Nested insert with an nested update inside

Questions / Help
1

Hi!
I am trying to do an insert of a structure with two nested structures inside. One of them i would like to be an insert but the other one an update.

%Appointment{
     %History{
            %Person{ ...}
      }
}

I would like to create an appointment with a new History but with an old patient i have on the database.
How could i do that? Right now i am doing a multi.insert(:appointment) and the cast_assoc in appointments create History and Person structs.