God with Us

O come, Thou Day-Spring, come and cheer
Our spirits by Thine advent here
Disperse the gloomy clouds of night
And death's dark shadows put to flight.
Rejoice! Rejoice! Emmanuel
Shall come to thee, O Israel.

~Author unknown

O Come, O Come Emmanuel was sung at Matt and Jennifer's wedding on December 6th, 2008 and at her funeral service on December 24th, 2012. 

December 26, 2012

It's gray and cold outside today. One of those days when all you want to do is hole up inside. I'm taking down my Christmas decorations and thinking of you. It feels like everywhere I turn something's there reminding me of you...

There are the ornaments you and I bought when we were at Lowe's picking out a Christmas tree that first December all three of us sisters were living together. Since we were just starting out, we didn't have many. You and I were both anxious to decorate the tree that night so the Lowes ornaments had to do the job. They were our ornaments. We bought them together but instead of dividing them up when I moved out, you let me keep them...

While boxing them up, I ran across a paper mache wise man you made for me the year you decided we should home-make our Christmas gifts. He's so ugly he's beautiful - beautiful because you made him for me, and you made him out of love...

Then there's the nativity ornament I bought when you and I were shopping one day in Franklin. You and I loved to shop together, and Franklin was one of our beloved spots. I think of our favorite shop, Avec Moi (French for "with me"), and the snowman china we bought there one winter. We both fell in love with the pattern, and you bought me more dishes to add to my collection the following year for my birthday. I ordered some coordinating plates on-line last week and they arrived today via Fed Ex. How I longed to snap a picture of them and send it to you so we could talk about how perfect they looked with the snowman dishes. I would have told you the website I ordered them from and what a great deal I got on them so you could buy some for yourself. We just liked doing things like that with one another...

Something else arrived in the mail today - your Christmas card. There you are, with Matt at Seaside, you're beaming and beautiful and again, I want to pick up the phone and call you and tell you what a great card it is, how happy you both look. I sit on my couch staring at it, missing you so much it hurts and trying to remember the way it was when you were 'that' Jennifer, the Jennifer pre-cancer...

I think of when you and I were sitting on my couch together this past Thanksgiving. I had just had my baby about five days prior. I was exhausted but so glad you were there. You commented on the painting above my mantel, how much you liked it. We made small talk, nothing shared of any great significance. But now every time I shift my gaze to that painting, a lump chokes my throat. Why didn't I talk to you about anything more important than that stupid painting? Why didn't I tell you, right then and there, how much I loved you, how much I adored you, how wonderful I thought you were, how courageous, how compassionate, how caring? Why didn't I stop everything to tell you you were the best sister anybody could ever ask for?

There's a missed call and a voice mail on my phone. I check it and notice the last voice mail you left me. You were checking on the baby. In your voice mail, I can hear you struggle to breathe and it breaks my heart all over again...

I look around and see the plants and flowers that we took home from your funeral. Oh, Jenny, you would have thought the flowers were so pretty. They were so beautiful. Pink roses. They looked just like you...

I think back over the past 5 or 6 months. How hard you fought all 15 months, but especially those last months. You always held out hope. You never, ever, ever gave up. You wanted to live so badly. We all wanted you to live so badly. I think of all the things you encountered, all the things you endured - how hard it all must have been...

How hard it must have been... to be at work on a Tuesday afternoon in September... You had just gotten home from a lovely vacation and it was, by all accounts, a normal day until you got the phone call from Matt telling you to go to the ER, that he would meet you there.

How hard it must have been... to hear the news: leukemia. 30-years old, seemingly the prime of your life, and facing a disease threatening to snatch it from you.

How hard it must have been... to endure that initial, and lengthy, hospital stay with all of the tests and biopsies and chemo treatments.... to celebrate turning 31 in the cancer ward of the hospital. Wearing a knitted cap and a mask to your birthday party to cover up your thinning hair and to prevent risk of infection...to watch us all come and go while you sat, a captive in your room, Room 11010.

How hard it must have been...

....to find out your sisters, the two people in the world with the closest genetic make-up (or so one would think), were no where near a match to be your bone marrow donor.

....to hear the news: REMISSION, yet still wonder if you would ever live to hear the word: CURED.

....to face the bone marrow transplant... aware of the risks involved, wondering if the donor's marrow would 'take,' and understanding that it could be years before knowing if the procedure worked. It was anything but a quick-fix, and you knew full well the complications that could arise.

....to endure life post-transplant... constantly monitoring for fevers and signs of infection. Being told you could never enjoy being out in the sun again without wearing total body clothing with SPF in it. Knowing you couldn't risk things like gardening or eating certain foods. The exposure was too dangerous. Going in for PUVA treatments and having to wear big, funny looking glasses to protect your eyes from sun damage. Sitting through photophoresis treatments for hours on end. All the while waiting and wondering: am I going to be ok? The transplant's aftermath was physically and emotionally grueling, yet you faced it head on and made getting well your 24/7 job.

How hard it must have been...

...to find ways to occupy your time. You had poured so much of yourself into your work but in the spring after your transplant you were told that you were being replaced. You no longer had the option of going back to the job you loved and excelled at. You decided to throw your energy into sprucing up your home and finding activities and events that you were able to attend.

....to stand tall in public when children stared at you and the mask on your face. To hold your tongue and keep from shouting out to their mothers: I'm not wearing this mask because I could get them sick. I'm wearing it because they, and you, could make me sick! Please teach your children not to stare at people who look different! I remember standing in a check-out line during one such scenario. A little boy was staring at you. We both knew he didn't know any better. You ignored him and engaged me in conversation to quell the pain. You were a much better person than me. I couldn't ignore him. I stared right back at him as if he were from a different planet. If my eyes could have bored holes through him...

...to pick yourself up off the floor after falling time after time. You were weak and your balance was off. Sometimes while we were out running errands or shopping you would fall down. I remember one time Lindsey had taken you to one of your appointments while I stayed behind at the house to cook and clean. When yall got home she told me you had fallen outside the clinic that morning. I went upstairs to find you fumbling for bandages and antibiotic ointment. You sat on the edge of the bed, and I rolled up your pants legs to uncover your bruised and bloodied knees. I tried to clean them as gently as I could. Oh, those precious knees and those pitiful wounds. You never said anything about it. You never acted angry. You never blamed it on anything. You never cursed the stupid disease that was causing all this heartbreak and humiliation. Not at all. You simply picked yourself up and went on about what you were doing. My, how brave you were.

....to humble yourself and call others to come and care for you, to come and help you manage in your day to day when it was too difficult or you became unable to do it on your own. Our aunt happily gave so much of herself to you throughout the last year. We love her like a second mother. She's so full of life and energy. And, among other things, she has always been our favorite shopping buddy. As you rode in to your countless doctors' appointments with her, holding her hand and singing to the radio, I know you must have wanted to tell her: Let's skip the appointment! Let's just be carefree today, like we used to be, and shop all day and eat at fabulous restaurants and then go to the movies afterwards! But instead, you were forced to spend entire mornings or afternoons confined to treatment rooms and logging vital signs.

How hard it must have been...

....to find out your lungs were functioning at only 25% capacity. To know that you had contracted bronchial obliterans syndrome and that the medicines being used to treat you were simply a clinical trial. No medical evidence you could bank on. You could only hope.

....to have to repeat yourself to waiters over and over again trying to explain to them why you had certain food restrictions. Your voice was so soft and sometimes, because of your mask, they couldn't hear you forcing you to repeat your condition. As if it wasn't hard enough to say once. It was almost like a cruel joke. Watching you have to state your lot in life to these perfect strangers who didn't seem to care, all to avoid being served something that could threaten your life.

...to have to be helped when bathing or dressing. Being able to do very little all on your own. To have your hands shake so badly that you could hardly write and even tapping on your iPhone was a chore.

....to be told: The cancer is back. Not only are your lungs failing you, but the cancer is back. Oh, Jen. How scared you must have been, yet you never let on, you never let the fear of the unknown consume you.

...to arrange your final beach trip with your family. Did you know it would be your last? I never knew if you thought it was so. You were so very hopeful, so very optimistic. You spent each day with us on the beach. How hard it must have been to watch your sisters, nearly eight- and nine-months pregnant, playing in the sun and the water while your sickness forced you to sit under the umbrella shielding you from the sun, forced you to face the harsh reality that you would never know the joy of carrying a little one in your womb, of holding and nurturing and caring for a child of your own.

How hard it must have been to have to wear a helmet and ride a bike that was different from all of ours, one with three wheels instead of two, to prevent you from a fall caused by your imbalance....

On that last day, I'll never forget it for as long as I live, we were packing our beach bags to head back to the house. You stood up from your beach chair. You said, "I've come all this way to the beach and haven't even gotten to get in the water." (You couldn't because the bacteria in the water could have made you terribly ill.) You walked down to the water and put your toes in. It was October, and the water was cold. You stood there for a moment looking down at your swollen feet. Oh goodness, the steroids had made them so very swollen. You took Matt's arm and turned to walk through the sand and up the flight of stairs to the boardwalk. At the top, you sat down to catch your breath and to take in the beach one final time. Matt put his arm around you and you leaned into his shoulder. You paused with your eyes closed, your lips pursed to help you exhale, and your chest heaving with each breath. That image will be forever burned in my memory.

