Walking Alongside: Dr Juliet Fleming Reflects on 18 Years at Nelson Tasman Hospice

After nearly two decades at Nelson Tasman Hospice, Dr Juliet Fleming is stepping away from her role – leaving behind a legacy of compassion, clinical excellence, and deep connection with the people and community she has served.

But ask Juliet how she found her way into palliative care, and the answer is refreshingly simple. “I didn’t really know what I wanted to do,” she laughs. “I just knew I didn’t want to do general practice.”

It was a chance encounter, a job advertisement for something called palliative medicine, that set her on a path she had never planned but quickly knew was right. “I’d never heard of it before… but I got the job, and I just loved it. I thought, yes, this is what I want to do.”

Juliet’s journey eventually brought her from the Highlands of Scotland to Nelson Tasman, drawn as much by family and lifestyle as by opportunity. When she arrived, hospice care here was very different.

“There were only four beds, and no permanent medical staff during the day,” she recalls. “It was quite reactive.”

What followed was a period of significant development – not just for Juliet, but for hospice care across the region. Alongside colleagues, she helped build a more proactive, holistic model of care: introducing outpatient clinics, strengthening hospital links, and delivering education for GPs and District Nurses across the district and Junior Doctors at the hospital.

“We really pushed education… and developed Health Pathways – a localised online resource available for all clinicians to help deliver palliative care in hospitals, Aged Care facilities and at home, so that palliative care became something much more proactive.” Today, that approach is embedded in how care is delivered, supporting people earlier, and often in their own homes.

For Juliet, hospice has never been “just a job.”

“It becomes a part of you,” she says. “It’s my second home, really, my second family.”

Over 18 years, it’s the people who have made the deepest impression. “Whether it’s patients, families, or staff, it’s always the people.” She speaks warmly of the team around her, particularly through times of change.

“I am so proud of this team… watching people grow into palliative care, supporting each other, it’s been really special.”

And it’s not just the clinical work that has stayed with her.

“The laughter we have, with each other, and with patients, it’s incredible. Humour is much more potent than any medicine I can prescribe.”

Despite how much hospice care has evolved, Juliet says one misconception persists.

“That there’s only one way out of hospice – in a box,” she says plainly. “And that is so untrue.” While the inpatient unit at Nelson Tasman Hospice is there at the very end of life for some, most patients come in for short periods of specialist support before returning home.

“The vast majority of people on the hospice service are actually cared for at home… hospice is about living as well as possible.” She believes one of the most powerful ways to shift this perception is through those who have experienced hospice care themselves. “They say, ‘I wasn’t expecting this.’ And I say – tell people. Help them understand.”

At its core, Juliet says, the philosophy of palliative care hasn’t changed. “It’s completely patient centred. And every patient brings something new.” Her role, as she sees it, was simple and profound. “I saw my role as walking alongside someone and their family to their death and helping to navigate some of the challenges.”

And when that journey is supported well, she says, something remarkable can happen.

“Death can be very beautiful. It can be gentle… yes, it’s sad – of course it is – but when symptoms are controlled, when people are ready, when the right people are there… it can be the best it possibly can be.” This is what she and the team have always strived for.

The emotional demands of hospice care are undeniable, but for Juliet, the work has always given as much as it takes. “The bucket empties, but the job also fills the bucket,” she explains. “It’s self-sustaining, because of the rewards you get from making a difference.”

Balance has also been key. Spending time with family, sailing, and life outside of work. “You have to live every day the best you can,” she says. “Some days are good, some aren’t, but you just live your life.”

Now, after nearly 20 years, Juliet is ready for a new chapter – though not quite ready to call it retirement. “I think I’ve still got more to give,” she says. “But first, I want to spend time with my family.”

That includes returning to the UK to reconnect with loved ones which is something she has missed over the years. She also hopes to spend more time sailing – a lifelong passion.

As she reflects on the future of hospice care, Juliet is clear about what matters most. “It should be a human right to have good palliative care so that we can die well, as well as live well.” And while much has changed over her time, that belief has remained constant.

Leaving is not easy.

“My colleagues – they’re more than colleagues. They become family,” she says. “We’ve had laughter and tears together… I’m really going to miss them.”

But her impact will continue to be felt here, in the team she helped shape, the care model she helped build, and the thousands of patients and whānau she has supported.

Because at the heart of it all is something simple, and deeply human:
“To try and make a difference.”