God’s Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine

by Victoria Sweet

  DR. CURTIS WAS HANDSOME as soon as I saw him, which isn’t always the case. Many of my friends and even patients seem pretty ordinary at first, and only as I get to know them do they become attractive. But Dr. Curtis was handsome right away. In fact, he was the handsomest of the physicians in a group of rather good-looking doctors. Dr. Major had a penchant for good-looking people.

  I met Dr. Curtis during my first week, while I was standing in the wide hall with the vending machines, looking at the scene. The hall was filled with cigarette smoke and patients in wheelchairs, who were gathered at the round tables, with cigarettes at the corner of their mouths, intently playing poker. The vending machines dispensed candy, ice cream, and coffee in paper cups printed with playing cards, and the patients were also betting on them, I saw, as the coffee came out of the machine.

  Dr. Curtis suddenly appeared next to me, and stood with me looking at the patients. Up until then, I’d seen him only from a distance as a trim, quick-moving figure. I knew that he was the assistant medical director and that he was leaving the hospital the next day to join a private practice on the coast. I also knew that when he wasn’t being a doctor he was being a surfer, and as he stood next to me, I noticed that he had a kind of surfer stance, holding himself from the center of his body, perfectly balanced. He was wearing a Hawaiian shirt. His hair was black and curly, and when he turned to talk to me I saw that his face was square and clean-shaven, his blue eyes warm and attentive.

  But it was his manner and smile that were arresting. His manner was quiet and poised; he seemed light on his feet and ready for anything. And his smile was particular. He didn’t show his teeth; rather, the corners of his mouth turned slightly up—exactly the smile of ancient Etruria—in a benign gaze that seemed to see just a bit into the distance. Standing next to me, Dr. Curtis was also looking at the scene, amused more than bemused. Then, out of nowhere, he said in a solemn tone and without any introduction, “You may not realize it, Victoria, but you should know that Laguna Honda is a special place.”

  It was an odd thing to say, and I looked at him more closely.

  “What do you mean?”

  He smiled. “Laguna Honda is a gift. You’ll see.”

  And with that he drifted off.

  It was clearly a message, but what he meant by it and why he delivered it to me, I didn’t know. Nevertheless, I remembered what he said; I tucked it away and took it out, now and again, when something remarkable, touching, or strange happened at the hospital.

  I didn’t see Dr. Curtis again for a number of years. He joined a private clinic on the coast and threw himself into creating the kind of medical practice that attended to what mattered to him: the way patients felt, the way the staff felt, and the preventative measures he believed in—exercise, diet, happiness.

  But like so many of the staff who left, to the accompaniment of parties and thank-yous and presents and plaques, after a few years, Dr. Curtis returned. He preferred the city. The surfing wasn’t that much better on the coast; city schools were better for his children; and he liked Laguna Honda. So he took up his duties as assistant medical director once again. This meant that while Dr. Major was at her ever-more-frequent meetings, Dr. Curtis was minding the store. He took care of the patients and covered the wards of doctors who were sick or on vacation; he interviewed prospective new doctors; he wrote procedures and protocols; and he provided a sympathetic ear for angry, stressed, or divorcing physicians—or sometimes just an ear.

  Since the admitting ward pretty much took care of itself, I saw him only rarely—up in the X-ray department or in the hallways. Still, I got to know him and discover that Dr. Curtis was a serious as well as a handsome man. What he was serious about was living his life well. After college he had not gone directly to medical school but to India, and there he studied yoga and Sanskrit and the lute. Then he decided to become a physician; he wanted to put yoga and Indian spirituality and Indian medicine into practice, so he strummed his way back to the United States and went to medical school. He came to Laguna Honda after he discovered the hospice movement and decided to set up the first hospice in the city.

