Pioneer Physician Assistant Retires

Starr Strong blazed a new role for 21 years at Chelsea Health Center

Starr Strong

Starr with a baby

Physician assistant Starr Strong retires on May 1 after 21 years at the Chelsea Health Center. Robin Palmer, a former journalist who now does marketing at Gifford, sat down with Strong this week to get her reflections on her career and two decades of commitment to the Chelsea community.

CHELSEA – Starr Strong took a meandering path to health care.

Raised in Connecticut, she studied eastern religion at Beloit College in Wisconsin and went on to travel in India and Nepal and work a variety of jobs, including for a childhood lead prevention program in Massachusetts and counseling troubled teens.

A self-described hippie, wherever she went she found a cabin in the woods to live with her dog, usually with no electricity. She “played pioneer,” she said.

She contemplated a career in social work, but after traveling found herself drawn to a relatively new career – that of a physician assistant.

Despite a complete lack of experience in medicine, as a white person traveling in India and Nepal she was often called upon by villagers to help with illness, she said. “They bring you their wounds. They bring you their sickness. I found that I loved it.”

Duke University had started the first physician assistant program following the Vietnam War for returning medics looking to put their skills to work, Strong recalled. Wake Forest University in North Carolina was one of the schools to follow. Strong entered physician assistant school at Wake Forest in 1979.

Coming home to Vermont

Starr Strong

Starr with a patient in 1996

She came to Vermont in 1981 while in physician assistant school to do what the industry calls a clinical rotation – like an internship – with local ob/gyn Dr. Thurmond Knight and midwife Karen O’Dato. It was not her first experience in Vermont, however.

Strong calls growing up in Connecticut “a mistake.” “I knew that I was so supposed to be here,” she said.

Strong’s family came from Brookfield. As a child they would visit the family homestead several times a year. Strong recalls her mother telling at her the end of one trip when she was 5 or 6 that is time to go home. “But I am home” was Strong’s reply.

Strong is the sixth generation to own that Brookfield property, where she still lives with husband John Button and one of her two children, Dylan, 28. Twenty-four-year-old daughter Maylee lives in Chelsea.

When she first came home to that old farmhouse with no running water, Strong envisioned a job at Gifford in Randolph, but long-time hospital Chief Executive Officer Phil Levesque told her no, repeatedly.

“I knocked on Gifford’s door every year,” said Strong. She repeatedly heard that the Medical Staff just wasn’t ready for a physician assistant, and might never be.

The hospital had just one private practice nurse practitioner affiliated with it at the time. The concept of a physician assistant – now commonplace in the industry – was completely new.

Starr Strong

Starr in 1996

Strong went to work for Planned Parenthood for a dozen years. She worked mostly in Barre doing gynecological exams and talking about birth control. But still she knocked on the door.

The door to Gifford edges open
In early 1993, the door creaked ajar. The hospital agreed to trial Strong in Chelsea a day and a half a week alongside new physician Dr. George Terwilliger, who had replaced retiring physician Dr. Brewster Martin.

Strong was Gifford’s first physician assistant and the first female health care provider at the Chelsea Health Center.

Martin made sure Strong stuck.

“He was incredible,” she recalled. He introduced her around time, advocated for her and he came during many a lunch hour to the Route 110 health center to chat.

The duo formed a mentor-mentee relationship and a strong friendship. They’d save up stories and thoughts to share. They talked about suffering and loss, life and death, and whatever they found funny.

“He was the wisest person I’ve known in my life. It was quite a blessing and I don’t use that word very often,” said Strong.

What she remembers most was that he would ask her thoughts on a subject.

“He gave me confidence,” she said. “I had so much respect for him that him asking me what I thought was enormous.”

Starr Strong

Starr in 2008


Soon Strong was working at other Gifford health centers, including in Bethel, at the student health center at Vermont Technical College, in Randolph and recently in Berlin. Chelsea, however, has been a constant.

She promised Martin she would stay in Chelsea for 20 years. This year marks 21.

Just the right fit in Chelsea
Strong found a home at the Chelsea Health Center.

“Chelsea’s an old time family community and people are fiercely independent and have a lot of pride. If they don’t have anything, it doesn’t matter. It’s down to earth,” Strong said.

For a woman loath to “lipstick and high heels,” it was just perfect.

And like with Martin, she formed relationships there.

“Medicine is not just a science. Medicine is an art and it’s about relationships and it’s about developing relationships with people,” she said.

Those relationships have come with generations of patients and with co-workers like nurse Judy Alexander, who became the closest of friend.

“She just made me laugh. I could call her at 4 o’clock in the morning and she would be at my house at 4:30, and you don’t get that in life often.”

Starr Strong

Starr with friend and patient Judy Alexander in 2012

Alexander is also a patient of Strong’s – a patient who is in the very end stage of terminal cancer. Like so many of her patients, Strong has been at Alexander’s bedside.

“At the beginning of my career, I thought birthing was my ticket and then I took care of a dying person and found that that is really where the juice is,” she said, noting the courage one witnesses in illness and death.

