He finds optimism at the end of life

There's a lot of noise in medicine about the fight against cancer and a "race for the cure." The reality, says Dr. Bob Buxbaum, associate clinical professor of medicine at Harvard Medical School's Palliative Care Program, is that "the death rate is 100 percent." Mortality can only, at best, be delayed -- whether from cancer or anything else. So Buxbaum has devoted himself to palliative care, meaning he helps make a patient's life better once that life is coming to an end.

"The medical profession is oriented around the idea of a cure," said Buxbaum, 76, who practices with Harvard Vanguard Medical Associates. "Some of my colleagues talk about life extension, where giving a patient two more months to live is considered a major breakthrough. But what about the quality of that life?"

Buxbaum and his colleagues practice a form of medicine that many people may, at first, consider depressing. As president of the Massachusetts Compassionate Care Coalition, an organization devoted to improving end-of-life healthcare in the state, Buxbaum sees a great deal of death.

But the universal nature of palliative care (we all die) and its concrete, visible good (lessening pain and maintaining a patient's dignity) makes for work that Buxbaum considers remarkably uplifting.

"Our typical patient may be about 85 years old, and has diabetes, heart disease, and depression, or any of eight or 10 different problems. We're not going to cure most of them. The question is how does a person have a productive life under those circumstances?"

It's a field of healthcare that, in American culture, doesn't garner nearly as much emphasis or money as its opposite; there's a gargantuan industry dealing in fertility, safe pregnancies, lactation, and all the attendant topics of birth.

"But I've learned that at the end of life," said Buxbaum, "everybody's on his own." Most families never plan for aging, much less death, until they face it, he said.

Buxbaum wasn't drawn to palliative care until relatively late in his career as an internist, but he began thinking about different ways to approach medicine when, as a young medical school graduate, he took a job at the San Carlos Apache Reservation in Arizona.

"It was transformative," he said. "It was analogous to going overseas. Their concepts of illness were different. They took death and dying for granted."

He learned that communication was the key to medicine, and that patients needed to be dealt with as whole people instead of just bundles of conditions.

Years later in the 1990s, after having spent nearly his whole working life in Boston as an internist, he started a geriatric rehabilitation program.

"I didn't realize how exciting it would be," he said. "Geriatric medicine is a growth field. As the population ages, it's increasing by huge numbers." Even so, Buxbaum sees a crisis in spending, particularly on hospice care, of which he is a fervent supporter.

Removing patients from the hospital ward and giving them access to art and music, to personal choices, and "an environment that supports life in a meaningful way" is often worth all the chemotherapy in the world.

"Bob is a visionary," said Dr. Mark Yurkofsky, chief of Harvard Vanguard's Palliative Care and Home Visit and Extended Care program. "He was the first person in our group to identify the chronic need for better palliative care services. He's even gotten insurance plans to expand their benefits for it. He's able to see the big picture."

Although he says that it's imperative to accept that decline is part of life, Buxbaum himself is as bright and energetic as a man half his age. The key to health, he says, is mental and physical activity. He has a personal trainer at the YMCA. He took up the oboe at the age of 40, and still plays in a chamber ensemble. "Old people tend to watch a lot of television in our culture," he said, which certainly exacerbates their health problems.

Even so, there's no avoiding the fact that "everybody has a terminal event." Buxbaum's hope is that people will start thinking about how to make that less of a sudden horror, and more of an accepted, and dignified, part of life.

Fact sheet

Hometown: Newton.

Family: Wife Ann, who works in international public health. Children Laura, 49, Carl, 46, Paula, 44, and Margaret, 41. Also, seven grandchildren.

Hobbies: Swimming, tennis, cross-country skiing, cycling, and the oboe. "We play for ourselves, but also sometimes for a captive audience of elderly people in a care facility, who seem to like it. Maybe when we play at an assisted living community, they'll be a tougher crowd."