Even as she approaches her 90th year of life, Teresa Plane, former registered nurse, continues to be an enthusiastic ambassador for palliative care – a professional and personal passion she has had for over 40 years.

For Teresa, palliative care can be compared with the once popular 19th-century railway platform tickets.

‘When we were young, you could buy railway platform tickets. If a person you knew was going on a train journey, you would buy a platform ticket that allowed you to get on the train with that person. The platform ticket ensured the traveller was comfortable and had everything they needed, and it allowed extra time to be together and for proper goodbyes. Once the time came to leave, the guard blew the whistle, and you had to get off. You could not continue on the journey with them. That's what I think palliative care is.’

From founding home to founder of Mount Carmel Hospital

‘I was born in 1933 at St Margaret’s Hospital in Bourke Street, Sydney, and placed in Waitara Founding Home. I was eventually returned to my family of origin but spent much of my young life in the care of the Mercy Nuns. I wasn't always interested in nursing; I actually wanted to study at drama school or go into broadcasting and radio plays. But in those days, there weren’t a lot of professions opened to girls either, so it was the nuns who encouraged me to become a nurse or to join them!’

Teresa became a theatre nurse after completing her studies, but shares that it was only in her later years of life that she has been able to accomplish some of her earlier dreams, including play writing, performing on stage and hosting radio programs.

After working as a theatre sister for a time, Teresa decided in 1955 to go into business with Raymond Sobel when they opened Cavell House in Rose Bay as a surgical hospital (now part of the Moran Corporation). She says its success was due to the large Jewish population in Sydney’s Eastern suburbs and the many Jewish surgeons who visited. Following the sale of the business, Teresa took her share of the sale profits to become a half owner of Mount Carmel Hospital with her then husband, Roy Williams. They purchased an old derelict building that once belonged to Ken Ranger, a prominent Sydney paddock bookmaker, and many other ‘colourful’ owners.

‘It was in 1962 I founded and became a theatre sister and matron of Mount Carmel Hospital in Sydney’s Seven Hills. The hospital initially had 19 beds for general surgery and obstetrics, to serve the newly opened Housing Commission estate at Seven Hills. Within a year the building was extended to include 60 registered beds and obstetrics facilities.’

Pioneering the opening of Mt Carmel Hospital’s palliative care unit

By 1978, Mount Carmel Hospital had extended to 96 beds, with two operating theatres, a full recovery ward and had a high turnover of patients. That year on ABC Radio, Teresa heard a ‘life-changing’ interview with Elisabeth Kübler-Ross, a Swiss-American psychiatrist and pioneer in near-death studies, who authored the internationally best-selling book, ‘On Death and Dying’. Elisabeth became famous for the five stages of dying, also known as the ‘Kübler-Ross model’.

‘I was driving home from the hospital one night, and Elisabeth Kübler-Ross was being interviewed. It truly changed my life. It challenged me. I thought, my goodness I had been a totally death denying nurse, always in the theatre, so it made me start to really think about death and dying.’

Teresa shares how her appreciation and understanding of palliative care grew with time, knowledge and experience.

Following that interview and subsequent conversations with Elisabeth Kübler-Ross, Teresa undertook a tour of a number of Hospices and Home and Day Care Centres in the United Kingdom, the United States and Canada. She recalls fondly the time she spent in London at St Christopher’s Hospice with the founder of the modern hospice movement, Dame Cecily Saunders, along with Dr Mary Baines and Dr Colin Murray Parkes who specialised in bereavement.

‘In 1978 I had the privilege of visiting the Royal Victoria Palliative Care Unit in Montreal, Canada and met Dr Balfour Mount, who was later recognised as the founding father of palliative care in Canada. I was there to attend the first international symposium on palliative care held at the Reine Elizabeth Hotel. It was so inspiring. I returned to Australia a zealot for this modern concept of care.’

‘When I came back from St Christopher's Hospice and Royal Victoria Hospital, I wanted to show people what could be accomplished, and I was in a unique position to do that because the hospital beds were already there.’

Many of Teresa’s ideas were based on the hospice methods she had studied in her overseas trips earlier that year.

Initially, 25 beds were allocated to Palliative Care and a multi-disciplinary palliative care team was established. At the time, the palliative care unit was subsidised by the busy surgical section of the hospital. Most patients living with end stage cancer came from the community and Westmead Hospital and were admitted on the criteria of need rather than the ability to pay.

‘I soon realised people wanted to remain at home with the people they loved for as long as possible. Our hospice saw the dying person and their family as a unit of care. We were there to meet their needs and allow them to be in control of what they wanted.

Over the next five years, we cared for over 800 dying patients and their families, both in Mount Carmel Hospital and in the community through our Outstretched Hand Foundation and the community nursing service.’

Mount Carmel Hospital held regular open education days for the generalist home care nurses in all the aspects of care and symptom control.

