Food can serve as a connecting bridge, reducing isolation and creating cherished memories and moments.
Walking through the palliative care ward of St. Andrew’s Community Hospital (SACH) on 16 July 2024, many could smell the distinctive aroma of Hokkien prawn mee wafting from the therapy gym area.
Curious staff and visitors who popped by were pleasantly surprised at the sight of a mini kitchen set up in the gym area. They were even more surprised to see a patient standing and actively leading the cooking session, giving instructions to the ward occupational therapist, pastoral care staff and therapy assistant like a restaurant chef.
The ‘chef’ was none other than 61-year-old Mr KS Goh, who had been admitted to SACH inpatient hospice since 4 June 2024. Mr Goh had been diagnosed with a relapse of Stage 4 left pyriform fossa squamous cell carcinoma in 2023 and underwent radiotherapy and chemotherapy. As the tumour was encasing his left carotid artery, Mr Goh’s tumour could not be completely removed with surgery. He was later referred to SACH for palliative care.
Prior to his diagnosis, Mr Goh had been working as a chef in the zi char trade (translated as “cook-fry” in the Hokkien dialect) at various coffeeshops for most of his adulthood. His debilitating illness and treatment resulted in bilateral vocal cord palsy and laryngeal oedema, which meant Mr Goh had both a tracheostomy and nasogastric tube inserted to augment his breathing and feeding needs.
As someone whose identity was built on food, dysphagia and altered taste were especially painful. The problem was exacerbated when he continually changed his mind about the meals served in the hospital due to textual sensitivity and what he described as a “flip-flopping” nature.
The abrupt changes to his life dealt him a big blow as he felt that he was too young to leave this world. During his stay, Mr Goh was reported to be in existential distress, manifesting as angry outbursts and frequent pacing along the ward corridors. Furthermore, he expressed extreme anxiety and fear of being alone. As a former chef, Mr Goh found the encroaching nature of his illness gradually replaced by that of a “sick patient”. His interest in food he previously enjoyed faded, and he was often listless with the hospital food offered.
To create a sense of normalcy, an occupational therapist sat down with Mr Goh to engage him in cooking as his legacy work. During his admission, Mr Goh cooked several popular dishes such as fried carrot cake, omelettes and char kway teow. Notably, his signature dish was Hokkien prawn mee — his pride and joy — which he successfully cooked while standing for two hours! His greatest joy was to see others enjoying his food.
Furthermore, a speech therapist worked with Mr Goh and his next of kin, Joanne, to create opportunities for him to increase his access to tastier foods beyond the four walls of the hospital. For example, Mr Goh perused McDonald’s menu with the speech therapist to choose foods he might enjoy while participating in a ward breakfast. Despite his physiological limitations, Mr Goh was very excited and was able to exert autonomy by self-modifying his hash brown.
On another occasion, the speech therapist and pastoral care staff went on a community outing with Mr Goh and Joanne. He played an active role in preparing his thickened fluids in a thermos flask for the event. Mr Goh also spent time with staff walking through the coffeeshop and supermarket to discuss the food he wanted to try or buy and brainstorming together if they were modifiable. Food was used in a variety of ways as a connector to maintain enablement and promote self-management for him, in accordance with the tenets of palliative rehabilitative care (Tiberini, Turner & Talbot- Rice, 2019).
Throughout his stay, the team sought to connect with Mr Goh by actively enlisting sources of resilience to aid him in reshaping his mindset towards suffering, rewriting his future, and translating his decisions into tangible action plans (Hayes et al., 2006). The goal was to help Mr Goh live in accordance with his core values, moving him from a posture of distress and helplessness to one of hope (Griffith, 2018).
Mr Goh spent the last few months of his life in the palliative care ward of SACH. Food served as a multi-modal catalyst for the team to think in an interdisciplinary manner in order to foster meaningful moments and memories for Mr Goh and Joanne. The activities Mr Goh participated in were not simply to pass time but a way for him to live fully. Before his death, Mr Goh expressed that these interactions provided him with emotional support, reduced his sense of isolation, and delivered a sense of joy and accomplishment in the face of impending death.