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For readers of Paul Kalanithi’s When Breath Becomes Air,�a medical “page-turner” that traces one doctor’s “remarkable journey to the essence of medicine” (The San Francisco Chronicle).�
San Francisco’s Laguna Honda Hospital is the last almshouse in the country, a descendant of the H�tel-Dieu (God’s hotel) that cared for the sick in the Middle Ages. Ballet dancers and rock musicians, professors and thieves—“anyone who had fallen, or, often, leapt, onto hard times” and needed extended medical care—ended up here. So did Victoria Sweet, who came for two months and stayed for twenty years.
���� Laguna Honda, relatively low-tech but human-paced, gave Sweet the opportunity to practice a kind of attentive medicine that has almost vanished. Gradually, the place transformed the way she understood her work. Alongside the modern view of the body as a machine to be fixed, her extraordinary patients evoked an older idea, of the body as a garden to be tended. God’s Hotel tells their story and the story of the hospital itself, which, as efficiency experts, politicians, and architects descended, determined to turn it into a modern “health care facility,” revealed its own surprising truths about the essence, cost, and value of caring for the body and the soul.
- Sales Rank: #21853 in Books
- Brand: Sweet, Victoria
- Published on: 2013-04-02
- Released on: 2013-04-02
- Original language: English
- Number of items: 1
- Dimensions: 8.24" h x .84" w x 5.47" l, .70 pounds
- Binding: Paperback
- 432 pages
Review
PRAISE FOR GOD'S HOTEL
“Transcendent… readable chapters go down like restorative sips of cool water, and its hard-core subversion cheers like a shot of gin… God’s Hotel [is] a tour de force… 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.” –The New York Times
“A radical and inspiring alternative vision of caring for the sick.” –Vanity Fair�
�“Engaging… You might not expect a book about San Francisco's most downtrodden patients to be a page-turner, but it is. With its colorful cast of characters battling the tide of history, God's Hotel is a remarkable journey into the essence of medicine.” –San Francisco Chronicle�
"Victoria Sweet writes beautifully about the enormous richness of life at Laguna Honda, the chronic [care] hospital where she has spent the last twenty years, and the intense sense of place and community that binds patients and staff there. Such community in the medical world is vanishingly rare now, and Laguna Honda may be the last of its kind… God's Hotel is a most important book which raises fundamental questions about the nature of medicine in our time. It should be required reading for anyone interested in the 'business' of healthcare�– and especially those interested in the humanity of healthcare." –Oliver Sacks, M.D. author of The Man Who Mistook His Wife for a Hat and The Mind's Eye�
“Victoria Sweet has written the best non-fiction book I've read this year… The qualities that make her a great doctor are the same qualities that make her book so powerful, original and relevant… For a very long time, a gang of renegades got away with practicing medicine the way it should be: sitting with patients, watching, listening, often doing nothing more than being present. And then Victoria Sweet, a candidate for sainthood, wrote a book that is a beacon in the darkness.” –Jesse Kornbluth, Huffington Post
“A beautifully written and illuminating book… [Sweet’s] metaphors are poetic and hint at the mystical, but then she pulls back with the educated eye of a scientist… For both the agnostic and the believer, Sweet pinpoints the element of medicine that makes it a calling rather than a job: the unique and sustaining love that is sparked between a doctor and patient.” –Jerome Groopman, The New York Review of Books�
"Remarkable… [Sweet] would appreciate that it took time for me to journey to and through her work since that may be one of the many compelling messages she so eloquently, yet simply by storytelling, conveys… permitting ‘tincture of time’ to also do its job." –The Huffington Post
“Sweet writes fluidly and well… She weaves a fascinating account of the historical forces that transformed our view of the body… It's high time that someone gets medieval on modern medicine's morass, and Victoria Sweet is just the woman to do it.” –Cleveland Plain Dealer
“Captivating… with this humane and thoughtful work, Sweet joins physician-authors such as Oliver Sacks, Jerome Groopman and Abraham Verghese.” –The Dallas Morning News
“Sweet’s tone in God’s Hotel nicely matches her subject. Her writing has a lovely, antique quality… This hospital, with its chronically ill patients, crumbling buildings, and never-ending budget woes, was 'a gift.' In this beautiful and unique book, she shares that gift with us generously.” –The Boston Globe
"Intelligent and moving… In this often lyrical book, Dr. Sweet reveals a deep spirituality and unsentimental compassion." –Minneapolis Star-Tribune
"Sweet paints a dynamic portrait… [which] is at its core testimonial to the body’s remarkable ability to heal when it is provided with the simple ingredients of time and care." –Utne Reader�
“Visionary… thoroughly subversive in all the best ways… Sweet proposes ways that we might reimagine our way forward by looking into the distant past… This book’s lessons and conclusions should challenge doctors, nurses, hospital administrators, and policy makers to stop and rethink their core beliefs.” –Journal of Health Affairs
"Containing no medical jargon… nothing too gory or gut-wrenching; just descriptive stories of patients, unusual treatments, a hospital in transition, and a doctor on a journey, learning to practice 'a beautiful art.'" –East Bay Express�
"By braiding… historical searches with her time at Laguna Honda, [Sweet] arrives at a compelling critique of modernized health care and a vision for transforming it." –Books & Culture
“[Our] healthcare system might function a lot better if every single American citizen, healthcare professional, politician and legislator would read Victoria Sweet’s insightful, beautifully written and moving book.” –Bookpage�
About the Author
Victoria Sweet has been a physician at San Francisco’s Laguna Honda Hospital for more than twenty years. An associate clinical professor of medicine at the University of California, San Francisco, she is also a prize-winning historian with a Ph.D. in history and social medicine.
