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What We Feed Our PatientsThe Journey, the Struggle, the Culture and How One Unrelenting Chef is Changing The Way Patients in Hospitals Are Fed
By Jim McGrody
iUniverse, Inc.Copyright © 2011 Jim McGrody
All right reserved.
Chapter OneWashington, DC, 2002
If you take out the killings, Washington actually has a very, very low crime rate. —Marion Barry, Mayor of Washington, DC
I had never worked in a hospital before; in fact, I never in a million years would have thought that I ever would work in a hospital. Health care was a new environment for me, and I had no idea what to expect. Culinarily, it was so different from what I had trained for my whole life. I wanted to be around good food and people who understood and cared about what they were doing. I was not so sure that was going to happen in health care.
My first job in this new world was in Washington, DC. The hospital I worked at was one of the largest in the city. It had over nine hundred beds and was a teaching hospital full of many challenges. This hospital is part of a huge medical complex in the northeast part of the city. Flanked by three other major medical centers, it is a busy place with hundreds of people coming and going all day long. I had arrived just days before from the sleepy town of Auburn, Alabama. Working in the heart of DC was a huge adjustment for me. Even parking was a formidable task.
My job title was associate director of food and nutrition. My responsibilities involved all of the retail operations in the hospital. This included three cafés, which fed doctors, patients, visitors, and employees. We fed thousands of people every week.
For the previous few years, I had worked at large universities in Arizona and Alabama. I was familiar with large numbers of customers. Nothing was new to me—other than the fact it was a hospital. Serving clinicians, patients, and doctors was far different from serving twenty-year-old college students. However, the change was good. I arrived ready to take on the world and to cook and serve good food. Wherever my travels lead me, my belief is the same; my goal is the same: serve the best food possible.
I began my career in health care with a fast start. I had to learn the differences between doctors: who were attending doctors; who were residents? Who were the nurses? What is a charge nurse? What does a registered dietitian do? How do you discern the difference between a nurse and anyone else working amidst the major complexities that make up an acute-care, level-one trauma center? What does level one mean? Where is MRI? What is MRI? It was all alien to me.
The last time I had been in a hospital was probably at birth. This new world was overwhelming at times. Luckily, I could draw comfort from my wife—she is a nurse, and she helped me to understand what everything meant and any other questions I had. She used to laugh at me, especially when I would pronounce something wrong.
There was also the long list of acronyms I had to learn: JCAHO (Joint Commission on the Accreditation of Health Care Organizations), these are the people who survey hospitals to ensure patient safety is being upheld; NPO (Latin for nothing by mouth), this pertains to very sick patients or those who have upcoming tests and cannot eat or drink; RDLD (registered dietitian/licensed dietitian); and then all the codes, some of which were matters of life and death: Code Red, Code Blue, Code Walker, Code Silver, Code Grey. What did it all mean? It was so new. Who could keep track of all this? And what was it with all those announcements over the loud speakers?
My previous job at Auburn University in Alabama was a far cry from DC. Auburn is a small college town with very little crime. I lived two miles from work. Now I had to do what millions of Americans do everyday, and that was to commute to work. That first week, I was alone and far from my family, and I was beginning without a clue as to who made up my management team. I had not met with the staff, and other than during the interview, I had never been in this hospital. I was temporarily living in a hotel that I thought was an okay place to stay. Little did I know that it was in the worst part of the city.
The hotel was located at the edge of Washington, DC, right off New York Avenue, close to the Maryland line. I stayed there two nights with the door locked shut. I heard gunshots my first night and thought to myself, What in the world am I doing here? Was this really a good decision? I had moved around a lot in my life, but I was unsure of this particular move. Looking back now after years of working in DC and getting to know the city, I cannot believe I ever stayed there. That hotel is now boarded up and no longer in business.
In the first conversation I had with my boss, I asked her, "Where can I stay while I look for a home?" I told her where I was staying, and her words still ring clear in my head, "Oh my, we need to get you out of there." I ended up moving to another hotel in College Park, Maryland, next to the University of Maryland, and things got better very quickly
When I first met my staff, they were very leery of me. Apparently, they had seen many managers come and go. They thought for sure that I was just another one coming through with the sole mission of making their day harder. They knew that they had been there long before I got there, and would be there long after I left. Sadly, for the most part, that was a true statement.
The hospital was a union account, which was also new to me, but I soon learned the workings of management in a union environment. It was actually easy to manage, as the collective bargaining agreement lays out all of the rules.
