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A LIFE OF SERVICE

Editor's note: Community Builder is a periodic Q & A series providing perspectives from local individuals who have been involved in significant change in Southern Oregon. Today's conversation is with Dr. John Forsyth, a leading local health care advocate.

Q: What about Southern Oregon led you to call this home?

J.F.: There were several things. In 1969, we were a young family looking for a community and my first job as a physician. The first thing that attracted me was the medical community. The quality of practice was exceptionally high.

More important were the conversations of the people with whom we talked, so often about serving the people in this whole community. We also discovered many other attributes of the area; really good public schools with a healthy mix of academics, music and sports; a small town feel with world class performing arts like Oregon Shakespeare Festival and Britt Classical. The third thing that drew us was the proximity to the outdoors. ... In this community, it is difficult to escape the fact that one is a part of something much greater than oneself. Not every community has that. But, first and foremost, we were struck by the people we met here — kind, generous and passionate about this region.

Q: Your reputation as a doctor was one of compassion and patient-centered approach. How did you come to this?

J.F.: Hmmmmm — only in my later years have I thought much about this. In retrospect, which is a highly focused tunnel, I suspect I may have inherited such a tendency. My mother was a nurse and my father was in the lumber business. They were both very kind people who spent a lot of time, without much ado, being of help to other people. My mother, in addition to her hospital duties, was also “Nurse Lucy” to our whole neighborhood. If someone was dying or too sick to care for themselves, she would go over and just be there.

My dad was this very congenial man who reminded me many times of Will Rogers. ... During the Depression there were a lot of “hobos” (unemployed men) who slept each night in the box cars that had delivered lumber to Dad’s warehouse. On most evenings, after dinner, he would take them something hot from home: mostly a hearty soup. He kept blankets in the warehouse, and if the weather was bad he would give them a blanket and a warm, dry place to sleep. I grew up assuming this was the norm.

When I was in college I was not initially interested in medicine. In four years I wandered through five majors, including physics, nuclear engineering, English, anthropology and psychology. In my senior year I ran out of money and landed a job as a night orderly at a hospital in Champaign, Illinois. I had always thought, since my mom was a nurse, that medicine was the last thing I wanted to do. That year I slowly got to know and admire the physicians who came to check on their patients at night. Many were so kind and caring — to their patients, their families and even to me. I was hooked.

Q: You got involved as a volunteer at Community Health Center, now Rogue Community Health, for many years. What service did you provide at Community Health Center?

J.F.: In 1992, Peg Crowley of Community Health Center and Polly Williams of La Clinica spoke at a monthly meeting of the Jackson County Medical Society, presenting to a roomful of physicians some data which showed that one-third of the people in our county did not have access to medical care except through hospital emergency rooms in times of crisis.

Basically, they said, “You are doing a good job caring for the people who have insurance or enough money to get in your front door. However, there is a huge group of local people who can’t get by your front desk to access your care.”

So, the next day I went down to the front desk of my clinic and popped this question: If I am an uninsured mother of a sick child, what do I have to do to have my child seen, today? (I was told) “You need a $100 deposit.”

When you have grown up in a small town, you know that $100 is beyond the capability of a whole lot of people. So, in 1993, I started volunteering at Community Health Center two days a month … and continued for over 20 years. I learned so much! It was my direct clinical experience there, of actually seeing and caring for the folks who came through the doors each day with serious acute and chronic medical problems, of learning to respect the enormous courage and perseverance it took for them to overcome the many barriers to adequate medical care … that made my time at CHC not only challenging and frustrating, but also immensely fulfilling.

In nearly 25 years, over 40 of my most respected physician colleagues have also volunteered. During all those years, if it hadn’t been for Community Health Center and La Clinica, these folks would not have had access to medical care until they were in crisis. One of these colleagues recently described this effort as “opening the door to the very heart of our medical community.”

Q: You and several other health care providers started VolPACT (Volunteers for Patient Access to Consultation and Treatment) many years ago as a way to provide access to uninsured patients. Tell me about VolPACT.

