Dr. Josefina B. Magno works with death -- in fact, dying is her specialty.
She is a doctor who still makes house calls and talks to patients -- sometimes for two hours at a time.
She is a doctor who still confers with families, answering their anguished questions about the mysterious -- and often frightening -- process of dying.
Magno, medical director of the Hospice of Northern Virginia, has been a national leader in bringing the hospice concept to America.
This month, Magno was honored for her work in the hospice movement when WETA-AM radio presented her with its monthly Woman of Achievement Award.
Magno is a small, neat woman with a round, flat face and the clipped accent of her native Philippines. As she speaks, she reaches out and touches the arm of a visitor, a habit that makes a visitor at home and commands attention.
In the hospice concept, Magno says, care of the terminally ill focuses on helping patients live comfortably, often at home, until they die.
Traditional medicine, she notes, "always tries to cure or to prolong life, but when it is evident that no cure is possible, there's no point in prolonging the dying person either."
As a spokesman for the National Hospice Organization, Magno has traveled throughout the United States promoting the hospice concept. In this country, there now are 210 hospices in some stage of organization. In the Washington area, in addition to the Hospice of Northern Virginia, Magno has helped establish an experimental program at The Washington Home in the District.
Magno is credited with convincing area doctors of the validity of hospice care and encouraging them to refer patients to the Northern Virginia hospice. She also has sought support from insurance firms, convincing them that they can save 80 percent in medical expense for terminally ill patients by adding hospice care to coverage packages.
From her work with hospice programs, Magno has become convinced that such care gives patients more than an acceptance of death -- it teaches them how to live.
She recalls an brilliant engineer who thought of his body as a series of pipes which were not working properly. He was frustrated by constipation, nausea and pain brought on by cancer, and by medications used to treat the disease.
Magno saw him at home and prescribed medication to relieve the symptoms: "One day he said to me, 'Doctor, I have no more constipation. I have no more pain or nausea. What am I going to do now?' and I said to him, "If you have no more problems, why can't we think of you as living?'"
After that, the engineer -- an avid amateur photographer before becoming ill -- went back to his darkroom. "Instead of dying, he was living," Magno said.
Magno says she came to understand the "living" concept when she discovered that at a certain point even medicine gives up on a patient.
"While we were doing all that we could, when we knew everything had failed, we really were not doing anything for (the patient)," she said. "That magic of hope keeps everybody going. When there is no hope is when the patients need us the most."
In hospice care, she said, "it's amazing what you can do."
For instance, Magno said, traditional medicine does not treat symptoms because if symptoms disappear, it is impossible to tell what is wrong. For a terminally ill patient, however, Magno believes the first step is to relieve pain and discomfort.
Next, she says, both patients and their families need help in coping with the inevitabilty of death.
"There are hundreds of unanswered questions. They really do not understand what is going on," Magno said. "Once families know what to expect, anxiety and fear disappear and they can use the remaining time with the patient more positively."
Magno's career began with a brilliant school record. After graduation she decided, to her family's chagrin, she wanted to study home economics because she liked to crochet. But her father told her she did not have to go to school for that and since she loved school, she chose the longest progarm she could think of -- medicine.
Her experience with death and the fear of cancer came while she was still in the Phillipines. In 1954, after 11 years of marriage, her husband died of cancer, leaving her with seven children, the oldest 9, the youngest a year old.
"For five years, I did nothing," she said, succumbing to "the laziness of grief."
Finally, a friend convinced her she was wasting her talent and she became an assistant to Phillipines' secretary of health.
Ten years later, in 1969, she came to the United States to spend a year studying but mostly to "bum around, walk around the stores and go shopping." She decided to stay.
Magno had a mastectomy in 1974, and her own stay in the hospital brought her in close contact with families of other cancer patients.
"I saw the anguish of the families and I decided I was going to cure all these cancer patients," she recalled.
Shortly afterward, she began studying at George Washington University -- and the rest is history.
People familiar with her work are full of praise for Magno.
"Her qualities are such that if I were dying, I would want Jo Magno," said Dorothy Rigdon, a board member of the Hospice of Northern Virginia, "and that's just about what it adds up to."