Finding A Better Way To End Life On a winter's morning, Dr Jelena Radosavljevic is finishing her rounds. Walking into room 11C, she greets a woman her own age. The woman is in the final stages of ovarian cancer. "Is that tight?" asks Radosavljevic, 52, pressing hard and deep into the smooth, swollen stomach of Anne Munro as if it is a ball of dough she plans to knead. Lying on the bed facing her, Anne nods: yes, it is. Back in Serbia, where Radosavljevic grew up and studied medicine, dying started with a funeral; the women screaming as bodies were slowly lowered into the earth; people in black, sometimes for years. Death itself always seemed sudden. Even when it was not. Doctor Jelena Radosavljevic: "I think this is what palliative care is about, filling in that gap [between being diagnosed and dying]." Here, in the St Joseph's Ward at Bethlehem Hospital in Caulfield, the palliative care physician is making death part of her life's work. She believes there is a better way to die, and to say goodbye, than the deaths she experienced back home. Deaths such as her uncle's. Radosavljevic lifts her hands, pauses, then places them onto the stretched flesh again. One hand starts tapping the other, creeping across the belly button, a tall red scar. "There is a fair bit of fluid there, and lots of gas, too," she says, looking up. Are we draining you this week? Anne nods. Tomorrow. That will help. Yes, I hope it will. With her blonde bob, jeans and a navy and floral cardigan, Radosavljevic could, at first glance, be mistaken for a visiting friend as she sits on the edge of Anne's bed, asking her about her sister's trip to the United States. Even now, with her short hair, and kilograms lighter than she was when she was diagnosed in November 2010, it is clear from the muscles that still flicker when Radosavljevic stretches Anne's leg that she has been a fit woman. A former physical education teacher at Mullauna College, Anne loves softball, netball and badminton. "This stiffness in my quads," she asks, looking up at Radosavljevic. She could be an ageing athlete lamenting to her coach. Is that just a sign I am going downhill? This morning she had struggled to walk along the small corridor of the blue-carpeted St Joseph's ward. Radosavljevic sighs. Yes, it is part of the deterioration. Have you been taking dexamethasone? That might also be weakening your muscles. Dexi? I know the lingo. We'll start reducing the dose. Do what you can but don't push yourself too hard. Achievable goals ... So much of palliative care medicine, Radosavljevic later tells me, is about "achievable goals." It has been more than a decade since she started to work in this area of medicine, after immigrating to New Zealand and eventually to Melbourne with her husband and two children. She was taken aback by the differences in treatment of sick and dying people in Australia compared with back home. That was a big shock for me because we don't talk about dying in Serbia. We don't talk about dying, we sort of grow up with lots of grief, but unresolved grief, just because we think that's the best way. And in last days we turn towards tradition. She talks about an inspirational doctor, Associate Professor Greg Crawford, who she met while working in Adelaide and who nurtured her interest in palliative care. There was something about the connections she saw him making with his patients that showed he was making a difference in their lives - and in their deaths. She thinks he saw something in her that made him think she would be good at it, too. "I don't know what," she shrugs and switches the conversation back to her mentor. The way he conversed with dying people was very special. He was straightforward. And he listened. One of the first things he taught her was to find out what patients wanted. What were their hopes? What were their goals? Often their answers were much the same. Less pain. To walk for as long as they possibly can. To get a coffee down the street. To say goodbye. Her job, she says, is to present information, not to decide what will happen next. She only works here part-time. For the rest of the week she is a general practitioner in the suburbs. For her dying patients, she says, she hopes only to support their choices. But this does not mean standing back. Sometimes people have asked her to help them travel back overseas to die. One girl, she says, asked her to organise a year 12 formal at her hospice. Another asked her to find a son she had put up for adoption decades earlier. "We are like Obama," she laughs. Yes, we can. But sometimes she can't. If a person is very close to death, getting them on a plane home can sometimes be impossible. Some say, 'I want to do it even if I die on the plane'. But it's not easy to die on the plane these days. You have to fight to get people overseas. But the main thing, she says, is to keep talking. Medically, a big part of her role at Bethlehem centres around symptoms for people undergoing curative treatments and for those who have decided against such treatments. The latter, she says, she tries to care for as their bodies shut down. Every human body is different and each person's body lets go of life in a different way. But Radosavljevic has seen enough death to be able to describe it. As a body shuts down, she says, there is more and more sleeping. People begin to eat less, to drink less. Often the body shrinks. The skin, says Radosavljevic, gets drier and often turns a little grey. As as a person moves closer to their final moments, it can become more difficult to breathe. Hearing can be the last thing to go. "It's natural," she says. She did not always think this way. Growing up, no one spoke about death. Not even the dying. In the final year of her medical degree in 1985, Radosavljevic remembers huddling, with her large extended family, around the surgeon who had just operated on her uncle - surgery aimed at removing what doctors believed was a small tumour on his lungs. The surgeon was also her professor at medical school. "I remember my dad asking, 'How was the operation?' " she recalls. "She said: 'We thought it was a small tumour but it's huge,' " she repeats, stretching this last word with a scowl. I remember feeling so shocked, he was the first person in our family to die of lung cancer. Later, Radosavljevic saw something that would shape her views on bad death: her father dragging his dying brother back to the hospital, begging passing doctors to give him more chemotherapy. And the poor man couldn't take three steps. "He never wanted to face the dying process," Radosavljevic says of her father. He was looking for life, he never thought about dying. Not even when it was his time to let go. From the moment she moved from Serbia at 34, she says, she carried the guilt of knowing she would never nurse her parents in their old age. When her father - like 12 others in her extended family - was diagnosed with lung cancer in 2006, her mother made the decision not to tell him. Radosavljevic was initially upset, but in the end conceded that it was her choice, their way. He lived six weeks after being diagnosed. For some people, like my folks, it's very difficult to fill in the time between being diagnosed and dying. There is a big gap. And I think this is what palliative care is about, filling in that gap. Radosavljevic flew back home and was there when her father died. She told him she loved him and said goodbye. At his funeral, she delivered his eulogy (close family in Serbia rarely do this, usually it is read by a more distant, less emotional relative). In it, she spoke about the disease that had claimed the life of her father and so many others in her family. She forbade the distribution of cigarettes, as is usually the custom at a Serbian funeral. She wore black, she smiles, but only for the day. It was, she says, her own little triumph against death. A small demonstration of what life as a palliative care doctor has taught her so far; to let go on your own terms. ■ Anne Munro died in the early hours of Monday, July 22.