The Hill I Die On is One of Food
By: Julia Parker, MS4
If heaven really exists, and its design is person-specific, mine would be one made of food. I would step through gates made of Red Vines and into a landscape resembling Willy Wonka’s Chocolate Factory. I would walk on candy grass, following a river made of dark chocolate through a forest filled with butterscotch bushes and truffle-filled trees. The flowers would be coated with the same sour dust that covers my gas-station go-tos and butterfly lollipops would never be out of reach. Beyond the forest, I would get a whiff of soy sauce, pulling me from a world of sweet to savory. It would lead me through a garden filled with bok choy, mushrooms, and green onions - a nod to my many attempts to spice up packaged ramen. From there, I would turn to see a playground filled with my childhood favorites. My dad’s green bean casserole would be sitting at the top of the slide, the bubbling cheese visible even from a distance. There would be homemade zucchini bread on the swings, grandma’s sugar cookies on the seesaw, and freshly grilled salmon hanging from a jungle gym resembling my backyard grill. As I continue through the clouds, I would come across dunes made of spices. They would remind me of the power of cumin, cinnamon, turmeric, and cardamom that I came to appreciate in my adult life. Throughout this theoretical heaven, I would find every cuisine known to man and hopefully a few new ones found only in the afterlife. With every meal, I would sit down to a table filled with the people I love, the people that encouraged my love of food in the first place.
In reality, I am not entering heaven’s candy gates but the hospital’s automatic doors. I make my way through the side entrance and walk down the hall, passing people in scrubs rather than the gum drops of my dreams. I sometimes get a whiff of the food being prepared in the cafe on my right, but it is never quite late enough for a second breakfast and I carry on. I continue down the hall until I arrive at the threshold between adult and pediatric hospital. I step from linoleum to carpet and make my way to our workroom. The courtyard I pass looks pretty appealing on a rare sunny day, but it certainly does not contain any of the ingredients for homemade ramen. After some time going through charts and prepping notes for the morning, I head off to pre-round on my patients: A child failing to thrive, a few infants with bronchiolitis, and lastly, a teenager with disordered eating. I save the teenager for last. I enter her room and find her lying in bed, eyes closed but not asleep. She quickly glances at me before averting her eyes and turning her head towards the window. Her sitter in the corner gives me a smile. I say hello and apologize, once again, for waking her up in the morning. She turns and replies, in barely more than a whisper, “it is okay.” Her eyes are downcast and her face holds little expression, paralleling the volume of her speech. Although she managed a few chuckles during our first encounter, it has become increasingly difficult to get her to engage, to connect in any meaningful way. I go through my usual list of questions, trying and failing to land a few jokes along the way, until we come to the question of how her nutrition is progressing. “What a silly thing to ask,” I cannot help but think. The week before coming to the hospital she had eaten almost nothing. During her first night here, she required a nasogastric tube for refusing meals. Over the last year, she has bounced from hospital stay to treatment center and back without much improvement. The food that we call “nutrition” is a source of great emotional turmoil for her. She would likely consider my calorically dense version of heaven a nightmare.
The heaviness of her room stays with me long after I leave. We fix her electrolyte imbalances, ensure she consumes enough calories, and coordinate her outpatient treatment. However, we do not have the time or ability to fix the underlying problem. It feels like we are duct-taping a hole in a sinking boat, hoping she will make it to shore before the roll runs out. I am left with a gnawing feeling of frustration that I cannot “fix” her relationship with food. Unfortunately, that troubled relationship swings to the other end of the spectrum just as often.
A few months prior, I recall standing in an exam room as my attending counseled a teenage girl with type 2 diabetes. Her labs had come back and, despite a recent switch to insulin, revealed that her disease was far from controlled. The attending gently broached the subject of needing to give additional insulin with lunch. I can still picture the patient’s face shifting from one of nervousness to despair, as the tears started to roll down her face. My attending placed a comforting hand on her back and expressed understanding at how unfair her new reality was, how hard it was to have diabetes at a young age. The development of her disease was influenced by many things other than diet, but my mind drifts once again to our relationship with food and its pivotal role.
Although each individual with disordered eating has their own unique story, it is hard not to point a finger at the world we live in. As I scroll through my own Instagram reels, my phone lights up with alternating videos of food and celebrities. One second I am watching a mouth-watering video of pasta being tossed with a mountain of parmesan cheese and the next, I am looking at an unattainably skinny movie star. Back and forth I rock from images of excess to ones of extreme restraint. In the face of opposing messages packaged into dazzling, addictive media bytes, how are teenagers supposed to find a middle path?
There is currently a bill in the senate titled the Kids Online Safety Act, which would be the first introduction of online safeguards for children in years. Although no legislation is perfect, and there are online resources that debate the bills’ pros and cons, we are faced with a youth mental health crisis that transcends food. It desperately requires action on a national level. Whether it is the patient admitted for malnutrition secondary to anorexia nervosa or the individual with newly diagnosed type 2 diabetes, we all deserve the opportunity to develop a positive relationship with food. This is the figurative hill that I will die on, so that my future patients do not have to die on the literal one.
Julia Parker is a fourth-year medical student at OHSU. She grew up in Eugene, OR, and made her way out east to Tufts University for her undergraduate education. Julia worked as a clinical research coordinator in infectious diseases and hematologic malignancies for three years before starting at OHSU School of Medicine. True to her Oregon roots, she loves being outside. She spends her free time hiking, running, and skiing in the winter.
