Atlanta Physician Specializes in End-of-Life Care
Written by Jan Jaben-Eilon Thursday, December 16 2010
Snapshot: Torey B. Clark 
Dr. Torey B. Clark has been the medical director of Harbor Grace Hospice in the Atlanta area since 2005. The mission of Harbor Grace is to provide end-of-life care with dignity, grace, and compassion. It has provided home hospice care to hundreds of patients since 2005, but only recently opened a 22-bed inpatient unit on the campus of Atlanta Medical Center, providing round-the-clock care to an underserved demographic of Atlantans.
Clark actively practices medical oncology/hematology and internal medicine. She is one of few physicians in metro Atlanta that is board certified in hospice and palliative medicine, and she has been recognized as an expert in the field of end-of-life care.
A New York native, Clark and her husband, Terence, an attorney who serves as general counsel for Harbor Grace Hospice, have three daughters.
Womenetics: I have heard that, as our population ages, hospice and palliative medicine are going to be a larger part of the medical field. Do you agree?
Torey B. Clark: Yes. As the population ages and with prolonged exposure to the risk factors that lead to chronic and incurable diseases, hospice and palliative care will become more integrated into the long-term care plans for management of end-stage illness, including heart disease, cancer, kidney failure, strokes, and dementia, where emphasis is placed on comfort and providing dignity and support of the patient and family unit.
Womenetics: When people think of hospice, they think only of a place to die. But it’s more than that, isn’t it?
Clark: Yes. The concept of hospice is derived from the European “resting places” for pilgrims and travelers and evolved into domiciles where people with terminal illnesses could be cared for in their final days. Although still thought of as a place to go, the majority of hospice care occurs at or in the patient’s residence, whether home, a family member’s home, a personal care or nursing home, or assisted living. Fewer than 20 percent of patients who elect their hospice benefit are actually admitted to a hospice facility, and this is usually when the medical care required is too burdensome for the caretakers to manage, either physically or emotionally.
Womenetics: How long do your patients usually spend at Harbor Grace Hospice?
Clark: The enrollment periods of hospice care are two consecutive 90-day “certification periods,” followed by unlimited 60-day periods. The majority of patients enrolled rarely make it through the first certification period and a minority beyond the second. Hence, the general rule of thumb that patients eligible for hospice care have less than six months of life expectancy. Most patients admitted to the inpatient facility stay less than two weeks.
Womenetics: Twenty-two beds doesn’t sound like a very big place. Are most hospices small?
Clark: Twelve beds is probably the average; the largest inpatient facility in Atlanta has 30 beds. The emphasis of end-of-life care is on comfort, tranquility, and is very personalized. Inpatient facilities strive to provide a home-like environment as opposed to a hospital environment and are therefore very small.
Womenetics: How did you get into this aspect of the medical field?
Clark: As a medical oncologist practicing for nearly 20 years, I have seen many of the patients under my care face the terminal stages of their disease. It is only natural to want to care for your patient during the final days, and I had already incorporated the palliative care component (symptom control) into my practice. It was a natural extension to incorporate the hospice philosophy into our decisions about end of life. I have worked with hospice companies since the early ʼ90s, and the opportunity to start Harbor Grace Hospice came in 2005. In June of this year, we opened our 22-bed facility in downtown Atlanta, in proximity to three of the largest hospitals in the city.
Womenetics: Did you want to be a doctor when you grew up? If not, what was your path to medicine?
Clark: My interest in medicine started in the 7th grade when I began studying the earth sciences. My mother was a pediatric nurse, and as a child I was frequently in the hospital environment. I participated in an advanced summer science program at New York University Medical School while in high school, and the path was set.
Womenetics: What are the advantages and disadvantages of home hospice versus in-patient hospice?
Clark: The most common issues faced in hospice care are facilitating relief of pain and other distressing symptoms and patient and family support. But frequently, the most burdensome obstacles to care are psychosocial: Is there an adequate caregiver; financial burdens; obtaining equipment and supplies; complicated medication administration. For many, these needs can be met by the family, with the assistance of the experienced hospice team. For some, these care needs can only be met in the inpatient facility. The choice of home versus inpatient care setting is highly individualized. The home setting provides familiarity for the patient and convenience for the family; the inpatient facility provides round-the-clock care by trained professionals and rapid access to equipment and medications to enhance comfort.
Womenetics: Does it take a special kind of person to work with terminally ill patients all the time?
Clark: Yes. Care of the terminally ill is definitely a calling, and there is special skill needed to be able to give bad news and provide empathy without pity or judgment. Hospice care as we know it was originally provided by the Catholic nuns in England and Ireland, without regard to race, religion, or ability to pay. This tradition of service has continued to today.
Womenetics: What do hospice workers need to do to balance their lives? What do you do?
Clark: This is the hardest question of all. Striving for balance is very difficult. Both my oncology and palliative care practices require dedication and many hours, and it is sometimes impossible to find personal or recreational time. I am fortunate to have a supportive family, and we enjoy the time we spend together for meal time, movies, and entertainment. I enjoy reading (fiction), shopping, and gardening.
Jan Jaben-Eilon was a founding staff writer of the Atlanta Business Chronicle. Since then, she has been the international editor of Advertising Age magazine and has written for such publications as The New York Times, International Herald Tribune, Washington Journalism Review, and Consumer Reports. She is the author of soon-to-be-published (There is) Life After Cancer. Jan and her husband have homes in Atlanta and Jerusalem.
