Man On A Mission
Near-death experience prompts oncologist to shift his focus to end-of-life care.
By Barbara Lewis / Contributing Writer / Detroit Jewish News
Jeffrey Forman stared down a life-threatening illness and emerged a changed man.
Forman, 60, of Bloomfield Hills was a nationally known radiation oncologist with a thriving practice. He was fulfilled in his career as well as his personal life, with his wife, Miriam, his three adult children (including one who is an oncologist) and his three grandchildren.
Then the doctor became a patient, and his life changed course.
Now, Forman is the medical director for Jewish Hospice and Chaplaincy Network (JHCN) and its palliative care program, LifeLinks.
LifeLinks provides in-home nursing and support services for people with serious, chronic illness who don’t meet the hospice requirement of a six-month prognosis. The emphasis is on palliative (comfort) care. LifeLinks also provides support services for caregivers.
Forman grew up on Long Island, graduated from Union College and New York University’s medical school, then did specialty training at Johns Hopkins.
He says he chose oncology during a medical school psychiatry rotation. He hated psychiatry, but he was deeply affected by one of his professor’s patients, a woman his age dying of Hodgkin’s disease. She was sad and terrified, and Forman decided he wanted to help people like her.
In 1988, he moved to Michigan to join the medical school faculty at University of Michigan. From there he went to Karmanos Cancer Institute in Detroit and served for 20 years as chairman of the radiation oncology department at Wayne State University’s School of Medicine.
Forman had left Karmanos and was working for 21st Century Oncology, the country’s largest private oncology practice, when he was diagnosed with myelofibrosis, a fatal bone marrow cancer. The only treatment is a stem cell/ bone marrow transplant, which he underwent at City of Hope Medical Center in Duarte, Calif., in May of 2016. He was there for four months.
About 10 days after the transplant, before the new bone marrow had a chance to start working, he suffered a massive infection that caused respiratory, heart, kidney and liver failure.
Forman wasn’t aware of how dire his situation was because he spent more than a week in a medically induced coma. His physicians and family had just about given up hope when, on the 18th day post-transplant, his bone marrow finally took hold and fought off the infection. His heart, lungs, kidneys and liver recovered.
“Doctors who hear this story can’t believe I’m still alive,” he said.
As he healed, Forman realized he no longer had the stamina to work the 60-hour weeks he’d put in as an oncologist, and he started thinking about alternatives. He remembered the young woman with Hodgkin’s disease he had met as a medical student, and realized that what had so touched him about her was not so much that her cancer was incurable but that she didn’t have the support she needed to find peace as she neared her life’s end.
“She wasn’t being well treated because she wasn’t getting the help she needed with the process of dying,” he said.
Forman had volunteered for Jewish Hospice and Chaplaincy Network before he became ill and thought end-of-life care was an area where he could make a difference. He talked to Rabbi E.B. “Bunny” Freedman and Rabbi Joseph Krakoff, the program’s directors, about expanding his role with JHCN.
“About a year ago, when he was beginning to feel better, Dr. Forman approached Bunny and me and asked if we’d be interested in deepening our relationship with him on a more permanent basis,” Krakoff said.
He and Freedman were ecstatic, realizing that Forman’s presence would be of huge benefit to the organization. “We looked at each other in disbelief,” Freedman said. “We couldn’t have even dreamed such a thing would be possible.”
MAKING AN IMPACT
Forman is the organization’s first medical director. When the program started in May 2015, it had a handful of patients; now LifeLinks cares for an average of 80 people a day. Most patients come to Jewish Hospice and LifeLinks through physician referrals. Krakoff said before Forman joined them they had little professional credibility with physicians, who saw them as kind rabbis who wanted to help.
“With Dr. Forman, we have gained the medical expertise that is extremely compelling to doctors,” Krakoff said. Physicians are increasingly seeing JHCN as a way to help their patients with incurable illnesses. “Not only is [Forman] a mensch in every sense, but he is smart, thoughtful and deeply respected throughout the medical community.”
