Suffering not required; Portland physician brings hospice care home
By Peter Smith
Published: December 14, 2006
The Forecaster
PORTLAND—On call, Dr. Robert Fried dresses in a blue mariner’s cap, a jacket and corduroys. Attached to his hip, the office phone.
Late Friday morning, Fried drove to his South Portland office: Ruth Traynor’s house.
Traynor has said she wants three things before she dies: One last Christmas, a trip to Foxwoods casino, and to remain at home until her final hour.
Fried has discussed all three goals with her. But his practice, Medical House Calls of Southern Maine, focuses on the last: helping patients die comfortably at home.
He is a practitioner of two medical specialties: hospice and palliative care.
Fried stopped his Subaru in front of the Traynor home. The roads were snowy, the kind of weather that might keep elderly patients snowbound.
He grabbed a black satchel from the trunk, said “hello boys” to Traynor’s dogs Fluffie and Alfie at the door, and sat down at the dining room table.
Traynor’s sister Betty sat in the living room, watching TV and listening to Fried. The air smelled of cigarette smoke. Fried pulled out a pad and pen.
“How are you” he asked. His voice was loud, clear and compassionate.
“Good.” Traynor had a light, raspy and concerned voice.
“Did hospice come?”
She told him Jamie, a nurse from Southern Maine Hospice, visited. Hospice provides her with home health care and hospital equipment, at no cost.
The alternative, Fried said, is expensive, repeat hospitalizations as symptoms worsen.
Her care is rare. Except for Alaska, Maine has the lowest percentage of hospice care. Fried came upon the recommendation of a hospital physician, one of 18 palliative care specialists statewide. But only Fried makes house calls.
Traynor’s son Tom sat at the table.
Fried asked her about pain.
“Yesterday was bad,” she said. “I had to take one of those extra pills. … It took a while.”
Fried prescribes opioids. They don’t have curative purposes. They alleviate symptoms: pain and shortness of breath. “The important thing is suffering is not required,” he said. “I think you’re looking pretty good.”
Fried took Traynor?s blood pressure and her pulse. He looked at her feet for swelling. He pulled out a stethoscope and checked her respiration.
“Good,” he said, “You’re still breathing. It’s your lucky day.”
He asked again about the pain. Then, about appetite.
“Not good,” she said. “I forget to eat.”
She looked apologetic.
Fried said that was OK. “People think you starve to death,” he told her. “But that’s not true. You don’t eat because you’re dying.”
Fried asked if Traynor had any other questions. “If you don’t learn anything, then this was a wasted visit,” he said. Doctor means to teach, he said.
Part of his work includes correcting myths about end-of-life care. He does not assist suicide. He wants to alleviate a painful death. It’s hard for patients to find peace, to give forgiveness, to be forgiven, and to say goodbye when they are in pain.
At Traynor’s, Fried’s office phone rang. A home health agency said a lung cancer patient opted out of hospice, but an oncologist said a cure was possible. Fried wanted to schedule a home consultation to assess symptoms and achieve goals.
“Hope is a good thing,” he said. “But you’ve got to know what you’re hoping for.”
Nine months ago, Traynor said she wanted Christmas. She opted out of chemotherapy for a lump in her chest. Fried wasn’t sure at first she’d make it to Christmas. But if he thought she’d go tomorrow, he’d tell her. During a fellowship in San Diego, he told a Yugoslavian man the truth. The man had made plans to have his brothers visit, but Fried said the patient wouldn’t live to see his brothers, so they came immediately.
Traynor spends her day working on the computer—making DVD scrapbooks for children, grandchildren and great-grandchildren, and mementos for former coworkers at National Semiconductor. Until he died, she coordinated a football pool with her brother, “the Duke.”
She definitely wants to stay home.
Part of the decision came from experience with her daughter’s end-of-life care. Debbie stayed home. She had hospice, but no doctor. Traynor’s husband and her oldest son also died, and she has learned to accept the inevitable. Steely-eyed realism is what Fried calls the family’s outlook.
Still, Traynor had some unanswered questions.
“I don’t know what to expect and when,” she said. “I’m not sure if things are going to happen all of a sudden.”
“I think there would be a period of a couple of weeks where you are in bed all the time, needing attention,” Fried said.
She nodded.
“So I can buy a 2007 calendar?”
“You’re not going anywhere,” her son Tom said.
“You wanted to stay home. That was the plan,” Fried said. “I don’t see why we can’t achieve that.”
Later, she told him about going out, to take a last chance at Foxwoods.
“If you’re feeling well,” he said. “There’s no reason you shouldn’t go.”
“Good,” she said.