Ask Me About My Husband’s Cancer

Sometime back in 2016 I found myself reading posts like this one. I was searching for information but, blog after blog, I’d stumble across the feared update: their person didn’t make it. This blog is no exception. My husband passed away on March 17th, 2019, while waiting for a liver transplant.

It’s important that those of you reading this and looking for answers understand – this is not your outcome. Ours does not foreshadow yours, even if you have the same cancer by name. Every cancer and every body is genetically very different. It’s always worth giving your all in the fight to live.

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I have a constant need for information. With cancer, it was all so that we could make the best decisions about Jeff’s treatment. I didn’t think there would be any decisions weighing on me if it ever came to Jeff’s passing. I wouldn’t even let it enter my mind. But now I know that Jeff’s passing only happened the way it did because I’d become friends with so many others who had lost their loved ones. They’d shared their experiences with me. Because of them, I knew what to fight for when the time came. I’m so grateful for them. I’m grateful that Jeff and I were able to have the best possible final moments together in what I would otherwise call the worst time of my life.

If you’d rather not think about the worst case scenario, I understand, but if you would rather know, I’m going to share some of the things that prepared me. The transition is hard enough without wishes and regrets.

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Chances are, you’ll know when the time is coming. Jeff entered the ICU on February 27th and I was told that he wouldn’t be alive through the weekend. I instinctively knew that wasn’t true. He was with me until March 17th.

If you’ve been with someone through treatment you’ll probably have a hunch. I’ve talked to others who have had similar intuition. This intuition can give you the time to fight for the really important things, like when to stay and ask for certain liberties (which I’ll get to in a minute).

Jeff needed to be intubated the following day but the staff were casual about it. I was told he’d likely be off intubation and talking again by the following day but I didn’t know how unlikely that actually was. I tell you this because there’s the possibility you’ll have a last moment to communicate and you won’t realize it. Our last words were “I love you” before he was sedated. I had no idea they would be the last words he’d ever speak. A single moment can end up being the most significant.

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Over the next few weeks, Jeff was essentially in a comatose state but open eyed. This same thing happened to other friends who have passed from cancer. Efforts to communicate go in and out with their eye movements and hand squeezing. No one knows how well people in this state are able to comprehend, but I had signals from Jeff that he was listening and aware. Talk to your person. Play their favorite music. Give them as much contact as you can. Now is a good time to mention: nurses will probably ask that you don’t sleep in the room but you can bypass this by sleeping sitting up in the same chair that would be in there regardless. You can find creative ways to sleep so that you can stay. Sleeping in the lounge does not give you good rest anyway (see pictured below). Everyone will try to get you to leave the hospital and rest, but I look back and I’m glad I stayed every moment that I could.

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Medical staff will likely want to do testing while in the ICU to try to resuscitate. A lot of tests are invasive and painful, and a lot of times your person can’t say they’re in pain. Sometimes you can see it on their faces. Pain medication can lower blood pressure (in other words, destabilize the body) so they don’t like to use it, but there are medications like Versed you can ask for. They’re thinking about resuscitating and not comfort, so it’s always good for the caregiver to keep being aware of how comfortable they look.

Cardioversion / defibrillation is where they shock your heart back into normal rhythm. Jeff had this twice. It’s not a rare occurrence in the ICU and absolutely doesn’t mean death but it is frightening to watch. If you’re in the ICU for any extended period of time you’re going to see your fair share of cardioversion and, unfortunately, death. In the 3 weeks we were in the ICU I happened to see 4 people pass. There isn’t a way to emotionally prepare for it, but you can expect it.

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Be nice to the nurses. They have the ability save lives just as much as the doctors. One of Jeff’s nurses brought his body temperature from 92 degrees to normal by engineering her own way to warm dialysis bags. This gave us extra time to try to resuscitate him, and for new doctors to make rounds. Changing doctors can be a good thing. We went from having one doctor who said he refused to do cardioversion if Jeff required it, to another doctor who constantly read papers to come up with new ideas on how to recover his blood flow.

And finally: fighting for the really important things. Jeff’s blood pressure steadily began dropping on the morning of the 17th. I knew it would only be a matter of hours. I asked the nurses to help move him closer to one side of the bed so that I could lay with him but, because of various infections acquired in the hospital, they didn’t want me to have that much contact with him. The hospital takes this sort of thing seriously but I refused to take no for an answer. You have to push back. They’re doing their jobs but this is something that will be with you for the rest of your life and doing what’s right in a loved one’s final moments is more important than any system. If you want something specific like this, your best bet is to find someone on staff to have your back. I was lucky to have a doctor on my side. He let me lay next to my husband so he didn’t go through it alone.

