Looking at the accomplishments he has garnered in his 40 years as a physician, what stands out about Dr. Alexander Nesbitt is that he not only has excelled in his field, but he has focused on helping people navigate life, from its beginning to its end.

Nesbitt, who is retiring as the medical director of Susquehanna Hospice and Susquehanna Palliative Care, recently reflected back on his career, which began as a Family Practice physician.

“For a little over 20 years, I was a family physician, and loved that very much, and delivered babies for 10 years and saw my patients in their home and wherever. So I really loved family practice very much,” he said.

“I started doing hospice, kind of on the side. So when I was still a family physician, I’d come over and meet with the hospice team, and then I heard of palliative care, which at that point was this new area. It wasn’t a thing in American medicine until about 25 years ago. Working in hospice, I went to a conference, and they were talking about palliative care, end of life care, and what could be done. And in that conference, honestly, I had this sense of, man, this is really important, somebody should make these changes and do palliative care at Williamsport. Who would do that? I don’t think there’s anybody who’s going to do it. I think it would have to be me,” Nesbitt said.

By the end of the talk, Nesbitt said, “I just had this feeling of dread, like, oh man, I’m probably gonna have to stop being a family physician to do this. I really should. I really should do this.”

It was at that point in his career that he trained and got certified in Palliative care. He would see people in his family practice office and then go to the hospital and consult with the hospice team. After a year and a half of doing that, he stopped his family practice and started doing hospice and palliative care full-time.

“For me, that was hard, because I really loved the family practice. You know, in family medicine, you get to know your people very well, and I got close to families. So that felt sad in a way, but I just felt like it was really important, I should do it,” he said.

Nesbitt was also instrumental in seeing the Gatehouse established at the Divine Providence Campus. He explained why it was important to offer an in-hospital, family-friendly setting for families who are facing the end of a loved one’s life.

“Part of why that was, was when we’re taking care of people in the hospice, you know, most people want to be in their own home as they’re going through their time. Hospice is all about trying to make sure that you get whatever you need at home so you can stay home,” he said. “But occasionally things get terrible. Somebody’s wildly confused, punching out their caregiver, bleeding out, screaming in pain. And even with all of what we do, and we do a lot of stuff in the home, you just can’t get a grip on this at home and in that situation, well, then what happens? Well, you can put the person in the hospital, but if the person says, I don’t really want to be in the hospital with tubes and poking at all, I don’t like being there. Or you could put them in a nursing home — don’t put dad in a nursing home, my gosh, he never wanted that,” Nesbitt said.

“So having a unit where it could be home-like, best we could, but rules, regulations, no poke and no jabbing, but where we can do whatever is needed to take care of these symptoms, even using complex interventions that normally could only be done in the ICU, but we’ll do that if this is what needs to be done to control this pain or this wild agitation or this terrible shortness of breath, or whatever suffering there is,” he said.

For about a year he said that he had looked for somewhere to start it, finally landing at the third floor of Divine Providence.

“The goal is that is part of the hospice system, but a unit where we can do intensive management of symptoms or problems that come up for somebody who can’t control this very well at home Almost half the people who come in with terrible symptoms, we get things adjusted, they’re doing better, and now we get the person at home on this pump or on this other combination of medicines,” he said.

He added that the other half of people who enter the Gatehouse are so sick that they spend the end of their life there.

“It’s turned out to be very, very helpful. I think most people who go there feel like this is helping. The nurses are great,” he said.

“I must say that when we started it, I was like, man, is this gonna work? Who’s are we gonna get to staff it? This is hard, this is scary, this is sad, but I feel like it is super fortunate that the right people stepped up, and we have just really great, great staff,” he added.

Part of his worries stemmed from the fact that inpatient hospice units are not money makers and usually lose money in the healthcare system, so can it be sustained?

“We lose money every year, but we work to make sure we’re losing small enough that when people make donations…and donations sit in the foundation, and it builds up enough that we can draw down to be even where we’re not making pile of money, but we’re not losing enough money to be a problem. We’re filling the gap, and that has allowed us to keep on doing what we’re doing,” he said.

Leaves vine their way along the walls of the Gatehouse. Each one inscribed with the name of a loved one who has passed, whose family has donated to help the Gatehouse continue to serve others.

“So that sort of thing has helped us be able to sustain what we’re doing, and it’s been really good in that when we were building that place, trying to set up a system that really feels not just like this is the medical care, but this is caring for this person, and not just this person, but their loved ones also in the best way,” Nesbitt said.

“When we started it, I had read about a program in Washington state that had blankets quilted for people in hospice. I thought that’s a great idea. Maybe we could have that here. We started this program called “Blankets of Love,” where anybody who comes in there, we give them a quilt or an afghan that’s been made by people in our community. And this is what’s covering the person while they’re there. And if they die while they’re there, the family can take that home. This is what covered dad during the dying time, which often is really a precious thing for them,” he said.

Those who are able to leave the Gatehouse also receive a blanket.

People from the community often bring in food for the families of the loved ones who are there so that they have something to eat.

There is also a group — the Gatehouse Singers — who come and sing for those who are dying, either at the Gatehouse or at home.

“Singing is really this neat thing for a lot of people. Music gets in, in a way that just talking doesn’t. Sometimes we’ll be singing for somebody and the patient or the family, are singing along with us, and it’s this human connection that’s a wonderful thing,” Nesbitt said.

“We’ve had some artists who have dropped off pictures that we have over there, photographs or pictures, and they’ve made this for the Gatehouse. So I have perceived it as just this wonderful spot where people in our region are able to help and support strangers. They don’t know that people are going to be coming. But let me just kind of help out in this way. It’s been really, really great,” he said.

