(My early exposure to meanings imbedded in food and eating)

Would you give a pork chop to a dying man?

April 1985. I got a call to come to see my brother while there was still time. He had been in hospital since February.

We now know the condition he had as Hepatitis C. At the time, the disease was unknown; there was no treatment.

I flew across the country and arrived at the hospital in the late morning. My brother was emaciated. His once handsome features were gaunt and he looked very old. His teeth were black. His hair, what was left of it, was white. His skeletal hands held mine. The lunch tray arrived. I remember that none of the foods were those that he, a lifelong particular eater, would have chosen. Among the items were crumbling low protein bread, a couple of tablespoons of grapefruit juice (he didn’t drink juice), some white rice (he hated rice), a half a canned pear, and 75 ml of weak tea (he never drank tea). Seriously lacking in visual appeal!  My dietitian self, one who spent worked with people going through cancer therapy and their families to find solutions to barriers to eating, wondered why one would use up a fluid restriction with tea? Why not something that contained calories…something my brother desperately needed?

I asked him, “Why did you order those foods; you don’t like some of them?”

“I didn’t order them. I’ve never seen a menu while I’ve been here” (over two months!). “Trays show up and I eat a couple of bites. I don’t like the food I get… I don’t understand why they are starving me”.

I could see the menu slip headed ‘25 g protein, very low sodium, 750 ml fluid restriction’. A common diet order, in those days, for people with liver failure.

“What would you like if you could have anything to eat?”

“A pork chop and peas”.

I knew that given his limited appetite, he wouldn’t eat more than a couple of bites so he was at no risk of exceeding the diet order. I could understand following the physician’s diet order; I couldn’t understand why Paul was receiving food he didn’t like, why he was not involved in marking his menus, or why someone from Food Services was not visiting regularly to check on his likes and dislikes and to offer encouragement to eat. These were all basic activities of providing foods for people in hospital, and part of my daily practice.  I wanted to consult with the ward dietitian about her nutritional care choices for my brother.

I knocked on a door labeled, “Diet Office”.  The door opened to reveal a surprised looking clerk. Had no one ever knocked on this door? “Hi, I am here to talk with the GI ward dietitian about my brother, Paul Morley”. “Just a minute”. The door shut leaving me in the hall listening to the sounds of pots clanging in the nearby dish room.  Although it was likely only a minute or two that I was alone in that hallway, it seemed longer. The door opened. “She’s not here”. Was the space in that office so vast that it took over a minute to figure this out? “I want to talk with her about getting my brother some foods he’ll eat”. She replied severely, “He’s on a very restricted diet – that the doctor ordered”.  “I understand that; I am a dietitian here visiting my brother. I work with people on restricted diets all the time and am familiar with what is possible. I’ll leave the number where the dietitian can reach me”.

The phone rang. The dietitian stated what I’d heard earlier; that my brother was on a very restricted, physician-ordered diet.  I was challenged to maintain my composure. “I know however, you know how poor his appetite is. I would be surprised if he ate close to 25 grams of protein in a day”. I said I was confused why he received foods that he disliked and asked why his preferences weren’t being followed. A long pause, followed by … ”To tell you the truth, I have never met your brother”. (Remember? It had been over two months! Our standard was to see people on restricted diets within 24 hours).

Another pause. “He is so sick and his diet is so restricted, I didn’t want to upset him with the news of how restricted it is…and given how sick he is, his situation intimidates me”.

“I meant to go every week and kept putting it off be”.

I was stunned. “This isn’t about you”, I thought. Her fear of being around someone who was so sick was worsening his state of malnutrition. I encouraged her to go meet Paul as he was a lovely person, and she would enjoy meeting him. (Not to mention, as I am hoping you are thinking, it was HER JOB!)

Later, when I got to the hospital during dinner service, Paul had received a small piece of chicken, peas, and mashed potatoes with extra butter. No coffee or tea. He beamed. “This is more like it!”, he exclaimed.  His roommate looked over and said, “How did you get that?” Paul replied, “Hey, this is my kid sister…she is a dietitian. She was here at lunch, then went downstairs to give the dietitian shit”. Taken aback that that’s what he thought I had done I said, “I only asked her to pay attention to your food preferences. Did she come to see you?” He nodded. He was slowly and carefully chewing a tiny piece of chicken. As I looked on, he ate a very small piece of meat, two bites of mashed potato, and two forkfuls of peas. He was happy. I estimate his total protein intake for that meal at 5 or so grams.

Paul never left the hospital.

He continued to receive regular food (not low protein) and ate little of anything. He was too weak to sit up for an entire meal, never mind to manage a knife and fork. Even with people feeding him, he didn’t eat much.

He died on July 10 of that year at age 36. I was 27.

My approach to my work as a dietitian was forever changed by the experience of supporting my brother to receive food he would like toward the end of his life.

I came to know the very real pain that families feel when their loved one cannot participate in the most basic expressions of love…that of accepting food that is offered. And the pain of the person who is sick who knows they are upsetting/disappointing/hurting those who are offering food because they are unable to eat. I learned to create space for the pain that their usual feeding/eating rituals and routines has been disrupted; space for people to express their sadness and grief. Learning that these situations are typical when someone is sick was reassuring. Learning that the sadness and grief stems from the loss of expressing love through food was reassuring.

I learned about the good that comes from offering comfort to people at the end of life, even when that comfort comes in the form of tiny bites of favourite foods.