Continuing with the topic of bad food, we move from Army food to Hospital food in
the latest installment of Sharon Farber's 'Medical Life' series. This article marks
the fifth year of this series, which began back when we lived in Tennessee. We
don't cross paths with her very often anymore, which made the meals we shared with
her in San Francisco high moments of our Worldcon trip.
During my internship year I attended the banquet at the World Fantasy Convention. I was given a salad with iceberg lettuce that was neither wilted nor drowning in Thousand Island dressing; a piece of meat that recognizably originated in a cow and might be chewed with ease; vegetables boiled for less than an hour and devoid of salt and bacon. I dug in with gusto. Then I looked up and noticed, to my embarrassment, that everyone else at the table was picking at their food and wearing expressions of disgust. The best meal I had eaten in the last four months was, for these writers and editors, the worst.
Not all hospital food is equivalent; there is a hierarchy of dreadfulness. The cafeteria food at the University was pretty similar to cafeteria food everywhere, though I must admit that in California I was never offered sweet and sour turkey. Also, the food in St. Louis was an uneasy mixture of Midwest bland (meat and potatoes, no flavor please) and Southern cooking (fried, anything green boiled with bacon, and the weird bits of the pig).
The food in the employee cafe was always less healthy and more attractive than the patient meals. Of course, there's just something intrinsically unappealing about food on plastic TV dinner trays, and much worse in hospitals than airplanes. Perhaps this is because on rounds one saw the dregs of meals -- cold and clotted entrees, mixed together unappetizingly, or spilled on gowns or vomited up on your shoes. Examining the patient, one regularly finds bits of scrambled eggs trapped in bodily fluids or embedded in stool on the sheets. Sometimes, one arrives while, during meals, when one is starving, the food still smells good, and the patient is chewing open-mouthed and drooling.
So when the nurse would call, "Hey doc, the guy in 14 died and we've got an extra tray -- want it?" I would hastily say, "No thanks."
Instead, with missed meals, I might raid the patient snack area. Smell (which is most of taste) is the intense evocative sensation, heading right into your temporal lobe without detouring through the diencephalon, making those memories more evocative than those of sight or sound. Thus the taste of cranberry juice or graham crackers makes me immediately nostalgic for sleepless, mealless nights at Barnes, and vanilla wafers remind me of the shrieking babies in pediatrics.
Some students stole cans of Ensure, the high calorie milkshake-like food supplement. They claimed it was actually pretty good, though since we frequently encountered it in vomitus and other toxic spills, it was an acquired taste. The regular flavors were chocolate and vanilla, though City Hospital seemed to have been given a bargain on the discounted flavors -- and not even the most persuasive nurse could convince a starving patient to drink a coffee or black walnut shake.
When I was a student, another team was investigating a young man whose urine was a frothy pure white; initially they thought it an unusual form of pyuria (pus in the urine) but it eventually turned out that he had a fistula allowing chyle (the fat content of digested food) to enter the kidneys. Anyway, I recommended we name the condition 'Ensuria'. People became quite angry with me. Not because of the bad pun, but because they could no longer face a can of vanilla Ensure.
The food in certain hospitals was so bad that even patients who had been starving on the streets regularly refused to eat. The green bologna at the VA was especially famous -- and if a veteran of the army refused to eat something, you knew it was bad.
At County Hospital, staff meals cost a quarter, and we felt we were being ripped off. The cafeteria was not open nights; midnight snacks were stored in a refrigerator. A hospital security guard stood there to make sure you left your 25¢ meal ticket.
The food at City was the ultimate in unappealing and inedible. Adding insult to injury, you had to work hard to obtain it. The cafeteria was open only briefly for lunch. To get breakfast or dinner, you had to call hours in advance and order the appropriate number of trays. This meant waking at 5am (in the rare event you were asleep), but this bit of scut work was never relegated to the students. They weren't considered responsible enough for this most crucial act of the day.
You couldn't get your breakfast until 8am, which at other hospitals was rounding time. At City, we'd all sit and watch the off call team eat; it was only polite. You'd order extra breakfasts for anyone desperate, and save the doughnuts and cereal for emergencies. These went into a drawer in the conference room, along with an illegal collection of feeding tubes (which invariably went bad Friday at 4:35 when Central Supply closed for the weekend), butterfly needles and small-gauge IVs (virtually unobtainable and very necessary), and extra vacutainers and tournequits (brought down from the University by each new team).
