SITTING amid the bustling lunch-time crowd with their sandwiches and sushi at the Mater Hospital cafe, a conversation about dying may seem inappropriate. But in many ways this is the perfect place. Because of Australia's steadily increasing rate of chronic disease and obesity, it is likely that we, or someone we love, will spend time in hospital before we die.
Not that we choose to contemplate this too often. It's a societal issue, believes Dr Erica Cameron-Taylor, and is partly to blame for the way palliative care is funded and delivered - poorly.
"There's not a thousand generations of people wandering around," she offers, cradling milky tea, a couple of loose cork-screw curls framing her face. "We all die but we are not very good at dealing with it. It also affects medicine. Our training is focused on this concept of 'cure'. You chase what's wrong with a patient by doing all these tests and giving them drug 'x' to make them better. That's what the paradigm is, but that doesn't always work. People eventually die of something, but our training doesn't prepare us for that.
"I think doctors get trapped in this pattern of doing more and more and more. That comes from a good place, but it's not the best way to manage treatment. There's a lot of fear and it's fear of that communication you have to have with someone who is dying and their family. It's much easier to order another CT [scan]."
The former Canberran decided to study medicine after completing a visual arts degree and working as a diversional therapist in the Blue Mountains with children with a range of disabilities; some also had life-threatening conditions. "The children and their families would have these awful experiences in the emergency department or with a specialist, and my arrogance came into play," she says, smiling. "I thought, 'Ha! I could do a better job than that'."
She gained a place at the University of Newcastle and completed the five-year degree over seven years, taking time off to have her two children, Jamie and Phoebe, who are now teenagers. She spent time at the Mater as a junior doctor and contemplated a career in emergency medicine, but decided to pursue general practice to make life easier on the home front. Her musician husband Adam is the Defence Force's only full-time piper and during the worst days of the war in Afghanistan he spent up to six months overseas to perform at repatriation ceremonies for dead Australian soldiers. It has been a demanding juggling act. "She's had a lot to cope with," says Adam.
But Cameron-Taylor also had a realisation. "I saw so much time wasted at the end of people's lives because of bad medicine. I wanted to try and make a difference and there were a couple of staff working here who were really inspirational and I really valued and admired what they did."
Mater palliative care specialists John Cavanagh and Phillip Good played a pivotal role. "They have the ability to take the last few weeks or days in someone's life and make it reasonable time," says Cameron-Taylor. "They can say to someone, 'Sorry there's nothing I can do to change the outcome, but I can make the time you have left as comfortable and dignified as possible'. That doesn't mean wiping them out with medication so they're unable to say the things they want to say, need to say."
The Mater Hospice is the only unit of its kind in the Hunter - John Hunter Hospital does not have a palliative care unit - and it also provides outreach services to Maitland, Port Stephens and the Central Coast. The 17 beds at the hospice are for people with complex needs and the majority of palliative care is provided by GPs and nurses in hospital wards or nursing homes who have very little, if any, support in this area.
Cameron-Taylor saw the need to support these healthcare workers and has written a book, The Palliative Approach, to assist them with the provision of "quality-of-life and comfort-focused" care. "It's a crowded curriculum when you do your training and I think it's important to increase education in terms of palliative care," she says. "The book is largely aimed at people working in aged care facilities because they're the least supported staff who have the most number of patients with palliative care needs. If it doesn't go well, there's ramifications for the family. People tell you horror stories about when their grandma died."
There is such a thing as a good death in Cameron-Taylor's experience. "People either want to do some important things when they're dying, or they want to rest," she says. "They can't do either if their symptoms aren't well managed. But when you can help, and the person is comfortable and has family to support them, it can be a peaceful experience."
Has her time in palliative care changed her? "Um . . . [long pause] . . . it's made me less certain of what happens [after we die]. I was always one of those we-are-just-carbon-atoms types, but I'm less certain of that having seen some of the things I've seen. I reckon the jury's out."
Known for throwing good parties, Cameron-Taylor is also firmly committed to living in the moment. "So many patients work hard all their lives, save their money and plan to do this and that after they retire," she says. "And then they get a barnstorming cancer and feel absolutely cheated. My job had definitely informed some of my decision-making."
To replenish her "well of compassion", Cameron-Taylor says it has been important to develop coping mechanisms. "I'm not someone who goes home and dwells, but you have to find out what sustains you and there's no recipe for that. You have to have a good internal radar. The last thing a patient needs is someone who is suffering alongside them; that's dangerous."
Cameron-Taylor practises iaido, a martial art that centres on controlled and graceful movements with a sword. She attends two classes a week in Hamilton - the rest of the family is learning aikido - and revels in the escape it provides. "It's good for me because I get to concentrate on something other than work," she says.
Adam believes Cameron-Taylor's strength as a doctor is her stability in spite of the sadness that surrounds her at work. "Sometimes it is difficult, particularly with younger patients. She's come home and said, 'I looked after someone today who is 30 with two kids and probably won't see out the month'. It does play on her mind, but she focuses on doing a good job."
If there is any sadness about her work, it is the lack of funding and cohesive training for all healthcare workers. Oh, and the quality of food. "I would hire a chef," she says. "Your last meal on earth should be special."