"A Very Nice Man" Faces Pleural Mesothelioma

As 2001 came to a close about a year ago, 58 year-old Jan Douma (pronounced "doe-muh") had much to look back on and be thankful for, and much to look forward to. He had led a very active but steady life, centered on home, the outdoors, and work. He had no reason to think things would be any different in 2002.

Jan and Leoann Douma have been married since July 23, 1965, and the family they nurtured has remained close. The Doumas have lived in their present home since 1968. The Doumas have two sons in their thirties, but the younger one lives with his family in another home on the Douma property. Jan sees his 13 year-old and 17 year-old grandchildren daily. He doesn't get to see his oldest son and other grandson in person as much as he'd like. But in his living room, he need only look to the largest wall, covered with framed pictures of all of his sons and grandchildren.

One frame on that wall literally holds a story, not a picture. The story, written in the hand of a young child on the lined paper of grade school, is titled "A Kind Person." It begins by noting that Johnny Appleseed was a very kind person, then discusses another very nice man who takes the young child bike riding and "in the boat to the island" and buys him chocolate bars -- his Grandpa Douma.

A VERY FULL LIFE ALONG THE COLUMBIA

The Douma property encompasses about four acres and is within eyeshot of the Columbia River. There are maple, cherry, cedar and fir trees, and even a redwood. Jan did not cut firewood from his own place for the woodstove, but would get a wood permit to cut elsewhere. He'd take a cord at a time, then split the wood by hand with a maul. Jan knows "it's a little crazy", but yearly he kept about three acres of the property neatly mowed with his tractor. He grows tomatoes, and Leoann "has flowers all over the place."

Back around 1992, he rented a backhoe and dug a fish pond in the back of his property. He also built an eight-foot wide, 30 foot-long fish rearing pond in front of his house using Nehalem Blue, a pretty, off-colored stone from Nehalem, Oregon. He'd buy the stone for so much a ton, haul it to his place and place the stones by hand. Then every year he'd buy 300 or so goldfish, bluegill, bass, and catfish, and after the fish reached a certain size, he'd transfer them to the other pond, which also has four sturgeons, four-footers. Jan has also restored two classic cars, one a '37 Ford Coupe.

At 58, Jan was in great shape. He walked three to five miles a day. He loved hiking, backpacking and camping. He enjoyed hunting elk, deer and bear along the Columbia. He preferred tracking prey to sitting in a makeshift blind. It was common for him to walk ten miles in a day of hunting, and that in very up-and-down terrain. He also enjoyed fishing for salmon and trout, and absolutely loved to go crabbing for Oregon's prized Dungeness. He owned a ski boat, and he and his family still went out on the Columbia or other points, if the weather was right. He loved rafting the Deschutes, walking to the North Jetty on Manzanita Beach, and riding motorcycles.

REMARKABLY HEALTHY, SAFE AND RELIABLE WORKER

Jan was blessed with unusually good luck in his health. In all of his life, he had never spent a night in the hospital. He had never broken a bone. The only stitches he had ever received were to his lip when he'd shot an elk and the recoil hit him in the mouth. He had never smoked tobacco: "I knew it was not a healthy habit, even before all the warnings came out in the 1960s and 1970s."

In his 37 years as a boiler and turbine operator at the Wauna Mill, a paper and pulp mill, Jan had never incurred an accidental injury. He had been awarded several safety plaques for his record. He is the most senior employee at the Mill -- at least he was, until February, 2002, when his good luck ran out.

A TURN FOR THE WORSE BEGINS WITH SHORTNESS OF BREATH

That month, Jan began having trouble breathing. He felt he had a bad cold or pneumonia. It got so bad that this man who could walk up and down hills for 10 miles could not walk up a flight of stairs. On April 29, he finally went to see the nurse at the Mill. She immediately discharged Jan from work to his primary physician, who ordered chest films. Jan remembers that at his doctor's office a woman came out of a room and asked if he had had his left lung removed. She showed him the x-ray and said, "It's full of fluid." The films also showed that the lung had collapsed from the pressure of the fluid. Jan's doctor sent him to St. John's Hospital.

For five days, Jan remained hospitalized at St. John's, where he was given antibiotics. About three days in to his stay, he underwent a thoracentesis, which utilized a large, 18-gauge needle to attempt to drain the fluid from his chest cavity. Jan says the thoracentesis felt "like getting stabbed or shot." Unfortunately, his doctors could not get at all of the fluid, and decided to attempt a second thoracentesis, this time guided by ultrasound. The pain and discomfort were the same, but a much better result obtained: the procedure removed almost a gallon of fluid.

Soon after his discharge from St. John's, more fluid accumulated in the left pleural cavity, and Jan was re-admitted and ended up hospitalized for another five days. During this stay, his doctors installed a permanent drain, and then discussed a thoracoscopy with biopsy. During the procedure, tissue samples were taken from the pleural cavity for pathological testing. The tissue specimens were examined by pathologists at Lower Columbia Pathologists. Using immunohistochemical staining, the diagnosis was epithelial malignant mesothelioma.

