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

by Victoria Sweet

  Then we stopped in front of glass double doors, which opened for us, and we walked into the great room of a neighborhood. It was just as spacious and well lighted as it had been virtually. Its floors were blond wood with matching cabinets, and in the back was the nursing station, which was a simple counter with a computer. It had no doors, closets, or cabinets. It was hard to imagine having enough quiet at that nursing station to think or to discuss a patient.

  Then we walked down the hall that came off the great room to see examples of the patients’ rooms. I was amazed. Each two- or three-bedded “room” was actually a suite, with its own little hallway. Each suite had a bathroom, tiled in teal, cream, and taupe, large enough for the widest wheelchair and the biggest patient. Each of the “beds” was a private room, with a window that opened and a door that closed. A flat-screen television was on the wall; the new bureaus had black rubber handles so patients wouldn’t hurt themselves. Under each pillow was a two-way monitor so a nurse could talk to a patient, and a patient to a nurse, without the need for face-to-face contact.

  Then Dave showed me the common spaces of the neighborhood. There was the carpeted Quiet Room for reading, the dining room for eating, and a small kitchen with a shiny stove and a dishwasher, because patients would now be served on china. The new dishwasher could compost on its own. I saw the hall of offices for the nurse manager, the activity therapist, the dietician, and the medical records technician. And what about the doctors? I asked Dave. Where were our offices? And the call rooms for the doctors who covered at night?

  Dave looked uncomfortable. It seemed that in the new buildings the doctors had unaccountably been overlooked. He didn’t know about the call rooms, but there were no doctors’ offices in the new Laguna Honda. He’d heard that we’d stay in the old building, though he couldn’t say for sure.

  Next we would go into the Link Building, which connected the two towers for patients. Since the elevators had some kind of electronic problem, he would take me down the stairs, which were all the way at the far end of the corridor and locked.

  This was a very inconvenient place to put the stairs, I told him. Code Blues required getting from one floor to another in a hurry, and that meant not waiting for an elevator or running all the way down a corridor. And why were they locked?

  Dave didn’t know why the architects had placed the stairs so far away from the elevators, but they were locked for security reasons, so patients couldn’t elope or do whatever they used to do in the stairwells in the old hospital. We’d gotten in too much trouble for that. Of course, staff members would have electronic keys to the stairs and the other locked places on campus on the property locator badges we would wear. There were also cameras in the stairwells for additional security, and cameras in the cafeteria and throughout the grounds.

  We arrived at the lobby of the Link Building. It was stunning. The wall that faced west was almost entirely of glass, and I could just make out the ocean outside. On the other side of the glass were two ancient flowering magnolia trees, thoughtfully preserved by the Tree Subcommittee. The other walls had tapestries, raku sculptures, paintings, and glass mosaics.

  Then we went to the cafeteria. Even the Swiss would have been satisfied. Spacious and white, it had small tables and colorful chairs and halogen lights. There was a new grill behind curved Plexiglas, and in the back, rows of Wolf ovens and Viking refrigerators. A cement patio gave out on to the cafeteria, looking just like the virtual patio we’d been shown so long ago, except for the absence of umbrellas and those slim young patients. I saw the gym with its two infinity swimming pools, and the outpatient clinic, furnished with the newest examining tables, computers, and equipment.

  On our way out to see the new barnyard, we passed a long, low building. That was for the computer servers, Dave told me, which would control everything in the new buildings—the electricity, lights, and heat; the cameras, doors, and elevators; the medications, telephones, and computers. Naturally I wanted to see it, and we went inside. It smelled of cement and was lined, floor to ceiling, with rows of shelves on which were hundreds of black boxes, connected by thousands of wires. Each wire came from a particular room into those black boxes, Dave explained, and there were separate wires for the telephone, television, ventilation, heating, and electronic toilets.

  One could only hope that those wires never got disconnected.

