Near the front door of Bob and Bobbie Barker’s Palos Verdes Peninsula home a table displays a black and white photograph of Bob dressed in a crisp naval uniform. Next to him, his wife Bobbie is dressed in white; both are smiling and cutting their wedding cake. Juxtaposed beneath the portrait hums a large blue box—an oxygen concentrator machine. It reveals the passage of 66 years—a life and marriage that have come full circle. An attached tube leads inside the room where Bob sits up in his bed, alertly fixed to TV news of Space Shuttle Endeavor’s arrival in Los Angeles. The tube helps Bob take each breath.
The Barkers await the visit of James McKinnell, M.D.
He opens the white picket gate leading to the Barkers' front door. Carrying a black bag reminiscent of a country doctor, he briskly approaches Bobbie, greeting her with a smile and a hug.
Before entering Bob’s room, Bobbie and McKinnell take a moment to chat about how Bob’s doing. After caring for Bob for almost a year, his care has become personal.
“I have a picture of Bob in my office,” McKinnell confides to Bobbie with a smile. “People ask me, ‘who is that?’ I tell them, ‘oh, that’s my grandpa.’” As they both laugh, McKinnell continues, “Bob is so funny!” Bobbie replies, “That’s why I married him.”
Bob was once a heavy smoker. He hasn’t had a cigarette in 25 years, but now 87, his health has been in steady decline over the past few years, ravaged by Chronic Obstructive Pulmonary Disease (COPD).
A year ago, after several hospitalizations for near-fatal bouts of pneumonia and a diagnosis of early stage dementia, Bob’s primary care physician suggested he might be ready for hospice care.
“Hospice” is the framework of care that provides comfort and support for patients and their families as they near the end of life’s journey. The concept of hospice has been evolving since the 11th century. It began to emerge in the 17th century, but many of the foundational principles by which modern hospice services operate were pioneered in the 1950s by Dame Cicely Saunders of England. Hospice care also involves assistance for patients’ families to help them cope with what is happening and provide support to keep the patient at home. Although the movement has met some resistance, hospice has rapidly expanded through the United Kingdom, the United States and elsewhere.
“Hospice has a mysterious and ominous sound, but the entire experience has been very enlightening,” Bobbie said. “People think you might go very quickly (once you’re in hospice care), but without it, I don’t think Bob would still be here.”
Hospice strives to optimize quality of life and bring comfort and support when during the course of certain illnesses, a patient, doctor and family decide that aggressive curative treatment is no longer appropriate. Even so, through the optimum in-home care it provides, the patient’s condition often dramatically improves.
Since entering in-home hospice care, McKinnell has brought Bob through three more near-fatal bouts of pneumonia. But through diligent attention, Bob has also made impressive progress.
“Two months ago he slept all day, he had to be fed and he couldn’t even form his words; now he is talking and can feed himself a sandwich,” McKinnell said. “His oxygen saturation has gone from 80 percent, which is like (breathing atop) Mt. Everest, to a near normal 90 percent while using his oxygen therapy.”
McKinnell recently joined the Torrance Memorial Hospice team as medical director. After graduating from Stanford University and Columbia University Medical School, he served his residency in Internal Medicine at Harbor-UCLA Medical Center. He was referred to the program while working as a consultant in infectious disease with the Milefchik-Rand Medical Group.
McKinnell, like most physicians, entered the practice of medicine to save lives, so treating only the terminally ill may seem like a dismal road to take. However, an experience in college gave him a new perspective on his future role as a medical practitioner. After his grandfather suffered a fall, he spent three days with him in a hospital room.
“I was basically left alone. No one spoke to me and no one was really there for me,” he said. “I really saw the need for that personal connection.”
He continued, “As physicians we take an oath to treat the sick and dying, but many physicians are often not really prepared to care for the terminally ill. It’s a learned art. It really is the purist form of old school medicine,” McKinnell said. “We’re not fancy, advanced care physicians. We don’t wear lab coats or work with x-ray machines. We visit patients in the home with just a black bag and a stethoscope. Our tools are hands, eyes, ears and our brains. What’s most important is the personal interaction during the time I’m with the patient. I am helping to give the patient and family peace, comfort and dignity.”
