Answer Happy

Mr. Li is a 65-year-old Chinese-American man, diagnosed one year ago with Amyotrophic Lateral Sclerosis (ALS). The patient has been told he has a "muscle and nerve disease", but despite the fact that his disease is clearly advancing, he has not been told of his diagnosis or prognosis. Mr. Li is losing weight (20 lbs in the previous two months) and appears to have difficulty swallowing. He lives with his wife in a second floor apartment. His two sons are both married and live in the area. He denies any religious affiliation. While performing a thorough physical assessment, the home hospice nurse observes round bruises over several areas of the patient's back. As Mr. Li's disease progresses, he becomes more weak and unable to move from bed. When asked how he is feeling, he always whispers "fine" and denies any symptoms. His wife, Mrs. Li, is tearful that her husband's appetite has not only diminished, but that he is having difficulty swallowing. She believes he will be cured if only he will eat and that he must try harder. The nurse observes the patient having difficulty swallowing, potentially aspirating, when given soft food. The nurse explains this to Mrs. Li, who appears unable to understand. During a later visit by the home care nurse and social worker, the sons also are present. Mr. Li is minimally conscious, febrile, tachycardic, and diaphoretic. The oldest son tries to encourage Mr. Li to eat. He refuses to listen to the hospice nurse about the possible outcome of feeding his father and the gravity of his father's condition. He angrily states that his father is going to get better and requests antibiotics for the fever. The youngest son, speaking privately to the nurse, understands that his father is dying. When the nurse speaks about preparations for Mr. Li's death, the wife and oldest son are unable to participate in the conversation. The next day, the family admits Mr. Li to the hospital, where he dies within 24 hours.

Discussion Questions: 1. What are essential components of cultural assessment for this family? 2. What aspects of Chinese-American culture are displayed in this scenario? 3. What could an interdisciplinary team have done to improve care at the end of life?