  He set about doing so lucidly, harmoniously, and with integrity; and within a year he had pulled in not only Dr. Major, who was easy, but also Miss Lester, director of nursing, who was not. Like Manjusri, the Indian god whose sword of discrimination cuts through difficulties, Dr. Curtis cut through knots and charmed away intransigence. He obtained grants for his hospice project and the service of all kinds of volunteers—Zen meditators, hippie harpists, volunteer gardeners. Then, once his new hospice unit was up and running, settled and operating smoothly, he handed it off, along with its glory, to Dr. Kay. Dr. Curtis wasn’t just enthusiastic, he was an enthusiast, in the ancient Greek sense of entheos—“having a god within”—and, as with the rest of us, his strengths were his weaknesses. He did not take root. He stayed where he stayed as long as was needed and then went on to his next project, his next enthusiasm.

  Dr. Curtis was one of my heroes at the hospital because, with his keen eyes, free of the spectacles the rest of us wore, he not only seemed to see farther and deeper than the rest of us but did, in fact, see farther and deeper. So while Dr. Romero’s and Dr. Fintner’s admitting notes were detailed and elegant, and Dr. Jeffers’s scrawly and to the point, Dr. Curtis’s were often no more than a page, neatly printed. I saw one once that was no more than a few sentences: Mr. Gates was terminal; he was to have hospice care; his family had been contacted; he was at peace.

  I learned a lot from Dr. Curtis, but it was with the case of the missing shoes that he taught me the most about care and caring, time and inefficiency.

  On this particular day, I met him by accident in the wide, windowed corridor that ran the length of the hospital and connected all the wards. He was in a hurry.

  Where was he going? I asked.

  Back to the rehabilitation ward, he said, where he was covering for a few weeks.

  The rehabilitation ward, like the admitting ward, was its own minihospital within Laguna Honda. It admitted the patients with the milder strokes and the less traumatic head injuries, most of whom would recover and be discharged back to their homes, if they had them, although its patients, too, were often without friends, money, or health insurance. Like the admitting ward, it had its own physicians to admit, examine, and discharge its patients, and this month, Dr. Curtis was one of them.

  He’d just returned from outside the hospital, he told me, and was headed back to a patient who, having been rehabilitated after a stroke, had been ready for discharge for months. But every day when Dr. Curtis made his rounds, checking on the thirty-six patients on the ward, this patient was still there, still zipping around in his wheelchair, still going to therapy.

  “Finally,” Dr. Curtis said, “I asked him why, since he was able to walk, he was still here. Why was he still in a wheelchair? Why hadn’t he been discharged?”

  “No shoes, doc. They ordered me special shoes, but they’re waiting for Medicaid to approve them.”

  “How long have they been waiting?” Dr. Curtis asked.

  “Three months.”

  Dr. Curtis thought a bit. “What size shoe do you wear?”

  “Size nine.”

  Dr. Curtis reflected for a while. He thought about his duties, his other patients, the charts he had to dictate, the quality-assurance forms he had to fill out. And then he left the hospital, got in his car, and drove to Walmart, where he bought a pair of size-nine running shoes for $16.99. He’d just come back with the shoes and was going over to the ward to put them on the patient and write the discharge orders.

  Was he planning to submit his receipt for reimbursement? I asked.

  He laughed.

  As I watched him hurry back to the rehabilitation ward, I wondered: Why had Dr. Curtis done this? And why hadn’t anyone else?

  It was a simple thing to do, but it never would have occurred to me to do it. I would have been frustrated with the shoe delay, of course, and I
would have filled out a second or even a third Medicaid request. I might even have written Medicaid or braved its phone tree to complain about the time that pair of shoes was taking. But it would never have occurred to me to go to Walmart and buy the patient’s shoes. I had too much to do, too many forms to fill out, too many other patients to see. It would have meant crossing a kind of inefficiency boundary. And yet Dr. Curtis got in his car without much questioning; and he was hurrying back to the ward with the shoes to put them on the patient—himself.

