Sweetness and Substance
Hospices and the role of food at the end of life. Words by Robin Craig. Photographs by Robin Craig and Georgia Rudd.
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Cooking from Life is a strand of essays that defy idealised versions of cooking – a window into how food and kitchen-life works for different people in different parts of the world; cooking as refusal, heritage, messiness, routine.Â
This week’s Cooking from Life is by Robin Craig. You can read our archive of recipes and essays here.
Sweetness and Substance
Robin Craig explores the role of food in his father’s final days, and shares a recipe for clementine drizzle cake. Photographs by Robin Craig and Georgia Rudd.
Guidance for carers often lists loss of appetite as one of the key indicators that death is near. Although it is true that people at the end of life require less sustenance and may become increasingly less able to eat, that does not mean that the process of dying ends all interest in food. All hospices, after all, have kitchens.
In practical terms, a hospice is an ecosystem that facilitates the natural and inevitable process of death. The UK’s hospice system is mammoth: each year UK hospices care for 300,000 people who are dying or facing serious life-limiting conditions, and provide bereavement support for a further 60,000 people. The hospice system is free at the point of use but is not part of the NHS. More than £1 billion of the £1.6 billion that hospices need to operate comes from public donations, with charities increasingly plugging the gaps in government funding.
A hospice chef’s primary duty is to provide three meals a day for patients, but their role differs from that of a standard hospital chef in that hospice patients often have little desire to eat. The focus in hospices is on ensuring the comfort of the dying rather than feeding people to get better, which means that chefs often make highly tailored meals with the primary aim of maintaining quality of life. In the words of Tajun Ali, a chef at North London Hospice, this can mean ‘developing nutritious smoothies to help patients who find it difficult to face solid food’, or ‘giving someone who is reluctant to eat a little of what they fancy’.
For patients and their loved ones, the hospice is both a waiting room and an endpoint: irrespective of whether you are the person dying or a loved one visiting, you both know that you will leave this place in very different ways and that, in the meantime, you have nothing to do but wait for the inevitable. In such a context, you can discover there’s little in this world that passes time better than eating.
When my father was in the Isle of Man Hospice – the island’s only palliative care centre – food became a focal point for him, for me, and for the daily pace of the hospice itself. He had had a short, intense illness that culminated in the declaration that he was terminally ill with ‘days or weeks to live’. After a brief stint of home care, he was moved to the hospice, where he lived for ten days before his death.
During those days, his already minimal appetite waned, then eventually disappeared altogether. When he was initially admitted to the hospice, the chef cooked him three meals a day that were left untouched, leading the nurses to add ‘Liquids only’ to the notes on his room door. He began drinking only Vimto, which I brought from home, with precisely three ice cubes. I did not eat much, except for the cream cakes and eclairs that the chef made for the lounge each day, paired with instant coffee from a vending machine. The one time I did request a plain cheese sandwich from the nurses, they happily obliged – the chef produced a sandwich cut into quarters and wrapped in clingfilm. It was perhaps the only ‘real’ meal I ate that week.
Despite our waning interest in eating, my father and I would sit together – me in a large recliner, him lying in bed, his small, frail hand, so unlike the hand of the father I had known, clasped in mine – and watch episode after episode of cooking shows for hours: Rick Stein in Spain, in Cornwall, in France. The rich food on the TV screen, and the vitality of its eaters, played out in front of the glass of Vimto on my father’s bedside table.
My father and I had never watched cooking shows before he began requesting them in the hospice. He had never been a cook – he was a breadwinner rather than breadmaker, as men on the Isle of Man were often expected to be, even in the 2000s. The only exception was when my mother had periods of illness during my childhood and he temporarily stepped in as homemaker, his burned baked beans on toast becoming the stuff of family legend. When my mother was well, he exited the kitchen once again.
Still, as he lay dying, he turned to me, a sad smile playing on his lips, and said, ‘I have got into cooking shows in my old age.’ He told me he did not like fish dishes much, but he enjoyed the way Spaniards cooked seafood paella. I nodded as though I understood him and remembered the previous year, when he had made a loaf of bread using a premade bread mix and said he wanted to get into baking, but had not baked again.
After watching a show about desserts, he mentioned to a nurse that he would enjoy some trifle if there was any available. He had not eaten solids for several days, so this came as a surprise to all of us. The nurse said she would see what she could do. My father and I went back to watching Rick Stein, the request all but forgotten until the nurse returned a couple of hours later with an obscenely large serving dish. ‘The chef made this for you’ she laughed, and I laughed, and my father tried to laugh. She set the trifle in front of him and he slowly, delicately, ate a single spoonful before declaring that he was full.
