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Memorial created 01-24-2007 by
Wendy Graca
Douglas Owen Nunes
October 28 1950 - January 23 2007

In June 2000, after approximately six months of strange behavior, we began to think that something might be medically wrong with Doug. He had become introverted and antisocial and would spend the majority of each day hidden away in his bedroom. When we started seeing PHYSICAL changes taking place, we KNEW something was wrong and we brought him to his Primary Care Physician. Upon hearing of the changes that had taken place, he immediately sent us to the local hospital to have a Catscan done of Doug's head. The devastating and shocking results: a brain tumor in the right frontal lobe. Everything became a whirlwind. It seems like within minutes we were sent to a neurosurgeon at another local hospital, who performed a craniotomy to remove the tumor and sent a sample of it off to pathology to be tested. The pressure that was relieved from Doug's brain was so immense that he reverted back to his old self almost immediately. We were so happy to see that despite having had brain surgery, he was fully fuctioning again! Our elation was short-lived however, when the neurosurgeon came back with some news which grounded us immediately. First, he hadn't been able to remove the entire tumor, so some cancerous matter remained...and second, the results of the biopsy showed that it was a glioblastoma multiforme-one of the most deadly and aggressive forms of cancer there is. He informed us that the next course of action would be chemotherapy and radiation treatments. We decided IMMEDIATELY that before anything else was done, we'd be going to Boston for 2nd opinions from doctors there.

 

Within a week, we were in the office of Oncologist Dr. Eric Wong, at Beth Isreal Deaconess Medical Center, in Boston, MA. Consulting with Dr. Wong was Neurosurgeon Dr. Julian Wu. Upon looking at Doug's previous and recent MRI's they were able to ascertain that there was a small cancerous mass still in his brain, but they felt that it WAS operable. We waited a couple of weeks to give Doug's incision from the first surgery time to heal and then he went to Boston for ANOTHER surgery. As much as he didn't like this idea, he (and we) knew that it was the best thing he could do in our effort to beat this thing. Doug came out of the surgery wonderfully, just as he did the first time, but shortly afterward he unfortunately developed a post-op infection which infiltrated an area of bone in his skull. So Doug's third round of surgery was scheduled immediately because they needed to remove the part of bone that was infected to prevent it from spreading any further. This left a good-sized dent in Doug's forehead, which the doctors offered to surgically correct, but Doug had had enough surgeries by that point. He made it painfully clear to EVERYONE that he didn't care HOW he looked...he wasn't having any more surgery unless it was deemed necessary to save his life.

 

After his third surgery, he was put on a number of chemotherapy medications, including Temodar (temozolomide), CCNU (Lomustine), and Vincristine, as well as Dilantin for seizure prevention. Not long after being on the Dilantin, Doug broke out in a rash, and they were able to ascertain that the Dilantin caused the allergic reaction, so they switched him immediately to a new anti-seizure medication, Neurontin. He was also asked to participate in a study for a new drug that was being tested, called Prinomastat. We were told that even the Dr's office wouldn't know if he was being given the real medication or a placebo, but it was pretty evident shortly after he began taking the medication that he was getting the real thing. It caused him to have extreme weakness in his limbs and pain in his joints. After he finished the expiramental drug, he received physical therapy to help rebuild his strength. That was around the same time that he had also finished his chemotherapy treatments and had begun radiation. He was very fortunate that throughout the treatments he didn't suffer too many of the common adverse side effects, such as nausea and/or vomiting. On a few occasions he passed out, which was very scary of course, but that was the worst of it.

 

After Doug finished the long trial of chemo and radiation therapy, he was required to go to Beth Israel regularly for MRI's to check for any cancerous re-growths. His visits went from being scheduled for every 3 months, to 6 months, to eventually once per year. Every appointment was approached with anxiety and fear, and was completed with a sigh of relief, because each scan came back clean every time. Doug's last "clean" MRI was taken in May, 2006.

 

Around Thanksgiving of 2006 the family started to notice a few small changes in Doug. He wasn't engaging in conversations as much as usual, and when he did he spoke slowly, with a slight slur. He also began to drag his right leg a little when he was walking. These things weren't happening consistently at the time, so it didn't immediately alarm us, but we were concerned. When asked why he was dragging his leg he would respond "I'm not", then he would deliberately (and exaggeratedly) lift it up with each step, and give a little smirk. We didn't want to assume the worst, so we chalked it up to getting older, being tired, or maybe the long-term effects finally manifesting themselves from all of things his body had been through. Events that took place on December 1st (loss of control over bodily functions) convinced us that his cancer HAD to be coming back.

