Reflections on Cooking at Hospice

I had coffee a couple of weeks ago with Valda, the kitchen manager and volunteer coordinator at the hospice in Wanganui where I have been helping out doing some volunteer cooking shifts.

She told me that she had recently watched a movie (American, of course) called “Two Weeks,” about a dying woman and her family. In one scene the woman desperately wants to eat her favorite meal of ribs and her family tries to dissuade her because there’s no way she can digest it. She insists that they make it and then sits down at the table. She takes a bite and chews it, savoring the flavor and texture, before spitting it out and then repeating the procedure. Around the table, the rest of her family slowly catches on and does the same.

We were discussing Valda’s input for a booklet I’m working on with one of the hospice physicians, Dr. Marion Taylor, who has long wanted to put together a guide for patients and their families about food and eating near the end of life. It is a topic -- like so many others at this time in a person’s life -- fraught with issues both physical and emotional. “Food is one of the staffs of life,” Valda said, “and when people feel like they can eat it, it begins to normalize their experience. When people can eat, it is comforting to them and their family. It’s not just about the food.”

It is for this very reason that, although I was drawn to the idea of cooking at hospice as soon as I saw their ad calling for new kitchen volunteers, I was also nervous. How would I handle working with dying people and their understandably stressed-out families? What if I made things they didn’t like, couldn’t eat, or, heaven forbid, caused them physical distress after they ate?

Valda was nothing but reassuring at our first meeting and she impressed me immediately as someone I would like to be in charge of my last meal. She has a stylish, blunt-cut blonde bob with bangs and the wide chiseled cheekbones characteristic of her Eastern European heritage. But, unlike the similar faces I remember from my one visit to the just thawing USSR back in 1984, hers sends out open, friendly vibes. She comes across as thoroughly capable and calm, and it was no surprise to find out later that she worked as a massage therapist before attending culinary school. One has the sense her strong hands could massage and simmer away all the bad stuff.

When we chatted about the expectations of a hospice kitchen volunteer, Valda explained that the cooking was pretty straightforward: a main hot meal of lunch for up to five patients and one support person each, and then something light and re-warmable for tea (what they call supper here in New Zealand), which the nurses or care attendants can easily prepare for patients. Nothing fancy, she said, just solid home cooking. And if patients weren’t up for a full meal, as they often aren’t, some soup, jelly (jell-o), ice cream, or mashed potato, presented nicely. “You can put food on a plate or you can place food on a plate,” she said. “The small things really make a difference,” she continued: a nice napkin or a flower on the tray, a sprig of parsley on the plate. “Those are really groovy,” Valda said with a smile, using what I soon recognized as a favorite word.

On my first day, Valda was there to guide me through the routine. The morning starts with “sussing” out what’s in the fridge or quickly defrostable from the freezer and dreaming up a meal around those ingredients. Hospice staples include loads of potatoes, beef, pork, chicken, white fish, a variety of fresh vegetables and some canned, rice, a little pasta, and lots of cheddar cheese. That day she had defrosted some beef and suggested I make a beef curry, which I did, adding some canned tomatoes, onions, green pepper and kumara, the New Zealand sweet potato and another staple here since early Maori days . After checking in at the nurse’s station, we then visited each patient to see if that option suited them. For those who were eating, it sounded fine, although the news that it would be served over rice prompted one feisty patient to respond, “What do I look like? A Chinaman?” Valda took it in stride and appeased him by offering to serve his curry over mash.

That first curry is about as adventurous as I’ve gotten. The prevalence of Indian restaurants in New Zealand seems to make people more comfortable with curries, mildly spiced, than I anticipate a similar demographic would be in the States. Since then, I’ve stuck mostly to simple things like creamed chicken over mashed potatoes, pork braised with leeks and mushrooms, macaroni and cheese with ham and zucchini, and crumbed white fish on a bed of tomatoes, silver beet (our chard), and onions. Last Thursday I ventured a little outside the comfort zone and stuffed red, green, and yellow peppers with a steak sausage and vegetable filling. Most of the patients and their family members were game but, as the daughter of one said to me, “Never had it. Don’t know what it is, but I’ll try it.” I dolloped the top with a cheddar cheese sauce and served it with mash and plates were wiped clean.

I’ve learned a couple of things cooking at hospice. One is that a little bit of mash and cheddar will go a long way to making less familiar foods seem familiar here. Most of the patients are of Western European heritage, Pakeha in the Maori language, although I have also cooked for a number of Maori patients. The comfort food touchstones of each culture are, of course, different, but the appeal of potatoes and cheese sauce seems to cross cultures. Nurses have told me, though, that they have had Maori patients who crave a boil up: fatty pork bones slow-cooked with watercress or puha, another wild green. Another mentioned how a family brought in a patient’s favorite meal, roasted fish heads, another Maori classic. Comfort is what you know and what brings you back to happy times of your life.

