Justin Cook | The Roanoke Times

''Only 7,000 more [slices] to go!'' says cook Sal Maida, who is making about 8,200 slices of turkey at the Carilion Clinic kitchen in Roanoke. About 900 pounds of turkey will be served at Carilion hospitals today.

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Cooking 2,300 Thanksgiving dinners for eight Southwest Virginia hospitals and one in Northern Virginia began early this week at a large industrial kitchen off Franklin Road in Roanoke owned by Carilion Clinic.

In one corner, on Tuesday, a worker used an electric pulley to lift a huge metal strainer filled with 50 gallons of green beans. Others filled tube-shaped bags of gravy and sent them down a conveyor belt. The kitchen's narrow aisles, each one a maze of oversize kettles and stainless-steel contraptions, buzzed with searing and steaming sounds.

As families across the region belly up to their Thanksgiving dining tables, Carilion's central kitchen will have already churned out hundreds of turkey dinners.

Hospital dietitians and chefs will have navigated the fine line between taste and nutrition, striving to match the traditional fare with a dizzying array of dietary restrictions that call for everything from low-fat to high-calorie meals. Lewis-Gale Medical Center in Salem has a similar challenge, but on a smaller scale, cooking about 800 dinners for patients, workers and guests at one hospital.

The preparations will mean compromises -- low-sodium gravy and sugar-free pumpkin pie -- but also comfort to those who will spend the holiday in this nontraditional setting, hospital chefs say.

"We are their entertainment for the day," said Michael Hodgkin, director of food and nutrition services at Lewis-Gale. "We're the only people not sticking them with something."

Still, hospital food, like airplane fare, has long battled a less-than-savory reputation epitomized by bland soups and cubed Jell-O.

Workers at Carilion's kitchen say their mission is to stomp out the "hospital food stereotype" by constantly testing recipes and offering twists on traditional staples such as pumpkin mousse, rather than pie.

"We want to make it good for you, but not so foreign that you couldn't make it at home," said Jay Brinkley, director of culinary services for the Barnesville, Md.-based FoodService Partners, Carilion's food service contractor.

Still, hammering out safe but savory victuals for about 1,000 patients a day is often a tug of war between the hospitals' dietitians and chefs, Brinkley said.

About 70 percent of the patients are on physician-ordered diets, and some of those diets change hourly, said Susan Carter, Carilion's clinical nutrition manager for the chain.

The hospital typically plans for nine basic diets but often makes variations according to the recipient. That means its kitchen menu must accommodate anyone from a heart patient to a diabetic to someone leaving surgery, or in some cases, all of the above, Carter said.

"The logistics are unbelievable," said Mary Miller, president of the National Society For Healthcare Foodservice Management, which represents more than 2,000 on-staff professionals.

What's more, most hospital systems are feeding a sicker population, she said, because patients overall are averaging short stays. "It used to be when a patient can eat, they were ready to leave intensive care," Miller said. "Now, it's when they are better, they go home."

At the same time, an increasing number of hospitals are starting to look at their food service as a way to boost their competitive edge, said Mike Buzalka, an editor at Food Management magazine, an industry publication for noncommercial food services. "That's why rooms service programs are becoming more prevalent" at hospitals, Buzalka said.

Hospitals nationwide are expected to spend an estimated $4.4 billion on food in 2007, a 4 percent jump from the year before, according to one study by Chicago-based food research company Technomic.

In Roanoke, Carilion built its central kitchen in 2002 in hopes of cutting costs and making its food quality more uniform, said Rebecca Ellis, senior director of dining and nutrition services at Carilion, which budgets about $10 million a year for its food services. Regardless, a hospital culinary operation is geared to work in large volumes, making Thanksgiving dinner on par with other meals, food service managers said.

Hodgkin at Lewis-Gale said the kitchen staff will boil close to 300 pounds of potatoes today. It will also roast about a 500 pounds of turkey. Usually, the hospital offers room service options to patients and varies its menu with four or five items. But on the holiday, it will limit its offerings to Thanksgiving Day fare.

"It's just another day in the office," Hodgkin said. "Instead of four or five entrees, it's just one."

The entire Thanksgiving dinner will cost at least $3,000 wholesale, a sliver of the hospital's annual $1.7 million food budget, he said.

As for Carilion, the kitchen will roast 900 pounds of turkey breast, make 1,000 pounds of stuffing, the same amount of mashed potatoes and about 500 pounds of gravy all for the Thanksgiving menu.

Food inventory costs for the meals will run anywhere from $16,000 to $18,000, Brinkley said, slightly higher than the $12,000 normally spent on daily expenditures for its food services.

On top of the Thanksgiving meals, the central kitchen was also cooking for another 3,500 employees at Inova Fairfax Hospital as part of its employee recognition lunch today. Carilion had a similar event for its hospital employees earlier in November.

"The hospital is open 365 days a year, Thanksgiving is a little heavier, but the effort is about the same," said Mark Hiner, general manager for FoodService Partners in Virginia.

Daily deliveries of hospital fixings leave the central kitchen at about 5 p.m. They are delivered to each of Carilion's regional hospitals, some as far out as Giles County, and compiled on site, Hiner said.

Today's meals will become holiday feasts for patients like Geraldine Simmons, 77, who is spending Thanksgiving at Carilion's Roanoke Rehabilitation Center. She's been at the center for several weeks following a stroke she had on Nov. 2. This will be her first Thanksgiving dinner away from her home in Roanoke County where she usually cooks for her four children, four grandchildren and four great-grandchildren, she said.

"Until this year, they've all come to our house," she said.

Even so, she seemed all right with the prospects of eating in the center's cafeteria.

"We've been here so long they seem like family," she said of the center's staff, whom she described as "angels."

Her only worry was eating the turkey, her favorite Thanksgiving item, because she's had some trouble chewing after the stroke. "I just hope they don't grind my turkey up," Simmons said, sitting next to her husband of 58 years, Elmer, who plans to spend Thanksgiving Day with her.

Still, for the cooks behind the holiday feast, feeding thousands of guests can prove to be an exhausting endeavor. Asked about his Thanksgiving dinner plans, Hiner said he intends to head to his mother's house in Bath County. "I'll have had enough cooking by then."