John Mulder did his residency in family medicine but found himself gravitating toward end-of-life and symptom management opportunities. Photo by Johnny Quirin
Dr. John Mulder, medical director of Trillium Institute, believes he has had a successful day when his work in the field of palliative medicine has helped patients and their families understand there can be purpose, hope and enjoyment in life when confronted with a serious illness or death.
“What gets me really excited is when I find the work of palliative medicine has allowed patients and families to look forward with anticipation to how life will play out for themselves and their loved ones,” said Mulder.
“Sadness always accompanies this because grief is part of the equation, but they know there can be purpose and enjoyment, and they don’t have to fear what lies ahead.”
Launched in October 2014, Trillium Institute is a nonprofit organization affiliated with Holland Home. It strives to align medical resources and practitioners with the personal values of the patient to advance the art and science of navigating how to live well, die well and grieve well.
Mulder said while he is a medical practitioner and meets with patients, part of his role with Trillium involves community outreach to the public and the medical field to enhance the visibility and utilization of palliative resources.
“I want people to know palliative care is a vital resource, it is available in this community, and more people should receive it and could benefit from it,” said Mulder.
“Part of that begins with education — what we are presenting to the community and how we are really bringing them to an understanding of what it really is and what the resources are.”
Ken Hekman, executive director of Trillium Institute, said he has known Mulder since 1991.
“We have forged a one-of-a-kind collaboration to improve the quality of life through to the end of life,” said Hekman. “He has boundless energy, undying compassion and extraordinary vision. He draws out the best in me, and his drive and commitment inspires everyone around him.”
The Trillium Institute focuses on educating medical students and the medical professional community, as well. Mulder also serves as director of the Grand Rapids Hospice and Palliative Medicine Fellowship program, which is recruiting for its sixth year and this year was part of the match program for the first time. The fellowship program is primarily funded by Trillium Institute.
“We’ve been fortunate to have an extraordinarily gifted crop of people who have come through our fellowship program. We had 30 applicants this year as opposed to our usual two to five,” said Mulder. “It signifies to me, in our year of existence, we have helped to enhance the visibility of palliative care and having demand for the services.”
Hekman said the institute is building momentum for training the next generation of physicians to understand and integrate palliative care into their practices.
“We are touching the lives of more than 100 medical students, residents and fellows annually, and we’ve integrated leadership development with palliative care fellows to prepare them to carry the torch forward,” said Hekman. “We’re also gaining momentum with repeat invitations to lifelong learning programs and local colleges and universities and engaging senior groups in meaningful conversations.”
While Mulder has worked nearly 15 years in the field of palliative medicine, he completed his residency in family medicine in 1983 in Grand Rapids, after attending medical school at Wayne State University.
“When I was in medical school, there were no hospices to speak of,” said Mulder. “The first hospice came to the United States in 1975 in New Haven, Connecticut, and over the subsequent seven years, just a few hospices emerged and they were all volunteer organizations. There was no payment structure for it.
“In 1982, congress adopted the Hospice/Medicare benefit as part of the Medicare program … and we saw a huge growth then, starting in ’83 and beyond.”
While in his fourth year of medical school, Mulder’s father passed away from cancer; he described it as an unfortunate end-of-life experience.
“He suffered. A lot of systems were not appropriately or effectively addressed. We, as family, were not well prepared for what to expect, and we don’t know that he as a patient was well informed of options,” said Mulder.
“It wasn’t that the experience instilled in my soul ‘I’m going to dedicate the rest of my professional life to make sure no one else has to go through that.’ It was just a sad moment in our lives.”
Upon finishing his residency, Mulder practiced family medicine in Muskegon and was asked to serve on the board of a local hospice in 1984 for a few years. He was then asked to serve as a part-time medical director for the organization and found he had developed “a great affection” for the work.
“I found great meaning being at the bedside. I was still full time as a family doc but finding time to do the hospice work, intermittently,” said Mulder. “I found myself doing more and more hospice, and when I went away to conferences, I found myself gravitating more toward end-of-life and symptom management opportunities.”
While traveling in 1999, Mulder said he had an interesting moment when he was hospitalized in an intensive care unit in Bangkok, Thailand. It was during that hospitalization when he contemplated whether he had accomplished professionally what he wanted to do and if he had achieved what he could with the talent he was given.
“It opened a door for reflection,” said Mulder. “When I was at the bedside of a dying patient, I realized if I wasn’t there, nobody would be. There is meaning in that work and a role I could fill that not a lot of people were available to do.”
In 2000, Mulder became board certified in hospice and palliative medicine, and was recruited to take a full-time position with Alive Hospice in Nashville and an appointment at Vanderbilt University Medical School. Mulder helped facilitate the launch of a pain clinic at the Vanderbilt cancer center and several palliative-based programs in hospitals in the area.
He returned to West Michigan in 2006 when he was recruited by Holland Home to help grow and develop hospice resources in the Grand Rapids area.
“People often ask me, ‘Isn’t it depressing to work with dying patients every day?’ and my stock response is, ‘The last time I checked all my patients are still living,’” said Mulder. “The problem is too many people think that way. Unfortunately, too many people in the medical profession think that way.”
Mulder’s vision for the future is to see the paradigm in which palliative medicine is recognized as an intricate resource for treating patients who have chronic diseases that impair quality of life and automatically are integrated into the care process.
“It will take a cultural change. We need to change the culture of how patients view this. Too many people still view palliative medicine as giving up, or it is the last thing you do when all hope is gone,” said Mulder.
“It is the very first thing you do on the front end to help to restore hope and bring purpose and meaning into life.”