  Last we came to the new barnyard. There was no comparison with the old barnyard. Rows of vegetable beds had been built at wheelchair level so patients could garden; the new greenhouse had accessible benches and equipment. The ducks and geese had a new pond, built to code, and the activity therapists, who would run the farm, had offices right next to the rabbits. Every animal had his or her own private room, with cement floors and warming lights. Dave showed me the little doors between their individual rooms that he’d been forced to add because the animal-rights people worried the miniature pigs and goats would get lonely with so much privacy. The little doors were so they could visit one another.

  Then we walked back to his office, and he asked me to wait while he looked through his book of plans.

  “I think I’ve found it,” he said, pointing to a little box labeled PHYS. “The call room for the physicians.”

  I looked. It was on the third floor of the North Tower, a little box without windows, labeled PHYS. I didn’t think so. More likely PHYS meant “physical plant” or “physical therapist” or even, given the complexity of the computer building, “physicist,” but not physician.

  I thanked Dave anyway, and as I walked back to my office, I wondered where in the new hospital the patients would drink, deal their pills, talk, and dream. For they would find places, I knew—stairwells, rooftops, a dark and windowless room labeled PHYS. Or perhaps they wouldn’t. Because, although privacy had been the main reason for the new hospital, what with the cameras, the property locator badges, and the two-way microphones under every pillow, patients wouldn’t have much privacy in the new Laguna Honda.

  I sat down at my rickety desk. I looked out my window at the hospital wing across from me—its red-tiled roof and turret reminders of the origin of our vocation in those old monasteries. I looked at my white coat—white to remind us of cleanliness and purity of motive—at my books, and at the index cards I still kept. I wondered where the doctors would be in the new hospital, or if we would be there at all.

  It was too early to say. And I still had one last lesson in my schooling at the old Laguna Honda.

  Because I was still taking care of patients. Somehow, despite all the changes, life at the hospital went on pretty much as it always had. The nurses made their rounds three times a day; the doctors took care of their patients; the therapists, social workers, and dieticians followed the strict regime laid down so long ago by Miss Lester.

  So it happened that just a few weeks after I took the tour, I was standing in a ward, finishing up with a patient, when one of my ex-patients, Mr. David Rapman, walked in. I recognized him right away. His voice was unmistakable—raspy and energetic, confident and inspired. He’d come into the ward to persuade some patients to attend the memorial service for Don Taylor, who’d been a substance-abuse counselor at the hospital.

  “Hey! Dr. S.!” he said, with a wide, white smile. “How ya’ doin’?”

  “I’m excellent,” I told him. “What about you?”

  “Oh, doin’ great, Dr. S.! Nine hundred and ninety-four days of sobriety since I left! Best thing that ever happened to me!”

  I could see that just by looking. Mr. Rapman was a far cry from what he’d been the first and second time I’d met him. Slim, brown, and effervescent, he had a brown-and-white ski cap on his curly black hair and was neatly dressed—buttoned, zipped, and belted. Only his voice connected him to that other Mr. Rapman I’d known two years before.

  I met him the first time when the nurses on the admitting ward asked me to check up on some blood tests that Dr. Rajif, who was out sick, had ordered. They were worried because Mr. Rapman ha
d gained twenty-four pounds in the past two days. Would I go over his blood tests and then check him out?

  Sure.

  I went over the blood tests first. They were easy to interpret. Mr. Rapman obviously had cirrhosis of the liver, and his liver had finally failed. Since the liver makes the proteins that hold water inside blood vessels, most likely the twenty-four pounds Mr. Rapman had gained was water that had leaked out of his blood vessels into his skin, abdomen, and legs. Short of a liver transplant, there wouldn’t be much for me to do about that.

  Then I left the office to examine him for myself.

  I found him in one of the semiprivate rooms in the front of the ward. It was very quiet when I came in. There was a mound of bedclothes on the bed, and the room was stuffy with a sad and stale smell. It’s not death and it’s not dying, but it’s on the way to both—it’s a kind of stoppage: the air not moving; the patient still; the body less warm than it should be. The mound of bedclothes, I discovered, was Mr. Rapman, who wasn’t moving and had the covers pulled up over his head.