McKinnell also points to statistics showing hospice actually extends life— including a 2010 study from the New England Journal Of Medicine, which found the mean survival rate nearly three months longer for patients with hospice and palliative medical care than for patients who did not receive specialized medical care from hospice physicians.
In spite of these improved odds, the program often sees patients, who suffer needlessly because they’ve waited too long before entering hospice, to benefit from its care.
“Some people think you have to be actively dying and have given up on treatments; some even feel we are here to help them die,” Theresa Ferry, Torrance Memorial Hospice administrator, said. “That is completely untrue. Our aim is to bring quality of life to the time they have left—to help them take that last trip with their family by making them symptom free. We try to give them the strength and freedom to do what they want to do in their last days.”
Because the focus is on comfort, people under hospice care feel better, which results in several positive occurrences: 1) patients are more likely to complete helpful treatments and take appropriate medicines; 2) they tend to eat better, exercise more, and socialize more, which helps them emotionally and physically, improving their ability to fight illness; 3) they are less likely to experience medical crisis, hospitalizations, and invasive procedures, which helps avoid significant risk of side-effects and additional suffering; and 4) hospice services help families navigate complex healthcare systems and make more informed decisions.
“It’s a better treatment choice,” McKinnell adds. We’re not doing less, but more.”
Doing more means tapping into what McKinnell calls the “art and science” of medicine. In addition to medical science, it utilizes social science and psychology to treat the patient and family as a whole- the mind and the body. The in-home environment contributes by providing a safer and more comfortable experience than a clinical facility
"Familiar sounds, smells, voices, bed sheets and pillows create a more peaceful and restorative experience,” McKinnell said. “It also allows more personal and intimate contact for the family with their loved one.”
When hospice care is prescribed, a case manager steps in to create the healthiest environment for the patient and make care giving as easy as possible on the caregiver.
This includes guiding them with medication management, and assessing the home to determine necessary medical supplies, the ideal temperature and lighting.
Torrance Memorial Hospice’s connection to the main medical center provides important advantages when an emergency arises or if a disease takes a sudden painful turn. McKinnell and his team can dial in to have an in-patient bed prepared in under an hour and connect 24/7 with its contracted infusion pharmacy, Premier Infusion Care, to quickly make the patient pain free and comfortable in the home or at the medical center.
Torrance Memorial Hospice consists of three staff physicians, a team of registered nurses and certified home health aides. Social workers evaluate the social and emotional factors affecting patients and families, and provide counseling and access to community resources. Non-denominational spiritual counseling offers compassionate listening, as well as assistance with family meetings, end-of-life celebrations and grief counseling. Physical therapists help restore patients’ mobility and strength, and occupational therapists employ techniques to improve function and safety during activities and in the home. For individuals with communication disorders, speech language pathologists work to improve dialogue.
To help Bob when professional caregivers aren’t present, Bobbie learned skills such as percussive therapy (cupping the hands on the chest and back) to help clear Bob’s lungs. She also learned about resources, such as an Alzheimer’s Dementia Support Group. Confident he was in the good hands of the Hospice care team, Bobbie recently took time away to attend the family’s annual trip to Catalina, and also to visit the couple’s children in Northern California.
“The job of the caregiver is 24/7 and can be very emotionally draining and often isolating,” McKinnell said. “The volunteers provide transportation, run errands for caregivers, or even just sit with the patient while the caregiver takes a break. It enables the caregiver to return refreshed and with a renewed perspective, which is ultimately better for the patient.”
Equally important is the social connection and comfort the volunteers provide the caregiver, which helps to relieve the anticipatory grief family members often experience and also lessens bereavement depression.
“The most important gift we can provide to patients and families is empowerment—some control over a situation that is beyond their control. It’s not perfect. Patients (who are confused or experiencing pain) still get ornery. But it enables everyone to look back on the entire experience knowing they did the best they could. They did things right,” he said. “We’re giving them a graceful exit.”
1925 – 2013
Bob Barker had a tremendous spirit and took great joy in living life. He and his wife Bobbie were bi-coastal having spent the earlier part of life together on the East Coast and later on the West Coast. Bob was a dedicated Navy man who adored his beautiful family. Bob’s gracious ways inspired us all.