It is not 100% clear to me what is causing your problem but one issue with your code that I foresee is resiliency around image sizes. You are using a lot of string processing to handle images which is very risky. If your image file size exceeds the length of a string, you will run into <MAXSTRING> errors and other problems. Particularly since this isn't human-readable text that you will need to do things like $ZCVT or $REPLACE, I suggest refactoring your code to handle this data as streams.
Another option to consider is at the time the EQ edge gets the fetch request, do a synchronous PatientSearchRequest to the hub for the demographics of the patient. Then transform that data into SDA. Unfortunately, while there is an existing XSLT to go from SDA to a PatientSearchRequest (csp/xslt/SDA3/SDA-to-MPIUpdatePatient.xsl), there is not a transform the other direction so you will need to build something..
Use SSL on an external web server such as Apache or IIS. Then disable the internal web server or at least restrict traffic to it. Note that many of the web services in HealthShare (if set up before deploying SSL) will be configured to use the internal (57772) web server. Those URLs in the Service Registry will need to be updated.
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