A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine
Where can you find a story that links together the last almshouse in America, the most obstreperous medical patients ever, a medieval female physician, and modern healthcare? In the book God’s Hotel by Victoria Sweet. Published in 2012, God’s Hotel is a tour-de-force of non-fiction that is part memoir, part critique of 21st century medical practices, and part time-travel to a twelfth century infirmary. As you immerse yourself in the story, Dr. Sweet, named a Guggenheim Fellow for 2014-2015, takes you along on her spell-binding journey of her two decades as a physician at Laguna Honda Hospital.
After several years of medical practice, Dr. Sweet wanted to find part-time work as a physician in order to have time to accomplish an academic goal. Laguna Honda, the last remaining almshouse in the United States, was the only medical facility in San Francisco open to the idea of a part-time physician. After a tour of the hospital, Dr. Sweet agreed to work at Laguna Honda Hospital, but only for two months; she ended up staying for over 20 years. In her time at Laguna Honda, Dr. Sweet grew to value the slow-paced, low-tech approach to medicine practiced at the facility — a type of care that was well suited to the difficult and persistently ill patients who were admitted to Laguna Honda.
Sweet did successfully achieve her academic goal by completing a Ph.D. in Medical History while practicing part-time at the hospital. This doctoral study, which centered on Hildegard von Bingen’s Middle Ages approach to medicine, proved to be a source of great practical help to Dr. Sweet while she was treating some of her most puzzling patients; the stories of these case studies are both captivating and eye-opening.
The title of the book, God’s Hotel, comes from Hotel-Dieu, the hospital for the poor, or almshouse, which was founded in Paris in the seventh century. Sweet says, “The West’s unique and, when you thought about it, surprising ideal — that a society should take care of its sick poor — had originated in those monastic hospices and infirmaries of the Middle Ages…. At one time, almost every county in the United States had an almshouse…as well as a county hospital. They had functioned together. The county hospital took care of the acutely ill, and the almshouse took care of the chronically disabled…Laguna Honda was probably the last almshouse in America, and with its 1,178 patients, it was as large as a village.”
Despite its cumbersome size and the demanding patients, Dr. Sweet writes that she loved her time at Laguna Honda because it was personal. People and their illnesses, doctors and their skills had time for give and take, time to interact at a human pace. In a one sentence summary of her practice at Laguna Honda, Dr. Sweet said, “When medicine is personal, it works.”
Dr. Sweet’s style of patient care at Laguna Honda eventually came to be directly affected by her in-depth study of the abbess, composer, mystic, and physician, Hildegard von Bingen, who lived in the 12th century. Dr. Sweet relates that the primary benefit she gained from Hildegard’s method of pre-modern medicine was an understanding that medieval medicine was far more holistic than modern healthcare, and was agrarian in its approach rather than mechanistic. That is, Hildegard, and other physicians of her time, saw their ill patients more as plants that needed to be restored to a flourishing state than as broken machines that need a mechanic to fix them, which is the industrial world’s model. Nevertheless, at the end of her investigation of Hildegard’s methods of medical practice Dr. Sweet wrote, “I was even more grateful for modern medicine then I’d been before, especially for its scientific method, which tests the past, rejects what is ineffective, improves on what works, and passes to the future its powerful results.”
God’s Hotel includes numerous fascinating stories of patients and their lengthy, complicated, and sometimes humorous, stays at Laguna Honda. The reader also gets a first-hand look at what came to be criticized by various agencies as inefficient medical care. One story of “inefficiency” is about Dr. Curtis, who spent $16.99 of his own money to buy a pair of running shoes for a patient who had been waiting for three months to get a pair approved by Medicaid. Once the patient had the shoes, the doctor wrote discharge orders for him, and the patient was able to go home. Dr. Sweet writes, ” And it was… ironic that, while the [efficiency experts] were examining just about everything about the hospital (except its patients) –the books, protocols, costs, and revenues–Dr. Curtis had been providing the most efficient health care of all, leaving his ostensible duties to perform his real duty. He must’ve saved the healthcare system many thousands of dollars by buying those shoes, and yet the [efficiency experts] would not have thought his actions efficient. They would have thought it very inefficient–wasteful of the time of a highly paid, highly trained physician.”
Near the end of Dr. Sweet’s time at Laguna Honda, the hospital finally entered the 21st century as the staff and patients moved into a new, sleek, modern Laguna Honda hospital which was built not far from the old hospital. Could the spirit of the old almshouse and its unique inhabitants transfer to the new Laguna Honda? “No,” thought Dr. Sweet, what with large numbers of Quality Assurance experts, the Department of Justice investigations and new administrators who introduced complicated regulations, numerous forms, cuts in nursing personnel and increases in management personnel. Dr. Sweet expressed her deep regret that slow medicine and lengthy face-to-face sessions with patients would most likely fade away, and that she herself might have to leave the hospital, too; this she eventually did.
In a June 15, 2012 video from Google called Google Authors, Victoria Sweet spoke about her book God’s Hotel, and made a persuasive case for the value of slow medicine in today’s healthcare setting. She stated that fast medicine is good and necessary for fast medical problems: cardiac arrests, appendectomies, traumatic injuries. But a venue to practice slow medicine is appropriate and helpful for treating patients who have long term, chronic diseases or conditions: brain injuries, HIV/AIDS, kidney failure, or patients who have a combination of chronic illnesses. Dr. Sweet made this statement at the close of the video: “It’s time to give the pendulum of healthcare a nudge backwards toward the inefficient, the human and the personal.”
If you read God’s Hotel you may find that you agree wholeheartedly with Dr. Sweet’s assessment, but you may also ask whether it is possible to go back to a more human pace in medicine? There does seems to be a growing interest in the idea of slow medicine (http://www.huffingtonpost.com/michael-finkelstein-md/slow-medicine-is-the-medi_b_5705923.html), just as there has been in the idea of slow church, (http://www.patheos.com/blogs/slowchurch/slow-church-book/). Can those who desire “a nudge backwards toward the inefficient, the human and the personal” create artisanal waysides for those desiring a slower tempo in life? Only time will tell.