It used to be that all doctors knew Latin. For centuries, medical books were written in Latin; medical terms were derived from Latin; and, most important, in the days before science, the knowledge of Latin differentiated the physician from the traditional healer. Even at Laguna Honda, all the doctors on the admitting ward, except for me, knew Latin, although each for a different reason. Dr. Fintner knew Latin because she went to medical school when Latin was still required. Dr. Rachman knew Latin because she’d been educated by nuns; and Dr. Romero knew Latin because she went, on scholarship, to elite Eastern private schools. But I had never learned it, Latin having been replaced by the time I went to medical school with physics, calculus, and biochemistry.
But Hildegard wrote in Latin, and I knew that reading her own words in her own language would be crucial for understanding her medicine. Finding a way to learn Latin, however, was not easy. The community colleges did not offer it, and even at the university the operator connected me through to Latin American Studies. So I got a tutor, and in the evenings after I’d taken care of my patients, I studied Latin. It was a provocative and rich study—not so much the military exploits of Caesar or the rhetoric of Cicero, but the language, the words themselves.
Next I went looking for a way to learn Hildegard’s Latin in particular. Because it turned out that Hildegard wrote Medieval Latin, not Classical Latin, and they differed. Medieval Latin was more colloquial than Classical; it was the language that the Middle Ages spoke, as well as wrote. It was also even more obscure a subject than Classical Latin. It took me a while, but, eventually, I found that the university near where I lived offered a seminar in Medieval Latin.
Dr. Major allowed me one morning a week at the university, and there I met and was mentored by that quintessential medieval scholar George Brown.
Professor Brown had not one but two PhDs, and before he’d become a professor, he’d been in a Jesuit seminary. Naturally tonsured by hair loss, he wore a beard, and looked surprisingly like the subject of his many monographs, the Venerable Bede. Small and fit, Professor Brown set the standard for medieval scholarship as much by the pressed shirt, precisely tied cravat, and wool blazer he wore, no matter how hot the day, as he did by his careful studies. He was as soft-spoken, modest, and quietly intelligent a scholar as Dr. Fintner was a doctor.
Classes were held in one of the tawny stone and red-roofed buildings of the university. It gave me a start, sometimes, as I walked past the fountains, the Romanesque church, and down the cloistered walk to class, to realize how similar were the institutions of university and hospital. Both had come into their own during the twelfth century. Both expressed the nonmonetary values that the West placed on learning and healing. Both professor and doctor were in service to ideals that went beyond themselves.
There were also profound differences. Around me, as I walked to class were youth and wealth. Society was spending its resources on its future—a long, productive life lay ahead of those students, not like the patients at my hospital. Also, education, unlike medicine, had not yet been commodified. The university was not yet an “information provider,” and Professor Brown not only looked and acted but was treated like the scholarly knight he was.
I learned not only Medieval Latin from him but also paleography—that is, how to read the handwriting of the preprint Middle Ages. I learned about glosses—the notes written next to or between the lines of a manuscript that commented on the text. And I learned about palimpsest, shadow texts that could sometimes be discerned beneath another text. Parchment—the sheepskin on which everyone wrote during the Middle Ages—had been expensive, and it was sometimes reused by scraping ink off old pages. This wiped the page clean, but not completely. The erased text could still be seen as a faint shadow beneath the new.
Palimpsest seemed to be a perfect way of describing what I was beginning to learn at Laguna Honda: That underneath our scientific modern medicine was an earlier way of understanding the body—erased, to be sure, just a faint shadow on our consciousness, but active in our thoughts and desires, nonetheless.
The two months I’d promised Dr. Major were long gone, and she had not queried me about my plans. I was comfortable on the admitting ward, seeing patients with Dr. Rachman, Dr. Romero, and Dr. Fintner, and I was more and more intrigued by the hospital. I was beginning to learn something special from my patients, something that would take me all my years at Laguna Honda to grasp, and that was the experience of being a patient.
