TONY Donkin has more than a superficial relationship with his customers. He talks daily to every person he cooks for, encouraging them to give him feedback and criticism on past dishes and urging them to tell him about their favourite foods and recipes.
This is because Donkin, as head chef and catering manager at Wakefield Hospice in West Yorkshire, is cooking for people who are dying and it's up to him to coax them to eat and give them pleasure from food. There, supported by another full-time chef, two part-time chefs and a team of volunteers, he feeds up to 16 residential patients and 20 out patients every day.
He explains that the key aims of Wakefield Hospice are to provide the highest standard of care to patients with terminal diseases and to improve their quality of life, through pain and symptom control and through food. "Food is one of those things that people have enjoyed throughout their life, so when they come here, I see it as my job to give them something they feel good about," he says.
Hence his insistence on listening to what they say about food. "When people first arrive, they often won't have eaten for quite some time and even the thought of food can make them feel nauseous. But with the help of drugs, the nurses can usually bring the nausea under control and I'll then talk to them about what they like to eat.
"Usually they'll start by saying they don't like anything, but by spending time with them I'll find out what used to be their favourite dishes. I make suggestions to them and gradually tempt them to eat. I guess my job is that of a salesman, in some ways."
Donkin explains that the majority of people admitted to Wakefield Hospice are in the latter stages of their illnesses with only a short time to live, so such concerns as nutrition are usually irrelevant. "It's not my job to add weight to most people, or to lecture them on what's good for them. My number-one priority is just to improve their quality of life. For instance, there's a young lady here at the moment (with cancer) who only wants to eat ice-cream with cream on top, and that's fine. I'm not going to tell her it's bad for her to eat so much fat, I'm just pleased to see her eating and enjoying her food."
Donkin's overall approach is to offer patients as much choice as possible. So at breakfast, served to residential patients only, everything from porridge, to prunes, to yogurts, to fry-ups, smoked haddock and boiled eggs is available.
At lunch, which is served to all patients from noon to 1pm, Donkin's menu always includes fruit juice or home-made soup to start, two hot main courses or a salad, and a choice of rice pudding, another hot pudding, yogurt or ice-cream for dessert. But, he emphasises, patients are also free to go off-menu and ask for anything else they want. "I see the menu as a starting point for discussion," he says. "Most people do choose what's on there, but they know they can ask me for other things too. For example, there's one chap who wants to eat cod in parsley sauce every day, so I'll cook it for him. I try to be as flexible as possible and keep a freezer full of food in an attempt to satisfy all tastes."
In fact, Donkin's flexibility and willingness to please has become almost legendary at the hospice. One nurse tells the story of a day patient who refused to eat for several weeks, until Donkin discovered that his favourite dish was tripe. "So every Tuesday, the day that the man came here, Tony would get one portion of tripe delivered and cook it for him especially," she says.
Donkin takes every lunch order personally soon after breakfast has finished, first visiting those residential patients who are well enough to eat and then visiting the day patients. He does this, he says, to enable people to choose their meal as close as possible to the time they'll eat it.
"In a hospital people will often be asked to choose their meals first thing in the morning, or even the night before, but that's no good here because our patients simply won't fancy anything," he explains.
In the afternoon, after the day patients go home, he'll follow a similar procedure, again visiting every residential patient personally to take their dinner order a maximum of two hours before they eat it.
At dinner his menu includes a selection of salads and sandwiches, lighter meals than at lunch to allow people to digest the food before they sleep. "But again everyone knows they can ask for what they want, so we'll often end up cooking a poached egg for one person, meatballs for someone else, a sausage for another one and so it goes on."
Donkin points out that another key difference between the approach at Wakefield Hospice and hospital catering is that, whereas most hospitals now use the cook-chill system, he and his team cook everything fresh to order and, wherever possible, use fresh food. This is because he believes the taste and look of fresh food is far superior to regenerated or processed foods and adds to patients' enjoyment of it.
Another surprise during a tour of the hospice's kitchen is that the cupboards are bare of salt, pepper, herbs or any other flavourings. Donkin explains that this is because many patients have been undergoing chemo- or radio-therapy, which changes their tastebuds. Often foods will take on an over-salty, over-sweet or metallic taste to them, he says.
"For the first year that I worked here, I was serving patients soup from tins and got endless complaints that it was too salty," he says. "Then it finally dawned on me that the soup had salt and all sorts of other things already added to it, so I started making simple fresh soups from vegetable stock and vegetables and the complaints stopped. I now know not to add seasoning to any dish, be it steak and kidney pie, roast meat or anything else because nobody here will like it or thank me for it."
The most common cooking techniques are braising, stewing or roasting for a lengthy period. "If another chef walked into my kitchen they'd probably think I was overcooking everything," says Donkin. "But it's important that I cook dishes until they are really soft. People who've had chemotherapy often have sores and ulcers in their mouths, so we need to prepare things in such a way that they'll require a minimum of chewing. The favourite dish here is stew with dumplings for that very reason."
He adds that cleanliness is another area the kitchen team has to be very aware of, the immunity of patients in the latter stages of a terminal illness is exceedingly low, so it's important to minimise any risk of bacterial infection from food.
The kitchen is rigidly demarcated into separate areas for raw meat preparation, cooked meat preparation, pastry, vegetables and salad. And knives and all other utensils are colour-coded, so that the brigade know which they can use for meat, vegetables and so on. "Any hot food that isn't eaten within an hour of leaving the kitchen is also destroyed to prevent contamination."
Enjoyment from food
Thanks to his seven years' working at the hospice, Donkin has become extremely ingenious at ensuring even the sickest of people can experience enjoyment from their food.
For example, because of the location of their tumors, some patients are physically unable to swallow food. "They sometimes won't have eaten anything at all for a long time and will tell me they can't have anything. But I ask what they really used to like and will make some for them to chew on. Sure, they'll have to spit it out afterwards, but they still get to taste egg and chips, if that's their favourite."
In other cases, patients can consume only liquids. "At home they may just have been given Complan. But, if they fancy tasting a complete meal, I'll liquidise steak and kidney pud, broccoli and potatoes and put them separately on a plate. It's amazing the pleasure that can give someone."
All in all, it seems nothing is too much for Donkin and his team at Wakefield Hospice. They will go to extraordinary lengths to make meals and source ingredients that patients enjoy. "My view is that I don't want to refuse anyone a dish that they really want, or tell them to wait until tomorrow, because tomorrow they may very well not be here." n
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