Alexander’s illness and waiting for just the right new providers to join the Chelsea Health Center in her place have in part kept Strong working past that 20 years she promised Martin.

A new chapter
But now she is ready.

Strong is 62, struggles with pain caused from arthritis in her spine and is slowing down. “I don’t have that vitality anymore,” she said.

And she wants to be home. Her husband has been building a new house on that family homestead in Brookfield. “I want to be there to finish it, and have the time to move in.”

She wants to travel and ski and kayak and garden and make stained glass and spend more time with her 95-year-old mom.

She can do all this because of family medicine providers Dr. Amanda Hepler and physician assistant Rebecca Savidge. Like Strong did 21 years ago, they have joined the Chelsea Health Center.

Dr. Hepler comes from Maine and has a passion for rural medicine and Savidge is a Chelsea native. They’re skilled and compassionate and plan on staying for a very long time. Strong couldn’t be happier.

“Once patients meet them, they’re going to love them,” Strong said.

In fact, they’re so great to be around that Strong anticipates a few visits to Chelsea of her own.

“Now I’m going to be the lunchtime girl,” she said, thinking back to those lunches with the retired Martin.

Wish Strong well in her retirement and meet Dr. Hepler and Savidge at a May 1 open house being held from 4-6 p.m. at the Chelsea Health Center that is open to all.

Assessing Quality of Life: Live Your Dash

The DashIn between birth and death there is a dash. You know: the diminutive line on a tombstone or obituary indicating all those years of life between birth and death.

Linda Morse made “The Dash” famous in a poem by the name that challenges us to reflect on how we live our dash.

On Dec. 5, Gifford Medical Center picks up the discussion with “The Dash: Quality of Life Matters.”

The free discussion open to all is a continuation of last winter’s popular education series on death and dying and reopens a new series expected to last into the spring, explains organizer Cory Gould, a mental health practitioner and member of Gifford’s Advanced Illness Care Team.

The talk will include interviews with pre-selected participants on their quality of life. For example, Dr. Daniel Stadler, assistant professor of medicine and an internist with special interests in geriatrics and palliative care at Dartmouth-Hitchcock Medical Center, will interview a woman in her 90s about her life experiences.

Other discussion points during the 5-6:30 p.m. event will focus on:

  • What do we mean by “quality of life?”
  • How do you measure it?
  • Is your quality of life different than someone else’s quality of life?
  • Does quality of life change over time?
  • How does one’s quality of life relate to the quality of one’s death?

“There’s a truism that’s been repeated over and over again and that is that people die as they lived,” says Gould. “We want to involve participants in a discussion of the question: ‘What gives life meaning for you?’”

Following this free talk, other talks are planned on advance directives; what dying looks like; a “death café” or open discussion about death; and a discussion on death with dignity versus assisted suicide.

Speakers will explore the concepts but there will be ample opportunity for group discussion and sharing.

Last year, the popular series included sessions on starting the conversation of end of life and preparing for death, such as through Advance Directives; what is a “good” death; and various aspects of grief.

Prior attendance at discussions is not required and all are welcome.

No registration is required for this free educational discussion. Gould can be reached at (802) 728-7713 to answer questions.

The talk will be held in the Gifford Conference Center. The Conference Center is on the first floor of the hospital and marked with a green awning from the patient parking area. For handicapped access, take the elevator from the main lobby to the first floor. For directions to the medical center and more, visit www.giffordmed.org.

Donor Profile: The Winslows

The following was published in our 2012 Annual Report.

donor profile

Above left – Peter and Joyce Winslow. Above right – Pictured at Magee is Peter and sons Todd and Dale. Not present is son Scott. Together they support community organizations, including Gifford.

Joyce Winslow instilled in her sons the value of giving.

“My mom told me there were two places in town that you need to take care of, because they can’t be replaced, and those are the hospital and Chandler,” Todd Winslow recalls.

For Joyce’s husband, Peter, the value of giving also came early on in life. During his childhood, his own mother went out of her way to give to the less fortunate. During their marriage, Peter and Joyce, in spirit and action, carried on that tradition.

The family nurturer and steadfast promoter of harmony, Joyce gave smiles and kindness to her children, their friends, and the customers she met at family-owned Belmains where she worked for more than 30 years. She was so thoughtful, says Peter, that if someone needed clothing, she’d take clothes right out of her own closet to give.

Together Joyce, Peter, their sons, and their first business – Magee Office Products, also in Randolph – have for years supported a variety of Vermont organizations, including annual gifts to Gifford. “We were a family of giving,” says Peter, who moved his family to Randolph in 1959.

When Joyce passed away in Gifford’s Garden Room 52 years later in November of 2011, it stands to reason that this family of giving once again considered how they could support their community. They designated both Gifford and Chandler for memorial donations in Joyce’s name. Memorial gifts soon came in great numbers.

The following summer Todd took up his mother’s memory once again as a participant in Gifford’s annual Last Mile Ride, a charity motorcycle ride for end-of-life care. Todd collected donations in Joyce’s name totaling more than $5,000 – the most money raised by a rider that year, or any year.

donor profileTodd credits the quality of the Garden Room and Gifford as two reasons behind the giving. “Most towns don’t have a hospital like Gifford,” he says.

