Finally, Dr. Stein had everything ready, and the archeological excavations commenced with bated breath. Because if any human bones were discovered—Native American burials, for instance—construction would come to a halt. Amazingly, fortunately, suspiciously, not a single bone was uncovered by the archeologists. Only whiskey bottles turned up—a veritable museum of whiskey bottles, some of them one hundred years old, thrown into the valley by rapscallion patients long since dead.
So then it was time for a party, a groundbreaking ceremony. The day was chosen and invitations sent out to the outgoing mayor, the incoming mayor, the Board of Supervisors, Dr. Stein, the press, the staff, and the patients.
I made sure to attend.
It was not only gray and foggy that day, to be expected in our city, but drizzly and even rainy; still, the volunteers and nurses managed to find umbrellas for the patients, and even some waterproof orange jumpsuits. The dignitaries gradually arrived, and after posing with hard hats and shovels, made their way to the dais. There was the outgoing mayor in his black fedora and long cashmere overcoat; there was the new mayor-elect, baby-faced, with his hair slicked back and his white smile. There was the city attorney in her gold pompadour, high heels, and skirt; the head of the hospital in his stiff black suit, grown a little pudgy and a lot older since he took over; and, in a wheelchair, a patient.
From where I stood in the valley I could see the old hospital high above our heads, with its square bell tower and red-tiled roof, and the trees sloping down the hill toward us. Dressed in black with gold buttons, and carrying polished brass instruments, was a band, playing Big Band music from the 1920s, 1930s, and 1940s. There was food—plates of smoked salmon, hot black coffee, even French champagne—and the able-bodied and mobile helped themselves. Wandering through the crowd were a few orange jumpsuited patients, including one I couldn’t help noticing because he seemed so out of place, a tall, white-haired, blank-faced man with a gap in his teeth and the halting Parkinsonian gait.
Light rain came and went. Everyone had something to say. The old mayor, the city attorney, the head of the hospital, all talked about how difficult it had been to persuade the city to rebuild. Ironically, it was thanks to Demon Tobacco that the city had been able to afford the five hundred million dollars the new hospital was going to cost—fifty times what the present hospital had cost and five thousand times what it had cost to build the original four-story building.
Last to speak was the patient in his wheelchair. He took the microphone and looked out over the crowd. It was great that the city was going to build a new hospital, he said, great and laudable and charitable. And yet, somehow, he was concerned. The old hospital—we all looked up to see it in the drizzly rain, high on the hill behind him—with its warrens of rooms and wards, was a kind of storehouse, he said, or a sponge, or, perhaps, an old body, which had absorbed all the things that had ever happened within it and been subtly changed by them. Small and big kindnesses; suffering quietly or not so quietly but courageously borne, or at least borne. Or perhaps the old hospital was like the air in an old church, redolent of once-burned incense and living mold. Best, perhaps, the old hospital was most like what it actually was—an old, old house, and it had its ghosts.
He was right about that. Walking through the wards, turning down hidden corridors, I did feel ghosts sometimes, just like in an old house—ghosts of patients past, suffering past, death past, Christmases past.
Mainly, he went on, he thought the move would be a good thing, but now that we would be starting with a fresh building, with new walls and windows, what would happen to the spirit of the old? Since everything old—the beds, bureaus, curtains, tables, the oak chairs in the library, the wooden desks in the nursing stations—was going to be discarded, the old spirit would have to be carried to the new hospital, he said, ending his speech, transported somehow by all of its people—by all of us—patients, visitors, staff.
We all knew what he was trying to get at, but I wasn’t sure it would work. Moving from an old, old house, leaving all the old possessions behind, to a new, new house, what can be transported? Within those new, spiffy walls of the new hospital with its fresh carpet, clean and shiny doorknobs, sharp edges, how would we remember, what would remind us, of the old patients and the old ways?
