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

by Victoria Sweet

  Paul did not do well those first few months.

  All he liked to do was sit outside in his wheelchair, rain or shine, and read and smoke, although he knew nicotine and sitting were bad for his circulation and the healing of his sores. He read even more than he smoked. He read all the time and everything, but especially science fiction, and he went through the books in the hospital’s library one by one. He was angry and irritable and way too smart for the staff; he wouldn’t let the nurses clean his bed or the space around it; and he had stuff everywhere: CDs and DVDs, brown paper bags, books. It drove the nurses, nice as they were, crazy; there was stuff everywhere, and they needed to straighten up, but when Christina tried to speak to him about the mess, Paul’s eyes would narrow; and he would refuse. He wouldn’t let them bathe him; his hair was dirty and his body unclean. He slept most of the day and stayed up all night, and he ate very little.

  The first thing Christina asked me to do when I was back from the first section of my pilgrimage was “Dr. S., go talk to Paul about his sores. He won’t go to plastic surgery or orthopedics, and they are looking very bad.”

  She was right. Paul’s wounds looked awful. Despite the antibiotics he’d been taking, the sores on his right foot and the big sore over his right hip were slimy and smelly and infected, probably down to the bone. It took quite a bit of persuading, but he agreed to see our orthopedic surgeons. They were not happy with what they saw. They told him that his prosthetic hip was infected and would have to be removed, that the sores on his right foot would have to be surgically debrided, and that some kind of skin covering would have to be fashioned for the huge sore over his hip. He would have to go back to the County Hospital.

  Things did not go as planned. He did go over to the County and was there for three months. The surgeons removed the prosthetic right hip, but Paul’s bedsore still did not heal. They debrided the sores on his right foot, and the foot did not heal either, most likely because of his peripheral vascular disease. So Paul’s lower right leg had to be amputated. Meanwhile, the sore over his right hip widened and deepened, and the surgeons finally gave up and took the whole leg off, including the right hip. They tacked the skin that was left back over the open area of his buttock and sent him back to us.

  Paul was not better, I saw, when I examined him. He was very thin, edgy, and depressed; and the new amputation was astonishingly deforming—he had no legs. But the most disturbing part was the skin flap itself, which was tacked over the five-by-eight-inch open area of his missing right buttock and was starting to turn black at the edges. Now all of this was scary—to be a no-legged, ex-handsome, ex-independent black man—but it would be nothing compared to having that skin flap turn gangrenous, as it seemed to be doing. Because if Paul lost that skin flap, if it finished turning black and sloughed off, then there would be nothing to protect his body from progressive gangrene. The gangrene would spread, and he would die a slow death.

  Even he was subdued. Not that he stopped smoking and reading, or staying up all night in his wheelchair watching television. But subdued in that now he let the nurses change his dressings and thanked them; he tried to eat; and when he was in bed, he tried to stay off what remained of his right hip.

  But the wound worsened. The skin that had been tacked down turned black, and the wound it covered was draining and malodorous, despite antibiotics. So I went with Paul to see our plastic surgeon and learn what else we could do. The surgeon examined the wound. There was no way to cover it or graft the area because Paul had no extremities left from which to take a large enough skin graft. He didn’t say anything, though, until Paul left the surgical suite. Then I asked, “What do you think?”

  He shook his head. “It’s a catastrophe. There’s nothing for me to do. If that wound doesn’t heal on its own, well … He needs to stay off that hip, and he needs to stop smoking.”

  It was impossible to imagine what would happen next, and I couldn’t think of anything else to do. But if nothing else was done, Paul would die, in the twenty-first century, of an old-fashioned, a medieval diagnosis—an open wound. And though I suppose you could blame it all on Paul—he did, after all, keep smoking and reading and sitting up in his wheelchair all night—I didn’t believe that if he stopped smoking and took to his bed, his wound would heal. It was just too far along.

