Old-style doc says house call is best medicine

BY JIM HALL

Dr. Wayland Marks tried to deflect the praise coming from Dorothy George, but she was having none of it.

“Quit trying to minimize yourself,” she told him. “They really do need to get more people like you out here.”

Marks, a geriatrics specialist, had treated George and her multiple health problems for years. However, he was retiring, and his visit to her home in April would be his last.

“I never dreamed when I got on like this that I’d ever be able to deal with it, that somebody would come to my house like you have,” she told Marks.

Marks was uncomfortable with George’s praise, but not her point. He too believes that the elderly can do better at home rather than in a hospital or nursing home, and that less medicine can be better for them than more.

“We need to meet their needs with less hospital care, fewer scans and a greater emphasis on providing care in their homes,” he said.

Marks’ retirement last month ended one of the region’s unique medical practices. It also gave him pause to reflect on the “frail elderly,” as he calls them, and the best way to care for them.

Marks started work in the Fredericksburg area as an internist 31 years ago. For more than 17 years, he had an office practice in Fredericksburg with Drs. Rebecca Bigoney and Patrick McManus.

Later, he became one of the area’s first geriatricians, or specialists in the care of the aged. He helped found the Senior Care Center at Mary Washington Hospital and was a full-time employee there. He also served as medical director for three local nursing homes.

For the last 10 years, he was a solo practitioner and one of the region’s few traveling physicians. Five days a week, he loaded patient files and a canvas medical bag into his Toyota Highlander and traveled throughout the region.

He visited assisted-living centers and patient homes, such as George’s in Stafford County and Frances Garnett’s house in Fredericksburg.

Garnett has end-stage dementia. She appears to be unaware of her surroundings and requires total care. Her nine children work in shifts to provide for her.

“We wouldn’t have it any other way,” said Ronetta Walker–Brown, her daughter.

Because of the travel, Marks saw only six to nine patients a day. A doctor with an office practice might see twice that many.

Most of Marks’ patients were in their 80s and 90s. His oldest patient, Ethel Davis, was 107 when she died April 30.

Many of his patients had the common ailments of later life: heart disease, lung disease, cancer, dementia, diabetes or persistent pain.

Many of his patients never left their homes. A few never left their beds.

George, 76, uses a power chair to move about her house. When Marks saw her in April, she had not left her home for four months.

A ‘SNAZZY’ PHYSICIAN

All Marks’ patients were insured by the federal health insurance programs Medicare or Medicaid, or both. Marks visited them when they were sick or once every three months for checkups.

He is a trim man of 69 who rises early each morning to run, swim or bicycle.

He shuns the lab-coat look, preferring instead a button-down shirt, khaki pants and hand-tied bow tie.

“I go around telling all my friends, ‘You should see this doctor that comes to see my mom. He is so adorable with his snazzy bow tie,’” said Leslie Laposka, daughter of Jean Torgerson.

Torgerson, 98, lives with her daughter in North Stafford. Marks visited their home to take her vital signs, refill her prescriptions and see how she was doing.

In April, Torgerson was seated on the living-room couch when Marks arrived. He sat beside her, put on a pair of surgical gloves and checked her blood pressure and pulse.

“Do you know what? It’s come back,” she told him.

“Are you serious?” Marks replied.

“I’m dead serious,” she said.

Torgerson was referring to the lump in her right breast. She had surgery last year to remove a malignant tumor and was one of the oldest breast-cancer patients Marks had ever had.

Now she was reporting that the lump had returned.

“Isn’t that a God-awful thing?” she said.

“Yes, if it has,” Marks said.

Marks quizzed her about pain or discharge, then followed her to the bedroom to examine her. When they returned, he told Torgerson and her daughter that he would talk to the surgeon who did Torgerson’s operation.

“I’m cautiously optimistic this won’t be a major problem,” he said.

Torgerson was doing well otherwise, and when Marks left the house, he told her and her daughter, “Good job.”

Marks repeated these words at every stop. He praised family members, he said, because he’s seen how demanding home care can be.