Oh Jenny, if I could turn back the clock and be back on that boardwalk, I'd tell you: Don't worry. Please don't be sad. Try not to be afraid. Where you are going is much more beautiful than this beach. You have all of heaven to hope for. We are the ones who should be sad because this beach is the closest we'll get to heaven for a while. The glory and grandeur of heaven will soon be your reality, and we will be left with nothing but this crummy old beach of South Walton, Florida. Of course I didn't tell you that. I didn't want to believe it. I was hoping, too, that you would pull through, that you would take many more trips to this 'crummy' beach with us. Your determination and perseverance wouldn't let me believe anything else.

You bought me a birthday present on that trip. Did you know it would be the last birthday present you would give to me? It was a small painted canvas of a cross. It sits on a table near my kitchen and every time I pass it now I think of you and your new life in the presence of the One who was slain on the cross for us.

....to visit Kosciusko, Mom and Dad's house, for the last time. To spend Thanksgiving writing down the rigid medicine schedule that enslaved you. I'll never forget the last time I saw you. My precious sister trapped in a body that was failing you miserably. We were at Mom and Dad's. It was the day of the Egg Bowl. Our Egg Bowls spent together cheering on the Rebs felt light years away. You wanted to hold and hug my baby one last time. When I handed Mac to you, he had his fingers caught in my necklace so he pulled me in close to you. That was the closest I had been to you in a long time, since we had given up hugs in fear of getting you sick. I tried to pull away quickly, scared to get too close to your face. I didn't want to be the one to make you sick. You said your good-byes but I can't, for the life of me, remember if I told you I love you...How I hope I did.

...in those last days, fighting for every breath. We talked on the phone exactly a week before you died. I called you and we spent a couple minutes chatting before you said you had to go upstairs, you'd call me back. It took awhile so when you called back you explained why it had taken you so long, that you had to catch your breath from climbing the steps. You shared with me how your feet were getting a little better but you were still frustrated that you couldn't wear most of your shoes. We talked about our dogs. We talked about the christening gown you wanted to buy for Mac. You told me to pick it out, you would pay for it. You made me promise not to let anyone else buy that for him. You never got to. You told me that Matt mentioned, starting 'next week,' you doing some light chores around the house. I know he was doing that to help you have a routine and to help you stay strong and focused but I told you, "Jenny, you don't do one thing you don't want to do. I'll tell Matt if you don't want to do those things." You know me, I wanted to defend you, even if it was unnecessary.

At your funeral service Rev. Plata said you were not afraid of dying, you were only afraid of leaving Matt here alone. I don't doubt that you were brokenhearted to leave the man you loved and had given your life to, but Rev. Plata was wrong. You were scared of more than leaving Matt. You told me you were in that last conversation. You said, "Lauren, I can't breathe. It's a scary thing to not be able to breathe, you know?" No, Jen. I don't know. I'm so very, very sorry that you had to know what that felt like. All I said back to you was, "I'm sure it's scary Jen. I know you must be scared."

You were such a fighter, Jenny, and you fought so hard. I honestly don't know how you did it for as long as you did. You never once had a 'woe is me' attitude. You never once let on like you might give up. You took your medicines diligently, up until your very last day. You were even putting on make-up and perfume that last week to go to your appointments, though not out of vanity. I don't know that you ever had a vain thought in your life. You just wanted to be normal, to be yourself, and you were constantly making an effort to be. You were focused. You were strong, though not physically. Your body was giving out long before your will did. It was this will to survive that kept you hanging on.

The night before you died, you were looking at pictures of Lindsey's baby she had delivered that afternoon. Daddy said you smiled at the pictures and that you loved her name - Dottie. You wanted to send cookies to Lindsey at the hospital. If we know anything about our baby sister, it's how much she loves cookies. You couldn't find the number to the cookie store so you told Matt and Dad to call me, that I'd take care of it. They told you to rest, to not worry about the cookies. Oh Jen, less than 24 hours before you would breathe your last, and you had someone else on your mind - your baby sister. You were always looking out for her and for me. You were always thinking of others.

You got up the next morning, just like you did every morning, to face a day that would be full of medicines, labored breathing, and doctors' appointments (appointments that seemed like torture because now the doctors' language had changed to 'keeping you comfortable' and concentrating on your 'quality of life'). A day that would have most people rolling back over in bed, no desire to go on. In fact, so many mornings I would wake up thinking, "What is Jen waking up to? How does she will her feet to hit the floor each day?" Just as I would lie down at night wondering, "How was she today? How much longer does she have?" then praying, "Oh Lord, rush to her and wrap her in your arms. Perform a miracle, Lord. Heal my sister."

That last morning Matt walked you downstairs, and you asked Dad to make you some cinnamon rolls. Something he always liked doing for us. He said he fed them to you, and you choked a bit. He encouraged you to spit it up and when you did it was blood. How scared he must have been. How scared you must have been. Daddy called me that morning to tell me you didn't have long. He was sobbing, Jenny. He loved you, his first little girl, so much. He helped you get to the couch and, laying you down, he watched you, wondering which breath would be your last. He and Matt were holding your hands when you slipped peacefully into Eternity.

Dad called Mom to tell her. She was walking into our aunt's house. She and Billie Jean had just left Lindsey at the hospital and were on their way to you in Nashville. Her phone rang and Dad gave her the news. She sat down on the couch in front of me and cried. She said, over and over, "No, no, no. My baby, my baby." She loved you too, Jenny, so very, very much. And would have done anything in the world for you. To help you. If she could've taken the cancer from you and put it in her own blood, I truly believe she would have. She hated leaving you in Nashville to go 'see about Lindsey' but told you that she was coming back. It would be no time and she would be back to take care of you. She didn't get the chance.

Praise heaven, you don't have to be taken care of any more, Jennifer. You are in a perfect body now, in a perfect home, with our perfect Father. I asked Him the other night, "Why allow her to go through all of that and not reward her with life at the end of it? Would it not have been better, been easier, been more loving to let her die on that fall afternoon she was diagnosed rather than let her live 15 months of suffering before taking her?" In my heart, I felt like His response might be, "Consider this: Would it not have been punishment to allow her to endure those 15 months of suffering only to let her go on living in a fallen, decaying, sin-ridden world constantly wondering in the back of her mind, 'will the cancer return'? Lauren, your sister has her very great and high reward. She has run her race and been granted her prize. And, I assure you, it is heavenly."

I don't believe for one second that you are reading this but still I write as if you can. Just because it helps a little and because I have to get used to knowing that this is the one blog post that you'll never read. I have to get used to knowing you're in a place where you are not bound by time and space. A place where no alarms ring for you to take your 8 o'clock meds. A place where chemo lounges and bone marrow transplants do not exist. You are in a place where there is no tears, no sorrow, no mourning. So I don't think you see my tears or bear witness to my sorrow and my mourning.

But I do believe you are with the One who does see my tears. You are with the only One who can comfort and bring peace to my sorrow and to my mourning. You are with the One, the only One that matters more than anything in life and in death, the Source of everlasting hope and joy and love and life. And I will be with you and with Him someday soon. My life on this earth, whether I live to 32 like you or to 89 like our grandmother, is but a vapor. It is a mist. And when it's over, I will rejoice for all eternity with you. I will rejoice with the angels, with the saints, with the prophets, the priests, the kings and all the rest who believe in Christ Jesus for their salvation. And we will all praise our great high Prophet, Priest, and King, our Emmanuel, forever and ever and ever. And it will be GLORIOUS.
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Dr. Jennifer F. Sample

Jennifer Fowler Sample, 32, died from complications of biphenotypic leukemia December 21st at her home in Nashville, Tenn.

Mrs. Sample was born in Flowood, and raised in Kosciusko. She received a bachelor’s of science degree in Pharmaceutical Sciences in 2002 and her doctorate of pharmacy in 2006, both from the University of Mississippi. She completed a residency in pharmacy practice in 2007 at the University of Mississippi Medical Center.

During her four and half years at UMMC, Mrs. Sample was a clinical pharmacist for the inpatient nutritional service, and she created and headed the pharmacy position in the outpatient gastroenterology clinic. She held a faculty appointment as assistant professor in the school of pharmacy and held an administrative appointment as the third in command of the UMMC pharmacy. Also while at UMMC, Mrs. Sample was acknowledged as a clinical pharmacy specialist and a drug information specialist and was a distinguished member of numerous committees.

After moving to Nashville, Tenn., Mrs. Sample joined the pharmacy team at Vanderbilt University Medical Center where she was the outpatient chemo pharmacy manager.

Aside from Mrs. Sample’s professional life, she was a member of Cathedral of the Incarnation Catholic Church, Nashville, Tenn. Above all else, she considered her vocation as homemaker and wife most important. She served this vocation proudly until her last breath. 

Mrs. Sample is survived in death by her husband Matthew A. Sample of Ebenezer; her parents, Mickey and Lee Lea Fowler; her sisters, Lauren McCool and Lindsey Dew; and her grandmother, Lucy Fowler, all of Kosciusko. She will be forever remembered as a compassionate and courageous woman who loved her family, her friends, and her Lord and Savior Jesus Christ.