Most helpful customer reviews
49 of 49 people found the following review helpful.
A brilliant, caring doctor and a one-of-a-kind hospital: a great great book
By Jesse Kornbluth
It almost always annoys me when someone who isn't a professional writer produces a great book, but Victoria Sweet has written the best non-fiction book I've read this year and all I wanted to do when I finished reading it was to meet her and congratulate her and ask her a lot of questions.
So I did.
Something happened at the start of that conversation that made me realize why her book dazzled me --- the qualities that make her a great doctor are the same qualities that make her book so powerful, original and relevant.
She heard me. She paid attention. She made me her patient.
Before I asked my first question, I mentioned a health issue. When she returned to San Francisco, she wrote me: "Now that you've let me know you haven't been feeling well, you need to make sure to let me know that/when you are feeling better and the meds are kicking in. Otherwise, I worry."
You want a doctor who has infinite time for you? Who cares --- as a person --- how you fare? Who uses not just the tools of current medicine but learns Latin so she can scour texts a thousand years old to learn the wisdom of pre-modern medicine?
For 20 years, to get that kind of doctor, you went to Laguna Honda Hospital in San Francisco.
To an almshouse --- a facility that provides medical and spiritual care to the poorest of the poor.
For free.
"God's Hotel" --- the term comes from the H�tel-Dieu, the French charity hospitals of the Middle Ages --- is four books in one. Because it reads as much like a memoir as a chronicle of daily life in an unusual hospital, it's the story of Victoria Sweet, who came to Laguna Honda on a part-time basis for two months, stayed two decades and, along the way, staged a successful "twenty year escape from health care." It's the story of her patients, many of them "Bad Boys and Bad Girls," and how treating them with dignity either sweetened their days or, on occasion, turned their lives around. It's an intellectual adventure story; a doctor follows an insight and reconnects with a way of practicing medicine that's almost totally forgotten. And it's the story of clueless government bureaucrats and "efficiency experts" whose apparent goals are to transform an adequate facility into a dysfunctional one.
It is, I suspect, this last thread that will resonate with most readers. We are not, most of us, poor. In the main, we are healthy. It's not likely we'll embark on a treasure hunt for obscure knowledge. But heartless bureaucrats --- yeah, we've met a few.
Laguna Honda did not, as legally required, deliver mail on Saturdays. The daily menus were not translated into Chinese. There was peeling paint. Dust. And --- horrors --- drug and alcohol abuse among the patients.
How to fix all that? Thin out the medical staff, add administrators. Bring in consultants who earn 10 percent of any savings they produce. Decide to tear down the old hospital and build a new one. Make sure the architects never talk to patients or doctors, so when it's finished there is no place to put the wheelchairs.
Infuriating stuff. And yet that's not what you feel at the end. What you leave with is, oddly, a sense of celebration. For a very long time, a gang of renegades got away with practicing medicine the way it should be: sitting with patients, watching, listening, often doing nothing more than being present. And then Victoria Sweet, a candidate for sainthood, wrote a book that is a beacon in the darkness.
JK: Give me three adjectives you'd use to describe your patients --- the poor.
