Felix: How did you get into medicine, and then specialise in palliative care?

Tamara: Actually, I wanted to become an archaeologist; I had no intention of entering medicine at all. But in Georgia, it often happens that you follow your relatives' advice. I performed well at school, but as soon as I graduated, they began ‘placing’ me—they enrolled me in a medical college. I am very grateful to my brother for that now. However, back then, I continued to resist; after college, I planned to apply to the history faculty. Then, a stroke of luck occurred—I met an acquaintance of my father’s who asked, ‘Do you want to work with some good people?’ I agreed, and that is how I ended up in a hospital, in the traumatology department.

By a twist of fate, I met some wonderful doctors who became my mentors. They allowed me to observe their work and taught me the most important skills: clinical thinking, planning, listening, and decision-making. They would give me books to take home, saying, ‘Here is a textbook—study.’

I also unexpectedly began palliative care in 2009. I was offered a position to substitute for a nursing care instructor who was going on maternity leave at the Preobrazhenie Hospice educational centre. I tried to object, saying I had never taught anyone before, but they persuaded me to give it a try for a month. I tried it—and I ended up staying. I taught while continuing my clinical practice. Later, I became the care coordinator at the hospice itself.

In 2012, I was offered training in Germany. I didn’t know any German, and my English was—well, so-so. But I went anyway; people helped me there and translated if I didn’t understand something. Since then, I have attended various other training courses and travelled to many places. Even now, I am considering enrolling in a psychology faculty. In short, one must always keep learning.

It is also crucial to mention that if it weren’t for my sister—if she hadn’t been in my life—I would hardly be where I am now: sitting in a parked car after a patient’s funeral, talking to you. In many ways, I owe my life to her.

She had Down’s syndrome and cerebral palsy, and throughout my childhood, I observed my mother, relatives, and friends caring for her. I lived alongside her for 13 years and didn’t even realise she was ill. To me, she seemed like an ordinary person; she just didn’t go to school and learned differently. Perhaps I simply didn’t think about it. Then, in 1989, she passed away. She was 22. Something in me must have shifted after that. It’s as if I didn’t choose palliative care myself, but was guided there, you see?

Felix: Thank you for your honesty. Many of us came to palliative care through personal stories, so of course, I understand.

Tell us more about the training centre you started working in 2009. Do you still teach there?

Tamara: I haven’t taught there for eighteen months now.

It remains the only educational centre in Georgia specifically for palliative care nurses. There are separate programmes, some courses, and related topics in therapy or care in Georgian, but very few of them.

When I first arrived there, I thought I knew everything, that I could handle it all. My first class consisted of 29 Georgian women, each with her own character. After the very first day, I thought: ‘That’s it, I’m not going back tomorrow because no one is listening to me.’ But I went back anyway. And soon, do you know what I realised?

My programme changed with each new intake. When I entered the classroom, I never sat apart from the students as a teacher. I always sat with them, right beside them.

You see, I was training nurses who already had an education and a diploma. And if you say to a Georgian woman, ‘Now I’m going to teach you what you don't know’—that’s it, you’ve made an enemy. But if you say, ‘Girls, there is a lot I don’t know either, but I do know a few things; tell me, what interests you?’—then everything changes. This understanding didn’t come to me immediately.

When I received the coordinator role, the nurses didn’t accept me at first either: I was taking someone else’s place, and that was painful for them.

We used to hold a general meeting every Thursday. One day, the Mother Superior suggested that each nurse write down what she disliked about Tamara. It was a real shock for me. They all began going up to the board and writing what they disliked about me, explaining why they found it difficult to accept me. At first, I wanted to take offence and leave, but I stopped myself—instead, I stood up and wrote my own weaknesses on the board as well.

If only you knew how healing that was. For fifteen years now, we have all been the closest of friends.

Uliana: How has your understanding of palliative care evolved over the years?

Tamara: Throughout my youth, I believed I knew a lot and could do many things better than others. In reality, I couldn’t. I realised this when my mother died.

We have protocols, resolutions, and guidelines in Georgian; everything is available. But you need to read it all, you see.

Uliana: What qualities do you believe are important for a nurse? Particularly a palliative care nurse?

Tamara: This is a difficult subject. A ‘good nurse’ is typically seen as someone skilled at setting up IV drips. But that isn't sufficient.