The Outstretched Hand Foundation: To help, to heal, to serve

Convinced that greater public and medical awareness about palliative care was needed, Teresa registered the ‘Outstretched Hand Foundation’ in 1980 with the generous support of a $200,000 donation from Jack Plane of the Andamooka Pastoral Company. The registered charity acted as an advocate for the dying and the bereaved, ‘To help, to heal, to serve’. A full multi-disciplinary team sat on the committee, led by President Teresa Plane, three registered nurses, Dr Murray Lloyd, the first medical director of the foundation, social worker Margaret Elder and Rita Ward, bereavement councillor.

‘When the Outstretched Hand Foundation was set up, we started doing home care from Mount Carmel, promising families that if they needed a respite bed, there were respite beds available; that was a very important part of palliative care.’

The Foundation produced 12 family support leaflets and three audio tapes to assist caring friends and the grieving. These leaflets were distributed freely to health professionals across Australia and funeral directors by the Foundation.

In the 1980’s Dr Balfour was brought to Australia by the Outstretched Hand Foundation to speak at a major seminar for nurses, GP’s and other health professionals at Leura. The Outstretched Hand Foundation also provided scholarships to nurses and three doctors wishing to extend their knowledge of palliative care to attend the Montreal international seminars’.

The palliative care work done at Mt Carmel Hospital soon received significant print, radio and TV media attention.

‘The impact of and our approach to palliative care attracted interest from the major print media, radio and television shows including Compass on the ABC and 60 Minutes on Channel 9 with George Negus in 1982 looking at home care for dying children.’

Palliative care in the 1980s and beyond

For Teresa, the next decade was filled with many exciting developments, as well as set-backs in the palliative care space. The years were also riddled with personal losses – the death of her husband and Mount Carmel’s Palliative Care Doctor, Dr Carl Spencer in 1988, and her son Andrew’s death in 1990. She reflects on some of the significant events.

‘In 1981 ‘Pallicom’ a quarterly educational magazine was established and distributed throughout Australia containing the main presentations of biannual papers given at the Montreal Palliative Care Conference. In the same year, the first NSW Palliative Care Association meeting was held at the Royal North Shore Hospital. Present were Dr Fred Gunz, the President, Dr Murray Lloyd, myself and others on the committee.’

Two years later, in 1983, the Outstretched Hand Foundation sponsored the first Bereavement Awareness Week for the National Association for Loss and Grief. In 1988 Teresa was made a life member of NALAG.

Dr Yvonne McMaster, another palliative pioneer GP, and the President of Push for Palliative, a lobby group for palliative and home care, asked Teresa to become an ambassador for the group. She continues in this role to this day featuring any palliative care report and always acknowledging National Palliative Care Week in her weekly radio programs.

Following an application to the Federal government in 1984 to have the status of the Mt Carmel Hospital upgraded for palliative care, everything changed. Mount Carmel Hospital was sold to a consortium of doctors and reverted into a conventional surgical hospital. Today it stands as Seven Hills Nursing Home and has over 100 beds.

‘I was lobbying the Hawke government for extra funding for palliative care beds and home care, and doctors were on strike at the time over Medicare funding. It became a very distressing time for me. We experienced numerous political attacks under Parliamentary Privilege, including personal criticisms from the Minister for Social Security, Senator Grimes, at the time.’

Despite the setback, Teresa Plane went on to establish Macquarie Hospice, a Home Care and Day Care Centre later in 1984. The multi-disciplinary palliative care team from Mount Carmel Hospital continued in this venture. She also began a rather long and fruitful journey as a guest lecturer and speaker at universities and national and state conferences, passionately educating about and advocating for palliative care. Her study into organ donation was presented at the Stockholm Bereavement Conference. Her ‘Time to Live, Time to Die’ seminars for health professionals were funded by Charles Sturt University External Education and presented from Mackay to Perth as well as urban and country areas.

Teresa’s trailblazing work didn’t go unnoticed.

On 17 December 1984 Dr Balfour Mount wrote the following words to Teresa to acknowledge her work:

‘As I read the disturbing details surrounding the closure of Mount Carmel, my mind kept going back to my visit there and a host of images of bright clean rooms, comfortable smiling patients, and competent, attentive staff … It is a sad day when excellence goes unrewarded. In my opinion you deserve the highest commendations for your pioneering work in Australian Palliative Care.’

The following year, Dr Balfour Mount was made a Member of the Order of Canada in recognition of ‘having founded the first Palliative Care Service at Montreal's Royal Victoria Hospital’.

Even 23 years later, in 2007, Milton James Lewis, an Honorary Senior Research Fellow, Menzies Centre for Health Policy, at the University of Sydney, praised Teresa Plane and Dr Carl Spencer for their pioneering work in caring for terminally ill patients at Mount Carmel despite the negative views of a politician in 1984.

But for Teresa, one of her most memorable experiences happened at a palliative care conference in Sydney, long after she had retired.

‘It’s a little story which again brings me to tears. I attended the conference just to see what was happening in the sector. And by then I had grey hair. At the end I thought I would just slip out and go home as I didn’t know anybody.

