This 4-part series originally appeared in the Medina County Gazette in August 2008.

By Sandy Mason Ciupak, Special to The Gazette

A nagging pain in the right side of his abdomen, a diagnosis of appendicitis, a simple operation — that was October 2007, and the pastor, his family and his church handled the inconvenience pretty well. Medina First Baptist’s senior pastor, the Rev. Mark Milioni, would need to take a break from things like pouring concrete for the church’s new youth building — something he’d been doing just a day before his emergency surgery — but the active 44-year-old wasn’t planning to let a minor operation slow him down.

Confident his follow-up visit to the surgeon two-weeks after the appendectomy would be routine, Mark’s wife, Barb, kept a hair appointment, and Mark went to the doctor’s office alone. He assumed the doctor would do a quick check of the surgery site and send him on his way. Instead, the doctor matter-of-factly delivered some very unexpected news: The appendicitis was caused by a cancerous tumor. You’ll need more surgery. And, oh, I’m not on your insurance plan. How do you want to handle this?

Hold on a minute, Mark remembers thinking. Forget the insurance stuff — what’s this about cancer? He had lost his dad, Joe, to colon cancer 19 years earlier, at the age of 58. But he had never heard of anyone getting cancer in the appendix.

The surgeon explained standard treatment for tumors like Mark’s was a right hemicolectomy, major surgery that removes about a third of the colon. There was a possibility of chemo or other follow-up treatment, but the surgery might be enough to arrest the spread of any cancer cells. As Mark got ready to leave the office, he recalls thinking, OK, this is what I’ve got to do, so we’ll just go ahead and do it. No reason to panic, no need to worry. Then the nurse handed him a copy of his file, and her concerned words raised a red flag: Good luck.

Twenty years in ministry had prepared Mark to handle just about any situation. He had guided countless others through sickness, cancer, death. He had faced devastating losses himself — his father, his mother, his infant son. But nothing had prepared him for what he was about to go through. How does a pastor face his own serious illness? How does he comfort his own family? And how does he guide his congregation through the ordeal?

“Helpmeet” is an old-fashioned word, familiar to Bible readers, but otherwise quickly fading into obscurity. The dictionary refers you to “helpmate — helper or companion, especially wife,” but it could just as easily say “Barb Milioni.” Barb would prove to be not just a helper and companion, but Mark’s lifeline in the difficult months ahead.

After 22 years of marriage, Barb still looks at Mark with the same eyes that singled him out in their high school band class, one year ahead of her. He graduated and became a local cop; she made sure he didn’t forget about the quiet clarinet player. Soon after their 1985 wedding, the Milionis left Albion for Baptist Bible College in Springfield, Mo. While Mark studied to become a pastor, Barb majored in elementary education.

Barb’s immediate reaction to Mark’s diagnosis was to learn everything she could about adenocarcinoid tumors of the appendix. She stayed home from church that first Wednesday night, putting someone else in charge of the AWANA Club preschoolers, and she hit the Internet. What she found was terrifying.

“One of the first sites showed a five-year survival rate of only 20 percent for some appendix cancers,” she said. Further reading convinced her Mark’s situation was much more serious than he seemed to realize. “I couldn’t breathe for awhile,” she admitted.

But she didn’t let her fears paralyze her. She quickly discovered the Cleveland Clinic boasts one of the country’s top colorectal departments, and making an appointment was as easy as sending an e-mail.

Over the next two weeks, as they waited for that first appointment at the Clinic, the couple learned appendiceal cancer is a rare and potentially lethal form of colon cancer. The way the tumor was discovered — Mark’s appendicitis — is a classic early symptom. That nagging pain in his side — and a wife who wouldn’t let him ignore it — may have saved his life.

What they didn’t know was if the cancer had spread. “Those two weeks were awful,” Mark remembered. “The things you begin to think about. What will happen to my wife? To my family? To my church? What about my house? Do I have enough life insurance?”

Still more questions for the pastor of a church family that numbers around 600: Who do you tell, and how much do you tell them — and when?

A church congregation is a mighty force, and to mobilize them this early in the game, with so little information to share, could initiate rounds of panicked phone calls, worried rumors and a surfeit of chicken soup. Mark and Barb chose to tell only their four children — ranging in age from 13 to 19 — and close family, friends and staff members at this point. Once they knew more, they would share the news.