VS: I don't think of them as poor. I don't know why I don't. They just didn't seem "poor" although they mostly didn't have money. But they were the bottom one tenth of one percent of our society; they were the ones who fell through the holes in the safety net, and they were always two standard deviations from the mean. Any mean.
JK: You write: "The diagnosis is written on the body." You write: "The secret in the care of the patient is the care of the patient." What other home truths have you picked up that you weren't taught in med school?
VS: One is from a book that many doctors have read, "The House of God"--- "In an emergency, the first pulse to take is your own." And then "the efficiency of inefficiency." Which means: do the thing in front of you first. The secret in caring for the patient sometimes is doing the little things. In Latin, there is no distinction between caring and curing --- "curare" means both. In that way, doctors can learn a lot from nurses; I know I did.
JK: You write enthusiastically about the "tincture of time"--- not an idea most of us are familiar with.
VS: This was the secret ingredient of pre-modern medicine. The old doctors had observed that almost everything gets better over time if you are able to remove or fix the initial problem --- the infection, the appendix, broken bone. The body wants to heal --- let it, help it. It's what I've come to call "Slow Medicine," as opposed to the Fast Medicine that works so well to remove the appendix, open the blocked coronary artery or shrink the cancer, but which doesn't work so well after the appendectomy, the operation, or the chemotherapy. That's when patients need time, rest, and Dr. Diet, Dr. Quiet and Dr. Merryman.
JK: Many of us know Hildegard von Bingen as a composer and mystic. For you, her importance is as a healer with insight into a concept called "viriditas." Explain, please.
VS: "Viriditas" means green. Hildegard used it to signify the greening power of plants. Her idea was that just as plants have a natural power of healing and growing, so too do patients; that the body is more like a plant, and the doctor, therefore, is more like a gardener, whose job is to remove what is in the way of the patient's natural ability to heal; to nourish and fortify it.
Hildegard didn't depend on numbers as we do. In that sense she was subjective, which is not to say that she didn't have measures. She took pulse and evaluated blood and urine; but it was more subjective and perhaps less repeatable than our own. Although I sometimes think that our measurements too are more subjective than we realize.
JK: In an election year, health care is a significant issue. I suspect you could --- with pleasure --- design an ideal health care system for America.
VS: Yes. And it's practical: Let people buy it.
JK: You mean single payer?
VS: No! Calling it single payer was a big mistake. If you sell it as single payer, most people won't want it. So let's just say that we'll let people buy into Medicare. Because, amazingly, it seems that the government has been able to create a remarkably good system, all things considered.
Most patients are satisfied with it, according to studies. Most doctors are satisfied with it, too. By that I mean, many doctors prefer to accept Medicare patients over patients who have insurance; apparently Medicare has less bureaucracy (!) and is more straightforward about what and how much it will pay. Of course, at this point, Medicare is starting to pay so little that many doctors can't afford to take it either.
The way it could work would to just let people buy into Medicare. I'm not an economist, but if you take Medicare's budget and divide it by the number of patients it serves, I think it comes out to cost about $700 per month per person. So if someone wants to pay $700 per month for a Medicare card, why not let them? It would be a wash for the government. (If you don't earn enough? The government kicks in $350.) That seems like a lot of money, but even Kaiser, our HMO in California, charges more than $600 for individual coverage.
A second piece of the plan would be to reinstate what we had in the old days, where every county had a free hospital and a free almshouse. They weren't fancy and they weren't equal but they were adequate, and they provided a place where anyone could go, no questions asked, to get care. Even if they were rich! If we had that, at least people without insurance wouldn't have to worry that they would go bankrupt if they got sick.
JK: At Laguna Honda, were you often annoyed by patients who wasted your time?
VS: It wasn't the patients. It was the administrators. But I don't think it's correct to say that the administrators were annoying --- it really was the bureaucracy that they were required to institute that was annoying. As people, the administrators at the hospital were by and large thoughtful and caring people. By and large, of course. I don't want to set up a personal ad hominem dichotomy.
JK: Would it have been better if the Department of Justice had not interfered with a patient-centered institution that didn't satisfy every modern code?
VS: In the `70s, young, idealistic lawyers at the DOJ had a mission: close snakepits. By the `80s, they had closed most mental hospitals. The plan was to move patients to small halfway houses. But then there were budget cuts, and the halfway houses never happened --- patients were put out on the street. Now the government has turned its attention to the last of the almshouses and state hospitals and are methodically trying to shut them down, too. I'm into adequate, not perfect.
