Hi Stella, yes you would do a merge. I recommend opening a WRC ticket for this issue, they will help get your problem sorted out.
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..
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