Immediately, I could see the food that was being served in our cafés was in desperate need of attention. I was working for a large contract management company that touted excellent food, but the food was not excellent. It was poorly prepared, poorly presented, and not up to my standards. My goal was to change the quality, service, and presentation of the food, and change it quickly.
The Beginning of the Revolution
If you walk past something you know is wrong and you keep walking, you have just lowered your standards. Never lower your standards. —Ed Steiner, my first boss in contract management, who said this to me over nineteen years ago. Words I try to live by everyday.
It was my fourth day on the job, and I was working in the dining area. We had a busy lunch crowd, and the place was packed. I noticed an elderly woman standing by herself. She looked distraught. She was holding a piece of paper and looking around feverishly. I approached the woman and asked if everything was okay, if there was anything I could do to help.
She explained that she was trying to get in touch with our catering department. She was trying to order a meal for her and her husband, who was a patient. She told me she had called our catering office and that she had left many messages, but no one had yet called her back. I told her I would help and asked what she needed.
She explained that her husband was on a VIP patient floor called Five North West. This floor was a special section of the hospital that patients could get a bed in by paying extra. It was like an exclusive hotel within the hospital. In fact, when you went into these rooms, you almost forgot you were in a hospital. The only reminder was that the persons lying in the beds might be hooked up to medical equipment.
The woman explained they were celebrating their forty-fifth wedding anniversary and that she wanted a special meal prepared. I told her I would take care of everything. I sat down with her to plan the menu. She wanted fresh fish, (tilapia, swordfish, or salmon), and he wanted a rack of lamb. I asked her when she would like the meal served. "Tonight," she replied. I did not want to see her upset anymore; I told her not to worry. The meal would be prepared.
I walked away and said to myself, "Now where am I going to get fresh seafood and a rack of lamb?" I was sure that these food items were nowhere to be found in our walk-in refrigerators. However, I had made a promise, and I was going to keep it. I hailed a cab from the front of the hospital. I had been in Washington, DC for only a week, and I knew nothing about the city. I asked the cabbie where I could find fresh seafood and fresh-cut meats. He took me to the Maine Avenue Fish Market on the Potomac.
The Maine Avenue Fish Market is one of the oldest open-air fish markets in the country. It's an amazing place. I picked up a side of salmon, some diver scallops, and some crabmeat. The cab driver then took me to a Farmers' Market in the Foggy Bottom neighborhood. I walked the rows and rows of farmer's carts, picking out the freshest produce I could find. I ended up with some fingerling potatoes and bunches of fresh asparagus, shitake mushrooms, and a couple bulbs of the best looking fennel I had ever seen. Assuming that the hospital would not have fresh herbs, I grabbed some basil, dill, and parsley as well. I made a mental note that I would be back soon to explore more of this incredible produce.
After the farmers' market, I headed to the gourmet store Dean and Deluca on M Street and Wisconsin Avenue in Georgetown. I entered the store and was amazed at what I saw. They had an incredible grab–and-go selection of amazing salads, prepared foods, and desserts. There were aisles of beautifully prepared foods laid out in open-air refrigerators. They had an imported cheese selection that seemed to never end. I watched them slice prosciutto paper-thin to order and lay it out on fresh bagels with arugula. I wanted to do the type of food they were doing!
I was taking a mini culinary tour of DC. This was so much better than Auburn, Alabama, where the only thing you could find in a supermarket were collard greens, potatoes, green peppers, and onions! It was refreshing to see such a vast variety of foods being sold by people who knew what they were talking about and appreciated quality.
Going to this length to satisfy a patient may sound farfetched, but I do it all the time. Going to the store for patients is common. My goal is to please them, and sometimes I just do not have what they need. So I go and get it. I have gone to the store for many items: from gluten-free pasta to Odwalla juices, soy products, and organic produce. I even had a request from a pediatric patient for Skippy Peanut Butter. It was the only peanut butter he would eat. It is all about service, and I am always willing to please. If patients want a certain food and I can reasonably supply it, I do. All I wanted to do that day was help this lady. It seemed like the right thing to do.
The physician upon admission to the hospital prescribes each patient a diet. This is how the kitchen knows what to feed them. This woman's husband was on a heart-healthy cardiac diet. This anniversary dinner meal would not normally be served to him. However, I wanted to liberalize his diet for this special occasion. I went to his floor and talked to the charge nurse. This nurse was in charge of that particular floor. Together, we got permission from the physician to go outside his diet. Both the physician and the charge nurse were happy to make this exception, as it was an important milestone in his life.