JK: You write that, in 3 years, the government forced Laguna Honda to discharge 139 patients --- at a cost of $46,000 per discharge.
VS: I had to pull that data myself. And when I asked, "Why are you spending so much time trying to discharge a patient who's been comatose for 10 years?" I got a blank look.
JK: Where were you in the administrative battle for the survival of Laguna Honda as a traditional almshouse?
VS: A group of passionate people fought the changes. I'm not an adversarial person by temperament, so I didn't. As a doctor in charge of patients, you have to choose between seeing a patient or going to a meeting. In the long term, it's probably better to go to the meeting. But doctors are really co-patients --- we don't know what else to be.
JK: In the pre-modern period, you write, there was a concept called the Turn of the Wheel of Fortune. "Each of us is attached to that wheel, which is Time, and sooner or later we will go down, and sooner or later we will come up." Right now, where are you on the Wheel?
VS: We have no idea where we are on the Wheel of Fortune --- that's the point. We are at the top of the world: rich, handsome, healthy. And one day we wake up and there are lymph nodes growing out of our neck and we have cancer. We turn a corner and are smashed to bits. And vice versa: we are a cook's helper at Laguna Honda, and we win the lottery. We go backpacking, and we eat a can of tuna, and we are dead. So I have no idea where I'm on the Wheel of Fortune. All I do know is that at the moment, this is a wonderful and satisfying time in my life. We'll see how long it lasts.
49 of 52 people found the following review helpful.
God's Hotel
By obsteve
I learned about God's Hotel from a blog by Dr. Danielle Ofri, one of my favorite medical essayists. She wrote the essay several days before the book was available and I got it as soon as I could order it and was definitely not disappointed. Dr. Sweet is an internist who was looking for a hospital in which she could work part time while pursuing graduate studies in the history of medicine. She found Laguna Honda hospital,probably the last almshouse in the country, caring for the castoffs of society in the way that medicine should be practiced....slowly, with attention to detail and individual caring for each patient.
She speaks of her triumphs and tragedies and of what she has learned from her patients. I have often felt that as a physician, I have learned as much from my patients as I have given them. I went to medical school in the Midwest at a time when you could still give that care that Dr. Sweet discusses. A place not unlike hers, in a building that was about a hundred years old with the occasional bat flying down the corridor on the top floors. I learned as she has, the incredible healing power that sitting with the patient and listening to concerns, fears, nuances of tone and voice could not only help healing but lead to the correct diagnosis.
I expected somewhat of a slow read but was delighted to find that her book is a page turner and written in an easy,lighthearted way but very authoritatively.
A great book and experience.
24 of 25 people found the following review helpful.
What we lost and gained from modern medicine
By C. Griffith
Dr. Sweet's memoir, like her diagnoses of some of her patients, has multiple independet but interacting parts. In part it is about her work in San Francisco's Laguna Honda Hospital, a public facility which is a direct intellectual descendent of the medieval almshouse. The second part is her study of the medical writings of Hildegard of Bingen, a 12th century Germany nun(and abbess) better known for her mystical religious writings. The third strain, which appears towards the end of the book, is about how her experiences walking the Santiago de Compestela pilgrmage in Spain, changed her thinking. As the descendent of an almshouse, Laguna Honda is now a very rare institution in the United States. Basically it has served (this may change) as a free, public hospital for those with chronic conditions. The emphasis on caring for people who aren't likely to get better distinguishes Laguna Honda from the public county hospital in San Francisco, which is supposed to treat acute conditions, after which if need be the patients will be transferred to Laguna Honda. Although Laguna Honda does have many patients with drug abuse problems and mental illnesses, it is not set up (no locked wards, etc.) to deal with violent or severely mentally ill people
The characterization of Lunga Honda as a hospital for the chronically ill may not hold true in the future. In conjunction with the completion of a new building in the last couple of years, Laguna Honda may become a facility focusing on the mentally ill and homeless, though the new building was not designed with those patients in mind. Those patients who are not mentally ill or homeless are supposed to be speedily rehabilitated (see page 325, not doubt released to the community (which may very well mean released to a Single Room Occupancy hotel on skid row). It will certainly house fewer patients. Part of the reason for this change lies in the budget problems of San Francisco, which in additon to Laguna Hospital has a public county hospital and a mental health facility to fund. The lawsuits and investigation mentioned below also played a part.
