Peter, Peter, pumpkin eater,
Had a wife and couldn’t keep her.
He put her in a pumpkin shell,
And there he kept her very, very well.
When I was little, I used to ponder a lot about Peter and his wife. What sort of a man would put his lover inside a pumpkin shell? Much to her annoyance, my poor mother was obliged to spin a tale every day about how Peter’s wife got on in her pumpkin home every day. “How did she stretch her legs? How did she get out of the house?” I used to demand. Then, I was introduced to Cinderella. I marvelled at how Cinderella’s fairy godmother transformed the pumpkin into a carriage with just a tap of her magic wand. Because of these nursery tales, the pumpkin won a special and sacred place in my heart. Since my mother had never bought a pumpkin, I imagined it to be extremely expensive and unavailable in Singapore. I was about 10 the first time I tried a small slice of pumpkin. It was air-flown from Japan and reserved only for my father. I remember steam escaping from its creamy orange yellow texture, its warmth and sweetness coating every inch of my inexperienced palate. The dark green pumpkin with its golden flesh was treasure that a Japanese visitor finally unearthed from my childhood fantasies.
Since I got married, I have learned quite a bit about the nutritional benefits one can yield from a pumpkin. Contrary to my imagination that pumpkins were only available in faraway lands shrouded in mystique, they are conveniently available at the local wet market and supermarkets. Now that I have my own kitchen, I always have a pumpkin sitting in my refrigerator and I make sure that Pumpkin is always accompanied by an assortment of his colourful cousins and nephews: tomatoes, carrots, corn, horse radish, broccoli, spinach, kale, lettuce, celery, white radish, sweet potatoes, beetroot, and cabbage. I figured in my childhood that Pumpkin and Peter’s wife must have been bored with each other. Pumpkin needs friends, just like all of us.
Cooking for Kai Ma, who is vegetarian has roused my interest in preparing vegetarian meals for convalescents. I am not interested in gluten based vegetarian meals such as mock duck or chicken because they are laced with oil, sugar, soy sauce, and salt. When a patient develops mouth ulcers and is unable to put on dentures, chewing and swallowing can become challenging. Porridge is a typical Asian convalescent diet served at home and at the hospitals. However, how much nutrition can one obtain from a bowl of plain porridge? While non-vegetarians have the option to supplement their diet with fish soup, chicken essence and other tonics, how does a vegetarian patient obtain an adequate portion of nutrition besides consuming only porridge, tofu, eggs and soy bean curd or milk daily? Asians, particularly the elderly, are not used to or open to trying wholegrains such as oatmeal, bran and quinoa. I have come across many who routinely eat only bottled preserved cai sim (pickled vegetables) with plain porridge because that is just what they are used to eating since their youth.
I have learned that it takes a bit of education, adjustment and compromise for both the patient and the caregiver. Generally, advice from a close family member is hardly appreciated. Advice from a third party, however, tends to work wonders. For this reason, it is important for the patient and caregiver to consult a clinical dietician appointed by the patient’s principal specialist. A clinical dietician works hand-in-hand with the principal doctor and his team, and would therefore be the ideal person to advise the food portions to be given to the patient. How much nutrition one requires varies between individuals because every medical condition and patient is unique.
Just as a specific nutritional deficiency can trigger a medical condition, a medical condition and its treatment can also potentially lead to different types of nutritional deficiencies. Having said this, clinical dieticians are not chefs or culinary professionals. The primary caregiver who prepares meals for the patient needs to be creative and flexible to innovate in the kitchen, and of course have a lot of patience to coax the patient to consume the well-intentioned meals. Love is always the most important ingredient in every recipe.
Colours from an assortment of vegetables not only add energy to a dish, they complete a meal with distinct nutrients and dietary fibre not found in animal protein. If I had had more time then to prepare Kai Ma’s meals, I would have pureed Pumpkin and his friends. Pureeing a whole pumpkin or a whole broccoli means the patient consumes a whole pumpkin or broccoli along with its health benefits.
Pureed vegetables have a smoother texture that allows saliva and digestive enzymes to start breaking it down as soon as it enters the mouth. To enhance digestion, it is best to thicken the consistency of pureed vegetables with less fluid or stock. This is because most people tend to ‘drink’ pureed foods as though they were fluids. ‘Drinking’ pureed foods does not allow the food to interact long enough with saliva and this could inhibit digestion. It is recommended that patients gently swish the pureed food in their mouth before swallowing it. This gives the saliva time to break down the food. It also allows the mucous membrane lining the inside of the mouth to absorb nutrients. Although stomach acidity, bile secretion from the gallbladder and enzyme secretion from the pancreas are also important factors in the process of digestion, we need to respect that saliva plays an equally vital role in the digestive system.
Some patients have complained that porridge and pureed food remind them of vomit. But porridge and pureed food do not have to look like vomit. The trick to pureeing vegetables is to either blend each vegetable on its own or similar colour tones together. As an example, blending spinach and carrots together results not in a cheerful orange, but a disgusting sewage green. Healthy persons and patients alike are not attracted to murky unappetising colours. A light yellow green is refreshing while a dark green instantly turns most people off. Conversely, blending a carrot, a tomato and a pumpkin would give you a reddish orange yellow. The intensity of the colour depends on the ratio of each ingredient added to the blend.
Our goal is to get the patient to look forward to meal time and to hopefully eat as much as possible. This is where presentation skills play a part. Very sick patients usually can’t eat very much. Using small jars e.g. recycled chicken essence jars and baby food jars, to store and serve bite-sized food portions is functional and very pretty to look at at the same time.
While Singapore’s government restructured hospitals may have to put in more effort to serve up dishes that excite and tempt the patients’ palate, private hospitals are already whipping up and garnishing meal servings in a more delightful manner.
Breakfast and lunch at the ward in Gleneagles Hospital
Everyone needs some motivation, coaxing and something to look forward to. Toss out all the chipped bowls and plates in your kitchen and invest in some beautiful claypots, crockery and cutlery that you can get affordably at $2-dollar shops such as Daiso, neighbourhood hardware shops or even at Ikea. You can buy a bowl at Ikea for just SGD0.90. Get hold of some colourful napkins, paper plates and party forks and spoons, and table mats. Use a different set every day, play Pretend or eat with just your hands. Colours, patterns, variety, citrus fruit and floral scents, light music and imagination can make the dining experience a treat to look forward to, as well as a memorable experience for the family.
Love is at the heart of all these efforts. So long as we remind ourselves that pleasant words are persuasive, caregivers should be gentle with not only the patient, but with themselves too. Tomorrow will glow brighter than Pumpkin and his friends when we continue to love and hope.