P(ractice) E(xit)

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I thought Saturday morning was it.  Dow woke up early that morning, went to the restroom and returned to bed. He said he could not catch his breathe and was panicking.  We'd been dealing with this for about 10 days, off and on. Last week when he went in for a check up, I addressed it with his doctor and she decided she thought it was probably anxiety driven and we discussed the measures to take when it occurred.  The week went on and Dow steadily declined. Finally Friday was time for his chemo infusion. We went in, they took his vitals, which again seems slightly off-but they went ahead with treatment.  Friday evening the breathing and discomfort continued and I checked for swelling, checked Dow's legs for clots (no swelling, color change, etc.) and he looked good.

Saturday morning was the first time he'd really presented with the tell-tale signs of a Pulmonary Embolism.  After about 45 minutes of not being able to calm him down, I ran to the drugstore and purchased a saturation monitor. This device checks heart rate and the percentage of oxygen flowing throughout the body.  A healthy person's is usually 95-100%.  When I got home, Dow's was 61%.  The fact that he was talking and coherent with this number is an anomaly.  We decided to call an ambulance.

Pulmonary Emboli are blood clots in the lungs which prevent proper blood flow and gas exchange. Left untreated, they are always fatal.  We both also knew that the treatment for these is administered blood thinners-a contraindication for brain tumors. As the risk is very high for these tumors to start uncontrollably bleeding.
Dow remained calm, and asks for a few minutes in our room-he felt he would not be returning home.  This really disturbed me, as anyone who has been around beings approaching the end-they usually know.  Having met they way we did, we spent a lot of time having extremely morbid discussions. And after everything we've gone through now, I knew the plan was for Dow to be made a DNR when the time came.  Luckily, for me-he was able to give me the gift of telling the paramedics that he was not to be intubated and compressed if it came to that himself. I was not going to have to make that call watching him gasp for air. Thank you, love.

Soon enough, the CT came back with a positive PE diagnosis.  After much discussion, we decided to take the risk with Lovonox shots.  Dow was admitted to the ICU for 3 days receiving blood thinners and oxygen therapy.

We were able to return home last night. He is doing great, wearing in home oxygen, and getting lovonox shots twice daily.  The oxygen will probably be temporary. Just until the clot fully resolves-the thinner on the other hand will be indefinitely.
While I was not prepared to lose Dow on Saturday, a massive PE would have been a peaceful and acceptable exit for all of us.  There is still a risk of the medication causing a massive head bleed at any moment-but this risk was worth taking with the alternative.

Sloane and Dow playing "hospital" at home

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