As if fate knew what lay ahead in his career, Dr. J. Andrew Billings found himself making house calls to two patients with end-of-life illnesses on his first day working for a neighborhood clinic run by Massachusetts General Hospital in the mid-1970s.
"I was fascinated by the devotion of the family members: one was a frail, elderly woman who was caring for her demented and sometimes violent husband; the other a middle-age bachelor son who had many siblings but was alone caring for his demented mother," Dr. Billings wrote in a 2007 article for the Journal of Palliative Medicine.
Assisting as much through his "simple presence," he wrote, "I also was amazed at how my appreciation of their work and my reassurance that they were doing the right thing for their loved ones helped them better endure and carry on in a very difficult and stressful situation."
Building on these early experiences, Dr. Billings become a pioneer in palliative medicine, helping develop the first hospice program in Massachusetts and becoming a founding member of what is now the American Academy of Hospice and Palliative Medicine.
He also was founding director of MGH's Palliative Care Service, cofounder of Harvard Medical School's Center for Palliative Care, and author of one of the first textbooks on hospice care.
"Ironically, the publisher insisted that I not use the term 'hospice' in the title, assuring me that the word would turn off most physicians, especially oncologists," he wrote.
Dr. Billings, who was diagnosed with lymphoma in early 2013, died Sept. 6 in Brigham and Women's Hospital. He was 69 and lived in Cambridge.
As an international authority on palliative care, he knew better than nearly anyone the benefits and perils of the path he chose when he opted for aggressive treatment.
"It's hard to ask those questions," he told The New York Times in 2013, speaking about information he routinely sought while on the physician side of the doctor-patient relationship, and then had to confront during his own treatment. "You have a lot of knowledge, a lot of awareness of what's likely to come," he added in the interview for an article about how doctors die, and how their own decisions help inform choices other patients make during life-ending illnesses.
Dr. Billings "was a pioneer in establishing the academic specialty of palliative medicine, recognizing that it was a specific body of knowledge that required specific individual training," said Dr. Diane E. Meier, director of the Center to Advance Palliative Care, a national organization based in New York City.
"Andy, first of all, was a brilliant intellect and someone who saw earlier than many the needs of patients with serious illnesses for relief from all different kinds of suffering: physical suffering, psychological suffering, existential suffering," she added. "Andy was among the first to recognize that those consequences from a serious illness occur from the moment of diagnosis, not just at the end of life."
As an associate professor of medicine at Harvard Medical School, and through leadership roles at the school and MGH, Dr. Billings was "one of the people who have peopled the field of palliative care," said his wife, Dr. Susan Block, who codirected Harvard's Center for Palliative Care and collaborated with him professionally.
"Andy was a very dedicated educator and a very innovative educator," she said, adding that "he loved his work. His identity as a doctor was central to who he was. He was the most content and grateful doctor I know."
Born in Los Angeles, Dr. Billings grew up on the west side of the city, the son of Jewish refugees who were radiologists. His father, Dr. James Henry Billings, was from Vienna. His mother, the former Dr. Marta Seligmann, was from Germany.
He attended the Putney School in Putney, Vt., and studied literature at Amherst College before setting aside plans to be an English teacher and entering "the family business," as he put it in his Journal of Palliative Medicine article. His brother, Paul, is a doctor who lives in Berkeley, Calif.
The literature background lingered, though. After opening with a quote from the "Precepts" of Hippocrates, Dr. Billings added to his palliative care essay an epigraph from "Middlemarch," by George Eliot: "If we had a keen vision and feeling of all ordinary human life, it would be like hearing the grass grow and the squirrel's heart beat, and we should die of that roar which lies on the other side of silence."
Dr. Billings graduated from Harvard Medical School in 1972 and, after an internship and residency in San Francisco, became a staff physician at MGH, initially treating poor patients at the hospital's Chelsea neighborhood clinic.
During the 1980s, he was involved with a national organization focused on hospice and palliative care, and in the early 1990s, Dr. Billings was among the first faculty scholars for the Project on Death in America, run by the nonprofit now called the Open Society Institute.
In 1995, he was the founding director of MGH's Palliative Care Service, and four years later, he and his wife created the Center for Palliative Care at Harvard Medical School.
Because much of the national medical community takes cues from Harvard, Meier said, "many other academic programs followed in his footsteps."
"Andy had an incredibly deep curiosity about human beings," his wife said. "He applied that curiosity to himself, to family and friends, to patients, to what he read, to everybody in his world. He was an amazing listener — gentle, patient. And he could talk about and tolerate really emotionally difficult experiences and feelings in a way I thought was pretty unusual."
Though Dr. Billings was shy, a trait not always sensed in his 6-foot-3 presence, "I think he figured out through his life how to love deeply," his wife said. They had met in San Francisco at a conference on the doctor-patient relationship and married in 1983. Dr. Billings and Block had two sons — Joshua, who lives in Princeton, N.J., and Gabriel of Cambridge.
Joshua said his strongest memories of his father "right now are of the real strength and patience with which he went through 2½ years of very, very aggressive treatment, and how he dealt with pretty unimaginable pain and sickness that came from the treatment itself — not because he was afraid of dying, but because he wanted to live for us."
A memorial service will be announced for Dr. Billings. Though driven by the goal of spending as much time as possible with his family, he "was extremely upfront with all of us about his wishes from the very beginning," his wife said. Those included being clear about the circumstances that would lead to the eventual decision to end life-prolonging treatments, which she made with their sons and Dr. Billings' physicians, including two he had taught during their training.
"We knew what he wanted. It was so clear," Block said. "It was us speaking for him, rather than us making decisions, which is the way it should be."