Mom Won’t Eat
“Food, like a loving touch or a glimpse of divine power, has the ability to comfort.”
There is some debate about when the term “comfort food” first appeared, but there is agreement that certain foods can provide physical, emotional, or social solace during difficult times. Food can be associated with childhood memories, a special person, an occasion, or a cultural heritage. For each of us, what evokes these positive associations can vary. It may be the smell, the cooking, the taste or sharing it all at the table. For Maya Angelou, comfort food was “greens, cornbread and fried chicken.” In my family, if you were sick, chicken soup and grapenut pudding would appear, a tradition that continues. My friend Peggi says that kasha varnishkes is a favorite Jewish comfort food. When people are ill or grieving, we bring covered casseroles. Food is common ground for sharing our love and compassion for others.
Food can also be medicalized with restricted diets for certain medical conditions and prescribed diet consistencies such as thickened liquids for individuals with swallowing disorders. “Drinking” water with a spoon or being served a plate with all pureed foods can be less than satisfying. Particularly towards the end of life, there are times when the patient or family may decide to disregard diet recommendations and, knowing the risks, choose to focus more on quality of life and the joy of eating. This usually involves signing a waiver if the individual is in the hospital or a nursing home.
When someone has an advanced illness and is dying, part of the process typically involves a loss of appetite. This can be immensely upsetting for families. They are no longer able to offer the comfort and gift of food. Meals and snacks tend to pile up at the bedside with relentless encouragement to eat. Family members sometimes try to force food intake. All out of love. One daughter called to ask me to intervene after stating angrily that her mother with metastatic cancer “won’t eat”! As body processes are slowing down, including the gut, it is not that patients won’t eat, they just can’t eat. To put it another way, “people don’t die because they stop eating, they don’t eat because they are dying”1 It is part of the terminal process and a natural way for the body to conserve energy. Eating more than small amounts can cause discomfort. It is still important to address any issues that could contribute to a decreased appetite: constipation, pain, nausea, or medications that could be discontinued. Understandably, family may ask if adding intravenous fluids could help, but there is no medical evidence to support adding artificial nutrition or hydration at the very end of life. In fact, additional fluids may leak into tissues causing generalized swelling and increased breathing problems.
Does it hurt though? Are they suffering? Based on research and experience, this does not appear to be the case when the comfort measures described next are offered. All these explanations may be heard, but their impact is mostly on the heart and the indication that death is near.
If not comfort foods, “comfort measures” can always be offered. It is key to follow the patient’s lead. If and when they do feel like eating, then the mission is to find WHATEVER it is that sounds good…..often it is ice cream. For one patient, all she wanted was 2 small bowls next to her, one with a handful of green grapes and the other with a mini éclair. Another patient requested only Dunkin’ Donuts blueberry muffins. Keeping lips moist, offering small sips and bites, saliva substitutes and impeccable mouth care should continue as tolerated. Keep lip balm in every pocket and every drawer. Understanding that this is part of the dying process can help to take the focus off of food and lessen any related suffering by the family. Mother Nature even offers her own level of comfort because along with dehydration and ketosis (the body breaking down stored fat) that occurs when someone is not eating, endorphins are released inducing a sense of well-being, similar to a runner’s high. Comforting to know, I think.
1 Mandola, J. Medscape - http://www.medscape.com/viewarticle/841512