CPMG physician letter
Colorado Permanente Medical Group (CMPG) Obituary
In his final weeks, Larry and our family learned an immense amount about how the medical system supports people at the end of life. Larry felt it was important to share those lessons with other medical providers. We captured them for the CPMG newsletter that Kaiser CO physicians receive and wanted to share them here as well.
Larry Ballonoff Obituary
As fellow CPMG physicians, my wife, Cris Ballonoff, and I are honored and saddened to share with you that my father, Larry Ballonoff, age 80, died peacefully in Laguna Woods, California on January 28, 2023, with his family surrounding him. Larry joined CPMG in 1981 and retired in 2007. Early in his career at CPMG, he led the creation of the endocrine department. He lived and breathed KPCO’s integrated model of health care, passionately believing in the value of heath maintenance, disease prevention, and the utilization of APP’s and nurses to improve the quality and affordability of health care. During his career, he earned the Permanente Award. He especially enjoyed his time volunteering as an attending teaching the internal medicine residents at Saint Joseph Hospital. He contributed to the lives of his KPCO colleagues and patients and was active in the endocrine community both nationally and internationally. He served as President of the American Diabetes Association and practiced medicine during career sabbaticals in Ethiopia and Barbuda. In the mid-1990s, he advocated for an Eritrean endocrinologist to escape the Ethiopian/Eritrean war and complete his training to be able to practice medicine in the US. Larry was both a doctor and a teacher who taught many of us about medicine over the years. In his final days, he wished to share one more lesson with his CPMG colleagues—his experience with taking Medical Aid In Dying (MAID) medication.
Over the past 4 years, my dad’s health declined from a combination of amyloid cardiomyopathy, cardiovascular disease, and metastatic prostate cancer. In December 2022, he was hospitalized three times for CHF exacerbations. He was discharged in time to take my mom (his wife) to dinner and dancing on New Year’s Eve. The photo of them dancing with his walker, forehead to forehead, with glow bands around their necks captures my dad’s love for life and his family. On January 3rd, when he arrived back in the ER, his cardiologist told him that there was nothing more to do for him medically. During that visit, my father made a very intentional choice about what he wanted his final days to look like. As we all know, hospitals are wonderful places for people needing medical treatment, however, they are not the best place for people who want to savor what they love about living and who are preparing to die.
As my dad had always been clear that he did not wish to prolong life if he did not have the quality of life he deemed necessary to continue, he promptly asked to be enrolled in Hospice. As he continued to retain fluid, he began to lose the strength to walk by himself, requiring assistance to transfer from one place to another. Concerned that he would lose his dignity, autonomy, and ability to care for himself and would be in pain, he also requested Medical Aid In Dying (MAID) medication so that he could exit life on his terms.
As soon as he embarked on the complex process of securing the MAID medications, Larry courageously and intentionally informed his close friends and family about the choice he was making. He felt passionately about sharing this information so that friends and family had the opportunity for closure that so many people desire at the end of life, yet few achieve. Some people accepted his choice and others resisted. My dad received everyone with an open heart and mind—even listening to criticism from those who were not ready to say goodbye.
During the three weeks between making the first request for the MAID meds and receiving them, Larry fielded countless calls from and was visited by several of his closest friends and family members. These conversations provided him with a profound sense of closure and peace at the end of his life. Cris and I, my mom, my sister and her husband surrounded him while he confidently took the medication, without hesitation, on January 28, 2023 at 2:40 pm. After sucking on a popsicle for about 2 minutes, he peacefully closed his eyes and lost consciousness. Within 10 minutes he was pulseless, and within 30 minutes he stopped breathing. While the MAID experience was quite confusing and frightening at first, it morphed into a beautiful and cathartic one for us all.
The process of obtaining the MAID medications was an eye-opening experience for our family in three specific ways. First, possibly due to our teachings of prolonging life, many of the providers my dad spoke with were unfamiliar about the process to request MAID meds. The MAID process was distinct from Hospice resulting in a full week of appointments with social workers, nurses and physicians from both programs that failed to integrate with one another. It took a lot of effort for our highly educated, medically oriented family to navigate the process. Second, the process of obtaining the medication takes a minimum of 3-4 weeks. For someone in decline, this timeline can feel overwhelmingly long. Third, the patient has to be able to consent at multiple times throughout the process, and take the medication orally without assistance. As my father navigated this process, armed with his medical knowledge, he was quite anxious that by the time he received the medication, he might not be able to take it. Once he obtained the medication, the relief that he felt in avoiding being incapacitated and experiencing unnecessary suffering was striking in his final days.
My parents both felt that this story, while profoundly personal, is also an important one to share with the medical community. As a practicing radiation oncologist at CPMG for 14 years, I have participated in MAID professionally with my patients, yet I realized I was surprisingly ignorant of the logistics and the spiritual/emotional journey associated with it. This process opened my eyes to the beauty associated with the option of deliberately taking charge of one’s mortality, allowing the patient and his loved ones to say what they need to say, do what they need to do, providing comforting closure to all involved. I know this experience will change how Cris and I counsel our patients about death and the options surrounding it, and Larry’s hope is that it may do the same for some of you too.