God’s Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine by Victoria Sweet
Reviewed by Stacey Hollebeek
So there’s this hospital in San Francisco called Laguna Honda Hospital that houses over 800 chronically ill patients, most of who can’t afford to pay a stitch of their medical care. The facility was built originally as an almshouse back in 1866 for the masses of people who came out for the California Gold Rush, but discovered only poverty and pain, yet stayed in the growing then-Mexican city. Since it was an almshouse, it contained acres of farmland for the residents to garden, greenhouses to grow their own vegetables. During a small pox outbreak in the late 1800s, the facility became more of a hospital, and a newer building was constructed along the lines of the medieval monastic “hospitals,” with wide halls, spacious solariums, open wards, aviaries, and turrets. Since then it has remained a long-term care facility for chronically and mentally ill and disabled, most of who have no other place to go.
If you look up the hospital’s website at LagunaHonda.org and check out the amazing place, you wonder how on earth this place is still functioning, much less sporting a swimming pool, artists in residence, and private rooms – when our hospital here in Gallup can barely keep its desperately needed pediatricians.
That’s what Victoria Sweet’s book, God’s Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine, is about – her more than 20 years at Laguna Honda as a physician in the midst of shifting politics and economics. She fell into the job she learned to love in the years following the mass closing of state mental institutions and the introduction of the “efficiency” of HMOs and health care, while Laguna Honda was there to take in those people – sometime over 1700 patients – who fell through the cracks. The book reads like Oliver Sacks crossed with Sweet’s medieval medical history dissertation on Hildegard von Bingen – a strange mix that actually is quite riveting.
Sweet explains in narrative – not figures – the survival of the hospital through its bumps and bruises, as one organization after another tries to take down the hospital, from the Department of Justice to varied disability lawsuits. And yet it survived, even thrived, as Sweet discovered the “efficiency of inefficiency” and the healing luxury of slow time.
At one point, in an effort to cut the hospital budget, the hospital decreased the head nurses by 50%: “It was stressful,” Sweet writes. “After the head nurses were cut in half, there were more illnesses and more sick days among the staff; there were more injuries, more disabilities, and earlier retirements. Among the patients, there were more falls, more bedsores, more fights, and more tears. And this, in the broader scheme of things – even of economics – is not efficient” (p. 84).
Sweet tells one story after another of her patients and colleagues from Laguna Honda, and what she learned from them about practicing medicine in an inefficient world. There was Terry Becker, a Native American woman rescued off the streets with complications of alcoholism and drug abuse, who simply needed time – lots of time, along with a pair of glasses; the regal African-American Mr. Bramwell with Alzheimer’s, who couldn’t remember his own wife and sister, yet could gracefully two-step to Glenn Miller; Mrs. Muller, who had been misdiagnosed as diabetic and psychotic, when she just needed her hip replacement put back into its socket; the double-amputee, Paul Bennett, who came out of his depression to fix all the staff’s computers. Through these personalities and their diseases, Sweet weaves the various issues of modern medicine – practicing medicine versus health care, open wards or private rooms, emphasis of doctors over nursing, long-term care in hospital versus at home, funding more administrators to make the hospital more efficient, while letting medical staff go.
One of the reasons Sweet took the job at Laguna Honda originally was because they gave her flexible part-time hours, freeing her up to complete a PhD. in medieval medical history. Sweet focused particularly on Hildegard von Bingen, the twelfth century German nun who boldly wrote her own music, recorded her autobiography of visions, and scribed her medical practice books, besides starting two monasteries, and interpreting her version of Benedictine rule there. Through her studies, Sweet also visits a Swiss hospital, and admires its mix of medieval medicine practices smartly combined with modern, including prescriptions of whiskey for sleep and wine served with every meal – for both patient and physician.
In the midst of national local and slow-food revolutions, Sweet preaches the value of slow medicine, and how in the end, it’s time, community, common sense, and caring relationships that best heal. While reading the book, I couldn’t help but continually apply her themes to our own Rehoboth Hospital, and all its current difficulties. Yet, I often found myself appreciating Rehoboth Hospital for many of the same themes that Sweet was preaching – doctors like Chris Gonzaga who spent time listening to and problem solving my husband’s digestive issues rather than just prescribing another $1000 scope or test; Dr. Poel who once met my panicked self in the emergency parking lot to care for our toddler screaming with red ant bites; an invaluable chaplain, Kris Pikaart, who helped explain (efficiently) to the emergency room nurse (when she wouldn’t believe me) that my husband didn’t normally talk like a Dutch immigrant – that this foreign accent was a result of his recent possible concussion; midwife Linda VanAsselt-King who helped bring all three of our children into this world. And my list could go on of the Drs. Arrowsmith, Tempest, Kamps, Dr. Flor Gonzaga, nurses Beatrice and Mary Ippel – all medical practitioners who are friends, fellow Gallup residents whom we meet at the grocery store or gas pump, worship with, bike and hike with, who care for us, their patients and fellow community members, in time and in ways that it would be difficult for locums or traveling nurses to improve upon, enriching our lives here in this community in small (but efficient) ways that hospital administrators rarely are privileged to see.
I’ll leave you with one final quote from Sweet on the importance of time in healing: “The picture [of Terry Becker] tells it all; it shows just what Laguna Honda could do in its time and with its time. Whether it was efficient or inefficient, I’ll leave you to decide, but I think you’ll agree that only death is truly efficient. Life is very inefficient and not cost-effective at all, from a health-care efficiency point of view” (p. 98).