What the Patient Really Wants

Having reached the probable limits of their healing powers, several clinicians and administrators at Gundersen Health System made sure a patient got what he really needed—no matter what.

Patrick Conway, MD, is usually all business when it comes to cancer.

The radiation oncologist at Gundersen Health System in La Crosse, WI, is used to being aggressive—the cancers he sees usually require immediate treatment and the plan has to be acted on quickly. His patients are usually as eager to get on with treatment as he is. But sometimes even he meets his match. Which is why what happened the Friday before Labor Day last year was so unusual.

That was the day Dr. Conway met with a 37-year-old never-smoker named Elvin Smothers who had previously been treated successfully for an oral tongue cancer.

His cancer, thought to have been in remission, had come back. Conway was meeting with Smothers and his fiancée, Kathy, to go over a new regimen that involved aggressive, grueling radiation treatments for cancer that doctors had found in his lungs and spine. Smothers' case was terminal, and he, his fiancée, and Conway all knew it as they sat together in the ICU.

Smothers had proposed to Kathy when a PET scan came back clean following two surgeries, chemo, and radiation treatments for his first cancer diagnosis. The wedding date was set for November 2013, but the new diagnosis gave Smothers a heightened sense of urgency.

"The cancer was growing despite treatments and we were making some adjustments," Conway says.

Conway asked Smothers what he wanted to do.

"He was a very quiet person, but we began talking to him about that," Conway says. "His fiancée spoke up and said what he really wants to do today is get married. That took me by surprise."

But for Smothers, it was the most important thing for his healthcare that day.

"He was acutely aware of his situation, and that's why he wanted to make sure they got married as soon as possible," says Conway.

A wrinkle was that the couple had a Minnesota marriage license, but not one for Wisconsin. Conway and his nurse navigator initially viewed the request as something beyond their purview, but, knowing the physical debilitation the new treatments would cause for Smothers, Conway promised to check into it.

Conway and his nurse navigator made their way back to their department, but as they talked about the request, Conway decided to head over to Gundersen's administration building to see if the request could be accommodated somehow. The person he was looking for wasn't there, so Conway began to walk out on the way to another appointment. That's when Bryan Erdmann, a Gundersen vice president, took an interest.

"He looked like he needed to talk to someone, so I just asked if there was anything I could do to help," says Erdmann.

Conway told Erdmann of Smothers' request and his idea that the couple could be transported via ambulance across the nearby state border into Minnesota and married quickly.

Erdmann said, "Well, let's get 'em married then" and went into action.

He checked with the Gundersen's legal department and found that an emergency Wisconsin marriage license could be issued. He talked with Smothers' attending physician to see whether the patient was up to it physically, if the service were performed on the hospital campus. Getting a yes, Erdmann passed the word around to the hospital staff, which , although short because of the impending holiday weekend, responded enthusiastically.

The next question was the wedding site. "We didn't want them to have to do this in his room," says Erdmann. The employees in facilities got to work on a courtyard that had been neglected because of construction of the new hospital next door.

"Then we bought a cake and got some flowers and the facilities guys decorated our courtyard," Erdmann says. "There was weed-whacking and leaf-blowing all over the place."

Erdmann enlisted the help of another staffer who he knew could play the piano, and she knew someone in the lab who could sing. The chaplain service worked out the details of the ceremony itself, and the media department prepared to shoot wedding photos and video the event.

"While all this was going on, I communicated with the fiancée that it was going to happen," says Erdmann.

She didn't know her way around the town of La Crosse, so someone volunteered to drive her to pick up Smothers' clothes and her wedding dress.

"She met me in the parking lot, and I lugged her dress and the clothes up to the room, but I never told them we were setting all the rest of this up behind the scenes," Erdmann says.

But two more documents were required from another city 20 miles away.

"I thought there's no way we would get this done by 2 pm," Erdmann says. "All these people dropped what they were doing in the moment, and it wasn't like I had to even ask them. There are countless people who I don't even know who helped with this."

But they pulled it off. The bride's brother made it to the ceremony with minutes to spare. The wedding had at around 50 "guests" from the hospital in attendance.

Staff on the ICU floor made the couple a honeymoon suite and decorated the room. They added cards, sparkling grape juice, and candles. Later, they gave a wedding album and the video to the bride and groom as a wedding present.

"Our treatment plan took a back seat that day because of something much more important," says Conway, adding that the idea took on a life of its own and reminded him of what's really important when treating patients.

"We, as clinicians, sometimes kind of forget the most basic questions, like, 'What are the patient's goals for his care?' His goal that day was to get married," says Conway. "He was stuck in a hospital and if it didn't get done, he would've missed something. That refocused me to pay attention to the patient's goals. It's a basic question we should be asking. I got caught in doing what I do, which most times is, What are we going to do to address the cancer? It's a good lesson for me that patient goals are how we should start and end our conversations."

Smothers and his wife were so touched by the extra mile run by so many of Gundersen's staff that when the hospital asked to share their story, they were enthusiastic. Local station WKBT took an interest and produced a story and a touching video about how Elvin and Kathy Smothers met and married.

"They told us they wanted other people to hear this, so clinicians who find themselves with a patient goal that is out of the norm will pay attention. That's a critical part of care and we have to be mindful of it," says Conway.

Erdmann adds, "It wasn't about Gundersen; it wasn't about me or Dr. Conway. But look at what so many people came together and accomplished: what the patient really wanted. It was such a team effort."

After he was discharged, Smothers kept in close contact with Erdmann, texting back and forth about twice a week.

Elvin Smothers died the week before Thanksgiving 2013. He wouldn't have been able to make the original wedding date.

"I wanted to go to that funeral because I had developed a friendship with him," says Erdmann. "It was pretty amazing when I went because I didn't know one person other than Kathy, but there were multiple people who came up and thanked Gundersen, through me, for everything we did for this family."

Though Smothers' death turned out to be inevitable (as ultimately, everyone's is), the experience with his wedding helped remind a first-class healthcare organization that sometimes the best medical care and technology doesn't make a difference.

What you do when the patient can't get well matters just as much. Maybe more.