Lorraine ate today and it was a moment worthy of celebration. Two months ago she was in surgery having a dead segment of colon removed. Now, after ventilators, dialysis, multiple trips back and forth to the OR she is able to eat. And it’s not just tolerating tube feedings or a few liquids. Steak and a baked potato; well, really chicken, green beans and mashed potatoes, but still a major hurdle overcome on the long road to recovery.
A thousand miles away my mother was able to eat with a fork for the first time in more than a year since she suffered serious head trauma and it was a reason to rejoice.
Everyday, three or four times, more or less, we sit down or belly up or stroll through the park, consuming the food that keeps us going. We take it for granted, this ability to eat, but for the very sick and badly injured, eating a normal diet, consumed in the normal way, is often the final step of a long journey.
When a body becomes very sick and its defense mechanisms are turned on to the max, the intestines, at that moment a non-essential organ, are shut off; the body utilizes all its reserves to stay alive. Keep the heart pumping, send blood to the brain, but, those bowels, they’ll be OK, at least for a short while. A failing heart, severe infection, or a bleeding body will usually have an associated paralytic ileus, a fancy word that means the bowels have been turned off, at least for now. That explains why people suffering heart attacks have nausea, or the badly injured, even if there are only broken bones, may vomit. This phenomenon may be transit, lasting only a few moments or may persist for weeks.
During such times, normal eating becomes impossible, food languishes in the stomach until it is rejected by an act of vomiting; nutrition must be supplied by alternative routes. If there is no external source, the body starts to consume itself. Glycogen stored in the liver is consumed, fat stores are depleted and muscle is metabolized, our reserves are mobilized to keep vital organs functioning. Modern medicine, however, provides alternatives to such consumption. The individual that cannot eat can be fed intravenously, receiving thousands of calories, fluids and complete nutrition via Total Parenteral Nutrition (TPN). If the GI tract is functional, but the patient is unable to eat, enteral feedings can be provided via tubes that pass through the nose into the stomach or directly through the abdominal wall into the stomach or small intestine, a bit more natural and physiologic than TPN but still a far cry from normal eating.
Normal eating. We take it for granted; I’m hungry, what’s in the fridge or pantry or down the street at Millie’s Diner. It seems our lives are built around the act of eating. We plan our meals for the day or week. Almost every new relationship starts with a shared meal or drink, “let’s do lunch” or “I’ll meet you for dinner”. In the OR, the director spends most of his or her time ensuring that the staff has “lunch” even if it’s 9:00 am or 4:00 pm.
Eating in all its shapes and forms is essential to our being, just as breathing and sleeping are important to an individual’s survival and sex is important to the survival of the species. I have to say that we spend far more time on food and eating than we do on sex, perhaps a reflection of the relative importance of each endeavor.
The mechanics of eating; the consumption and digestion of food and drink certainly cannot be considered attractive, despite attempts to make such activities appear more refined. Our food is placed before us, on plates, in bowls, poured into glasses and mugs, ready for intake. We take up a knife and fork, or spoon; we raise a glass to our lips and receive our fare into our mouth.
The steak is chewed, the pasta slurped, the beans crushed and then it is all washed down with a fine red wine. Each bite is savored by thousands of sensory receptors in our tongue, combined with our olfactory cells to convey taste to our brain; the tongue also provides the sense of texture and temperature providing the complete package of gustatory splendor; the pleasure of eating.
Each organ that participates in this orgy of sensation plays a vital role. Starting with the eyes and the nose we look for a pleasing appearance and aroma; both prepare the consumer for the pleasures of the repast that is forthcoming. Our lips, incredibly sensitive organs that are essential to eating and for demonstrating affection receive the first sensation of temperature and texture as the food passes into the mouth where the tongue mingles the sensations it receives with the aroma already received to convey the complete sense of taste to our brain. Powerful jaws and teeth tear and crush, mix and masticate, turning the once palatable dinner into a paste of appropriate consistency to be propelled to the oropharynx. Parotid, submandibular and numerous minor glands add saliva to soften and dilute the conglomeration, easing its passage from the oropharynx to the hypopharynx and finally propelled, by the coordinated action of several pharyngeal muscles, into the esophagus where the ingested mass begins its long journey through our body.
The stomach churns and mixes and further dilutes before delivering our once irresistible meal to the intestines for more complete digestion, leading to eventual absorption or expulsion. Our meal of steak, pasta, beans and wine is transformed into fat on our hips, muscle on our arms, sugar in our liver, along with a number of other essential elements for our body, or passes out of our body where it returns to the earth and may eventually be consumed again and the journey repeated
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Such a complex process, repeated over and over and over. It’s amazing that we never tire of eating, although we often seek variety: Italian, or Greek, or French, but even if we’re stuffed to the gills we manage to find room for that seven layer chocolate cake. Eating may be our greatest pleasure; the act frequently performed in the public eye; shared with any and all.
Therefore, it’s time to stand and applaud Lorraine’s return from death’s door to the realm of the healthy and whole. Every ingredient that is necessary for a body to eat and digest has resumed proper function and soon she will be home with family and friends, enjoying a dinner at home or out. Although at this moment she may not appreciate it, the ability to eat is a great gift; one that should be cherished.
