After 15 years of service, the Palliative Care Outreach Program closed on June 1st. Click here to view the original story.

Palliative care crusader passing torch; Pioneering 67-year-old retiring, confident others well-trained to carry on work

Thu May 10 2012
Pauline Tam

Dr. Margaret Farncombe, Ottawa's first palliative care specialist to make house calls to the terminally ill and dying, is retiring after two decades and winding down her unique practice.

Farncombe, 67, is the heart and soul of the Palliative Care Outreach Program, a grassroots charity she established with the belief that people choosing to die in their own homes, rather than in hospitals, should not have to settle for second-class care.

Her compassion, energy, and empathy - widely lauded by her patients and their families - are born of a highly personal reaction against a brute logic that shaped medicine for decades: die pain-free in the hospital or stay home and suffer.

With her gentle bedside manner, Farncombe inspires the loyalty and affection of her patients' families, who talk about how she not only gave them the courage and know-how to help their loved ones through pain, nausea, anxiety and other symptoms, but also offered them counselling in the aftermath of their loss.

Sandi Grant's mother died of esophageal cancer in 2009, six weeks after her diagnosis. Grant said her family felt abandoned by the health-care system until they were referred to Farncombe, who ensured her patient was able to die peacefully at home.

Afterward, Farncombe was also on hand to counsel Grant through her grief. "I wouldn't have gone to see anyone else because I'm a very private person, but Margaret knew my mom and my whole family, and she knew what I had been through."

Grant went on to volunteer for Farncombe's charity and eventually became its chief operating officer.

For years, as the lone doctor willing to treat dying patients in their homes, Farncombe was seen as a maverick. However, public attitudes, and those of the medical establishment, have finally caught up with Farncombe's.

At least nine other community based palliative-care physicians are now practising in the Ottawa area.

"I would feel very differently about stopping this program if that meant there weren't any physicians who were well-trained in palliative care and who were going to carry on the work, but there are others out there now," Farncombe said.

She stopped taking new patients last fall and is winding down her counseling practice and charity, which funds a small team of nurses and support staff. As of June 1, the Palliative Care Outreach Program will no longer exist. However, it is looking to set up a scholarship for the training of doctors or nurses with an interest in palliative care.

"We'd have to find a partner to administer it, but I think it's a good legacy for Margaret," said the charity's chairman, Craig Szelestowski.

With Farncombe's retirement, the charity debated continuing with a roster of five family physicians mentored by her, but concluded that no one could replace Farncombe and her uncommon devotion to patients, Szelestowski said.

"Our business model is very much based on having a committed founder. Being on call 24/7, 365 days a year is not sustainable. However, the fact that Margaret is so passionate and dedicated means she managed to pull it off."

Nothing about Farncombe's path to palliative medicine was conventional.

At age 20, she was traumatized by the death of her mother, who refused to spend her final days in a hospital after being diagnosed with colon cancer.

"She was in horrible pain. Excruciating, unbelievable, screaming-all night pain," Farncombe recalled. "She had a doctor who said, 'If you come to your senses and you go to hospital, I'll give you some morphine. If you stay at home, you get nothing.' And she stayed at home, and she got nothing."

When Farncombe entered medicine relatively late in life, turning 40 midway through medical school, she resolved to honour her mother's memory by tending to the dying on their terms. "You should not have to have inferior care because you want to stay at home."

Yet she found herself surrounded by a death-denying establishment that saw her as a failure for wanting to care for the dying. "The attitude among physicians was, 'You probably wouldn't do it if you could do anything else.' " Indeed, until recently, few doctors made a living practising end-of-life care full-time because provincial fees for it were so low.

Because Farncombe's husband was the family's primary bread-winner, she was free to focus on her practice without worrying about making ends meet. "You couldn't make $30,000 a year. I made far less money billing than the nurses who worked here," Farncombe said.

That started to change in 2005, when Ontario, through its funding decisions, recognized palliative care for the first time as a distinct branch of medicine and gradually increased provincial fees. "Now, it's a very honoured, very special profession that a lot of people are wanting to get into," Farncombe said.

Posted with the express permission of: “Ottawa Citizen”, a division of Postmedia Network Inc.