A day in the life of Dr Juliet Fleming

A day in the life of Dr Juliet Fleming – Senior Medical Officer Nelson Tasman Hospice

Frankie, the cat is my alarm, at 05.49 a wet cold nose nudges me awake in the hopes that I will give her a menu for breakfast, always about 30 secs before the gentle alarm goes off! Following this, a brisk walk with my neighbour and her 3 mad dogs, shower, then a 25 minute drive to work. I love this time to think and reflect and enjoy the beautiful countryside, I get to enjoy the mist in the valleys in autumn, the sunrise in winter and new life in the spring.

Once I have that essential cuppa tea, I set about catching up on the nights/weekend’s events, reading the patient notes and looking at any extra medications that have been required. I also speak with our House Officer (who will be with us for 3 months as part of their learning journey into their medical career), answer the extraordinary number of emails that arrive and have a ‘handover’ from the nursing staff with other members of our team, such as our Spiritual Care practitioner and Social Worker.

If we have a spare 10 minutes, we also use this time for some impromptu education depending on the particular challenges of the day. Then, with the community nursing team, we create a ‘PLAN A’ for the day although sometimes we’re on ‘Plan Z’ by lunchtime! That is one of the things that makes my job so interesting – no 2 days are ever the same.

My main clinical role is to provide care for people in the specialist palliative care inpatient unit. The aim is to help with whatever is challenging for that person and their family, using the te whare tapa whā model of care, which addresses physical, emotional, spiritual and whanau wellbeing. First we get to know each other a bit and I try to find out what makes them ‘tick’. I spend time explaining what is happening medically for them in plain, easy to understand language, often with the use of pictures (which makes us laugh sometimes due to my lack of drawing skills!). This helps bring understanding and acceptance and also gives us an opportunity to prepare them for what may lie ahead, so it is less scary and unknown.

As a team with different skills, together we aim to ease any physical symptoms through of a range of options as well as addressing other causes of distress. I liaise with other team members to add to the social, emotional and spiritual support that the doctors, nurses and Health Care assistants can provide.

With good preparation and planning, the majority of our patients are then discharged home again. They may need to come back once or even a few times but most stays in the hospice are short, usually between 3 and 10 days.

Once a month, I travel to Golden Bay to see people in their own homes or the hospital with the wonderful team of District Nurses there who provide hospice support to patients in this rural location. In between visits, we also catch up weekly by Zoom and if required, do Zoom outpatient appointments. Oh, the wonders of modern technology and what covid has taught us!

Teaching is a big part of the job, with a new House Officer every 3 months, medical students, and other staff members, as well as doctors and nurses in General Practice and the hospital who want to learn more about palliative care. We have produced local online practical and informative guidelines about palliative care for all doctors so they can refer to these when needed. I am also part of a national group where we are developing Specialist Guidelines for all of New Zealand’s Hospice and Palliative care teams to ensure that all New Zealanders have access to the best possible care wherever they may live.

At the end of the day, my hope and goal is that my patients have been able to live the best possible life despite their failing health; and when they get to the end of their life, they are comfortable without physical distress, ready emotionally and spiritually for this part of their journey, in the place of their choosing (if this is practical) and with the right people about them. If all of these things come together, death can be a beautiful thing, sad – yes, but a necessary and inevitable part of living.

And at the end of the day, I go home to Frankie who is still waiting for that menu!

You fundraised and danced in this year’s NBS Dancing for a Cause. What was your biggest highlight from this experience?

Dancing for a Cause was an extraordinary experience from beginning to end. I NEVER thought that I could actually enjoy ballroom dancing, but with an expert (and extremely patient) dance partner and teacher, we had a lot of laughs. It was fantastic to get to know and have fun with the other contestants too. The relief that I didn’t forget my steps and fall over on the night was the biggest highlight!

Finally, if you could be a piece of furniture, which would you be and why?

I think I would be the bar. Somewhere you can lean up against for support, while you have a yarn and a tipple and pass the time with your friends and family. I hope there are lots of wise words as well as stories and laughter. But also I would want to be a comfortable space to be alone in, to have time to contemplate and dream and hope.