  So I left the hospital and went for a walk at the beach. I wanted to think. Surely there was something left for me to do. “Remove obstructions,” I remembered from Terry Becker, but the obstruction in Paul’s way was not a simple obstruction. It was a malevolent and active closing of his blood vessels, a lack of flow, a blockage. As I walked, I went through my list. He was already on antibiotics. There wasn’t anything left of him to debride and remove. He already had a special bed and good nurses. He could stop smoking, but he wouldn’t, and even if he obeyed the plastic surgeon and went to bed, there wasn’t much left to lie on anyway. I couldn’t think of anything else to do.

  As I walked I thought about the pilgrimage, and I thought about Hildegard. What would Hildegard do, I asked myself, if she had nothing left to do? She would pray. What would she pray for? For Paul’s healing—body, mind, and soul. So I did. Pray. Not to anyone in particular, though. I didn’t have to. I was, after all, walking on the beach, in the sand, with the salty wind coming off the water and the waves coming and going.

  Then I went back to the hospital. As soon as I got back, that instant, Dr. Bart paged me. And while I wouldn’t say that her call was miraculous, it did mark the beginning of Paul’s healing—physically, mentally, and spiritually.

  “I’ve been just thinking about Paul,” she said. “How’s he doing? I saw him outside. We talked; he was reading and smoking as usual.”

  I told her.

  Then Dr. Bart had an idea I hadn’t thought of. “Why not try hyperbaric oxygen?”

  Hyperbaric oxygen is 100 percent oxygen administered under pressure to the patient while he lies inside a clear plastic chamber, the idea being that the high concentration of oxygen somehow helps the healing of wounds. It isn’t a common or a proven treatment, and I had never used it before.

  “You think?”

  “I’ve had it work for a few other patients. It’s a hassle to arrange, but it just might work. Let me tell you how to make it happen.”

  She did, and I arranged an appointment for Paul at the only hyperbaric chamber in our city. We went over together to meet the hyperbaric specialist in charge. He talked to Paul, examined his wound, and thought it might work. So Paul began going over to the hyperbaric chamber every day.

  It did work. It was amazing. In a few weeks the black skin over the wound began to turn pink, and the gangrene began to flake off. After eight weeks, Paul’s wound was healed.

  During those few months, other things healed, too. Paul had been estranged from his family—sister, ex-wife, son—but one day while he was sitting outside smoking, he recognized his niece, who happened to work at the hospital. She began to visit him in the evenings, and she let the rest of his family know where he was. They began bringing in his favorite foods, and he began to gain weight.

  Pretty soon Paul was just another of the patients on E4. Only with a twist because, as it turned out, he had a gift. He knew how to build computers out of parts and pieces, and while he was healing on the ward, he built himself one. The patients around him were fascinated, and from his bed, he taught them about computers. Soon the nurses were coming to him with their computer problems. Often, especially in the evenings, I would see them, small and pudgy and giggling, surrounding Paul, who, in bed with his sheet pulled up, looked like the full man he really was.

  Paul became a popular person. Not least because his cousin, James, brought him bootlegged versions of the newest films, which Paul copied onto DVDs and sold around the hospital for three dollars each. He made enough money to buy himself an LCD television and keep himself in cigarettes. He and Donald, one of the starstruck patients across from him, started to make plans to open a DVD store after t
hey were discharged.

  He did have a few setbacks. There was an episode of pneumonia. There was a computer breakdown that required a new motherboard and a soldering iron to connect it. But he recovered from the pneumonia, and from somewhere acquired a soldering iron, which he used one night near someone’s oxygen. He didn’t start a fire, but the nurses were pretty upset, and they took the soldering iron away, though not before Paul’s computer was once again operative. He had phantom-limb pain from the amputated right leg. But the bedsore over his hip had healed; he was bright and alert; and he was looking forward to reconnecting with his son.

  We began to think about discharge.

  It would not be easy. Although Paul was resourceful and independent, managing his own finances, doing his own care, establishing businesses, and building computers, the last time he’d been out in the community, he had been a six-foot-tall handsome black man. Now he had no legs and could barely balance himself in his wheelchair. Nevertheless, the social worker began scheduling interviews for Paul at various hotels—the kind of hotels our patients went to, that is.