I couldn’t imagine that they, the ghosts, would move with us, without their beat-up furniture, the easy chairs with the torn Naugahyde, the cracked and peeling many-times-repainted walls. I doubted that the ghosts would feel all that comfortable in the new climate-controlled, computer-designed building anyway. Instead of moving with us, they would stay on in the old building, I thought, lurking in their accustomed places like ghosts always do. And, since the city’s administration was going to move into the old building—renovated, to be sure—in the end, the ghosts might do more good by staying put.
Because even after the renovation, the old walls, the jail cells, the breezeways—all those haunts of the old ghosts—would survive. And there would sit the city’s strategists and implementers, suddenly taken by a momentary lapse of focus—by a breeze of boozy breath, of long-banished cigarette smoke; by the phantom squeak of a wheelchair, music from an invisible piano, or the whisper of a ghostly deck of cards being shuffled somewhere in the hall.
Though that was a long time off, I reflected as I walked back up the hill.
We didn’t even have blueprints yet. Still, the new health-care facility would look nothing like the old. It would have private rooms and flat-screen TVs—all the accoutrements of modernity. It would reference the hotel branch of its etymological family tree, not the monastic hospice branch. There would be no open wards to encourage community; no wide hallways for fortuitous meetings; no Romanesque arches to remind us of the religious and spiritual roots of hospital. No solarium standing in for the chapel, no turret for a live-in priest. I wasn’t sure how much these architectural reminders influenced the hospitality of the old hospital, but I did wonder whether we could transport the spirit of the old to the new.
Perhaps the patient on the podium was right; perhaps the spirit was not mainly in the building itself, with its memories, its ghosts, and its references to medieval hospitality. Perhaps its spirit was in the people, in the nurses, the doctors, and especially the patients; and perhaps the new Laguna Honda would be as tender, as intense, as the old.
Well, I would find out, eventually—later rather than sooner, as it turned out. In the meantime, I still had a lot to learn from my patients, especially from my new patient, Mr. Thomas Teal, and his bride, Mrs. Thomas Teal.
Eight
WEDDING AT CANA
IT WAS UNUSUAL for E6 to get a new patient.
Its demented patients didn’t come or go, and by and large, if I didn’t bother them, they didn’t bother me. In fact, it was amazing to see how little medical care they required. They hardly ever needed the blood-pressure medications they’d been taking; on E6 their cholesterols mysteriously normalized; their diabetes improved; and their cancers stopped growing. Diseases that would have killed an intelligent and thoughtful person didn’t phase E6’s demented patients one bit. They danced to the tune of Glenn Miller; they tapped on their tables; they read their newspapers every morning, though sometimes upside down. They rarely got sick, and none of them died.
But after we discharged Mr. Temkin back to his single room above the bar, we did have an open bed, and I did get a new patient. And if Lorna Mae, Mr. Bramwell’s sister-in-law, taught me the first principle of Laguna Honda—which was hospitality—then Mr. Thomas Teal taught me its second principle, which was community. Among the other things he taught me, such as unselfish love and a certain kind of resurrection.
Mr. Teal was admitted because he was, as the law put it, “gravely disabled” from dementia. On the admitting ward, Dr. Romero did her usual thorough workup and concluded that he was demented, and that there was nothing more to be done for him. So she sent him up to E6, where he inherited Mr. Temkin’s bed in one of the semiprivate rooms. Thi
s turned out to be a good thing because Mr. Teal was a bit of a loner, and I doubt he would have tolerated the open ward long enough to undergo the various miraculous transformations that awaited him.
When I met him for the first time, he was alone in his room, a lanky figure curled up on his right side, with the covers pulled up over his head. He did pull them down when I came in, however, and greeted me in a slow drawl. His face was leathery and weather-beaten; his hair, white, thin, and scraggly; and his nose was crooked, broken at some time and never set.
He did not do well on the mental status exam.
He was demented; yes, so it seemed. He thought he was in Jefferson Memorial Hospital in Florida, which was not good, and that it was 1983, which was particularly bad, because I’d noticed that the depth of dementia could be measured by the difference between the actual date, the actual place, and the actual president, and the date, place, and president that the patient answered when asked. So “Obama and 2012” was great; it signaled a quick recovery and probable discharge. “Roosevelt and 1936” was bad; it meant a severe and irreversible dementia. Mr. Teal’s “Florida and 1983” was not hopeless, but it wasn’t good either.
