A Doctor, A Hospital, and a Pilgrimage to the Heart of Medicine
Victoria Sweet, 2012
Laguna Honda Hospital is a unique part of the San Francisco healthcare system. Many of the most difficult and challenging psychosocial patients that come to my unit at UCSF are Laguna Honda residents. Being residents at a hospital may sound like an odd term, but Laguna Honda serves as a longterm care facility for the poor and chronically ill and its patients can stay there for many months or even years and therefore earn the “resident” status. The hospital does not have an Emergency Department and if the patient-residents develop new complications they must be transported to one of the city’s medical centers such as UCSF or SFGH for an advanced diagnostic workup. Despite these limitations, Laguna Honda is capable of maintaining and delivering complex medical regimens such as IV therapy and being a hospital it can deliver care that many skilled nursing facilities cannot. It is a public funded non-profit facility that serves the community of San Francisco. Speaking from my role in the medical field, I am extremely grateful that Laguna Honda exists because there are many patients we send there to where I do not know where else they could go if Laguna Honda wasn’t an option.
Since Laguna Honda is located just up the hill from me, I drive and bike by the hospital all the time. However, in the 10 years I’ve lived in San Francisco I’ve only been inside Laguna Honda once. This was in 2010 when I was a student nurse doing an internship at an SRO in the Tenderloin. One of the SRO residents was at Laguna Honda due to his kidney failure and the SRO’s onsite nurse was asked to participate in a goals of care meeting with the Laguna Honda staff. I was able to tag along as a learning opportunity and I was impressed at the collaboration of Laguna Honda’s inpatient medical, nursing, and social work staff’s dedication to work with their patient’s outpatient nurse and case manager to develop a plan to work with this patient and facilitate a safe and feasible discharge from the hospital back to the SRO.
During my visit, the nurse I was working with gave me a brief tour of the Laguna Honda facility and although I was impressed by the dedication of the staff, I was less than impressed by the facility. This was the century old Laguna Honda facility and not the current, modern, new facility that is open today but was under construction when I was at Laguna Honda in 2010. The patient wards were mid-century style, with at least 18 or more beds in one unit with curtains being the only separation of privacy in the larger ward. The windows were small and everything had an worn down, old feeling to it. It hardly inspired optimism and seemed kind of depressing to me. As I have mentioned, Laguna Honda has since been remodeled and apparently the new facility has private or semi-private rooms and has done away with the larger multi-patient ward style of care.
So, having a little bit of appreciation and a little bit of leeriness towards Laguna Honda, I was excited to read Victoria Sweet’s memoir God’s Hotel (an account about one physician’s time working at Laguna Honda) as an opportunity to learn more about this facility that serves such a unique function in the San Francisco community. Sweet has worked at Laguna Honda for over 20 years, starting off as a part time physician in the admitting ward and then she moved on to spend several years in both the dementia ward and the complex medical ward. Sweet writes with a lot of nostalgia for the old Laguna Honda and its rag-tag style of “slow-medicine” that was off the radar of the joint commission for many years and allowed its patients to leave the grounds to smoke, promoted the patients and physical therapists to participate in gardening together, and even had a chicken wandering the halls of the AIDS ward. None of these activities meet the modern model of efficient medicine and as Laguna Honda was faced with several inspections and lawsuits, it was forced to modernize its facility and modify its healthcare model by reducing the patient population and promote discharge to the community. Sweet writes of these changes with begrudging, disappointed judgement towards the changes enforced upon Laguna Honda.