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I can’t reiterate how much the final moments can impact you. Try to go easy on yourself. Start therapy as soon as you can, try to find a grief specific therapist. There are groups like Our House where you can meet other spouses / siblings in your age group (I find this to be important) in similar situations. If an in-person group isn’t really your thing, my friend Nora started The Hot Young Widows Club where you can ask anything and everything online.

But even with various resources and incredible friends and family, grief can sometimes feel like an island. That’s because cancer has a way of deepening your love before taking them from you. Cancer makes sure you see someone at their very core and then, when they’re gone, the grief is what is left. At Jeff’s celebration I talked about how we fit 30 years into the last 3. I talked about how most couples would be lucky to get the same amount of time we did in a whole lifetime, but the reality is I was lucky to find Jeff at all.

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He gave me more love than most people receive in a lifetime. I’ll hold on to that forever.

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No matter how long it’s been since my last post, please don’t hesitate to reach out to me. If anything that Jeff and I went through can be helpful to you, I’m happy to talk about it. I can add it to the long list of beautiful reasons we were given this life together. So please keep asking me. Ask me about my husband’s cancer. Ask me about loss. Ask me about life. JessicaRBlackwell@gmail.com

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GIFS ABOUT STEM CELL TRANSPLANT

WHEN FRIENDS SEE YOUR STOCK PILE OF DRUGS BUT YOU DON’T WANT TO BUM THEM OUT WITH THE REALITIES OF TRANSPLANT

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WHEN YOU’VE ONLY BEEN AWAKE FOR 3 HOURS AND THE FATIGUE HITS

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WHEN THE DOCTOR SENDS YOU HOME AFTER UPPING YOUR PREDNISONE DOSE

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WHEN SOMEONE TRIES TO SELL YOU ESSENTIAL OILS TO HEAL GRAFT VS HOST DISEASE

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WHEN YOU FIND OUT YOU’RE NOT ABSORBING AS MUCH PROTEIN AS YOU WERE PRE TRANSPLANT

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WHEN YOU GET A SURPRISE CALL ABOUT PAST DUE MEDICAL BILLS

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WHEN YOU’VE BEEN INDOORS WITH NO IMMUNE SYSTEM FOR WAY TOO MANY WEEKS STRAIGHT

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WHEN YOU’RE FEELING FINE BUT HAVE A LOW GRADE FEVER AND HAVE TO GO TO THE ER TO BE ON THE SAFE SIDE

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WHEN SOMEONE ASKS WHAT IT’S LIKE TO BE A CAREGIVER 

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WHEN YOU FIND OUT IT TAKES DAYS TO GET BIOPSY RESULTS BACK

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Blood Work and Lab Results – CBCs and WTF does any of this mean?

Quick disclaimer (and humble brag): I’ve been able to accurately “diagnose” a few things before the medical staff treating my husband. That being said, the only medical school in my repertoire is Google and the only accredited degree I hold is in the very closely related film & television arts.

Now that we have that out of the way, here’s why it’s important to understand lab results…

If you’re like me, you assume a lot about medicine. You probably assume doctors have access to a program where they can easily identify trends. They don’t. They look to see if anything’s in the out-of-normal range as they happen and if something is off (or trending in the wrong direction) but they don’t catch it, it can cause real problems. Being a proactive patient in this scenario can only benefit you.

I know this because Jeff had blood work that should’ve alerted his physician to his cancer back in March of 2015. His doctor noticed the high WBC (White Blood Cell counts) and noted that it likely signified a virus but did not catch his incredibly low HGB (Hemoglobin) which should have been a red flag for additional testing. That was enough reason for me to learn the meaning of every acronym and how they relate to each other.

Alright, enough explanation. Let’s run through the big ones. Don’t feel intimidated.

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When a doctor orders lab work he will likely, first and foremost, order CBCs – the Complete Blood Count. I’ve found the below to be the most important parts of the CBCs:

WBC (White Blood Cells): a high white cell count can signify anything from an infection, to a virus, to inflammation, to cancer. If your white cell count is high, you can look at the results that follow the white cell count to get more of an idea of what is going on – the results I’m referring to are Lymphocytes, Neutrophils, Eosinophils. Each of those cell types have a different purpose when it comes to attacking things in the body that shouldn’t be there. I’m going to stop here on the high white blood cell counts so your eyes don’t glaze over.

A low white cell count leaves you to prone to infection. This normally occurs right after chemotherapy and that’s why, post chemo, Neupogen shots are given. Neupogen shots make sure your ‘good’ white cells replicate quickly so you aren’t compromised. These shots cause bone pain (because of the white cell count being forced to quickly grow in the bone marrow) and generally suck.

