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

Friday, August 29, 2008

Taco Bell, Bugs, and a Graceful Diagnosis

Taco Bell. Not the Mexican phone company. The other one. That one with Nachos Grande, Taco Supreme, Soft Tacos, Lemonade, little packets of mild sauce, black plastic spoonorks wrapped in shriveled-up plastic. Yes, that one. Where I challenge my arteries on a weekly basis.

My vantage point was such that I didn’t pay particular attention to the elderly gentlemen who selected and occupied a table in my direct line of sight. In fact, I paid no attention to him at all. Until, that is, until something caught my eye with a motion I was totally not expecting.

For it was the bowing of his head that triggered something within me. An old head. An old white-haired head. A balding and thinning white-haired head. And when he bowed his head, his lips moved. The movement of grace and gratitude for that of which he was about to partake.

In a few moments, the whispering stopped. He hesitated a moment. Raised his head. Reached for several packets of the “pink stuff”, shook them to get the powder sweetener to settle to the bottom, ripped the tops off and poured the stuff into his extra large cup. Must have been iced tea. Nothing else in the fountain would need that kind of sweetening.

His clothing was rough. A chocolaty brown pair of trousers and shirt. Black half-wellington boots of some kind. Garish yellow logos over his left breast pocket and on his back. A rip in the seam in the side of his shirt. A really beat-up leather phone case saddling his belt.

And I watched him. Eat. The motions. The rituals. The arranging of things on the tray.

Three wrapped up tacos of some kind. Each in their little paper envelope. He would carefully unwrap one. Pick up two little packets of sauce. Snap them and flick them with his index finger to get the contents to settle. Stick the tops of the foil packets in his teeth and tear them open. Spit out the foil fragment. Had to have his natural teeth. Gold Bond Denture Cream isn’t that good.

As parts and pieces of the lettuce and tomatoes and cheese would fall out the side and land in the paper envelope, he would lick his fingers, stab the wayward ingredients, and nearly lick the paper clean.

I watched him bite. Ingest. Chew. And chew. And chew. Smack his lips. Lick his fingers. Clean out the paper envelope.

For one of the packages, he opened a salt packet, and dumped the whole thing over the food item. If he was hypertensive, he was not in compliance.

I simply had to know what those logos said. This guy, looking the part of being in his upper seventies and all. Who and what was he doing?

So I made a point of dumping the refuse of my artery attack in a waste bin on the opposite side of the eating area. And then made the non-obvious look of looking to ascertain his identity.

His name was “Jerrell.” Sewn in that garish greeny-yellow over his right breast pocket. And the logo. “County Pest Control.”

When I got out to the parking lot, the vehicle next to mine, a white pick up truck with several bins in the back, was labeled “County Pest Control.” On the back was the marketing slogan “Somthin’ buggin’ ya?’ . . . call 800 – xxx - xxxx .”

When that unexpected motion jarred my routine, I had no idea there would be something bugging me.

It has been years now, many years, since I bowed my head to say grace.

It is not that I am not grateful for the bounty of the earth of which I partake. Not at all. For I truly am.

It is not the pro forma ritual of praying like the hypocrite in the temple, the in-your-face holiness of one’s visible works.

It is not that I deny the source of my physical strength. For I understand the chemistry of the assimilation, the ingestion, the digestion, the absorption, the transport, the metabolism, the elimination of the essential components of life.

It is not that I deny that a God, any God, all gods, have had a direct hand in preparing my victuals. It was not even my resentment of the Archer Daniel Midlands, the Tysons, the Monsantos, the Iowa Beef Packers of the multi-national agriculture conglomerates that have bastardized my food supply.

It is not my obstinate insistence that it was me, my work, that provided the money to procure that chain of mystic chemistry.

But it was the memories of childhood.

Frightened at church school, that when it came my turn to say “Grace,” or as my working class family called it, “The Blessing,” before the noon meal, I would not know what to say. My silly little “Dear Jesus, thank you for this food. Amen” seemed so childish and trite. And as a trite child, I knew that.

And then learning from a PK (preacher’s kid) a more sophisticated rendition, of which all of us kids quickly adopted: “God is great, God is good, let us thank Him for our food. Amen.”

With the rite of passage to high school, it became “For the bounties of the harvest, Oh Lord, and for this food of which we are about to partake to nourish our bodies and souls, we are truly thankful. Amen.”