J.F.: In the years after Community Health and La Clinica began providing basic primary care, but before there were many specialist volunteers, patients without health insurance who needed specialty care often weren’t able to access it. ... So, a small group of docs at Jackson County Medical Society dreamed up a plan, a pilot project, attempting to satisfy these requirements, providing specialty consultation and procedures to patients who had demonstrated both a medical and financial need. Next, we asked the over 300 specialist physicians in Jackson County if they might consider volunteering for such a plan on a one-year trial basis. Astonishingly, over 80 percent of the specialists signed up, agreeing to see an average of 5 to 10 such patients per specialist each year.

Furthermore, all three local hospitals participated. ... In subsequent years, more than 90 percent of local specialists participated and the program attracted great interest as an interim strategy, both regionally and nationally.

Q: Within the past few years you have been very involved with end-of-life issues. Why is this potentially uncomfortable conversation important?

J.F.: During my many years of sharing in the care of many persons near/at the end of life, I have observed so often how a dying person can gain great peacefulness by focusing attention on what has been most meaningful in life. Approaching death allows us to focus more clearly on that! I have slowly learned the great value of providing opportunities in end-of-life care for people to focus on the meaning of their lives and on meaningful closure to their relationships.

For some time I have also realized that, although my colleagues and I have done a reasonable job treating acute medical crises in people who could recover, we have often not provided appropriate care for those in whom there was little or no hope of recovery. As my profession became enthusiastically engaged in applying medical technology until the very end of life, we somehow lost our comfort in talking with people about what was most meaningful in their lives — or even allowing time for them to talk with each other about that! Until recently, we had lost a great deal of that ability … and are only just now beginning to regain it … with the reintroduction of palliative and hospice care near end of life.

Unfortunately, recent data has shown that nearly half of people who qualify for hospice care during their last six months of life are unable to be cared for in the most ideal place, their own home. Today, there is a wonderful new idea of having a hospice house, which really focuses on palliative care, on making dying people and their families comfortable, providing a place where meaningful conversations can happen.

There is a dedicated group called Southern Oregon Friends of Hospice ... people who have long held a vision of creating a hospice home to come to near end of life. Plans are well underway; they have purchased a lovely place here in Medford (the Holmes mansion on Modoc Avenue), which will be renovated and should serve well as a hospice house for our entire region. I have great optimism that such a marvelous facility for end-of-life care can and will happen soon.

Q: Is there a philosophy or belief that powers you and led you to a life of service?

J.F.: Oh, my gosh! Fairly early in my adult life, I was bitten by a bug called “philosophy” … and have been wrestling with some form or other of this question ever since. Answers have been slow in coming, have gradually evolved over time, are still encased in mystery … and much uncertainty remains.

That being said, I now believe that there are, in fact, many philosophies and beliefs which validate a life of service. All reflect an innate sense of kindness to others, which comes from deep within the minds of many, perhaps most human beings, and which may well have a genetic or epigenetic basis. Outwardly, this ethic of kindness is expressed in many different religious and nonreligious faiths ... and is known by many different names. Caring, the sixth principle of modern medical ethics, is the simple bottom-line summation of all these, as stated in so many versions of the Golden Rule.

I now believe it is NOT so important what we CALL it ... as what we DO about it! We each have a choice: to respond to this inner kindness within us … or not. The ethic of caring, therefore, is about two things: first, recognizing this elemental kindness within each of us; then, even more importantly, doing something about it.

Such action brings us full circle, fulfilling and enriching the life of the person doing the caring … such a simple and reassuring concept … most especially to folks like me who are closer to the end of life. Now, in my own late autumn, I feel such gratitude ... to have been given the opportunity to share these precious moments in time … with so many thoughtful and caring human beings, in this most remarkable community.

 — Steve Boyarsky is a retired educator and longtime resident of the Rogue Valley. He continues to be involved in educational and youth programs.

Dr. John Forsyth says health care should include end-of-life options such as hospice, which a local group hopes to provide at the Holmes mansion in Medford. Mail Tribune / Denise Baratta