Hgb (Hemoglobin): Chemo can cause anemia aka low hemoglobin, and so can cancer. This seems like a good time to mention that the more you learn about lab results, the more you’ll realize that a single result can point you in a handful of different directions. If you suffer from anxiety, good luck.

A high hemoglobin can signify something called Polycythemia. Then again, it could be that you are dehydrated so that your lab results are just falsely high.

Platelet: Platelets prevent you from literally bleeding out. Without the ability of your blood to clot, you’re in big trouble. The normal platelet count (by MD Anderson standards) is 140-440. Jeff’s platelets like to hover around 40, which sounds insanely low, but a lot of patients don’t even have results of 10 and need replacements daily. Platelets are hard to come by and it can often take 3-4 donors to make a single bag of platelets. Now that you know this, you’ll hopefully feel inclined to donate platelets, which you can find out how to do here: Donate Platelets

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Now for my absolute favorite…

LDH (Lactate Dehydrogenase): it’s a lab result with an identity crisis. It has no idea what it’s signifying, but it’s there and it’s gonna love watching you lose sleep at night. High LDH! What could it be? It could be the chemotherapy working, could be cancer growing, could be an impending heart attack, sepsis, a virus taking over, who knows! It simply signifies cells being destroyed and it’s the most ridiculous of them all.

Creatinine: Having creatinine be a little low doesn’t normally signify a huge problem, high creatinine tends to be a problem. The kidneys are under stress for some reason (like a blockage, or medication toxicity) and they’re going to start getting cranky. When they start getting cranky you have to find ways of removing some of the stress or they’ll eventually shut down, leading to kidney failure, dialysis, and eventually a transplant. eGFR is another way this is monitored, but it’s taken less seriously than creatinine.

eGFR: This monitors the filtration rate of the kidneys. You’ll watch these numbers slowly decline if the creatinine is high (not confusing at all, thanks!) but the difference with this result is that it takes other lab results into account. It should be monitored to better identify kidney stress, even when creatinine is in the normal limits.

STORY TIME!

The normal eGFR for Jeff was 185, but the normal population eGFR is around 107 (that’s by MD Anderson standards). So, when Jeff and I saw his eGFR hit 110 one day, we knew his kidneys were not happy. The doctors would have not caught this because he was still in normal range to them, but we’d been steadily tracking it. They quickly made some substitutions to solve the problem when realizing the decline was after taking a new, high toxicity medication.

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Bilirubin, AST, and ALT: These are liver lab results. When they’re high, it could be anything from drug toxicity, to liver cancer, to Graft versus Host disease. When one organ is under too much stress, the rest usually follow. When Jeff’s kidneys were unable to handle the toxic burden of medications we often watched these numbers slowly creep up.

Protein: Gastrointestinal issues often cause low protein. When the intestinal walls thicken, they can’t absorb as much protein. The malnutrition caused by this can also have an affect on your electrolyte panel – sodium, potassium, calcium – you’ll likely need replacements via pill or IV.

Albumin: Low protein causes low albumin. It’s a problem because low albumin causes something known as ‘third spacing’ – that’s when fluids no longer hydrate your organs and actually sit in places like your feet. This is called nephrotic syndrome and can be extremely uncomfortable. There’s no cure except for to figure out the underlying problem and fixing that. Now you’re on the journey of trying to figure that out. Great.


Now that you know what is low or high in your lab results and your symptoms, you can take to Google (but ONLY MEDICAL PAPERS – NO WEBSITES). Part of the challenge is finding free medical papers. Some want payment. I find this ridiculous. Almost as ridiculous as learning how political medical papers are, with doctors fighting over who gets to be lead author on the research.

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I plan to fight for all free medical information – but right now Jeff has to get over this GHVD, first things first.

You’ll quickly find that a lot of symptoms and/or lab results add up to be the same things. That’s why WebMD makes hypochondriacs.

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But good doctors will listen to why you think symptoms are adding up to a certain diagnosis. Chances are, they’ll give you piece of mind as to why it’s not what you think it is – you know, because they spent years in medical school where they’ve had to learn all of the small details surrounding what makes up a particular diagnosis.

And try to keep in mind you don’t want to be the patient advocate that cries wolf to the point that no one takes you seriously (although I know first hand it’s undoubtedly difficult when you feel like you know what is suddenly wrong and it needs to be fixed immediately). Always check your sources, do your own research, trust your intuition,  advocate, advocate, ADVOCATE.

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