Nesbitt acknowledged that hospice and palliative care have changed since he first entered the field.

“A lot, actually, nationally, a lot of change, and in our region, a lot of change. So, you know, honestly, a part of that is what drew me into doing this — like I should do this, because there’s a lot of things that can be changed to make it better. When somebody’s really sick and it’s really scary, and there’s all these options and choices and they’re not really sure. How can we make sure that we understand what the person most wants and that they have the support that they need as they’re bumping their way through their care,” he said.

“The way I think of it, palliative care, 30 years ago, there was no such thing. You were either in hospitals or you were in regular care, and now we have a well developed palliative care team, so that we’ve got a bunch of nurse practitioners and doctors in the hospital. We have nurse practitioners who go see people at every nursing home. We have those who go out and visit people who are at home. We have doctors who see people in the office. So seeing people who aren’t really ready for the hospice — they don’t need that now — but boy, are they sick, and they’re having a lot of symptoms and issues, and we can help them in a more thorough way as they’re bumping their way through their illness going forward,” he continued.

“Then if they get to a point where they’re ready for hospice, we can help get them into hospice care in the right way so there’s a much more thorough support across all different sites of care, in the home, in the hospital, in a nursing home,” Nesbitt said.

He noted that when he first started in hospice care, they would take care of about 30 people at any given time whereas now they care for about 150 to 170 people.

“So, it’s much more and that’s not that there are more people in our region dying than there were back then, it just mean that I think that for people who are approaching their dying time and needing hospice service, we’re much more able to get help for them, even if they live an hour away from here, up north, down south, all over. Even if they need interventions to control their symptoms that 20 years ago, we’d say, I’m sorry we can’t do that as a part of hospice. Now we can do that,” he said.

“You have bad anemia because of your myelodysplasia, and when you get super anemic, you’re so tired you can’t get out of bed, and you need a blood transfusion to perk you up because your son’s getting married next week, we can arrange for you to have a transfusion to help get you through that, to improve the quality of life during this time. Or you’re building up fluid, and we need to put in a tube to drain that fluid. Twenty years ago, we’d say, I’m sorry. I’m not able to do that as a part of hospice. Now, we’ll do that if how you’re getting along helps your quality of life. We can do that as a part of hospice care. So we’re able to do a lot of stuff integrated into part of hospice for somebody who really wants that level of support but needs additional interventions, we’re able to do that in a way that 20 years ago we weren’t able to do so much,” he explained.

With a large segment of the population at a time in their lives when they need to think about their quality of life moving forward, Nesbitt suggested that it’s important for anybody having health issues to “have control of their physical symptoms.”

“If you’re so nauseated, you can’t think about anything else, nothing else matters. So controlling your physical symptoms and to be able to say, here’s what’s most important for me at this stage of my life. Here’s what most matters, and having an understanding is, what is my prognosis, what’s going to happen? What do you think? And having that done in a good way,” he said.

“A big part of what we’re focused on is, who is this individual? How do we know and understand what’s best for them? I don’t know what’s best for them, but they would know what they want in the context of their loved ones and their family. And then how do we line up care that matches what most matters for them? I would say that 70 years ago, there was more of a cultural sense that, well, whatever the doctor says, I don’t know, the doctor knows I don’t know. (That’s) not OK now. People want to be able to say, this is what matters to me, and I want to line up care that matches what I want. And that’s right, we should. And so trying to really have a system set up so that we ask and understand and can implement care that matches what the person wants, and if they change their mind, we can change the care to match what they have decided,” he said.

Sometimes that means that a patient will decide they want hospice, but then their health situation improves or they find a new treatment they’d like to try, so they no longer want or need to be in hospice care. At that point, he explained, they could have the palliative care team follow their case to monitor how they are doing. If they get worse instead of improving, they can then move back to hospice care and that’s OK.

“I think of it as a much broader system of care. It isn’t like what used to be called the cliff. That is, you get full care, everything, everything, and when you’re ready for hospice, boom,” he said.

“Often that means a really hard choice, where we may have to give everything else up to be on that. No, we can have a system where there’s palliative care on hospice, and they’re interlinked, and wherever you are along your disease, we’ll make sure you’ve got help. And if things change, you can go back and forth,” he said.

As the interview winds down, this quiet man with the soft, reassuring voice shares his plans for life in retirement. Like most who have entered that point in their lives, Nesbitt, who is the father of three and the grandfather of four, plans to spend more time with his family, especially the grandkids, whom he calls “a big deal.”

He admitted, that looking back, he sees where his dedication to his profession sometimes came first.

“I must say, through the years of being a doctor, and this was particularly true back in the day when we started, there was a sense that you’re a doctor — you’re a doctor, you do whatever is needed. And so I was very often off in the hospital and delivering babies or in the ER or whatever, and so my kids all turned out wonderfully, mostly because I married a wonderful woman, but I have felt like I have some regrets,” he said.

“One regret is, boy, I was spending so much time on the doctor part of stuff that I really want to spend a lot of time being a grandpa and being there and being involved with these kids as they come along. So that’s a high priority, and spending time with Nancy (his wife). I’m involved very much with my church, and so being involved with that… traveling. I love woodworking, so I’ll be spending time with that,” he shared.

Nesbitt will be honored at an open house from 1:30 to 4 p.m. Friday at UPMC Williamsport, Education & Conference Center, Walnut Conference Room, 700 High St., Williamsport.

The Susquehanna Health Foundation has also established the Dr.Alexander Nesbitt Endowment to honor his work and to support hospice and palliative care at UPMC North Central Pa., including The Gatehouse.