The efficient way of slow medicine: the story of the last US almshouse through the eyes of doctor and historian of medicine Victoria Sweet

Victoria Sweet, associate clinical professor of medicine at the University of California, San Francisco, and former PhD student in History of Medicine at DAHSM, is one of a kind, in many regards. Just to name one, Victoria is unique in having spent several months at the beginning of her career as a medical doctor looking for a position that would allow her to practice medicine and also pursue a doctorate in the history of medicine, while many doctors would pursue their interest in history or the medical humanities more as a pastime. That search would prove to be more difficult than expected, until Victoria found a position – which at the beginning she thought was going to be temporary solution- at Laguna Honda hospital in San Francisco. Instead of staying for the two months of the initial contract, Victoria ended up staying for more than twenty years, and witnessed the many trasformations of Laguna Honda hospital from the last almshouse in this country to a modern health-care facility, while at the same time she was working on the history of premodern medicine in Switzerland, studying the role of nun Hildegard von Bingen. In the book ‘God’s Hotel’ – which is also her debut as doctor and writer – Victoria narrates the fascinating story of the unique patients of Laguna Honda and of the ‘efficient inefficiences’ of the hospital. The book is very intruiguing, starting from the title. The ‘God’s hotel’ reflects both the etymology and the origin of Laguna Honda hospital. As a matter of fact, Laguna Honda was one of the last – if not the last- ‘almshouses’ in the US, or as the French called them, and ‘Hotel-Dieu’. ‘Hotel-Dieu’ (literally, a ‘God’s hotel) comes from the latin “domus dei”, which was the name of monastic hospices and infirmaries where monks and nuns would take care of the sick and poor, and of all those who couldn’t take care of themselves.
While in the past, almost every county in the US had an almshouse, which would function together with the county hospital -the former took care of the chronically disabled, and the latter would take care of the acutely ill- over the last forty years almost all of the almshouses have closed down, except for Laguna Honda, which had anyway to withstand radical transformations in the recent past to comply with the requirements of a modern hospital. As illustrated by the stories narrated by Victoria, at Laguna Honda the usual medical adage from “common things occur commonly” was reversed to “uncommon things occur commonly”. The patients were usually very sick, with a combination of morbidities and severe side effects of long-term drug abuse, alcohol, and of living in the streets, and had “rare, fascinating diseases” that could not be found elsewhere, and were a privilege for the doctor who could witness them. What was also unique at Laguna Honda was that doctors were practising an older, and slower, kind od medicine, and were able to dedicate long chunks of time to observe and talk with their patients, and listen to their stories. This slow pace of medicine proved to be fundamental for the formulation of a correct diagnosis in those chronically ill and often with multiple co-morbidities, who have a hard time finding their right place in the high-tech and sporadic delivery of health-care of nowadays.

The author photographed by Denise Zmekhol

Besides, as Victoria illustrates with her many fascinating stories, the kind of care delivered at Laguna Honda was also in many ways more efficient from an economic point of view, as required less trips to the emergency rooms, and often would take patients off some of the too many medications they had been put on during a moment of acute crisis.
The spirit of the ‘God’s hotel’ which was Laguna Onda is captured for Victoria in the double meaning of the Latin word ‘hospes’, which means both host and guest, and is the root of the English words for “hospitality” and “hospital”. This double meaning is the essence itself of true hospitality, where guest and host are peers, and is the essence itself -says Victoria- of the special relationship between doctor and patient, the very relationship that risks dissolving in the contemporary, fast delivery of health-care where doctors become ‘providers’ and patients become ‘customers’ or ‘clients’. In the true doctor-patient relationships, doctor and patients are peers too, like host and guest, as they are playing a part, a role that is interchangeable, and will be interchanged at some inevitable time in the future, as we all destined to become patients at some point of another in our lives. More information on the book can be found here.

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Last modified: May 24, 2012