Although my father had no appetite, food and drink retained a social and symbolic role for him. When he requested a final toast a few days before he died, my mother, sister, and I brought a bottle of champagne and some flutes into his room, despite the hospice rules forbidding alcohol on the wards (the nurse leaving his room charitably pretended that she did not hear the cork pop). The glass of champagne in my father’s hand, imbued with the knowledge that it would be the last he would ever drink, appeared to contain all the sweetness of his life.
After he died, we began the slow business of sorting through his belongings, including the bag he had kept with him during the two months he had spent in hospital before his illness was declared terminal. In the bag was a municipal blue notebook in which he had kept rigorous notes of the treatment he was receiving, with time and date stamps. At the back of the notebook he had written down things he was looking forward to doing once he was better, as well as a list of foods he wanted to eat: butter beans, roast pork, sprouts, bread sauce. There were also several recipes he wanted to make, including a clementine drizzle cake.
He, of course, didn’t get to make this cake. I let the recipe sit for two years after I found it: it was too painful to know that he had wanted to do something – to cook, to get into food, to bake – but had not had the chance. When I eventually baked the cake earlier this year, I took two slices to his grave. I placed a slice on the grass in front of his gravestone and told him he would have liked it. As I sat there and ate my slice, Anna Belle Kaufman’s poem ‘Cold Solace’, in which she describes eating her mother’s frozen honey cakes years after her death, rattled around in my head. Extracting the cakes from the freezer, Kaufman cuts herself a thin slice and tastes the message her mother baked into them while she was ill:
I love you.
It will end.
Leave something of sweetness
and substance
in the mouth of the world.
Clementine drizzle cakeÂ
Cuts into 8 decent slices
Time 1 hr
Ingredients
175g unsalted butter, softened at room temperature
200g golden caster sugar
4 eggs
175g self-raising flour
½ tsp ground ginger
2 clementines, zested and juiced
pinch of salt
for the syrup
2 clementines, juiced
50g granulated sugar
for the icing
125g icing sugar, sifted
1 clementine, juiced
Method
Heat the oven to 190°C/180°C fan. Grease and line a 20cm round cake tin with baking paper.
Chop the butter into small chunks, then put it in a bowl with the golden caster sugar. Whisk or beat together until creamed – the mixture should be pale, with a light, fluffy texture. Add the eggs, one by one, beating after each addition.
In a separate bowl, mix together the flour, ground ginger, clementine zest, and a pinch of salt. Fold half of this dry mixture into the butter, sugar, and eggs, being careful not to over-mix, then add the clementine juice and gently mix to combine. Fold in the remaining dry ingredients until everything is evenly combined.
Pour the mixture into the lined cake tin, then bake for 35 mins, or until a knife or skewer inserted into the centre of the cake comes out clean.
While the cake is baking, make the syrup. Add the clementine juice to a small saucepan with the granulated sugar and bring to a simmer over a low heat. Simmer, stirring regularly, for about 5 mins, until the sugar has fully dissolved and the mixture has thickened.
Remove the cake from the oven, but leave it in its tin and wait for it to cool a little. Poke some holes in the top of a cake using a skewer or fork, then brush or drizzle over the syrup.
Make an icing by whisking the icing sugar with the juice of a final clementine. Once the cake has cooled, remove it from the tin, then drizzle the icing over the top.
Credits
Robin Craig is a London-based writer interested in sex and death. He is currently writing a book on the history of perversion and maintains a Substack delving into taboo fetishes and what they say about the culture we live in. In 2022, he was awarded The White Pube’s Creatives Grant for early-career writers. You can find him on Instagram at @robin__craig.
This recipe was tested by Georgia Rudd. The full Vittles masthead can be found here.
I pretty much had to hold back tears throughout the whole article. I have personal experiences of feeding a dearly loved parent to the end of their life and this brought back memories which are tender to touch. It must have taken courage to write about something so personal and painful so thank you for sharing, Robin.
Thank you for this. For my mum, who died in 2022 after two strokes, we did hospice at home. In her final week she refused everything but root beer floats. We make them on the anniversary of her death: place two huge scoops of vanilla Haagen Dazs in a tall glass, then slowly pour over one can of A&W or Barq’s root beer until the glass is full or the can is empty.