But the real motivator was surely his mother.

“I really think it was because of my mom,” Todd said after the charity motorcycle ride in August. “One guy (I asked for a donation) said, ‘How can you not say yes?’”

In Joyce’s memory and for the good of their community, the Winslow family has made a tradition of saying yes.

Last Mile Ride Raises Record $56,000 for Patients at End of Life

Last Mile Ride

The Stockwell family is ready to ride Saturday at Gifford Medical Center. (Provided: Janet Miller)

RANDOLPH – Nearly 300 motorcyclists, cyclists and runners/walkers participated in Gifford Medical Center’s eighth annual Last Mile Ride on Saturday, raising a record $56,000 for end-of-life care.

Beneath sunny skies, the day juxtaposed heart-wrenching, yet inspiring, stories of loss with a celebration featuring the high tempo sounds of “Jeanne and The Hi-Tops,” food, fun and prize awards.

Earning the top prize for his fund-raising efforts was Reg Mongeur of Randolph, who collected $3,458 from generous friends, family and strangers alike. A much-anticipated Harley/$5,000 cash raffle was won by Carol Bushey of Brookfield. A quilt made by Gifford nursing staff and a patient went to Martha Howe of Randolph.

Last Mile Ride

Runners sprint through the start line of the 5K Fun Run as part of the Last Mile Ride. (Provided: Tammy Hooker)

Palliative care physicians Dr. Cristine Maloney and Dr. Jonna Goulding along with rider/founder and Gifford nurse Lynda McDermott all addressed the crowds, offering thanks for riders’ efforts to make the hospital’s dream of providing alternative therapies, special wishes and more for free for patients in the last mile of life.

“Everyone has arrived here today for unique personal reasons to unite in a larger, common cause. Many are motivated to be here to honor the loss of a loved one and to ensure that future families shepherding someone to the end of life are granted gifts or services … ,” Gifford Director of Development Ashley Lincoln said.

Last Mile Ride

Cyclists leave Gifford Medical Center Saturday for the Last Mile Ride. (Provided: Janet Miller)

“The enthusiasm of this crowd and the building excitement of riders garners more and more sponsors, gives me and the staff at Gifford … not only financial reserves but emotional reserves to walk alongside our friends and neighbors on some of their longest days,” Lincoln continued.

Shelly Pearce knows how long those days can be. Her husband Kevin died in the Garden Room on July 4. On Saturday, Shelly Pearce offered an emotional, personal thanks to riders.

“The Last Mile Ride funds helped us as a family in numerous ways,” said Pearce, describing massages for pain management, meals for the family, a gas card and a special family celebration. “So whether this is your first or your eighth time participating in the Last Mile Ride, I want you all to know what a difference you making in a patient and their family’s life. Keep participating or volunteering even if it seems like a small thing, because it is very important and appreciated.”

Last Mile Ride

Led by Orange County Sheriff Bill Bohnyak, motorcyclists return to Gifford during the Last Mile Ride held Saturday in support of end-of-life care. (Provided: Janet Miller)

The Last Mile Ride began in 2006 when McDermott brought the idea forward to help provide comfort measures for people in life’s last mile. The first ride was held in 2006, and since its number of participants, funds raised and impact have all grown.

The event now includes a 5K and cycle ride in addition to the popular motorcycle ride. And this year’s event featured a Friday night “Kick-Off Rally” of dinner and dancing at the Three Stallion Inn with more than 80 community members and Last Mile participants in attendance.

The Randolph Area Chamber of Commerce made the event possible.

Last Mile Ride

Cyclists and motorcyclists line up for the post-ride BBQ. (Provided: Janet Miller)

The Last Mile Ride was made possible by a huge group of volunteers, who were mostly Gifford employees who gave up their Saturday to support the cause, as well as volunteers from the Combat Veterans Motorcycle Association, Orange County Sheriff Bill Bohnyak, the Green Mountain Bike Patrol, police support in multiple towns, and Terry Heath and Erin Bianchi of Massage Professionals of Randolph.

Significant community involvement came in the forms of people lining the event routes to show support and many, many sponsors. Among this year’s sponsors were the Frankenburg Agency Inc., Froggy 100.9, Lucky’s Trailer Sales, Northfield Savings Bank, Wilkins Harley-Davidson, Booth Brothers Dairy, Connor Contracting, E-Management Associates, Mascoma Savings Bank, Aubuchon Hardware, Barry T. Chouinard Inc., Dimmik Wastewater Service, Gillespie Fuels and Propane, Infinitt North America, K&R Rentals and Storage, Kleen Inc., Magee Office Products, MetLife, Rain or Shine Tent and Events Company, Schiring Radiographic Imaging, Superior Development and many others.

Next year’s Last Mile Ride will be Aug. 16, or the third Saturday in August.

