I’d like to introduce you to two characters who come up in metastatic cancer conversations: Mabel and Ned. Mabel, often called “Stable Mabel,” refers to the news from the staging scans that your cancer has not progressed—it’s stable. Ned refers to a scan result that indicates “No Evidence of Disease” (or sometimes “No Evidence of Active Disease”—but NEAD isn’t really a name, so Ned is more commonly used!). Of the two, Ned is the character that every patient most wants to have as a companion. Ned means that the treatment has obliterated any evidence of disease that we’re currently able to detect. But living with Mabel is good, too. Mabel means that the treatment is working to hold the disease at bay.
Cancer patients are often called warriors, and treatment is described as a battle, a fight, a war. I don’t mind the metaphor, and I don’t feel any inclination to impose linguistic pacifism when discussing this disease. But when I think about the battle, the fight, the war, Mabel and Ned offer two variations on combat. In the case of Ned, the enemy has been removed from the territory. It might not be entirely gone—guerrilla cells might still be lurking, undetected but not yet in a position to wreak havoc. Monitoring is still needed, and repairing the damage left in the wake of the enemy’s assault might be required, but living with Ned is more like a peacekeeping operation in which treatment serves to patrol the reclaimed ground.
With Mabel, the enemy is still present, still visible, still threatening. There is a wary armistice in which neither cancer nor treatment dislodge the other. Perhaps small bits of territory might be ceded, slowly, but the overall conflict looks more like two sides guarding their positions, alert to any change that might signal an incursion from the enemy.
A few weeks ago, I had my appointment for my most recent scan results. Good news first: The scans were fine. No progression evident. The treatment appears to continue to be working. The oncologist was happy. (Obviously it is very good to have a happy oncologist!) We’ll continue on for three more months and then scan again. I am living with Mabel, which is great.
In an effort to help relieve some of my scanxiety, the oncologist said that if I’m feeling well that is a good indicator that a scan will show stable results. It would be unusual, though not impossible, to feel super and then have the scan results show a progression of disease.
So why does this very good news leave me feeling tired? A year ago, stable scan results were exuberant news! As I’ve reflected on this current stage of wearying warrior-ing, I think it is the effects of constant vigilance. Since our ability to detect progression by scans is so much less perfect than we’d wish, monitoring your own body is also essential spycraft to determine whether there’s any enemy movement. Is that ache or pain or feeling a symptom—evidence of a new hostile incursion? Or is it just the collateral damage from existing disease and treatment? Or is it just the usual twinges or groans of aging? The stakes for gathering this intelligence feel so high!
My body is a 49th parallel, and patrolling this DMZ can wear me out.
How can you live in the shadow of malignant missiles pointed toward you? How long can you scrutinize every shrub and satellite for enemy movements?
And yet somehow it is possible to live in the shadow of latent hostilities and thrive. Perhaps part of the answer is to realize that wisdom, not worry, is essential for the warrior. I want perfect knowledge, which will be forever elusive, when what I need is wisdom and discernment.
Another piece is to prioritize peace—that fruit of the Spirit—over the cessation of hostilities with the cancer cells. Peace doesn’t come from the defeat of cancer. It can only come from the work of God in hearts and minds, no matter what’s happening in my bones. And recognition of the gift of Mabel—however imperfect, however limited—helps to refocus my anxiety and exhaustion into gratitude for this respite.
The enemy is still there, but it’s not winning today. We’ll keep monitoring and patrolling and treating. While I have Mabel, I hope I’ll also have wisdom, peace, and gratitude.
Spine News
I’ve just had my follow-up appointments with my neurosurgery team to check the status of the impressive collection of hardware that’s holding me together and to review my overall healing from the surgery. Good news first: The scans were fine. Everything is in place. I’m healing well. The neurosurgeon was happy. (Obviously it is very good to have a happy neurosurgeon!)
We’ll continue to monitor one vertebra that’s not in great shape but that currently isn’t causing any trouble. I need to continue with physical therapy to regain strength and functional movement, and I’m doing well enough now that the next planned follow-up appointments will be next summer. I am so grateful for this team, for this surgery and recovery, and for the ability to regain so much functionality and relief from pain.
Prayer Notes
Gratitude for stable scan results and ongoing effective treatment.
Gratitude for good recovery so far from my spine surgery.
Request for wisdom, peace, and gratitude when anxiety and worry lurk and threaten.
A Final Character
Here is my friend Jennifer’s cat Stella, who was determined that we were going to be friends, despite my allergies or feelings about having an enormous fluff ball sitting on me. And Stella was proved prescient—allergies did abate, the cuddles were comforting, plus she adds a bit of glamour to every encounter!
Glad to hear your doing well 👍
I am from McDaniel's Corners Bible Church where your Dad was our Pastor for many years. I have enjoyed reading your e-mails and your progress on the many treatments you have had. God is good and I am praying for you.
Elaine Peters