The Kitsap doctor who left a legacy of choice in this community
Choice in religion and healthcare, especially at the end of our lives, are deeply personal. These decisions should be made by each one of us, individually. Personally, I am a fifth-generation Irish Catholic. I attend Mass regularly; my youngest son recently made his first communion and my oldest was confirmed just a few weeks ago. However, I believe that my religion does not belong in the exam room.
Professionally, I am staunchly pro-choice, a feminist, and believe birth control pills (and all contraceptives) should be readily available to those who wish to use them. As an independent private practice physician, I have the freedom to separate church and state. Unfortunately, healthcare professionals employed at hospitals affiliated with the Catholic Church do not have that choice.
When it comes to end-of-life matters, small pockets of independence do exist: at Seattle Cancer Care Alliance, End-of-Life Washington, and hospice programs not affiliated with the Catholic Church. In my last column, I introduced you to Berit Madsen, MD, the radiation oncologist who cared for Maria Meyer, the subject of that column. What I didn’t explain was that Dr. Madsen had a pivotal role in bringing Seattle Cancer Care Alliance to our community, and in doing so, she left a legacy of choice to us all.
Also by Niran Al-Agba: Losing healthcare choices means death with dignity nearly isn't an option
In 2013, Berit’s own father utilized death with dignity. He had suffered for a number of years with sarcoma, a cancer affecting tissues which support and connect the body. As healthy cells change and grow out of control, sarcomas (tumors) occur in bones, cartilage, muscles, tendons, blood vessels, nerves and skin. These tumors can be painful, particularly after they metastasize to the bones. Berit’s father was 84 when he developed painful bone metastases. Eventually, controlling his pain caused him to become less independent and functional.
Not wanting to lay in a hospital bed for the rest of his life, Berit’s father asked, “Isn’t there a pill I can take?” At that time, Harrison Medical Center physicians could honor this request for terminal patients. After speaking with his doctors, Berit’s father was able to obtain the necessary prescription to make his own choice at the end.
Berit remembers the day her father called and said he was ready to die the following Saturday. A bit surprised at first, she took the rest of the week off to spend time with her father. They made French onion soup and strawberry ice cream from scratch. These were his favorites, although he ate very little. Together, they shared the best bottles of red wine and spent time looking at photo albums from his younger days in Denmark, his travels, and of all their family celebrations. Her father told his family how lucky he felt about the life he lived.
During that final week, her father was deliberate about certain preparations. He changed the ink in the printer, filled up the car with gas, and rotated the tires on the car. He wanted to make things easier for his wife after his passing. A volunteer from End-of-Life Washington, a nationally recognized organization that provides support to the terminally ill, was there to support Berit's father as well as her entire family throughout the process. On that Saturday, he took the prescribed medication and, after a time, he appeared to fall asleep. Berit told me that it was a beautiful and sunny day. Her father died while sitting out on the deck at her home. He seemed at peace, both with his decision as well as when and where he took his last breath.
At the same time, Berit was four years into running Peninsula Cancer Care Center. After spending 15 years working at Virginia Mason, she had resigned after the organization implemented the “Toyota Production System,” a manufacturing philosophy prioritizing efficiency at the expense of patient care. Understanding patients were not cars or parts and that doctors and nurses were not mechanics, Madsen dreamed of creating a facility devoted to clinical excellence while maximizing comfort for cancer patients.
In September 2009, Peninsula Cancer Care opened to much acclaim. There was a waitlist of patients, dogs could accompany clients, and the walls were cheerfully decorated with rotating art on loan from the Bainbridge Art and Crafts gallery. The physicians and staff were like family and worked as a team. When Harrison offered to buy PCC, Berit and her partners refused. However, by 2016, declining reimbursement for radiation treatment placed survival of the center at risk.
Madsen saw the value of choice in her father’s death, so it was important when she sold PCC that patients would not lose their end-of-life choices. Madsen reached out to Seattle Cancer Care Alliance (SCCA), and after four long years the sale was finalized. While Madsen misses Peninsula Cancer Care, the transition to SCCA brought a silver lining: Madsen not only ensured high-quality cancer care remained in Kitsap County, but also left a legacy of choice to this community. She said that one of her favorite moments involved delivering the news of the sale to CHI’s then-President David Schultz.
A few weeks after the transition to SCCA was complete, Dr. Madsen moved to Maui, acknowledging the challenge of watching the clinic she poured her heart and soul into slip away. While Berit works in radiation oncology from time to time, these days she and her husband are more focused on expanding their chocolate farm.
There are fewer things more certain in life than death. Although, if we lend support to organizations aligned with choice, including End of Life Washington and other independent healthcare entities, we can improve access to death with dignity. I am grateful to Dr Madsen and hope her story inspires others to fight for choice in healthcare. Please continue to support independent physicians, physical therapists, radiology centers, laboratories and ancillary healthcare services in our community.
Dr. Niran Al-Agba is a pediatrician in Silverdale and writes a regular opinion column for the Kitsap Sun. Contact her at niranalagba@gmail.com.
This article originally appeared on Kitsap Sun: Berit Madsen left a legacy of choice in Kitsap County