Last Mile Ride

Shelly Pearce, right, offers her heartfelt thanks to Last Mile riders as her daughter, Samantha Blakeney, provides her comfort. Pearce’s husband, who was Blakeney’s stepfather, died just last month in the Garden Room at Gifford. The ride raises money for patients like Kevin and families like the Pearces. (Provided: Tammy Hooker)

Motorcycle Ride Honors Kevin Pearce, Others in Life’s Last Mile

On Saturday, Aug. 17, hundreds of motorcyclists, cyclists, and runners/walkers will take to the streets of the Randolph area for the Last Mile Ride. The ride raises money for special services for Gifford Medical Center patients in advanced illness and at the end of life.

This is one patient’s story.

Kevin Pearce

Kevin Pearce in 1976 at age 16. (Photo provided)

A native of Waitsfield, Kevin Pearce was born in Vermont in 1960. He moved to Massachusetts with his family when he was just 3. He grew up in Charlemont and Ashfield, Mass., dropping out of high school to work on a potato farm during a time when dyslexia was less understood and Kevin found himself labeled as “dumb” for his inability to read.

He went on to run heavy equipment, assembling and disassembling ski area chair lifts in Massachusetts, until tragedy brought him back to Vermont.

Kevin had been married, divorced, was engaged, and moving in with his fiancée when she was killed in an automobile accident by a drunk driver on her way to bring her final carload of belongings to what was to be their shared home.

Immediately following the funeral, Kevin packed a bag and took a bus to his native Vermont. Continue reading

A ‘Good’ Death

Free Jan. 31 community discussion
focuses on how to live well while dying

RANDOLPH – Few would likely pick a “bad” death. But what is a “good” death and how do you choose one?

Those are the questions regional hospice and health care experts will address at a Thursday, Jan. 31 event at Gifford Medical Center titled “What is a ‘Good’ Death?” The talk, a free community discussion open to all, is from 5-6:30 p.m. in the Randolph hospital’s Conference Center. Continue reading

‘Start The Conversation’

All ages invited to join local experts in talking about end-of-life care options, to improve quality of life now.

Start the ConversationRANDOLPH – Visiting Nurse and Hospice of Vermont and New Hampshire, the Vermont Ethics Network and Gifford Medical Center’s Advanced Illness Care Team are joining to create a community discussion around end-of-life care planning.

Called “Start The Conversation,” the talk will be held on Nov. 29 from 5-6:30 p.m. in Gifford’s Conference Center at the main medical center in Randolph.

“Start The Conversation” is a public education initiative of Vermont’s Visiting Nurse and home health and hospice agencies in partnership with the Vermont Ethics Network. Collaborating with medical providers like Gifford, the talk is offered around the state. A Web site, starttheconversationvt.org, also focuses on the issue of end-of-life planning.

“In life we prepare for everything: college, marriage, children and retirement. Despite the conversations we have for these important milestones, rarely do we have conversations about how we want to be cared for at the end of our lives,” explains the site.

“Talking is the single most important thing that you can do to prepare for the death of someone you love. While difficult, the end of life can be amazingly rich. Talking about this time makes a rich ending more likely. Often such conversations are avoided out of an understandable desire to spare each other’s feelings. They need not be.”

An Advance Directive is one way to get the conversation started and experts leading this Nov. 29 talk in Randolph will talk about end-of-life options, medical decision making and how to put ones wishes in writing through an Advance Directive.

“Planning for end-of-life care before it becomes a worry is as important as all the other life plans you make. Having a plan in place makes it easier for you, your doctor and your loved ones if you are unable to tell them your health care choices because of an injury or serious illness,” explains Jared King, business development manager for Visiting Nurse and Hospice of Vermont and New Hampshire.

“Every moment is precious – especially at the end-of-life. Starting the conversation early can ensure that your choices are heard. It also means that when time becomes short, it can be spent doing what you most enjoy and not making last-minute decisions.”

As a psychologist and member of Gifford’s inpatient care management team, Cory Gould spends much of her day talking to patients about Advance Directives. “We spend a lot of the day holding discussions with family members about how to talk about death,” Gould says. “The beauty of bringing this discussion to the forefront is to improve the quality of all of our lives.”

If end-of-life wishes are known there is more opportunity to enjoy the present and erase the worry, Gould explains. Discussing how one wants to celebrate the end can also increase understanding about what matters most to that individual in life. “Thinking about death is a way of celebrating life,” Gould says.

For Gifford and its Advanced Illness Care Team, the talk will be the first in a series on death and dying. Titled “A ‘Good’ Death,” the series will look at what is a “good” death, family dynamics when death approaches, what happens when someone dies, grief and more. The series begins with “Start The Conversation.”

“Start The Conversation” is free and open to people of all ages. Registration is not required. The Gifford Conference Center is on the first floor of the medical center and marked by a green awning from the patient parking area. For handicap access, take the elevator from the main lobby to the first floor and follow signs to the Conference Center.

To learn more about this talk or the upcoming series, call Gould at (802) 728-2608 .

 

Last Mile Ride raises $54,000

‘Great’ ride supports ‘special’ cause: the Garden Room and end-of-life care

Last Mile Ride 2012

Cyclists leave for a 38.4 mile loop to Northfield and back as part of Saturday’s Last Mile Ride at Gifford Medical Center.