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As mentioned in her obituary, Jennifer had converted to Catholicism after their wedding. I respected her decision, and we had many conversations discussing our Christian faith. I, along with our family, do not uphold the beliefs of the Catholic church. We do believe that all Christians, no matter their religious preference or background, can and should be brought together by their shared love for Christ and that those who believe in Jesus and his redemptive work on the cross for their salvation will enjoy eternity with Him.

Thank you, Lord, for Christ. Thank you for leaving your throne in heaven to be among your people. Love come down from above to be with us, our Emmanuel. And thank you for living in the hearts of those who ask. Thank you that you are with us, even now, guiding us and directing us, loving us and comforting us. Oh Lord, help us to love and to serve you better with each passing day. Let our lives be lived wholly for you. The Lamb is worthy.

For God so loved the world that He gave His only begotten Son, that whosoever believeth in Him shall not perish but have everlasting life. John 3:16

Words Cannot Express...

Sometimes things in life render you speechless...

 a marriage proposal...

 the untimely death of a close family friend...

crystal clear ocean water and sugary white beaches...

 news that the cancer has returned...

 These are moments where, as humans with limited means, we simply cannot find the words to express what we're feeling.

At the beach last week, Matthew and I were riding our bikes through town and we noticed a crowd gathering on the boardwalk. We parked our bikes and headed down to see what the fuss was about, assuming it was a wedding. Lindsey and Eli were already there so we sidled up to them to get the scoop. There was no need for them to say anything and even if they had, there was no way their words could have captured the moment. All Matthew and I had to do was follow their (and the crowd's) gaze westward.

Stunning. Beautiful. Awesome. Remarkable. Breathtaking. All would have been good words to describe the sunset we saw that afternoon but none would have come close to doing that sunset justice. Truly, sunsets are one of God's greatest masterpieces and He had painted this one on this particular day, for this particular group of folks, as a gift and a reminder that I AM is still in charge. No one can top Him. No one is in His realm. Or even close.

As I struggled that evening to describe the afternoon sunset to my mom and dad, I realized - there are no words in all the world's vocabulary to capture what we had witnessed. We were given a momentary glimpse of something straight out of Heaven, and I was reminded of Isaiah's words in Isaiah chapter 6, verse 5 when he found himself standing before the throne room of God,

"Then said I, 'Woe is me! for I am undone; because I am a man of unclean lips, and I dwell in the middle of a people of unclean lips: for my eyes have seen the King, the LORD of hosts." 

In that grand moment, where so many chalk it up to happenstance or a big bang or "Mother Nature," our eyes saw the King. If I have this much trouble summing up a momentary glimpse of the King, how will I dare speak when I open my eyes in eternity and find myself standing face to face with him, with Yahweh?

That name alone - Yahweh - evokes a sense of, "there are no words." It was used by the Jewish people to reference God. It was the holiest of names that he was called. So holy, in fact, that they wouldn't even utter it out of reverential fear for their God who bore the name. If they were to write it, the pen used was immediately destroyed. That's how seriously they took the mention of our Lord's name. I could easily go into a rant here of how flippantly His name is thrown around now, how lightly we consider it when it comes off our lips (and I am certainly in the guilty party); but I'll save that rant for another day...

The point is, in all sorts of ways and wonders, God renders us speechless at different points in our lives.

And so it was upon hearing of Jen's news a couple Mondays ago... The speechless feeling struck, and I wrestled to find the words to covey the hurt, grief and heartache I felt, and still feel, for her. God has brought her so far. She has endured so very, very much. She longs for a life of normalcy. A life with no doctors, no hospitals, no chemo and no cancer. I long for that for her. But I have a greater and deeper longing than that one...

Oh God, be magnified, be glorified. Make this all about You. For when it's not, it all becomes absolutely pointless. We are an unclean people, fallen and living in a broken world. You are our only Hope. We do not hope in treatments, medicines, doctors, or cures - We hope in You. Our Shelter, our Rock, our Mighty Fortress, our Firm Foundation, our Savior. You are our Perfect Provider and in this perfect provision, you made a way for us to speak to you when our finite minds can't find the words. The Holy Spirit listens to the praises, the longings, the desires of our hearts and translates them to you. Thank goodness for the Spirit, for we would forever come up short in our worship of you and in our pleading with you. Lord, I do not know how to pray for Jennifer now. I do not have the words. Give me a prayer from your Spirit that I know you will hear. Until I am given the words, listen to the aching and groaning of my spirit and give us all that we need to make much of You in this difficult and trying time.

Like the beautiful sunset, we can know that this too is momentary. There will come a day when we live in an eternal home where the sun never sets. There will be no more darkness, no more pain, no more sorrow, no more grief, no more tears. The SON will reign forever, and we will rejoice in ways and with words that we were never capable of while on earth. Praise God for that day. A day where we stand before his throne and cry out, "I am undone. My eyes have seen the King."

 Prayerful Ponderings: 

 Jen began her first round of chemo last Monday, October 29th. All seemed to go well and by the end of last week her blast (cancerous cells) count had leveled off with no increase or decrease. The prayer is this: That the chemo, though it is not as aggressive as before, will be effective against the blasts rendering a decrease in blast percentage. Also, that the GVHD will be kept at bay. Right now, all seems to be going well in the GVHD department, and we pray that it continues as such. Pray most of all that Jennifer's spirit will be bolstered and ministered to by God. That she will count this suffering all joy for His sake. Pray, rejoicing confidently, that God is sovereign and whether or not He chooses to heal her, we know He will do what is best for her and what brings Him utmost glory. Our hope is not in what He can do for us now or in the future but in what He has already done. Praise Him for Christ and his work on the cross, without which all would be lost.

The Vandy Verses:

 In the same way, the Spirit helps us in our weakness. We do not know what we ought to pray for, but the Spirit himself intercedes for us with groans that words cannot express. Romans 8:26

Tell us what we should say to him; we cannot draw up our case because of our darkness. Job 37:19

Update

271 days ago, Jennifer received a fully ablative bone marrow transplant.  In English, she had an extremely toxic chemotherapy and radiation regimen to totally eradicate her own bone marrow and had another person's bone marrow put in its place.  This was a risky maneuver and fraught with fairly high treatment related mortality, but the trade off for us was that if afforded Jennifer the best chance at disease free survival. Today, we are sad to report that Jennifer's leukemia has returned despite our aggressive approach in treatment.  This was what we all lived in fear of.  We met with Dr. Savani today, Jennifer's transplant doctor, who went over the results of the bone marrow biopsy and the treatment options we have.  Due to Jennifer's recent bone marrow transplant (less than 1 year ago being recent) and her extensive graft versus host disease, an aggressive regimen of chemo to quickly put her back into remission is ill advised.  It is associated with around 30% treatment related death (i.e. death as a direct result of chemo).  We are offered a less intense regimen with the goal of slowly achieving remission.   Our chances of remission are slim, and our chances of sustained remission meaningful for long term survival is even more slim.  However, we are not without hope.  Patients have survived this in the past and Jennifer's attitude is superb.  We will give this our best shot.  We will need your unceasing prayers for remission and safety in treatment.  We will also need your prayers for our steadfastness in this endeavor and that our focus will not be removed from glorifying God through this illness. Jennifer and I along with our families will be taking an impromptu trip to Florida for some much needed R&R and bonding prior to this next round of treatment.  Be prayerful that we will be safe, avoiding infection, and enjoy our time with one another. My best to you always, Matt

Prayers Please

Jen received news today that the marker that gauges bone marrow engraftment revealed 97% engraftment. This is down from 100% several months ago and 99% a few months ago. While a 2 or 3 percent drop does not sound like much, it is obviously not as desirable as maintaining 100% engraftment. The drop could be caused by the steroid dosage she is on or, worst case, her body is rejecting the donor marrow. Please pray that her body is continuing to accept the marrow and that the drop is in fact being caused by the steroid dosage which will be a more easily remedied scenario. Please pray for the doctors, that they will continue to be blessed with wisdom and graciousness as they tend to Jennifer. Please pray that she will have THE peace that surpasses all human understanding.

The Power of Prayer and a Dose of Perspective

About a week and a half ago, September 13th, marked the one-year anniversary of Jennifer's biphenotypic leukemia diagnosis. I was in Nashville for the big anniversary, and she and I were talking about the providential blessings the Lord has showered down on her and, by extension, our family throughout the past year. Even when we didn't know how to pray for her, God knew what she needed and provided every step of the way through any and every means possible.

One of the biggest blessings I've experienced personally over the past year is PERSPECTIVE. Oh my, how my little self-made kingdom and the surrounding culture can so disastrously distort my perspective on the things in life that really matter. The Lord has used this past year and Jen's illness to increasingly mold my perspective into an eternal one, focused on things of true significance. Admittedly, it is a constant, and promises to be a life-long, battle to retain this focus. My sinful, self-focused nature fights tooth and nail to hang on to the fleeting pleasures of a world built around ME. It is by his good grace and mercy, his loving kindness, patience and faithfulness that I've even come this far - to see that a life lived for him is the only one worth living.

Father, don't give up on me. Don't give up on us. Continue to work mightily in our hearts and minds that we may be given eyes to see the things in life that matter, those things that are important to you. Set our affections on heaven. Equip us with all we need here on earth to be prepared for our eternal lives at home with you.