And listening to my WASP father joke about how the Catholics did it in Latin: “Grace be here, and grace be there, and grace be all over the table. Pick up your knife and fork and eat all you’re able. Amen.”

And then those family gatherings, were the senior male present would pontificate over the food, both trying to and yet trying not to, to sound too ridiculously theological. For it was some kind of badge of honor for a lay person to really lay out a theological smorgasbord of morsels of thanksgiving. After the blessing, some crazy uncle from the closet would snicker in a near inaudible way that if the prayer had gone any longer, the food would be stone cold.

And then teaching food science in a Seventh-day Adventist college, getting to the section on food safety, telling them about HACCP (Hazard Analysis Critical Control Points, discrete steps that are accomplished to kill pathogens in food, such as heating a product to 165 degrees F for 15 seconds; the principle of keeping it cold, keeping it hot, or not keeping it long), pointing out the food safety minefield of a church potluck dinner. And my only advice was for the group to find the member at the potluck with the best connection to God, and to have that person plead for the safety of the food on everyone’s behalf.

I vividly recall a 50’s family in our church with a son and daughter of similar ages to myself and my younger sister. Those kid’s father was a suit of some kind, not a working stiff like my father. But they invited us over to their home for dinner one time after church. What a thrill for me. For that kind of experience was a rare experience indeed. Just to see how another might live. And how that boy taught me the game “Battleship,” with the goal of sinking subs and destroyers and cruisers.

But it was what happened after the dinner that stuck with me.

For certain, there was the obligatory grace at the beginning of the meal.

But at the end, when the children asked for permission to be excused from the table, they robotically moved to the side of their father and personally thanked him for the food that they had eaten.

Later, my father had made some reference to it being sort of Nazi-like. I knew not of what he meant . . .

An unexpected motion in a Taco Bell.

That ritual of that elderly gentlemen kind of ripping me apart. Bugging me into thinking of things I have not thought of in one long, long time.

The saying, or the not saying, of grace.

Be it in public or private.

It hit me that it is truly a sentinel marker on one’s spiritual journey.

Ya. It does bug me. Because I honestly don’t know of just what it is, that it is diagnostic of.

The Refectory Manager

Tuesday, August 19, 2008

"‘Cause you're sugar and you’d melt?”

‘Twas the close of the workday. I was dragging my carcass down the long hall leading to the elevator and to the exit of the hospital. A lady in scrubs was ahead of me. She stopped at the elevator, then turned to look back up the hallway to me and shouted, “Are you going down?”

I replied, “Yes, but don’t wait for me.”

But she did wait. She held the elevator door until my speeded-up shuffle got me there.

She leaned back against the side wall, head tilted back. That sort of exhausted look.

Elevators are those awkward confinement facilities where you try your damndest to not notice or to be noticed. That purposeful avoidance.

But I did take a quick little peak. Kind of a butch haircut. A fresh coat of bright red lipstick. Noticeable rouge.

In a manner of small talk, I did ask if she knew if it was still raining outside. Seemed a non-invasive way of acknowledging her presence, and kind of a round-about-way to let her know I appreciated her kindness in holding the elevator for me . . . without blurting out the obvious.

“I don’t care if it is. I just want to get home.” A look of exhausted resignation.

I kind of chuckled in accepting her answer. “But I don’t want to get wet!”

She then looked at me. It was a look of demurred devilment.

“Is that ‘cause you're sugar and you’d melt?”

I felt my face turn sugar-beet red and my tongue twisted into a contorted knot. I was trying to stammer out just about anything.

“That’s awful to make an old man blush!”

And she laughed and she laughed and she laughed.

The Refectory Manager

Sunday, August 03, 2008

Four Doors Apart

As I knocked and walked in to his darkened hospital room, it took a moment to make out the curled up form of a man lying in that hospital bed. The blanket was taut around him, pulled up to even cover his face.

As he sensed my presence, he pulled the blanket down. I introduced myself, and verified his identity, and broke the ice like I typically do by asking how he, his appetite and his food were all getting along.

I knew some of his history from reading his chart. I had read the results of the last panel of laboratory values. I knew what medications he was being given.

But the lab value of particular interest was the HGB1Ac. A blood test that indicates the general level of control of diabetes over the last three months. In his chart, it was flagged as “greater than 14” which means it was off the chart. A number of 6 or below is desirable. The higher the number, the higher the blood sugars have been in a chronic state.

