Mr. Rapman fell silent and, microphone in hand, looked out over the crowd. The heads on the tattooed arms nodded and murmured, and suddenly I understood that there was a whole nexus of life at the hospital I’d never been aware of. I’d known, of course, that many of the addicted knew one another, and talked and gossiped in the glass bus-stop shelter where smoking was still allowed. Yet it had never occurred to me before that their chatting might not only have been gossip and old history, but the same kind of questioning that my group spent our time, in our cubicles, at our lunch tables, doing—about the death of a patient, the meaning of life, how to live, and how to die.
As I, too, looked over the quiet crowd, I wondered how many of those I called Bad Boys and Bad Girls were, in reality, spiritually thirsty and spiritually sick. Perhaps they were the most sensitive, the most easily hurt of all my patients, the most tortured by the human fate of knowing we are going to die. Perhaps the tattooed, prematurely aged, skinny, and solemn patients in front of me were the real empaths, and my patient, Mr. Rapman, had something to teach me—that my life was unmanageable, that I might think about giving it up to a higher power, and that the twelve never-ending steps were, like the pilgrimage, for me also to tread. How was I any different from these quiet, attentive people, touched, even transformed, by the life of someone now dead?
Mr. Rapman sat down, and others came up to the microphone. Each spoke of how Don had saved his life, and the memorial service went on all afternoon. Don Taylor had saved many lives. And really saved them—not just saved them from death but saved them for life, in the same way that Mr. Rapman was not only no longer ill but well.
I don’t know what a saint is, except a person sanctified by the Vatican, and though Don was a Catholic, I doubt he will ever be sanctified. But if he was not a saint, he was for sure a bodhisattva, someone who came to the end of a certain path, had an overwhelming realization, and then turned around and came back. Not to a glorious martyrdom either, but to the daily egregious errors, the foolish irritability of Mr. Rapman. And sure enough, over the next few weeks I saw photos of Don Taylor appearing like those of any saint, over the beds of his quiet, invisible disciples.
As for Mr. Rapman, I’ve kept up with him a bit. Today is his 1,724th day of sobriety, and he has gone back to school. He wants to go into juvenile justice—to teach or act in some way so that others, especially the kids, don’t have to go through what he went through.
Mr. Rapman was the last lesson in my schooling at the old Laguna Honda, and I knew it at the time. It was the capstone; it summarized almost everything I’d learned. There was the importance of modern medicine, with its intensive care units, transfusions, and antibiotics. Without that “medical model of care,” Mr. Rapman would never have survived his fatal liver disease. But modern medicine was not enough. Mr. Rapman also needed the Way of Laguna Honda, the Way of Hildegard and premodern medicine—tincture of time, the little things, Dr. Diet, Dr. Quiet, and Dr. Merryman—to heal completely. But even that had not been enough. It took Don Taylor, with his enactment of meaning and of love, to save Mr. Rapman’s life for good.
After Don Taylor and Mr. Rapman, I took a sabbatical from the hospital. But when the day finally came—move-out, move-in day—I made sure to be there.
Ever since Dr. Dan realized that the move would need careful planning, administration had been organizing. Mirene and Adrian did not use Dr. Dan’s cottage-industry plan, however; instead, they hired three professional consulting firms who spent two years and almost half a million dollars preparing the staff and the patients. There had been innumerable memos, focus groups, and PowerPoint presentations, monthly training sessions, and mock move days. Also many delays. The firing of Dr. Sonnen and Dr. Dan, Mr. Conley’s death, Drs. Kay and Romero’s complaints; the visits of the Department of Justice. Most delaying of all had been the problems with the new buildings themselves.
Because a few of those wires in the computer building did get disconnected and then reconnected not quite correctly, so that when the toilet flushed on the fourth floor of the South Building, the heat turned off on the third floor of the North Building. There was the flooding of the fifth floor of the North Building whenever it rained. There were the rats who were eating the wires. There were the state inspectors who mutually disagreed on what was required for permits. There were problems with the electronics of the elevators, the stairwells, the hidden cameras, and the automatic locks. And those were just the problems we heard about.
