Sunday, 27 June 2010
The first week of my B placement has ended, and I have a weekend in which to play. I deliberately kept it clear of commitments in case of exhaustion or mental stress, but I have experienced neither, and have spent the day cleaning and cooking. Also, we have taken our plumbing situation a step forward by two trips to the DIY store (OK, it should have been one trip but we're a bit rubbish), and we successfully exchanged the towel radiator that was leaking. Mr A has installed it, so far without incident. Now we have to wait a little while to see if it leaks, but if not, we can progress with the bathroom floor, followed by the rest of the bathroom. Meanwhile, the rest of the house continues to rot. Very slowly.
The placement has started slowly, as might be expected with any new job. I have started to find my way around the hospital site, learned to use the bleep system, filled in a record card, and been given a swipe card for the locked doors in the department, a Student Dietitian badge, a photo id for the hospital, a parking permit for my car, and a free biro. I have successfully used the photocopier, and I know where to find the kitchen.
We have also been introduced to the catering department, a critical therapeutic function of a hospital that is often overlooked. A lot of work goes into the design of menus, and there are always several competing demands: gluten-free, dairy/lactose-free, fortified (which is called the 'recovery' menu in this hospital), and soft or pureed for those who cannot chew or who have an impaired swallow. There are meat, fish and vegetarian options, hot and cold options, starters, mains and desserts.
When I was in Rotherham they made everything from scratch on the day, which meant that patients had to fill in their orders a long time in advance, and new admissions received whatever the previous occupant of the bed had ordered. This hospital operates a 'cook-freeze-chill-regenerate' system, so that food is cooked in bulk in advance and frozen, then brought to chilled temperature and plated as needed, loaded into ward trolleys then heated in big docking stations in ward kitchens. The trays are divided in two and half remains chilled, so an order of both hot and cold food in the same meal can be accommodated. Orders for the following day are collected in the evening, and new admissions can usually make a lunch choice at breakfast time the same day. It seems very efficient, but I expect that it needed a good deal of capital investment in the necessary equipment.
We met the 'Diet Chef', who is responsible for the pureed meals, gluten and dairy-free menus, and anything out of the ordinary (like vegan). He uses real food and thickener for pureed meals, which also contain extra energy and protein on the assumption that those who need soft food are probably in need of building up as well. The different components (e.g. sausages, mashed potato and vegetables) are frozen separately into molds, so that when plated up they resemble the original food, rather than unattractive mounds on the plate. He assembled four pureed meals for us to taste, and I really wouldn't have minded finishing any of them. One of the other chefs also gave us a plate of the standard chicken curry to taste, and it was delicious.
In Rotherham I spent a morning on the lunch conveyor belt, loading gravy onto plates that were going straight out to wards. The belt here plates up chilled food, so the workers were all dressed in fleeces, hats and gloves during the hottest week of the year so far. We went out to a ward to shadow a 'hostess', responsible for dishing out the food and helping people to eat it. I helped feed a lady with pureed food - she ate no more than two tablespoons of chicken, a teaspoon of mash, and two teaspoons of chocolate sponge. The (pureed) sponge had the consistency of a chocolate terrine and looked delicious; I tasted some afterwards, and unfortunately it was unpleasantly gluey.
There are several other ways that patients can get meals - the wards are able to collect food from the standard restaurant and there are 24-hour snack boxes. Unfortunately, both of these incur an extra cost to the ward, and may not be offered to patients.
The main food focus for most patients is to ensure that they get the meals that are available and are suitable for their situation. The ones who can't manage to eat enough in the normal way might be prescribed supplements, usually in the form of 200 ml bottles of flavoured drink: sweet, yogurt-style or juice-style, or there are soups for people who prefer savoury, and thickened desserts for those with an impaired swallow. There are versions with and without fibre, and low potassium for renal patients. These supplements contain all the necessary vitamins and minerals as well as protein and energy, so can actually replace the whole diet if necessary, and there are a couple of options that pack it all into 125 ml doses instead of 200 ml if patients have a really small appetite and can't manage any more.
Meal times on wards are pretty hectic. It's difficult to provide timely assistance to those who need it, to help them eat their food while it's hot. Other patients may be doing all kinds of things in the next bed, then you're feeling ill, and there's the hot weather, and you may not like the food much. It's not entirely surprising that most people lose weight in hospital. This might sound like it doesn't matter too much for all of us overweight people, but you need the full range of nutrients for the immune system and for wound healing, so hospital residency becomes longer if people aren't fed well, and that costs money.