A good cup of soup can be comforting during illness. It’s like a form of medicine. Soups have many vitamins and minerals, protein and carbohydrates, and of course, water or cream to help stay hydrated. Salt makes a sore throat feel better (like warm salt water gargling) and heat clears nasal congestion (which relieves pain and sinus pressure). As such, a typical cup of restaurant soup costing $5 or $10 could be a valuable purchase in the healing process.
But could a cup of soup be worth $20,000? That had better be one good, restorative cup of soup. Or prevent a much greater medical expense.
So it was that a simple cup of soup did both, saving a pregnant patient a $20,000 admission for hyperemesis gravidarum.
Passing through our ED’s observation unit late one evening on the way to the main hospital, I came upon a young woman asking for assistance disconnecting from IV fluids so she could go to the bathroom. I disconnected the tubing and accompanied her to the toilet. I inquired as to why she was in the hospital.
Shuffling slowly along, she informed me she had hyperemesis gravidarum and was staying overnight for antiemetic medications and slow introduction of foods.
I inquired if she were hungry.
“Oh, yes,” she said, “for soup. The only reason I haven’t eaten anything is they haven’t offered me any soup.”
“Good choice,” I said. “Soup’s good for both calories and hydration.”
She asked if we had any soup.
I searched the unit for food. No luck. The rolling metal transport cabinet was empty of meal trays. The unit’s nurse confirmed there were no remaining uneaten trays.
I wandered around the ED checking refrigerators and tray cabinets. All were bare of anything resembling meal-quality food. And, more importantly, of soup. Empty-handed, I informed the patient that dinner had already been distributed and we had no food other than hospital-grade saltines, graham crackers, and applesauce.
Her grimacing face betrayed that none of those appealed to her and were more likely to make her feel more sick to her stomach.
I imagined what would unfold the next few days. She would not eat overnight on account of unappealing food, or near-total absence of food. The next morning, the nighttime Physician Assistant staffing the observation unit would sign out to the daytime PA that she hadn’t eaten. She would be offered breakfast, which, based on whether she still preferred soup, she may or may not eat. Her initially mild anion gap metabolic acidosis would increase on account of the normal saline she was receiving, mimicking a worsening starvation ketosis. At that point, her allotted 24-hour time in the observation unit would be over. Not having eaten satisfactorily, and with an increasing metabolic acidosis, she would be admitted to the hospital. In 2016, the average hospital stay for hyperemesis gravidarum in 2016 was $16,000. Given 4.5 percent annual health care inflation, by the time this occurred in early January 2023, her hospital stay would cost ~$20,000.
“What kind of soup would you like?” I asked the patient.
“If you have clam chowder, that would be great.”
I asked her to wait a few minutes.
I walked to the in-hospital private cafe. No clam chowder. I returned to her and asked if she had an appetite for potato/bacon chowder or broccoli cheddar soups.
She smiled encouragingly. Apparently, any creamy soup would do.
I returned with one hot, steaming cup each of creamy potato/bacon chowder soup. $6 total.
She swallowed the first few spoonfuls and I left her bedside.
Passing through again the next morning, I noticed her bed was empty.
“What happened to the patient in Bed 7 with hyperemesis gravidarum,” I asked.
“She went home. She regained her appetite and held down soup,” the PA said.
$6 for soup to comfort a person and avoid a $20,000 charge. That’s a great ROI.
Don’t underestimate the manifold impacts of small acts of kindness. And a good cup of soup.
The author is an anonymous physician.
