Saturday, August 11, 2012

Review: God's Hotel by Victoria Sweet

The latest memoir I completed reading was God's Hotel by Victoria Sweet.  This was a doctor's memoir of her over 20 year experience at one hospital named Laguna Honda.  She examines the theory of "Slow Medicine" requiring a physician to get up close and personal with a patient as well as to spend time with him/her in order to fully understand the patient's medical issues.  She discusses also the politics inherent in going from "Slow Medicine" to a system called "Delivery Of Health Care".  Dr. Sweet did an intensive study of a nun named Hildegard of the 12th century and her pioneering ways in terms of administering quality medical care.  Finally, the reader gets to see the hospital's transition from a 100 year old medieval castle to a gleaming, 21st century new hospital and all the positives and negatives contained in both facilities.

Initially, Dr. Sweet speaks of her strategy for treating patients which involves a thorough workup including patient history, physical examination, and blood tests as well as x-rays.  Since this is a hospital for the sick poor, the doctors have limited access to new diagnosing technologies and they each generall read their own x-rays.  Because Laguna Honda was made up of wards whereby patients were often together in one open area, there became a sense of community among the patients, nurses, and doctors.  Dr. Sweet learns what it is like to be a patient because she sees her patients two, three, and four times a day.  It is so vastly different from the hospitals of today where you might see your surgeon prior to surgery, remain in the hospital, be visited by one of the surgeon's associates, and never come back into contact with your surgeon until after you have been discharged and return to his/her private offices for a follow up visit.

Dr. Sweet learns that just when you think there is nothing more you can do for a patient, there really is, but it lies in the little things.  For example, obtaining a different diet for the patient, having the patient examined and fitted for glasses, or even obtaining shoes and clothes for an indigent patient.  According to Dr. Sweet the analogy that is best for the doctor/patient relationship is to see the patient as a plant and the doctor as the gardener.  The secret of healing is the relationship between doctor and patient.  This relationship takes time and it's not according to administrative standards, an efficient use of a doctor's time. 

Dr. Sweet studied Hildegard of Bingen, a 12th century Benedictine nun who studied medicine under monks and in monastaries before building one of her own whereby she could treat patients in her fashion.  Hildegard's medical strategy involved removing any obstructions the patient has in order to heal and then restoring life spirit to the patient through Earth, Water, Air, and Fire or rather good nutrition and vitamins, proper liquids, deep sleep, and sunlight.  Hildegard's strategy for treating a patient would be to observe the patient, check patient's vital signs and respiration, examine the body part disturbing the patient along with the patient's blood and urine.  Finally, Hildegard would give a prescription for the patient inclusive of a regime for how to live and then also a herbal mixture.  The precription or regime for how to live would include Dr. Diet (foods to eat), Dr. Quiet (how much exercise and sleep for a patient), and Dr. Merryman (how much sex a patient required and the emotions needed for optimal health to be achieved or restored. 

The interesting part of Hildegard's medical system was that it was based on a system of fours and the effects the four seasons had on plants, animals, and humans.  She felt a patient needed the right balance of the four humors inside the body which depends on seasonal changes outside the body.  Dr. Sweet actually went on a pilgramage to Spain in order to learn what the experience of being an "other" or "stranger" or even "patient" might be like.  In other words, what is it like to leave home and immerse yourself by speaking a different language, eating different foods, and encountering different expectations.  For the average patient a hospital stay might indeed make you feel like a complete stranger with all the medical jargon, interesting hospital food, and how your life suddenly changes because of a chronic illness or disease.  One day you are a healthy teacher and the next you are learning to cope with disability; your own world and priorities are turned upside down. 

The best things Dr. Sweet seemed to take from her time at Laguna Honda Hospital was that a patient needs hospitality (little things like a toothbrush, soap, shampoo, proper diet, clothes, shoes).  Also a hospital needs to provide the patient with community or a place where they can share and learn from others experiencing an illness similar to theirs with staff that promotes activities and an atmosphere of inclusiveness.  Finally, a hospital needs to provide charity whether that is in taking extra time to make sure a patient receives proper care after discharge, the patient has a decent place to stay or live, as well as indulging a patient's emotional happiness which may be catering to their likes/dislikes whether it involves food, music, or activities. 

I enjoyed this memoir quite a bit.  Some of the cases encountered by Dr. Sweet were scary and unpredictable.  At times I felt like my teeth were going to drop out when I read what was being experienced by a patient at Laguna Honda.  It was also eye opening to see how much politics influence health care.  I think the main reason I enjoyed this memoir is because it gave me a chance to see how a doctor views a patient, hospital red tape, and how they develop and implement their personal philosophy of medicine.