RANDOLPH – With blue skis overhead and temperatures in the 70s, 225 motorcyclists, 60 runners and 20 cyclists rolled into Gifford Medical Center Saturday for the seventh annual Last Mile Ride, together raising an estimated $54,000 for end-of-life care at the non-profit Randolph hospital.

It was the hospital’s most successful ride to date, attracting more participants than ever before, offering a 5K for the first time and raising the most in the ride’s already impressive history.

The event supports end-of-life and advanced illness care for Gifford patients.

Last Mile Ride 2012

Runner and cyclist David Palmer of Randolph brought along a friend, the family dog, for Saturday’s Last Mile Ride.

Gifford provides special care in a garden-side suite, the Garden Room, for patients at the end of life and to their grieving families. The ride was created by Gifford motorcycle rider and nurse Lynda McDermott to support the Garden Room and comfort services, such as massages for pain management; family photos by a local professional; music therapy; one-time gifts for special needs, such as a handicapped ramp at home or special wish; care packages; food for families staying with their loved ones in the Garden Room; bereavement mailers; help with Advance Directives; staff training; and more.

To a mostly leather-clad crowd standing before the reflective chrome of 162 motorcycles, hospital administrator Joe Woodin offered his thanks to the participants.

Last Mile Ride 2012

Motorcyclists leave for the seventh annual Last Mile Ride on Saturday at Gifford Medical Center in Randolph. The ride supports end-of-life care.

“Thank you for coming today. This is a great event,” Woodin said. “It’s been really lovely to have so much support and people’s involvement. Over the years we’ve had a lot of people take up the cause in memory of a friend who perhaps passed away or a loved one and it’s really nice for people to say ‘The experience we went through we’d love to help those in the future.’”

Dr. Cristine Maloney, an internal medicine and palliative care physician who participated in both the 5K and cyclist portion of Saturday’s ride, shared stories of patients who have benefited from the ride funds over the last year. “None of this is possible without your time and your commitment and your fund-raising. These improvements in symptoms as well as the time and space to let families let go more comfortably are because of you.

Last Mile Ride 2012

Bunny Huntley of Bethel waves from the back of Gail Osha of Randolph Center’s bike as the duo takes off Saturday as part of Gifford Medical Center’s Last Mile Ride.

“We appreciate your commitment to providing comfort at the end of life whether at the hospital or at home or in the nursing home here.”

Many spurred by their experiences in the Garden Room, nine participants raised more than $1,000 each for the cause. The top fundraising honor and associated prize – a Porter Music Box – went to Todd Winslow and Lu Beaudry of Wilder who alone raised $5,325 in memory of Winslow’s mother Joyce, who passed away in November in the Garden Room at age 82.

“When my mom went into the Garden Room … I decided that day – and I didn’t tell anyone – that I would figure out a way to raise money for it,” said Winslow, who later used e-mail to reach out to friends, family and business contacts. He wrote about the Garden Room and asked for help raising money in his mother’s name. “And I got an unbelievable response from all of them.”

Last Mile Ride 2012

Howard Stockwell of Randolph Center waves on the back of Mike Anderson’s bike as 225 riders return from the Last Mile Ride on Saturday at Gifford Medical Center.

“The Garden Room,” said Winslow, “you don’t know what it is like until you experience it. It is the neatest thing there is. Gifford has something, or the town has something, that most towns and hospitals don’t have. It’s really special.”

Winslow set a goal to raise $2,000, met it, raised it to $3,000, met that and continued on to $4,000 and then $5,000 goals, exceeding each.

“I really think it was because of my mom,” said Winslow of how he was able to raise so much. “One guy said ‘How can you not say ‘yes?’

“It was kind of neat to do it in tribute to my mom because my mom was really a neat person. She never had an ego. She was one of those people who wanted to help everyone and listen to them. So I wanted her to be recognized at that ride.”

Thanks to her son’s efforts, she was.

Last Mile Ride 2012

Ken Perry drives and Brenda Wright waves as riders return from the Last Mile Ride on Saturday at Gifford Medical Center. Perry and Wright live in Bethel.

Linda Chugkowski and Robert Martin of Northfield earned the second place prize, raising a remarkable $3,134. Chugkowski and Martin are long-time friends who participate each year in memory of several loved ones, including Martin’s dad, Robert Martin II, and this year former Northfield Saving Bank president Les Seaver.

“It’s a great ride for a great organization. We participate to ride and remember the loved ones that we’ve lost,” said Chugkowski, who works at Northfield Savings Bank and also serves on Gifford’s Board of Trustees.

Chip and Marie Milnor, who launched their fund-raising efforts on the Tuesday before the ride, collected $2,879 in just days in honor of their friend and Braintree neighbor John Rose Sr., who was in Gifford’s Garden Room as the ride was taking place.

Last Mile Ride 2012

Volunteers Penny Maxfield and Jamie Floyd, both Gifford Medical Center employees, help man the grill at Saturday’s Last Mile Ride, which concluded with a barbecue, live music from Jeanne & the Hi-Tops, and prize awards.

