Slight to begin with, Madhur has lost weight since her admission to us 3 weeks ago. At 160cm (5’3”), she now weighs just 37kg (5st.11lb).

After noting the measurement displayed on the screen, I indicate that she should step off the scales and I walk with her back to her bedside. I tell her she has lost weight. “Yes”, she replies, smiling up at me and patting my arm with her bony hand. I’ve looked after Madhur enough now to know that, as an Urdu speaker with very little English, “Yes” is her go-to response when she doesn’t know what has been said. Back at her bedside, I look at a piece of paper with words like “pain”, “nausea” and “water”, helpfully written out in both Urdu and English by Madhur’s son. There is nothing there I can use, so I pull out my phone and talk to Google, showing her the translation on the screen.

The use of automated online translation services is not recommended practice in the NHS. Rather, we are encouraged to use Language Line, a third-party service that connects your call to a trained interpreter for which the ward pays by the minute. Whilst this service is considered a must during medical consultations, it is rarely employed for the ongoing and haphazard communication that occurs during everyday bedside care. This is navigated with a mix of precise enunciation, charades, Google Translate and the engagement of patients’ friends and relatives.

I draw on this last resource later in the afternoon when I see Madhur’s son. “Other than toast and jam at breakfast, she barely touches her meals. Does she not have much of an appetite?”. He explains it’s not her appetite, but the food that is the problem: “I mentioned it to your colleagues, but they just keep ordering the same thing”. Turns out that despite enjoying a wide range of food, she’s been being given the same two meals for lunch and dinner for the last 3 weeks – a vegetable or chicken curry, one for lunch, one for dinner, sometimes swapped around but always the same.

This might have been surprising considering the Trust boasted “a wide range of menu choices including Afro-Caribbean, halal, kosher, vegetarian, vegan and gluten-free options” which could all be found on an “additional dietary requirement” menu. This was handed out upon request but for the majority, the standard menu was given, which included a range of hot meals, salads, and sandwiches.

“My mum likes pasta, sandwiches. She’s not even Muslim!”  

I winced thinking about the assumptive behaviours that had led to Madhur only ever being offered from the alternative menu, despite not having any additional dietary requirements. It seemed more than likely that this was rooted in the same line of racial stereotyping that was leading to someone repeatedly and inappropriately ordering halal curries for her.

The catering staff that took Madhur’s lunch and dinner orders worked for an external supplier. They only came around in the morning and were not present to witness plates of food being delivered and taken away uneaten. They used an ordering system that was inaccessible to ward staff and could not be amended. Only the food that was ordered was delivered so ward staff were limited in what, if any, alternatives they could offer later. The only way they could intervene would be to collar the catering staff while they did their morning orders, for which bedside staff weren’t always available or quick enough to catch them.

Perhaps it was because of these gaps in communication or because they were short on time; perhaps it was because they worked in isolation or maybe they were not adequately trained; perhaps they weren’t thinking or maybe they just didn’t care. But whatever the reason, when language barriers prohibited Madhur from choosing from the menu, instead of taking the time to muddle through translation or speaking to a member of ward staff, the catering staff were simply selecting what they presumed to be the most suitable meal for her – a curry.

To help manage this, I sit down with Madhur’s son to make a list of items titled “I like to eat:”. We stick this list on the patient information board above her bed with “FAO catering staff” written boldly at the top.

Pleased with this initiative, I reassure her son that from now on she’ll receive a variety of meals which will hopefully help her appetite.

The next morning I’m stood at the bay entrance when a member of catering staff arrives to take Madhur’s order. “Veg curry?” he says. “Yes” she replies.