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What’s Underneath: On Hospitality and the Hospital Sandwich : Emergency Medicine News


hospital sandwich, hotel business


I started writing this column while watching a sandwich in the hospital. It was offered to a patient who had lied and waited and lied and waited some more in our emergency department. The man was starving and discouraged, alone and at sea in the mass of the department, a department that was oblivious and oblivious to almost all of his human needs.

I thought more and more about that anemic portion of “food” and wondered when we got so stingy with our edible care. Little did I know that question would bring me squarely back to King Henry VIII.

But, first, the hospital sandwich. You have all seen it. Whiter than a ghost. Its delicately curved fine edges. Its innards even paler than its shell – lettuce, ham, butter, all soft and slimy and indistinguishable from each other. The mobile meal that’s been irradiated and time-stamped and nestled in a glossy, sealed, never-degradable wrap, kept cold in the fridge so wilt turns stiff.

I handed it to the gentleman, and he said he was grateful, but his eyes spoke of disappointment. He didn’t feel hospital.

And then, as usual, I started wondering how a hospital, certainly an emergency department, wasn’t very hospitable, and how come their etymological roots could be so similar.

A ticket to paradise

The history of hospitals is, of course, vast and deeply fascinating. Hospitals, in the sense that we understand it, did not really exist until the Christian era, but they began to flourish all over the world around the 5e century. They had many similarities, despite their geographic differences. They were not expressly intended for the sick, but as places of respite for poor, dying and disabled patients and travellers.

Italy has led the way over time. It has become mandatory for monasteries to have a collocated hospital, hospice for pilgrims. Besides a roof over their heads (and spiritual help), the main offering to those admitted was nutrition. And what hearty nutrition it was. Hospitals had their own farms, and customers received fresh milk, bread, beer, oatmeal, and fruit from the orchards.

This type of hospitality was surrounded by a co-dependency with theology. Roman Catholic teachings held that wealthy men could earn God’s grace through good works. Monasteries and hospitals were funded by those who wanted to buy a ticket to heaven. But then came the great tearing, under the hands of ham, if you will, of the most truculent of the Tudors. Henry VIII sparked the Reformation, and everything Catholic was to go. He dissolved the monasteries and the church withdrew support for hospitals. To add insult to injury, the poor and disabled were no longer considered righteous in their suffering, the prerequisite path out of purgatory, but were seen as an example of the ungodly – lazy and unworthy. Earthly banquets have ceased.

The rest is history (literally). The Protestants, for all their avarice, have at least begun to move the care of the sick away from the religious and towards the scientific. The Lights had begun. Modern hospitals have taken root. Unfortunately, the principle of food as comfort, consolation, complement to healing, as well as its benefits on nutrition, is slow to catch up.

Most Wanted

Sure, modern emergency departments aren’t restaurants, but they don’t have to be punitive either. I could see it at my man as I handed him the sandwich. It’s not a punishment, I meant.

We don’t even know what a sandwich is. Its alleged inventor was John Montagu, the 4e Earl of Sandwich, but really, he just gave it the name; the concept of a sandwich existed in antiquity, with the meat placed between slices of unleavened bread.

The US Department of Agriculture, strangely, uses the definition of “at least 35% cooked meat and no more than 50% bread” in response to the watered down and misunderstood term. (New York Times. April 14, 2015; Is a hot dog a sandwich? Bruschetta? Other types of bites?

However we describe it, the hospital sandwich, I think, went the way of Anne Boleyn. Discarded, no longer wanted, more beautiful. Executed (perhaps a little too long bow to draw?). The one I held in my hand was not a queen. And it brought cold comfort to my patient. Bring back the porridge, I say.

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Dr Johnstonis a certified ER doctor, so the same as you but with a weird accent. She works at a trauma center in the old fashioned end of Perth, Western Australia. She is the author of the novels dust fall and Little uncertain miracles, available on his website, She is also a regular contributor to the blog, Life in the Fast Lane, Follow her on Twitter@Eleytheriusand read his past columns on