Atul Gawande’s marvelous book “Being Mortal: Medicine and What Matters in the End”, is a must-read for anyone who plans to age in the USA. Dr. Atul Gawande is a surgeon, a professor at Harvard Medical School and the Harvard School of Public Health, a writer for the New York Times, and the author of three bestselling non-fiction books on science and public health. He makes difficult subjects interesting and understandable. You don’t have to be a scientist to understand and enjoy his books.
In “Being Mortal”, Dr. Gawande writes eloquently about the history of how we care for our aging population and the importance of retaining the dignity and freedom to be the “authors of our own lives.” In the end, when all else is said and done, that is what matters.
This book has inspired me. This month, I spoke at the Arizona Geriatric Society’s Fall conference. My topic was “Managing Dysphagia Beyond Acute Care”. Once read this book, I reworked my presentation. I made sure to address the joy of eating, the social aspects of sharing a meal and the cultural significance of food. The medical professionals who attended this conference know the science so I shared with them my thoughts on the art and soul of eating.
“Being Mortal” is a call to action for doctors and other medical professionals to expand our responsibilities beyond trying to “fix” what is wrong and embrace the final years of living. This time period should be about living as fully as possible and having the best possible day (week/month/year); it should not be focused on dying. As we reach advanced age or fight a terminal illness, much of what happens to our bodies can’t be “fixed”. Yes, we can eat right and exercise but there is nothing we can do to stop time.
For many of us, as we age, our ability to swallow can become impaired. Illnesses like oral cancer and dementia can rob us of more than our vitality; they can steal from us our ability to eat and enjoy food. According to the National Institutes of Health, one in six Americans over the age of 60 is having trouble swallowing. In 2013, over ten million Americans had a swallowing assessment.
In “Being Mortal” Dr. Gawande builds the case that “as our time runs down, we all seek comfort in simple pleasures – companionship, everyday routines, the taste of good food, the warmth of sunlight on our faces”. Not being able to eat and drink like everyone else can interrupt our everyday routines, be isolating and can lead to depression. Food and eating is basic to our survival, but is even more important to our quality of life and our joy of living. How we eat and with whom we eat feeds the spirit.
Caring for someone with swallowing problems is about more than the mechanics of feeding. Doing it right is science combined with art. With the right tools, creativity and information, it may be possible for those with swallowing problems to share and enjoy a meal. Diagnoses and food modifications help to sustain the ability to nourish the body but we should acknowledge that we need to feed the soul, as well.
To my father, food was love. Dad was a “Great Depression” baby and spent his childhood during a time when food and resources were scarce. When he was a child, there was no school lunch program. The SNAP program didn’t exist. Families grew much of their own food in their yards and, as World War II approached, lived on ration coupons. Owning urban chickens may seem like a trendy thing to do in 2014, but during my father’s childhood, it was a necessity.
Dad’s mother, Louise, was a single, working mother during a time when being a single mother or working mother was not nearly as common as it is today. “Grandma Weezee”, as we called her, was a passionate gardener and a fabulous cook. Her pies are legendary in the family lore and vivid in my memory. One bite of strawberry-rhubarb pie with vanilla ice cream and I am six years old again, sitting on the top platform of a step-stool, eating with my family at her Sunday dinner table.
Dad inherited his mom’s gene for gardening. Dad worked in an office, but the garden was in his blood. For almost four decades, he had a 12’ x 12’ plot in the neighborhood community garden at the bottom of the hill. While the other dads in my neighborhood were playing tennis and golf or having a cocktail with their buddies after work, my dad was in the garden. The community garden had its own social network, but the real reason my dad was there was to feel the dirt in his hands, work the soil and watch nature take over after everything was planted.
From late spring until the hard frost of fall, dad would be getting his hands dirty after work and most of our meals contained what he grew. The idea of not eating your vegetables was insane! “Dad grew that.” was a sentence I heard over and over. From the fresh peas of early spring, to the lettuces of early summer, the tomatoes of August and winter squash of autumn and everything in between, we feasted.