I arrived back at the hospital, cooked the meal, and served it. I met the husband, who was a nice guy and very appreciative of his lamb chops, and hung out for a few hours to ensure that they had all they needed. Then I went home.
Two or three weeks went by, and I had moved on to other things. I actually had forgotten about the meal—I have done so many meals over the years that it is sometimes hard to remember what the menu was from any particular one.
I was walking from my office, and I saw the woman again. She was again looking around the room. I approached her, and when I got near, she recognized me. She ran up and gave me a big hug. She began to cry and kissed me on the cheek. She explained that her husband had died and that she was looking to thank me for what I had done. It had been their forty-fifth wedding anniversary, and I had made it special. She said the last days of her husband's life were filled with joy. He had loved the meal and had talked about it till his death. I really did not know what to say. I was saddened by the fact that he had died, but I was happy that I was able to make their last big meal together a memorable one.
Driving home that day, it hit me. I had actually made a difference in someone's life by cooking! I had cooked for many years, working in restaurants, hotels, and colleges, but I never once felt that I had actually made a difference—until this one meal. It was a meal that I had cooked many times before, but this time, it was special. I had made a difference in someone's life. What a feeling that was—and it still is.
I have been cooking for patients ever since that day and hopefully will do so for a long time. This is by far the most rewarding job I have ever had.
The Early Years
Hingham, Massachusetts, 1983 When your name is on the side of the building, you can cook the way you want to cook; until then, you will do it my way. —My first lesson on following recipes.
I started in the food business when I was in high school. I began where all aspiring cooks start—the pot sink. I worked as a dishwasher at Fiddler's Restaurant in Hingham, Massachusetts. I was sixteen years old.
Hingham is a small upper-middle class town south of Boston. It's located right on the water. I lived in a neighborhood called Crowes Point where my house looked directly across the bay toward Boston. It was a great place to grow up. We had the harbors and beaches at our disposal. Many of my friends had boats, and we would spend countless hours on the ocean. We had an amusement park right on the beach and way too many opportunities to get into trouble. All these fun things cost money, and money was something I didn't have. Given my destitute state, as soon as I was old enough to work, I found my first dishwashing job.
Fiddler's Restaurant was located right across the street from Hingham Harbor. It was a very busy place, not too expensive but trendy for the times. It was especially busy in the summer. The restaurant primarily served seafood, but we also served steaks, chicken, and pasta. It had a very busy bar scene, and the place was hopping most of the time.
As a dishwasher, I was at the lowest rung of the restaurant "food chain." We were always the brunt of jokes and assigned the worst tasks imaginable. It was rough, but I loved both the fast pace and being around the cooks. I thought these guys were amazing.
In between washing pots, I would watch them on the line pumping out three hundred dinners. I was amazed at the sauté station and the flames erupting in the pan as they deglazed with Marsala wine, at the banter between the expediter and the cooks. "Ordering! One shrimp scampi!" "Fire one osso bucco!" or "Picking up! Two Marsalas, medium-rare tenderloin, and a broiled lobster!" I wanted so badly to learn what they were doing. It was fascinating how they could keep track of all that and keep the food coming. It was like a machine.
After a year of washing dishes and constantly bugging the cooks to teach me what they knew, I finally had the nerve to ask the owner if I could move up to a cook's position. He took one look at me and said, "Kid, you are too young; you'll get hurt up there." I told him I would work for free for one week, and if he did not like what I was doing, I would go back to the pots sink. He must have been impressed that I wanted it so bad, because he gave me a chance.
The next day I went up to the line and said, "I'm ready, Chef. Can I work the sauté station?" All the cooks laughed at me and said that I had to pay my dues first. I was not ready to take on the beast. The "beast" was the twelve-burner stove that was without a doubt the most involved station in the restaurant. It was where the seasoned vets worked. They were right; I was not ready for that station.
They sent me to the prep area. They told me all "wannabe cooks" had to start here. I learned how to dice onions, peel potatoes, open Quahogs for chowder, clean squid, de-beard mussels, fillet fish, and stuff lobsters. It was not very glamorous. And I smelled like fish when I went home.
Excerpted from What We Feed Our Patients by Jim McGrody Copyright © 2011 by Jim McGrody . Excerpted by permission of iUniverse, Inc.. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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