 

We notified Dr. Wu's office immediately of the changes that had transpired with Doug. His MRI appointment the following Monday (December 4th) was approached with AMPLIFIED anxiety and fear, but we tried to keep hope in our hearts that we were catching it even sooner this time than the first time, so he HAD to have a good fighting chance. We also knew that the same symptoms we saw this time developed and occurred a lot quicker than the last time, and that truly scared us to the core. We remained positive, even after the MRI confirmed that there definitely was SOME sort of regrowth present. The doctor wasn't sure if it was cancer or perhaps radiation scar tissue, so Doug went in for a biopsy and surgery (hopefully) to remove the tumor on December 13th. The hospital's neurosurgeon, who had replaced the original neurosurgeon he had, Dr. Wu, came back from the surgery with mixed news. While Doug had done well during the surgery and had come out of it fine, they found that all they could really do was just the biopsy. The Dr. said that the location of the tumor made it impossible to remove, so he had just scraped a little off (not enough to make a difference) and then closed him up. Pathology confirmed that it was the same cancer that he had in 2000. The doctor informed us that the next best possible course of action would be to get him started on his chemotherapy treatment again.

 

Unsatisfied with hearing that the tumor was deemed inoperable, we instantly made an appointment for a second opinion with the Dr. Wu, the neurosurgeon who successfully performed Doug's surgery in 2000. Although it wasn't under the best of circumstances, it was nice to see Dr. Wu again on December 20th at Mass General Hospital. He greeted us quickly and warmly, and his familiarity reminded us of the fact that he had given us the last 6 years with Doug. We sat down with Dr. Wu to look at the most recent MRI films that had been taken at Beth Israel Deaconess Medical Center. He explained that they had injected dye into Doug's bloodstream so that it would provide a contrast that would make the cancerous cells visible. When he told us that anything that appeared as white against the black shadow of Doug's brain was cancerous matter, we knew instantly that there was nothing he could do, as skilled as he was. Basically what we saw on the films looked like a white spider. There was a solid white center (spider's body) and faint white lines extending off of it (spider's legs). We stated the obvious to Dr. Wu, that he couldn't operate on it, which he confirmed and then apologized for. We assured him that no apologies were necessary, as he was our savior in 2000 when he gave us 6 years with Doug that we technically shouldn't have had. We left Dr. Wu's office emotionally deflated and resolved with the fact that chemotherapy and radiation really WERE his only treatment options.

 

Christmas weekend was spent relatively quietly in the home of the Nunes Family. Christmas shopping hadn't been a big priority in the month preceding, so a minimal amount of gifts were exchanged. To add to the lack of festive Christmas spirit, Joey's Uncle Sonny (her son Doug's Godfather and mother's sister's husband of many years) passed away the week before, and her mother fell and broke her hip, requiring surgery to have an artifical hip implanted. Add to that the fact that the family's refrigerator broke 2 days before Christmas so all of the food inside spoiled, and you're left to wonder how their spirit didn't break as well. To truly test their inner strength, the family suffered another shock. They received a call from the hospital Christmas morning notifying them that Joey's mother was BACK in the hospital, with renal failure and respiratory distress. As common as those afflictions are, they seem to have been too much for her, as she passed away very early in the morning the day after Christmas. Later on that same day, while Joey was with family trying to make arrangements with the hospital for her mother, Doug suffered some sort of seizure. His sons Jason and Matt, and their cousin Jamie was there to take care of him and call 911, thankfully. When the ambulance brought him to the local hospital, Joey and her family were already there. The ER doctors felt that he MAY have had a seizure, they couldn't be sure, but they got him stabilized & then had him transported back to Beth Israel Deaconess to be in the care of his oncologist.

 

Doug was kept on seizure precautions at Beth Israel for about a week and a half. During that time, they began his chemotherapy treatments intravenously. This time he was put on the standard PCV regimen, which consisted of Procarbazine, CCNU (Lomustine), and Vincristine. They also administered Compazine and Zofran to help with fighting off the side effect of nausea. This time he was also on the antiseizure medication Keppra and the steroid Dexamethasone to keep down the swelling in his brain. During the process of his chemotherapy he also received some occupational and physical therapy, with the hopes that he could build up his strength and coordination enough to be able to go home. Other than the day of her mother's funeral and the day she had to clean out her mother's personal effects from her apartment, Joey was by Doug's side in Boston. He also had visits from his sons and grandchildren while there.