Looking back, it is amazing to me the sheer amount and variety of vegetables my dad grew on 144 square feet of Earth. We shared our bounty with our neighbors and friends, often overwhelming them with produce. To this day, my mom can make zucchini in about 426 different ways, including five variations on zucchini bread alone!
But I never liked being in the garden. There were bugs. It was dirty and smelled of compost and soil. I HATED weeding, so I avoided working in the garden for much of my childhood. When I graduate college and moved to the desert southwest, I bought my vegetables and fruits in the grocery store like civilized people do. My love for produce (and pie!) is deeply ingrained, but store-bought vegetables and fruit just don’t taste the same. Produce from the farmer’s market is an upgrade and those from a CSA (community supported agriculture) are better still, but they are still not the same. There is something ethereal about eating lettuce (or anything else) that was in the ground, breathing, just minutes before it hit my plate.
The autumn after Dad died, I was hit with the urge to put in a vegetable garden. Truthfully, what I felt was more than an urge, it was a compulsion. It was a herculean task to remove a 50 year-old prickly pear cactus that occupied the perfect corner of our yard for growing vegetables, so I enlisted my husband and his brothers to make it happen. Desert soil is nothing like mid-western soil so we had to amend and amend the sandy clay to give the seeds a fighting chance. It didn’t matter: I was driven like never before.
My first vegetable garden was a success in more ways than one. I was able to feed my husband, son and neighbors the fruits (and vegetables) of my labors but, more importantly, I felt closer to my dad and his mother than I ever had in the past. I discovered that I, too, have the gene for gardening. It was long dormant but I share it.
This year marks my fifth year vegetable gardening which means that it’s been five years since we lost Dad. My 2014 garden is shaping-up nicely. This year, I planted Tuscan kale, heirloom rainbow beets, red carrots, mixed lettuces, scallions, tomatoes, and a variety of herbs. Dad never grew Tuscan kale, but I know he’d love it in the minestrone I’ll make when my husband has declared that he is tired of eating kale salad and kale chips.
Working in the garden helps me remember my dad in his best, most vital time, not in his final years when dementia overtook him. Now, if I could just make a pie like Grandma Weezee’s…
When I speak to dementia support groups, I mention how helpful it can be to use specially adapted eating utensils. Something as simple as a fork with a larger handle can help restore a bit of dignity to someone who is struggling with feeding themselves.
Recently, I was visiting my friend Yolanda Romero-Alemany in her medical supply store and I saw the helpful eating/feeding items she stocks. Yolanda is a great resource for medical equipment and supplies so I asked her to write this guest blog:
Ever wonder why restaurants’ menus and interiors often are red? Studies have shown that the color red stimulates the appetite.
How does this relate to people eating independently, especially those with Alzheimer’s or Dementia? Red is the color easiest to perceive for Alzheimer’s and Dementia patients which makes it great for tableware. Many Alzheimer’s patients do not eat enough due to lack of hand-eye coordination with silverware or not being able to distinguish the food from the serving bowl/dish. At Scottsdale Medical Equipment & Supplies, we carry the Power of Red line of utensils, bowls, and cups by Essential Medical. The red dish and bowl have nonslip bottoms which hold it in place while eating and the great red color provides contrast between the food and dish. The forks and spoons have large handles to make it easier to grip and can actually bend so the motion to scoop something up from a bowl to the mouth is easier. The Power of Red line also includes a cup with a nose cutout so people don’t have to tilt their heads back to drink. These items range in price from $18-$45.
Scottsdale Medical Equipment & Supplies stocks other Aids to Daily Living products carried at our store in Scottsdale, on the NW corner of Loop 101 and Shea Blvd. We stock many eating/feeding tools which make meal time more enjoyable for everyone.
If you are in the area, stop by our store is at 8752 E. Shea Blvd, Scottsdale, AZ 85260 and “Let our Family Take Care of Your Family”.