So, as previously mentioned, Jen and I were discussing God's providence throughout the last year and decided to list the ways God blessed her and our family. This list certainly doesn't even begin to cover it all, but it's a start. I know it will be a sweet, tangible reminder one day when we look back on this blog and can read through these blessings.

Father, thank you for your provision and for always listening to and answering our prayers. Thank you that we can trust that those answers, though they may not be what we want, are exactly what we need when we need them. Father, how we long to give you thanks and praise and worship in all the perfect ways you deserve. Forgive us for our imperfections, even in our worship, and thank you for your patience. Thank you that you are preparing us, even now, to one day perfectly worship you, our perfect Father, in your perfect Heaven.

(Jennifer) I am thankful for these answers to prayer:

-having a godly husband and being able to grow closer to one another and to God through this journey;
-a close friend staying at the house that week who was a first-responder as soon as we got the news;
-a mother and father willing to sacrifice everything to ensure I was getting the best care and in good hands;
-Dr. Gary was able to tactfully and graciously deliver the news of my diagnosis to my family, and he and Donna lovingly made the trip up to Nashville to see me just days after being diagnosed;
-physicians that are respected around the world for their knowledge of cancer and transplant patients being responsible for my case;
-doctors were able to make the correct diagnosis, realizing it was a hybrid leukemia showing characteristics of both AML and ALL;
-doctors chose a treatment regimen that achieved a speedy remission within the induction round of chemotherapy;
-chemo side-effects were minimal;
-multiple successful blood transfusions with no adverse reaction;
-family members and friends being willing and able to offer round-the-clock care and support through the duration of the treatments;
-physically able to tolerate all chemotherapy doses without neurological side-effects that would have led to termination of chemo treatment;
-did not have to be readmitted due to mouth sores; any mucositis acquired was treated in-patient and never recurred;
-godly, like-minded physicians, nurses, and caregivers in the hospital that were willing to pray with and for us;
-nurse practitioners that "fought for me" and sought the best care possible during my hospital stay; they understood that my comfort level was just as important as medication;
-having the support of the Vanderbilt Pharmacy, especially the chemo pharmacy;
-random encounters of encouragement from people of all walks of life and many different backgrounds;
-few hospital admissions;
-Vanderbilt finding a donor in a timely manner;
  -few secondary infections post-transplant;
-bone marrow engrafted quickly;
-my body continues to accept the bone marrow;
-my skin and gut GVHD have been kept under control and there are positive indicators of being able to control my lung GVHD/BOS;
-I'm able to resume some levels of normalcy with life post-transplant including going on mini-trips and running errands around Nashville;
-the amount of resources Vanderbilt is able to provide me with outside the medical realm; Gilda's Club which offers support groups and enrichment classes and the Dayani Center which offers personal trainers and a great exercise facility;
-having a supprt system outside of family and friends that can help me with the day-to-day goings on around the house.

Thank you, Lord.

My grace is ALL you need...

Jennifer and Matt were both diagnosed with bronchitis today. Jen is understandably upset by another setback. Thinking about her circumstances this evening, this scripture immediately sprang to mind:

I begged the Lord three times to take this problem away from me. But the Lord said, “My grace is all you need. Only when you are weak can everything be done completely by my power.” So I will gladly boast about my weaknesses. Then Christ’s power can stay in me. Yes, I am glad to have weaknesses if they are for Christ. I am glad to be insulted and have hard times. I am glad when I am persecuted and have problems, because it is when I am weak that I am really strong. 2nd Corinthians 12:8-10

No commentary necessary. What a powerful, reassuring passage. Thank you for your prayers for a quick recovery and for Jen to be encouraged knowing God's grace is truly all she needs. It is all any of us TRULY NEED.

Good, Not Great

Just a quick update. Jen had a follow up appointment to test how well her lungs were responding to the new meds last Thursday, August 2nd. The doc said lung function seems to be improving and for Jennifer to continue her breathing exercise class and to stay away from crowds due to an increased risk of infection. Both would only help to further the seeming improvement. Still, there are some reservations over the news as Jen described it being, "Good, not great."

Regardless, we are thankful for this good news and remain hopeful that God is using these meds to heal her lungs. Trusting that He continues to move and work on Jennifer's behalf and with His glory being top most priority.

Father, continue to use this for your glory. Inundate Jennifer's spirit with peace, joy, comfort and strength. Things that can only truly come from You, and things we can never be robbed of as long as we abide in You. Thank you for your perfect care.

Nothing can separate us from the love of God...

In an attempt to update this evening, seems as though not much has changed with Jenny. A report today from our aunt who is with her this week read:

"Working her little heart out! Breathing and exercising to get better! GVH on skin is better....Praise God for his grace and mercy!"

We are so thankful her skin GVHD seems to be clearing; this probably means she's a little more comfortable. Breathing seems to be the same. Jenny is going to exercise classes nearly every day to improve and strengthen lung function. The docs will wait another week (next Thursday, August 2nd) to run tests on lung function in order to give the meds enough time to take effect.

Please join us in praying that the Lord will use these meds to strengthen her lungs and improve her condition. Please continue to pray that God will give her comfort and peace and use this time and this struggle to draw her and those around her closer to Himself.

Some great verses for Jenny and us sent from our uncle Keith last night:

(Side note: I chose the title for this post from one of the truths listed below...Nothing - no disease, no affliction, no scheme of man, no height, no depth, nothing in all of space or time - NOTHING can separate us from the love of God. Whew. Now that's a truth worth hanging your hat on.)

“MY PEOPLE ARE DESTROYED FOR lack of knowledge.” (Hos. 4:6)
John 1:12 But as many as received Him, to them He gave the right to become children of God, even to those who believe in His name.
I am God's child
John 15:15 “No longer do I call you slaves, for the slave does not know what his master is doing; but I have called you friends, for all things that I have heard from My Father I have made known to you.
I am Jesus’ friend
1 Cor. 6:17 But the one who joins himself to the Lord is one spirit with Him.
I am united with the Lord and one spirit with Him
1 Cor. 6:19-20 Or do you not know that your body is a temple of the Holy Spirit who is in you, whom you have from God, and that you are not your own? For you have been bought with a price; therefore glorify God in your body.
I have been bought with a price; I belong to God
Eph. 1:4-5 Just as He chose us in Him before the foundation of the world, that we would be holy and blameless before Him. In love He predestined us to adoption as sons through Jesus Christ to Himself, according to the kind intention of His will.
I have been chosen by God and adopted as His child
Col. 1:13-14 For He rescued us from the domain of darkness, and transferred us to the kingdom of His beloved Son, in whom we have redemption, the forgiveness of sins.
I have been redeemed and forgiven for all my sins
Col. 2:9-10 For in Him all the fullness of Deity dwells in bodily form, and in Him you have been made complete, and he is the head over all rule and authority.
I am complete in Christ
Rom. 8:1 Therefore there is now no condemnation for those who are in Christ Jesus.
I am free forever from condemnation
Rom. 8:35-39 Who will separate us from the love of Christ? Will tribulation, or distress, or persecution, or famine, or nakedness, or peril, or sword? Just as it is written, “FOR YOUR SAKE WE ARE BEING PUT TO DEATH ALL DAY LONG; WE WERE CONSIDERED AS SHEEP TO BE SLAUGHTERED.” But in all these things we overwhelmingly conquer through Him who loved us. For I am convinced that neither death, nor life, nor angels, nor principalities, nor things present, nor things to come, nor powers, nor height, nor depth, nor any other created thing, will be able to separate us from the love of God, which is in Christ Jesus our Lord.
I cannot be separated from the love of God
2 Cor. 1:21-22 Now He who establishes us with you in Christ and anointed us is God, who also sealed us and gave us the Spirit in our hearts as a pledge.
I have been established, anointed and sealed by God
Col. 3:3-4 For you have died and your life in hidden with Christ in God. When Christ, who is our life, is revealed, then you also will be revealed with Him in glory.
I am hidden with Christ in God and will be revealed with Him in glory
Phil. 1:6 For I am confident of this very thing, that He who began a good work in you will perfect it until the day of Christ Jesus.
I know that the good work God has begun in me will be completed
Phil. 3:20 For our citizenship is in heaven, from which also we eagerly wait for a Savior, the Lord Jesus Christ.
I am a citizen of heaven
John 15:16 “You did not choose Me but I chose you, and appointed you that you would go and bear fruit, and that your fruit would remain, so that whatever you ask of the Father in My name He may give to you.”
I have been appointed and chosen to bear fruit that will last
1 Cor. 3:16 Do you not know that you are a temple of God and that the Spirit of God dwells in you?
I am a temple of God indwelt by His Spirit
Eph. 2:6 …and raised us up with Him, and seated us in the heavenly places in Christ Jesus.
I am seated with Christ in the heavenly realm
Eph. 2:10 For we are His workmanship, created in Christ Jesus for good works, which God prepared beforehand so that we would walk in them.
I am made by God and equipped by Him for His great purpose
Phil. 4:13 I can do all things through Him who strengthens me.
I can do all He asks because He supplies the power to do it

The Battle Wages On

As the post title would lead you to believe, Jen is still very much in a battle against the diseases that are waging war on her body. She contracted graft-vs-host disease (GVHD) post-transplant, which surprised no one and is to be expected in many cases. GVHD manifests itself through a wide range of difficulties- with skin rashes at one end of the spectrum and organ failure at the other, more severe, end. Jennifer experienced a skin rash and issues with her gut (both GVHD-related) through the spring and both were thought to be under control after a regimen of treatments. Unfortunately, both have come back, more so the rash than the GI tract issues, and are making Jen quite uncomfortable.

