As part of a lifestyle and aging series, we’re working with renowned photographer Terry Lorant to showcase inspirational leaders in the industry. Each month, we’ll feature an inspirational member of the Amazing Care Network community who is using his or her voice to empower others in the collective aging experience — and read, in their own words, what the Amazing Care Network’s efforts mean to them.

I’ve lived in Hawaii pretty much my whole life since I was 10. I was the oldest of 4 children. My father was invited to come over and start local television news back in 1958. At that time the station was KHVH which stood for Kaiser Hawaiian Village Hotel. Because Henry Kaiser had seen a new future, after his retirement here in Hawaii, and said, ‘listen, I’ve been around before when a new state was formed’, most importantly for him, Florida, when he was a really young man doing roadwork, and he just watched Florida grow. And so after his retirement here, he realized, ‘this is exactly my kind of deal, I can’t not participate!’ So he called Oakland and said, ‘I need cement because we’re going to start building’. And they said, ‘Mr. Kaiser, you’re retired, you don’t understand’. And he said, ‘No, you don’t understand. You’re either going to be here under my leadership, or, you’re gong to have a competitor in me, and you’re going to lose’. So, they sent cement. And they built a quarry, and Mr. Kaiser purchased the Hawaiian Village Hotel and that’s where our family first stayed.

So that’s how I came here, and that’s what made me a Kaiser Baby. Because I became a member at age ten of what is Kaiser Permanente, and my personal care physician, Willis Butler, turned out to be one of the true renegades and innovators. He was my hero in many ways growing up. I did part of my medical training here. They didn’t have a 4 year medical school in Hawaii in those days. They had two years of pure science, and then you had to go elsewhere. So I finished at University of Washington in Seattle, and then came back here for an internship at St. Francis Medical Center in Liliha. I stayed in that facility as an emergency room doctor for the next couple of years, during which time I met my wife who came to work with the group as a nurse. And we’ve been together ever since. We have a 30 year old daughter who is an open heart nurse. And we have an 11 month old grandson, her first child.

So that’s my background. We left the island in 1977-78 and lived in the SF Bay area for 8 years, then came back here. Lena, as a nurse, also became a flight attendant, and flew around the world…she speaks 5 languages. I went to work for an education company. Then we returned to the islands in 1985, I needed to re-train in internal medicine. They were good enough to give me the opportunity to finish 3 years of work in 2. I did that, took my boards, and 15 days later, I was here at Kaiser Permanente for a career.

I was here for a year and a half or so while there was confusion about who was leading this region from the health plan’s perspective. Cora Tellez was the answer to who’s leading this region. She arrived in the early 90s. She was such a breath of fresh air, I can’t tell you the difference that she made for my medical director. She was really the first leader we had who had grown up in Kaiser healthcare. She was a great partner, and at that same time, Dr. Chaffin gave me the opportunity to be what was at that time the VP for Quality. I got to work on programs, to kind of shift the paradigm from ‘what did I do wrong?’, to ‘this is what I did, how do we improve it? How do I collaborate better, and how do we understand complexity?’

The typical response to a medical error usually looks like ‘we’re going to find that person in the chain that made it break and we’re going to blame that person’. And if the doctor thinks ‘it’s me’, then she or he wants to pull back, go under cover and be silent for a while. But, a big part of shifting a culture, is that if you teach people to understand that errors are very complicated…they start 5, 6 steps before you get a chance in your window of opportunity to see, do, communicate, change, and then there are 3 or 4 steps after you had your window of opportunity, where things also happen.

So if people can begin to understand that it is always a collaboration of error, never one point, one person (few exceptions) if we can get that together, then the question is, how do we communicate more effectively, who really is part of the team, how do I include them so that we decrease fear, we decrease hierarchy, and we promote, ‘this is my offer’. We can then communicate better and decrease error.

The nice thing was, I was also responsible. When I got the opportunity for Quality, I felt like a kid in a candy store. We didn’t have a physician who had been doing recruiting, so I needed to develop a relationship with our recruiter, so that I could help with the onbarding process. We now have a Quality program that we’re developing, great. Oh, and we better be thoughtful about this new thing called evidence based medicine, which Dr. David Eddy and Dr. Brent James and a few people started talking about in the early 90s. So I was right in the middle of this new swell of new thinking about quality, about safety, and what is this evidence based medicine? I had the chance to develop the culture here by sending leaders from different departments and divisions to come with me to the best training program in America at the time in Colorado Health Sciences for eight days of the best education around all of these issues.