As a book I found God’s Hotel to be a disappointing read and a lot of the excitement I had at the start of opening its pages was quickly deflated as I discovered that this book was less a chronicle about Laguna Honda and more a memoir about this particular doctor’s time at Laguna Honda. During her early years at Laguna Honda Sweet was studying medieval medicine with a focus on the medical writings of the 12th century nun Hildegard with the goal of obtaining a doctorate in medical history. So, with this in mind, much of the book is written in a formulaic style that goes like this: a brief story about a patient and what Sweet learned from her diagnosis of the patient, a little discussion about the politics of Laguna Honda, and then a little discussion about her studies of Hildegard. It goes on and on like this and after Sweet gets her PhD in Hildegardian historical medicine she later replaces the discussion of her studies with discussion of a pilgrimage walk through France and Spain that she embarked upon in sections over 4 years; but the formulaic style is pretty much the same. The way she speaks about the patients and how they offered her something to learn from was annoying. I’m sure that Sweet is a very giving and compassionate person, one has to be in order to work with the Laguna Honda population for such an extensive period of time, but her style of writing was less compassionate than I’m sure she intended and came off as somewhat dishonest and self-centered as it is consistently celebrating what the patients teach her about her approach to medicine and rarely speaks of what many of us feel, frustrations with the patient’s choices or the inevitability of their poor prognosis. As an example, take this following passage about how great Sweet feels about herself after getting a present for her patient for Christmas:
“When I woke up that Christmas, the first thing I thought about was Paul getting his vest. I hope he liked it and I hoped it fit. And I couldn’t help notice the pleasure I was getting out him and that vest. It didn’t seem quite right, somehow, but there it was. This got me thinking about charity – its motivations, its emotions, and how, after hospitality and community, charity was the third principle of Laguna Honda.” (255)
Such writing is overly nostalgic and feels trite. Furthermore, this book greatly desired an editor to clean up the mess that it is. In discussing medical diagnosis and medical equipment, Sweet repeats herself over and over again within the same pages, completely unaware that she had just said the same exact thing a few paragraphs earlier. Additionally, her excessive desire to remove any culpability in her writing was annoying. Of course I understand that the names of patients must be redacted for HIPPA compliance, but she applied the same level of anonymity to the extreme, referring to the “county hospital” and the “city’s university hospital,” which I immediately recognized as SFGH and UCSF and she even goes so far as to make the mayor anonymous, simply referring to Gavin Newsom as the “outgoing mayor” and Ed Lee as the “incoming mayor with the baby face.” This level of blanket anonymity gave the book a sense of over cautious CYA out of fear of discrediting anyone or any institution she disagreed with. And it only gets worse as she refers to the light-rail MUNI train as a “trolley,” which totally frustrated me because no one in San Francisco would ever refer to the MUNI as a trolley and I had no idea why she chose to use this word over and over again.
On top of her annoying writing style, Sweet chose some odd moments to unconsciously display some racist undertones in her descriptions of the hospital staff. It is an undeniable fact that many of the healthcare workers in the Bay Area are of Filipino heritage, but Sweet writes about Filipino nurses as though they are animals and not partners in the providing care for her patients, as depicted in the following:
“Allen, our male nurse, was the peacock of the staff…Allen was a peacock in the way that all male Filipino nurses played peacock to the reserved peahens of the female Filipina nurses.” (241)
The above passage is totally belittling and embarrassing to read. The passage below is even more embarrassing as a depiction of a conversation between Sweet and Rose, the Chinese janitor cleaning her office:
“Her face lit up, “Ah, Dr. S! Bird Gone! I clean floor now! And Window! And Walls!” She shook her head. “Bird not belong in hospital!”” (281)
Rarely does Sweet provide quotation of dialogue in her writing, but for some reason she felt it necessary to point out that her janitor has poor English in what she considers a cute way, with emphatic exclamation marks after each sentence and broken grammar. The inclusion of this brief dialogue was totally unnecessary and served no purpose other than to display Sweet’s discomfort with her Asian coworkers.
The overt use of anonymity, the odd racist moments, and the persistent usage of her patients as learning opportunities as opposed to human beings with needs, caused me to dislike Sweet as a narrator. And in being a dislikable narrator she failed to convince me that her nostalgia for the old Laguna Honda and her fear of the changes ongoing at the facility was the right perspective to believe. There were some quality moments in the book. I did enjoy her discussion of moments when she would simply listen to her patients and I really appreciated that it was her practice to go see her newly admitted patients and assess them firsthand before reading their charts because it would allow her assessment to be unbiased. I totally agree with her claim that many new doctors don’t know how to perform an adequate physical exam because their education is overly focused on reading lab values and CT scans. I find many of these criticisms of the practice of medicine to have some measure of truth and quality, however the overall message of the book was weighed down by many of the negatives aspects of her writing and unfortunately it failed to provide me with the insider’s insight into Laguna Honda that I was looking for in these pages.