Making the last moments of life count can be tough call

Nutrition in end-of-life care has undergone a metamorphosis over the past two decades. Previously, due to the tremendous weight loss experienced in these patients, focus was on providing a high-caloric diet. There was no emphasis on the wholesomeness of the calorie source.


Photo credit: Fotosearch

What you need to know:

  • Nutrition in end-of-life care has definitely undergone a metamorphosis over the past two decades
  • With research, the recommendations now focus on a well-balanced diet
  • The patient should eat wholesome foods, properly prepared to preserve their nutritive value and in the right quantities

As a curious medical student, I met a lively 108-year-old woman, who taught me valuable lessons on life. She had enjoyed her century on earth and was ready to exit the world with a curtsey.

Hattie* had smoked her whole life. She grew up on a tobacco plantation in North Carolina.

I was on attachment at the hospital where I met Hattie. Here, smokers got a nicotine patch stuck on them to alleviate nicotine withdrawal while in the wards.

She showed up in the ward with a nicotine patch and was hooked onto an oxygen tank. She had stage four lung cancer and knew she did not have long to live. She was not afraid of death. She had declined all attempts to treat the cancer and was on palliative care.

Hattie was with us for 10 days before going back to the nursing home. Every morning I found her at the smoking corner as I entered the hospital. She would be in her wheelchair, oxygen tank strapped onto the back, with her nasal prongs firmly in place; blowing rings of smoke into the air.

The first time I found her indulging, my eyes popped out as she laughed. She looked me in the eye and asked: “How much more damage can the smoke cause?” The question hit home and I always ask myself this one question before I rattle off a list of ‘Dos’ and ‘Don’ts’ to a patient whose time with us is already gravely limited.

Fast forward to two decades later when I witnessed a family friend battle pancreatic cancer. By the time the diagnosis was made, Solomon* was already in stage four of the disease and we only had four months with him. They were the most difficult four months I had to witness and it broke my heart.

Fight cancer

His dedicated wife, Rosanne* was not ready to lose him, even after he had long resigned to his fate. She sought a second, third and fourth opinion from various specialists locally and the response was always the same. She needed to accept the diagnosis and focus on making him comfortable.

In a moment of desperation, Rosanne met a woman who introduced her to naturopathic medicines. Solomon was put on a regimen of herbal teas, nutrition supplements and a dietary overhaul. He was on a full vegan diet, eliminating all meats and other animal products from his menu. All wheat products were also curtailed.

He drank plenty of raw blended vegetables. His solid foods comprised sweet potatoes, arrowroots, cassava and legumes. He drank six glasses of fresh fruit juice daily, flavoured with garlic, turmeric and ginger. It would have been offensive to advise Rosanne otherwise. She clung onto the belief that the diet helped fight the cancer.

The experience reminded me of Hattie and the contrast was not lost on me. She had made peace with her impending departure and made the best out of the time she had. I was not sure Solomon would have made the same choices for himself, evidenced by the grimacing with every sip.

Nutrition in end-of-life care has definitely undergone a metamorphosis over the past two decades. Previously, due to the tremendous weight loss experienced in these patients, focus was on providing a high-caloric diet. There was no emphasis on the wholesomeness of the calorie source.

With research, the recommendations now focus on a well-balanced diet, incorporating healthy food options while cutting down on refined sugars and processed meats. The patient should eat wholesome foods, properly prepared to preserve their nutritive value and in the right quantities to meet the caloric demands of the body, including the extra requirements imposed by the disease.

Herbal medicine

Care must be taken to meet the micronutrient requirements by use of nutrition supplements without overdosing the body. Healthy foods such as garlic, ginger, ginseng and turmeric are great for cancer patient, but excessive use will compromise the blood clotting system and may interact negatively with prescription medication, resulting in complications.

Several herbal medicines have been studied and have demonstrated value in slowing down the cancer. These may be safely used with full disclosure to the doctor so as to avoid adverse effects.

As caregivers of these extremely vulnerable patients, we must put aside our desperation and put the patient first. If you do not enjoy the food you have made for the patient, why would they?

If I had three months to live, I would choose my favourite smoothie any day over raw leaves, as I toast to Hattie.