A couple of weeks ago, Jennifer went in to have her lungs tested. At her 100-day post-transplant appointment, her lung function was registering poorly and the doc wanted to test it again. This go-round lung function was down to 25% capacity. After what seemed to be a clear CT scan, the docs concurred that GVHD has entered into the tiny air passageways that feed into her bronchial sacs. (The presumption is because the GVHD is in such a small area, a CT scan could not pick it up and therefore presented clear.) In the lungs, GVHD takes on a new name: BOS (bronchiolitis obliterans syndrome) and can be terminal. The docs decided to begin Jennifer on a new regimen of meds- a clinical trial called FAM. These are anti-inflammatory steroids that should help her air passageways stay open so that she can exhale properly. You see, inhaling is not the problem. She can take a good, deep breath just the same as you and me. It's the exhaling that proves to be tricky. By pursing her lips together, she can force air out but anyone that has ever had trouble with their breathing (for any reason) can attest to it being a scary, uncomfortable thing. In some cases, FAM has proven to reverse damage done by BOS and in a few it has treated the BOS completely.

Now it is a matter of time waiting to see the effect the meds will have on Jen's condition. It can be a frightening, anxiety-laden day-to-day but once again we turn our eyes to Jesus and ask for the comfort, peace, and healing that only he can give. And, O Lord, in your mercy and graciousness we beg you to use this for your glory. Glorify yourself in the life and struggle of Jennifer. Bring her, as well as those impacted by her journey, closer to yourself. Oh, that you would be honored, that you would be glorified, that your name, the name greater than all others, would be praised, lifted high and adored. That you would be seen as a loving, caring, just and sovereign God deserving of all our worship, adoration and praise. This is our prayer. Whether you choose to heal Jennifer on earth or in eternity, let our hearts rest knowing that you hold it all in your hands, and it is all GOOD. We love you, and we thank you for your matchless love towards us.

TURN YOUR EYES UPON JESUS
Words and Music by Helen H. Lemmel
1922

O soul are you weary and troubled?
No light in the darkness you see?
There's light for a look at the Saviour,
And life more abundant and free.

Refrain
Turn your eyes upon Jesus,
Look full in His wonderful face,
And the things of earth will grow strangely dim,
In the light of His Glory and Grace.

Through death into life everlasting
He passed, and we follow Him there;
Over us sin no more hath dominion -
For more than conquerors we are!

Refrain
Turn your eyes upon Jesus,
Look full in His wonderful face,
And the things of earth will grow strangely dim,
In the light of His Glory and Grace.

His Word shall not fail you - He promised;
Believe Him, and all will be well;
Then go to a world that is dying,
His perfect salvation to tell.

Refrain
Turn your eyes upon Jesus,
Look full in His wonderful face,
And the things of earth will grow strangely dim,
In the light of His Glory and Grace

Samples of Summer

This past week Jen and Matt had the opportunity to take a nice little getaway to Chattanooga. They stayed in a quaint B & B, went to Rock City, visited Covenant College, and explored an aquarium (*see pics below!).

In front of the penguin exhibit.

Penguins! ...or not?

Jellyfish! I dare you to jump!

The summer has been trucking along rather smoothly for the Samples. Matt finished his residency last Friday, June 22nd and began his fellowship today, June 29th. Jen is doing well, with not too many changes recently. It seems as though the GVHD that was appearing on her skin and in her gut is clearing. She is hoping her docs will begin to wean her off of her meds and her photophoresis treatments, preferably the meds first as they have some unpleasant side effects. She is anticipating them making some decisions next Thursday. Jen is asking for prayer for Matt as he begins his fellowship in cardiology at Vanderbilt and also for her lungs. Her lung function took a dip in the past couple months, and she is prayerful that the docs will find her lungs up and running at their baseline (pre-transplant) level, especially because this will prevent her from having to take more meds.

Matt and Jen have enjoyed spending some time at Cheekwood in Nashville throughout the summer. Cheekwood is a really neat venue that hosts concerts and other musical events along with botanical gardens and other exhibits of interest. One exhibit they visited more recently were treehouses that had been built based off of children's books such as a pirate ship and a rainbow fish (that one was made out of cds, really cool!). In honor of Matt's birthday this Sunday, they are going to see Jerry Seinfeld's stand-up comedy act tonight.

As you can see, Jen is having a great summer and staying pretty busy! Though she's careful to schedule naps through the day as she is still lacking some energy, something that can easily be zapped in this hot, southern Summer sun!

As always, thank you for your prayers and your concern. Let us all be in prayer that we will not take our health or our days so graciously given to us for granted. We serve such a loving God. He is so good to us, and his goodness knows no bounds. Thank you, Father, for your care, your protection, your love, and your goodness to us. And, (grimace), thank you for the sunshine, Lord. Though it is hot, keep us mindful of our complaining. We are an abundantly blessed people. Let us not forget that.

The Great Physician at Work

The latest bone marrow biopsy results are in and reveal 99% of Jennifer's marrow as being donor marrow. The 1% that is showing up as her's could very well be from some of the bone getting into the sample when they drew, and the doctor sees no reason to be concerned about that 1%. Furthermore, there were no cancerous cells detected, and the doc has recently 'green-lighted' her to drive. After eight months of being dependent on someone else for transportation, this all-too-often-taken-for-granted freedom is a sweet release for Jen.

Please join us in praising God for these results. Again, they are direct evidence that the Great Physician is very much a part of Jen's treatment and healing. He has not left her side for one moment, and it is thrilling to see Him so actively at work through this positive news. We remember, though, had we gotten unfavorable news, He is still the Great Physician, still our loving Father, still our merciful Savior, and still our sovereign Lord. We do rejoice that He found it in her best interest and most glorifying to Himself to allow Jen to have what seems to be a successful transplant. We pray He will continue to heal her body and restore her health; that He will protect her major organs from graft vs. host disease; that He will continue to uphold her with His strong right hand. Thanks be to God for all of His goodness and mercy to us.

Oh for grace to trust Him more...

Tis so sweet to trust in Jesus
Just to take Him at His word
Just to rest upon His promise
And to know, "Thus saith the Lord."

Oh, how sweet to trust in Jesus
Just to trust His cleansing blood
And in simple faith to plunge me
'Neath the healing, cleansing flood

Yes, 'tis sweet to trust in Jesus
Just from sin and self to cease
Just from Jesus simply taking
Life and rest, and joy and peace

I'm so glad I learned to trust Thee
Precious Jesus, Savior, Friend
And I know that Thou art with me
Wilt be with me to the end

Jesus, Jesus, how I trust Him
How I've proved Him o'er and o'er
Jesus, Jesus, precious Jesus
Oh, for grace to trust Him more...

~Louisa M. R. Stead

Jennifer's testing last Thursday revealed there was no GVHD in her eyes. Bloodwork indicated a low platelet count and low white blood cell count but more tests yesterday showed her counts had recovered. The tests performed on her lungs revealed her lung function is not up to par with her baseline ('baseline' being all her major organs' functions pre-transplant). The doc didn't seem too concerned with this but has prescribed two meds and an inhaler to help with lung function. We are still awaiting the bone marrow biopsy results.

Prayerful Ponderings:
Father, thank You for protecting Jennifer's eyes. Thank You for her count levels recovering. I pray for her lungs. I pray You will restore them and strengthen them. I pray for her other major organs, that You will protect them from GVHD. Place Your healing hands upon her body and restore her health. Father, whether You choose to heal her completely, partially, or not at all, help us remember that Your glory is of utmost importance. Our temporary discomforts, and even momentary happiness, on this earth are nothing but vapor. We are made for eternity. Father, thank You for providing a Way for us to spend eternity with You. We await the day when we join all the others who have gone before us in worshipping You forever, worshipping You perfectly- the way You deserve. Thank You for Your patience with us when we become so consumed with this world. Help us remember we are just passing through; not only is it momentary but it is to be lived with You at the center, not ourselves. There is coming a day when all of this will pass away, we will be called to give an account for the way we lived our lives, and we will be judged. Thank You that when we, as Christians, stand in judgement, we will be clothed in the righteousness of Christ - a gift You graciously made available to all who would accept it. Thank You for Your goodness to us. Thank You that even in moments of turmoil, strife, sadness and heartache, our hope is not lost. We have the hope of heaven; we have the redemptive work of Your Son to cling to; we have the blessing of looking forward to an eternity spent with You.

The Vandy Verse:
Many, O Lord my God, are the wonders you have done. The things you planned for us no one can recount to you; were I to speak and tell of them, they would be too many to declare. Psalm 40:5

The Nuts and Bolts of BMT

The following is a wonderfully comprehensive document on bone marrow transplants that a church friend of our's found. I thought I would post it here as it serves as a great summary of what Jen has endured.

