I feed the starving. I feed the dying.
I’m no Mother Teresa, but the act of feeding the unfortunates who can’t eat appeals to me. How could you not like the person who feeds you? You don’t bite the hand.
I feed people, patients, whose stomachs are diseased or destroyed; destroyed by rare diseases, infections, botched surgeries, gunshots, etc. Their only hope to avoid starvation is me.
People often joke when I come into their hospital room to check on the feeding solution that I have prepared. When I enter a patient’s room, I’m often greeted with, “Here comes the food man,” or “Can you change the flavor?” or “Can you grind up steak or lobster and put it in that bag?” Sometimes, they call me “the chef.” I smile. I am a doctor, but to them, I’m the very generic “food man.” I’ve become okay with it and grown to like the epithet.
The medical term for the solution is parenteral nutrition, and it’s all the calories, proteins, fats, vitamins, and minerals that are to be infused directly into the bloodstream, bypassing the useless and diseased digestive organs. It keeps a patient nutritionally intact for whatever other doctors have up their sleeve.
And, they have a lot up their sleeve.
Patients and family in the frightening and confusing setting of a hospital can relate to being fed. They understand it. It’s all good. To them, I am the familiar.
“I’m here to keep you nutritionally intact,” I tell them. “My solution will keep your body sound so you can heal your wounds and fight infection. It contains all the calories and protein you need for health.”
They thank me again and again. It’s almost embarrassing.
I had planned to do great things in my medical career. But if you want to make God laugh, tell him (or her) you have a plan.
In medical school and residency, I found a Viktor Frankl meaning in uncompromising patient advocacy. It made me an outstanding medical intern and resident, but once in the real world, I found myself at odds with medical insurance companies, the hospital, and even the local pharmacy, which demanded prior authorization of just about every significant drug I prescribed.
“It seems to me,” I told the insurance companies or pharmacies, “that if I prescribe a drug and you don’t fill the prescription, you should be sued, and not me.”
“That’s not the way it works, Doctor.”
I was not fitting in, so I decided to reinvent myself and devote my career to feeding the starving. It was perfect. I could stay under the radar and not compromise my humanity.
When I took care of very complex patients using very sophisticated medications (that required a prior authorization), I rarely received a “Thank you,” but was often on the receiving end of hostility. Families were mad that their loved one was sick and would not get better, and somehow it was my fault.
“But you promised she would get better.”
You can’t say anything, not even to remind them you never promised them anything. They hear what they want to hear.
But with my new career, even when things are going to hell, the families know that their loved one is being fed by me, “the food man.”
They love me.
The work is not very dramatic, but once again I enjoy it. I particularly like taking care of the pregnant patient. Pregnant women have nausea and vomiting, but in some cases, it’s more than usual and can result in serious weight loss. Weight loss in pregnancy can be very dangerous for the baby. Even fat women need to gain weight during pregnancy.
You have to be alert: two lives are at risk.
Feeding the pregnant patient can be quite complex. If you give insufficient calories, the patient will go into a protective starvation state and produce too much acid. A fetus exposed to an acid environment will grow up intellectually impaired.
If you give too many calories, the baby can grow too large, and it is very difficult for the woman to deliver the child through the birth canal, resulting in injury to both mother and baby, not to mention an increased incidence of miscarriage or the need for a Cesarean section.
I must add folate. Without folate, the baby’s spine won’t form and the infant could be born paralyzed. Iron is important, as are the B vitamins, particularly thiamine. I include them all.
I’m good at providing nutrition. The more I study the science, the more complex I have found the discipline to be. Other doctors don’t think there is that much to what I do. They try to steal my practice and do it themselves. I’ve seen some nasty accidents. Most give up and turn the patients over to me and my service. They are afraid of a malpractice lawsuit.
I am uncomfortable with feeding patients with advanced cancer. It only prolongs the inevitable and agony. When I make rounds on a cancer patient and they are asleep, I’m careful not to wake them. I hope that in the mysterious, wonderful elixir of sleep, they dream that they are healthy and free of disease.
Once I took care of a patient who was pregnant, but during the pregnancy, she was found to have terminal cancer. The cancer prevented her from taking nutrition.
There was talk of surgery to remove her stomach and put her on chemotherapy. This would result in a miscarriage or a badly deformed baby. Termination of the pregnancy was offered, but the woman refused.
She was a single mom. She was told that after surgery and chemotherapy her life expectancy would be two years.
I would visit her daily, checking on her physical state and the composition of the feeding solution.
She was upbeat and cheerful during my visits. Her attitude surprised me. I expected anger, depression, self-pity, and anxiety. I saw none of those.
A male social worker came to help arrange for an inevitable adoption. I overheard their conversation. The social worker confronted the patient’s upbeat attitude. He called it “denial” and suggested she undergo surgery and chemotherapy to prolong her life.
The patient smiled and said that the aggressive treatment might give her two years but put the health of the baby in jeopardy. She said two years meant nothing in comparison to giving her child a lifetime, and that the decision was easy and would give her final few months clarity and meaning. Meaning that most people never get to experience. She considered herself a very lucky person.
I understood her desire for meaning.
She agreed to continue nutrition in order to keep the baby healthy.
Like I said, when things are going to hell, they love and accept the food man.
I supplied the nutrition and she delivered a healthy boy. She was fit enough to care for the infant for several weeks, and she got to meet the adoptive parents, whom she liked very much.
She then went into hospice.