What Lies Beneath: On Hospitality and the Hospital Sandwich : Emergency Medicine News

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What Lies Beneath

What Lies Beneath

On Hospitality and the Hospital Sandwich

Johnston, Michelle MBBS

doi: 10.1097/01.EEM.0000898232.55007.89
    hospital sandwich, hospitality

    I started writing this column looking at a hospital sandwich. It was being offered to a patient who had been lying and waiting and lying and waiting a little more in our ED. The man was hungry and disheartened, lonely and at sea in the hulk of the department, a department that was oblivious and heedless to almost all of his human needs.

    I thought more and more about this anemic slab of “food” and wondered when we became so miserly with our edible ministrations. Little did I know this question would lead me squarely back to King Henry VIII.

    But, first, the hospital sandwich. You've all seen it. Whiter than a ghost. Its thin edges delicately curled. Its innards even paler than its shell—lettuce, ham, butter, all limp and slimy and indistinguishable from one another. The mobile meal that has been irradiated and time-stamped and nestled inside glistening, sealed-up, never-degradable wrap, kept cold in the fridge so that the wilt has transformed to stiff.

    I handed it to the gentleman, and he said he was grateful, but his eyes spoke of disappointment. It did not feel hospitable.

    And then, as is my wont, I began to wonder how a hospital, certainly an emergency department, was not very hospitable, and how it was that their etymological roots could be so similar.

    A Ticket to Heaven

    The history of hospitals is, of course, vast and deeply fascinating. Hospitals, in the sense of the word as we understand it, did not really exist until the Christian Era, but they began to spring up all over the world in about the 5th century. They had many similarities, despite their geographical differences. They were not expressly for the medically ill but places of respite for poor, dying, and disabled patients and travelers.

    Italy led the way as time progressed. It became compulsory for monasteries to have a co-located hospital, a hospice for pilgrims. Apart from a roof over their heads (and spiritual succor), the main offering to those admitted was nutrition. And what hearty nutrition it was. The hospitals had their own farms, and patrons were given fresh milk, bread, ale, gruel, and fruit from the orchards.

    This type of hospitality was wrapped in co-dependence with theology. Roman Catholic teachings held that rich men could gain God's grace through good works. The monasteries and hospitals were funded by those who wanted to buy themselves a ticket to heaven. But then came the great rending asunder, under the ham-like hands, if you will, of the most truculent of Tudors. Henry VIII sparked the Reformation, and all things Catholic had to go. He dissolved the monasteries, and the church withdrew support from hospitals. To add insult to injury, the poor and the disabled were no longer considered righteous in their suffering, the prior path out of purgatory, but were held as an example of the ungodly—lazy and unworthy. The earthly banquets ceased.

    The rest of it is history (literally). The Protestants, for all their stinginess, at least began to wrestle care for the ill away from the religious and move it toward the scientific. The Enlightenment had begun. Modern hospitals took root. Sadly, the principle of food as comfort, consolation, an adjunct to healing, as well as its benefits in nutrition, has been slow to catch up again.

    No Longer Wanted

    Sure, modern EDs are not restaurants, but neither should they be punitive. I could see it in my man as I handed him the sandwich. It's not a punishment, I wanted to say.

    It's not even clear what a sandwich is. Its alleged inventor was John Montagu, the 4th Earl of Sandwich, but really, he just gave it the name; the concept of sandwich had existed in antiquity, with meat being placed between slices of unleavened bread.

    The U.S. Department of Agriculture, strangely, uses the definition of “at least 35% cooked meat, and no more than 50% bread” in response to the term being diluted and poorly understood. (New York Times. April 14, 2015; https://bityl.co/E42j.) Is a hot dog a sandwich? Bruschetta? Other types of finger food?

    However we describe it, the hospital sandwich, I feel, has gone the way of Anne Boleyn. Discarded, no longer wanted, no longer beautiful. Executed (perhaps slightly too long a bow to draw?). This one I held in my hand was no queen. And it brought cold comfort to my patient. Bring back the gruel, I say.

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    Dr. Johnstonis a board-certified emergency physician, thus the same as you but with a weird accent. She works in a trauma center situated down the unfashionable end of Perth, Western Australia. She is the author of the novels Dustfall and Tiny Uncertain Miracles, available on her website, http://michellejohnston.com.au/. She also contributes regularly to the blog, Life in the Fast Lane, https://lifeinthefastlane.com. Follow her on Twitter@Eleytherius, and read her past columns at http://bit.ly/EMN-WhatLiesBeneath.

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