“I wanted to do something for the family. What do you do? And it hit me: I’m going to do something for the Last Mile Ride,” said Chip Milnor, who set a goal of $3,000 and reached it on the Monday after the ride as money was still coming in.

“People thought the world of John,” said Milnor, who lost his friend late Sunday afternoon. “Our neighborhood is definitely not going to be the same without him.”

For Milnor, the ride was about recognizing his friend and others the Garden Room will help, and participating in a great ride.

“It’s a well put-on ride. We do a lot of rides and that one is really well organized. They do a really good job. I can’t think of anything on that ride that needs improvement. It’s getting bigger and bigger, and I hope it keeps getting bigger and bigger.

“It’s for a good cause,” said Milnor. “It’s not about the hospital. It’s about the Garden Room and what they do for the family and how they take care of people.”

Last Mile Ride 2012

Jeanne & the Hi-Tops play at Saturday’s Last Mile Ride at Gifford Medical Center.

Also supporting the event were numerous business sponsors, prize donors, volunteers and individuals lining the motorcycle route.

Led by Orange County Sheriff Bill Bohnyak with road guard services from the Combat Veterans Motorcycle Association, this year’s motorcycle ride took participants on a 75-mile loop through central Vermont. Along the way, people held up signs reading “thank you” and naming loved ones lost. Some people were openly crying. Others cheered.

Riders waved and honked and later posted rave reviews on Facebook.

“Wonderful day, great ride with great people,” wrote Roxanne Benson. “Thank you to all of those who work so hard to pull this off every year. So glad $54,000 was earned for the Garden Room.”

“Thank you for a wonderful ride and a magnificent day! Already have the calendar marked for next year,” wrote Caryn Wallace from Connecticut.

“A great time this year! Next year cannot come soon enough! A big thank you for all involved with organizing and helping run LMR ’12 and for everyone who showed up to walk, run, pedal and ride,” wrote Brian Sargeant II.

Next year’s ride is slated for Aug. 17, 2013.

Photos by Janet Miller and Tammy Hooker

Connie Niland: A lady and an optimist

Niland family carrying on ‘attitude of gratitude’ by joining Last Mile Ride

Connie Niland

Connie smiles on her 94th birthday on Dec. 24, 2011.

RANDOLPH – Connie Niland was a fearless optimist.

So even when her husband died of a massive heart attack on the day of his retirement, she carried forth with his plan to move from their home in Peabody, Mass., to Vermont.
Connie and her youngest daughter Lisa (now Lisa Hill of Bethel) moved to Barnard in 1972 when Lisa was 13 and Connie was 55.

In Massachusetts, Connie had offered guided tours of the North Shore for women, but mostly stayed home with her four children and played golf. In Vermont, Connie went to work as an administrative assistant first at Dartmouth College and then Vermont Law School. She also shoveled the roof, maintained the home and took care of Lisa and the family’s horses. The older children were already out of the house.

Connie Niland

Connie, born Constance Allington, age 7 months, sits in a high chair on her family’s back lawn in Everett, Mass., on July 12, 1918.

Connie worked until age 84 and then filled in on vacations. Lisa recalls her mom’s intellectually curiosity. “She just had this wonderful curiosity about people and ideas.” Connie loved the law school students and computer technology. She learned to Skype and text her older children. “She was as fearless as that as she was with other things.”
And she was fearless about death.

Lisa calls her mom a “buddhiscopalian.” She read incessantly about spirituality and a relationship with God.

In 2002, she moved from Barnard to an apartment in Randolph on Randolph Avenue, when the home became too much to take care of alone. “She really considered that she had moved from the country to the city,” Lisa says.

And Connie embraced her new community. She became active with the Randolph Senior Citizen Center, the Gifford Medical Center Auxiliary and began volunteering at Gifford. “My mother was just so grateful for Gifford and loved that it was such an important part of the community where she had chosen to live,” Lisa says of her local hospital.

Connie Niland

This undated photo shows a younger Connie Niland.

Connie also continued to play golf into late 80s and was such an optimist that age 90 she took out a four-year lease on a car.

Eventually rheumatoid arthritis and limited mobility would cause her to stop driving, but still Connie lived well and with her constant “attitude of gratitude.”

She turned 94 on Christmas Eve last year. After a day of visiting with family and drinking a bit of champagne – one of Connie’s favorite – Lisa called to check in. “I’m just sitting here thinking about how lucky I am and how happy I am,” Connie told her youngest.

A few days after New Year’s she had a stroke.

Connie Niland

Connie married husband William Niland in Boston in 1941. He died in 1972.

On a whim, Lisa visited on New Year’s Eve day, a Saturday, with Connie’s monthly scratch tickets and her winnings from the previous month. “When I got there, she was out of it,” says Lisa, who brought her mother to the Emergency Department. She had a urinary tract infection but a CT scan revealed nothing else unusual.

