GOD’S HOTEL
GOD’S HOTEL
A Doctor, a Hospital, and a Pilgrimage
to the Heart of Medicine
VICTORIA SWEET
RIVERHEAD BOOKS
a member of Penguin Group (USA) Inc.
New York
2012
RIVERHEAD BOOKS
Published by the Penguin Group
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Copyright © 2012 by Victoria Sweet
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Published simultaneously in Canada
Library of Congress Cataloging-in-Publication Data
Sweet, Victoria.
God’s hotel : a doctor, a hospital, and a pilgrimage to the heart of medicine / Victoria Sweet.
p. cm.
ISBN: 978-1-101-56181-2
1. Sweet, Victoria. 2. Physicians—United States—Biography. 3. Laguna Honda Hospital (San Francisco, Calif.)—History. 4. Hospital care—California—San Francisco—Anecdotes. I. Title.
R154.S925A3 2012 2011049340
610.92—dc23
[B]
Printed in the United States of America
1 3 5 7 9 10 8 6 4 2
BOOK DESIGN BY AMANDA DEWEY
While the author has made every effort to provide accurate telephone numbers and Internet addresses at the time of publication, neither the publisher nor the author assumes any responsibility for errors, or for changes that occur after publication. Further, the publisher does not have any control over and does not assume any responsibility for author or third-party websites or their content.
Penguin is committed to publishing works of quality and integrity. In that spirit, we are proud to offer this book to our readers; however, the story, the experiences, and the words are the author’s alone.
All of the names and identifying characteristics of the patients have been changed.
ALWAYS LEARNING
PEARSON
FOR MY PARENTS
and
FOR THE PATIENTS OF LAGUNA HONDA HOSPITAL
IN SAN FRANCISCO, CALIFORNIA
Contents
Introduction. HOW I CAME TO GOD’S HOTEL
One. FIRST YEARS
Two. THE LOVE OF HER LIFE
Three. THE VISIT OF DEE AND TEE, HEALTH-CARE EFFICIENCY EXPERTS
Four. THE MIRACULOUS HEALING OF TERRY BECKER
Five. SLOW MEDICINE
Six. DR. DIET, DR. QUIET, AND DR. MERRYMAN
Seven. DANCING TO THE TUNE OF GLENN MILLER
Eight. WEDDING AT CANA
Nine. HOW I FELL IN LOVE
Ten. IT’S A WONDERFUL COUNTRY
Eleven. RECALLED TO LIFE
Twelve. THE SPIRIT OF GOD’S HOTEL
ACKNOWLEDGMENTS
NOTES
Introduction
HOW I CAME TO GOD’S HOTEL
IT WAS MY FIRST AUTOPSY, my first day in the clinical clerkship of medical school called pathology.
Of course, I had seen and even taken apart dead bodies before, in the first months of medical school, but those had been bodies that were clearly ex-bodies. They smelled like the formaldehyde no longer running in their veins, and my hands and fingers were wrinkled from touching them. Except for that smell, they might as well have been made out of plastic.
But when the covers were lifted from this body’s face, I was stunned. It was Mr. Baker! One of my first-ever real patients! A short, stocky, cigarette-smoking “blue bloater,” whose emphysema had destroyed his lungs and given him his barrel chest; thick, short neck; and gravelly voice. Whose arteries and veins had been so difficult to get blood from, and who had been so understanding, so cheerful, so lively. I was sure he’d done well, been discharged, gone home. But apparently not.
As I looked at this body, however, I began to have doubts. I knew that it was Mr. Baker, but, really, it didn’t look like him. Or rather it resembled Mr. Baker the way the figures in a wax museum look like Clark Gable or Winston Churchill—like them, but not them.
I watched as the pathologist set to work with his electric saw. He opened the chest wall and removed the soggy, honeycombed lungs. He weighed them each separately, first the right lung, then the left. Then he took out the large and heavy heart, with its right side hypertrophied from lung disease, and documented its weight in grams. Next he opened the abdomen and ditto the liver, the spleen, the pancreas, the kidneys. Each organ was removed and weighed, and its weight in grams tallied. The blood vessels, large and small, were inspected and commented upon. Then the saw attacked the head. Sure enough, there it was—the brain—looking just like it did in the books, gray, spongy, with a texture kind of like pâté—homogeneous, boring. Then Mr. Baker was done. We were done. Finished. That was it. Nothing more inside.
I found myself strangely disappointed. There was nothing else to see. No hidden place, unexplored and unexplorable, no unopenable, small black box, hidden in all those wiggly intestines. It was undeniable—Mr. Baker had completely disappeared. Autopsied, his body was nothing more than a suit of clothes lying disregarded in the corner.