It happened because I saw my patients twice or even three times a day, usually for months; I got to know them, and they, of course, me. Toward the end of those first years, there was one patient in particular, a terrible patient. She wasn’t even my patient. She was Dr. Romero’s patient, but her bed was between two of my patients, and I passed her every day. She had a horrible disease, and a horrible disease at Laguna Honda was really horrible.
Miss Tod was thirty-five years old. She had cancer. Her cancer was brain cancer, and what made it horrible was that it was just behind her right eye, and it had grown, in spite of surgery and radiation, right out of her eye. The surgeon had removed the eye and sewn the eyelid down over the cancer, but the cancer was still growing.
Miss Tod had never been beautiful, but, what with the radiation, which had caused her hair to fall out; the steroids, which had caused her face to balloon; and the sewn eyelid, which had started to bulge, she was now very hard to look at. Yet she was pleasant and quiet. She always smiled as I passed her by. Eventually we were on speaking terms, with a quick hello and a how-are-you from me to her, and from her to me. I got used to her deformity, although only by blocking out, in some way, my experience of her experience.
One day I finally braved my reluctance and stopped by her bed. Full stop. We looked at each other. She at me, white-coated, rushed, a bit disheveled. I looked only at her left eye.
“Is there anything I can do for you?” I asked her, after we talked a bit.
“Yes,” she replied, “there is. I really don’t like the food they’re giving me. It’s all cut up and bland. Do you think it could be changed? And another thing. Could you arrange for me to visit the eye doctor? I need a new pair of glasses.”
I was, and am to this day, floored by her response. I was, and am, awestruck by such equanimity. She wanted—not euthanasia or a miraculous cure, stronger pain medications or a second opinion but—different food. A pair of glasses. She said nothing about her terrible misfortune. She was calm, matter-of-fact. Somehow she’d accepted her fate, and it was the small things, the little daily things, that were important to her.
We did change her diet, and we did get her new glasses. Not long after, she moved to another ward, and there she died peacefully, eighteen months later. But her lesson, which I was taught over and over again by so many patients, took me much longer to assimilate. Bravery. A core, a rock of self, radiating courage.
It’s a quality that most young doctors, even most middle-aged doctors, can’t understand, having had the good fortune to never have been a patient, at least not a patient like Miss Tod. Doctors, after all, start out as young students, healthy, curious, hardworking. What do we know of misfortune and the hand of God?
One medical school tried to remedy this lack with a preadmittance program: Medical students were required to check themselves in as patients, incognito, to the hospital where they’d be working in the near future. This was so that they could gain some idea of what it felt like to be a patient—your watch and belt given over, and a backless gown put on, to wait exposed and vulnerable on a gurney in the hall, a luckless anonymity. It was a good idea, but it didn’t work too well. Long about June, when those young and handsome men checked into area hospitals, hair and face and eyes intact, the nurses and doctors knew who they were, of course. They winked; they smiled and even flirted with these “patients” admitted for “abdominal pain.”
Still, it was a good idea, a good thought.
Miss Tod capped my experience of those first years at Laguna Honda.
She summarized it and hinted at what I would be learning later. Even when there is nothing to do for a patient—no cancer to discover, no paradoxical pulse to take—there is still something to do. It doesn’t have to be lifesaving, grandiose, and heroic. It can be as simple as a pair of glasses or a different diet. In fact, it usually is.
She taught me that I didn’t have to be afraid of the possibly contagious bad luck of my patients. That they would manage by themselves. What I had to do was ask them what I could do for them and then do it, if I could. For those who couldn’t answer for themselves, there were other ways of learning what they needed: their neighbor-patients across the way, the nurses, the nursing assistants, the volunteers.
Before I came to Laguna Honda, I’d been convinced of the importance of scientific medicine; Miss Tod convinced me of the importance of the little things.