“You’re doing all the work,” he told family members.

A CALMING INFLUENCE

At the home of Anatoly Trepatschko in North Stafford, Marks held up a notebook and said, “Look at this. They are so thorough.”

Trepatschko, 69, suffered a stroke in 2008. Since then, his family has cared for him in their home, keeping a daily log of blood-pressure and blood-sugar readings.

At Aulis Williams’ house in Fredericksburg, Marks praised Sandra Brooks, Aulis’ stepdaughter and caregiver.

He pointed out that Williams, 87, had gained weight since his last visit, and that his legs were not as swollen.

“He’s still a little stubborn when it comes to keeping his stockings on and keeping his feet elevated,” Brooks said.

Family members said they appreciated Marks’ praise, but, like George, they refused to let him minimize his role.

They are able to care for their loved ones, they said, because someone like Marks is there to back them up.

“He takes the stress level of patient care all the way down,” said Nick Trepatschko, who helps care for his father.

At Kate Johnson’s home in Fredericksburg, Marks quizzed her son, David Johnson Jr., about her blood-sugar levels.

“What’s her 70/30 in the morning?” Marks asked.

“I’m getting a 42 in the morning,” Johnson replied.

That number was too low, and Marks told David Johnson to reduce the evening dose of his mother’s diabetes medicine.

Kate Johnson, 89, suffered a stroke in 2005 and has been in bed ever since. Johnson cares for her in their home, with help from Tilisha Minor, a nursing assistant.

“Dr. Marks is one of the coolest guys I know,” David Johnson said. “There were times when I first started out that I would be in the panic mode. He’d be very calm. He’d bring me down and walk me through everything.”

Kate Johnson takes eight medicines each day and requires almost total care. David Johnson was told after her stroke that she would not live long. Yet, she has thrived under his care.

As Marks said, “David, you’ve done a great job.”

BETTER MODEL FOR CARE

Marks said he’s seen it often: Patients with complicated medical problems, such as diabetes or congestive heart failure, doing well at home with care from their families and backup from a medical professional.

“Most of the elderly would rather be cared for at home, even if they’re ill,” Marks said.

What usually happens, however, is that elderly patients get sick and end up at the hospital.

There they undergo tests, scans and procedures. Afterward, they are discharged to a nursing home for rehab. Some never leave the nursing home, while others eventually return to their homes.

This cycle is expensive and often does not result in better outcomes for patients, Marks said.

“It’s usually a continuous decline,” he said.

Marks said his practice offered a glimpse at an alternative way. He would prefer to see the elderly living at home and cared for by their families, he said.

When the elderly person gets sick, the family could call a home-care team that would respond quickly.

The team would include a physician leader, nurse practitioners, home-health nurses, hospice workers and mobile X–ray and lab services.

With help from one or more team members, the patient could avoid hospitalization and a nursing-home stay, Marks said. Care under this plan would be cheaper and often better, he said.

This model would not work for all, Marks said. Many of the elderly don’t have families, and many family members are working and can’t stay home with their loved ones.

But for others, the focus would be on providing less, rather than more, high-tech in-hospital care, Marks said.

“Care at home, even during an illness, is reasonable,” he said.

FAMILIES SAD TO SEE MARKS GO

The families that Dr. Wayland Marks served said they were happy that he was finally able to retire. But they also were sad to see him go.

“I’m going to try not to cry,” said Linda Davis when Marks came to her home in Stafford County in April.

Marks had been visiting the Davis home for several years to help care for Ethel Davis, Linda Davis’ 107-year-old mother-in-law.

Marks told Linda Davis that he had made arrangements for Ellie Gibberman, a nurse practitioner at Senior Care Geriatric Medical Center, to take over for him.

Even so, Davis said she was heartbroken.

“I feel so lost,” she said. “We’ve built a lot of faith in you over the years.”

Ethel Davis may have felt similarly. In what was probably a coincidence, she took to her bed and stopped eating soon after Marks’ visit. He arranged for hospice care for her, and she died on April 30, his last day on the job.

—Jim Hall

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