My mom doesn’t take diabetes medicine; she keeps her blood sugars normal through a combination of common sense and careful carbohydrate consumption. A few years ago, she had to be hospitalized at her local hospital for what she called a “minor procedure.” The procedure went fine, but the food did not. The very first meal they brought consisted of breaded fish (frozen), mashed potatoes (instant), corn (canned), a dinner roll (frozen), and tea (with two sugar packets). “If I ate that, my blood sugars would go through the roof!” she said. She drank the tea, and called my dad, who arrived shortly with chopped salad, roasted peppers, and meat loaf. This week’s post is about hospital food, if you can call it that. There’s certainly lots of opportunity for improvement. Most hospitals make it pretty hard for patients, families, visitors to find real food.
Imagine, for example, a diabetic guy in the intensive care unit. This patient’s blood sugars have been completely out of control, up and down, up and down. He is recovering slowly from a dangerous pneumonia, and is only now beginning to eat again. The nurse asks if I would like to order an 1800 kcal ADA diet. I do not.
An “1800 kcal ADA” diet means 1800 calories total each day, in accordance with the recommendations of the American Diabetic Association. This diet is loaded (I am not exaggerating) with stripped, processed carbohydrate products guaranteed to make it nearly impossible to control one’s blood sugar. No thanks.
Years ago, when I was seeing hospitalized patients, instead of an 1800 kcal ADA diet I would order a “low-glycemic diet,” which was not actually one of the approved options in the hospital. I knew I was setting myself up, but there were no other options I could order in good faith. Real food? High fiber and protein? Low-processed-carb? I wish. The hospital kitchen routinely sent fake scrambled eggs (“beaters”) and a large blueberry muffin. No kidding. This is one of the options that hospital cafeteria actually sent my diabetic patients. It should surprise no one that this kind of meal can easily send blood sugars into the 400’s. Once I asked if we could just get the patient a hard-boiled egg. No, we could not. The hospital did not actually have eggs. Just beaters.
Patients aren’t the only people who eat in hospitals. A few years ago I purchased a cup of coffee in the hospital cafeteria. I looked for the milk, but there was none. Just single servings of liquid non-dairy coffee whiteners. I don’t use those because they are not food. I was told that if I wanted real milk I would have to purchase it.
Patients in better condition than my intensive care unit patient were permitted to choose their own meals. They were provided with lists, or “menus,” as the Dietary Department called them, of all the items available for consumption in the hospital. Patients would choose what they liked, and a version would be prepared that attempted to meet their dietary restrictions.
A common scenario for me, as a physician, would be one in which I am working to control a patient’s blood sugars in an attempt to heal a leg infection and avoid an amputation. High blood sugars interfere with healing because they prevent white blood cells from working correctly. Imagine me walking into a room and seeing a patient eating a bowl of Raisin Bran (one of the highest sugar-containing cereals), along with a glass of orange juice, tea with sugar packets, and 2 slices of toast with margarine. I know these items will spike my patient’s blood sugars and make it virtually impossible to get them under control. I am left wondering why those options were on my patient’s “menu” in the first place.
If it weren’t so serious, it would be comical. “Like putting a humidifier and a de-humidifier in the same room, and letting them duke it out” (thank you, comedian Steven Wright). I don’t want to duke it out. I simply want to ask for, and receive, the tools I need to do my job successfully. Assigned the task of healing patients and controlling their blood sugars, I have a good idea of the tools I need. Different kinds of professionals use different kinds of tools. I start with food.
I can totally relate. My daughter was in a local hospital for 1 month w/a broken hip. She is a healthy eater, and the selection of food available was abominable. One supposedly vegetarian dish – Lasagne, came laden with meat sauce. Instead of fresh, healthy meals, almost every meal contained unappetizing gravies. Nothing appeared to be fresh. A mixed salad came in a tiny cup & consisted of a bit of iceberg lettuce, a sliver of carrot, and maybe a small slice of tomato. Every meal came w/a slice of unappetizing bread wrapped in cellophane. It frequently appeared on the tray even though she specifically said she didn’t want it. The dietician stated that the food on the tray must add up to a specific number of calories. So, if what the patient orders doesn’t add up, they need to make up the difference. It doesn’t matter if the patient doesn’t eat it, and it ends up in the trash as long as the right number of calories is on the tray. I ended up bringing food from home, so that she wouldn’t starve. A conversation with one of the nurses revealed that several services at the hospital are outsourced, and food is one of them. Is this patient centered care? I don’t think so.
This makes so much sense. If it weren’t sad it would be funny just like you said.