Americans’ enduring can-do attitude combined with the prowess of contemporary medicine unintentionally makes some people’s waning stage of life much harder than anyone would want for themselves or those they love.
I know, because as a doctor and academic, I’ve spent most of my career trying to help correct that unnecessary and sometimes emotionally difficult situation. From 2003-13, I had the privilege of leading the palliative care program at Dartmouth-Hitchcock Medical Center.
I wonder if people who live in the communities of northern New England appreciate the role that Dartmouth-Hitchcock has played in collective efforts to care well for people throughout life, including during illnesses we cannot cure. I hope so.
Years ago, Dr. Jack Wennberg’s groundbreaking research into variations in medical practice showed that the treatments ill people receive often have more to do with where they live than with what they want or need. The Dartmouth Institute’s Atlas of Health Care monitors services and outcomes from one geographic region to another. Among the valuable data it publishes are statistics on how often people with advanced cancer or dementia are admitted to a hospital, and how many days on average they spend in an ICU during the last month of life, as well as how likely they are to spend those days at home with hospice care.
Beyond calling attention to what’s needed, the D-H health system has long been part of the solution. During the period when Dr. Wennberg was crunching numbers, clinical researchers Dr. Joan Teno and Dr. Joanne Lynn were laying the foundation for one of the nation’s first academic palliative care programs. With generous support from Jack and Dorothy Byrne, the program grew under the leadership of Dr. Gil Fanciullo and flourished during the years I practiced at Dartmouth-Hitchcock. Since I moved to the West Coast to follow my children (and now grandchildren!), leaders like Drs. Rich Rothstein, Ed Merrens and Kathy Kirkland have continued to build a premier interdisciplinary specialty palliative care team and fellowship, and are weaving key components of palliative care within mainstream primary care, hospital medicine, critical care, surgery, geriatrics and cardiology.
Today, advanced care planning, shared decision making, ongoing symptom assessment and treatment, and coordination of care are becoming routine throughout Dartmouth-Hitchcock — and that is exceptional.
I am delighted that Dartmouth-Hitchcock has broken ground on the Jack Byrne Center for Palliative and Hospice Care. Having been both a physician and friend to Jack Byrne, I am confident he would be proud of this ambitious endeavor.
The clinical and support services and training programs the Jack Byrne Center will provide will be invaluable for residents of the Upper Valley and northern New England — a place my wife Yvonne and I lived in for years and still love. The clinical advances and population health research generated by this center will benefit us all.
Ira Byock, M.D.Torrance, Calif.
As a Vermont native and a Dartmouth alum recently moved back to the Upper Valley, I feel compelled to address the controversy raised by the proposed indoor practice field. I have been embarrassed by the college’s arrogance in its attitudes toward the Chase Field neighborhood, and agree with the main points made by Francis Manasek in a recent column, in which he also questioned the need for the huge building.
The college would do well to step back and reconsider the balance between wants and needs. How much will this building enhance the education of students? We see the cost of higher education rising all across the country, and part of the problem is keeping up with the Joneses when it comes to facilities.
I recall a guy on my floor freshman year who was on the crew team. How much he enjoyed sleeping in once the season was over! Do we really need year-round sports? At what cost?
And then there’s the Rennie Farm. Granted, in the ’60s and ’70s society had different attitudes about waste disposal. But once the problem was recognized, why weren’t neighbors alerted right away? Why weren’t all potentially contaminated wells tested? And why was the cleanup put on hold in 2013? Why was the contaminant plume allowed to migrate, rather than employing pump-and-treat remediation back then?
Dartmouth can do better. The Higgins family should be fully recompensed. I agree with Peter Spiegel, who was quoted in a recent Valley News article that “to turn their back and not do a complete job . . . seems totally inappropriate.”
Other recent news from campus makes me wonder if Dartmouth has lost its heart when it comes to treating people well in the community. Minority faculty are far underrepresented. The mishandled inquiry process that led to lacrosse coach Amy Patton’s dismissal has left a bitterness among lacrosse alums. Dartmouth can do better by recognizing that its greatest assets lie not so much in big new facilities, or even the idyllic campus, but in the people of the larger community, from students to faculty and staff to townspeople.