But ten million dollars and thirty-six months delayed, the move days were set: December 7 and December 8—Pearl Harbor Day for the first half of the patients to move, and Buddha’s Enlightenment Day for the second half. Which seemed to me to be ironic and propitious both, and I volunteered to come in and help out.
On the first move day, I parked my car in its usual spot and, as instructed, went over to the recreation hall, which was filled with chairs and tables and staff. I signed all the required forms: I promised not to abuse any of the patients and affirmed that if I was abused, I knew whom to call. I was given my assignment, which was to monitor the elevators in the new building. Only one of the elevators was working, and my job, therefore, was to make sure that only patients used them and that everyone else took the stairs.
Were the stairs unlocked? I asked the staff member checking me in.
She looked puzzled, but reassured me that, yes, the stairs were … not locked. Then she handed me a special cell phone in case I needed to call Command Central, and gave me a purple move-day T-shirt to put over my clothes. Everyone—doctors, janitors, volunteers—was supposed to wear a move-day T-shirt, blue for staff and purple for volunteers. It would help identify me, and I could keep it as memorabilia.
It was lightly raining when I walked out of the old hospital and into the lobby of the new. I checked the stairs. Yep, they were locked, and the cell phone for communicating this to Command Central hadn’t been charged. So I put the T-shirt aside, sat down in one of the new chairs in the new lobby, and waited for my friends to arrive. T-shirtless, they were all moving in—the speech therapist, the activity therapist, the doctors, the psychologists, and as they came in, we chatted and got caught up. Then Dr. Jeffers, who was also volunteering, showed up, and together we wandered the new hospital. Eventually we came to the cafeteria and were greeted by the old MHRF nurses whom Mirene had moved over from the County. Their job that day was to sit outside the new cafeteria and monitor the patients as they came over from Old to New.
What had happened was that the official corridor between the Old and the New had not been finished in time. Actually it had been finished but hadn’t yet passed inspection, so the state agreed to let it be used if it was lined with white plastic, lighted by construction lights, and only one patient at a time came through. So staff members were positioned at either end, and when a ward was emptied, its patients were brought down in the old elevators to wait their turn in front of the corridor. When all was clear, a signal would be given, and the next patient would leave the old hospital, enter the corridor, and then come through. Since it was the first time any patient had been inside the new hospital, each one, as he or she came out of that tunnel, would crane his head around, blinking in the bright light and trying to see this new world, precisely like an infant popping out of the birth canal. Then each would be whisked away to his or her new room, and the next patient would start on his journey from Old to New.
It was a great place, the right place, to be for the move, and Dr. Jeffers and I sat down to watch.
By the end of the day, half of the patients had been moved. The next day the rest of the patients would be moved and the old hospital closed.
On my way home, I reflected on how meticulously the move had been prepared and how well it had gone. Only one thing was missing: No one had planned a ritual to mark the end of the old hospital, and that was too bad. Some kind of final Miss Lester parade, with the priest and his incense, and doctors and nurses walking the wards, laying the ghosts to rest, ack
nowledging the suffering and devotion those old wards had seen.
I needn’t have worried. Because a kind of ritual did occur, spontaneously, in the old organic way, and a more beautiful one than anyone could have planned. It was the next day, with Dr. Grace.
Dr. Grace was the Buddhist of Laguna Honda. I say that although there were many Buddhists at Laguna Honda, by birth or predilection, but Dr. Grace was the Buddhist of the Buddhists. She lived at Zen Center, and she was the person whom everyone went to when there was something awful to think through or grieve through. She never judged; she always listened; she didn’t say much; yet afterward, whatever it was would feel different—peaceful, still painful perhaps, but with a sweetness. She’d started at the hospital eighteen years before in order to practice medicine in the AIDS ward. It was in the middle of the epidemic, and the treatments were not very effective. She told me once that she and Dr. Tommy, her partner on the AIDS ward, had signed over 1,500 death certificates.
