George Piarelli loved food. His Italian-born wife, Bianca, made the creamiest risotto, the most tender chicken and the tangiest sausage he knew. Next to his wife’s cooking, his second passion was wine – bold, richly flavorful northern Italian wines like Bardolino, Montepulciano d’Abruzzo and Barbera d’Alba. No one ever crossed the Piarelli’s threshold without getting a back-slapping bear hug and an invitation to food and wine.
George’s stroke was devastating. He lost his powerful baritone voice and struggled to learn how to just whisper again. He lost almost all movement on one side of his body and worked for months in rehab to regain a fraction of strength.
Worst of all, George lost his ability to swallow. He had a feeding tube placed through a hole in his abdominal wall and lived on a steady infusion of nutrition solution going straight into his stomach without giving him the pleasures of the sight, smell or taste of food.
George spent many quiet hours every day in his room at the nursing home. Sometimes he watched cooking shows. Rarely he listened to Opera music.
A few months ago George asked to see me during rounds. His mouth struggled to form the words and I leaned forward until his breath touched the side of my face.
“I want to eat”, he managed to whisper.
I glanced over at Suzanne, the charge nurse and repeated his statement.
“He’s been asking all week”, she said.
“Do you think you can swallow again?” I asked.
“I know it”, he whispered.
There was a new fervor in his eyes and his face didn’t look as flaccid as before.
“Let’s order a swallow eval and see how you do”, I suggested.
He nodded his head and gave me a thumbs up with his good hand.
The modified barium swallow results came back the following week. According to the speech pathologist, George could handle certain consistencies, but not solids. George was not pleased. He wanted to eat.
“I’ll sign a paper”, he said.
I reminded him how aspiration pneumonia or choking could kill him. He looked away and ended our exchange.
Two months went by. George swallowed his nectar-thick liquids without trouble and barely spoke to me during rounds.
Near the end of last month he waved me closer and whispered:
“I can eat now.”
“Are you sure?” I asked.
“Test me again”, he answered.
His follow-up swallowing evaluation arrived at the office two weeks ago. The concluding paragraph read:
In summary there has been remarkable improvement since the previous study and the patient this time demonstrated adequate swallowing of all consistencies.
Suzanne took my verbal order to let George start trying to eat at the nursing home.
When I saw him at rounds again, Bianca was with him.
“We want to have a birthday party at home next weekend for George”, she explained.
“An Italian feast”, I surmised.
“Absolutely”, she beamed. “Saltimbocca, risotto, chicken cacciatore, all his favorites.”
“How has he done with eating here this week?” I asked.
“No problem whatsoever”, Bianca answered while Suzanna nodded in agreement.
“All right”, I said and shook George’s hand.
The following day George left in the wheelchair van.
Monday morning the fax machine at my office had the news waiting for me:
George Piarelli was admitted to the Intensive Care Unit over the weekend with aspiration pneumonia.