BONE MARROW TRANSPLANT
COLUMBIA PRESBYTERIAN MEDICAL CENTER
Herbert Irving Comprehensive Cancer Center

The Nuts and Bolts of Bone Marrow Transplants
Bone marrow transplantation (BMT) is a relatively new medical procedure being used to treat diseases once thought incurable. Since its first successful use in 1968, BMTs have been used to treat patients diagnosed with leukemia, aplastic anemia, lymphomas such as Hodgkin's disease, multiple myeloma, immune deficiency disorders and some solid tumors such as breast and ovarian cancer.

In 1991, more than 7,500 people underwent BMTs nationwide. Although BMTs now save thousands of lives each year, 70 percent of those needing a BMT using donor marrow are unable to have one because a suitable bone marrow donor cannot be found.

WHAT IS BONE MARROW?
Bone marrow is a spongy tissue found inside bones. The bone marrow in the breast bone, skull, hips, ribs and spine contains stem cells that produce the body's blood cells. These blood cells include white blood cells (leukocytes), which fight infection; red blood cells (erythrocytes), which carry oxygen to and remove waste products from organs and tissues; and platelets, which enable the blood to clot.
WHY TRANSPLANT?
In patients with leukemia, aplastic anemia, and some immune deficiency diseases, the stem cells in the bone marrow malfunction, producing an excessive number of defective or immature blood cells (in the case of leukemia) or low blood cell counts (in the case of aplastic anemia). The immature or defective blood cells interfere with the production of normal blood cells, accumulate in the bloodstream and may invade other tissues.

Large doses of chemotherapy and/or radiation are required to destroy the abnormal stem cells and abnormal blood cells. These therapies, however, not only kill the abnormal cells but can destroy normal cells found in the bone marrow as well. Similarly, aggressive chemotherapy used to treat some lymphomas and other cancers can destroy healthy bone marrow. A bone marrow transplant enables physicians to treat these diseases with aggressive chemotherapy and/or radiation by allowing replacement of the diseased or damaged bone marrow after the chemotherapy/radiation treatment.

While bone marrow transplants do not provide 100 percent assurance that the disease will not recur, a transplant can increase the likelihood of a cure or at least prolong the period of disease-free survival for many patients.

TYPES OF TRANSPLANTS
In a bone marrow transplant, the patient's diseased bone marrow is destroyed and healthy marrow is infused into the patient's blood-stream. In a successful transplant, the new bone marrow migrates to the cavities of the large bones, engrafts and begins producing normal blood cells.

If bone marrow from a donor is used, the transplant is called an "allogeneic" BMT, or "syngeneic" BMT if the donor is an identical twin. In an allogeneic BMT, the new bone marrow infused into the patient must match the genetic makeup of the patient's own marrow as perfectly as possible. Special blood tests are conducted to determine whether or not the donor's bone marrow matches the patient's. If the donor's bone marrow is not a good genetic match, it will perceive the patient's body as foreign material to be attacked and destroyed. This condition is known as graft-versus-host-disease (GVHD) and can be life-threatening. Alternatively, the patient's immune system may destroy the new bone marrow. This is called graft rejection.

There is a 35 percent chance that a patient will have a sibling whose bone marrow is a perfect match. If the patient has no matched sibling, a donor may be located in one of the international bone marrow donor registries, or a mis-matched or autologous transplant may be considered.

In some cases, patients may be their own bone marrow donors. This is called an autologous BMT and is possible if the disease afflicting the bone marrow is in remission or if the condition being treated does not involve the bone marrow (e.g. breast cancer, ovarian cancer, Hodgkin's disease, non-Hodgkin's lymphoma, and brain tumors). The bone marrow is extracted from the patient prior to transplant and may be "purged" to remove lingering malignant cells (if the disease has afflicted the bone marrow).

PREPARING FOR THE TRANSPLANT
A successful transplant requires the patient be healthy enough to undergo the rigors of the transplant procedure. Age, general physical condition, the patient's diagnosis and the stage of the disease are all considered by the physician when determining whether a person should undergo a transplant.

Prior to a bone marrow transplant, a battery of tests is carried out to ensure the patient is physically capable of undergoing a transplant. Tests of the the patient's heart, lung, kidney and other vital organ functions are also used to develop a patient "baseline" against which post-transplant tests can be compared to determine if any body functions have been impaired. The pre-transplant tests are usually done on an outpatient basis.

A successful bone marrow transplant requires an expert medical team - doctors, nurses, and other support staff - who are experienced in bone marrow transplants, can promptly recognize problems and emerging side effects, and know how to react swiftly and properly if problems do arise. A good bone marrow transplant program will also recognize the importance of providing patients and their families with emotional and psychological support before, during and after the transplant, and will make personal and other support systems readily available to families for this purpose.

BONE MARROW HARVEST
Regardless of whether the patient or donor provides the bone marrow used in the transplant, the procedure used to collect the marrow - the bone marrow harvest - is the same. The bone marrow harvest takes place in a hospital operating room, usually under general anesthesia. It involves little risk and minimal discomfort.

While the patient is under anesthesia, a needle is inserted into the cavity of the rear hip bone or "iliac crest" where a large quantity of bone marrow is located. The bone marrow - a thick, red liquid - is extracted with a needle and syringe. Several skin punctures on each hip and multiple bone punctures are usually required to extract the requisite amount of bone marrow. There are no surgical incisions or stitches involved - only skin punctures where the needle was inserted.

The amount of bone marrow harvested depends on the size of the patient and the concentration of bone marrow cells in the donor's blood. Usually one to two quarts of marrow and blood are harvested. While this may sound like a lot, it really only represents about 2% of a person's bone marrow, which the body replaces in four weeks.

When the anesthesia wears off, the donor may feel some discomfort at the harvest site. The pain will be similar to that associated with a hard fall on the ice and can usually be controlled with Tylenol. Donors who are not also the BMT patient are usually discharged after an overnight stay and can fully resume normal activities in a few days.

For autologous transplants, the harvested bone marrow will be frozen (cryopreserved) and stored at a temperature between -80 and -196 degrees centigrade until the day of the transplant. It may first be "purged" to remove residual cancerous cells that can't be easily identified under the microscope.

In allogenic BMTs, the bone marrow may be treated to remove "T-cells" (T cell depletion) to reduce the risk of graft-versus-host disease. It will then be transferred directly to the patient's room for infusion.

PREPARATIVE REGIMEN
A patient admitted to the bone marrow transplant unit will first undergo several days of chemotherapy and/or radiation which destroys bone marrow and cancerous cells and makes room for the new bone marrow. This is called the conditioning or preparative regimen. The exact regimen of chemotherapy and/or radiation varies according to the disease being treated and the "protocol" or preferred treatment plan of the facility where the BMT is being performed.

Prior to conditioning, a small flexible tube called a catheter (sometimes called a "Hickman" or central venous line) will be inserted into a large vein in the patient's chest just above the heart. This tube enables the medical staff to administer drugs and blood products to the patient painlessly, and to withdraw the hundreds of blood samples required during the course of treatment without inserting needles into the patient's arms or hands.

The dosage of chemotherapy and/or radiation given to patients during conditioning is much stronger than dosages administered to patients with the same disease who are not undergoing a BMT. Patients may become weak, irritable and nauseous. Most BMT centers administer anti-nausea medications to minimize discomfort.

THE TRANSPLANT
A day or two following the chemotherapy and/or radiation treatment, the transplant will occur. The bone marrow is infused into the patient intravenously in much the same way that any blood product is given. The transplant is not a surgical procedure. It takes place in the patient's room, not an operating room.

Patients are checked frequently for signs of fever, chills, hives and chest pains while the bone marrow is being infused. When the transplant is completed, the days and weeks of waiting begin.

ENGRAFTMENT
The two to four weeks immediately following transplant are the most critical. The high-dose chemotherapy and/or radiation given to the patient during conditioning will have destroyed the patient's bone marrow, crippling the body's "immune" or defense system. As the patient waits for the transplanted bone marrow to migrate to the cavities of the large bones, set up housekeeping or "engraft," and begin producing normal blood cells, he or she will be very susceptible to infection and excessive bleeding. Multiple antibiotics and blood transfusions will be administered to the patient to help prevent and fight infection. Transfusions of platelets will be given to prevent bleeding. Allogenic patients will receive additional medications to prevent and control graft-versus-host disease.

Extraordinary precautions will be taken to minimize the patient's exposure to viruses and bacteria. Visitors and hospital personnel will wash their hands with antiseptic soap and, in some cases, wear protective gowns, gloves and/or masks while in the patient's room since they often carry fungi and bacteria that pose a risk of infection. When leaving the room, the patient may wear a mask, gown and gloves as a barrier against bacteria and virus, and as a reminder to others that he or she is susceptible to infection. Blood samples will be taken daily to determine whether or not engraftment has occurred and to monitor organ function. When the transplanted bone marrow finally engrafts and begins producing normal blood cells, the patient will gradually be taken off the antibiotics, and blood and platelet transfusions will generally no longer be required. Once the bone marrow is producing a sufficient number of healthy red blood cells, white blood cells and platelets, the patient will be discharged from the hospital, provided no other complications have developed. BMT patients typically spend four to eight weeks in the hospital.
WHAT A PATIENT FEELS DURING THE TRANSPLANT
A bone marrow is a physically, emotionally, and psychologically taxing procedure for both the patient and family. A patient needs and should seek as much help as possible to cope with the experience. "Toughing it out" on your own is not the smartest way to cope with the transplant experience.

