what is the mind of the Spirit."
Now it makes sense to me. I mentioned just now that the body seems to be in direct touch with
the spiritual. When I first had my diagnosis, and particularly up to the time that my tumour began
shrinking, I can only say that deeply felt prayer seemed to burst up out of my body without any
conscious initiative on my part. As it flashed by, so to speak, I tried to attach words to it, but I knew
that it was not really verbal. May it not be some such experience that Paul is referring to? I find
now that my body is often (if you will allow the word) nagging me to pray - saying in effect "come
on, get down to it, I need help". I have tried using Our Lord's Gethsemane prayer, but I find it
appallingly difficult. It needs more objectivity than I am capable of. I find my prayers coming to rest
in the verse we use in Compline "Into thy hands I commend my spirit, for thou hast redeemed me,
O Lord thou God of truth". Our communion hymn "What a friend we have in Jesus" was chosen to
help us articulate the value of prayer.
When we turn to public prayer, I used to wonder about the value of our intercession list. Not any
more. I cannot describe the sense of comfort and strengthening which comes over you when you
hear your name being prayed for, and when people tell you that their parish, or their prayer group
is holding you before the Lord. The Bible says clearly (James 5:16) "Confess your sins to one
another; and pray for one another, so that you may be healed." The direct link between prayer and
healing will never be provable, but you have only to think of the recovery of Bill Derby to believe
that if there is no link we have seen some pretty strange coincidences. I would like to say a most
profound "thank you" to all those who have told me they are praying for me, and to ask you never
to give up.