I wish God’s Hotel were a book with pictures. No matter how precise Victoria Sweet’s descriptions, the world her words conjure is difficult to imagine. A hospital that looks more like a peach-colored, red-roofed monastery. Turrets, archways, and a tower with tucked-away priests’ quarters. Sixty-two acres of land, complete with a greenhouse, solarium, an aviary, and two pigs wandering the barnyard. An AIDS ward with an egg incubator and a chicken roaming from patient to patient. A nurse who knits a blanket for every patient on her floor; a co-medical director who stays late into the evening to arrange bouquets.
All this, perched on a hill in San Francisco in the 1990s.
Laguna Honda Hospital is still in existence, though in a very different form. It is the last almshouse in the United States. Nearly every county in the U.S., the author explains, used to have an almshouse – a catchall space for the chronically disabled, the addicted, the unemployed. Now, there’s just Laguna Honda, an extended-stay hospital for those with nowhere else to go.
Victoria Sweet first came to Laguna Honda as a physician intending to stay only two months. Over two decades later, she’s still there. God’s Hotel is her account of Laguna Honda as the pressures of national trends, local administration, and economic agendas ushered it into the modern-day healthcare industry. Political intrigue met bureaucratic nightmares: new staff positions were invented, new policies written, new inspections instituted, and new ballot measures drafted. Doctors were fired, rehired, and quit, and a shiny new hospital (sans turrets, sans archways) was erected. Sweet stayed through it all, and her chronicle of the hospital tells us a little of what was gained and a lot of what was lost.
Sweet makes no claims that old is always better. For example, when remodeled wards give long-term patients their individual rooms, they lose a sense of community but gain a sense of privacy. Sweet’s stories reveal the vivid tradeoffs when one medical philosophy is traded in for another. Yet many of these tradeoffs demonstrate what some doctors sense, but few have the courage to articulate: the efficiency of inefficiency.
Sweet does not condemn profit-conscious medicine, but rather suggests that it doesn’t go quite far enough in assessing what efficiency might actually look like. She gives the example of an elder patient who arrived at Laguna Honda on a myriad of medications prescribed by doctors at another hospital. Yet after several conversations over the course of weeks, Sweet began to suspect that the woman had been misdiagnosed. Simple tests confirmed her suspicions, and her patient was taken off dozens of unnecessary medications and discharged.
Sweet’s leisurely examination of the woman saved the hospital thousands upon thousands of dollars in medications and living expenses. It is only because of the time that she had that she saw the signs that all the doctors before her had missed. Yet there is no room in the practice of “efficient” healthcare for leisurely conversations between doctors and patients. There is no room in “efficient” healthcare for the hospital to serve as a place of real rest, either. Economic maneuvers pare away at good food, big windows, and quiet surroundings to make room for more drugs and more tests. When Sweet talks about the efficiency of inefficiency, she points out that more drugs and more tests may not actually be what our bodies need.
“Slow medicine” is what she calls it – the analogue of fast food versus slow food. Slow medicine is medicine in which doctors get to know their patients, patients start to trust their doctors, and the hospital community functions as a micro-ecosystem of peace, rest, and healing. Fast medicine is what the rest of America has already embraced.
It is not difficult to read God’s Hotel as an indictment of the healthcare industry, because of course it’s precisely that. As a pre-medical student, I read God’s Hotel with an eye for improvement – what could I take away from this reading that might shape my own practice? Yet Sweet’s book doesn’t offer us only a different vision of healthcare, but more broadly, a different vision of our relationships to our bodies and to one another. She asks us to reimagine not only our hospitals, but also our selves.
Victoria Sweet is both a doctor as well as a PhD in History. As she tells us the story of Laguna Honda, she also tells us the story of her doctoral research into Saint Hildegard of Bingen, a twelfth-century German nun and mystic who developed various medieval medical treatments, as well as theorized about connections between human health and the natural world.
Sweet brings the concepts of Hildegard’s work to bear on her own experiences in the hospital, and in doing so, challenges the notion that knowledge about the body comes just from MRIs and lab results. Sometimes, a less analytical and more instinctive relationship with the body tells her more than hard science ever could. Several years into her career at Laguna Honda, Sweet begins to take the time to do what she calls “just sitting.” With all of her patients – especially those with problems the medical team can’t quite pin down – Sweet leaves her beeper and her cell phone in another room, and sits with her patients. Sometimes they chat, but oftentimes they just sit in silence. And when she emerges from this semi-meditative state, she has often learned something new about the patient’s body – something that tells her a little bit more about what’s gone wrong, and what she can do to heal it.
In a way, “just sit” is exactly what Sweet does with Laguna Honda as a whole. She sits with its stories, and invites us to sit with them. With warmth, patience, and quiet observation, she tells us about the life of Laguna Honda through the lives of its inhabitants – the patients, the nurses, the doctors, and the administrators that made it what it was and turned it into what it is now. And by the end of her meditations, we’ve learned something about what’s gone wrong with our bodies – both individual and institutional – and what we might do to heal them.