The bone marrow transplant is a debilitating experience. Imagine the symptoms of a severe case of the flu- nausea, vomiting, fever, diarrhea, extreme weakness. Now imagine what it's like to cope with the symptoms not just for several days, but for several weeks. That approximates what a BMT patient experiences during hospitalization.

During this period the patient will feel very sick and weak. Walking, sitting up in bed for long periods of time, reading books, talking on the phone, visiting with friends or even watching TV may require more energy that the patient has to spare.

Complications can develop after a bone marrow transplant such as infection, bleeding, graft-versus-host disease, or liver disease, which can create additional discomfort. The pain, however, is usually controllable by medication. In addition, mouth sores can develop that make eating and swallowing uncomfortable. Temporary mental confusion sometimes occurs and can be quite frightening for the patient who may not realize it's only temporary. The medical staff will help the patient deal with these problems.

HANDLING EMOTIONAL STRESS
In addition to the physical discomfort associated with the transplant experience there is emotional and psychological discomfort as well. Some patients find the emotional and psychological stress more problematic than the physical discomfort.

The psychological and emotional stress stems from several factors. First, patients undergoing transplants are already traumatized by the news that they have a life-threatening disease. While the transplant offers hope for their recovery, the prospect of undergoing a long, arduous medical procedure is still not pleasant and there's no guarantee of success.

Second, patients undergoing a transplant can feel quite isolated. The special precautions taken to guard against infection while the immune system is impaired can leave a patient feeling detached from the rest of the world and cut off from normal human contact. The patient is housed in a private room, sometimes with special air-filtering equipment to purify the air. The number of visitors is restricted and visitors are asked to wear gloves, masks and/or other protective clothing to inhibit the spread of bacteria and virus while visiting the patient. When the patient leaves the room, he or she may be required to wear a protective mask, gown and/or gloves as a barrier against infection. This feeling of isolation comes at the very time in a patient's life when familiar surroundings and close physical contact with family and friends are most needed.
"Helplessness" is also a common feeling among bone marrow transplant patients, which can breed further feelings of anger or resentment. For many, it's unnerving to be totally dependent on strangers for survival, no matter how competent they may be. The fact that most patients are unfamiliar with the medical jargon used to describe the transplant procedure compounds the feeling of helplessness. Some also find it embarrassing to be dependent on strangers for help with basic daily functions such as using the washroom.

The long weeks of waiting for the transplanted marrow to engraft, for blood counts to return to safe levels, and for side effects to disappear increase the emotional trauma. Recovery can be like a roller coaster ride: one day a patient may feel much better, only to awake the next day feeling as sick as ever.

LEAVING THE HOSPITAL
After being discharged from the hospital, a patient continues recovery at home (or at lodging near the transplant center if the patient is from out of town) for two to four months. Patients usually cannot return to full-time work for up to six months after the transplant.

Though patients will be well enough to leave the hospital, their recovery will be far from over. For the first several weeks the patient may be too weak to do much more than sleep, sit up, and walk a bit around the house. Frequent visits to the hospital or associated clinic will be required to monitor the patient's progress, and to administer any medications and/or blood products needed. It can take six months or more from the day of transplant before a patient is ready to fully resume normal activities.

During this period, the patient's white blood cell counts are often too low to provide normal protection against the viruses and bacteria encountered in everyday life. Contact with the general public is therefore restricted. Crowded movie theaters, grocery stores, department stores, etc. are places recovering BMT patients avoid during their recuperation. Often patients will wear protective masks when venturing outside the home.

A patient will return to the hospital or clinic as an outpatient several times a week for monitoring, blood transfusions, and administration of other drugs as needed. Eventually, the patient becomes strong enough to resume a normal routine and to look forward to a productive, healthy life.

LIFE AFTER TRANSPLANT
It can take as long as a year for the new bone marrow to function normally. Patients are closely monitored during this time to identify any infections or complications that may develop.

Life after transplant can be both exhilerating and worrisome. On the one hand, it's exciting to be alive after being so close to death. Most patients find their quality of life improved after transplant.

Nonetheless, there is always the worry that relapse will occur. Furthermore, innocent statements or events can sometimes conjure up unpleasant memories of the transplant experience long after the patient has recovered. It can take a long time for the patient to come to grips with these difficulties.

IS IT WORTH IT?
Yes! For most patients contemplating a bone marrow transplant, the alternative is near-certain death. Despite the fact that the transplant can be a trying experience, most find that the pleasure that comes from being alive and healthy after the transplant is well worth the effort.

So Glad You Made It!!

Happy 100-days to you!
Happy 100-days to you!
Happy 100-days dear J-E-N-N-I-F-E-R....
Happy 100-days to you!!

Today is Jennifer's 100th day post-transplant!! Congratulations Jenny! You continue to be such an inspiration to us all, and we are overwhelmed as we look back, not only on the last 100 days but all the way back to September 13th, and see God's hand clearly at work in your life and your journey through this illness.

The last 100 days have been incredibly hard. Jennifer went through a very aggressive round of chemotherapy and radiation therapy. Her bone marrow was completely ablated; her immune system obliterated. The bone marrow transplant was, as far as we know up to this point, successful. Her bone marrow has engrafted and is 100% donor. Graft-vs.-Host-Disease (also known as GVHD) has reared its ugly head, as it commonly does with transplant patients. GVHD occurs when the donor's organ (in this case, the bone marrow) recognizes the host as an unfamiliar, unfriendly site and begins to attack it as a foreign body. Jennifer's GVHD manifested itself in the form of a rash which covered, at its worst point, up to 50% of the surface area of her skin. The rash was treated with phototherapy (tanning bed-like sessions) and began to clear. She began having issues with her GI tract, and there was concern that the GVHD had entered her gut. She was prescribed sessions of photophoresis where blood is extracted from her body, run through a machine that rids it of its T-cells, and then reenters her body. She is currently undergoing photophoresis at twice-a-week clinic visits and seems to be improving with it.

Along with the daily 'grind' of having to be extraordinarily particular with her diet (due to the GI issues), wearing a mask anytime she's in public, taking staggering amounts of various medications, and dealing with the general 'what now?' feelings, Jennifer is continuing strong and courageous as her fight wages on.

She is, of course, human. Anyone undergoing this strenuous amount of treatment would certainly find it nearly suffocating, perhaps insurmountable, at times. I have often been reminded that God allows nothing to come into our lives that we, with Him at our side, cannot handle, that He will not let us endure anything we cannot bear. Then I think, "Boy, He must believe Jennifer to be one tough cookie." Of course this toughness, this ability to  bravely face the fear and the unknown and the seemingly endless treatment of this disease all comes from Him. There is nothing good in any of us that does not come straight from Him. So I thank Him for equipping her with what she needs for every minute of her sometimes grueling days. She is a fighter and continues to fight well. She has a good Leader in this fight, and I am certain that one day she will come into the blessings of being His faithful follower.

"Well done, good and faithful servant! You have been faithful with a few things; I will put you in charge of many things. Come and share in your Master's happiness!" Matthew 25: 21

Prayerful Ponderings:
Please pray, with thanksgiving, that our gracious Lord and heavenly Father has seen Jennifer through these last seven and a half months and, especially, the last crucial 100-days. Please pray that He will lift her spirits and give her a renewed sense of purpose with this essentially 'new' life she is beginning post-transplant. Pray that her heart will be filled with the hope and encouragement that can only come from the True Source of these things; that she will find joy in each passing day and find herself overwhelmed by the sheer delight of her soul in the Lord. Her 100-day evaluations are on Thursday. Please pray these go well and for her to receive postive reports on her progress up to this point. Also, please pray the photophoresis treatments continue to be effective. Praise God for His great mercy and unending lovingkindness toward Jen and her family. We are undeserving of all the goodness He has mercifully rained down on us. Humbly, we thank you Lord.

Home Again, Home Again

Thankfully, Jen got to come home today and is hoping for limited hospital visits (meaning: hoping for none!) from here on out. She's resting well and eating pretty well. Again, asking for prayer that her body will gain strength, that her medicine levels will stay therapeutic to prevent a hospital stay, and that her blood counts will reach a desired level to prevent a transfusion. Thank you so much for your prayers.

Hospital Stay

Jen was admitted to the hospital early Tuesday morning around 3:00 with GI issues and low cyclosporine levels. She's doing well now - eating some soup, crackers, applesauce, etc. Things that will be gentle on her stomach as it recovers from a rough couple days. One of her doctors offered some encouraging words saying these bumps in the road are to be expected and that the levels will be watched closely so they do not reach a dangerously low or high amount. She's hanging in there albeit a tad discouraged after getting such a positive report at her clinic visit on Monday and then being back in the hospital within 24 hours. The hope is she'll get to head home tomorrow.

She is asking for prayer for the cyclosprine to stay at a consistently safe level and that her other blood counts will reach desired levels. She's also asking for prayer that her body will continue to be receptive to the transplant and not reject it as this is still a possibility. Please pray that she will get to enjoy more time at home with no more hospital stays. Also, please pray for the Lord to continue to guide the doctors, nurses, and other caregivers and for Him to encourage Jennifer and draw Him closer to Himself with each passing day. Oh that He will be glorified, high and lifted up. He is most deserving of all our praise. May this journey be stamped with: TO GOD BE THE GLORY.

