God’s Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine
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Page 325. The old-fashioned “medical model” of physicians would be replaced by a “social model”: Of everything in the Ja Report, perhaps the most eye-opening was the idea that the “medical model” should be replaced by the “social care” model. It took me a while to understand this. Apparently the “medical model of care” did not mean the modern disease/cause/treatment/scientific method of modern medicine. Rather, in the long-term-care world the “medical model” meant a specific architectural model of the hospital where patients were categorized by their disease, management was top-down, and physicians had a privileged place. The new idea was that for patients who needed nursing homes, there should be something less like a hospital and more like a home. For more on this, see www.pioneernetwork.net. But the Ja Report used “medical model” in a still different way to mean “favoring physical health over mental health and substance abuse” (21). And it connected the “imposition of the medical model” to the “professional dominance of MDs” (20). When all was said and done, though, the social model of care was in fact a code for taking care of the mentally ill substance abusers, those patients at the MHRF whom Dr. Stein had been trying to get into the hospital for almost ten years.
Page 325. Last, they demanded an audit of the two-million-dollar Patient Gift Fund: Laguna Honda’s Patient Gift Fund was a pretty great thing. I first learned about it from Dr. Major. Nearly two million dollars had been given to the hospital over the years by grateful patients, families, and philanthropists, specifically for the unmet needs of patients—for the little daily things. It was this Patient Gift Fund that paid for Terry Becker’s flight back to her family in Arkansas; for storing Paul’s things; and for Radka’s telephone calls to her son in Bulgaria. Dr. Major and Miss Lester had husbanded it carefully, spending only the interest on the account, and Dr. Romero knew it well from her days as medical director. When she was told that the two-million-dollar fund had been depleted, she and Dr. Kay set to work. They went through more than 1,300 documents and discovered that much of the money had been spent not on patients but on staff parties, nurse training, and administrative trips—my favorite expense being the $5,015 spent for museum-quality frames for pictures placed in the administrative suites; $745,000 could not be accounted for at all. See “Cost Shifting at Laguna Honda Hospital,” at www.stoplhhdownsize.com/Part%201%20-%20LHH%20Gift%20Fund%20Cost%20Shifting.pdf. For Dr. Kay’s retaliation suit, see “Case No: 380-10-505443: Complaint for Damage and Demand for Jury Trial, Superior Court. www.stoplhhdownsize.com/Dekerr_Endorsed_Complaint.pdf. KGO-TV covered the story on May 20, 2010.
Page 326. Then Dr. Talley called her first meeting of the medical staff: Here I’ve used three meetings and three different memos from January 4, 2010, March 5, 2010, and May 3, 2010, to summarize what had happened.
Page 327. But then I remembered what Florence Nightingale had written about the struggle between medicine and nursing and administration: “A patient is much better cared for in an institution where there is the perpetual rub between doctors and nurses or nuns; between students, matrons, governors, treasurers, and casual visitors, between secular and spiritual authorities … than in a hospital under the best governed order in existence” (Nightingale, Notes on Hospitals, 184).
Page 329. It was time to take the tour: For a virtual tour of the new hospital, see www.lagunahonda.org.
Page 336. He’d joined Alcoholics Anonymous, he told me: The inspiration for Alcoholics Anonymous came, amazingly enough it seemed to me, from Carl Jung. The story is that he told his patient Rowland Hazard, who had come to him for treatment of his alcoholism, that his case was hopeless without a spiritual conversion. “All you can do is place yourself in a religious atmosphere of your own choosing and admit your personal powerlessness to go on living.” Jung recommended the Oxford Group in England, which was where Hazard eventually did have his spiritual conversion, and then incorporated its principles into his Twelve Steps. Bill W. wrote to Jung reminding him of this story, and Jung wrote back, “The craving for alcohol was the equivalent on a low level of the spiritual thirst of our being for wholeness. Expressed in medieval language, the union with God…. Alcohol in Latin is spiritus … and the formula is spiritus contra spiritum” (Bill W.’s letter to Dr. Jung, January 23, 1961). There was something remarkable to me that the lesson that ended my apprenticeship at God’s Hotel was a lesson from the man who had inspired it at the beginning.
Page 336. He was back to attend the memorial service for his sponsor, Mr. Don Taylor: Don Taylor’s real name is Tom Lawlor, and since he was never my patient, I suppose it’s ethical and legal to give his real name, which I’d like to do because he deserves it. His obituary reads: “R. Thomas Lawlor. Tom will be missed by the Doyle family, extended family, and a vast fellowship of friends in recovery. Tom celebrated twenty years clean, along the way touching countless other lives. Tom loved his job, patients, and community at Laguna Honda Hospital” (The San Francisco Chronicle, March 6, 2009).
Page 336. Hc was no longer not ill, but well: The root of the English health is hàl, which also gives us hale as in hale and hearty, and, crucially, whole. Healthy, whole, and well all come from the same root that originally meant “whole, intact.” See Buck, Dictionary, 301-2; 307.