The Refectory Manager

The refectory . . . A place to nourish the soul. A place to share the savory comestibles, the sweet confections, the salty condiments of the things that matter. A place to ruminate the cud of politics. A place to rant on the railings of religion. A place to arrange the flowers of sanguine beauty. A place to pause in the repose of shelter. Welcome, my friend. The Refectory Manager

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Location: College Place, Washington, United States

Sunday, January 27, 2008

To Begin Again

The first time I met him, it was painfully obvious that he was an exacerbated, frustrated, irritated man.

“I haven’t had a thing to eat or even a drink of water in thirty days!”

His medical chart would confirm that, and a casual observer might even believe him.

After introducing myself as a dietitian and the reason for my visit to see him as being a part of the protocol for TPN (total parenteral nutrition) patients, he continued on with a diatribe of frustrations of his precarious situation. For this 46 y.o. man of Middle-Eastern descent was indeed in a personal crisis of acute pancreatitis.

The TPN protocol required that I again see him in three days. To continually reassess that his nutritional needs were being met by the three-in-one solution of crystalline amino acids, dextrose, intravenous fat emulsion and a mix of trace minerals and vitamins currently being infused at 120 ml/hour directly into his subclavian vein. This, with other IV fluids made up his “eating and drinking” for the last 30 days. To continually reassess how he was “tolerating” this, to monitor his lab values, his weight status, and yes, even his love-hate relationship with that hanging bag of milky white stuff tethered to his neck.

He was one of many patients that I saw that day. And everyone of those patients had something unique and memorable about them. Each, with a unique crisis laden basket of burdens. Some of those burdens were truly intractable.

For this is a referral medical center, and the patient acuity level is pretty high.

And I couldn’t help, selfishly, think of the burdens in my heart. And the burdens in the hearts of others in a forum of which I belong. And not only in the hearts, but in the wallets and purses, in the lives, in the physical existence, in the relationships, in the employment, in the spiritual journeys. Life is but the bearing of burdens. Sharing the burdens is but life.

In three days, I saw him again. This time, he was quiet, subdued. Even had the slightest hint of a smile on his face. Perhaps it was because he was now moved to the window position in that hospital room. A room with a view. Perhaps.

And he remembered me.

This time he complained about the taste of milk in his mouth. He was staring at that bag of TPN fluid, the color of chalky thin skim milk. Mind over matter or something. But he had the taste of milk in his mouth. I reassured him that absolutely positively there was no milk in that solution. And further-more, it was nowhere near his taste buds. It was going straight in to the vein . . . by-passing the gut altogether. That is why it is called “parenteral” nutrition. He smiled and conceded that I was right.

And then he started to talk about his business.

“What kind of business are you in?” I asked.

“I used to own a restaurant. A little restaurant.” As he looked wistfully toward the ceiling.

A point of commonality. We were both in the food service industry in some way.

“But in that last hurricane that hit here, I lost it and my two houses. Gone. Nothing. Wiped out. Totally wiped out!”

What am I to say? How can I say it, whatever it is that will fumble its way out of my mouth.

The scenario is racing through my mind. This man, a business entrepreneur, with his whole life and livelihood wrapped up in a little ethnic restaurant somewhere on the east coast of southern Florida, intensely struggling to fulfill his American dream . . . and boom! Wiped out! And now lying in a hospital bed with acute pancreatitis.

He pointed to his belly. “I know the stress did this to me.” His voice was pregnant with resignation. “It had too.”


I have thought of him a lot in the last few days.

And then two nights ago, I could not believe my e-mail inbox. A message with the title “I am here.”

A signal from the man who loves me. Like a faint transmission from a far-flung space explorer. A transmission made it through!

And that signal was locked on-to. And it was like a resurrection. A story of unbelievable circumstances. The realization that I was the first one he made contact with when he finally could, once again, make contact. And something connected like a conjunction. The story of “I am here.” The story of a wiped out business man.



As I got ready to leave the bedside of that critically ill, devastated restaurateur, he smiled at me, shrugged, and resolutely, forcibly, positively, told me of his intentions.

And I shared those intentions with the “I am here” in my life.

And I share those intentions with the others that know devastation only too well.

“We’ll just start over and do it all again!”


The Refectory Manager

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