There are very few things that palliative care pioneer Dr David Brumley has done half-heartedly. But he admits, when it came to retiring, he didn’t give it his best shot.

The former Ballarat GP, who was among the first doctors in Australia to become a palliative care specialist, was recently awarded a Medal of the Order of Australia (OAM) for his service to medicine and palliative care.

It’s an accolade that recognises achievements locally, regionally and internationally over a 40-year career. But for all of his high-flying titles and gongs, the key to Dr Brumley’s success boils down to something relatively simple. Consistently, colleagues mention that the humble, unassuming doctor has communication skills that nurture the soul, giving him an extraordinary ability to make people feel valued.

Dr Brumley’s failed retirement is largely due to the rewards that come with being able to improve terminally ill patients’ quality of life.

“When you’ve been working with a patient for some time with different problems, whether it’s pain, depression or anxiety, and you finally succeed in fixing it – they are the small and quite frequent pleasures that keep me working,” he tells Palliative Matters.

“I tried to retire when I moved from Ballarat to Geelong two years ago, but I was a bit lost without the contact with patients and the home care, which I really enjoy.

“That is where I get the greatest reward. I decided if I still enjoy it, I might as well continue.”

While the OAM has left Dr Brumley “a bit amazed and taken aback”, colleagues consider it well-deserved and long overdue.

"You always felt very special when you talked to David."

Ballarat Hospice Care executive officer Carita Clancy, who started working with Dr Brumley about 20 years ago, says he is as a leader, a supporter and an initiator, who has “a level of spirituality about him”.

“In David’s words, what we do is gently bring people into the reality of the situation. That resonates with me still, and keeps me very aware that while we look after many people, this experience is unique to each of them. Dying only happens once, so that spiritual side is about helping them to understand.”

Mrs Clancy says he enables people to realise they are still contributing, even on their death bed.

“We still learn from them. They may think they are not giving, but they do give us a gift that gives better meaning to our lives,” she says.

She says while Dr Brumley could represent palliative care at the highest level in the medical and political arena, he would also make a point of phoning the on-call nurse for the local home-care hospice on Christmas Day to make sure everything was okay.

Caring in the home more creative

Dr Brumley was still working as a GP when he start part-time as Ballarat Hospice Care's clinical director, inspired by the idea of supporting people with advanced illness to live and die at home.

He says putting patients into a hospital bed can be dehumanising and make them anxious, while caring for them at home is a more relaxed and creative process. He learns from what patients have on their walls and mantel piece, and the people who come and go from the home.

“Seeing a patient in their own space tells you far more than if they were in a hospital bed,” he says.

“And because of the power relationships are different, when people are in the comfort of their own space they are more willing to tell you what they think and believe.

“If I want to talk about something difficult, like ‘What are you afraid of as you are dying?’ people are much more included to be direct about that.”

While his key passion is home-based care, he says achieving a dedicated palliative care unit – the Gandarra Palliative Care Unit – at the local public hospital was “a real thrill”. Dr Brumley made the big decision to leave general practice and started work as the new unit’s clinical director.

He says hospital doctors generally like to work with other specialists, which made the move daunting. But the majority of his colleagues were quick to start referring patients and participate in a new team of palliative care consultants.

Maree Kewish, nurse unit manager at Gandarra, says his calming presence reassured anyone feeling anxious, in pain or distressed.

“He connected with people at the core of who they are, who they have been and what they wanted. He treated them as a whole, as if they were really paramount. You would never have known how busy he was. Patients would never glean any of that from their interactions with him, because if he was caring for them, they were his focus,” says Mrs Kewish.

“And he is such a gentle man. He can talk to people and be clear about their condition in the most reassuring way. It opened two-way communication, allowing patients to be open and frank if they needed to be.”

A background in general practice

Dr Brumley enjoyed the 14 years he worked locally as a GP and says this experience encouraged him to move into palliative medicine.

“It became clear to me that a lot of people weren’t dying particularly well and even clearer to me that I didn’t know what the hell to do about it and there was a lot of learning to do,” he says.

Caring for one of the senior doctors at the general practice had a big impact.

