Her son was feeding her like she was a little baby. A hospital cafeteria-issued tuna fish sandwich sat atop a soggy swatch of cellophane on the palm of his left hand. In his right was a butter knife that he used to excise tiny chunks of the sandwich. As I entered the room, he proudly gestured to the remaining portion of the sandwich and communicated reassuringly in broken English that he would keep working hard on getting the whole sandwich into his mother. He was part of our team, and his job, he implied, was to contribute to the project of healing his dying mother by nourishing her with love and calories.
She was a 70-year-old Cantonese-speaking woman with aggressive ovarian cancer. She had been receiving hopeful chemotherapy from her oncologist, but it clearly hadn't been working. On her most recent clinic visit, she had become so critically ill that her doctor had abruptly admitted her to the ICU for stabilization, withholding chemotherapy, to the family's consternation.
Until recently, the cancer had lived quietly inside her, preparing its attack slowly and without raising too much alarm. This time, though, it had risen up like a guerrilla army to fight its final, multi-front battle. Fluid around her lungs squeezed like the worst kind of corset so that every breath exhausted her. Cancerous fronds curled around her intestines, distending her abdomen and further compromising her breathing.
And so she lay there, barely able to breathe, intestines obstructed and bursting, every line on her face reading defeat.
Family members frequently feed my patients food, but it is never just food. It is "lumpia, just like he likes it, with roasted pork," or a "mole chicken burrito, not too spicy this time." Beginning with the breast, food is not only physical sustenance, but spiritual and emotional too. It is a pancultural symbol of love, from Chinese and Ethiopian to Jewish and Vietnamese. The dishes have been carefully and lovingly prepared to bring a taste of home into a sterile and frightening place. They are meant as signs of hope, signs of love, signs of reassurance. And not only for the patient, but for the feeder, too.
And yet for all living things, there comes a time when food becomes something different, something unwelcome, even harmful. An obstructed intestine cannot accommodate a tuna fish sandwich. Even chicken broth, the universal healer of all remedies, can increase the pressure in the stomach, causing nausea, vomiting, and stomach pain, as well as impeding breathing.
That this elderly Chinese woman was being fed a tuna fish sandwich by her son attested to the desperation he must have felt at that moment. Hospital tuna fish sandwiches are rarely eaten by little women from the Chinese mainland. He was caught off-guard by her abrupt transfer from the outpatient oncology clinic into the intensive care unit. He hadn't had time to prepare a special dish.
Her face showed sheer exhaustion as her worried son pushed bite after bite of the foreign substance into her mouth. As with so many patients with advanced illness, food, once enjoyed, was now a burden. Her body had lost the ability to process it, and hunger was a thing of the past.
Yet her son was desperate to love her, and this was all he knew how to do.
Worried, I gently coaxed the sandwich away from him. He nodded vigorously as I tried to explain the risk of feeding. But I couldn't climb our Tower of Babel. I made the universal "I'll be right back" sign and ran off to find an interpreter.
But before I had found one, I heard the familiar crackling words over the PA: "Code Blue, 5th Floor." She had indeed aspirated the sandwich. Her already strangled lungs had been filled with what is often a toxin for a dying body -- food.
In feeding our dying loved ones, we are feeding ourselves, warding off our own fear of loss. But when physical life begins to pass, we must learn to transfer our love and support into a different medium. The tuna fish sandwich was a desperate act from a desperate son who wanted to love and honor his mother. But his effort in fact may have shortened her life and caused unintended distress and suffering. When food stops being love and starts being dangerous, it doesn't matter whether it's a bowl of grits, matzo ball soup, or a cafeteria tuna fish sandwich, it is time for us to pull back and discover new ways to sustain ourselves and our loved one.