What can we learn from a hospice chef?

Thought for the Fortnight

In planning a book on hospice care, I was hoping to interview a series of people working in two hospices, to learn what it was like to work closely with patients in this setting. 

In one hospice, staff were invited to volunteer – and I was pleased with the range of roles that emerged from the process.

In the other, a senior manager decided who we should interview. This included the hospice cook, referred to as the ‘chef’. I said no, I wanted to interview nurses and doctors – those working closely with patients. She replied forcefully, no, you must interview the hospice chef. We went around that circle once or twice and in the end, I thought well, it doesn’t matter so much, so I caved in.

And you guessed it. He was fascinating. So many thoughts on how to improve patients’ last days.

Have a read.  I call him Andrew.

Creating time for those you love

Cooking for people who are terminally ill is not easy at the best of times. Few patients are hungry or even thinking about food. Yet this is a time when some sustenance is more essential than ever.

Andrew had put considerable thought into the matter:

Encouraging people to eat will improve their quality of life at the end. I tell the patients, “Just think of yourself as a car. If you don’t put petrol in that car, it won’t run…You will sleep and sleep and your family will be sitting here – you are going to miss a lot of time when you could be talking to them.”  And they go “Well, ok, I will try some breakfast tomorrow.” 

And because they eat, they have a really ‘up’ day. The family are worried sick about the person dying, but when they see them eating, you can see the relief in their face. And the patient then sees that relief. They feed off each other. That’s what I am trying to achieve – bringing that little quality of life back.

Giving people time enabled them to say their good-byes and make peace with each other:

People need that time at the end. We all keep secrets – and we think if we knew the day we were going to die, we would undo all the bad things we have done. If you have a patient who doesn’t eat – and just goes into sleep mode – they are never going to deal with issues that their family might want to talk about. 

Maybe they had a fight a year ago – people do keep petty thoughts in their head….If we feed them and get them to sit and talk, they can actually communicate, they can have quality time with each other. They might bring up “Remember last year, I fought with you – I’m really sorry.”  When they clean the slate, people die happier or as happy as you can die.

Tempting patients to eat

The question was how to get patients to eat. The first thing was to offer them some sense of choice:

I go ‘round and talk to the patients every day, asking what they would like to eat. It’s important for them to have choice. When you’re ill and the doctor says: “Take these pills,” you feel your life is dictated by someone else. I am not telling them what they are going to eat, they are telling me what they want.  

At hospitals, you will find “Here is the soup – take it or leave it,” but here they have options. It will be a small option, but to the patient, it is a big, big option.  They have grabbed a bit of control.

The next challenge was not to overwhelm people with too much food. Andrew had worked out systems for offering people minimal but tempting meals:

We discovered that if patients see a big plate of food, it just puts them off.  We bought side plates, which deceive the eye. For soup, we use the little bowls that you get rice in in a Chinese restaurant. There might only be three tablespoons of soup in it, but they finish it and the patient goes “God, I didn’t think I would eat all that!” It is just an optical illusion. 

They might have one thin slice of roast beef, maybe one Brussels sprout and two pieces of fresh carrot for colour and one boiled potato. And then some dessert. To them it looks like they have eaten a whole Sunday dinner. And they finish it – they can always ask for more if they want to.

He learned that small amount of alcohol could be beneficial:

We also have alcohol. A study has shown – if you gave a patient a teaspoonful of wine or sherry half an hour before lunch, it is just enough to stimulate their appetite. So, we encourage them.

And he learned how to address the interaction of drugs and taste.:

It was a learning curve. A lot of drugs make things taste salty, so how do we get flavour?  Let’s buy parsley, coriander and mint – we use lots of herbs and spices.  They hadn’t tasted food for weeks – if you don’t taste food, you are not going to eat it.

Eating as a social occasion

Andrew argued strongly that eating should be a time for talking with others:

I like going into a nice restaurant, I like going to friends’ houses. I like to break the wine open – let’s talk and have a laugh and share this food. If you are talking to somebody, you don’t actually realise how much you are eating.

He was planning to set up some seating areas, where patients could get away from their beds and eat together:

The patients take their medication in their bed, they poo in their bed, they wee in their bed, they have the blood leaks and all these things that happen – and then you bring them nice food and say: “Here is your dinner!”  

When we get this new area, we will put nice linen covers on the tables. One patient may come up in a wheelchair, another on their Zimmer frame and the family can come and order lunch as well. So, you are sitting there with your daughter, your wife, having lunch as if you are in a little restaurant somewhere. 

You create this idea that “I am not in that room where I was in terrible pain last night or getting a blood transfusion.” Food has got to be thought of as social occasion or you will just not eat.  

You will not be surprised that Andrew loved his work:

It is not about the pay. You walk out of here at the end of the day and think “I have done something worthwhile.” To actually have another human being say “You don’t know how much that meant to us that Mum ate that food, she thoroughly enjoyed it, she talks about you coming to talk to her every day.” 

It does make you view the world differently. You realise that life is not really worth much unless you enjoy it and do things that you want to do.

I like the idea of coming to work and thinking “What can I do to make this person’s quality of life better?” 

I learned a lot from Andrew.

Over to you: any thoughts?

You can read more of what this chef had to say – and numerous other hospice staff – in my book Life in a Hospice: Reflections on caring for the dying.