Another realization is that, unlike at home, I shouldn’t get upset if the plates aren’t returned clean. Even when they want to eat, often patients can’t eat much and Valda taught me to serve very small portions so as not to overwhelm them. (They have these perfectly sized little oval ceramic dishes that make a small serving look generous.) Many of the patients apologize for not being able to eat very much and I’m always careful to assure them that I don’t take it personally and they should absolutely eat only what they want when they want it. I mean, you’re dying for heaven’s sake, I want to add. You don’t need to apologize to me.

Although all of the patients at hospice are suffering from terminal illnesses, the nearness to the end varies widely. I cooked one Monday and came in a couple of days later to see three names wiped from the whiteboard and the kitchen door that opens into the main hallway closed because the undertakers were coming through. But that has happened less frequently than one might expect. Even though I don’t have a regular schedule, I have cooked over the last few months for a few repeat patients who have come in and out of hospice from home or hospital. One woman for whom I’ve cooked several times, was back in this week after having fallen badly at home. I know she loves broccoli and cheese sauce so I made sure to include those in my meal plan. The first time I cooked for her, I brought her meal and she said to me, “You know, I meant to ask this before, but would it be too much trouble to get a little cheese sauce to go all over this?” Sure, I said. Cancer I cannot cure, but cheese sauce I can whisk up in a jiffy.

Another patient just out of hospital after four weeks was craving an egg sandwich, his daughter told me. No problem, I said. Egg salad or fried egg? Fried with mayonnaise and sliced tomatoes. On white or wheat toast? White bread, not toasted, never toasted, she said, with a look of amusement. (Soft white bread, buttered, is a favorite of many Maori and, I found out later, whole loaves can be consumed this way in the middle of the night.) He loved it, ate it all up and gave me a big grin when I came to check if he wanted another.

It is these moments of pleasure that are a privilege to deliver and that’s what I focus on as I cook in the kitchen with its view of the peaceful green gardens with roses and herbs and a pond in which, last Thursday, some small dark birds were taking baths as two little girls ran across the lawn to the big primary-colored play structure. Mostly the door from the kitchen into the main hallway stays open and, as I cook, I can hear the quiet hum of nurses, doctors, and caregivers to’ing and fro’ing from the nurses’ station to the five patient rooms. They, in turn, can hear me clatter the pans, smell the onions sautéing, and the dish sterilizer whooshing. I hope the sounds and smells are comforting to patients but I wonder if, for some, the scents are unappealing or even nausea-provoking.

I have also learned that they might even be frustrating. A few weeks ago I chatted with one of the hospice’s repeat patients who lives alone and comes in from time to time for the doctors to see how he’s doing on his complicated cocktail of drugs and to give him a break from looking after himself. He is someone who loved his food, but, as his disease progresses, he has had to start being very careful about what he eats. “Suddenly you got to watch everything you bloody eat,” he said with a mixture of frustration and disgust. “It’s always all those things you love,” he added wistfully.

Food and eating at the end of life can be a source of both comfort and stress not only for the patients, but also their families. At the end, there is often little a partner or child can do but plump a pillow or escape into the kitchen to make a favorite dish. But all too often, the patient may not be able to eat the carefully prepared meal and the family member may feel sad and possibly even rejected. One patient went on so glowingly about a lunch I had made that his wife called in to speak to the cook. He really enjoyed your lunch, she explained, and she wasn’t sure if he’d prefer to also eat the meal I’d prepared for later in the day, although, she added, she had made a favorite of his to bring in. Oh what I made is nothing, just a little light snack, I assured her, I think he would love your beef ribs. I could almost hear an audible sign of relief.

Most of the patients are older and seem to have lived full lives, so I have not felt wrenched with the tragedy of untimely death as much as I expected. There was, last week, a much younger patient whose beautiful and composed wife graciously accepted a meal, but he was not eating. When I had popped quickly into the room to check on their lunch needs, all I could see of him was a long black ponytail hanging down his thin white back as he lay curled on the bed. I heard, over the weekend from a friend, that he had passed on and that he was a member of a very respected Maori family and had a leading role in the community. His tangi (Maori funeral or memorial service) was held on Friday and would be attended by hundreds, my friend said.

It is the husbands and wives and children of patients for whom I feel the most sorrow. They hover, patiently, waiting. Many of them don’t take advantage of the offer of food, but others accept gratefully and bring their trays back to the kitchen door with effusive thanks. The older women, especially I think, are not used to being cooked for. “What a treat,” one said to me recently when I brought her meal. “You’re spoiling me.”

It’s the least I can do, I usually reply, thinking that there isn’t enough mashed potatoes in the world to fill the hole a dear one leaves behind.