She also convinced me of the corollary: It’s not the big thing. The big thing—the hand of God, fate—can be accepted, perhaps because it is so big and fateful, so unchangeable. But the small things are correctable, or should be, if people only cared to notice. The thrice-daily arrival of an unpalatable diet, the broken glasses—these are constant reminders that we are not cared about. Perhaps we can accept that God has it in for us for reasons of His own, or reasons (in the case of Laguna Honda’s patients) that we know very well. But that our fellow human beings don’t care enough to change our diet or repair our glasses …
Which is why the cute medical students who went incognito to their hospitals-to-be, waited in admitting, gave up their watches, belts, and clothes, even lay in a gurney for the elevator, couldn’t have learned about the real small things. Because the winks, the nudges, the tender flirtations of the staff reassured them that they were worth caring for, and were cared for.
Not too long after my experience with Miss Tod, I met Professor Brown, by accident, in the library.
He was impressed by my project for his paleography class, he told me. But I had come to the end of what I could do without formal training in history. I knew Latin well enough to read Hildegard, and I knew enough paleography. Still, if I wanted to go further, I needed to go to graduate school, and not in medieval history but in the history of medicine. There were only a few such graduate programs in the country; however, there was a good one just around the corner from Laguna Honda. He advised me to contact its chief—Professor Doctor Gerhard Weitz, MD, PhD.
So I did. On the phone, Professor Doctor Gerhard Weitz was rather cool. His was a small graduate program, he said, and a PhD in medieval medicine would be difficult, perhaps impossible, for him to supervise.
Would he be willing to meet me for an interview, anyway?
He would. So we arranged to have lunch together at a restaurant near the hospital the very next week.
Two
THE LOVE OF HER LIFE
I RECOGNIZED Professor Doctor Gerhard Weitz right away.
He was almost exactly what I’d imagined from our phone conversation—white-haired, clean-shaven, blue-eyed, the very model of the German medical scholar. He was dressed less formally than I’d expected, though, in slacks and a white open-collared shirt. We met at the South American restaurant he’d recommended, found an out-of-the-way table, and sat down. He ordered a roasted-red-pepper dish and a small glass of wine, and I chose the same.
As soon as he opened his mouth to speak—a full mouth with red, moist lips—I understood the dissonance between his German appearance and his un-German manner. He was Latin. Though born in Germany, Dr. Weitz had been raised in Argentina, and his accent was a mix of German and Spanish. Just so, beneath his German exterior there beat a hot-blooded, cayenne-loving heart. To his detriment, I would learn over the years. Like the gender misfit—a woman in a man’s body—Professor Doctor Weitz, MD, PhD, was a Latin in a German body, ever mis-taken and ever mis-understood.
He began the interview by telling me about his graduate program in medical history, which was tiny, he said, with only two professors, and focused on American medicine. It was not equipped to take on premodern medicine or Hildegard. If he accepted me, I would have to take classes and organize advisors at other universities, although, frankly, he had no idea how that might be arranged. First I would complete a master’s degree, and then—perhaps—go on to the PhD, which had formal orals at the end of the third year and two required languages. As a practicing physician, I would not find his program easy. But … here he sat back in his chair and looked at me. My project interested him. A medieval German nun who’d written a practical medical text …
His own project was hospitals. As a matter of fact, he was writing the definitive history, he hoped, of hospitals. With this, he brightened and leaned across the small table, trespassing on the arm’s-length distance decreed by German etiquette.
What was interesting about hospitals, he said, was that they were specifically Western and Christian institutions, not Greek or Roman. The closest thing the Greeks had to hospitals had been their healing temples—which were beautiful places near healing springs, but staffed by priests, not by doctors. The Romans did have something like hospitals, but only for their soldiers; nothing like a hospital system for their sick citizenry. Instead it was the Christian monastery of the Middle Ages that originated the hospital system we know today. In the monastery, caring for the sick was the foremost Christian duty, and each monastery had, therefore, a hospice for taking care of the sick poor and an infirmary for taking care of the sick monks. A monk infirmarian or, Dr. Weitz supposed, even a nun infirmarian, would be in charge of both the hospice and the infirmary, but no one knew much about what they did or how the system worked. Yet these monastic hospices and infirmaries had been the models for Europe’s hospitals and almshouses. Sometimes even their direct ancestors; today’s Hôtel-Dieu in Paris was founded by monks in the seventh century, and it still functioned as Paris’s hospital for the poor. 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.