  He reminded me of an aphorism I loved but had never understood: “The secret in the care of the patient is in caring for the patient.” I’d always assumed that it meant caring about the patient—loving or at least liking the patient—but when I saw Dr. Curtis rushing off to put shoes on a patient he barely knew, I thought there must be more to it than that. So I tracked down the quote and found it in a talk by Dr. Francis Peabody to the graduating medical class of Harvard in 1927. It turned out that Dr. Peabody didn’t mean caring about a patient but caring for a patient, which, he explained, meant doing the little things, the little personal things that nurses usually do—adjusting a patient’s bedclothes or giving him sips of water. That took time, Dr. Peabody admitted, and wasn’t, perhaps, the most efficient way for doctors to spend their time. But it was worth it, he told his students, because that kind of time-costly caring was what created the personal relationship between patient and doctor. And that relationship was the secret of healing.

  So what Dr. Peabody really was saying was that the secret in the care of the patient was—inefficiency.

  It was ironic. And it was also ironic that, while Dee and Tee 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 have saved the health-care system many thousands of dollars by buying those shoes, and yet Dee and Tee would not have thought his action efficient. They would have thought it very inefficient—wasteful of the time of a highly paid, highly trained physician.

  Dr. Curtis also reminded me of the Indian description of the good, the better, and the best doctor. The good doctor makes the right diagnosis and prescribes the proper treatment. But the better doctor also walks with his patient to the pharmacy. And the best doctor waits in the pharmacy until his patient swallows the medicine. Going to Walmart to buy shoes was exactly what the best doctor would do.

  Before Dr. Curtis and the shoes, I’d striven to be a good doctor—to make the right diagnosis and prescribe the right treatment. Dr. Curtis raised the bar. Miss Tod taught me the importance of the little things—a changed diet, a prescription for new glasses; Dr. Curtis taught me that I might consider, now and then, fetching the food or fixing the eyeglasses myself.

  Afterward, I did that sometimes, as did many of the doctors at the hospital. Once in a while I would cook special food for an anorexic patient or fix the eyeglasses of a desperate reader—downstairs in the clinic with the beautiful tools in their shabby velvet case and the huge jar of ancient eyeglass screws. Such inefficient care often was efficient, in the sense that it solved a problem quickly and definitively. And I wondered for the first time whether Laguna Honda’s care, with all of its inefficiencies, might not actually be more efficient than Dee and Tee’s cost-effective health care. Even from a monetary, Excel-spreadsheet point of view.

  We did have many inefficiencies at Laguna Honda, and I had my favorites. There was Christmas, for instance, which was particularly inefficient, especially the Christmas presents.

  Every year, the morning before Christmas—and I mean real Christmas, not Happy-Holidays-Hanukkah-Kwanzaa Christmas—with its dusty trees and resuscitated ornaments, the police department would deliver 2,356 wrapped presents. To the women’s wards, presents for women; to the men’s wards, presents for men. Every patient in the hospital would receive two wrapped presents, and talk about inefficient! That entire morning nothing else happened. I’m not even sure that patients got all their morning medications, although, knowing the head nurses, they probably did. The activity therapist of each ward would place the two presents, one small and one large, at each patient’s bedside, and then the rest of the staff would gather around to watch, or often help, the patients open them.

  There would be plaid shirts for the men (red, blue, green; small, medium, large) and cardigan sweaters for the women (pink, blue, beige). In the small packages, watches (steel, gold, silver). And for the rest of the morning there would be the trading of shirts and watches; the collecting of wrapping paper, ribbons, and boxes; the fitting of batteries to watches; the donning and doffing of clothes; the swapping of colors and sizes. It was extremely inefficient, and it wasn’t even health care.

  Later, after the head nurses were eliminated, the new nurse managers, busier and more efficient, changed the system. The packages were still delivered to the wards, but written on them were size, color, and style; and days before Christmas, the activity therapists would take orders from the patients. A steel watch or silver? A blue cardigan or pink? The day before Christmas, presents would be passed out appropriately. It was quieter; it took less time; and the patients did still receive their new shirt, sweater, watch. But it was not as much fun, neither for staff nor for patients. It was subdued and a little sad. And it made me wonder whether fun, although inefficient, might actually be therapeutic and, therefore, efficient.

  Even Christmas was not my favorite inefficiency, however. My favorite inefficiency was the barnyard, the greenhouse, and the aviary. I only got out to the aviary once, but once was enough.

