Triage in the kitchen

NEW! City Slickers feature series - City Slickers: This new series takes us behind the scenes to the heart of Alberta’s agriculture and food industry through the eyes of foodies Jennifer Cockrall-King (left) and Terry Juzak (right).

Story by Jennifer Cockrall-King and Terry Juzak
Photography by roth and ramberg

Say what you like about hospital food, but how would you like to serve nutritionally balanced meals to 1000s of patients—hot, on time, three times a day?

A hospital may not seem a likely place to find two food writers, pens and notebooks in hand, but our curiosity about food often leads us to places where others fear to tread. Case in point: the hospital kitchen.

We know that the days when patient meals were actually prepared in hospital are long, long gone. The reality is that for economic reasons, as well as for quality and nutritional control, most foods, from a patient’s morning toast and hot cereals, to lunch sandwiches and dinner entrees, are cooked or prepared in a large commercial kitchens and delivered in bulk to the hospitals. Each hospital, in turn, takes on the task of sorting its patients’ various diets, assembling meals to meet those needs and getting the meals to the patients’ bedside. (It kind of puts cooking a dinner party for 8 into a different perspective, doesn’t it?).

This is the kind of planning ahead, buying in bulk, commercial-quantity cooking and overall logistical operation that would make even the most organized home cook’s head spin. It’s also the kind of food story we love to delve into, so we eagerly jumped at the chance to follow the food trail from raw ingredient to patient and to get a glimpse into the daily tasks of preparing the 1,000+ meals in Edmonton’s Capital Health region.

The Morning Shift Begins

We arrive, blurry-eyed, lattés in hand, at 8 a.m. at our first destination, the Regional Food Production and Distribution Centre, a 20,000 square-foot warehouse in southeast Edmonton. Our tour guides for the morning are the Centre’s quality control specialists, Kamela Garneau (a registered dietician) and Shauna Hofmann (a food scientist). Looking stunning in our borrowed, mandatory white lab coats and blue hairnets, we get a primer on how the raw ingredients are first received onto a loading dock, then promptly unpacked, labelled and whisked away into coolers, freezers or dry storage.

Next we visit the “cold production” side of the kitchen where over 95 different cold items are prepared. “We make a lot of sandwiches,” says Shauna as we pass through the cold kitchen. In fact, 264,000 sandwiches are made here every year. Indeed, we’re stopped in our tracks by the sight of a huge meat-grinder, brimming with hardboiled, peeled eggs. (Egg salad sandwiches for 1500? No problem, especially when you have a recipe that calls for 43 kilograms of hard-boiled eggs.)

“And we make A LOT of Jello,” Shauna continues pointing us towards a rainbow-coloured battalion of single-servings of this classic icon of hospital comfortfood.

Yum, Puréed Sandwiches

Shauna disappears into one of the giant freezers and returns with a small plastic container. “Have you ever tried a puréed sandwich?” she asks in all seriousness. “They’re really very good.” These sandwiches, she tells us, provide a welcome relief from the other watery and mushy foods that stroke and throat cancer patients, accident victims, seniors, and others who have trouble chewing and swallowing are usually limited to in their diet. Puréed sandwiches require no chewing, but they miraculously look and hold together in your fingers like the real thing.

It’s apparent to us, as we listen to Shauna and Kamela, that they are as interested in the flavours, variety and textural appeal of foods they prepare as the calorie counts and nutritional profiles.

This is a good thing; otherwise preparing hospital food could get rather clinical. Over 30 food allergies need to be considered on Capital Health’s standard seven-day rotational diet. Special medical requirements (low sodium, low potassium, diabetic, low calorie, low fat and fluid restricted diets, to name a few) as well as ethnic preferences also enter the equation. Capital Health’s Aboriginal First Nations’ diet choices include rabbit-rice soup, caribou soup and “bush goose” soup, as well as bannock from a local Edmonton bakery; kosher meals are not made on-site, but rather get shipped in from BC.

Being kitchen gadget junkies, the 100-gallon soup kettles also catch our eye (soup for life!), but the Combination Tumble Chiller /Cook Tank is a true revelation. The preparation of many of the dinner and breakfast items involves this ingenious machine that can cook up to 300 kilograms of meat at a time and then chill it within 60 minutes for storage.

The last stop for the prepared foods made at the warehouse is the giant cooler. But this is only a brief stop, as the refrigerated carts of sandwiches, Jellos, bulk portions of soups, stews, scrambled eggs and the like are already making their way to the hospitals. In case of any complaint or problem linked to any of the food items, small samples from every batch are taken, dated and also stored in this cooler.

At this point, we follow the hospital food trail to the University of Alberta Hospital to discover how these bulk portions end up as individual meals delivered to hungry patients.

Next stop on the food trail

We arrive at the University of Alberta Hospital’s kitchen famished. We offer to try a puréed sandwich, now convinced of its culinary merit, but to our disappointment not one single extra is left in the building for our “taste testing” purposes. Instead, we turn our attention to the strange white trays with two round cut-outs, one large and one small. Carol Graham, coordinator for patient services at the hospital and our guide in this kitchen, explains that this is how each patient’s tray is customized and assembled. All items, whether they will be served hot or cold, are placed on the tray cold. Entrées and soups sit in ceramic dishes that nestle into the cut-outs. All trays are placed in special mobile carts that have corresponding heating elements to heat the hot food, while the rest of the tray stays chilled in the cooler. Carts are wheeled from the cooler to the ward, still heating through the hot plate until each of the 450-some patients is served.

While none of our food tour guides this day were claiming that hospital food is a gourmet experience, we were impressed with the commitment to finding a balance between the practical and the palatable, the dietetic concerns, the sheer volume and a diverse patient population. Currently, the University of Alberta Hospital is even running a pilot project to tackle the difficult problem of getting sick children to eat. Carts which circulate with kid-friendly menu choices, rather than a set meal delivered on a tray, seem to be meeting with great response from little patients.