Something was missing. But what? Mr. Baker’s breathing? His movement? His warmth? What I had expected, I later came to realize, was some sort of thing, some unopenable last nubbin, like what you find at the center of a baseball when you unroll it. I had expected some thing that was, well, ineradicably Mr. Baker, something the pathologist’s saw could not open and destroy. But there was no such thing; I could see for myself.
Much later I learned that medicine had once had a name for this, this something present in the living body but missing from the corpse. Two names, actually. There was spiritus, from which we get the English spirit, although the Latin spiritus was not as insubstantial as “spirit.” Spiritus was the breath, the regular, rhythmic breathing of the live body that is so shockingly absent from the dead. Spiritus is what is exhaled in the last breath.
And there was anima. Usually translated as soul, the Latin is better for conveying the second striking distinction between Mr. Baker’s dead body and Mr. Baker—its lack of movement. Because anima is not really the abstraction, “soul.” Anima is the invisible force that animates the body, that moves it, not only willfully but also unconsciously—all those little movements that the living body makes all the time. The slight tremor of the fingers, the pounding of the heart that shakes the living frame once a second, the gentle rise and fall of the chest. Those movements by which we perceive that someone is alive. Anima, ancient medicine had observed, is just as absent fro
m the dead body as spiritus.
By the time medicine got to me, however, words like spiritus and anima had been banished from the medical vocabulary. I had no concepts for describing what I’d seen. Perhaps it had been autopsy—from the Greek auto-opsia: seeing for oneself—that brought about the disappearance of those words from the Western vocabulary. Perhaps it was the absence of that little black box.
I formed no hypothesis, at the time, about the absence of Mr. Baker’s spiritus or anima at the autopsy of his body. I didn’t even know that such concepts had once existed. But I did tuck away in the back of my mind the image of his dead body as a crumpled suit of clothes, abandoned in the corner of a sterile white room.
When my family learned I was going to medical school, they were shocked. No one in the family—and our family history goes way back—had ever been a doctor, medicine being too physical a profession for our businessmen and intellectuals. Medicine was too physical for me also, but it intrigued me with its possibility of engaging with what Catholics call the last things: death, resurrection, heaven, hell, and purgatory. Also, I liked that medicine would require me to meet with everyone on a kind of equal basis. Anyhow, I reassured them, I was going into medicine through a side door that was not physical at all—the door of psychiatry. The work of Carl Jung fascinated me, and I hoped to imitate his life—seeing brilliant, well-paying patients in the morning in my stone house on Lake Zurich, writing and lecturing in the afternoon.
After the first two years of medical school, which teach the basics of medicine—anatomy, physiology, biochemistry, and pharmacology—there are the two clinical years, when the student gets to apply this learning to real patients. I hadn’t expected to like this part, but I did. There was a lot of psychology to it. I discovered that I loved taking the “history”—the story that the patient tells, within which is hidden the real meaning of his condition. I loved the physical examination of the patient, on whose body was written, if I could only read it, the real diagnosis. And I loved analyzing the facts and reaching a conclusion, which is the diagnosis, the treatment, and the plan.
After medical school I started my psychiatric training. But psychiatry, I soon realized, had changed since Jung. Madness was now located in the brain and caused by a chemical imbalance; its treatment was not analysis but medication, which often worked remarkably well. So instead of becoming a psychiatrist, I went out and practiced medicine in a county clinic, and then in a rural private practice. Eventually I went back for more training and finished the three years of a medical residency. After that I practiced in a community clinic and became its medical director.
During all those years I was ever more impressed by the power of modern medicine—by its logic, its method for arriving at a diagnosis and a treatment. Yet every now and again I had other experiences like that with Mr. Baker—experiences that left me wondering. The moment of birth. The moment of death. A mysterious knowing of just when a patient was about to get ill. All evidence of some subtle but shared world, where beings popped up and disappeared, of invisible connections with visible effects.
Naturally, I assumed that modern medicine had investigated such phenomena, and I began to research what it had learned about them. They had acquired very boring names, I immediately discovered: the “doctor-patient relationship”; the “placebo effect”; “psychosomatism”; the “effect of prayer.” Also, they had been assigned to the realm of psychology, where they had been psychologized—separated, that is, from the body where I’d seen and felt them.
Next, I looked at alternative medicine for answers. Chinese and Indian medicine did give me some insights, since the body they described was a body of flows and blockages, balances and imbalances, a body that might explain the borderless energy I’d felt in my patients. But the languages and cultures of Chinese and Indian medicine were just too different; they stood in the way of my integrating their point of view into my own.
It was at this discouraging moment that I stumbled across a book that surprised me. It was the record of a German nun’s medical practice from the Middle Ages, translated from the Latin. Hildegard of Bingen, I learned in its introduction, had been a twelfth-century German mystic, theologian, and, amazingly, medical practitioner, and she had written a book about her medicine. And, although Hildegard of Bingen’s Medicine was not a great book, it was thrilling. Because the world underlying its medicine was just the kind of world in which the observations I had tucked away for so many years had been known and used—in the West.