Then I began my physical exam. I looked at Mr. Teal’s hands, with their fingertips stained with nicotine, the slight curve of the nails, and the calluses of the once-working man. His eyes were blue, dull, and a little puffy; his teeth poor. His lungs were fair, with some evidence of his fifty years of smoking. His heart was better than I’d expected, given his three heart attacks; it beat sluggishly, but, all considered, it was a pretty good heart. The rest of him, too, was serviceable, I found, except for his right hip, that, after a fracture he must have ignored, had twisted and contracted into an unusable position. My exam concluded, I went back to the nursing station to read about the life that Mr. Teal could not or would not recount.
He grew up in Alabama, I learned, and dropped out of school in the twelfth grade. He made a living painting houses and had also studied religion, he told Dr. Romero, through correspondence courses. Eventually, like so many others, he decided to leave Alabama and come to California. To make his fortune? To escape bad debts, enemies, a prison sentence? To become a hippie or, given his correspondence courses, to find God through LSD? In any case, he ended up an alcoholic, living in shelters or on stoops or under bridges, with frequent visits to the County Hospital.
Then a few months before, he was picked up by the paramedics because they’d seen him “down”—that is, collapsed and unarousable—on the street. They stopped, examined him, and found that he had a bad cough and swollen legs, and they took him to the emergency room. This was the first miracle. If the paramedics hadn’t stopped, examined him, and taken him to the emergency room at that very moment, Mr. Teal would have soon been dead.
Because, just as they got to the emergency room, Mr. Teal’s heart stopped beating. The emergency room called for the Code Blue resuscitation team, which came running; and they were able to resuscitate Mr. Teal, with the shocks and tubes and magic medications of modern medicine. This was the second miracle, since, in spite of what we see in the movies, only one in twenty-five cardiac arrest victims are successfully resuscitated; of those who are, only one in a hundred survives to discharge. But Mr. Teal was successfully resuscitated and then sent to the intensive care unit, where, a few hours later, the blocked blood vessel that had caused his heart to stop was opened with a stent. His heart attack was massive, however, and he needed a heart pump to keep him alive. Eventually he recovered, though not enough to go back to his stoop and his vodka. The County psychiatrist found him so demented from the cardiac arrest and his vodka that he could no longer manage for himself and determined he would need care for the rest of his life.
For the next many months, Mr. Teal did not move from his room on E6. Withdrawn and reclusive, he stayed in bed, curled up on his right side twenty-four hours a day. Whenever I came in to ask him how he was, and urge him to get up, to use his wheelchair, to go to physical therapy, he was pleasant enough. His weathered face would crease into an apologetic smile and with a drawl he would respond, “No, ma’am, Ah don’ feel bad; Ah jest don’ want to git up.” Eventually, though, he did agree to see the physical therapist, who fitted him with a wheelchair and tried to get him to exercise his stiff and contracted hip. But he wouldn’t. He just would not. Nor would he take the heart medications I prescribed to prevent another cardiac arrest. He understood that I meant for the best, and often he told me he would take them, but he never did.
He did, however, uncurl himself eventually and take to his new wheelchair, and soon he was gone from the ward all day long, coming back only at the end of the day, reeking of alcohol and cigarettes. He’d discovered the coterie of miracles like himself—the group of resuscitated or grafted or operated-on drinkers, smokers, and drug addicts who congregated outside in the smokers’ ghetto named “Harmony Park,” to smoke, drink, and sometimes talk.
The nurses didn’t like this new behavior at all because, looped and high on whatever he was drinking, though pleasant as always and turning ever more brown and leathery outside in the wind and sun all day, Mr. Teal began to refuse not only his medications but also his daily, then biweekly, and, finally, weekly baths. He started to look and—worse—smell, like the homeless wino he was. He was unshaven and dirty in the way that the movies can never portray, with a dirt deep in the creases and the pores and the cuticles and the hair and the hair follicles, back of the neck, ears, clothes—layer upon layer upon layer. And smelling of a really dirty dirt, mixed with old cigarette smoke, old nicotine on fingers, yesterday’s alcohol, and today’s and the day before yesterday’s.
