With no family nearby, Bellingham couple plans ahead for late-stage medical care

FOR THE BELLINGHAM HERALDJuly 15, 2013 

7 13 Prime Coulter

Mary Jo Coulter, 77, in her Bellingham home with her dog Dodie, May 14, 2013. The Coulters have no children, so they are learning about making end of life decisions now.

PHILIP A. DWYER — THE BELLINGHAM HERALD Buy Photo

Name: Mary Jo Coulter.

Age: 77.

Hometown: From Texas, she now lives in Bellingham.

Family: Married to Edmund Coulter, 77, from Northern Ireland. They have no children.

Before Bellingham: Mary Jo and Edmund lived in Texas for about nine years before living on Saturna Island in British Columbia for five years. They visited friends in Bellingham and decided to move to Fairhaven, where they have lived for eight years.

Planning ahead: When the time comes, Mary Jo says she hopes to go to bed with her husband and die peacefully in her sleep. In case that doesn't happen, she has been thinking and planning ahead.

With no children and no family members nearby, end-of-life arrangements are a bit more complicated than usual for Coulter and her husband, she says.

Learning more: Mary Jo attended a workshop organized by Whatcom Alliance for Health Advancement and hosted by Parkway Village, the mobile home community for seniors where they live. Since the workshop, Mary Jo has collected literature and pursued information about issues of death and dying.

"I'm not morbid, I don't dwell on this," she says. "But I don't want to pop off and have (Edmund) have to decide what to do, and vice versa."

Progress, setbacks: While questions and issues remain to be resolved, Mary Jo has taken steps in her own planning, starting with a POLST document, which stands for "Physician's Orders for Life Sustaining Treatment."

The document, once signed and dated, dictates to doctors and other medical workers what lengths to go, or not, in the event of a medical emergency.

While so-called "advance directives" state a person's wishes at the end of their life, such directives don't address unwanted care for a seriously ill person. The POLST form often includes directions on whether to use CPR, provide IV fluids and antibiotics, use mechanical ventilation, or provide artificial nutrition.

Edmund Coulter was recently hospitalized and a man he shared a room with had only one arm, was in pain and was mostly unconscious of his situation and surroundings.

"It would have been kind to allow the man to die," he says.

After the experience, Mary Jo knew that was not a position she would want to be in. While drafting their POLST document, they chose to forego any extraordinary measures, releasing medical personnel from the obligation to take every measure to sustain their lives.

Neither of them wants to be kept unconsciously alive by machines, she says.

The couple ran into a roadblock, however, when it came to choosing a health care agent who would know their wishes when the time comes, she says. With no family nearby, she is looking for someone to take on the position as a business arrangement.

"That is our major hang-up," she says.

Property for pets: While they still need an executor for their estate, the Coulters have already decided how to deal with their home and possessions.

While helping her sister-in-law clean a house, Mary Jo says, the sorting through and disposing of items made a tremendous impression on her. She quickly decided she wanted to have a plan for the disposal of her and her husband's possessions, instead of leaving it for family to deal with.

As dog lovers, it was an easy decision for them to leave their house and property to Whatcom Humane Society, Mary Jo says. The society will sell the house and other items to fund the society and its programs.

Mary Jo encourages other people to start thinking and talking about the tough, end-of-life questions early, instead of putting them off. Though the conversations can be difficult, they are necessary and worthwhile, she says.

"We're not by any means ready yet," she says, "(but) as you age, unless you're stupid, you realize you're on your way to death."

Alisa Gramann is a freelance writer in Bellingham.

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