 

On January 5th, Doug's oncologist regretfully informed his wife Joey that they didn't feel that he would benefit from any further treatment and that they'd be sending him to a skilled nursing facility with hospice services to be cared for. They felt that the chemotherapy wasn't working and said that the tumor was too widespread to be treated with radiation, so on January 6th, Doug was transported to Wedgemere Nursing Facility in Taunton, MA. There he continued to be given his antiseizure and anti-inflammatory medications, but nothing more. He was in and out of awareness as well as sleep for the most part, and he wasn't eating or drinking very much. We can't be sure, but we think humility played a part in his refusal to eat, at least early on. It probably bothered him greatly to have people hand-feeding him like a child, so most of the time he drank milk shakes and whatever other "treats" we brought him, since he could manage to hold the cups himself. Other than that, he'd try a small bite or two of whatever food was served and then turn his head away in refusal.

 

As his days in Wedgemere went by, he slept more and ate and drank less. He was "awake" for about 4-6 hours per day, but wasn't usually aware of what was going on around him. He'd stare at the tv without really watching it, and he grunted and mumbled answers to questions anyone posed to him. Despite his apparent "obvlion" there were times when we could see something in his eyes that reflected recognition and relayed his true feelings and fears from deep within. He couldn't vocally express them, but we were able to read them in his eyes, and there were a few times when he actually did speak clearly. He knew what was happening, and as upsetting as it was that it was happening so quickly, we have since come to realize that it was better that way. Although not one day went by that we didn't visit him at Wedgemere, the time it took to travel to Wedgmere from Wareham every day was too long and stressful for Doug's wife. On Friday, January 19th, Joey made the decision to move him to a more efficient nursing facility that was closer to home. We knew that time was of the essence, so we made some calls ourselves to get the request handled more quickly, and Doug was transferred to Forestview Nursing Facility in Wareham, MA on Monday, January 22nd. We were told that he had suffered a small seizure that morning, which lasted about a minute, and the transport took a little longer than anticipated, so when he finally reached Forestview, all he could do was sleep. Meanwhile, the rest of the family breathed a sigh of relief, because we knew upon arrival that he was where he SHOULD be.

 

Early in the morning on Tuesday, January 23rd, Joey received a phone call from the Forestview Nursing Center. The nurse wanted to let her know that Doug was not doing well...he was having trouble breathing and had a fever. At 6:45 Joey notified the immediate family members she could reach, left messages for those she couldn't, and with her son, Jason, immediately rushed to Forestview to be by the bedside of her soulmate. Shortly after, a few other family members arrived, including Doug's only sister Mary, and his 2 granddaughters, Melanie and Michaelah. His breathing was very labored and there was a "rattle" noise in his throat, but with almost every breath there came something that sounded like he was saying "No". Although he seemed to be asleep the majority of the time, he did open his eyes a few times, and even though they rolled around and back a lot, they also focused a few times on whichever loved one was situated in front of him at the time. We're as positive as we can be that the "No" sound he made was his resistance to leaving us, at least until everyone got there. It was a tense time, waiting for the rest of the family to arrive while watching him like that, but the relief was so profound when his other 2 sons, Doug and Matt, showed up, that the sigh of relief that was simultaneously released from EVERYONE was heard throughout the room. Once absolutely everyone was there (including a few close friends who provided transportation and support to the family), they reassured Doug that everyone was with him. It was about an hour after that, around 11:15 AM, when he finally let go. Naturally there was a mix of emotion felt throughout the room, especially grief and sadness, but after getting over that initial reaction, we then spent time with him, swapping memories and stories, celebrating and honoring the life of the man that we'll miss so deeply.

 

The Nunes Family would like to share the following comforting thought with loved ones: A beautiful little 4 year old girl named Mary Katherine Conroy passed away the day before our beloved Doug, also of a brain tumor. The cancer which afflicted her was called an ependymoma. We choose to believe that they have become acquaintances in Heaven and are probably even bringing each other the familial comfort they may be missing here on earth from us. For information about Mary Katherine, or to share your condolences and prayers with her family, please visit: http://www.caringbridge.org/visit/mary

 

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