Mrs B is a 75-year-old patient who is culturally Bulgarian and has a history of heart disease and placement of an implantable cardiac defibrillator. She lives in a fourth-floor walk-up (stairs only, no elevator) apartment in New York City with her husband. She speaks only Bulgarian but has several family members who live nearby and who speak English, including her son, who is her designated health care agent. She has a history of inconsistent follow-up with her primary medical doctor (PMD), but her PMD shares her cultural background (ie, she is also Bulgarian) and is able to provide culturally congruent care to Mrs B when Mrs B attends follow-up appointments.

While at home one afternoon, Mrs B experiences substantial arm and shoulder pain, becomes short of breath, and seeks care at the local emergency department. The health care providers in the emergency department admit Mrs B to the intensive care...

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