SPRING HILL — Dr. David McGrew knows well just how precious life is, especially the final moments, when apologies, regrets and forgiveness are no longer concerns that can be put off.
Through three decades as a tending physician and medical director for HPH Hospice, McGrew can recall thousands of happy endings when family members gathered to comfort a loved one and worked together to help make the transition from the living world a loving, peaceful one.
McGrew believes there is no reason a life should end any other way, and has always preached a humane approach to end-of-life medicine.
"The truth is, modern medicine isn't aware of just how poorly it serves those who are facing end-of-life circumstances," said McGrew, 55. "They are often hauled through an endless stream of treatments that often bring little or no benefits. Seldom are they encouraged to accept death as an inevitable part of life."
McGrew proudly admits that his philosophy toward death is a reasoned one, cultivated through countless experiences, both personal and professional, that have earned him accolades from nearly every facet of the medical community.
In recognition of his accomplishments, McGrew was recently named by his peers in the American Academy of Hospice and Palliative Medicine as one of the world's 30 most influential leaders in hospice care.
Previously, in 2009, he was presented with the Josefina B. Magno Distinguished Hospice Physician Award, an honor reserved for doctors who have helped to advance palliative care in their communities.
Steve R. Smith, executive director and CEO of the academy, said in a statement that McGrew's most recent honor "recognizes key individuals who have been critical in building and shaping our field over the past 25 years. These individuals represent thousands of other health care professionals that provide quality medical care and support for those living with serious illness — each and every day."
Indeed, those familiar with McGrew's long service with HPH Hospice in Pasco, Hernando and Citrus counties know that he has been preaching the gospel of a "good death" nearly as long as the nonprofit organization has been in existence. Over the course of his career, he has fought more than his share of battles, often against a stubborn medical community, which every year welcomes advances in the treatment of the terminally ill.
McGrew, who said he was honored to receive one of the highest awards given in his field, likes to point out that many treatments intended to extend a patient's life come with a high price as far as quality of life is concerned, and there is substantial evidence that they do little or nothing to prolong it.
"A doctor's primary mission is to make people well, and that's something our society relies on," McGrew said. "But for patients who are not physically able to withstand treatments, or choose to forgo them, the ability to decide how to spend their remaining days is paramount to their happiness. That aspect is what we concentrate on."
McGrew's introduction to palliative care came in the mid 1980s, when the hospice movement was just gaining a foothold in the United States. Up until then, patients too ill to be saved were often shuffled to the end of a hospital hallway and forgotten. The son of one of Spring Hill's earliest physicians, McGrew was asked to attend a small conference in Colorado for primary care physicians interested in a more practical way of approaching care of patients suffering from terminal illnesses.
"There were only about 30 of us, and most of the doctors were from outside the country," McGrew recalled. "But what they were discussing was a radical departure from the way we had been treating seriously ill patients."
The idea of focusing more on a patient's late-stage essential needs rather than medical management of the illness intrigued him. He returned to Spring Hill and gave up his private practice in favor of lending his services to the fledgling HPH Hospice, then known as Hernando-Pasco Hospice. He managed to convince his late friend and fellow University of South Florida alumnus Dr. Joe Wheeler, a noted vascular surgeon, to join him. Through the years, they and a handful of other like-minded physicians worked tirelessly to turn the tide in Hernando County's medical community and how it perceived palliative care.
McGrew and his team of 13 physicians are in constant pursuit of what they, the patient and family members feel will provide the most comfortable outcome in the end stages of life. Unnecessary medicines that are apt to cause nausea, shortness of breath and discomfort are dropped in favor of treatment that improves cognizance and awareness. McGrew said that many patients actually experience an improvement in their quality of life while often prolonging it as well.
In addition, HPH doctors offer counseling to family members and encourage them to focus their efforts on the patient and activities that bring the person joy.
"Most of the time, a very loving environment evolves, even when there wasn't one before," McGrew said. "In time, the negatives tend to fall away one by one, and are replaced by more and more positive emotions."
He said that if he had one future wish that could be fulfilled, it would be to convince caregivers to provide the terminally ill more end-of-life services sooner. But the subject, he says, is still a touchy one with many physicians.
"There will probably always be a clash of philosophies in the medical community when it comes to palliative care," McGrew said. "The important thing is that we continue to do what we do and that people in the community who believe in what hospice does continue to support it."
Logan Neill can be reached at firstname.lastname@example.org or (352) 848-1435.