Lisa stayed with Connie in Randolph over the weekend. They cooked, laughed and giggled, and had a great time. On Monday, the day after New Year’s, they enjoyed a nice lunch. After lunch, Lisa was rubbing lotion on her mom’s face and asking her a question, when Connie failed to respond. When she finally looked up, her face pointed to one side. “I literally had her face in my hands,” says Lisa, and “It was clear that she had had a stroke.” Lisa activated Connie’s Lifeline and awaited an ambulance to bring her to Gifford.

Connie Niland

Connie poses with Karen Lyford of Chelsea at the Vermont Law School, where Connie worked until age 84.

She didn’t get better.

“She clearly wasn’t progressing. It was just clear that she had a really devastating event,” says Lisa, who was faced with the decision of moving her mother to a nursing home.

That Friday, Lisa came to the hospital ready to do just that, but Connie, who “couldn’t stand” nursing homes, had made a different decision. She had stopped eating, was growing sicker and was moved to the Garden Room for end-of-life patients at Gifford.

She was there exactly one week until her death on Jan. 13 of this year. The whole family came, all four children, including two or three who stayed over every night, and almost every grandchild. The room, which includes a patient room and family room, was filled with 12 or more people at a time.

Connie Niland

Connie Niland, 1917 – 2012

“My mother was very gracious and she loved to entertain. She had a steady stream of people (visiting her in the Garden Room), and we were loud. We sat with her and we talked about great times in our family’s life and we told the funny stories that we always told when we’re together,” Lisa recalls.

The family faced no difficult choices. Connie had made her wishes clear in “the most beautifully written Advance Directive.”

They brought her quilt from home and other comfort items were provided in a kit from the hospital. The hospital fed the family during their weeklong stay. Connie had Reiki for pain management as well as music therapy from Brookfield’s Islene Runningdeer and local hospice singing group “River Bend.”

Most importantly, says Lisa, the hospital staff preserved Connie’s dignity – an important measure for the family and for Connie who was foremost always a “lady.”

“That experience of being in the Garden Room and the support that we had was such a beautiful experience. It just was incredible to us how thoughtful everyone was,” says Lisa.

The special services Connie and her family received – the family meals, Comfort Kit and music therapy – were provided thanks to funds raised at Gifford’s annual Last Mile Ride – a charity motorcycle ride this year to be held on Aug. 18.

And this year, Lisa, her brother Richard and two friends will be participating in the Last Mile Ride for the first time.

“For us, it’s knowing what we received in the Garden Room, we want to make sure we give back a little of that so another family can have an island of calm in the middle of such chaos,” Lisa says. “Until you are there you have no idea how much you need and our family was just so overwhelmed with how much (hospital staff) did for us.”

The Last Mile Ride is supports end-of-life and advanced illness care at Gifford Medical Center, including free services for patients and their families. This year’s ride is Aug. 18. The event also includes a cyclist ride and 5K. Learn more online at www.giffordmed.org or call (802) 728-2380. Participants can register up to and on the day of the event.

Health Focus: Understanding Palliative Care

‘It’s not a death sentence.’ It’s patient-centered care.

Gifford's palliative care physician Dr. Cristine Maloney with a palliative care patient

Gifford’s palliative care physician Dr. Cristine Maloney with a palliative care patient

With three outpatient palliative care physicians, Gifford Medical Center is already offering palliative care to outpatients early in their illness. To understand the discussion, however, you must understand the meaning of palliative care.

Gifford internal medicine provider Dr. Cristine Maloney of Randolph completed a year-long palliative medicine fellowship at Dartmouth-Hitchcock Medical Center in Lebanon, N.H. In the article below from Gifford, she explains the difference between palliative medicine and hospice medicine and why more of us may benefit from palliative care than we think.

One day last fall, David Wark of West Topsham awoke barely able to breath. “I thought I was going to die. I got up and I couldn’t catch my breath.”

Besides emergency care for a truck accident in the mid-’90s, the 58-year-old hadn’t been to a doctor in well over 20 years. But after that 2011 incident, and at the urging of his ex-wife and good friend, he called for an appointment.

Gifford's palliative care physician Dr. Cristine Maloney with a palliative care patient

Gifford’s palliative care physician Dr. Cristine Maloney with a palliative care patient

A construction worker, Wark was helping with the remodel of Randolph’s Cumberland Farms, so he called nearby Gifford Medical Center.

He got in right away, undergoing pulmonary function testing, X-rays and blood work and then sitting down with internal medicine physician Dr. Cristine Maloney.

“‘Don’t bull#@*# me. Just tell me the truth,’” Wark remembers telling the doctor.

The truth was worse than he expected. Wark, who had struggled with shortness of breath for years, suffered from tuberculosis as a child, experienced asbestos exposure and smoked since his teens, had late stage emphysema, or chronic obstructive pulmonary disease (COPD).

He didn’t know it at the time, but the diagnosis meant Wark was now a palliative care patient.

“Palliative medicine is designed for anyone who has a serious illness,” says Dr. Maloney. She lists cancer, dementia, heart failure, COPD, liver disease, renal failure, stroke, cystic fibrosis, congenital malformations and extreme prematurity as examples. “It’s any illness that has the potential to shorten your life.”

