The last meal

Special collaboration with Ms. Dulude, Head of the Food Services and Clinical Nutrition Department at the Montreal Heart Institute

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My name is Eloïse, I’ve been working at the Foundation for a few months now, and I’m usually the one who writes these texts. Today, however, I’m giving the floor to Ms. Dulude, Head of the Food Service and Clinical Nutrition at the Montreal Heart Institute. She tries to highlight the work of the multidisciplinary Food Service and Clinical Nutrition team every chance she gets. She wants to shed light on one of their most delicate mandates: orchestrating last meals in the context of medical aid in dying. Her touching words have moved every person at the Foundation who has read them, so much that we couldn’t help but share them too. 

The title is by no means meant to imply this will be a text with a religious undertone. It was simply chosen as a nod to The Last Supper, a piece of art depicting a meal that, with the inevitable looming, serves as a sort of profound communion, a collective rite emphasizing a connection with other beings and with the food itself. 

November brings with it a cold that cuts to the bone. But the activities related to medical aid in dying pay no heed to the weather. They go on year-round because nothing can slow down the march of time. After all, life and death are constants. 

The palliative care team sends the last meal request to the nutritionist. The unit then mobilizes and the message is subtly passed on to the Food Services Department. The nutritionist consults with the care team to confirm what can be offered, free from any nutritional and consistency constraints. The day’s announcement is then discreetly conveyed. The dietary technician is part of the bedside team, she will be planning the last meal – which we call the “ultimate meal” to strip it of any discomfiting connotation. 

Food is a means to take care of both the body and spirit. When a person’s health is no longer a factor, a meal can only serve to provide comfort and remind the person of the fond memories they associate with the food in question.

In terms of a last meal, the patient is free to plan their feast and may deviate from their usual dietary restrictions. Once the meal has been chosen, planning can begin. Do we know how to cook this meal? Do we need to purchase ingredients? Will the recipe require multiple days to concoct? Our cooks are genuine artisans who are able to take on any challenge, such as applying a torch to a crème brulée at the last second with all the decorum and care required. 

There is a common misconception that these patients must all request caviar and lobster. While our pool of patients who have requested a last meal is small, we are able to put to rest the notion that their choices would only be found on the menus of Michelin-starred restaurants. Here are a few examples of last meals served: fettuccine carbonara, meatball stew, potato pancakes, eggs benedict, Jell-O, and specific kinds of fruit – raspberries, melon, blueberries. In one case, a patient half-heartedly invoked a Mimosa behind a wrinkled yet playful gaze and were then surprised to see a flute of the beverage appear on their meal tray. 

The meal is served with special floral silverware. There is no plastic, cardboard, or paper in sight. The dish is placed on a fabric placemat and supplemented with a cotton cloth napkin. 

In the kitchen, a heavy, meditative, silence reigns. Once ready, the meal is personally delivered outside normal hours. We might get feedback, or we might hear nothing further. One patient declared it was the best breakfast of their life. 

A few hours from death. That’s a sentence that stays with you. The tray returns. The porcelain is washed with care. Everything is placed back in the box designated for these requests. Members of the team congratulate themselves in a subdued manner with a few gentle pats on the back or a quiet fist bump. Other patients and clients await their meals. The noise level ramps up again. For a few more hours amid the hustle and bustle of the Food Services and Clinical Nutrition Department, the team will be imbued with a sense of pride knowing they’ve offered the best until the very end. 

Another meaningful day comes to an end.

Photo of a final meal served in November 2023, including a crème brulée and a mimosa for lunch. 

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