  I introduced myself anyway and explained why I was there, but the bedclothes did not stir. Then suddenly, I felt movement, a rush of cool, fresh air, in back of me, and a tall, vigorous woman walked in—Mr. Rapman’s sister. She stopped just behind me.

  Mr. Rapman rolled the covers down then and let me do a quick exam. I started with his hands, which were cool and puffy. Then I took his pulse, which was rapid and weak. I looked at his eyes, which were yellow from the jaundice of his cirrhosis; I looked at his chest, which was covered with bruises from the lack of clotting proteins due to his failed liver. His belly was swollen, and his legs were edematous.

  He was going to die soon, I told them after I’d finished—in a few weeks or maybe months. He would bleed to death all of a sudden, in a minute or two. Or he would get infection after infection, until the last one, by definition, killed him. Or he’d go into a coma—the hepatic sleep of a liver no longer able to cleanse his blood. The only thing that might save him, I explained to his sister as he watched me through half-closed eyes, was that the patients at Laguna Honda were pissy, and he was pissy, I could tell. That pissiness, that toughness, that scrappiness might—just might—save him. This time. It was impossible to know for sure. But I’d give him a fifty-fifty chance of surviving—better than I’d give anyone else so sick. Though not if he kept drinking.

  “See, I told you, David,” his sister said. “I’ve told him, doctor,” and here Mr. Rapman shut his eyes completely and pulled the covers back over his head. “But he’s gone back to drinking so many times.”

  I shrugged. I admit it. Then I murmured my condolences and left the room to write some new orders for him. And a few days later, sure enough, Mr. Rapman got even sicker; he was transferred to the County, and there he spent weeks in the intensive care unit, getting transfusions, lab tests, and many antibiotics.

  When he returned, I admitted him. He looked about the same as when I’d seen him before, which, in a case like his, meant that he was better. Not dying had bought his liver a bit of time, and a few new liver cells had formed, making a bit more protein. So his clotting was a bit better, his swelling a bit less, his blood a bit cleaner.

  As I was examining him this time, I realized how handsome he was. Even-featured, with unlined and unblemished brown skin, white and straight teeth, Mr. Rapman was another good-looking patient to add to my long list. Most of the patients at the hospital were good-looking, I thought, and not just because they were my patients. But we had mostly Bad Boys—old, young, or middle-aged; and who but the good-looking—or the bizarre—could have survived the obstacle course of elementary school counseling, high school principals, juvenile court, prison, and the streets they’d had to navigate to get here?

  Not only was Mr. Rapman’s liver a bit better, but Mr. Rapman himself was better. He was attentive during my exam and interested, although irritable and grouchy, which was also an improvement. Grouchiness is ego, is self come to life—angry, yes, but also energetic and alive. Once again his sister appeared, and this time he listened carefully to my prognosis. Anyone else would have died by now, I said, but he, like so many of our patients, had nine lives, and this was life number seven and a half.

  A few weeks later he’d improved enough to move out to Clarendon Hall, and I didn’t see him for a year. Then he came over to the admitting ward, to find me and to say good-bye. He was being discharged, and he wanted to thank me. He was still swollen, but less so; and he was upright, standing on both feet. And most of all: “I’ve been sober! Dr. S.! Two hundred and sixty-four days of sobriety!”

  Now, two years later he was back, but not as a patient. As a volunteer. He’d joined Alcoholics Anonymous, he told me, and he was back to attend the memorial service for his sponsor, Mr. Don Taylor.

  “Don was a great man, Dr. S. He saved my life. I can’t believe Don is dead!” he said, in his scratchy voice. His face was shiny, and he shifted his weight from one slim leg to the other. “Don was the sponsor for a lot of the patients here—hundreds—and he came to me when … Well, you remember how angry, how irritable I was. I threw him out of my room. But he kept coming back, and finally I did the first step, Dr. S.! I admitted that I was powerless, that my life had become unmanageable, and I gave myself up to a Greater Power! I’m on the fourth step now—taking a searching and fearless moral inventory of myself—again, because you’re never done with the twelve steps; you do them one by one and again and again, because it’s a rich and depthless program, AA. Are you going to the memorial service, Dr. S.?”