Then one day, two and a half years before, Dr. Grace came in to attend a meeting on her day off, and on her way home, a car swerved and hit her head-on. Her car was crushed, and she was helicoptered to the ICU. She sustained twenty-eight fractures and severe abdominal trauma, and was in a coma for months. She woke up on the Fourth of July. Her mind was clear but her arms and legs took years to heal, and she was still in a wheelchair.
She hadn’t been back to Laguna Honda since the accident. But she wanted to come for the move, and so she and I arranged to meet up on the second day of the move in her old AIDS ward.
I found her in the middle of the empty ward. Its patients were already in the new hospital, and its walls already stripped of their corkboards, pictures, and paintings. Sitting in her wheelchair, Dr. Grace was very still, as she had come to seem since the accident, but also full of life and even more beautiful than before.
“I didn’t think it would be so intense,” she said, as soon as she saw me. “To be back. To remember all those patients. All those deaths.”
Next to her was Dr. Tommy. He, too, hadn’t been back for years, and he, too, had come back for the move. He’d always been ironic, and this day he was wearing an overcoat, felt hat, and heavy black-plastic 1950s glasses.
“I went to a Leonard Cohen concert last night,” he explained, “and decided to dress as Leonard Cohen for the move.”
Then we all took off together for the new hospital.
I pushed.
Dr. Grace was much loved, and every ten feet or so, someone—a patient, a staff member, a volunteer—recognized her, called out, came over, and gave her a hug.
“Are you coming back?” each one asked. Even the demented patients.
It took us quite a while, but eventually we did make it through the central hall and down the elevator to the mouth of the corridor that led from Old to New. We waited in line, and then it was our turn to walk through the white tunnel with the light at its end. And as dramatic as it had been the day before, it was even more dramatic pushing Dr. Grace with Dr. Tommy dressed as Leonard Cohen at my side. Because from that side, going from Old to New, I couldn’t tell whether it was the tunnel of birth or of death. It was white and clean and bright, and the light at the end got bigger and bigger.
Then we popped out, and Dr. Grace saw for the first time the cream and taupe walls of the new Laguna Honda, the halogen lighting, the huge windows, and the art glass.
“How beautiful!” she exclaimed.
We walked all around. We looked at the aviary, now a topiary, alas, the birds not having survived their renovation. We saw the cafeteria, the beauty salon, the great rooms with their coffeemakers and soda dispensers, balconies, and views, and Dr. Grace was thrilled. She’d been in a lot of hospitals and patients’ rooms herself during the last few years and knew what was important. The flat-screen televisions! The windows that opened! The under-the-pillow speaker and monitors! The teal-and-cream tiled bathrooms!
In the late afternoon we made our way back to the old hospital, sneaking in a very illegal way back in a wrong-way mode through the tunnel, from New to Old. Which could only mean that it was the tunnel of death, and we were revenants, I suppose, if you want to keep that metaphor.
We ended up just at the intersection of Old and New, in the lobby of the Old with its 1930s WPA frescoes and telephone-switchboard office. This was where everyone ended up. The last of the patients coming out of the elevator and going through the tunnel; staff walking back from the New to stand in a crowd around Dr. Grace: Dr. Benicia, Dr. Jeffers, Mirene, Adrian, Dr. Talley, talking, laughing, telling stories of the day. Whenever someone left, the heavy glass-and-bronze doors would open to give a view of the Florence Nightingale statue, outside looking in.
Finally we put Dr. Grace in her van, and I went back to the new hospital. The evening was coming on, and I walked around the neighborhoods. The nurses were putting their old books and policy-and-procedure manuals on the counters, and taping up on the walls their curling paper schedules. The patient chart racks had been moved, and there they were. Behind, in the dining room, the medical records people had taken up their usual positions, sitting at the new dining tables, randomly thinning charts. The patients were in front in the great room, drinking their coffee and talking together.
Last I walked back to the old hospital.
It was empty. Not a single person was left, by accident or by design. Not one Bad Boy or Bad Girl; not a single little old lady or little old man; no sleeping Chinese janitor, having dozed off during his break in one of the chairs upstairs. There was no one in the stairwells or the elevators. Heavy chains now locked the doors of the wards. I looked through a window: Inside the ward, it was dark, an old calendar still on the wall, a doomed plant on the floor.