For those patients, palliative medicine focuses on providing relief from symptoms, pain and

Gifford's palliative care physician Dr. Cristine Maloney with a palliative care patient

Gifford’s palliative care physician Dr. Cristine Maloney with a palliative care patient

the stress associated with having a serious illness. It involves listening to patients so their treatment is aligned with what is important to them. It works to enhance the patient’s, as well as their family’s or caregiver’s, quality of life through symptom management. And it includes an interdisciplinary team of caregivers helping to care for the patient’s diverse needs, not just treating his or her disease.

Palliative care is often confused with hospice care.

Hospice medicine is subset of palliative medicine, but is for patients nearing the end of life. Medicare defines hospice care as for a patient who two doctors have determined has six months or less to live and who understands that care going forward will be palliative, not curative, Dr. Maloney explains. Most private insurers have similar definitions, although sometimes allow patients to pursue both symptom management and life prolonging treatments.

Palliative care is offered early and throughout an illness. It doesn’t mean foregoing curative treatments. And it doesn’t mean giving up your primary care provider to meet with a palliative care physician like Dr. Maloney.

Gifford's palliative care physician Dr. Cristine Maloney with a palliative care patient

Gifford’s palliative care physician Dr. Cristine Maloney with a palliative care patient

Instead it is an extra layer of care, where a doctor spends time with patients to determine their wishes, help them understand their options and navigate the health care system, and answer their questions so they have better control over their disease and their care.

Long-time internal medicine physician Dr. Milt Fowler has referred patients to Dr. Maloney and Gifford’s other palliative care physicians. “My referrals to Dr. Maloney are to have her join forces with me in caring for patients with serious illnesses that would be helped by a team approach,” Dr. Fowler said.

“The palliative care specialty is young, but very useful. Patients who I have referred have felt our team approach has offered them more options and more availability. We have used this team approach both in office consults as well as with a number of home visits, which we often make together,” he said.

Research also backs what Gifford physicians have found anecdotally to be true.
“Many, many guidelines say this is the way to go. If you get patients onboard sooner, they do better,” Dr. Maloney says, citing studies from Massachusetts General Hospital and Dartmouth-Hitchcock Medical Center that found cancer patients undergoing palliative care had a better quality of life and improved mood, and, in the case of the Mass General study of metastatic lung cancer patients, slightly longer lives with less aggressive care.

This type of care also often produces less confusion and conflict with family or friends about a patient’s treatment goals, says Dr. Maloney.

Gifford's palliative care physician Dr. Cristine Maloney with a palliative care patient

Gifford’s palliative care physician Dr. Cristine Maloney with a palliative care patient

Over a longer appointment than the average doctor’s visit or over several appointments if the patient isn’t yet ready to discuss certain topics, Dr. Maloney determines a patient’s wishes by asking questions – without judgment – about treatment wishes; their home and financial resources, including family support and worries or concerns about their illness; their spiritual beliefs; if they want to know more about their prognosis; and their wishes should they be unable to speak for themselves.

“No one asks people what they want. They make the assumption they want the most care possible, which may not be the best care possible,” says Dr. Maloney, who often hears “I want to be home,” “I don’t want to travel to get treatment,” “I want to play with my grandkids” or even “I want to putter in my woodshed.”

Based on a patient’s wishes, Dr. Maloney then provides help achieving the patient’s goals to the best extent possible. That help might include referrals to a massage or music therapist, a visit with a chaplain or social worker, or help completing an Advance Directive and expressing wishes to family.

Gifford's palliative care physician Dr. Cristine Maloney with a palliative care patient

Gifford’s palliative care physician Dr. Cristine Maloney with a palliative care patient

In Wark’s case, Dr. Maloney prescribed breathing medications and recommended both that he quit smoking and participate in the medical center’s pulmonary rehabilitation program. He’s chosen not to pursue pulmonary rehabilitation yet, but has cut back on his smoking and says the medications have greatly improved his life.

“It’s a lifesaver. I can walk up my hill now,” says Wark, who is staying active with yard work and walking his Siberian husky dogs.

He knows “there’s going to come a time eventually that I’ll have to have oxygen.”

He’s OK with that. But he has also discussed that he doesn’t want the kind of aggressive care his own mother, for example, received for cancer. “I’d rather live a shorter life, but be more comfortable than receive very aggressive medications. I don’t like it. I don’t want it,” says Wark, who has signed a “do not resuscitate” order, which he’s shared with his ex-wife and keeps on his fridge.

And he remains upbeat about this illness.

“I’m not going to sit around and feel sorry for myself,” says Wark, who should have years to live. “It’s not a death sentence. You just have to deal with it and let the doctor help you.”

In addition to Dr. Maloney, Gifford’s palliative care physicians who can help are Drs. David Pattison, an internal medicine provider and pediatrician, and Jonna Goulding, a family physician. All three palliative care physicians serve on Gifford’s multidisciplinary Advanced Illness Care Team, which aims to promote and provide patient-focused palliative and hospice care both in the outpatient and inpatient settings.