Extreme Measures by Jessica Nutik Zitter MD

Author:Jessica Nutik Zitter, MD
Language: eng
Format: epub
Publisher: Penguin Publishing Group
Published: 2017-01-31T14:57:30+00:00

Food

Almost all of the patients I encounter come from worlds where food is evocative of love and care. Indeed, I can’t think of a culture for which this is not true. And in the face of death and suffering, many families see food as a major form of support, both physical and spiritual, for their loved one. Yet this is not the case. Food can be the worst thing to give a dying patient. It burdens an already overloaded system, stopping up the gears, bringing discomfort and suffering to the dying process. When people are actively dying, they almost never want to eat. Yet loving family members will sometimes force food on them—and can feel hurt and desperate if it is not accepted. This may drive an unnecessary wedge between patients and their families at a precious time.

• • •

MY PATIENT WAS a seventy-year-old Cantonese-speaking woman with aggressive ovarian cancer. She had been receiving hopeful chemotherapy from her oncologist, but it clearly hadn’t been working. On her most recent clinic visit, she was so critically ill that her doctor abruptly admitted her to the ICU for stabilization. He also decided to withhold chemotherapy, to the family’s consternation.

Until recently, the cancer had lived quietly inside her, preparing its attack slowly and without raising much alarm. This time, though, it had risen up to fight its final, multifront battle. Fluid around her lungs squeezed like the worst kind of corset, every breath exhausting her. Cancerous fronds curled around her intestines, distending her abdomen and further compromising her breathing.

The first time I met this patient, her son was at her side, feeding her as though she were a little baby. A hospital-cafeteria-issued tuna fish sandwich sat atop a soggy swatch of cellophane on the palm of his left hand. In his right was a butter knife that he used to excise tiny chunks of the sandwich. As I entered the room, he proudly gestured to the remaining portion of the sandwich and communicated reassuringly in broken English that he would keep working hard to get the whole sandwich into his mother. He was part of our team, and his job, he implied, was to contribute to the project of healing his dying mother by nourishing her with love and calories. She lay there, barely able to breathe, intestines obstructed to bursting, every line on her face reading defeat.

Family members frequently feed my patients food, but it is never just food. It is “lumpia, just like he likes it, with roasted pork” or a “mole chicken burrito, not too spicy this time.” Beginning with mother’s milk, food is not only physical sustenance but spiritual and emotional too. It is a pan-cultural symbol of love, from Chinese and Ethiopian to Jewish and Vietnamese. The dishes have been carefully and lovingly prepared to bring a taste of home into a sterile and frightening place. They are meant as signs of hope, of love and reassurance. Not only for the patient, but for the feeder, too.

And yet

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