PHILADELPHIA REFLECTIONS
Musings of a Philadelphia Physician who has served the community for six decades

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Subcultures
E pluribus unum refers to thirteen colonies peacefully becoming a single nation. But it applies to Philadelphia in a different sense. Philadelphia is a city of neighborhoods.

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Old Age, Re-designed
A grumpy analysis of future trends from a member of the Grumpy Generation.

Food

In one of those intervals when several casual acquaintances are detained together, awaiting the beginning of some ceremony, there was desultory conversation, jumping from topic to topic. The recently retired President of the University probably had a delayed lunch on his mind. "The older I get, he said with a smile, the more important food seems, and the less important sex does." The considerably younger group knew how to respond to this sally, which was with broad but inaudible smiles, and no comment. This was, after all, the President of the University making a faux pas.

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Women Cooking

In retrospect, it seems remarkable the rest of us could be so obtuse. During the working years of life, meals are fitted around the workday; the employer defines the day's structure, and meals fit around it. That pattern persists on non-workdays, imposing its schedule even on those who do not go to work. In Haddonfield, the town whistle blows at noon, in Philadelphia the clock opposite City Hall booms twelve. However, in a hospital, nursing home or retirement community the eight-hour day for the cooks sets mealtime. Breakfast comes at 9 AM, dinner comes at 5 PM. The wait staff starts clearing tables ninety minutes later, because they want to go home. To working class families, this sort of schedule is not objectionable. A man who does heavy manual labor wants his dinner ten minutes after he gets home at night. The remarkable docility of his wife contains a faint hint that he can get grouchy or worse if he has to wait a jot for dinner. There are others who respond well to institutional mealtimes; you can see them crowded around the locked entrance of the dining hall, waiting for doors to open. Diabetics, too, have learned the wisdom of regular meal hours. All of these people can be expected to rally around the administration if someone starts to urge more flexible and leisurely meals; they would have trouble understanding the issue. What's lacking, of course, is the deference one comes to expect when dining out. At a restaurant, the diner sets the time he wants the meal to start, and makes the decision when to call for the check and declare the meal is over. If the waiter hustles you, cut his tip. In a restaurant, the meal is a special occasion, caters to your wishes. In an institution, the purpose is to get people fed. In general, people go along with this because they are on a budget, and understand quite well the dining organization wishes to minimize complaints, but only within the constraint of minimizing labor costs.

{Breakfast}
Breakfast

If that's the system we live by, it really would seem reasonable to contemplate a return to having the big meal of the day at noon, in the style of the Victorian era or the hotter siesta countries like Spain, Greece and southern Italy. Commuting twice a day is probably the problem that switched American custom to having a big meal in the evening. But in retirement, all this is no longer an issue. It takes time for customs to change, but it almost takes a century to change breakfast habits. For half a century, we have denounced high-fat breakfasts, and breakfast still responds slowly. There was a time of my childhood when breakfast consisted of fruit, cereal with heavy cream, fried or scrambled eggs with bacon, two glasses of rich milk, two pieces of toast and butter. Right now, it has settled on quick foods before train time, orange juice with one slice of toast and coffee; a so-called continental breakfast. But a Frenchman wants a croissant, a German wants a sausage, a Spaniard wants eggs with tomato sauce. An Englishman wants kippered herring with his breakfast tea. And an Australian insists on tomatoes for breakfast, so help me. Now that many women are working late hours, there is more eating supper in restaurants, and lunch is mainly a quick lunch. But most people prepare breakfast for themselves, at home. They buy the ingredients for old favorites at the same place, usually once a week, and once a pattern is established, it seldom changes. So if you retire to a CCRC, it would be wise to leave your habitual breakfast without tampering. Switching the main meal of the day to noontime, however, could create the opportunity for leisurely dining, even recreational dining. And the staff could get home for their TV program without hustling people to finish their supper. That is, unless golf is a big feature of the place.

{Cowboy Casserole}
Cowboy Casserole

One of the major reasons couples enter retirement communities, is that the woman of the pair has become tired of cooking. It's a little hard to know what they mean when they breeze past that comment, because it may really mean that some serious illness has come along, which they would prefer not to discuss with strangers. Or it may reflect early Alzheimer's Disease, usually manifested by repeatedly walking away from a heated frying pan with smoke or even fires above it. Substituting an electric stove lessens this home hazard for a while, but eventually it leads to a demand that something drastic must be done. There are even a few upper crust families who have always had their own cook. That has its limits, however, and in one case I know a former college football hero went to cooking school and learned some special dishes to entertain his guests. Somehow, that always seemed just a little strange, until the subject of kitchen restoration came up with his wife. Not interested in that nonsense, harrumped this lady who could obviously afford to restore a dozen kitchens if she chose. And then she uttered the phrase which unlocked the whole situation. "My mother," she said with finality, "Never set foot in the kitchen."

The sort of food that bachelors and widowers eat is apt to bring tears to your eyes. The only for-sure case of scurvy I ever saw in a long practice of medicine afflicted the Treasurer of my own hospital. It proved easier to give him vitamin pills than to reform his pizza-for-breakfast habits, regardless of how grateful he was to have his teeth stop falling out. Nevertheless, when I became a widower after sixty years of marriage, I was still puzzled by the question, asked twice by two old friends, "Have you been getting any casseroles, lately?" As time goes along, the meaning of this question gets clearer, but the problem got solved in a strange way. I share a cleaning lady with the family next door, where the lady of that house is a truly outstanding French cook. The cleaning lady started bringing me some outstanding dishes, the source of which was soon clarified. She had begged the famous chef lady to teach her how to cook these fancy things, and was quite proud of her new accomplishments. However, the grim fact emerged that her working-class husband absolutely wouldn't touch that stuff, and so she brought it to me rather than stop the cooking lessons. By this route, we get to a dinner conversation held at a table for eight in a nearby retirement village. Three women and five men, far from an average assortment in a predominantly female environment. One extroverted lady, the center of all activities, made an excited proposal. Why don't we set up a table for eight men and go into the kitchen and cook special things for the poor dears? The idea, however, was immediately squelched by another lady at the table. "Why in the world would you want to concentrate what few men we have, all in one place?"

(1718)

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