So I began to study Hildegard’s medicine. I began to realize that our medicine, modern medicine, had not been the first Western system for explaining the body, but the second. Before the reductive modern medicine I’d learned in medical school, there had been a different medical system in the West. This “premodern medicine” had originated with Hippocrates in the fifth century BC, and it had once been how everyone understood the body. Its approach, I realized as I studied Hildegard’s medicine, was not mechanistic: The body was not imagined as a machine nor disease as a mechanical breakdown.
But if the body was not imagined as a machine, I wondered, then how had it been imagined in the 2,500 years that preceded my medical education? Could it be that the West did have explanations for the difference between the dead body and the living, and for the other experiences I’d had in my medical life? And that these explanations had been thrown out with the triumphs of modern medicine? Did premodern medicine and modern medicine perhaps make up a unit—one thing seen from two perspectives, like those drawings that show two different images at the same time?
I didn’t know. But I was intrigued, and I resolved to find out.
To do so, I needed time, however, and time was another concept left out of modern medicine. In the premodern world, medicine had not been a full-time profession but a craft, transmitted through families and learned as an apprentice. Most practitioners, therefore, were not only doctors, but doctors and something else. The elite were doctors and professors; the majority were doctors and farmers, doctors and herbalists, doctors and barbers. This had some advantages. For the patient, it meant that doctors had more than one point of reference; for the doctor, he or she had time to think about other things in other ways.
In the modern world, though, medical training was arduous and costly; physicians were obliged, both professionally and financially, to be available to their patients at every hour of the day and night. Personal time was scarce, and part-time positions unheard of. Today this is no longer the case. Medicine has completed its metamorphosis from craft to profession to commodity, and health-care providers now sell their wares—that is, their time—by the piece on the open marketplace. Back then, however, I spent several months looking for a position that would allow me to practice medicine and also pursue a doctorate in the history of medicine. Without success.
Until I contacted Dr. Major, the medical director of Laguna Honda Hospital in San Francisco. On the telephone, Dr. Major assured me that she could accommodate my requirement for a part-time position; many of the doctors she’d hired did other things with their lives. She had doctor-musicians, doctor-sculptors, doctor-physicists, and doctor-mothers. She knew that time was the special perk she had to offer.
So I drove over, somewhat skeptically, for my interview.
When I saw Laguna Honda for the first time, I was taken aback. During my medical training I’d occasionally had a patient admitted to it, but, like most physicians in the city, I’d never visited. If asked, I would have said that I imagined it as a concrete parking structure where patients were stacked one on top of another, floor by floor, in some dusty, industrial part of the city. Instead, what I saw as I drove in the front gate and past the gatekeeper’s abandoned cottage was an elegant, though somber, riff on a twelfth-century Romanesque monastery. High on a hill, its peach-colored, red-roofed buildings overlooked the ocean. Each of the six wings of the hospital was lined with rows of windows, and at the end of each wing was a turret, with swallows flying in and out of it
s open arches.
I met Dr. Major in her office and, after our interview, she took me out for the tour. Laguna Honda was an almshouse, she explained as we started, or, as the French called it, an Hôtel-Dieu—God’s Hotel—a kind of hospital from the Middle Ages that evolved as a way of taking care of those who couldn’t take care of themselves. At one time, almost every county in the United States had an almshouse, she told me, 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. In theory. In practice, the almshouse had been a catchall for everyone who didn’t fit someplace else—it was a shelter, a farm for the unemployed, a halfway house, and a rehabilitation center, as well as a hospital. Over the last forty years, though, just about all the almshouses in the United States had closed, except for Laguna Honda. Laguna Honda, Dr. Major said, was probably the last almshouse in America, and with its 1,178 patients, it was as large as a village.
We walked under a delicate, wooden statue of Saint Francis, the patron saint of our city, and then into a wide central hall with floor-to-ceiling windows. There were vending machines and small round tables, and the hall was filled with patients, smoking, drinking coffee, playing poker. Then we turned and walked through heavy doors into a ward. We passed a small working kitchen, a dining room, a doctor’s office, and the nurses’ station, and then we entered the long, open ward.
It was lined with beds, fifteen to a side, and each bed was set next to an open window. By each bed was a bureau for the patient’s belongings, a chair for visitors, and a small table. At the end of the ward was a round room, windowed and sunny, the solarium, designed so that each patient could have access to sunlight and fresh air without leaving the ward. (So that was the purpose of the turrets!) There were thirty-eight wards in the hospital, Dr. Major explained, and they were more or less identical. They’d been designed before the antibiotic era so that, in case of infection, every ward could be quarantined from the rest of the hospital and still function as a separate minihospital.
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