On my way out the door, a man turned around and he said, ‘Oh my god it's Teresa!’ I looked at him blankly and he explained he was a palliative care consultant from Gosford before he turned towards a group of nurses that were there and said, ‘Here's the woman whose shoulders we all stand upon’. And that reduced me to tears.’

Dreams realised

In 1992, the Chapel Hill Retreat opened in the Blue Mountains, with seminars and residential meditation retreats as well as support and frequently fun weekends with farm animals for dying children, their siblings and their parents. Touch the Earth days for residents from aged nursing homes enjoying a visit to the chapel and luncheon were very popular.

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‘The chapel, set in five acres of paved gardens, was built by my ex-husband Jack Plane – a man who was often known as ‘God’s banker’ by Mount Carmel staff – who gave generously to many causes including the Outstretched Hand Foundation. The chapel and magnificent stained-glass windows were dedicated to all the patients who died at Mt Carmel Hospital and others cared for at home by the Outstretched Hand Foundation. Two side windows honoured my husband Dr Carl Spencer and son Andrew.’

In 2016, Teresa joined Radio Station 2RPH broadcasting from Glebe presenting two radio programs each week: Ageing with Attitude (funded by the Department of Ageing and Disability) and Meditative Moments, on Sunday nights. It was the same year that Teresa’s long-held dream of acting was realised. She achieved her ambition after taking an acting course and debuting in the bittersweet short play ‘The Dancing Lessons’, where she played the role of an aging mother suffering from dementia. The following year her own play, ‘The Last Shuffle’ won the audience award in the Short and Sweet Play Festival.

Now living independently at the ANZAC Memorial Village at Narrabeen, Teresa, who turns 90 years old in 2023 still believes strongly that nobody should die alone.

‘Living in residential care has meant that many residents, including people receiving palliative care, have not been allowed to have visitors.

I met 99-year-old Ben Taylor two years ago, and he has become my palliative care one-on-one buddy in a bubble of care. It’s such a privilege to be able to support him and even help write his memoires. For the past two years, I have spent Sundays as a volunteer in the dementia care home ‘Connie Fall’, on the campus here and sing regularly with the Veteran’s Voices, the village choir.’

Teresa’s closing remarks

‘Hospitals and nursing homes are often short-staffed, and lockdowns have also meant that people without family or friends nearby don’t always have somebody to sit with them when they’re dying. Nobody should die alone. I always say I’ll never be too old to sit and hold somebody's hand.’

In all Teresa’s years as a palliative care nurse only two patients raised the question of euthanasia; John, a young man with Motor Neuro Disease, the other Teresa’s son Andrew, who suffered a long dying trajectory with AIDS.

‘I’d like to comment on Voluntary Assisted Dying, or as I prefer, Dying with Dignity. With access to high-quality well-funded palliative care and excellent pain and symptom control, I’ve seen how the unfinished business of patients can be discussed with loved ones, people have time to ask for forgiveness or to be forgiven and people can reconcile differences together. Quality time is so important for everyone, especially in the bereavement period for families.’

Teresa is quick to acknowledge that working in the palliative care sector is not for everyone. But for those who do, they usually find it very rewarding.

‘You need to have the desire to work in palliative care. You need commitment to the journey, compassion for those you care for, and above all competence. As a society we're not comfortable with dying. Unless people have confronted their own mortality, they are going to feel very uncomfortable sitting with somebody who's dying. That’s why I believe the best nurse is often a loving family member – and when family members and young children are involved, supported by the multi-disciplinary palliative care team, the dying person becomes more comfortable with dying.’

For many years Teresa was a mentor and guide to many students and staff. The advice she often shared with them is still very relevant today.story

‘Palliative Care is quality of life, and for the dying this means maintaining real life as long as possible, ensuring that the patient is alert and comfortable, capable of enjoying family and surroundings, not desensitised by pain and anxiety. Quality of life includes observing the sunrise from an open window, listening to the birds, smelling the flowers, holding a baby, watching the joy of your family at Christmas, taking walks in a garden with loved ones, or alone, reading, creating with mind and/or hands... enjoying the infinite activities of an active life. Palliative Care is love in action, a journey of faith and trust.’

Teresa is proud to say she will never be burnt out.

‘I’ve never lost my passion for palliative care. We always used to have these wonderful ‘goof days’ – time aside for ourselves to have some fun. And I’ve been a meditator for 40 years – that is where my resilience and strength has come from.’

‘And what have the dying taught me personally? They taught me the value of living one day at a time and the great importance of discovering that it is always possible to have gratitude in life. They have taught me that it is possible to experience peace of mind when meeting the challenges that life throws at me as my body journeys through older age. And I tell you that is a big challenge, the biggest that I have ever had.’

But today Teresa says she is living a fulfilled and contented life. It is her wish that when she nears her own dying days, weeks or months, she too will have someone who has bought a platform ticket to be with her.

‘I’m in a very happy place. I’m ready to go, and my bags are packed.’