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.
With the change of weather and cooler temperatures, I’ve been craving braised red cabbage, something I don’t normally eat. But I don’t want just cabbage. I want potato pancakes made from shredded potatoes, or “rosti” which are Swiss hash browns and meat. Gotta’ have some sort of pork seasoned simply with salt and pepper; the darker the meat, the better.
I don’t normally eat this way. All summer, I live on salads and vegetable-based meals combined with some grilled meats and maybe some grilled fish. But for the last couple of weeks, I’ve wanted cabbage, potatoes and pork; German comfort food.
I think my craving may just have something to do with the genealogy my sister, Renda, has been doing. Recently, she traced the maternal side of our family back to our great-great-great-great grandmother Catharine Brodbeck, who emigrated from Baden, which is in southwestern Germany, through the city of Breman, to the US in 1854. Catharine traveled with her nine (!) children on a small ship, landing in New York on the day after Christmas in 1854. She then traveled to Ohio to join her husband, the father of her children. Catharine had a total of 14 children but the nine she traveled with ranged in ages from seventeen to as young as four years-old.
When I think of the kind of woman great-great-great-great grandma Catherine must have been, I’m in awe. She traveled half way around the globe, without her husband, with nine children in tow. When she climbed aboard that ship, she’d left behind her home and her extended family. Like so many immigrants, she and her children left their homeland to escape war and economic hardship. Baden is on the banks of the Rhine River, an area that has seen struggle and conflict for centuries.
Once aboard that small ship, what was daily life like for Catharine and her children? How she they feed everyone? What did they eat? I can’t imagine traveling for weeks and weeks with nine hungry, growing children.
And when they arrived in the US, how did the family travel the 540+ miles overland between New York and Ohio? How long did that trip take? How did she feed everyone then? She and her children made this journey a century before the interstate highway system, with its convenient rest stops and exits for food and restroom breaks. Cars wouldn’t become commonplace for another six decades. What drive, determination and optimism they must have had to have completed just that part of the journey!
So, last night when I made a dinner of braised red cabbage with rosti and grilled country-style pork chops for my family, I thought of her. These foods I’ve been craving are traditionally German. Did Catharine feed her family these foods, as well? Is she why I crave them? As I looked across the dinner table at my nine year-old son, I thought about Catharine. I could feel her presence so I told my son her story, which is his story, too.
Sharing and eating goes far beyond nourishing the body, it also touches the soul and honors the past. Braised red cabbage = family ties for me.
Braised Red Cabbage
2 tablespoons butter
1 medium head of red cabbage, quartered, cored and cut into ¼ inch strips
1 tart green apple, skin-on, quartered, cored and cut into ¼ inch slices
¼ cup apple cider vinegar
¼ cup water
3 tablespoons granulated sugar
2 teaspoons salt
¼ teaspoon ground black pepper
¼ teaspoon ground cinnamon
In a heavy large skillet or Dutch oven, melt butter over medium heat. Add the cabbage and apple and toss until all is coated with butter and begins to melt. Add the vinegar, water, sugar, salt, pepper and cinnamon and mix thoroughly. Reduce the heat to a bare simmer, cover and cook for about one and a half hours, stirring occasionally and adding more water, as needed, to prevent sticking.
This dish is even better the second day!
For a mechanical soft diet: no modifications.
If you are on a puree eating plan:
In a mini food processor, pulse ½ cup braised red cabbage with 2 tablespoons water. Once finely chopped, add ½ teaspoon instant food thickener and process until completely combine. It should have the texture of firm mashed potatoes.
Yield: 6 servings
97 calories. 3 gm fat, 17 gm carbohydrate, 4 gm dietary fiber, 3 gm protein. 800 mg sodium. 44% Vitamin C. 181% Vitamin A.