Thursday, October 4, 2012

God's Hotel by Victoria Sweet

I chose this book on our book club reading and may have made a mistake, considering the preferences of the other readers, but I enjoyed it. It is a book I'd have  read with or without the book club. It has depth and value; I learned while reading it.  To me, that is important in books.  A curious reader will  enjoy it.  Someone who wants just light reading,  sheer entertainment will not.  I will pass this book along to my own doctor who does practice spending time with patients, a rarity.  But then I go to Mayo and it is different. 

 Early reviews gave me the impression that "God's Hotel"  was about treatments of  aids patients at Laguna Honda Hospital in San Francisco, but it is far more than that. Infact, there is little about aids patients.  It  has comedic parts including the chicken of the ward which of course had to be removed when state inspectors arived.  Yes, a real live chicken that kept the patients happy. 

 A fast read at 348 pages, published in 2012 and authored by Victoria Sweet,MD, it is more than aids, it is a history of the medical and non medical treatments at what is one of the last almshouses in the country.  Laguna Honda has cared for the poor, the homeless, the alcoholics, those without resources for a long time.  The city of San Francisco has heavily supported it.  Dr. Sweet  goes there after  med school unaware that she will spend her career there.  Her  sort of memoir of these times describes the changing healthcare system and processes and depicts the plight of the "residents."

I was familiar with  the issues between governmental  bureaucracy, regulation and funding of  Laguna Honda from my career at the state Department of  Health Services.  However, after reading this book, I have to agree with Dr. Sweet, there has been unnecessary  tampering and tinkering by bureaucrats that has not contributed to effective care for patients.  Laguna Honda had a mission from it's founding to care for  those without  resources.  It desperately clung to that.  Dr. Sweet tells the history of Laguna Honda along with her own maturation in medicine.   Page 38,  "Slowly the two of us came to understand that Dr. Fintner had the temperament of the physician and I, although I was an internist, the temperament of the surgeon.  I was interested in action, or not; she was interested in the mos precise action and would spend quite  a bit of time to get it right...."   Pg. 39,  "...seemed to be sleeping.  But as we stood there, waiting or maybe just watching, I gradually became aware of a quality I'd felt before with patients, though never consciously--the quality of shared, peaceful silence.  It was a healing space,, I realized at that moment, and not only for the patient.  For the doctor too, a quiet space of non-asking and non-answering of non-doing."  The techniques, relying on old school time spent and sensing are emphasized and as she admits, not techniques covered in today's medical training which emphasizes technologies. 

Page 98 describes a recurrent theme of treatment, "a tincture of time." "...Not only did her healing take a long time and need a long time, but time was the most important ingredient in her treatment.  Premodern medicine knew about that special ingredient; it was called "tincture of time." Almost everything it had observed, healed in time under the right conditions.....it was watching her healing that was miraculous, that reformed my practice of medicine.  In this day of efficient health care, no one ever gets to see such a process...It seemed to me more than mechanical; it seemed magical a sleight of hand....."

There is detail in the history of medicine going back to Hippocrates and the anima, spiritus, physics.  There is a lot of information as Dr Sweet continues her studies in the practices of  a 12th century healer, Hildegard who knew the essence of spirituality and time.  Pages 160-162 describe her work in the dementia ward and the distinct difference between various dementias and Alzheimers.  However today every dementia is termed Alzheimers when that is not accurate.  Dr Sweet's journey is marked by time off to study early Hildegard, to make pilgramages in Spain and Europe, to learn the lesson of pilgramage is to (pg. 244) "expect the unexpected." 

I was fascinated by her deep historical descriptions and alayses of terms of words.  On page 228 she  describes hospitality, community and charity as the  3 principles of Laguna Honda.  Then  continues to trace the word, "charity" thru history, bringing it bcack to Laguna with a description of "eleos" and alms.    Page 253 she emphasizes an important distinction, "the practice of medicine had become the delivery of healthcare....."  This book weaves a tale of the difference between those two concepts as well as distinguishing between  nursing and medicine. he reorganizations that Laguna uses to react and work along with political and fianancial decisions are also interesting.  My sympathy rests with the worker bees who become entrapped by these changes all in the name of efficiency.

 I give this book a 4* and recommend it to people who are interested in medicine, healthcare, history, words.  I hope my bookclub enjoys it, and will learn about that  in a week or so when we meet.  It  would be a gret text for aspiring doctors but unlikely to be acknowledged in today's training which emphasizes technology, rapid diagnosis and moving on to the next patient.