Doctor at Joliet Hospice catered to the needs of dying patients

JOLIET – In 1990, when a physician friend asked Dr. Raymond Orenic of Joliet to help with a hospice program, Orenic had to admit he knew little about hospice care.

“I had to extend my knowledge about end-of-life care and terminal illnesses,” Orenic said. “I had to learn to refocus on the patient, not the disease.”

But, Orenic said, it was an easy transition for him, and he cared for hospice patients until he retired a few weeks ago. Over time, Orenic refined his care, focusing on the dying individual and his or her family, not simply on treatment.

“I had my eyes opened many times as to the proper way to handle a situation,” Orenic said. “People have a right to choose what they want done. Some want all the treatment in the world; some just want to be comfortable and let the natural course of events take over. We should understand and respect that.”

Over the years, Orenic has worked in private practice and at the Glenwood Medical Group. For the past 25 years, he has been at the Joliet Area Community Hospice as its sole full-time physician.

Path to medicine

Orenic had several reasons for choosing a medical career. He was a good student, so when a biology professor urged his students to do what they did best, Orenic chose medicine. It was a challenge, he said, but it made his parents – who had little formal education – proud.

Most physicians starting out in 1972 became general practitioners, Orenic said. There were few specialists, and Orenic said he often treated several generations of the same family.

“It was an honor and a pleasure to take care of people I knew,” Orenic said. “In the old days, the GP looked after family and patient as a person, from birth to death. Some of that was lost as we became a profession.”

The Joliet Area Community Hospice was the first free-standing, in-patient hospice unit in Illinois, and Orenic said he believes JACH still is the best. Just four people served it when it opened, Orenic added.

It has since grown to 140 people, including one full-time physician, several part-time physicians, nurses, social workers and chaplains and 250 trained volunteers, Orenic said.

During his time at JACH, Orenic also witnessed the beginnings of the Medicare program.

“Medicare benefits lots of folks,” Orenic said. “Like most things in medicine, there is a business aspect. I’m not sure that medicine has changed, but the rules have changed.”

Often, these rules are made by people not operating the program or without sufficient physician input, Orenic said. During the past two years, Orenic has noted about 20 changes regarding rules for visiting patients and how it’s reported, as well as electronic record keeping.

Restoring dignity

Still, for all the changes, hospice care restored the dignity of the dying patient, which Orenic appreciated.

“In the old days, we had hospice-like care and catered to the needs of the dying patient,” Orenic said. “Most families died at home. Mine did. Hospice was a way back to that.”

Orenic enjoyed mentoring senior medical students and giving them opportunities to see hospice doctors, nurses and chaplains in action. Although many of those students chose family surgery, he believes they gained valuable perspective on the essence of hospice care.

“I think the rules on how you live your life direct how you handle hospice,” Orenic said. “Follow the Golden Rule: Treat people like you would like to be treated.”

The skills necessary for hospice work are different when it comes to dosages or combinations of medicine, Orenic said. But the challenges of medicine – such as constantly being on call – can make one weary over time.

At 75, Orenic believes it is a good time to retire. He’s looking forward to traveling and to maybe sleep in once in a while.

“It has been my honor and privilege to be a hospice physician. We’ll see how retirement goes,” Orenic said. “I hope it is half as good as it was when I was working.”

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KNOW MORE

According to the National Hospice and Palliative Care Organization at www.nhpco.org, it's a good idea to discuss end-of-life care before it is needed:

• Hospice care starts as soon as a formal request or a “referral” is made by the patient’s doctor.

• For each patient and family, the hospice interdisciplinary team writes a care plan with the patient/family.

• The frequency of volunteers and spiritual care often is dependent upon the family request and the availability of these services.

• Most hospices have nurses available to respond to a call for help within minutes, if necessary. Some hospice programs have chaplains and social workers on call as well.

• Hospice staff receives special training to care for all types of physical and emotional symptoms that cause pain, discomfort and distress.

• Hospice volunteers generally are available to provide different types of support to patients.

• Hospice services can be provided to a terminally ill person wherever they live.

• There are state licensure requirements that must be met by hospice programs in order for them to deliver care. In addition, hospices must comply with federal regulations in order to be approved for reimbursement under Medicare.