“If you are a poet, you will see clearly there is a cloud floating in this sheet of paper. Without a cloud, there will be no rain; without rain, the trees cannot grow; and without trees, we cannot make paper.”

Such is the beginning of 'The Heart of Understanding' by Thich Nhat Hanh. I put the book down and thought about that for a while and quietly wished I was more of a poet. There is a cloud floating in every piece of paper I have read since. Everything is connected.

He goes to tell us how there is sunshine in the paper, without sunshine the tree cannot grow, without sunshine, the wheat cannot grow to make the daily bread that feeds the lumberjack. Without the lumberjack, the tree cannot be felled.

“Time, space, the earth, the rain, the minerals in the soil, the sunshine, the cloud, the river, the heat. Everything co-exists with this sheet of paper”.

We hear it every day in other metaphors, but it doesn’t always land; it doesn’t always sink in how crucial and ineffable all of this really is. Interconnectedness and interdependence.

Life, death, nature, love, the universe; somehow meaningless, without connection.

I felt this most recently in TC Alfred as I write this in the aftermath. On the neighbourhood pages on the internet, total strangers were helping each other. Offering food, shelter, water, hot showers, generators.  It was very moving, and I physically felt it in my chest, a swelling, a relief, that generosity and kindness are still fundamentally out there. Seeing the suffering in someone else and being moved to help, is what defines compassion, and you cannot have compassion without connection. Connection is at the heart of compassion.

When I first started palliative care, I worked as a junior doctor in a hospice in the South of England. I remember feeling utterly paralysed and terrified about talking to patients. What on earth could I possible have to say, that would be of service to someone who was dying? I felt very disconnected, awkward and self-conscious in any sort of discussion I had to have with a patient, or their family. I watched with awe, the nurses and social workers who talked so effortlessly with patients. I watched as the patients engaged so readily with the staff, wanting to laugh, cry, be touched, be valued and of course to connect.

I do remember the first time I really connected with a dying patient in those first few weeks of my life at the hospice. Her name was Margaret. She was a lady in her seventies who had had polio as a child and was diagnosed with motor neurone disease as an older adult. Something I have never seen since and probably never will. Because of the MND, she could no longer talk. There were no iPhones, or iPads or speech devises. All she would use was a piece of paper with the alphabet on, so together, we had to spell out every single word to make up her sentences. She had become very pedantic, and it was a pain staking undertaking to have even the shortest conversation with her.

I am smiling as I write this as I remember her face so well. She could smile with her eyes. Here was someone who was not at all defeated by the cards she had been dealt with in life. She remained optimistic, spirited and good natured.

However, to simply ask Margeret how she was feeling, would take the best part of half an hour. In a busy hospice, that is a lot of time for a nurse to spend with one patient. Therefore, it would usually fall to me to ask Margaret how her night had been, how she was feeling today, how her pain was – the usual questions.

So, I remember one morning, sitting down on her bed and going through her thoughts and feelings in her very slow, deliberate, pedantic, painful pace. We’d been together for about 30 minutes, and she seemed tired.  For some reason I said, “You know, if you left out the swear words, this would be a lot quicker for both of us”.

She looked at me in shock, there was an awful pause, and then something magical happened. We both started crying with laughter. It was an absolute joyous moment. We could not stop laughing, joined together in the triumph of 2 people feeling the lightness, darkness and ridiculousness of life, and laughing wholeheartedly at it all.  It was such a beautiful moment of connection, and one that I will cherish for the rest of my life.

This leads me on to the 2025 Oceanic Palliative Care Conference (25OPCC), because the central theme is connection, and as you can tell, connection is something I have thought about for a long time in palliative care.

The theme for 25OPCC is 'Connecting Systems for Better Care', which begs the question, what are those systems? What systems are needed to provide care to a patient, their carer and their family? Being seriously ill can be a disorientating, frightening and sometimes lonely business that it is ever changing. It makes sense that something so complex needs a systems approach, and by that, I mean separate, interconnected systems that talk to each other. Interconnectedness and interdependence.

Palliative care sits under many umbrellas, not just health care, but community care, spiritual care, social care etc. In health care alone the systems are complex. We work in interdisciplinary teams within our own service. We work in a health care system that integrates with other teams, hospitals, hospices, primary care, community services and aged care. Our health care system sits under a governance system that supports policy development, funding and responds to societal expectations. Health care sits a societal system, which again is a system of law, culture, history, environment and ideology. And so on.

It’s complex stuff but we need the big structures around us, to be able to provide the care that we do.

I am hoping we explore more of this at the conference. If we understand the big picture and its components, we are more able to understand fragmentation, communication failure and equity issues. We are more equipped to affect change.

When I think about Margaret and her needs, I was a small part of the big system, and in order to provide her individual needs, I needed to be part of that system. She taught me this over 30 years ago. Her piece of paper that only contained the alphabet, also contained the universe.

Life, death, nature, love, the universe; somehow meaningless without connection.

I wrote this on a piece of paper, and you are reading it, so already we are connected. Hope to see you in September!

The 2025 Oceanic Palliative Care Conference will take place at the Brisbane Convention Centre, 10 to 12 September, with A/Prof Joanne Doran as MC. Some speakers have already been announced with the full program to be released very soon, early bird registrations are now open, find our more at the 25OPCC website.