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After 21 years with the medical group, I’d already had been a volunteer in hospices, St. Francis hospice here and Hospice Hawaii, and I was on the board of directors and I asked the Executive Director if he’d give me permission as a board member to not only volunteer in people’s homes but to actually volunteer in the office, to be with the staff and to watch how the interdisciplinary teams worked. I’d been on the board for 4 years, so I knew quite a bit about hospice function, but I’d never been inside the operation. And he was good enough and generous enough to say ‘I trust you to take off your board hat and really be a volunteer here’. So I started volunteering for Hospice Hawaii. Then a brilliant medical director was called away, because her husband, also a physician, received his dream job opportunity in Tacoma Washington, so they had to leave, and I had the opportunity to apply for and be accepted as the medical director at Hospice Hawaii. Now that was really, into the frying pan. I hadn’t really had my own panel of patients for 10 years. I was a well-trained internist, so I wasn’t fearful about direct patient care but I jumped right in…I needed to go to national meetings, I needed to develop relationships, I needed mentors, and I needed to be board certified. Within a year, all that happened and I was board certified in hospice and palliative medicine; I had a phenomenal practice and privilege of working for 5 years with people in their homes. In our own facilities, we had a couple of homes in communities where individuals could come, particularly if they needed more intensive symptom management.

Palliative medicine is only about reducing suffering, whether it’s pain, nausea, vomiting, diarrhea, constipation, those things…how do you allow someone who has been disrupted by a chronic illness to be at ease with respect to symptoms. That may not help them with the degree of disruption. That’s why hospices have chaplains, to address your spiritual life, they have social workers who are clinically trained to have therapeutic relationships, not resource jockeys in the community like you would be as a discharge planner from a hospital. That’s where you have nurse case managers who are really fluid with how do you really support care givers in a home, how do you support someone accepting care? This is new in your life. You’re not able to do certain things. Your spouse is doing them. Your family is doing them, hired people are doing them, volunteers are doing them. Can you allow others to give to you in this time of crisis? That’s very hard for a lot of people. Hospice care is team based care, so I never was the head of a hierarchy because we didn’t have one. My role was, I would be invited to people’s homes by the nurse case manager because she knew the family, she knew the case, he knew the symptoms that needed to be treated and it’s ‘Dr. G, you need to come here’. And after leaving here I was never “Dr. Galbraith” anymore. Dr. Geoff at the most formal…it was team based care. So I got to do that for a little over 5 years. 2009 – 2014. During that time I hired a physician, a woman who is smarter than me, more certified than me, more creative than me, and I said, if you will come to work with me at Hospice of Hawaii, I promise that you will be the medical director when you say now’s the time. So we worked together for a couple of years. ‘Now’s the time’ came in 2014, and again, another transition in my life.

I’ve never had a Plan B. For anything. It’s all been transitions. That’s why I’m reluctant to call retirement, retirement, because it’s all been transitions for me. Evolution is a really good word. Because retirement, or, if we talk about a transition, if it’s an authentic transition, where you don’t have a Plan B, then you don’t have a schedule. You have some dynamic tension if you feel urgent inside that Plan B won’t show up. But in part, I’ve been through enough changes, or enough ‘I don’t know what’s next’ and the opportunity shows up that I have an enormous trust that it’s going to show up. And when it does, I’m not going to miss it. This requires being unscheduled, except when you are. It means having conversations, and being a living invitation for a conversation.

So it was a huge surprise and at the same time, no surprise at all to get a call from Cora Tellez to say ‘Geoff, I’m developing a new business, I’m developing a new entrepreneurial engagement and, this is different, because while I bring myself to everything I do, this one is my family, and I’m seeing a need inside my own family for support groups, for an engagement of people whose lives are being disrupted by a chronic illness, or have been disrupted, and are left bereft, alone, having been with someone in a chronic illness who passed away. And she said, ‘I’m seeing in these groups that there’s not enough structure for the groups. They’re not supported as related to what to expect, and, when they get to a point where something’s changed, they’re often financially not educated about what’s needed during these transition times. From their own insurance, from the kinds of stress that take place after the loss of a loved one, and she said, I’d like to talk with you about this.

So then she painted the picture for me, and was good enough to come over and meet and introduce the notion to me of the Physician Friend of the Family. And so, I’m living the Physician Friend of the Family now. So, what is my next opportunity? I don’t know. But, I do know it’s in the context of the Physician Friend of the Family. And actually, your family doesn’t need to know me. I’m fine with that. The idea is, I’m no longer, the doctor authority, carrying medical malpractice who is advising people to make decisions, or, worse, deciding for them what they should do as it relates to some health concern or some life transition. I’m simply a friend saying I have some experience in this area and if you’d like I’ll share it with you, but really, my bigger job is to invite you to share with me. Tell me about your story, tell me about your concerns, and how this situation is impacting you, and if we can, start to talk about what makes you happy, what brings you joy, what makes you really satisfied and nurtured and if there’s something that you’d invite me to offer, I’m happy to do that. But remember, it’s only an offer. It is nothing about “shoulds”, it’s nothing about A or B, it’s about how do we encompass this picture so that you may have greater confidence making the decisions that you need to make. Oh and by the way, there are no wrong decisions. There are decisions that can then invite a new conversation and a new opportunity. So don’t worry about that.

I don’t carry medical malpractice. If there’s a concern, I’m not hesitant to let anyone know that. We’re not in a circumstance where I’m pretending to be an expert in your life. I’m a friend of the family. I am a physician. But, they don’t even call me doctor anymore. It’s just Geoff. I’m a volunteer.

I’m never satisfied unless we’re opening a new paradigm, or new territory.

Stay tuned for Part II, coming mid-December.
Story and photos by Terry Lorant.