The
meal regime confirmed my worst fears. It
was the mad hatter’s tea party without riddles to leaven the mood - where any
great interest in “questions of eating and drinking” were futile. Meal sheets would appear relentlessly every
day, with the vague expectation that boxes ticked would deliver nutritious fare
– wrong!
It was made very clear that
mealtimes would be observed strictly. All
the inmates would be ‘wheeled’ or walked in to contemplate meals that were
mostly doomed. It took me back to
gastronomic dog days at boarding school - the smells of a forthcoming meal
would creep into one's consciousness hours before the reckoning like loathsome
golems.
Carolie would sit aimlessly in front of torpid meals full of sugary or
salty carbohydrates, tired vegetables and tortured proteins. With her eating
reflex impeded, she needed someone in attendance to prompt and assist. I suspect the unappetizing fare played as
much a part as her injury in her listlessness during meals. She has always had a minor swallowing
impediment, which had been further exacerbated by weeks of tracheotomy treatment. The swallowing reflex is a complex mechanism
that we take for granted until it is disrupted by trauma.
It
was a worrying indicator of the overall tenor of ‘rehabilitation’ on offer,
especially as good nutrition is a key component of recovery. All of the literature I explored on the
subject confirmed speedy and effective post-surgical recovery requires catering
to specific nutritional needs while the body is in a relatively weakened
state.
No heed of this concept seeped
into the operational modalities of the hospital, and I expect the same is true
of most large hospitals. It would
require a patient-centred holistic response that is impossible under existing
modalities and funding realities.
Nutritional strategies to enhance recovery were completely lacking; the
poor quality and limited choices of food probably actively impeded the
process.
A capacity to choose healthy
food suited to a patient’s specific needs would be an empowering element of a
recovery journey. Such a notion was
completely missing. One of the partners
of another patient became so incensed by the poor meal regime, he wrote a
letter of complaint to the relevant government minister.
Mealtime
was an opportunity to gauge the overall tenor of the place. I never heard someone say they wanted to stay
on the ward, which is not surprising really, as everyone wants ‘out’ after
surviving various traumas. The yearning
for normality can become all-consuming in a setting that is quite disempowering. However, the vehemence of some patients’
determination to leave surprised me.
An
almost universal disgruntlement with meals was evident, apart from an
occasional recovering stroke victim who gobbled everything as a reflex response
and stared fixedly ahead. Cognitive impairment was apparent in many patients,
some of whom had experienced multiple strokes. Their dignified stoicism was
humbling, and occasionally unsettling. I
was often uncomfortable watching a patient grit their teeth while consuming a meal
grudgingly, with a sentiment that seemed something akin to ‘survival is
everything’! Alice again:
The
Hatter was the first to break the silence. ‘What day of the month is it?’ he
said, turning to Alice: he had taken his
watch out of his pocket, and was looking at it uneasily, shaking it every now
and then, and holding it to his ear.
Alice considered a little, and then
said ‘The fourth.’
‘Two days wrong!’ sighed the Hatter.
‘I told you butter wouldn’t suit the works’ he added, looking angrily at the
March Hare.
‘It was the best butter,’ the March
Hare meekly replied
‘Yes, but some crumbs must have got
in as well,’ the Hatter grumbled: ‘you shouldn’t have put it in with the
bread-knife.’
The March Hare took the watch and
looked at it gloomily: then he dipped it into his cup of tea, and looked at it
again: but he could think of nothing
better to say than his first remark, ‘It was the best butter, you know.’*
Yes,
exactly! Except the best butter was not
being used to make the clock tick and the crumbs were the least of our
worries. Occasional dark humour leavened
the mood at these thrice-daily gatherings but I found mealtimes
depressing.
Concern
over Carolie’s nutritional status grew.
Her reflux responses continued unabated and she appeared to be consuming
less and less. Sudden vomiting fits were
alarming. As ‘soft’ foods gave way to
‘normal’ on the dietician’s spectrum of definitions she lost weight and was
largely disinterested in food. The
nursing staff weighed her regularly to monitor weight loss. From her massively distorted figure as a result
of post-operative oedema, she was now tipping the scales at just over 40kg and
trending down.
Friends left home-made
meals occasionally, which I could heat for her in a microwave. She would have a few mouthfuls but could not
sustain interest for long. If she had more regular small meals tailored to her
nutritional requirements, we would have had a better chance of mitigating the
worst effects of post-surgery but the meal regime was set in stone and presented
no opportunity for a managed nutrition program.
It would require working closely with a nutritionist familiar with the specific needs of a patient and a food regime responsive to these needs. Both were singularly lacking. I am not sure what the occasional ‘nutritionist’ contact was meant to achieve, but from our perspective it was meaningless - another exercise in box ticking.
It would require working closely with a nutritionist familiar with the specific needs of a patient and a food regime responsive to these needs. Both were singularly lacking. I am not sure what the occasional ‘nutritionist’ contact was meant to achieve, but from our perspective it was meaningless - another exercise in box ticking.
To be continued...
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