Then Mr. Teal began to insist that we discharge him, preferably to Reno, Nevada, but, if necessary, back to the streets of our city. Our kindly psychiatrist objected; she was sure that Mr. Teal was still gravely disabled from the many insults his brain had suffered over the years. So we tested him, and Mr. Teal was able to demonstrate that he still knew enough to meet the minimum criterion of the law: He was able to provide for himself as well as he had provided before his miraculous resuscitation—that is, sleeping on stoops, begging for money, and drinking on the streets. So the law decreed that Mr. Teal could leave whenever he wanted, and the social worker began looking around for a room. This was more difficult than we’d imagined, because Mr. Teal turned out to be well known for setting fires in his rooms, and no one would take him even when a room was vacant and even if the state paid for his discharge.
So Mr. Teal stayed on.
He spent less and less time in his room, however, showing up late at night, unkempt and rowdy and, sometimes, angry. Still, we couldn’t quite bring ourselves to discharge him in his wheelchair onto the streets of the city. But the nurses were beginning to find half-pint bottles of vodka in his bureau, and administration was starting to crank up the pressure for just that kind of discharge when suddenly …
Well—nothing. It took me a while to realize that Mr. Teal had stopped being an issue. True, he was never in his room during the day, so I never saw him, but the nurses no longer told me about liquor bottles, and his room, when I passed it, seemed less like a flophouse and more like a boarding house room—plain and simple, but neat and clean, and not aromatic of alcohol and dirt. Finally I asked the nurses about him.
“Mr. Teal? Oh, he’s not a problem anymore. He stopped drinking. Because he has a girlfriend. In fact, Dr. S., they’re going to get married in the chapel next month; do you think you can be there?”
“Married? A girlfriend? Who is it?”
“Oh, it’s Jessie, one of Dr. Bart’s patients on the women’s ward downstairs. He’s been seeing her for quite a while. Since he met her, he takes his bath and lets us shave him every day. They’re getting married in June on the fifteenth; it’s a Wednesday; don’t forget.”
It was very busy at the hospital, though, and I did forget. Fortunately, I ran into Mr. Teal on the morning of his wedding.
It was one of those beautiful sp
ring days we sometimes have in our city, when the fog is blown off by a crisp wind coming in from the ocean, up our hill, and through the hospital. Mr. Teal was sitting in his wheelchair in the breezeway, smoking, but I didn’t recognize him at first. He was spotless, kempt, immaculately groomed—his silver hair pomaded, wavy, and parted on the left; his face meticulously shaved; and the pungent, attractive, and masculine smell of aftershave lotion was the only smell coming from him. He was dressed in a gray-green silk Armani suit, a starched and very white shirt, and a white silk tie. There was a white carnation in his buttonhole, his slacks were creased, and I could see gray silk socks in polished brown leather shoes on the footrests of his wheelchair.
As I came up, though, he smiled at me, and I recognized him—his cornflower blue eyes in that brown leathery face gave him away. Then I saw that his hands were shaking as he held his cigarette, and he told me that today was the day he was going to the chapel to get married. At eleven AM. Would I be there?
I would be there, I told him.
I kept track of the time, and a few minutes before the ceremony, I started for the chapel, which was downstairs at the front of the hospital.
I wasn’t the only one. As I made my way, I was amazed to see how many people were walking in the same direction. There was my friend Dr. Bart, who was the bride-to-be’s doctor; there were the physical therapists, the speech therapists, and the activity therapists; there were nurses, social workers, volunteers, and many others, all heading to the chapel. There were patients, too, limping or wheeling themselves down the corridor. I could barely find a seat in our chapel, which was not really a chapel but a small church, with stained-glass windows and rows of polished wooden pews.
God’s Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine Page 20