We had a patient admitted to our hospital for a thoracotomy. He had a mass that was presumed to be a metastasis from a history of stomach cancer. He was a 70+ year old Asian man with a wife who only spoke Korean, a son who lived in Houston, and 2 daughters that lived in the area. Of his daughters one was pregnant and expecting her first child, the other one was engaged and to be married in the next year. The patient had had a gastric bypass in the past for his stomach cancer, chemo and radiation. He was emaciated with a low protein and albumin level prior to surgery, as since his stomach cancer and the surgery to remove the stomach cancer, he had had a hard time getting enough nutrition orally. The pathology report came back it was determined that he did not have metastatic lung cancer but chronic lung injury from aspiration. After many weeks in the ICU he was well enough to transfer to a long term acute care facility. There were many discussions with the family about his poor prognosis with all the complications he had experienced during his ICU stay. The family was always consistent with the theme that the patient would recover, and get well enough to go home. They even requested that pain and sedation medication be withheld so that he would be awake enough to fight to get better.

Melanie Hanes was assigned to care for the patient and family. When she assumed care she was scheduled for 4 days in a row. The first day she provided care of the patient she met all of his family members and developed a bond with them. The second day she asked the family a question, that went something like this: I notice that you are very concerned that your dad be kept comfortable and not experience any pain, I see that his comfort is of the utmost importance to you, the doctors keep writing in their notes that they do not see your dad recovering from this illness, why is it so important to you that we keep your dad alive? The pregnant daughter who was the family spokesperson stated that in our culture unless a father is present when his daughter gets married the marriage would be a failure. We need our dad to be alive when my sister gets married, or else her marriage will not be success. Our number one goal is to keep our dad alive and get him well so my sister's marriage will be a success. Melanie then had a longer discussion about the father being able to recover enough for this to be possible. The daughters when asked both felt that their dad would not recover enough for this to be a realistic goal. Melanie then spoke with the daughters about what was necessary in their culture for a marriage to be recognized. It was decided by the family, nurse and Chaplain at the hospital that a symbolic marriage could occur at the bedside, between the daughter and her fiance. She arranged for our Chaplain to marry the couple at the bedside the next day.

On her last day of caring for the patient the family allowed the hospital personnel to change the focus of care to comfort care and allow the patient to experience a natural death. She was with the patient and family when he passed away.