Mark’s appointment with their surgeon at the Cleveland Clinic was a relief. Now they were doing something; now they could start the fight. The surgeon agreed a right hemicolectomy was the best option. The surgery was scheduled for Nov. 23, the day after Thanksgiving. Mark faced a week to 10 days in the hospital, and a recovery period of anywhere from three to six months.

It was time to tell the church.

Part 2

A pastor shares his heart with his congregation week after week, year after year. Privacy is sometimes hard to come by, so a pastor learns to jealously guard those few areas where privacy is still possible: family, for one; personal health, for another. But other difficult circumstances had taught Mark a pastor’s special responsibility to his congregation sometimes trumps privacy, even in the most painful situations.

Fifteen years ago, the death of their third child, a son, just days before Barb was due to deliver, took the Milionis through one of the darkest periods of their lives. But the way they responded to that loss — with sorrow, with anguish, but always with faith — showed others God was real in their lives. Along with the grief came a truth Mark has never forgotten: “How I go through things is going to be a lesson for other people someday,” he said. “It’s just part of being a pastor.”

Mark crafted the announcement carefully. He had to accomplish many things in just a few short minutes. He wanted to share the facts, to reassure people and to steer the focus away from himself. Others in the congregation were struggling with cancer as well, some with a much grimmer prognosis.

He also wanted people to remember what he had preached to them just a few weeks earlier from the book of Daniel, Chapter 3, the old story of the fiery furnace: We don’t know exactly what is coming, but with faith in God, we know that “Either way, it’s OK.”

He had to do all this, and he had to do it twice: First Baptist Church has two morning services. Mark can laugh about it now, the stark contrast in the hallways between services when the somber first-service crowd left the auditorium, some in tears, as the cheerful second-service attendees filed in, still in the dark. Eventually, they all heard the same message, and the same practical suggestions about how they could best help their pastor: Step up. Help out. Be faithful. Don’t send flowers — give to the building fund. Don’t burden the kids with a lot of questions. And finally, the pastor’s most important request: Love my wife.

“The best thing anyone can do for me is to love Barb,” Mark said. “I wanted them to take care of her.”
At the request of congregation members, Mark scheduled a special prayer meeting to follow the Thanksgiving service, but he emphasized it would be a time of prayer not for the pastor alone, but for everyone in need of healing. Led by a longtime member of the deacon board, church members gathered around those who had come forward and prayed for God’s healing.

The day of surgery finally arrived: Nov. 23. It had been six weeks since the appendectomy, four weeks since the diagnosis. All those weeks of waiting, and the surgery was over in a matter of hours.

Barb took the call on her cell phone as she sat in one of the clinic’s spacious, comfortable waiting areas with her sister, her aunts and few friends from church. Everything had gone well. There were no visible signs of more cancer. And she could see Mark as soon as he came out of anesthesia.

Part 3

The phone calls began; e-mails and text messages flew across the country to Mark’s many pastor friends. The church’s meal ministry kicked into high gear to make sure the family was fed while Mark was in the hospital.

The initial recovery period was painful and challenging, which Mark had expected. It was also more than a little disgusting, which he wasn’t quite prepared for. The smells and sounds on the gastrointestinal ward were a rude shock for a relatively young and otherwise healthy patient, and Mark found it difficult to get any rest. He managed to convince the doctors he would be better off at home, and they released him just four days after surgery.

Sleeping in his own bed, cared for by a loving Barb and surrounded by his family, Mark’s continued recovery seemed a sure thing. Soon there was the best possible news from the surgeon: the cancer had not spread. There would be no need for chemotherapy or radiation.

Mark and Barb returned to the Cleveland Clinic a week later for removal of the staples that spanned about 10 inches up and down Mark’s belly. By his second weekend home, he was starting to eat normal foods. A right hemicolectomy results in a shorter bowel, but the body adapts quickly; a patient can soon go back to regular eating habits.

And a pastor can go back to regular Sunday habits. He didn’t preach, but Mark made a brief appearance in church on Dec. 9 to thank everyone for their prayers and to share his progress with the congregation. He was thinner, but his color was good; he was weak, but he was feeling stronger every day.

