At the beginning of the last century, the average American life expectancy was only about 47 years. With the introduction of antibiotics and other medical advancements, that average was up into the 70s by the 2000s.
"In 1900, death was really thought of as something that was part of life," says Dr. Margaret Jacobson, medical director of Whatcom Hospice. "By 2000, it had become sanitized and institutionalized. People almost always died in the hospital instead of at home and it was also considered a failure of medicine."
So it makes sense, Jacobson says, that the advent of the hospice and palliative care specialty is a relatively new one for the medical field.
"A specialty that dealt with death and dying was not as heroic as wresting people from the jaws of death," she says.
After finishing her residency in the Midwest, Jacobson moved to Wenatchee with her husband, Dr. Richard McClenahan, while he worked as a doctor for migrant farm workers. The couple moved to Bellingham in 1989 to open a practice at Squalicum Family Medicine, where Jacobson practiced until September 2013. McClenahan still practices there.
The couple co-parented: while one was working, the other stayed at home for the day with their three sons; the next day, they switched.
As their sons got older and didn't need their parents at home as much, Jacobson found other work. For 10 years she served as medical director at Mt. Baker Planned Parenthood, in addition to practicing family medicine. After she left Planned Parenthood, an off-duty hospice nurse approached her while they were both at a garage sale and told her Whatcom Hospice could use her help.
Though her work had never focused on dying patients, Jacobson says the request to work in hospice resonated with her.
"I had become increasingly frustrated with how technological medicine handled people who were dying," she says. "I realized hospice would allow me to relieve suffering in a way we weren't usually able to."
She served as associate medical director for Whatcom Hospice from 2003 to 2006. During that time, Jacobson says the nurses were incredible teachers and helped her learn about the nature of healing without curing. In 2006 she was board certified in palliative medicine and became medical director.
Around the same time as the home-birthing movement was coming into vogue in the 1960s, Cicely Saunders, a British registered nurse who mostly worked with cancer patients, started the hospice movement in the 1960s.
"It was an effort or consciousness that these two major life events needed to be reintegrated into the business of living," Jacobson says.
Among the principles of hospice are: pain is more than physical, medication should be given regularly to prevent pain, and it is not necessary to cure to heal, Jacobson says.
"People think we stand at the bedside and sing 'Kumbaya,' but we do more than that," Jacobson says. "We help patients weigh length versus quality of life, review their life expectancy and find out what they want to do for that time."
To receive hospice care, patients must have a terminal prognosis, with two doctors determining the patient likely has six months or less to live. Hospice also helps patients and families cope with grieving, something Jacobson recently had to grapple with herself.
In 2012, her sister was diagnosed with a rare form of cancer, and three months later, Jacobson was diagnosed with breast cancer. Jacobson's sister died Jan. 8, 2013. Jacobson was able to make it through her own treatment and is in remission, but says the loss of her sister was devastating for her.
"I think I understand families and I understand grief and existential despair better having experienced them myself," she says.
Jacobson also says she better understands complaints from patients or family members, having had less-than-wonderful experiences with medical professionals surrounding her sister's death.
"I had a lot of opportunity for self-reflection," Jacobson says. "Most physicians are so busy they don't think about who they are and the nature and quality of their relationships. I'm less dismissive of complaint letters now."
Jacobson says she has seen the Whatcom community become more engaged in end-of-life conversations and hopes that consumer-driven change will occur with end-of-life plans as it did with family births, which were largely started because mothers started asking doctors to allow their spouses in the room.
"We want doctors to formulate end-of-life care plans," Jacobson says.
Other ways people are getting more involved in their own plans for death include setting up advanced directives and power of attorney before illnesses prevent patients from acting on their own, Jacobson says.
Medicare pays Whatcom Hospice about $175 per patient, per day, to cover costs for staff salaries, medications, beds, physical therapy, massage and psychological care. The program relies heavily on philanthropic donations.
"The way hospice is funded accounts for some national disparities," Jacobson says. "If a rural community only has 10 patients, they can't afford a program."
Jacobson helped apply for grants and start the in-patient Palliative Care Initiative at PeaceHealth St. Joseph Medical Center, and hopes to help start an outpatient clinic in January 2014.
The Palliative Care Initiative, along with Western Washington University's Bachelor of Science in Nursing program, will help run a half-day conference on Feb. 7 called "Heal Without Cure." The conference will focus on difficult conversations, empowering patients with skills they need to talk to doctors about end-of-life care, and teaching doctors how to talk to patients about terminal illness. More information on the conference may be found at wwu.edu/bsn.
Jacobson currently works three days per week, and says she hopes to spend more time with her husband and visiting family in the coming year.
Contact Samantha Wohlfeil at email@example.com or 360-756-2803.
ABOUT THIS SERIES
The Bellingham Herald salutes Whatcom County people who help make our community a great place to live with our annual Ten Who Cared series. If you have a suggestion for an organization we should salute next year, please email firstname.lastname@example.org.