Saturday, September 24, 2016

The End and the Beginning

Deborah Lynn Keller Harrell June 15, 1959 to September 12, 2016

I never saw it coming. Sure, she had cancer, two bouts with chemo and ongoing pain, but last fall I never saw the clues or guessed that she was starting her final journey.

She had such warmth and happiness and was hopeful that her chemotherapy days were behind her. She was still taking medication and occasionally she would have pain, or a bad day, but the only change I saw was that she reminded me of every detail of everything we did together. Turn here, don't forget that and so on. 

I should have known that it was a reaction to her condition and that she was gripped in a struggle, a journey to death that was a secret to all except three people.

But the fall of 2015 would bring certainty that her cancer had spread to her lungs, spine, skull and bones. We got through Thanksgiving and Christmas and then in February she started chemo again. The side effects were so severe that they had to lower the dosage to try and control the nosebleeds, the battle (a losing one) with nausea and an inability to eat.

In the New Year we talked about camping and going places, we had normality until the chemo. Then it seemed like there was nothing that anyone could do to relieve the constant pain and the damage to the taste buds so dominant that all Deb could eat was broccoli cheese soup from Panera. Everything else came up. So while not getting much food or nourishment she was also abusing her digestive system.

People tell me now that even through the pain and side effects she was upbeat and cheerful. She did not like to give in to anything. And yet somehow she still found ways to be close to me and lay her head on my shoulder. She would snuggle with me and I would hold her, hoping beyond hope that if I could hug her enough that the sadness and pain would leave her. 

Fast-forward to August 26, and our visit to the doctor. She was still feeling pretty good but tired and needing more rest. Her platelet count had slipped from 195 in July (normal) to 47. We found out the next week that her tumor markers had gone from 70 something to 353. She had a conversation with Dr. Weyburn and he ordered a CT scan and a bone scan. 

Deb started to have trouble climbing stairs and walking. She had to rest more and more. She helped me cook and was able to shower but unable to do much of her normal routine. 

September 8th she had the scans and needed a wheelchair to move around the hospital. She seemed chipper and we waited together for her final scan and talked. 

That night was one of her worst, with constant pain and vomiting that kept her from sleeping at all. The next morning she consented to an ambulance ride to the hospital and was admitted. Her red blood cells were low and the platelets were low. She received two units of blood and one of platelets. Even with that, while the numbers went up they came back down. Visiting her on Sunday she was in a good mood and she had been placed on full time oxygen. Kathi and Miku with me and we spent some time chatting with her. She was smiling and talked about coming home. The next day she was gone. 

The culprit was DIC. 

Blood clots develop throughout the bloodstream, blocking small blood vessels. The increased clotting depletes the platelets and clotting factors needed to control bleeding, causing excessive bleeding.
  There are a number of possible causes, including infection and surgery.

  Excessive clotting is followed by excessive bleeding.

  The amount of clotting factors in the blood is measured.

  The underlying disorder is treated.

Disseminated intravascular coagulation (DIC) begins with excessive clotting. The excessive clotting is usually stimulated by a substance that enters the blood as part of a disease (such as an infection or certain cancers) or as a complication of childbirth, retention of a dead fetus, or surgery. People who have a severe head injury or who have tissue damage caused by shock, burns, frostbite, other injuries, or even a bite by a poisonous snake are also at risk. As the clotting factors and platelets are depleted, excessive bleeding occurs.
Symptoms and Diagnosis

DIC that develops suddenly usually causes bleeding, which may be very severe. If the condition follows surgery or childbirth, bleeding may be uncontrollable. Bleeding may occur at the site of an intravenous injection or in the brain, digestive tract, skin, muscles, or cavities of the body.

If DIC develops more slowly, as in people with cancer, then clots in veins are more common than bleeding. If clots form in veins (usually in the legs), the person may have swelling, redness, or pain in the area. However, sometimes no symptoms develop. A clot that forms in a vein may break free and travel (becoming an embolus) to the lungs. Clots in the lungs may make people short of breath.

Blood tests may show that the number of platelets in a blood sample has dropped and that the blood is taking a long time to clot. The diagnosis of DIC is confirmed if test results show large quantities of plasma d-dimer (indicating that more clots are being produced and broken down than usual, ) and often a low or decreasing level of fibrinogen (a protein produced when blood clots).

The underlying cause must be identified and corrected, whether it is an obstetric problem, an infection, or a cancer. The clotting problems subside when the cause is corrected.

DIC that develops suddenly is life threatening and is treated as an emergency. Platelets and clotting factors are transfused to replace those depleted and to stop bleeding. Heparin may be used to slow the clotting in people who have more chronic, milder DIC in which clotting is more of a problem than bleeding.

I've had lots of time to think and go through so many photos and memories. Why she ever wanted to marry me is a mystery.  Maybe it was a God thing. A way of giving me a wonderful love that was unconditional and constant.

I'm so proud of her and sparing the family of a premature time of mourning. What strength she had to keep her secret from last fall until now and continue to respond to pain with smiles. There is no amount of gratitude I can express that would come close to the wonder I feel in being her husband, lover and friend. 

My life has changed but it goes on and someday I hope to be with her, because I know that she is happy in paradise the place where all angels go. 

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