LifeLinks’ services are similar to those of hospice, including in-home nursing, nutrition advice, help with social networks and family interaction, and spiritual support. But unlike hospice care, in-home palliative care is not reimbursed by insurance. JHCN never charges patients and their families for services, so most of the professionals who work for LifeLinks are volunteers. As medical director, Forman oversees patient care and serves as a resource to other staff. He educates community healthcare professionals about JHCN/LifeLinks and seeks grants and other modes of funding. In November, he coordinated a conference attended by more than 200 physicians about talking to patients about serious illness.
Community doctors are increasingly receptive to LifeLinks, Krakoff said.
“LifeLinks extends physicians’ reach into a patient’s home,” Forman said. “It takes a big burden off them. And when patients don’t have to make so many repeat visits to the office, the doctor has more time to spend with them when they do come in.
“We’re not competing with the physicians; we’re not trying to take their patients away. We’re helping to fill a gap.”Forman describes LifeLinks as “anti-entrepreneurial” because under current insurance reimbursement models, it doesn’t bring in any income.
But Freedman and Krakoff hope Forman’s medical credentials and business savvy will help convince funders that LifeLinks is a sound financial model.
Forman recently secured a large grant from the Michigan Health Endowment Fund that includes a rigorous data collection component. LifeLinks is now measuring the number of days its patients spend in the hospital, the number of emergency room visits, the number of days in intensive care and the number of visits to the doctor’s office.
For most patients, these measures decrease significantly once they join the program, meaning the cost to insurers would be lower — if only insurers covered LifeLink’s services.
Forman says he hopes his research will convince the Centers for Medicare and Medicaid Services that programs like LifeLinks add value for the patient while reducing costs. If government payers start reimbursing providers, private insurers would likely follow suit. He feels the field of in-home palliative care is bound to grow and to become as accepted as hospice care.
PATIENT PEACE OF MIND
For patients and their families, the benefit of LifeLinks is not economic; it’s the tremendous increase in comfort and reassurance they feel, Forman said. Receiving more care at home, along with social and spiritual support, gives them peace of mind.
Janet Levine of Huntington Woods turned to LifeLinks last spring when her husband, Ellsworth, “Ells,” was struggling with Parkinson’s disease and depression.
As a longtime Jewish communal volunteer, Levine was familiar with Jewish Hospice and Chaplaincy Network. The rabbis came to visit, followed by social workers, who explained the LifeLinks program, and a nurse.
“They were just there for us. They provided emotional and spiritual support, which we really needed,” she said. “It’s an invaluable part of our community.”
Forman has started exploring ways LifeLinks can provide increased support to family caregivers of its patients. Caregivers often neglect their own wellbeing and hesitate to ask for help for themselves. They are relived when they learn that someone is interested in them as well as in the patient.
Recently, LifeLinks started adding “enrichments” to the patient experience. Musicians visit to play and sing for them, through the late Carole Jo Lasser Fund for Music Enrichment. Beauticians style hair and do manicures. Plans are afoot for art and pet therapy and life review activities.
LifeLinks is unique in the United States, Freedman said. “There is such a need, but not many hospitals or physician groups are willing to take on patients they don’t get paid for.”
Because LifeLinks is not covered by insurance and patients are never charged for any of the services, the program relies on donations and grants.
While he misses his oncology colleagues and his patients, Forman is happy in his new career. “It’s the most meaningful work I’ve done in a long time,” he said. “It’s been rejuvenating.===
LifeLinks helps those who have a terminal illness and are not ready for hospice, have distressing symptoms or progressive decline, require symptom management at home or wherever they live and those who wish to avoid multiple emergency room visits and hospitalizations. The program helps homebound patients and their doctors manage active cancer; end-state heart, lung and kidney disease; progressive neurological diseases such as dementia, Parkinson’s disease, MS or ALS. There is no charge for help. To learn more about LifeLinks, call (248) 592-2687