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

 

Image from Penguin Random House

God’s Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine
By Victoria Sweet
416 pp. Riverhead Books.

When Victoria Sweet decides to become a physician (the first in her family) she thinks she is going to be a psychiatrist. She is drawn to the intellectual aspects of medicine, to the mind. She loves the idea of story: of hearing the patients’ narratives, listening for clues as to their diagnoses. But she soon becomes disillusioned with this choice—psychiatry has become largely a discipline of dispensing—and switches her residency to medicine.  In her pathology rotation, she observes her first autopsy, stunned to realize that the body they are dissecting is that of her first patient on the clinical wards. Sweet is vaguely disappointed when the procedure is over. Each organ has been cut out and weighed, each vein and artery opened, its condition documented. But Sweet leaves wondering where was the essence of her patient? What was it in that autopsy room that made him human?

It was only much later in her career, as a physician but also as a medical historian, that Sweet finds the words for what was missing that day. The Latin word spiritus captures the last breath a patient exhaled, while the language’s anima describes the invisible force that once animated his body. Sweet continues to be deeply curious about the mysteries of the body—not just the moments of birth and death—but why some patients get better and some do not. How prayer and mind and soul and belief all affect patient outcomes. She studies ancient eastern medicine disciplines from China and India before stumbling upon a German nun from the Middle Ages in a book called Hildegard of Bilgen’s Medicine. Western, but pre-modern, Hildegard’s practice originated in the 5th century BC with Hippocrates. While modern medicine’s view of the body is a machine and disease, a mechanistic problem to be fixed, Hildegard’s approach is one of gardener, tending to the body as to a plant which needs certain combinations of the elements of earth, water, air and fire.

Sweet decides to study Hildegard for her PhD thesis in medical history. But she soon realizes that she will need a commodity that modern medicine seems to have dispelled with altogether: time. In trying to procure a position that will allow her the part-time patient-care hours she needs to further her studies, she arrives at Laguna Honda Hospital, the last alms house in California (and quite possibly America). Here she studies Latin (Medieval, not Classical) in order to read Hildegard in the language in which she wrote. She learns paleography—the pre-print “hand-writing” of the Middle Ages. She learns about glosses: notes written between manuscript lines, and palimpsest or re-used parchment resulting in texts written under texts.

And palimpsest is, in a way, the perfect metaphor for the kind of medicine Sweet was practicing at Laguna Honda. Learning to read the body, to listen for the subtext underneath the obvious. The answers that come from dementia patients as Sweet sits quietly at their bedside—“I was at my high school prom and the boys were so handsome”—that give credence to Sweet’s belief that even in dementia (literally ‘deprived of mind’) the anima, the soul, is still there.

Sweet relates many stories of where today’s emphasis on rooting out inefficiencies in our health care system is also destroying some of its humanity. One of her colleagues, upon learning that a discharged patient is still in the hospital because his insurance company has not yet approved payment for a pair of shoes, simply goes out and buys him a pair. Another buys her patient a pair of reading glasses rather than wait for insurance to pay for them through the usual channels. In an AIDS ward (which is essentially a hospice ward as this is before effective treatments were available) the nurses let a chicken run around at mealtime, scavenging scraps and bringing smiles to the ill patients, before administration puts a stop to the practice.

The idea that rings truest for me is Dr. Sweet’s concept of Slow Medicine. She is convinced that if given sufficient time, doctors could save health care dollars by coming to diagnostic conclusions more organically than via expensive testing. Examples abound in her book: The tumor found through careful examination; the misdiagnosed dementia revealed after withdrawing unnecessary medications; a bed sore, too large to be operated on, healing with Hildegard’s prescriptions of cleanliness, good nutrition, fresh air and sunlight.

Sweet’s love of language imbues her book with a richness that runs deeper than the mere war stories of doctors of a certain age. The root word of hospital, Sweet tells us, is hospitality. And hospitality is at the core of Laguna Honda’s mission. Hospes means both guest and host. (And every doctor will surely be a patient one day.) The word community’s derivations include communio from the verb munio meaning “to build a wall around.” Rather than isolating, though, this wall is meant to instill in all within it a shared specialness. Communio also derives from the noun munis which means gift. Therefore community can also mean “those who share a gift in common,” an apt definition for the community at Laguna Honda.

Sweet learns lessons from her patients by defying the mandate that we physicians need to keep a certain distance between us and our charges. In my own community of Dominicans and Puerto Ricans, there is a saying that “there is no personal relationship or professional relationship. There is just the relationship.” Allowing herself to have that relationship with patients—meeting their families, attending their weddings—provides her with some of her deepest lessons and us with a most meaningful and satisfying read.

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