But that was pretty much all we knew about them, which was why my project intrigued him. Perhaps Hildegard of Bingen had been the infirmarian for her monastery, and that was why she wrote her medical text, Dr. Weitz said. Then I could use it to find out what went on inside the infirmary and hospice: how diseases were diagnosed and treated; what medications were used and why; even how premodern medicine actually worked. I could use what we already knew about medieval medicine as the background for my research. It was an extraordinary opportunity and would be very helpful to him for his book.
Dr. Weitz leaned back in his chair, wiped his mouth, and looked directly at me.
“It’s going to be a long and complicated project, though. You will have to learn German, as well as Latin, and you will spend a lot of time in libraries, looking at medieval manuscripts. You must cut your medical practice down to half-time. The department has a small fellowship, and I will award it to you.”
With this generous if abrupt offer, Dr. Weitz stood up, and so did I. We walked out of the restaurant together and down to the corner, where he stopped. Then he gave me an intense but shuttered look, turned up the street, and walked back to his university.
When I told Dr. Major about my plans to start graduate school in medical history, she was supportive and flexible. As it turned out, Dr. Romero was taking a leave of absence, so I could cut back to half-time by taking her place, job-sharing with Dr. Fintner. Dr. Isaiah Jeffers would take my full-time position.
Up to then I’d known Dr. Jeffers only slightly; we would get to know each other very well over the next years. He was tall, dark, and handsome—black, as a matter of fact, and a success story of affirmative action, as he told me one day. He grew up in Florida, and his grandmother raised him out in the country. Jim Crow laws were still in force, and at his school they’d studied with the previous year’s used textbooks. Which were okay, he pointed out with his signature smile; they weren’t an
y less accurate than the new ones. He won a scholarship to Morehouse College in Atlanta, and then he was “affirmative-actioned” into medical school. The system had worked for him, he said; and by “worked” he meant that his two children, who were in private schools, would not need affirmative action when it was time for them to go to college.
Dr. Jeffers took over the desk opposite mine. It was not really a desk but a narrow counter that ran along the wall. Over the years it would always be the desk of the lankiest male physician, perhaps because, lacking drawers, it had a natural place to wrap and store those long legs.
Unlike Dr. Fintner, Dr. Jeffers did not know just about everything about medicine. He knew just what was necessary. And unlike Dr. Rachman, his workups were not long and elegant, but short; his scrawl transgressed the lines of the paper and went right to the point. What interested him was not so much what the patient might have—he was usually satisfied with the conclusions of others—but where the patient was from and what kind of life he’d lived.
Dr. Jeffers also knew a good thing when he saw it, as he said to me one slow afternoon. Pushing back his chair from his counter desk, he looked around the walls of our office, which were just as bare as when I’d arrived. He glanced at our lone, uncomplicated computer, at the books on our bookshelf, and at our single, barred window. He tilted back in his chair and then said in his low-pitched drawl, “You know, Victoria, we’ll never have it this good.”
And what he meant was—this peaceful, this unhassled, this left-alone-to-do-what-we-needed-to-do for our patients. No one paid any attention to us. The pharmacists left us alone to use medications the way we wanted, for their side effects or their off-label use; insurance companies didn’t bother to manage us; outside hospitals were simply delighted when we took their complicated patients. Above all, Dr. Major trusted us to do what was right for our patients. Which, for a doctor, is a wonderful thing.
God’s Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine Page 4