  It was around Christmas. I’d known Paul for more than a year, and I liked him a lot. Was there something he wanted, I asked him, from Santa?

  He looked up at me from the depths of his wheelchair. Sometimes, sitting in that chair with only half his body left, he looked so small.

  “I want a fishing vest,” he told me. “One of those fishing vests with all the pockets. And I can’t get hold of one here.”

  “A fishing vest? Why?”

  “I can’t keep the stuff I carry with me organized. ’Cause I don’t have legs I don’t wear trousers, and the only pocket I have is here on my shirt. Not enough. I figure with a fishing vest I’ll have places for everything.”

  So one lunchtime I went over to the Big Box Store. Fishing vests were over in the manly section, I was told, by the fishing rods, and I found lots of them in grays, beiges, taupes—manly colors. They were not expensive, and they did have pockets—big and small, zippered and open, square and rectangular—all over. I picked taupe because it would look good with Paul’s skin tone, and medium, which would fit. I had the vest wrapped, and I wrote him a note, signed SANTA. When I got back to the hospital, I gave the present to Christina and asked her to put it on Paul’s pillow Christmas morning.

  When I woke up that Christmas, the first thing I thought about was Paul getting his vest. I hoped he liked it, and I hoped it fit. And I couldn’t help but notice the pleasure I was getting out of him and that vest. It didn’t seem quite right, somehow, but there it was. This got me to thinking about charity—its motivations, its emotions, and how, after hospitality and community, charity was the third principle of Laguna Honda.

  The charity I meant was nothing organized. It was not in the hospital’s mission statement, on its new website, or in the PowerPoint presentations of middle management. And yet charity, in the medieval sense of a “personal action evoked by dearness and contributing to the well-being of its giver as well as its receiver,” was as much built into the place as its arches, bell tower, and church.

  Charity came into the West when Saint Jerome translated the Greek word agape by the Latin caritas, which became the English charity. Today agape is usually translated as “love,” but agape was more nuanced; in ancient Greek it meant “to treat with affectionate regard.” Caritas, charity, is closer because the root of caritas is cara—“dear”—as in expensive and cherished. So caritas has the sense of “dearness”—of a love that is precious and sweet.

  In English, charity evolved over the centuries. At first it meant “the love of God”; later it meant the actions that expressed that love—in specific, caring for the sick poor. In the Middle Ages, charity was accepted as doing as much for the giver as it did for the receiver, the “goodness of charity being a bond of love that draws us to God.”

  And even when the monasteries in England were disbanded, this insight—that caring for the sick poor was a spiritual good for the giver—continued to inspire charitable institutions. It was one reason why the state built hospitals to care for the sick poor, and why we still believe and act as if taking care of the sick poor is something that a society should do. Charity built Laguna Honda in the first place, and charity was why the bond for the new Laguna Honda had passed by a margin of three to one. At Laguna Honda, charity was in the air.

  There was our volunteer organization of nearly one thousand members. It ran the little store where patients could buy candy and shaving cream, and staffed the clothing department, where patients could “shop” for clothes (donated, cleaned, and mended), such as the Armani suit Mr. Teal wore at his wedding. It put on dances that supported the Patient Gift Fund, and it sponsored the monthly outings that got every patient out of the hospital to a ball game, a restaurant, or the horse races.

  But in addition to this organized charity, and at least as important, was personal charity, and the longer I was at Laguna Honda, the more of it I saw. There was the nurse who roasted an entire pig on his Sunday off for a homesick Tahitian patient with breast cancer. There was the doctor who took a music-loving patient to the opera. There were the birthday dinners for patients that staff paid for themselves; clothes brought in, cats adopted. All simple acts, not expensive, not cumbersome.

  But why? I asked myself that Christmas morning. What was the motivation? And was the pleasure charity gave me good or bad?