“He was a very gentle old man who taught me a bit of acceptance and about the mortality of doctors,” says Dr Brumley.

“He was the first doctor I had cared for during his dying. And because he was a senior and revered partner [at the general practice] it was anxiety provoking and powerful learning for me. When you are dealing with the uncertainties of dying in the messy world of people it is not always straight forward.

“It brought it all a bit closer to home and made me think about what I wanted to do in life.”

A visit to town from one of palliative care’s foremost clinicians, Dr Rosalie Shaw OAM, also influenced on his decision to change career direction. He headed to Perth in order to work with Dr Shaw at a hospice for a few months, before signing up to study a Masters in palliative care, taught by another eminent palliative care specialist, and former Senior Australian of the Year, Professor Ian Maddocks AM.

This was all occurring before palliative care was recognised as a specialty. But Dr Brumley was rubbing shoulders with other doctors who shared his passion, and together they initiated the Australian and New Zealand Society for Palliative Medicine, which focussed initially on having a specialist qualification in palliative care recognised. He contributed to the society as both a council member and secretary.

While he has spent much of his career mentoring nurses, he has also educated GP registrars and lectured tertiary students. He was a senior lecturer at the University of Melbourne Rural Clinical School and Flinders University of South Australia, and remains a senior lecturer at Deakin University, Geelong. He has also undertaken self-funded trips overseas, teaching palliative care in Malaysia, Vietnam and India.

“The teaching is pretty important,” says Dr Brumley.

“If you believe you have something to offer you feel an intense desire to share it and talk about it.

“Mostly I do the overseas stuff because it’s good fun, there’s lots of good food and people who are happy to see you. But it also brings you back to reality, in terms of the resources we have here in Australia, and makes you understand that although there are great struggles here to make things better, in other parts of the world it is so much harder.”

Jade Odgers, manager of the Grampians Regional Palliative Care Team, encouraged colleagues to listen and learn from Dr Brumley at every opportunity.

“He would walk into a room with a cup of tea and sit down with the patient, and I’d know how busy he was. He showed the patient and family he had all the time in the world and that was quite unique; you always felt very special when you talked to David.

“It meant patients relaxed and took their time to explain the things that were really important for them about end-of-life care. He focussed on emotional cues and could draw out information very easily in a relaxed way.”

Mrs Odgers says distance did nothing to dampen Dr Brumley’s enthusiasm for visiting patients in their own homes, and he covered many thousands of kilometres while working for the regional palliative care team. While she was focussed on getting the best value out of finite resources, Dr Brumley regularly reminded her of the importance of home visits in order to assess the supports and barriers affecting how people would be able to die at home.

His theory was that people in regional, rural or remote areas shouldn’t be disadvantaged, but aspects of care had to be delivered differently. She says he recognised the roles played by everyone from the local neighbour to the local publican, and was careful to support people in those roles and not take them over. Similarly, he focussed on supporting local GPs to support their patients, never intruding on their role.

Mrs Odgers, like Dr Brumley, is on the board of Palliative Care Victoria (PCV). She says he is held in regard by countless people, who are grateful for the impact he has had on their lives, through the care he provided their loved ones in death. Yet his modesty is extraordinary.

“We nominated him for a life membership of PCV and he was quite overwhelmed by that. I thought it was a bit of a given,” says Mrs Odgers.

“He said he was really humbled and he didn’t know whether he deserved it. I thought David, if you don’t deserve it, I really don’t know who does.”

Learn from Dr Brumley before Victorian conference

Next month Dr Brumley will lead a workshop in Melbourne which explores how people caring for others can maximise their own happiness and effectiveness.

The workshop, called ‘Caring Well, Growing Stronger – Sustaining Ourselves and Others’, runs from 9am-5pm on Wednesday 27 July, on the eve of Palliative Care Victoria’s biennial conference.

The workshop challenges ideas of professional distance. It suggests how to enter the world of the patient and see suffering, and offers skills to enhance care while learning and growing from the experience. The workshop includes sessions on self-awareness, communication skills, compassion, resilience and growth.

For more information on the conference and other workshops go to https://www.ivvy.com/event/PCV16/