Dr. Sweet ended up at Longa Honda because at the time it was the only place she could practice medicine part-time. She wanted to work part-time in order to carry out serious academic research on Hildegard of Bingen. Her interest in Hildegard was a result of an experience in medical school, where she witnessed the autopsy of a man who had been her patient. Something seemed missing in the autopsied body; that something was a soul. The experience got her to wondering if medicine had always been the mechanistic affair it now was. It may be relevant to note that Dr. Sweet had originally intended to be a psychiatrist, but ended her psychiatry residency early once it became clear to her that mental illness was now (and often very successfully) treated with drugs rather than the talk therapy of her hero Jung. She became an internist instead.
She did discover, though, that prior to (very roughly) the 19th century, medicine had not been a mechanistic endeavor and that concepts such as the soul were part of medicine. This interest is what got her to read Hildegard's medical work. Hildegard's thinking about medicine was pretty standard for the times; it revolved around what is sometimes called the system of fours. This system appears to be (there is a helpful diagram on page 181) a set of relationships between the seasons, the cardinal directions, the (medieval) elements, bodily humors, the patient's temperament, and 4 qualities, all of whch come in groups of four. The qualities are cold or hot, wet or dry. The bodily humors are blood, melancholia, bile, and phlegm. The four elements are air, fire, earth, and water. As an example of the associations among these moieties, spring is associated with ot and wet air, the dominant humor is blood, and the associated temperament is sanguine. The medieval practitioners goal was to bring the body into accord with patient's age and the season, through appropriate drugs and appropriate behaviors, such as the correct diet. To decide on the appropriate treatment, the doctor had to consider both the personality of the patient and the patient's environment. On the whole Dr. Sweet is happier with modern medicine, but does think some things have been lost.
Dr. Sweet worked in the admitting ward (now abolished in conjunction with the move to the new building; patients will now be admitted directly to the presumably relevant ward, oops I forgot the euphemism for ward is "neighborhood"), the dementia ward, and two complex medical wards. The dementia ward is what it sounds like; one thing I learned is that a diagnosis of Alzheimer's since the 1980s is at best an elimination of other possible causes of dementia and, more often than not, is simply the default description given to those suffering from dementia but who have not really been thoroughly examined to eliminate other possible causes. Before about 1980 Alzheimer's specifically meant a kind of dementia arising before old age. The medically complex wards were for those who had major medical problems and who could not, for other reasons, take care of themselves.
One of the things I learned from reading about Dr. Sweet's medical experiences was the benefits of giving a doctor the time to make a really thorough exam. In part because many of her patients had had chronic illnesses for a long time, a two-hour physical exam could tell you quite a lot about a patient without blood tests or imaging. I also learned that many patients are taking drugs they no longer need, largely because doctors generally continue prescriptions that their patients got from previous doctors. Dr. Sweet was often able to eliminate one-third or one-half of her patient's prescriptions. Nor were these prescriptions simply unneeded; often they were actively harmful.
The fate of Laguna Honda as an institution was bound up in two lawsuits (Davis and then Chambers) by disability-rights lawyers, a multi-year federal Department of Justice investigation, and money. What the disability-rights lawyers appear to have wanted was for everyone to be let out of the hospital and receive home care. In Dr. Sweet's view, the basic problem with this option was that money was an issue, and that, contrary to the plaintiff's claims, home care costs more because the increased medical expenses. The Department of Justice's complaints to some extent overlapped the claims in the lawsuits, and an elaborate but basically unsuccessful process was put into place to review which patients could be discharged; the number was much smaller than the Department wanted. Also, the Department, like most other outside observers, hated the open wards that housed most of the patients. The Department believed that the open wards were violation of the patients' rights to privacy. The Justice Department also noticed the drinking, illegal drug use, and sex that some of the patients were enjoying. The Department was correct that all of this was going on to some extent. However, I am puzzled that the Justice Department didn't consider the possibility that the increased privacy in the new building (patients basically has their own bedrooms, sharing a bathroom with 2 or 3 others) won't increase the amount of drinking, illegal drug use, and sex. Perhaps all the cameras in the new building (which would seem to me to be a violation of the patients' right to privacy) is supposed to prevent this, in conjunction with the fewer entrances and exits in the building. My hunch is that, unless the cameras cover every corner and unless every visitor is searched, the new building will lend itself to more drugs, alcohol, and sex.
I greatly enjoyed this book, which I thought was well-written. I first posted this review at Goodreads.com
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