Hospice and Reflexive Eating

We talked about “reflexive eating” in a hospice meeting.

It’s when nourishment is automatically eaten.

I immediately thought about my next meal.

It’s when opening the mouth for food or liquid is more from habit than need.

I eat too much.

If food is placed before me, I might take a bite or ten without even being hungry. Could I be a reflexive eater? Could I blame this problem on Mom? As a kid, we not only had three nice meals a day, but after school there was usually a plate of cookies. It was such a Leave It To Beaver stereotype, with me home from a grueling day in fourth grade. There, ready for me, were a cool glass of milk accompanied by freshly baked chocolate chip cookies (with walnuts, of course).

There’s more.

What about declining dessert after dinner, but scheming for—while later watching Bonanza or The Twilight Zone on ye olde TV—a bowl of ice cream? One scoop? Two?

What about my lifelong chips and salsa relationship?

I could continue confessing bad food habits, and I suspect I’m not alone in the struggle to say “No” to a second helping or late-night refrigerator gazing and grazing.

Reflexive eating is one of the serious concerns faced by hospice staff as they work with patients . . . and even more with the patient’s families. As someone nears death, she or he will often eat less. Or, they’ll have no interest in food whatsoever.

But equally often, kind friends and concerned family members continue attempting to feed their loved one. Sometimes, it seems to work. Like me with ice cream on the couch while watching Pa Cartwright teach Little Joe a life lesson, a patient may reflexively take whatever is placed before them. In a way, they are going through “old motions,” with a hand gripping a fork and aiming for the scrambled eggs or a mouth opening wide whenever a spoonful of soup is offered.

Some hospice patients habitually open their mouths, their muscles repeating the lifelong mealtime actions. But they don’t gain good weight, and often continue to diminish in size and energy. As hospice nurses observe this behavior, they’ll know food is no longer helping the patient. I’ve overheard nurses talk about it at patient care meetings.

The hospice medical director might ask, “Is Mr. Garcia eating?”

The nurse, who saw Mr. Garcia the day before, will pause, and then respond, “A little, but it’s only reflexive . . .”

The doctor sighs. The nurse nods sadly and continues her report.

Families struggle when reflexive eating, or the absence of eating, occurs. Adult children argue over feeding a dying parent. Giving or not giving chicken noodle soup becomes a battleground, a test of wills, or a resurgence of lingering grudges.

We believe if we feed someone, they’ll get better. We believe if we feed someone, it pleases the one who eats. We believe if we feed someone, the one serving the food is doing a good job caring for a parent or friend.

I recall waking from surgeries (including several procedures on my knees), wanting to “prove” I’m ready to leave the hospital. How? By drinking and eating! If I can sip and nibble—without upsetting my recovering body—it’s all good news! And though I’m always confused about the edict to “feed a cold and starve a fever” (or is it the other way around), I’m confident we’ll always want ourselves and others to get better . . . and therefore we offer food.

Quick, give me a bowl of soup and I’ll feel better!

Here, have a bite of buttered toast and you’ll feel better!

But there may come a time when a patient will only reflexively eat. And there are those times when spouses or siblings or children will feed their loved one because they so desperately want them to get better. The soda cracker and broth and next spoonful become a plea not to die.

It is extraordinary difficult to realize it’s no longer time to serve a meal, but instead to serve your loved one with the “nourishment” of compassion and to, sometimes, give permission to die.

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