For the last couple of years, I’ve been dealing with a handful of minor but annoying health issues—the kinds of things that I can live with as they are now but want to deal with so they don’t get worse. I’ve had good medical care in general, but I’ve sometimes been aggravated at how each symptom is treated as a discrete problem, unconnected to my other complaints. I’ve kind of wished for someone to sit down and really look over my whole history and see which problems might link up and point to a particular root cause.
I thought a lot about this when I was reading Victoria Sweet’s memoir about her years as a doctor at the Laguna Honda Hospital in San Francisco. This old-fashioned hospital, in which patients stayed in large open wards, was actually an almshouse, a place where the elderly or poor who needed long-term care were sent. She worked at Laguna Honda for more than 20 years, and during that time, she also was studying the medieval medical practices of Hildegard of Bingen. What could a 12th-century nun teach a modern medical doctor about healing the body? Sweet found value in what she saw of Hildegard’s mind-set:
I began to understand that the premodern system was based on the gardener’s understanding of the world, and that Hildegard took a gardener’s approach to the body, not a mechanic’s or a computer programmer’s. She did not focus down to the cellular level of the body; instead, she stood back from her patient and looked around. She calculated in her mind not just the internal balance of the four humors, but the whole balance of her patient within and as part of his environment. With that numberless measure, she manipulated and rebalanced the environment inside of and outside her patient. She did so slowly, like a gardener, by fussing and fiddling, doing a little of this and a little of that. Then she waited to see what would happen. Which is to say that she followed the patient’s body; she did not lead.
Through her study and her work at Laguna Honda, Sweet came to believe that something that she calls slow medicine might have answers for us today. Slow medicine involves not just doctors taking time to give patients a thorough work-up but also patients having time to rest and heal in a calm setting with good food and good cheer (or as she calls them, Dr. Diet, Dr. Quiet, and Dr. Merryman).
Sweet does not deny the value of modern medicine—far from it. Modern drugs and tests and treatments are important tools, and she uses them. But her focus is not just on applying those treatments to solve a pressing problem; she also looks for ways to remove obstructions that prevent healing. The modern and premodern are both tools in her toolkit.
The kind of treatment offered at Laguna Honda was not clearly cost-effective—although one wonders if it could be in the long-term—and the hospital was often under attack from efficiency experts and money crunchers who wanted the hospital to follow more standard practices. Sweet describes some of the struggles the staff faced as administrators came and went and new rules came down. Eventually, the old hospital building closed, replaced by a more modern building, but Sweet’s initial tour of the facility left her less than confident that the update was a true step forward.
The book follows these multiple threads, with most chapters looking at a lesson from Hildegard or Sweet’s later pilgrimage to Santiago de Compostela, the administrative issues at Laguna Honda, and a patient whose story seemed relevant. The story follows what seems to be a chronological order, although I was vexed at the lack of dates in the book. Particularly when looking at the hospital’s evolution over time, I really wanted to know how quickly things were happening. I suspect that the timeline of patients and the hospital timeline didn’t dovetail neatly, but I don’t think that would necessarily be a problem. The lack of dates, on the other hand, was. The administrative issues were the least interesting part of the book, but the confusion wrought by the lack of dates made the already bewildering process of change even harder to follow.
Sometimes, too, the connections between the particular patients, Hildegard, and Laguna Honda weren’t as clear as they could be—they seemed chosen to fit the structure, rather than to illustrate a point. It’s a hard balance. I wouldn’t want the examples to be too pat or obvious, but I do want to understand what the various bits and pieces have to do with each other. If the book had been shorter, there might have been less of this seemingly off-point wandering, and the main points of the book would still have been explored. This is not quite an article expanded to the length of a book, but that doesn’t mean the book wouldn’t have benefited from some trimming.
Still, I appreciated Sweet’s approach to medicine very much. It seems like we’d all be better off if our doctors really could take time to listen to our whole story and not just look for patches to cover the latest symptom.