When Martha Twaddle was in high school, she imagined herself a researcher, developing a cure for the cancer that had struck one of her friends. Later, in college, a professor suggested she switch career paths and become a doctor.

And then, years later, when Twaddle was chief resident at Evanston Hospital, another mentor suggested she take on the volunteer position of medical director of the Hospice of the North Shore. It was a move that changed her life.

Supporting people at the end of their lives is now Twaddle's passion, her raison d'etre.

"I have the sense that this is where I belong," said Twaddle, an internist who has worked in hospice for more than a decade while juggling a private practice and family. "There are so many life experiences that bring you to this point. It perfectly suits my personality."

Hospice and palliative care (which switches the emphasis from treating the illness to caring for the whole person) were in their infancy when Twaddle, who is a palliative care consultant, entered the field. As a pioneer, she began studying the aggressive management of symptoms, such as pain and nausea, with the goal of improving the patient's quality of life.

"I really wanted to better care for people when they're dying," Twaddle said. "So much weds the psychological and spiritual parts of a person. It's the essence of being a doctor."

Twaddle, 41, now heads a group of physicians at the Palliative CareCenter of the North Shore. A large part of their responsibility is working at the Inpatient Hospice Unit headquartered at Rush North Shore Medical Center in Skokie. The Inpatient Unit, which was previously located at Evanston Hospital, has 15 private rooms and occupies an entire floor designed to feel more homelike than the traditional hospital.

"It's about loving, being with their families and having experiences that give them pleasure," Twaddle said. "We don't take away their hope."

There can be no personal agenda for Twaddle when she's helping families cope with an impending death. Nor can she allow her emotions to cloud her judgment. Only the patient and family matter, she said.

"What I value and people value is closeness. They know I care about them. What you're doing with a patient is coming alongside someone and walking them through a process. There are few times I will tell people what to do. I can't make quality judgments for them."

Instead, she gives people choices.

"It's not about me. People have a right to make their own decisions and I have to respect that. It's about listening to people and what's important to them. You have to listen, respect and honor what people are and their beliefs.

"The life they have left needs to be lived intensely," she said. "I facilitate their decision-making. And I will help them as a family get through this time."

Debra Citron's family is one that has used the hospice program. Three years ago, the Highland Park resident watched Twaddle help her sister Laurie cope with the late stages of breast cancer.

"Dr. Twaddle showed a never-ending compassion and love to my sister and my family," Citron said. "The last months that we were blessed with Laurie (who died at home) were only savored because of her pain being managed brilliantly by Martha Twaddle."

Ironically, when Citron, a paralegal, decided last year to change fields after 16 years, she applied for the position of legal assistant to the vice president of provider relations at the Palliative CareCenter. She got the job.

During orientation, Citron was asked whether she would also consider being the assistant to the medical director of the hospice unit (Twaddle).

"All I could do was smile and say, `It would be a privilege.' It's truly part of my healing process to work with Martha."

Twaddle's initial two-or-three-hour-a-week volunteer job has evolved into a paid position, and now she spends as many as 30 hours caring for patients. An assistant clinical professor at Northwestern University, she also lectures around the country several times a month to fulfill one of her goals: educating more heath-care professionals so "people can die well."

Twaddle's colleagues consider her an authority on pain management.

"She's a groundbreaker, a pioneer, a trailblazer," says Dr. Stephen Kurtides, chairman emeritus of medicine at Evanston Hospital and professor of medicine at Northwestern University who has known Twaddle more than 20 years. "Her impact is felt nationally."

Twaddle is modest about her accomplishments and balks at being labeled "an expert."

"Pain is challenging to treat," she said. "It's been grossly undertreated because of societal values. Yet it is one of the most prevalent symptoms and it robs people of their quality of life."

Twaddle, who is on the board of directors of the American Academy of Hospice and Palliative Medicine and serves as chairwoman of its publications committee, notes that pain management is in a field (palliative medicine) that was new in 1989.

"I have history," she says. But she believes "you always have things to learn. At the same time, you have things to share. I see myself as a student because I have so much to learn."

Twaddle maintains that "hospice doctors aren't made, they're born. I have certain gifts granted to me that facilitate me doing this type of work. I'm blessed to be able to do it. I couldn't take out a gall bladder or be an anesthesiologist."

Qualities that serve her well, she says, are her ability to listen, her intuition and her sense of humor.

"If you had to go through life with a name like Twaddle, you have to be able to laugh at yourself, or succumb."