A Mechanical Soft Diet (Huh?)
Food matters...
During patient care meetings, a hospice nurse would report that a patient had started “a mechanical soft diet.”
What was that? My serious side guessed something happened to the food for easier swallowing and digesting.
But I confess to imagining expensive equipment—with complex moving parts—processing a meal before it arrived on the patient’s plate. Maybe the food was delivered from a secret laboratory to the patient’s home? Don’t astronauts require special preparation and packaging for dining in space? The U.S. military has the MRE—Meals Ready to Eat—for troops in locations without portable or permanent mess halls. I’ve hiked with freeze-dried food stashed in my pack. Whether orbiting the earth or exploring wilderness, weren’t some “mechanical” steps taken to create those meals?
I asked a nurse. (Always ask a nurse!)
She explained, “It’s when the food is cut into small, bite-sized pieces.”
No surprise, it was a fancy name for a simple procedure. However, it also has more elaborate descriptions:
A mechanical soft diet comprises soft-textured foods that a person has pureed, mashed, or blended. It is ideal for people who find it difficult to swallow solid foods. It is possible to include all the major food groups in a mechanical soft diet. For this reason, it can be as nutritious as any other diet.
Patients can struggle with swallowing. In hospice, the challenges with food may be from the progression of the illness or recovery from a procedure. Other diets may be required, such as only eating pureed food. For some, a thickener will be added to their liquids.
Food is always one of the most difficult aspects of caring for a dying loved one.
We want our beloved to be well fed. Probably everyone has faced hunger. Some have been only briefly hungry; others confront hunger on a troubling daily basis. None do well without food. And then, when a first meal enters our system, we feel better. After a long stretch of hiking in the mountains, I’ve chowed on freeze-dried food dubbed with fancy names—Katmandu Curry, Mountain Magic Meatloaf—that looked grim in the cooking pot. But I licked the bowl to capture every molecule. I needed that energy!
In hospice, our loved ones may slowly (or swiftly) arrive at a point where how much food is eaten and how it’s prepared will change. To safely swallow, the meal will need to be “pureed, mashed, or blended.” Drinks like Ensure—with its makers touting it a “complete, balanced nutrition for everyday health”—might need to be purchased.
Preparing or buying the meal may be easy, but they are never easy to consider.
As a patient declines, they may eat less. With hospice patients, we often estimate the amount of food eaten. Are they still having two or three meals a day? How much is finished? Everything on the plate? 50%? 25%?
Astronauts probably complain about the food they must eat. Soldiers, hunkered down in a scary spot, definitely complain about the food they’re forced to gobble. I know from experience that the freeze-dried food I greedily ate, even with mountain grandeur surrounding the campsite, received complaints. We hikers griped and grumbled as we spooned nourishment into our bodies.
But there comes a time . . .
For a person in hospice care, she or he may physically not be able to eat. Certain diseases, and the medication used for pain control, cause patients to become drowsy much of the time. Certain diseases, even when the patient remains alert, have damaged the body and there’s no way she or he would consider eating.
Some patients simply (though it’s never simple when this time arrives) don’t want to eat anymore.
The worst thing a loving caregiver can do is to try to make them eat. Whether it’s begging a husband or grandmother to take a spoon of tapioca or demanding the hospice nurse place an IV so that a best friend or favorite uncle can receive fluids, we become desperate to continue feeding the patient. We use guilt, even as we feel guilty. We bargain, setting up everyone for losing. We threaten, refusing to voice our deeper fears about vulnerability and loss.
Food, even the awful MRE, is life!
I urge family and friends to do the nearly impossible: pay attention to your loved one’s real needs. Eventually, they may only want tiny slices of cheese, or buttered toast cut into melt-in-the-mouth portions, or a smidgen of fresh fruit swirled into yogurt. It is likely, and maybe soon, when they will only swallow sips of a thickened liquid.
And it’s likely—when still able to chat, still able to hold your hand, still smiling at family stories, still waiting for the grandchild to arrive for a visit—they will no longer want to eat.
Sometimes a patient doesn’t eat or drink for days. And days. Caregivers are anguished. How can this be? Isn’t their loved one dying a terrible death? The hospice medical staff will give you gentle and well-researched reasons for a lack of eating . . . but all reasons seem inadequate.
A part of you, if your loved one has stopped eating, would cross oceans if she or he would just try another bite of applesauce. Regardless of what I write or your hospice nurse explains, dealing with food will be a struggle.
If only there was a mechanical soft explanation to help families understand why food may no longer be needed or desired.
If only there were a few easy-to-digest, bite-sized reasons that would make perfect sense.
If only . . .
+++++++++++
My book, A Companion for the Hospice Journey, is available at Amazon.
What I learned from Steve's dying at home is that slowing then stopping eating food is part of the natural dying process. Liquids are important to the dying so they can remain calm. Thanks for your thoughts Larry!