Peter Thompson Post Mills
In 1949, I was a 10-year-old when my father became the manager of Newport’s second movie house: the new, elegant, air-conditioned Latchis Theater. My mother began her long career in shoe shops at that time. That meant I had no supervision after school let out at 3 p.m. The new theater was a short 10-minute walk from the Richards School.
Back then, theaters offered 2 p.m. matinees every day. Thus, I ended up at the Latchis Theater five afternoons a week, munching on popcorn and being mentally absorbed by the big screen — I have never forgotten the torture of sitting through the big musical Oklahoma for 10 days. (After that I detested musicals.) Usually, the movie changed after one day.
In 1949, movies were my only connection with the outside worlds. Most movies weren’t very good, nor were the actors remembered. When I was a teenager, us kids took our dates to movies and learned many important social skills.
I was an unofficial “student of cinema” through the years. I kept a list of over 3,000 of the films I watched. Here are my all-time favorites, in order: From Here to Eternity, The Odd Couple, Thirteen Days, Twelve Angry Men, JFK, The Seven Year Itch, Music of the Heart, The Graduate, On Golden Pond, The Oxbow Incident, It’s a Mad, Mad, Mad, Mad World, The French Connection. Favorite actor: Henry Fonda. Favorite actress: Meryl Streep.
Roger Small Claremont
According to Donald Jessome, CEO and president of TDI New England, 200 megawatts of the recently approved, 1,000-megawatt high-voltage DC line, owned by Blackstone Group, is reserved for Vermont. Vermont has the option to purchase up to 200 megawatts, but Jessome said he doesn’t expect the state to take advantage of that option. Apparently, according to VTDigger, Green Mountain Power, et al., prefer to buy much higher cost wind and solar energy from a variety of local suppliers.
The high-voltage DC line likely will be in operation about 2018-2019. The line will run from Canada to a new DC-to-AC converter station near Ludlow, Vt., and feed into an area of the high voltage grid that used to be fed by Vermont Yankee.
The 200 megawatts could provide at least 1.3 million megawatt hours per year of low-cost, steady hydro energy. This would be in addition to the existing Hydro Quebec power purchase agreement of about 1.25 million megawatts per year, for a total of 2.55 million megawatts per year, or about 28 percent of GMP-projected utility purchases.
That hydro energy is steady (not variable, not intermittent), and is renewable, with near-zero CO2 emissions (less than wind and solar), and low-cost (less than wind and solar). It would be very helpful to achieve Vermont’s 90 percent renewable energy goal.
That energy would be available much sooner, and at near-zero subsidies, near-zero capital cost, zero environmental damage to ridgelines and meadows, and zero social unrest, rather than an equivalent capacity of wind and solar systems that would produce high-cost (two to five times New England wholesale prices), unsteady, variable, intermittent, potentially grid-disturbing energy. The world would be “saved” much sooner, and at a lower cost!
However, under the renewable energy mantra of transitioning away from a few large power purchase agreements toward smaller and more diverse sources, it appears GMP has no intention to significantly increase its purchases of hydro energy. Hydro renewable energy credits being less valuable than solar and wind renewable energy credits may have something to do with it.
The Public Service Board should demand GMP buy additional Hydro Quebec hydro energy, instead of swallowing GMP’s Integrated Source Plan, which has wording in many paragraphs, that, in a carefully nuanced manner, echo much of the words and mantras of renewable energy proponents.
Willem Post Woodstock
It is almost laughable to think Donald Trump would have anyone other than himself as a role model. And yet, such a model might be found in King David of Israel.
Like Trump, David started off as a political outsider. Both men vanquished their foes in grand fashion. And yes, both committed indiscretions.
What makes David a potential role model is his relationship with God. He enjoyed God’s favor but did not take it for granted. He knew that God’s favor is based on a man’s heart, not his outward attributes (1 Samuel 16:7). When confronted with his adultery, David did two things: first, he asked God for a heart transplant (Psalm 51:10).
Next, he pleaded with God not to withdraw his favor, without which David knew he was sunk (Psalm 51:11).
Perhaps Trump would denounce David as a weakling for whom God was a crutch. That would be unfortunate, as Trump could stand to learn from this beloved Hebrew king.
David ThronHanover