David Powlison is a cancer survivor four times over. He’s also a man with more than 30 years of experience in counseling others and the executive director of the Christian Counseling & Educational Foundation. His new little booklet, When Cancer Interrupts, contains observations and wise instruction that resonated poigantly with me as a first-time cancer patient.

I’m eager to distribute it to friends and relatives concerned for me and to those who are cancer patients themselves. I only wish the brief “minibook” (as New Growth Press calls it) were available online as a free PDF.

Pastoral Address 

Powlison opens the 20-page essay by noting that cancer is never expected or wanted. The person receiving a cancer diagnosis feels violated and betrayed. He or she can be disoriented, overwhelmed, and anxious (3). One’s faith in God is put to the test by the threat of what cancer might mean for him or her. Cancer tests you, says Powlison, yet “that is exactly where Christ meets you” (5). He quotes Psalm 46:1–2: “God is our refuge and strength, a very present help in trouble. Therefore we will not fear though the earth gives way.” He then comments, “Those are not just words in a book. When you take them to heart, you find them true” (4). The style of the essay is conversational, the tone frank but compassionate. Powlison is confident in God and reassuring of Christian readers. He knows about which—and about whom—he writes.

Powlison centers this pastoral address on the fact of God’s promises to dwell with his people, never leaving nor forsaking them. “Cancer is not an exception to [that] rule,” he says. “It is where the rule comes true” (11). Not only is the triune God with us, but he is also for us in every moment. He is the “hands-on Father,” the “Vinedresser,” and our “Good Shepherd” who designs the experience of cancer to teach us to better trust him and love others (11–12). God, unlike any human, can understand exactly what we are going through, can “get on the inside” of us, and “rewrite the script of [our] hearts” (12). Cancer is meant to “wean you away from self-absorption, unbelief, false beliefs, and sins” (21). That is the “wonderful gift” (4) of cancer that is “something far more significant” (5) than even a cure.

Bibline Air

The essay is divided into four main parts. The point or thesis of each is as follows:

  • Be candid about your trouble since what you’re experiencing matters (neither living in denial nor living as if you can beat cancer with mere willpower and medical intervention);
  • Remember who God is and that the simple reality “God is with you” overarches all of his other attributes and promises (Powlison, like me, has found particular solace and hope in Psalm 23);
  • Cling to Christ as you “look death in the eye” and experience both your faith and joy in God deepening;
  • Let growing faith move into service of others. Your suffering is providing opportunities for love now and preparing you for the overflow of comfort to others in the future (Powlison cites 2 Cor. 1:3–11).

The middle two main sections are primarily theological. Powlison quotes and alludes to the Psalms, Gospels, and Epistles. The air in these sections is certainly “bibline,” to quote from Charles Spurgeon’s description of John Bunyan. These sections were for me yet another means of God’s overwhelming mercy and grace in these trying days. The first and final sections are largely comprised of practical observations and pastoral admonitions, both of which evince the author’s firsthand experience of cancer and time spent listening to others. The wisdom in these observations and exhortations bear testimony to Powlison as a man who has lived, looked, listened, and learned well. He has been made a theologian, as Luther posited, by suffering as well as by study and prayer.

Eight Troubles

Powlison lists eight “particular troubles” associated with cancer:

  • uncertainty
  • pain (including the dehumanizing aspects of treatment)
  • fears
  • questions (including “What if I can’t have sex, or go to the bathroom?” and “Is God punishing me?”)
  • loss (noting that sorrow can deepen and then “freeze into depression”)
  • blame (noting that “some people wallow in self-recrimination and regrets” while others accuse God)
  • becoming your diagnosis (this is when people seem only concerned about your cancer and forget that “there is a person inside your cancer diagnosis”)
  • and unhelpful advice (“Of course no one intends to blame, but the line of questioning and the implicit or explicit advice steadily identifies you as the responsible party”).

This list validated as “typical” my own unfolding experience with cancer and would probably pique the interest of a reader not already poised, as I am, to hang on Powlison’s every word.

Particular Opportunities

In the final main section Powlison poses a few specific ways the readers can “love those around you in the midst of your weakness” (17). Cancer, like all other suffering, provides a temptation to become self-focused. The physical, emotional, and spiritual struggles of it all pose a challenge to the ability to love others (16). The author reminds us, especially men, that by simply expressing our weaknesses we can enhance our relationship with another person: “A healthy candor will revitalize relationships as you get personal and open your heart to others” (17). God has wonderfully done this in my life by the gift of cancer. Powlison also urges Christians with cancer to ask others to pray that we experience peace, patience, growing faith, and the inclination to love others (17–18). Powlison knows we need the prayers of the saints and the empowerment of God for these things.

“Cancer creates opportunities for more profound intimacy with those around you,” Powlison knowingly observes. “People pay attention when a sufferer is being honest” (18). That last sentence reminds me that cancer provides Christians experiencing it an opportunity to teach the rich God-centered doctrine and lessons of faith we’ve previously learned and that have prepared us for processing suffering biblically. We’ve been given a platform for speaking into the lives of unbelievers and “prosperity gospel” adherents whom we know and love. Powlison might have intended that takeaway as well, but it’s not stated explicitly. The booklet itself, on such a topic as cancer (Powlison calls it “one of the defining killers in our era” [16]), might be used to introduce many a reader to Powlison’s Reformed evangelical perspective. May God make it so.

Next, in this final main section, Powlison evinces a laudable compassion for medical personnel. He counsels us to learn the names of those caring for us:

Medical people have a hard job. . . . They earn a living by showing practical love. . . . To recognize what someone does for you is a way of loving them back. It humanizes the medical experience that can be dehumanizing for all of us. (18) 

I’m glad Powlison included this counsel. Many of the doctors, nurses, technicians, and receptionists I’ve dealt with have been an extraordinary means of common grace by way of their kindness. Even those who perform their functions in a more perfunctory manner are a gift from God for the medical attention they provide. The medical field provides a tremendous opportunity for Christian vocation and financial earning as well as a context for the mission of being a patient to the glory of God.

Two Kinds of Cancer Patients 

Near the end of the essay Powlison appeals to the person God “has not yet befriended,” the person with cancer who has “not yet sought [God] and relied on his mercies.” Powlison models here, as in the rest of this essay, the simultaneous urgency and patience that he says is true of the Lord. He warns that to “beat” cancer (quotation marks his) without God “may only make you more foolishly self-confident” and “more invested in avoiding the God to whom you are accountable” (21). He then urges and assures the non-Christian reader, “Turn around. Seek his mercy. He is mercy incarnate, and his door stands wide open.”

Powlison makes clear that the stakes couldn’t be higher: a cancer diagnosis without Christ as one’s Lord “will only magnify your problems,” perhaps yielding bitterness, despair, addiction, fear, or frenzy (21). The moral cancer that is “10,000 times more deadly than any physical cancer” will prevail. However, the Christian cancer patient “will come to terms with life and death on [God’s] terms.” God will purify him or her. “He will make you need him and love him. He will rearrange your priorities so that first things come first more often. He will walk with you” (22).

After quoting Psalm 130:1–4 in full, Powlison writes, “Because of Christ, we are forgiven. Because of Christ, we stand. Because of Christ, we hope. With Christ, even though we die, we live forever.” 

David Powlison. When Cancer Interrupts. Greensboro, NC: New Growth Press, 2015. 24 pp. $3.39.