A proper resident spent part of each day scrounging for these bits of equipment, without which you could not keep patients going, and which the hospital administration felt were unnecessary. For instance, they gave us plenty of intravenous catheters -- yeah, two inch long 14-gauge, something you'd use to get a blood donation from a healthy muscular football player, not something you'd dream of trying to insert in a frail, older patient who'd been hospitalized two weeks and didn't have a good vein left. And since we were technically no longer an ICU, despite having all these patients on ventilators, our allotted blood gas kits lasted about a day and a half.
Whenever the emergency room abused me, I'd retaliate by sticking a couple of 20-gauges in my pocket. Then I'd return, like some primitive hunter-gatherer, and hand out goodies to the interns. I left City Hospital for my next rotation, at Childrens, where butterflies were ubiquitous and all needles tiny. After a couple days there, I realized that I'd been unconsciously filling my pockets with IV catheters.
We lived in the fear that the gynecology residents, with whom we shared our floor, might locate our precious doughnut and needle stash. They would have no compunctions against ripping us off, we knew -- we were the same folks, after all, who kept our lab such a mess that I once looked through the microscope at a sample of spinal fluid and saw sperm.
Hard as it was to obtain breakfast, dinner was chancier. We were usually in the emergency room, and barely able to run to the kitchen at the last minute -- only to find that the gynecology team had stolen our trays.
Even when the food was there, it was mostly inedible -- I remember a long discussion as to whether bits of liquid cheese on cubes of white bread was Welsh Rarebit or culinary desperation. We joked about sending the occasional bits of meat to pathology for identification -- though we were afraid that we might be returning them to their starting point.
If you missed dinner, you were on your own. The neighborhood was too dangerous for pizza delivery, and only a large or foolhardy medical student would volunteer to run out for burgers. That left the munchie machines, and in the rare event you had any change they were probably empty.
Late one night, I ventured into the basement hunting for the mythical full munchie machines. Everything turned out to be empty except the Coke machine, and while I was there a security guard wandered by. She said, "I was just out on the street and heard screaming," and proceeded to tell me a long and incomprehensible story, the gist of which (I think) was that some girl was raping some boy in the bushes, which I found hard to believe as there was very little greenery around the hospital. I make it a habit to be polite to people who carry guns and tell weird stories, and I subsequently avoided that area of the basement as much as possible.
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The most disgusting hospital food has to be the pureed glop for people with problems swallowing. You have to specify pureed -- the soft diet may deliver bacon and white bread. I always feel hypocritical when I stand above a tray with its little plastic rectangles of green stuff, brown stuff, yellow stuff and gray stuff, and urge the patient to eat up. If only the food wasn't so bright!
One day at City Hospital, my chief resident said, "There's a guy on the medicine floor who I think has bulbar myasthenia. I'm due in clinic -- I want you to do a Tensilon test."
Myasthenia is a disease where antibodies attack the acetylcholine receptor, in essence blocking the muscle's 'on' switch. In the Tensilon test, you inject something that increases the acetylcholine available, and if the person really has myasthenia, he'll be much better until the shot wears off, in about ten minutes. (Then you can treat with a long-acting pill form of the medicine.)
I read carefully how to do a Tensilon test -- it was my first time -- then went upstairs. The patient was a tall, skinny black man with droopy eyes and a voice so slurred that his speech was unintelligible. He sat staring disconsolately at a tray of pastel purees.
I introduced myself, and explained that I was going to inject him with something that would make him better. Then I picked up a needle full of saline -- the book recommended starting with a placebo, because some people fake weakness and improvement. Of course, I later realized that, when you have something objective like ptosis (droopy eyes) or dysarthria (slurred speech) you don't need to bother with the placebo.
"This will make you feel a lot better," I said encouragingly, and injected the saline. Not surprisingly, it didn't. He looked angry, then began to mumble something I couldn't understand.
I gave him the Tensilon next. He was still mumbling, and suddenly his speech became clear. "...God damn idiot doctors..."
He stopped his diatribe, realizing that his voice was back to normal. He flexed his arms. He stood. For the first time in weeks, he was able to walk. He strode up and down the room, saying, "Praise the Lord!"
I felt like Oral Roberts.
He walked back to the bed and looked down at us. I thought he was going to thank us. Instead, he pointed to the tray of puree.
"This is the worst food I have ever seen in my life!" he began, and proceeded to tell us everything that was wrong with the food, the nurses, the hospital... All the pent-up frustration that he'd been unable to express emerged, with us as the target.
We felt intense relief when, several minutes later, the Tensilon wore off and his speech was once more low and unintelligible.
We wished him bon appetit, and got the hell out of there, hoping the cafeteria was still open for lunch...
All illustrations by Teddy Harvia