Winning the War

The first 100 days post-transplant are extremely tough. All things considered, Jenny is holding up remarkably well as today closed out her 52nd day. The rash, caused by GVHD (graft v. host disease), is somewhat advanced affecting over 50% of her skin area. The docs don't want to increase her steroid dosage, which is used to keep the rash under control, so they've moved to the next step. She's starting phototherapy (a procedure that is similar to a tanning bed session) three times a week for five weeks. She will have to wear special glasses when she's outside the house for the next five weeks to protect her eyes from UV rays which can put her at risk for cataracts. Thankfully, she is able to eat more now. Though Jen is still in the throws of her 100 days, we are continuing to offer prayers of thanksgiving. Thankful the Lord has brought her this far, and He will not leave or forsake her now. Please join us in praying that the phototherapy sessions will resolve the GVHD, that she will tolerate them well, and that she will be encouraged daily during this battle with her cancer's aftermath.

I've been reading through the book of Joshua, and it struck me this evening how incredibly poignant Joshua's story is right now in our lives and especially Jennifer's. After Moses' death, it is left to Joshua to lead the Israelites into the Promised Land- Cannan. Trouble is, it's occupied. For the Israelites to gain control over the land they must fight for it. The first five chapters set the stage for what's about to go down.... Joshua and the people are in a state of preparation as they focus in on taking the key city of Jericho. God reminds them of His great power by leading them across the Jordan River, during flood stage, on dry ground. Their ancestors saw Him do it with the Red Sea. Now it's their turn. They gather rocks from the river's bed as proof of His might and as proof of His deserving their utmost repect and honor.

Once they've crossed the river, the Israelites set up shop just outside of Jericho and wait for instructions as a blanket of tension envelopes their camp. Then, Joshua has a divine encounter with none other than the commander of the Lord's army. Joshua asks for a command but first he gets overwhelming affirmation: The Lord said to Joshua, "Look, I have given you Jericho, its king, and all its fighting men...." The Lord goes on to describe to Joshua, in detail, exactly how he wants him to take the city. Not with swords, shields, horses, and carriages but with horns and trumpets and shouts. Joshua relays the command to the priests (his army) and the 'battle' ensues.

God gave the Israelites victory that day. Literally, handed their enemies into their hands. Unbelievable, right? Oh, but believe we do. For it is this faith, this belief in these unbelievable stories of the 'little guy' coming out on top because they've got the one true God fighting not with them but FOR them that keeps us hanging on. It gives us hope. Perhaps the most unbelievable of all these stories of this great God doing mighty things for this helpless people is the one involving the selfless sacrifice of His perfect Son. The sacrifice that ended, once and for all, the battle that wages in all of us- the battle against sin. Like He did for Joshua, God gives us a sneak peek into how it all is going to turn out: He tells us, "Look. I've taken care of all of it. I have won. Sin and Satan and the power they hold will not prevail. Trust. Believe. Have faith. My Son paid the price. He went to war in your place, and He came away victorious. You will struggle through many battles in this life, in this world. But join with ME, for I have WON THE WAR, and we will be VICTORIOUS."

The Vandy Verse:
...Be strong and brave! Joshua 1:6
Remember that I commanded you to be strong and brave. Don't be afraid, because the Lord your God will be with you everywhere you go. Joshua 1:9
...Just be strong and brave! Joshua 1:18

100%

Further biopsy results are in....(drumroll please) Jennifer's engrafted marrow is 100% her donor's marrow. This is wonderful news!! We are so thankful and blown away by God's gracious mercy to her throughout this trial. We are praying that everyday will find her stronger and find God providing her with the peace and wisdom she needs.

Solomon in all his Splendor

Yesterday the temps were in the warm 70s here in Nashville with a sunny, crystal clear blue sky - like spring come early. Jen, Matt, Mom, Travey and I soaked it all in with a picnic and a walk at a nearby park. You gotta love spring and all the life that comes with it. New growth on the trees, flowers pushing through the winterized earth, animals (and some people for that matter) coming out of a seasonal slumber. Spring is the glorious resurrection God gifts to His creation. One of the best parts of spring is its aforementioned flowers.... There are just a few beginning to pop out to give us an early taste of what's to come in the months ahead. They remind me of Jesus' words in the book of Luke:

Consider how the lilies grow. They do not labor or spin. Yet I tell you, not even Solomon in all his splendor was dressed like one of these. Luke 12:27

Solomon, by far one of the wealthiest men ever to walk the earth, in his finest regalia is humbled in his comparison to God's creation. God took time to work out the most intricate of details in this tiny flower. A flower who had nothing to give - no relationship, no love, no communion - yet God found important enough to masterfully craft. He found it worthy to speak of His glory.

And how much more important, how much more worthy does He find us. Like the lily, we are masterfully hand-crafted with the life-purpose of boldly proclaiming His glory. God cares about the lily - which holds a temporary role in His divine plan - cares enough to provide exquisite adornment for this perishing flower. How much more does He care, will He provide, for us? We, like the lily, come into this world perishing. Similar to the lily in its inability to spin, labor, or even clothe itself, we can do nothing of eternal significance on our own. But UNlike the lily, a part of creation which could never hope to enjoy relationship with the Father, we have the eternal promise of relishing in His goodness to us forever.

Spring reminds us - God still cares. God remembers. He hasn't forgotten to awaken the bear tucked snugly in her den. He hasn't forgotten to tell the sun to begin melting away the cold. He hasn't forgotten to call forth the bulbs buried deep within the earth. And in His caring remembrance of us He speaks hope and promise just when we think we've been forgotten and left to wonder if the 'winters' of life will go on forever. They won't. There will be life. And it is everlasting.

Prayerful Ponderings:
Jennifer had her bone marrow biopsy on Wednesday of this week. The procedure went well and quite routinely. She was expected to go in to clinic everyday but has enjoyed the blessing of being able to stay home and only go in every other day. Yesterday being an especially great day to not have to go in to clinic.

This morning Mom took Jen in to clinic where the results of the biopsy were divulged. Jen's marrow remains cancer-free but they won't know for several days the percentage of the donor's marrow that is present. We are praying it is 100% donor marrow. To quote the doc, all of Jennifer's cells are "doing what they should be doing." So, it is with hopeful hearts that we are seeing all of this playing out in a most gracious and merciful way.

Please pray, with thanksgiving, that Jennifer's marrow is cancer-free and will remain as such. Please pray that the biopsy will reveal all of the marrow engrafting is the donor's (i.e. cancer-free). Pray that Jennifer will keep her focus and that we will all be reminded this is a time of great opportunity to glorify the Lord - that we may have the grace to do so.

The Vandy Verse:
Look at the birds of the air; they do not sow or reap or store away in barns, and yet your heavenly Father feeds them. Are you not much more valuable than they? Matthew 6:26

Broken Angels

A letter to Jennifer from Lindsey- too precious not to share:

I hope you like the angel I sent. If you didn't notice, she is broken (ha)...

I love this broken angel. She was one of five different angels I received after our accident. The angels have joyful or serene expressions, but this one is different because of her broken spot. She has been wounded and is different from the other angels but keeps her faith in God (you know how I have to personify and simplify everything).

After our accident, everything was broken into pieces. Everything changed. I was so different. I needed "accomodations" (a dreaded word!). I was no longer who I was and had to find my identity in I AM. Before, life was comfortable and manageable. I knew how to live my life. Then God changed it, upside-downed it, and even as I thought I was finding my way back to who I was, I wasn't! These words are getting tricky! I don't do grammar. Living in and for Him was all I could do. Living for myself didn't work anymore because I didn't even know myself. I guess that's one way God can take the "self sin" out of life!

I know that our experiences are completely different and our personalities are pretty different. We all wish we could do something to spare you pain, swelling, rashes, headaches, medicines, treatments.... While so many lives are indirectly affected through this, it's different being "the patient." You are going through the process of becoming a different kind of angel (I know we aren't angels but just go with it). I finally accepted that even though I was broken into pieces, God loved the pieces. I didn't know what to do with them but trusted God did.

I love you,

Lindsey

"And God said to Moses, ' I AM who I AM.' And he said, 'Thus you shall say to the children of Israel, 'I AM has sent me to you.'" Exodus 3:14

Prayerful Ponderings:
As of last week, Jennifer's immune system was showing signs of strengthening and her white blood cell count was on the climb. One of the lead doctors commented that it looks as though her marrow is beginning to engraft. She is cautiously hopeful while remaining acutely aware that she is not out of the woods yet. Jen was sent home from the hospital on Monday, February 6. Mom felt that Jen made the transition remarkably well. She goes into clinic each morning to have lab work done to monitor her progress. This morning her cyclosporine levels were found to be low due to a prescription error. Cyclosporine is what will help her body fight graft vs. host disease. When the levels were found low the docs thought it best to readmit Jen. They are confident they can right the error and get her levels back up where they want them. She will be in the hospital for another couple days though. Please pray the cyclosporine levels come up, that her body continues to get stronger and that her immune system will sufficiently protect her from any potential infection she may come into contact with during another hospital visit. Pray that that she will physically, mentally and emotionally handle the strain of being jostled between hospital and home. Pray her heart will be ministered to by the Father during yet another trial. Thank you for your prayers.