  I hadn’t planned to, but Mr. Rapman had captivated me with his vitality, his evident wellness. He was no longer not ill, but well. In fact, his wellness exuded through his skin, his rocking to and fro on his feet, through his voice, hair, and eyes. And while medicine had done a good job of saving Mr. Rapman from death, it was something else that had made him well, and that something seemed to have been Don Taylor. So I decided to go to the memorial service.

  The chapel was closed for renovation, and so Mr. Taylor’s memorial service was being held in the library, which was also a good place for a memorial service.

  The library was quiet and airy; it smelled of books and paper, and had an enormous inlaid oak table at its entrance, with legs carved into lions. Like the chapel, the library was from an earlier time than the celadon tiles of our operating room or the metal hair dryers of our beauty parlor. It was from the time when to be free meant to be free from work, free to read and to think.

  When I arrived, I was surprised to see that the library, which was huge, was completely filled with people. Chairs had been arranged in many rows, and every one was taken; people were standing in the back and on the sides in front of the bookcases. Since there was no other place to sit, I sat on top of the carved table in the back and looked out across the sea of people. Next to the rows of folding chairs I saw many wheelchairs; canes and dirty denim jackets were hanging from the chair backs; and quite a few bare shoulders had tattoos. With me in the back were staff—a few doctors, nurses, dieticians, psychologists. In spite of the crowd, it was quiet, with just a little whispering here and there.

  In the front, a blown-up photo of Don Taylor had been made into a poster and put on an easel, and as I looked at it, I remembered him. He wasn’t very big and not particularly outgoing, and he wasn’t handsome either. Low-set ears, flat nose, eyes tilted downward at the corners, it was the face that alcohol in utero sometimes produces. So he must have started out not only with genetic alcoholism but with environmental alcoholism, too.

  Just on the minute, the first speaker got up from his chair and went to the front. He was clean-shaven, wearing a starched open-collared white shirt and Levi’s, precisely creased. He was Don’s cousin, he told us, a very distant cousin, but he knew Don well because when Don was twelve, he moved in with him and his family. Don’s mother had died of alcohol when he was three, and his father died of drugs when he was eleven, and it had taken him a year to find another fa
mily.

  Don was a sweet guy, as everyone here knew; a great guy, but he didn’t do well in school, and in his late teens he took to drugs and alcohol and even crime. Nothing big—thefts and burglaries—and, eventually, he went to prison. Which was good for him and lucky, as he always said, because in prison he joined Alcoholics Anonymous. And he cleaned up; he became sober and more than sober. He walked every one of the twelve steps, and when he got to number eleven, he prayed and meditated and asked the Power greater than himself to show him His will, which was for him to become a sponsor in AA. Which he did.

  And what a sponsor!

  Don was the sponsor of all sponsors—a guide, an elder brother, a true friend. Always there when you needed him; always there when you thought you didn’t need him, too. When he got his job at Laguna Honda, he was so happy! He loved his work. When he lay in the hospital, dying of the disease he got from drugs, he was more lonely than scared. All he could talk about was his patients. How were they doing? Without him?

  The thing was—Don had found himself, found his path, which was to help others see what he’d seen: That we are all powerless; that there is a higher power; that what makes us truly happy is love.

  The room was very quiet. The tattooed arms did not fidget; the gold-ringed ears did not turn.

  Then Mr. Rapman stood up. He’s a good speaker—his hoarse but energetic voice, white teeth, shiny face, snappy brown eyes. He held the microphone in one hand and, as he talked, shifted his weight from leg to leg.

  “Don was my friend,” he said. “And he was the friend of most everyone here. No one will ever know how many people Don saved and helped through their bad times. When I was here and I was angry, and they sent Don over, I threw him out of my room—many times. But he kept coming back. Finally I let him stay, and he came every day. He saw all his patients every day, Saturdays and Sundays, too. You could call him anytime. And I stopped drinking, and my life became manageable, and after I left the hospital, Don became my sponsor. He saved my life and many other lives.”