LOCAL PHYSICIANS TEAM WITH WORLD-RENOWNED EXPERTS TO DIAGNOSE AND ADVISE ON TREATMENT PATH

The renowned Dr. Samuel Hammar of the Diagnostic Specialties Laboratory in Bremerton, Washington and a member of the Joint U.S.-Canada Mesothelioma Panel also reviewed the specimens and confirmed the diagnosis. Jan's primary care physician Dr. Eric McNellis told him that he had a form of cancer called mesothelioma, and Jan replied that he wanted to see "the best." Dr. McNellis recommended that he meet with Dr. Eric Vallieres at the University of Washington School of Medicine in Seattle, Washington. Dr. Vallieres is a renowned thoracic surgical oncologist specializing in the treatment of mesothelioma and a member of the Science Advisory Board of the Mesothelioma Applied Research Foundation ( MARF).

Dr. Vallieres confirmed the diagnosis of mesothelioma, then explained to the Doumas that this type of cancer was fatal. This came as a severe shock to the Doumas. At the same time, Dr. Vallieres gave the Doumas hope that Jan could be a long-term survivor, because his cancer appeared to be early stage. A series of CT scans and a PET scan indicated that the tumor was limited to the left pleural cavity and had not spread to the lymphatic system. The plan was to administer four cycles of chemotherapy to Jan at the Seattle Cancer Care Alliance. If tests performed after chemotherapy indicated that Jan remained a good candidate for surgery, Dr. Vallieres would next perform an extra-pleural pneumonectomy (EPP), removing the left lung and pleura. After affording Jan some weeks to recover from the surgery and heal, he would be examined again to see if any of the cancer had been obviously missed by the surgery, and if so, to administer radiation therapy to any trouble spots.

While optimistic, Dr. Vallieres and his team were careful not to make any promises as to how long Jan might live with this treatment. Jan held out hope that chemotherapy would work so well that Dr. Vallieres would not find it necessary to perform the EPP.

TRAVAILS OF CISPLATINUM AND "JIM BEAM" ENDURED, EPP NEXT

Last August, Jan began chemotherapy with Cisplatinum and Gemcitabine, which he jokingly refers to as "Jim Beam." Jan and Leoann would make their way to Seattle, then check Jan into the hospital. (They drove to Seattle twice, but found it less stressful to take the train). After administration of Cisplatinum, Jan would spend the next two days in the hospital "heaving my guts out." He would then go home for a week, and then return for the "Jim Beam", which was "not as violent on your stomach." He would be given another week to rest, and as soon as he was "starting to come back up", he would get hit with another cycle of chemo.

On November 11, 2002, after enduring nausea, vomiting, "dry heaves", fatigue, ringing in his ears and numbness in his feet, Jan completed the fourth and last cycle of chemotherapy. Imaging and other tests indicated that Jan remained a good candidate for EPP, which Dr. Vallieres recommended. Jan decided to go forward with the surgery, which has been scheduled for today, December 30, 2002.

A NEW YEAR'S RESOLUTION FOR JAN DOUMA

Now 59 years old as he looks back on 2002 and forward to 2003, he cannot believe how much has changed, so quickly. Now, the man who enjoyed such extraordinary health must bear constant pain. He is a shadow of his old self. The man who strode purposefully up and down the canyons of the Columbia struggles to walk 1000 feet out from his home, and 1000 feet back, and though short of breath and very tired, he twice a week wills himself to slowly walk two miles. While he putters around outside and rakes a few leaves, he can see everything which needs his hand but must be neglected. He gets mad and tries lifting something he shouldn't, but pays for it later. What can he do? He can file for medical retirement from his employer.

He doesn't sleep well anymore. Wild dreams, dreams of not being able to breathe, of dying, haunt him at night. He does his best to keep the darkness at bay, to think hopefully of the surgery at year's end, of adding years of life with his wife, sons and grandchildren. His family, his friends, his coworkers at the Mill, and his physicians all have one common resolution for the New Year: more life, for a very nice man.

*** POSTED DECEMBER 30, 2002 ***

*** Mr. Jan Douma passed away on May 22, 2003 ***

Dear Sir,

I just came across this page about my cousin, Jan, quite by accident tonight. His father and my grandfather were brothers, my grandparents being Jacob "Jake" and Elmira Douma and his parents were "Babe" and Sally Douma. Babe & Sally owned a beautiful house in Wheeler below my Uncle, Elner Douma's house. Their home was, and still may be, the only home in Wheeler with a private swimming pool, though the only ones swimming in the pool the last 20 years or so have been ducks and geese.

I remembered Jan telling me some years ago, in August, 2001 about using "Nehalem Blue" stone in his yard. My father passed away on the 25th of June, so I was researching "Nehalem Blue," with thoughts of using it for a headstone for my parents when I came across your website dedicated to Jan.

I want to thank you for a lovely tribute to Jan.

Dale Underhill Aloha, Oregon