A Hospital That Gave Its Patients Time to Heal

A Hospital That Gave Its Patients Time to Heal

By ABIGAIL ZUGER, M.D.

Published: May 28, 2012

But if you’re one of the millions of doctors and patients out there choking on their dust, this is the book for you. Its compulsively readable chapters go down like restorative sips of cool water, and its hard-core subversion cheers like a shot of gin.

Dr. Sweet writes about the 20 years she spent practicing medicine at San Francisco’s old Laguna Honda Hospital, a giant chronic care facility for the city’s destitute and ill. At one point, almost every county in the nation had a place like it, where patients could live for months, years, as long as it took. These medical back wards, like their psychiatric counterparts, have now evaporated in the name of community-based services: the old Laguna Honda was called the last almshouse in America.

On the days she was not at the hospital, Dr. Sweet was earning a Ph.D. in the history of medicine, focusing on the life and work of the remarkable 12th-century German nun Hildegard of Bingen. Cloistered from age 12 until her death at 81, Hildegard became not only a prominent theologian and a composer of Gregorian chants, but also a health care guru, devising medical regimens for her own community and leaving behind several influential manuscripts.

Dr. Sweet surrounds the stories of her patients with detailed excursions into Hildegard’s medical practice and its occasional unexpected utility for modern problems. And while these two layers would make for a perfectly fine memoir, what turns “God’s Hotel” into a tour de force is its third: a bitingly skeptical eyewitness account of Laguna Honda’s transformation from anachronism into efficient, computerized 21st-century rehabilitation center.

During Dr. Sweet’s first years at the hospital in the early 1990s, it was a peach-colored “riff on a 12th-century Romanesque monastery,” perched on a hill overlooking the Pacific, full of windows and turrets, with swallows flying through its open arches. It housed almost 1,200 patients, most on large open wards with a head nurse stationed at one end and a turret-shaped solarium at the other. The grounds included a greenhouse, an aviary and a barn.

Not that all the residents conducted themselves in suitably monastic ways: The patient population included quantities of what Dr. Sweet calls Bad Boys and Bad Girls, the substance-addled, impossibly behaved denizens of the city’s streets whose chronic medical conditions had forced their game indoors. And so sex and drugs, drinking and gambling were hospital activities alongside gardening.

Caring for those who care little for themselves entails immense frustration and wasted time, but time was one thing the doctors had — time and the medieval medical interventions of regular meals, clean linens, cheerful surroundings and the opportunity for careful observation. Occasionally a remarkable transformation would result from very little more than those simple things, the miserably self-destructive becoming well and whole.

Over time, though, the old hospital was slowly jostled into the present. Elderly staff members and their outmoded, if appealing, routines were retired (one ward nurse had spent her workdays knitting blankets for her patients). Old buildings were demolished. Finally, in 2010, a sparkling new facility sprang to life, sans arches and swallows, with a third fewer beds and a staff newly mandated to focus on short-term rehabilitation and early discharge. The days of endless time were over.

Dr. Sweet reviews the byzantine politics behind this expensive rebirth with careful documentation but no pretense at impartiality. Presumably there is another side to her story — the old hospital may well have provided worse care than Dr. Sweet allows, and the new one may bring better things than she foresees. But the loss of all that time — now, that’s a clear-cut disaster.

Others have written about the relationship between time and medical care with similar eloquence and urgency, but the centuries of perspective that Dr. Sweet brings infuse the point with unforgettable clarity.

Sick people need time, she demonstrates repeatedly, and their doctors do too. The sick body takes time to heal, the mind even longer, and in the elderly it all takes longer still. Medications take time to work; misprescribed ones take time to leave the system. Doctors need time to sit with their patients, to think, to read, to consult, to catch their mistakes. The whole process moves like a snail — or, perhaps, like an ancient nun navigating a garden path. But when you rush it, you get exactly the problems that now confound us all: consumer misery and medical mistakes galore.

Take one of Dr. Sweet’s Bad Girl patients — actually, Terry was just about the Worst Girl. Addicted to alcohol and drugs, in a wheelchair because of a spinal cord injury, she repeatedly left the hospital for community care, her community being a cute boyfriend who got her high, then robbed and beat her. Nodding out in her wheelchair for days on end, she developed a massive bedsore that ate through the skin, fat and muscle of her buttocks to the bones of her spine.

Then one day, back at Laguna Honda for the third time, sober, washed, rested and well fed, lying face down on a gurney she wheeled around with her hands, Terry got rid of the boyfriend permanently. She stopped smoking and gained weight. Her sore slowly began to heal.

“That awful crater filled in from bottom to top and from side to side,” Dr. Sweet writes. “It took a long time. It took two and a half years. But we were in no hurry, and neither was she.”

Health care in no hurry. Can you even imagine such a luxury? Will it ever return?