Let me give you an example. Long ago, I had a neighbour—a man with a drug addiction, but otherwise a good person. And another neighbour was an intensivist who, if he couldn't insert a central catheter, would call the neighbour with addiction for help.

It is also important to be able to empathise. I teach it like this: when you are positioning a patient, lie down exactly as you would place the patient. Feel where it’s uncomfortable, where it hurts, and where there is discomfort. Then you will understand what needs to be changed.

The issue is that nurses often merely follow orders. They don’t make decisions; everything needs to be coordinated, asked for, or called in.

In palliative care, the situation is even more desperate. An attitude surfaces: ‘Well, what can we do? He’s dying anyway.’ This discrimination based on diagnosis or age infuriates me.

It’s a disaster.

At the same time, we have capable nurses. They possess excellent practical skills but lack theoretical thinking and initiative. They often hesitate to say: ‘I think we should do it this way.’ You don't even need to read complex books for that; you simply need to think. I used to be afraid of taking responsibility myself because, when you suggest something, you are accountable for it.

It's important to be able to admit your mistakes, to voice them to yourself and to those around you—just like that, out loud. You wouldn’t believe how much it inspires people. If you do this, people begin to trust you, trust your expertise, ask questions, and truly learn from you.

This is how I teach my nurses. At first, they didn’t want to do anything or make decisions on their own; now they ask me what materials they should read. They have learned to describe their actions and analyse them. This is extremely important.

A plan can change as you progress: something might not work here, something may have altered there—everything must be documented, considered, and kept in view. Only then can we discuss quality care.

I don’t enjoy paperwork myself, but I understand it’s necessary, so I write alongside my nurses. I try not to take documents home but to describe everything right there on the spot. They learn from me and begin recording everything themselves.

And do you know what the most wonderful thing is? Later, if they move to other organisations, they teach other nurses to do the same. My knowledge continues to spread without my further involvement. That is incredibly valuable.

It is much more difficult than it appears. This time, I didn't succeed—it felt as though I was losing my mother for the second time. However, I am also thankful for the experience, as she taught me a great deal. She introduced me to new approaches to post-stroke care.

That is the essence of practice.

Pause at any time and reflect. See the world through the patient's eyes. Then view it from a medic's perspective. Most importantly, you must love what you do. Without that, nothing will succeed.

Uliana: How do you handle such an overwhelming amount of emotion? Do you have your own method of easing tension or dealing with grief?

Tamara: There are now far more medicines in my first-aid kit than there used to be. And that isn't just due to age. Of course, work also plays its part. It is essential—you must look after yourself.

You need to trust people and give them the chance to learn.

I lost a lot in life because of my character. But then I learned to thank God. Life is very hard without faith. It is hard for me; I don't know about others, but that is what helps me.

And I have my own ways of healing. Getting behind the wheel—and God forbid anyone is with me at that moment: I have the music blasting at full volume, very loud. I walk a lot—it helps me breathe. And most importantly—visiting my granddaughter, playing with her for an hour or so, makes me forget everything: the morning's blood pressure, the swollen legs, the fact I could barely get out of bed, and that things went wrong at work.

That is my therapy. Everyone must find such things for themselves. Everyone has their own. And, thank God, I have friends. One of my close friends is a psychologist; she helps me a lot. Because in the 21st century, faith is important, but you cannot manage without a psychologist either.

In short, one must not be afraid to live. Not afraid to fall asleep, not afraid to wake up. Not afraid to speak of one's sins and to analyse oneself.

I just remembered something else about that patient I’ve told you about before: she was lying in bed, and I lay down beside her—I often do that, I lie down with patients, and we chat. An interesting point, by the way—I don't smell anything, you know, what people call the ‘smell of old age’ or the ‘smell of illness’. If a person is clean and well cared for, there is no smell, though others say there is; I don't sense it. Yet on the street, I am very sensitive to all kinds of smells, but at work, not at all.

So, we were lying there together. She was speaking with difficulty, but she was speaking. And we had this dialogue:

She said: ‘I’m going to die.’ And I said: ‘Babo, I will die one day too. I don't know when, in 10 or 20 years. I’d like it to be in 40, like you, but I don't know.’ And do you know what she said? ‘When you die, I will be there to look after you.’

Do you understand what that means? It isn't just gratitude; it's a desire to give back to you what you gave her. I still find it hard to comprehend. That is why I say: thank you to all those who have passed on.