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Fulfilling a final wish: One patient’s ‘great love story’

Led by a Stanford Health Care ICU nurse, a team of health care workers helps fulfill a patient's last wish: a vow renewal.

After 105 days in the intensive care unit, 80-year-old Hazel Billings wrote "Will you marry me?" on the small LCD tablet she'd been given to aid in her communication and handed it to her husband. Touched, Bob Billings showed the message to Hazel's nurse.

The couple had been hoping to renew their vows in two months' time at their 60th wedding anniversary, but now Hazel was in the throes of multi-organ failure; it was clear they couldn't wait.

"I knew deep down she might not even have 24 hours," said Avani Rakholia, RN, who cared for Hazel in the cardiovascular intensive care unit (ICU) at Stanford Health Care and had developed a special bond with the Billings family. "At most, Hazel had 48 hours to live. But I thought, what if we could make this happen today?"

'One last wish'

Everyone on the ICU team had been moved by Bob's extraordinary dedication to his wife, Rakholia said. For the entire three months of Hazel's hospital stay, he had arrived at 8 a.m. and stayed by her side until visiting hours were over. "Every morning I'd see Bob walking down the hall with his briefcase," Rakholia said. "Day after day, without fail."

In her nearly 10 years as a nurse, Rakholia had never organized a vow renewal ceremony, but now she leapt into action. "It takes an army of helpers to hold a ceremony in the hospital and make it feel as real as possible," she said. COVID-19 protocols further complicated the task: since visitors were limited to one per patient, everyone who participated needed to be a member of the hospital staff.

Rakholia's first step was to find an officiant on extremely short notice, but the on-call chaplain was an intern who had never performed a wedding ceremony or affirmation of vows. "I told him, 'The patient is about to pass away. There's nothing else we can do, but we can give them this one last wish,'" said Rakholia, who received a Stanford Health Care C-I-CARE Service Spotlight award for her efforts to see through Hazel's final ask.

Thankfully, when chaplain Daniel Tate, MDiv, went to visit Bob and Hazel, he quickly recognized the couple's special bond. "You could tell how much they loved each other," said Tate, who is now a chaplain resident at Stanford Hospital. "Right away I saw a great attachment between this couple and the staff. That happens sometimes when people are in the hospital for a long time, and the whole floor becomes like family."

Music, flowers and cake

Rakholia was thrilled when Tate agreed to perform the vow renewal ceremony at 1 p.m. that same afternoon, but that gave her only 2.5 hours to pull together all the elements of a celebration that normally takes months to plan. "I wanted to make the ceremony as beautiful as possible," she said.

She enlisted the help of Stanford Guest Services, who began calling their list of volunteer musicians. However, the combination of short notice and COVID-19 restrictions meant none of the usual volunteers were available, so Rakholia came up with plan B: "I knew we had an ICU attending who plays guitar, because I hear him playing all the time in his office."

Bob and Hazel Billings

That doctor-guitarist, Charles Hill, MD, former professor of anesthesiology at Stanford Medicine, was working that day and happy to play for the ceremony -- except he didn't have his guitar with him. So, Rakholia reached out to the critical care team and found an anesthesiology resident who lived right across the street from the hospital and owned a guitar. Cheng Cheng Ma, MD, called her husband, who raced to the hospital with a guitar for Hill to borrow.

After Rakholia found an ICU-approved bouquet in the downstairs gift shop and ordered an emergency cake, delivered in under 2 hours, decorated with the words "always and forever" from a local bakery, it was time for the ceremony to begin.

'Special for all involved'

More than two dozen doctors, nurses, physical therapists and other team members gathered outside the room to watch Bob and Hazel renew their vows. "We'd gotten to know a lot of people," Billings said. "Hazel was one of those ladies everybody loved."

The nurses prepared Hazel ahead of time, making sure she was comfortable, aware and mentally and emotionally present for the ceremony. As gentle guitar music filled the room and Hazel held her bouquet of flowers, it was clear she'd gathered all her remaining strength for the occasion, Rakholia said. "First the chaplain gave a beautiful speech, and then Bob told Hazel: 'I loved you then, I love you now, and I will love you forever.' By the time he said 'I do' and she said 'I do,' we were all crying."

"I had watched Bob at Hazel's side each and every day of her prolonged ICU stay," said clinical professor of anesthesiology Sheela Pai Cole, MD, who led Hazel's care team. "It was beautiful to see how their relationship and commitment had continued during the most difficult time in Hazel's life. We hear of great love stories; this is one of my favorites."

Billings said he was surprised and amazed by the outpouring of support from the ICU team, and especially by Rakholia's huge effort to pull together the ceremony so quickly. "Just the fact she wanted to do that for us," he said, "it was incredible."

"It was really special for all involved," said Tate, who describes performing the ceremony as an important moment of growth in his early career as a chaplain. Rakholia, too, said she will never forget the time she spent with Hazel, nor ever stop checking in on Bob, who she stays in close touch with more than six months later.

"This is what we do in nursing," Rakholia said. "This is what nursing is really about, bringing people closer together."

Hazel passed away the day after the ceremony, on September 12, 2021. "She was a sweetheart from the moment I met her," Billings said, "and now we have these sweetheart memories."

Photos courtesy of Bob Billings

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