  The aviary was next to the barnyard, and it was enormous: long and tall and made out of large panes of glass set into a wooden frame. Its walls were lined with homemade wooden worktables, whose surfaces were covered with droppings from the doves and pigeons roosting in the nests above the tables. There were also finches and sparrows, who, like the hospital’s homeless but healthy patients, had somehow sneaked in. On the left of the entrance were incubators with chicken eggs and, in a box on the right, chicks.

  The activity therapists were in charge of the aviary, the greenhouse, and the barnyard. On Saturdays they brought patients out from the hospital to the greenhouse to pot little bent plants, which was how Mrs. McCoy got the plant she gave me. During the week they sometimes brought patients to the barnyard to visit the rabbits in their hutches, the little black potbellied pigs who foraged in the lawn, and the birds in the aviary.

  One day an activity therapist took an incubator and some eggs to the AIDS ward, and a few weeks later one of the eggs hatched into a chicken. This was before effective treatment for AIDS, and Dr. Curtis had set up the AIDS ward as an extension of hospice, so that AIDS patients could die in peace. And they did die, almost every day, usually after becoming demented. Demented or not, the AIDS patients loved that AIDS chicken, who turned into the AIDS hen and roamed through the open ward, pecking at the bread the patients saved her from their meals. Also at the potato chips (which she didn’t much like), the soft green peas (ditto), and the limp lettuce. She preferred bread. Still, she did quite well; she survived many patients.

  Of course she was messy, being no less than the demented men with AIDS, untrainable and incontinent, and she left bits of lettuce and chicken droppings around, but the nurses cleaned up after her. Which was inefficient, not to speak of unhygienic, as the investigating nurse from the State Licensing Bureau noted in one of her reports. Although, as a matter of fact, in the months when the AIDS hen roamed the open AIDS ward, she did keep her diseases to herself, as the AIDS patients did for her.

  Nevertheless, it was deemed unhygienic to have an AIDS hen wandering about the ward, and one day she was gone.

  As for inefficient, she was that, too, but there was therapy in her inefficiency. I can’t document the numbers, but it was worth my while to walk to the AIDS ward just to see the spark of interest in those cachectic faces when lunch wa
s served and the AIDS hen began her strut down the ward. It was a spark of life, an extra spark and sparkle that must have extended a life or two by a day or two, which, when you only have a few days left, is worth something.

  I wasn’t sure whether all of the hospital’s inefficiencies were therapeutic, but I did begin to wonder how it would come out if they were all added up. Correct diagnoses instead of incorrect ones. Visits to the emergency room avoided because doctors had enough time to spend with their patients. Feelings soothed, glasses fixed, free avian entertainment. Would the money saved on unnecessary hospital days by a doctor who runs out and buys shoes at Walmart balance out or even pay for luxuries like the best food and drink, massages, fresh flowers, alternative medicine? I began to think that perhaps, in this new day of evidence-based medicine, the Laguna Honda model of inefficient health care deserved a trial.

  During all this time, I was working on my PhD on Hildegard and premodern medicine. I had completed all the requirements, including German, Latin, and French, and put together my thesis committee; now I began sketching out my dissertation. I wanted it to show how premodern medicine could work as a way for conceptualizing the body, once its underlying horticultural metaphor was understood.

  I would explain Hildegard’s medicine and the System of the Fours using her text and those other medical texts in Latin, German, and Hebrew that I’d unearthed in my master’s thesis. I would show that the four elements, four qualities, and four humors were not the abstractions of the philosopher, as most writers had assumed, but the practical concerns of the gardener. It was ambitious. I would start small, I decided. I would start by condensing my master’s thesis into an article for publication.

  It was not unlike condensing everything I knew about a patient into that essence: the history of present illness. And right away I ran into something I’d missed in my master’s thesis—Hildegard’s remarkable concept of viriditas. Viriditas comes from the Latin word for green, viridis—which also gives the French vert, and the Italian and Spanish verde. Viriditas meant greenness. So usually it referred to the color of plants or of gems like emerald, although it was also used metaphorically to mean vigor or youthfulness.