At the age of 56, Merran Cooper became a doctor. She was inspired by personal tragedy to help people live better lives — and die better deaths.
Our lifejourneys often lead us towards our goals. I suppose mine started when my husband died — I was 23 and he was 24. His name was Mark.
It was a difficult time. Mark went through 11 months of chemotherapy and radiotherapy. Palliative care wasn’t an option in Australia back then, and there was no grief counselling. There’s no denying that it was a traumatic experience, but the end of Mark’s life was as satisfying as it could be, because we had discussed it openly beforehand — with his family, with our community and with each other. Even though he was very young, there was nothing left unsaid at the end of his life.
Even though he was very young, there was nothing left unsaid at the end of his life.
My life went on. I remarried. I had children. And when my best friend, Jane, was diagnosed with a degenerative neuromuscular disease called Friedreich’s ataxia, I cared for her over a period of 20 years. She was insulin-dependent, and she finally made the decision that she didn’t want to be given any more insulin. She went into hospital, where she eventually went into a diabetic coma and passed away, but we made the most of her last two weeks — we partied, we drank rum and Coke, we divided up her jewellery and we talked about music and the things she loved. It was a wonderful way to complete her life.
After going through those two experiences, my mind and my heart were made up. I have a Masters of Physiotherapy and I had been working in that field, but I knew I needed to work in palliative care so I could help other people to have a good death like Mark and Jane had. In order to do that, I decided to go back to school and study medicine. On my 50th birthday, I passed the six-hour Graduate Medical School Admissions Test.
I had a wonderful time at medical school. My children had already grown up and left home, so I didn’t have to look after them while I was studying, and they were incredibly supportive of me. All my fellow students were in their 20s — I had my 51st birthday on the same day the girl sitting next to me had her 21st birthday. But when we were discussing medicine and pathology, the age gap vanished.
Study is very collaborative these days with a lot of group work, so you have to be willing to listen and contribute. You can’t assume that just because you’re older, you know more than the other students. As older people, we sometimes think that we know it all, but you have to keep on being open, because the next generation will share their knowledge so willingly if you let them. I think it’s all in the attitude of the older person. If you don’t push back with a ‘been there, done that’ attitude, young people will be happy to help you learn how to operate in the modern world.
As older people, we sometimes think that we know it all, but you have to keep on being open.
I was 56 on my first day of work as a junior doctor on the ward. Many of my colleagues and even my bosses were virtually half my age, but it wasn’t an issue for them. We just got on with the job and did what had to be done. There was a mutual respect. They might have been saying funny things about me behind my back, of course, but I never saw any sign of that.
Sometimes, however, a patient would say something that only an older person could truly understand. For example, a 65-year-old caring for her 70-year-old husband might say, ‘I’m just so tired’, and I would know exactly what she was talking about. I wouldn’t say, ‘Oh, I can give you a pill for that’, because there is no pill for that — sometimes, the stresses of life just get you down.
And sometimes I did speak up on behalf of the patients, more than a younger person might have. I would have discussions with patients that younger doctors wouldn’t have about end-of-life care. They would ask me, ‘What’s really going on here?’ There’s a knowingness there, when you’re talking to someone your own age in that situation, without even saying the words.
We’ve made so many advances in medical care that we can give people so many choices and options now, right up until the day they die. The problem is that, rather than sitting someone down and saying, ‘Look, you might die from this in a few months or even a few weeks, and you need to prepare for that’, we rarely face that possibility. We turn away from it and we keep trying everything, and the end result of that is that a lot of people are dying without being prepared for it.
A lot of people are dying without being prepared for it.
We’ve got doctors who are exhausted, providing care they know is futile, because the guidelines say they have to. Our hospitals are full of families who are afraid to talk about dying, so they don’t, and doctors who are simply not trained to talk about dying, so they don’t. And everybody just goes down this route of ‘overcare’ by default, rather than hitting the pause button and saying, ‘What are our options here, really? What can we offer in the way of quality palliative care?’
Before you take that turn towards palliative care, though, you need an advance care plan — a document to tell your doctors or family how you want to be treated if you can no longer speak for yourself or make your own decisions. When I was working in hospitals, hardly anybody had one. And when you don’t have an advance care plan, and you can’t speak for yourself, your doctors have to default to providing all the care they can.
I decided to take time out and work on a digital advance care plan that travels with the patient all the way through the healthcare system. That’s now become a start-up business called Touchstone Life Care. I’ve decided that rather than working as a GP in palliative care, I want to work on changing the system itself, to try to prevent ‘bad dying’, as much as encourage ‘good dying’.
I’m also trying to change the culture. I’m working with a writer and a producer on a three-episode documentary on end-of-life care — what we’re currently doing in hospitals, how we can do it better, and how we can fund those improvements — and we’ve been successful in securing funding from Screen Australia to make that.
It’s funny — working in digital health and the tech space, I’m once again surrounded by young people, putting myself out there and learning new things every single day. You can’t afford to let new things pass you by. If you’re afraid of change and you don’t keep up with technology, it just gets further and further away from you. Besides, it’s nowhere near as hard as you might think it is to keep up with new communication channels like Slack, Trello and Google Drive, and people are always willing to help when you’re willing to learn.
You can’t afford to let new things pass you by.
The only negative experience I’ve had with a younger person was back in my first term of medical school. We had to grade each other as part of a 360-degree feedback process, and somebody wrote, ‘Merran has done a lot of things and she’s got a lot of stories to tell, but I don’t want to hear them’. And you know what? I get it. Because when you get to my age, you have had a lot of experience, but young people don’t want to hear about that. They want to go and experience those things for themselves.
They’ll ask you questions sometimes, of course. But it’s best not to frame your answer as the answer — it’s just an answer, until they figure out their own. After all, you can have all the advice in the world, but then you go with your gut feeling, and it either works out or it doesn’t.
All I know, as someone who has led a fulfilling life and been there at the end of many others, is that life is a smorgasbord. You can’t have it all at once, but if you leave enough room for the next course, you’ll be surprised how much you can fit in.