Committed to Seniors
By Maria Scrivani
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Practicing medicine the old-fashioned way has earned Buffalo physician Kenneth Garbarino kudos as one of the nation’s top geriatricians. He listens, considers, and consults with patients and their families. It’s a slow process more akin to Marcus Welby than the turnstile-delivery of today’s profit-driven health care system.
At the end of a typical day recently, Garbarino, who is Medical Director of the Geriatric Ambulatory Program at Millard Fillmore/Gates Circle and Kaleida Health, sat in his office and said, “I saw fourteen people today, and I’m drained.” Contrast that with a routine day in the life of a busy internist, who may see thirty patients a day in specific time allotments. Garbarino knows he’s fortunate to be salaried by the hospital and some grant money. He doesn’t have to worry about billing, as most of his physician colleagues do. It gives him the luxury of time, exactly what this doctor orders for his elderly patients.
“When I first started practicing geriatrics, the frail elderly were brought to you because of less functioning; often, they were on too many medications. Your job was getting people off medicines,” says the Long Island native, who graduated from State University of New York at Stony Brook and studied medicine at St. George’s in Grenada and Coney Island Hospital in Brooklyn. Having enjoyed working with elderly people and, realizing the demographics were there, he saw his future in gerontology.
In 1987, Garbarino came to Buffalo to do a two-year fellowship in geriatrics at the VA Hospital. The two years stretched on, and, in 1989 he signed on as director of the nursing home at Erie County Medical Center. In 1996, he was enticed to take over a new program in subacute care for the elderly at Millard, where he’s been ever since.
It’s been an exciting time, Garbarino says. In the last ten years, there have been dramatic developments in the pharmaceutical industry, as well as treatment options for the elderly, and a consequent shift in philosophy regarding geriatric care.
“There are new medicines for osteoporosis, better drugs for dementia, options for treating high cholesterol and diabetes that we didn’t have before,” he says. “Surgeries are better. We have eighty- and ninety-year-olds undergoing cataract surgery and hip replacements. Before, we might not have treated urinary incontinence, and we might have ignored depression. Today we look at all of this differently, and the expectations of patients and their families are different, as well.”
Possessed of boyish good lucks and cheerful demeanor, Garbarino seems too young to connect well with his patients. But they love him, and it’s clear that he is deeply concerned with their care. It’s partly because he is close to his own aging parents. The youngest of three, Ken Garbarino has a sister who is a homemaker in Virginia and a brother who is a pediatrician in Pennsylvania. Their mom, who is in her seventies, and dad, who is eighty-three, also live in Pennsylvania.
Every spring and fall his father and uncle come up for a week to help him open up and then close his house on the Lake Erie shore. “It’s a long-standing tradition for us,” says Garbarino. Even though there’s less in the way of actual help from his elderly relatives these days, he clearly treasures the visits. “It helps me gain perspective, to see what’s happening in my own family.” Once, when he ended up calling 911 in the middle of the night for his uncle, a newly-diagnosed diabetic who was wandering around the house in a confused and weak state, he learned the value of first-hand experience.
“I knew it was low blood sugar, but I couldn’t get him to eat anything,” Garbarino recalls. “When I brought it up at a team meeting with our social worker in the office the next day, someone told me about keeping a tube of cake frosting in the house for diabetics who might need to have their blood sugar elevated quickly. I didn’t know that!”
It’s that kind of anecdotal/experiential advice you don’t learn in medical school, and it’s the kind of valuable information Garbarino gathers and shares in his cooperative medical practice. “We have family meetings, and we educate,” he explains, when a patient’s care is at a crossroads. A social worker is brought in, and siblings and/or the spouse of the patient sit together. Perhaps an elderly woman wants to remain in her own apartment, but some family members worry about her being alone. What if she has a bad fall?
“Maybe you bring in Lifeline, make sure her hot water heater is turned down so she can’t be scalded, have someone come to help her count out her pills, make sure there are working smoke alarms,” Garbarino says. “It’s amazing how many people do well in their own environment. After all, you can fracture your hip in a nursing home, too. What you don’t want is to have your mother, who lives alone, fall and lie there for two days until someone finds her. So you arrange for twice-daily check-in phone calls.”
There are support groups to help patients and their families, and all kinds of ways to plan for what-ifs, Garbarino says. “I am a strong advocate of quality, not necessarily quantity, of life. So often we wind up doing so much at the end, instead of doing more at the beginning to prevent some things from happening. People need to be given the time, and helped to make plans.”
As a clinical associate professor of medicine in the Division of Geriatrics at the State University of New York at Buffalo, Garbarino and his colleagues at Millard Fillmore train residents and fellows in geriatrics. And even though the elderly segment is the fastest-growing proportion of our population, the number of medical students choosing geriatrics is not increasing. The truth is it’s not particularly financially rewarding.
Too bad, says Garbarino, who finds his work fascinating and deeply satisfying on a personal level. He says Buffalo, with its aging population (and many elderly whose children live out of town), is an ideal place to practice this kind of medicine. And, though an early marriage ended around the time he decided to move to Western New York (after turning down offers of work in more glamorous locales like Manhattan and Seattle), he thinks it was the right decision. He finds life here delightful, whether walking the beach near his place in Angola or savoring the pleasures of urban life at his city home. He’s a skier and kayaker, a collector of antiques, and, one might add, a collector of wisdom from the long-lived patients he serves.
“I’m enjoying my own quality of life right now,” he says. “Life is just too unpredictable!”
Maria Scrivani is a freelance writer living in Buffalo.
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