  The Greeks called that emotion eleos, I later discovered, and defined it as the “feeling of pain caused by the sight of some evil that befalls one who doesn’t deserve it.” The pleasure I felt was, in part, the relief of pain by giving. Eleos gave the Latin eleemosyna, the French aumone, and eventually even our English alms. The emotion of eleos was why Laguna Honda had been built as an almshouse in the first place and why it was still an almshouse despite its name, because eleos—alms, charity—was still one of its main motivating forces.

  Charity assuages eleos and it is selfish, at least in part. And there is more selfishness in it than simply the relief of one’s own pain; there is a complicated pleasure in it, which is what gave charity its bad name and what made it, as the third principle of Laguna Honda, a secret. Its motivation is always suspect—acts done not necessarily for the good of the receiver but of the giver. That was why at Laguna Honda charity was hidden; and although I saw a lot of it, I never heard it mentioned. It was passed along only in actions. But it was passed along. If I hadn’t seen charity all around me, I don’t think I, as Paul’s doctor, would have gone out and bought him a vest. Yet at Laguna Honda, buying that vest seemed natural; everybody did that sort of thing.

  Paul wore that vest for a good long while. And propped up in his electric wheelchair, cigarettes in the left pocket, matches in the right, he looked manly and imperturbable.

  In the meantime, while Paul was healing and I was taking care of my patients on E6 and E4, the new hospital was in the planning stages. And then we saw the architects taking measurements around the grounds. Like the administrators, they wore real shoes and real clothes, but it was easy to tell them apart. The architects were small, neat men, and their shoes were brown loafers with no socks; their uniform, a charcoal gray jacket, black T-shirt, and pleated slacks; their look, a short haircut and silver rimless glasses. In fact, they were as different from all the denizens of Laguna Honda—doctors, nurses, patients, and administrators—as their virtual health care and rehabilitation facility would be from the hospital we knew so well.

  It took about a year, but finally they were ready to present their designs to us, the doctors, in the medical library on the eighth floor. The library wasn’t much, but it was ours—shelved journals around the walls, sofas, and a conference table, and the big open windows that were almost a signature of the place. The architects had been working for quite a while on their plans. What they would show us today was preliminary, and they’d like to hear our thoughts.

  The head architect began. The patients, now called “residents,” would be house
d in three identical six-story buildings, he explained. Two would be built in the valley between the present buildings; the third would be on the site of the 1910 Clarendon Hall, which would be demolished. The patient buildings would be connected to one another by a three-story glass “link” building; it would contain the lobby, a new aviary, two swimming pools, the library, and the auditorium, as well as the X-ray department and the dialysis units. The four buildings would surround an open space that would have the new greenhouse and animal farm. Gardens, perhaps a maze, would be placed outside the buildings, and everything would be built to the highest ecological standards.

  Then the lights went down, the PowerPoint came on, and we went on a virtual tour of the new Laguna Honda-to-be.

  With the valley and the old Clarendon building gone, I can’t say I recognized anything. The general effect was very green, with computer-simulated vegetation and new trees. The three patient buildings were square and windowed, and along with the glass “link” building, seemed to grow out of this green, like office buildings out of a new suburban development.

  Then we went inside, starting with the lobby.

  Inside it was light and airy. The lobby was high and wide; the aviary was glass, with bamboo around it and a ledge for sitting. There were simulated patients enjoying themselves—slim, smiling, and sitting in immaculate wheelchairs with their legs crossed, or leaning on their canes, peering out at green vistas. We saw the new dining area, which was nothing like the old dining room. It had curved booths, halogen lights, and a long shiny grill; and outside was a deck with wrought-iron tables and Cinzano umbrellas.

  Then we went into one of the virtual patient buildings. There were lots of windows and glass doors that opened to a balcony where other elegant, simulated patients gazed out at the sky and down into the gardens six stories below. The space was beautiful and calm, with cream-and-coffee-colored walls, and I found it hard to imagine our Fourth of July goat or our Thanksgiving turkey making a visit, no matter what hat and sunglasses they wore, not to speak of Mrs. McCoy, yellow and swollen, really quite messy and actually diseased, at least when she first arrived.