The hospital, the old hospital, was empty.
And it felt empty.
I’d wondered for years what the move would be like. I’d always assumed that the spirit of the place was created by its architecture—its arches, towers, turrets; its open wards with the solaria at the end, reminders of medieval hospitality. But now that it was empty, I could see that the spirit of God’s Hotel was not in the old building, and yet it wasn’t in the new, either. That spirit, I realized at that moment, was neither just the building nor just the people in it. It was some kind of amalgam, made up of the way the hospital looked and felt, what went on inside it, and the people inside it, too. Perhaps that spirit could not be transported. And when the iron praying mantis came to tear the old building down—afterward, nothing would remain.
Or perhaps, after the shock had settled, after the spirit of God’s Hotel had spent the requisite forty-nine days that a spirit has to wander in the Bardo, or however long for the spirit of a building, it would reincarnate in the New, stunned a little by its fresh young body, confused, a little surprised.
I stood there in the old building for a long time. I couldn’t decide, one way or the other, whether the spirit of God’s Hotel would live or die.
I thought about the new facility. It was beautiful but it wasn’t warm. If the old hospital was a decrepit, sprawling farmhouse, then the new facility was a five-star hotel, shiny, sterile, impersonal.
I imagined what it would be like to work there. It would not be like the old place, where the open wards had been so inviting to wander. It would take mental effort for me to visit my patients in the new neighborhoods, negotiating locked doors and locked stairwells, and entering each patient room, one by one. When the electronic records came online, the paper charts would go, and with them, the freedom of flipping through pages, recognizing the handwriting of my friends, and writing the real story of a patient. I would spend my time at a computer instead, providing health-care data so that administration could prove that Laguna Honda provided cost-efficient, culturally competent care in a nonabusive setting, with a focus on short-term rehabilitation and discharge. When would I see my patients, sit on their beds, and listen to their stories?
Maybe it would turn out all right, though. Maybe after everyt
hing settled down, and the patients figured out where they could go to read and spit, think and dream. After the hidden cameras broke and the wires in the computer building permanently crossed, the locked doors sprang open and substitute linen closets emerged. Clutches of patients would once again gather in special places of their own—the smokers in a new Harmony Park, the Chinese mahjong players, the Hispanics, the Bad Boys and Bad Girls—and the spirit of God’s Hotel would reappear, in a new body, yes, but alive and still recognizable.
I thought about everything that had happened to me in that old place, and how important it had been. Being in that old hospital changed my life. It had allowed me to explore Hildegard and understand her Way, which was slow—fussing and fiddling, removing obstructions, nourishing viriditas, and calling in Dr. Diet, Dr. Quiet, and Dr. Merryman for every patient. It had allowed me to go on pilgrimage and realize how it was possible to be happy and cold and wet all at once, and to know the quiet that underlies activity.
Perhaps I could have had those experiences … someplace else.
But no place else could I have discovered the hospitality, community, and charity that were in the walls and the air, because you had to be there for a long time to feel them and the kindness that was their source. And no place else could I have discovered the “being myself” with my patients, or the “just sitting,” or the anima at the back of the eyes.
I learned commitment there—throwing myself into the mix, regardless. Before, I’d stood back from my patients—not a lot, but a little; I was wary of the transference and the countertransference. I threw myself in, but not completely, only for that fifteen-minute visit, that two-hour workup, that two-month or even six-month period. But gradually I learned from Dr. Curtis, from Christina and Lacy, from Dr. Dan, Don Taylor, and so many others that that wasn’t being the best doctor. The best doctor walks with you to the pharmacy and stands with you until you drink your medicine. They taught me that the real name for the transference and the countertransference was love, and that the doctor-patient relationship was, above all, a relationship. So in the end, if it was the end, and whatever happened in the future, I had to agree with what Dr. Curtis told me on my very first week—God’s Hotel was a gift.
God’s Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine Page 36