That night, Mark became ill. By Monday morning, he was vomiting. Barb put him in the car and drove through a fierce Ohio snowstorm to get him back to the clinic. “I knew he was bad,” she recalled, “because even though the driving conditions were horrible, he slept the whole way.”

It was Dec. 10, Barb’s 44th birthday. She stayed with him until 2:30 a.m. Tuesday morning, finally going home because Mark didn’t want the kids to worry. In retrospect, she wishes she had never left him; in retrospect, Mark is thankful she wasn’t there. He spent the early hours of the morning in such agonizing pain that all he could do was moan. “I can’t even begin to describe how painful it was,” he said. “It was like my flesh was being ripped and torn.”

His temperature continued to rise, and his body shook uncontrollably. A new CAT scan showed pockets of extraluminal air surrounding the anastomosis, the area where the colon had been reattached to the stomach. Doctors suspected an anastomotic leak — a rare and potentially deadly complication of this type of surgery. Mark’s abdominal lining was infected, causing intense pain.

What he remembers about the next few days: Nose tubes. IVs in both arms delivering antibiotics. No food, no water. Fever. Overwhelming thirst. When he could walk again, he would drag his IV pole into the bathroom, close the door and stick his head under the faucet just to cool off, rinsing his mouth out with cold water to try to relieve his dry mouth. And unremitting pain: trouble with a series of morphine pumps meant that for the first few days, the pain was barely dulled.

He would be hospitalized for almost 10 days — more than twice the length of his original hospital stay. Mark described the experience as “the most devastating of my life.” He felt drained in every way — depleted physically and spiritually, unable even to pray. “I couldn’t think, I couldn’t pray. I could moan and groan, and I’m thankful that God can understand.”

Barb remembers feeling terribly vulnerable, always on the verge of tears. But she didn’t cry in front of Mark. “That was one thing I learned about Barb,” he said. “She was stronger than I knew. She’d never had to be that strong before. And I knew that she’d be OK … ” He didn’t finish the sentence, but it’s clear what he meant: She’d be OK — no matter what.

Part 4
As worried as she was, and despite those late nights and a family at home to take care of, Barb took time to dress up a little when she went to the hospital — because it made Mark feel better.

“I knew he’d worry if he saw me looking as bad as he did,” Barb said.

After that rough beginning, Mark began to feel better, little by little. Doctors drained the area where an abscess had formed and the pain began to recede, little by little. He remembers watching TV — he didn’t have the energy for anything else — and noting all the people on the screen looked healthy and happy. He watched weather reports with shots of people shoveling snow and thought, “That’s supposed to be me!” He was used to being someone who helped others, but he could barely sit up in bed.

And while he still wondered if his energy would ever return, he was finally able to go home on Dec. 19, nine days after being readmitted. He wouldn’t be working for a while; he wouldn’t be traveling anywhere. The family’s post-Christmas cruise, planned for more than a year, wouldn’t be happening. But he was home, and he was going to be all right.

When Mark preached his first sermon three and a half weeks later, on Jan. 13, the external changes were obvious: First Baptist’s normally energetic pastor was moving slowly; he had lost 30 pounds, more than he could afford; he was preaching sitting down because he still didn’t have the strength to stand for very long.

The inner changes weren’t as apparent — until, fighting tears, he began to share his story. He didn’t have easy answers for people facing hard times; he freely admitted that, “Despite being on multiple medications, I didn’t see Jesus at the foot of my hospital bed.” In fact, he admitted to his congregation, he’d felt emptier than he’d ever felt in his life. He understood for the first time in his ministry why some people, faced with overwhelming pain, simply give up and wish for death.

That first Sunday back, the pastor did not have all the answers. What he did have to share was a hard truth: “We are all going to come to the place where life hurts the most.” He knew this firsthand; he’d been there. But he also knew this was nothing more or less than what the Bible promised.

His text for the morning was John 16:33. In that verse, Jesus shares a hard truth with his disciples shortly before his crucifixion. “In the world you will have tribulation,” he tells them. But he also tells them this: “In Me you may have peace.” This is the promise Mark clings to today, the promise he shared with his church family that first Sunday back in the pulpit. “In this life, there is trouble,” he concluded simply. “But God is bigger, and God has a peace to get you through it.”

Two follow-up visits at the Cleveland Clinic show Mark is still cancer-free. With the congregation, he is busy celebrating the 175th anniversary of First Baptist Church.