The principle of the test works the same way that a baker or cook in the kitchen makes a fine, golden crust on a baked cake or hash browned potatoes. It is the chemical reaction between sugar (glucose) and protein. A non-reversible reaction that permanently changes the protein (specifically an amino acid making up the protein). In the kitchen we call it the “browning reaction.” Makes that desirable caramelized look on the surface of starchy foods. The chemists call it the Maillard Reaction. What drives it in the kitchen is heat. What drives it in the body is concentration. And that high blood sugar concentration forces the reaction between the sugar and the amino acids in proteins to change, become damaged, become non-functional. It happens in the micro-arteries of the eye, the kidney, the extremities, the heart . . . the precursors to the horrible complications of diabetes. Red blood cells last about 90 days. That high sugar concentration attaches to a specific marker in red blood cells, hence the hemoglobin A1C test is an indicator of diabetes management over the last 90 days.

The patient was in his early 40’s.

The H&P (history and physical) provided a brief synopsis of his disease process.

Horrible.

And a litany of his total non-compliance with medication or life-style issues surrounding his condition. And yes, a history of alcohol abuse.

The man was frightened. He had been admitted through the emergency room with blood sugars in the 800 range. He had been in metabolic acidosis. He was sick. Very sick.

I asked him about his diet history. It didn’t surprise me at all. One meal a day. Fast food. High fat, high sodium, low fiber. Cheap, quick, and easy. The constant drinking of sugared, caffeinated beverages. For just a few pennies more, you can really up-size. A chain smoker. A job, when he did work, that was sedentary.

We talked some more about what he knew about diabetes management. Virtually nothing. He had never been instructed on how to check his blood sugars. For some reason, he had been on oral hypoglycemic agents only and not insulin . . . and hadn’t taken that. He had no functional knowledge whatsoever about nutrition, the role of carbohydrate, the difference between complex and simple carbohydrates with respect to their effect on blood sugars. Food was anything he could get going through the drive-thru and consume before he hit the center lane of traffic again.

But now he was frightened. And quite willing to listen. And his education would take several sessions. He was worried about how he was going to get education with no insurance. And the other little complications that a for-profit-insurance-based-health-care system forces on all we citizens.

I did my best to reassure him that we would work with him while he was still in the hospital. And I alerted the Certified Diabetes Educator on the hospital staff of his plight.

We talked some more about how diabetes can be managed. Lots and lots of people do it. From little kids to grandparents. That it is something that he could learn and do . . . if he wanted to.

Still frightened when I left, but with a degree of hope.

Four doors down the hall.

I knocked on the door, and received a rousing “Come in.”

And sitting in the chair, ready to leave as soon as his ride showed up, was a youthful-looking man that I knew from his chart was well into his 80’s.

His new pacemaker had been installed, and he was a tickin’ and ready to go.

His diet order had been “Cardiac Diet” and so I wanted to briefly assess his knowledge of just what that meant.

And wow! Did I get a lecture on his prudent cardiac diet eating practices! This guy was a poster boy for the American Heart Association!

And it showed.

With that pacemaker, he would out-live me!

We talked of the hiking trail in Longview, TX that I had just discovered. He was down to walking it now, ‘cause he was afraid he might fall on his bike.

But his walking, his snacking on almonds, his near vegetarian diet, his avoidance of processed foods with a passion, his drinking of only water . . . he was a living, breathing practitioner of wellness.

And I had to tell him my story of how to go shopping. Of how the big grocery stores are laid out. Of how to tackle that corpulent pit of compulsion. When you enter, stick to the outside walls. That is where you will find the least processed foods. Closer to the way that Mother Nature made them. Start in the bakery with the whole grain bread. Not just that “wheat bread,” but the real stuff. That multigrain European-like artisan bread. Then move into the dairy section for the low fat/fat free stuff. And if you dare, try soy milk. Look for the cholesterol-free egg substitute products. If you must have eggs, look for those eggs from chickens feed omega-3 fatty acids. Then in the meat section . . . small amounts. Use meat as a condiment. Pick the low fat. The skinless. Fresh. Not processed. Then head for the produce section. Go crazy there. Pick something of every color you see. And then. Take one little side trip down the aisle where they sell the brown rice, whole grain pasta and the peas, beans, lentils and that good stuff. You can pick up some canned tomato sauces if you like.

Then get the heck out of there!!

The rest of the store will just do ya’ in.

He laughed and laughed!

And that new ticker was doin’ its thing.

And I did something I shouldn’t have done, for I knew it would bring sadness to his face.

I mentioned a little bit about four doors down.

The Refectory Manager