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Preface:Why I Am Writing about Death
“To everything there is a season, and a time to every purposeunder the heaven: A time to be born, and a time to die …” (Ecc.3:1-2a, KJV).
Skin cancer; it was skin cancer that killed my dad. And no, hewas not always beet red or golden brown from working outdoors.In fact, he was a white-collar engineer who did a little outdoor maintenance on our home through the year. We did live in one of the worst states for skin cancer incidents—Arizona. With no beaches like Florida, its rival state for worst effects of skin cancer, people in Arizona get skin cancer from being out in their swim-ming pools, in tanning booths (although safer, you can still developskin cancer from their tanning rays), golf and other outdoor activi-ties. Wearing sunscreen is no guarantee against the disease al-though it helps. He had no family history, no physical examsshowing a propensity for developing the disease and no dark golden brown skin from excessive sun exposure. Instead; one daywe simply noticed a small mole on his arm that looked like it hadchanged color.
 
Kimberly Rose Carolan
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He went to his dermatologist’s office and a biopsy showed thatit was melanoma. Of the three types of skin cancer, melanoma isthe most deadly. This is typically the type of skin cancer a personhas when a mole changes color or shape. But he was not worried.After all, it was
 just 
skin cancer. His dermatologist removed atwelve-inch patch of skin a few inches deep in his arm. His derma-tologist and oncologist (cancer specialist) agreed that they “got itall” and that dad was “cancer free.” He was forty-five years old atthe time. All he needed to do was have routine exams to check for new cancerous moles. They did not check for the primary tumor’smovement or metastasis.Four-and-a-half years later he developed a knot under his arm- pit. While putting our Christmas tree up that year, he had troublereaching because of this odd knot under his right arm. He went tothe doctor to have it examined. They removed the lump and dis-covered cancer. It took a little time to figure out what type of can-cer it was, but there were two possibilities: melanoma or something else (like lymphoma or another migrating cancer). Thereport from the pathologists, the doctor who analyses cells, wasthat the cancer in his lymph node was melanoma.Cancer is a disease where the DNA of a cell is altered from itsnormal formation. At any given moment, most people have alteredDNA. However, special enzymes go up and down our DNA check-ing the pattern and “fixing” altered DNA. Problems arise when theenzymes are delayed in getting to the altered portion of the DNAand the cell reproduces itself. This creates cancerous “daughter cells.”Cells routinely reproduce themselves, but cancer cells can re- produce faster than normal, healthy cells. Once reproduced, theenzymes allow the daughter cell (the new reproduced cell) to keepits altered DNA structure. These altered or mutated cells reproduceand create a cluster of abnormal cells, cancer cells, called a tumor.Sometimes cells in a tumor break off and find a new place to re- produce. When the cells break off from the first tumor, called the primary tumor, it is called metastasis. This means that a small por-tion of the tumor moves to another part of the body, usuallythrough blood or lymphatic fluids. In this new region, the cells
 
Walking through the Valley of the Shadow of Death11
continue to reproduce. Cancer becomes incredibly dangerous whenthe cells migrate to an area of the body where a growing tumor im- pedes other bodily functions. Another danger is that tumors take“food” from other cells. This causes healthy surrounding cells todie while the tumor thrives. If the healthy cells are blocked fromdoing their normal function or die, significant damage can start tohappen to the body. This often results in death. The path of metas-tasis determines where these migrating tumors “take root” and con-tinue to cause damage.Most types of cancer have a particular “path” that they follow.When primary tumors metastasize, they are carried through the body a particular way. For melanoma, the cancer starts in the pri-mary tumor then to the nearest lymph nodes. In my dad’s case, hisarm then small glands in the armpits, neck, groin and scattered parts of the body; then to his brain or spinal cord. We found thatthe tumors had broken off of the original tumor on his arm. Thesurgery had not removed all of the melanoma. That led to about a billion cancer cells in the lymph nodes under his armpit.Lymphatic fluid travels throughout a person’s body. The lym- phatic system helps the immune system remove toxins and old cel-lular waste from the body. It is ironic that a system that usuallyhelps ward off disease was the conduit for cancer in my dad’s body. He took Interferon, a drug they dripped into his bodythrough an IV three times a week for an hour at a time. This wassupposed to increase his likelihood of fighting off the disease by33%. That is, as long as the tumors did not reach his brain as thedrug does not cross the blood-brain barrier. Nine days before my wedding to Joseph we found out that mydad’s most recent MRI showed that my dad’s cancer had spread tohis brain. There were four tumors, all about a centimeter in diame-ter. In the brain, these were large enough to cause damage thatwarranted a prognosis of four to six weeks to live! Can you imag-ine? Not four to six years or months but mere
weeks
 before sayinggoodbye forever to this world. The doctors started aggressivetreatment of these inoperable tumors. They used radiation and anexperimental chemotherapy.
Their goal was for my dad to be ableto walk me down the isle without the aid of a wheelchair.
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