ARUN RATH, HOST:
Facing the end of life is never easy, but it can be even harder for people in remote, rural areas. One doctor here in California is struggling to care for such patients in their own homes. To make that work, he's turning to the entrepreneur model for a new kind of start up. April Dembosky of KQED explains.
APRIL DEMBOSKY: Dr. Michael Fratkin is getting a ride to work today.
MARK HARRIS: Clear prop. My name is Mark Harris. I'll be your pilot today.
DEMBOSKY: They buckle into this Cessna 182 named Thumper. It takes off from a tiny airport in Eureka, California, 300 miles north of San Francisco. It's a 30 minute flight from here to the Native American reservation in the Hoopa Valley, where Fratkin's going to visit a patient dying of liver cancer.
MICHAEL FRATKIN: A good number of patients in my practice are cared for in communities that have no access to any hospice services.
DEMBOSKY: Fratkin's here to see a man named Paul James. Everybody calls him Pop. It's a visit his wife Cessie has been waiting for.
CESSIE ABBOTT: Doctor Fratkin has kind of been my angel to me, because he gets Pop to open up where he don't open up to me. Then I get to hear how he feels when he doesn't let me know, because he's trying to be strong for us I think.
DEMBOSKY: Paul and Cessie know he's dying, but it's hard for them to talk to each other about it. Cessie tells Fratkin that the pain in Paul's belly has been getting worse.
ABBOTT: He's like moaning in his sleep now.
FRATKIN: Have you ever taken morphine tablets?
ABBOTT: It don't work now.
DEMBOSKY: This is what palliative medicine doctors do - tweak meds to better address pain, nausea, breathlessness. They also try to have frank conversations with patients about death. Fratkin believes there should be a spiritual component of this discussion, too. Cessie says she's been hearing Paul praying when he's alone. Fratkin asks him to light some Indian root and say a prayer now.
PAUL JAMES: Great spirit, that created this earth and brought all of our people here...
DEMBOSKY: By the time Fratkin flies back from the Hoopa Valley, he's spent half a day with one patient. This is something the hospital in Eureka just can't afford for him to do. Fratkin says he's under constant pressure to see patient after patient to meet the hospital's billing quotas.
FRATKIN: It's very hard for one doctor to manage the complexity of each of these individual patients and to crank it out in any way that generates productive revenue.
DEMBOSKY: Fratkin's convinced he can't provide this kind of palliative care within the healthcare system. So he quit and is launching a startup.
FRATKIN: I had to sort out an out-of-the-box solution.
DEMBOSKY: His idea is he'll have no office, no clinic. He wants to put those overhead costs into hiring a team of people who can travel to see patients at home. When time is short, he plans to use videoconferencing.
FRATKIN: So that we're staying on top of their needs and not burdening them with the need to come to the office.
DEMBOSKY: The key challenge is financing his big idea. Government programs like Medicare and Medicaid don't pay for video sessions from home, and they pay poorly for home visits. Fratkin's solution so far is a crowdfunding campaign. He's looking for foundation money, and he's even hoping some of his patients will pay out-of-pocket for his services.
Back at the Eureka airport, Fratkin hops into his blue Prius and drives 20 minutes north to see his next patient. Mary Maloney is dying of esophageal cancer. She tried chemo for a while, but it made her feel awful. Fratkin was the one who told her it was OK to stop.
MARY MALONEY: I mean, I love life. I don't want to let it go. But I don't know if I'm willing enough to put myself through all the things I would have to put myself through.
DEMBOSKY: About a month after Fratkin's visit to the Hoopa Valley, Paul James passed away. Fratkin hopes to provide the same relief and respect at the end of life to all of his patients. Like his young Silicon Valley counterparts, Fratkin thinks his start-up will change the world. He's also up against similar odds. Most startups don't succeed. For NPR News, I'm April Dembosky in Eureka, California.
NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.