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God's Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine

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San Francisco's Laguna Honda Hospital is the last almshouse in the country, a descendant of the Hôtel-Dieu (God's Hotel) that cared for the sick in the Middle Ages. Ballet dancers and rock musicians, professors and thieves-"anyone who had fallen, or, often, leapt, onto hard times" and needed extended medical care-ended up here. So did Victoria Sweet, who came for two month San Francisco's Laguna Honda Hospital is the last almshouse in the country, a descendant of the Hôtel-Dieu (God's Hotel) that cared for the sick in the Middle Ages. Ballet dancers and rock musicians, professors and thieves-"anyone who had fallen, or, often, leapt, onto hard times" and needed extended medical care-ended up here. So did Victoria Sweet, who came for two months and stayed for twenty years. Laguna Honda, lower tech but human paced, gave Sweet the opportunity to practice a kind of attentive medicine that has almost vanished. Gradually, the place transformed the way she understood her work. Alongside the modern view of the body as a machine to be fixed, her extraordinary patients evoked an older idea, of the body as a garden to be tended. God's Hotel tells their story and the story of the hospital itself, which, as efficiency experts, politicians, and architects descended, determined to turn it into a modern "health care facility," revealed its own surprising truths about the essence, cost, and value of caring for body and soul.


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San Francisco's Laguna Honda Hospital is the last almshouse in the country, a descendant of the Hôtel-Dieu (God's Hotel) that cared for the sick in the Middle Ages. Ballet dancers and rock musicians, professors and thieves-"anyone who had fallen, or, often, leapt, onto hard times" and needed extended medical care-ended up here. So did Victoria Sweet, who came for two month San Francisco's Laguna Honda Hospital is the last almshouse in the country, a descendant of the Hôtel-Dieu (God's Hotel) that cared for the sick in the Middle Ages. Ballet dancers and rock musicians, professors and thieves-"anyone who had fallen, or, often, leapt, onto hard times" and needed extended medical care-ended up here. So did Victoria Sweet, who came for two months and stayed for twenty years. Laguna Honda, lower tech but human paced, gave Sweet the opportunity to practice a kind of attentive medicine that has almost vanished. Gradually, the place transformed the way she understood her work. Alongside the modern view of the body as a machine to be fixed, her extraordinary patients evoked an older idea, of the body as a garden to be tended. God's Hotel tells their story and the story of the hospital itself, which, as efficiency experts, politicians, and architects descended, determined to turn it into a modern "health care facility," revealed its own surprising truths about the essence, cost, and value of caring for body and soul.

30 review for God's Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine

  1. 5 out of 5

    Darryl

    The original Lagunda Honda Hospital Laguna Honda Hospital was built in San Francisco in 1867 as an almshouse, which provided medical and spiritual care and a sense of community to the early residents of the city who could no longer support themselves. After it served as a place of refuge for many of the survivors of the devastating 1906 earthquake, Laguna Honda was rebuilt in 1909 as a 1,178 bed facility at the base of Twin Peaks, making it one of the largest almshouses in the United States throu The original Lagunda Honda Hospital Laguna Honda Hospital was built in San Francisco in 1867 as an almshouse, which provided medical and spiritual care and a sense of community to the early residents of the city who could no longer support themselves. After it served as a place of refuge for many of the survivors of the devastating 1906 earthquake, Laguna Honda was rebuilt in 1909 as a 1,178 bed facility at the base of Twin Peaks, making it one of the largest almshouses in the United States throughout the 20th century. The concept of the almshouse dates back to medieval Europe, as a Christian tradition that existed in most larger communities. These almshouses, initially run by monks and nuns, became the earliest hospitals, the most famous being the Hôtel-Dieu de Paris, which was founded in the year 659 and remains in existence today. Lagunda Honda Hospital, built in 1909 Lagunda Honda Hospital's main focus was on long term comprehensive care for people with dementia, traumatic brain injury, and end-stage illnesses such as cancer, alcoholic cirrhosis and in later years, AIDS. It also provided rehabilitative care for patients with non-life threatening conditions whose physical limitations, lack of caretakers, poverty and homelessness, mental illness or substance abuse did not allow them to recuperate fully at home. Most of its residents lived there for months and years; some succumbed to a peaceful death surrounded by supportive family members and hospital staff, and many were released to a supportive environment after they were physically and spiritually healed. Victoria Sweet was a newly minted internal medicine physician who sought a position in which she could practice on a part time basis while she pursued a doctoral degree in the history of medicine. She was somewhat familiar with Laguna Honda from her medical training, but was skeptical that practicing in an almshouse was the right fit for her. She accepted a temporary two month position, and more than 20 years later she continues to practice there. God's Hotel is Sweet's chronicle of her career at Laguna Honda, the patients, staff and colleagues who taught and enriched her, and the transformation of the hospital from one of the last almshouses in the United States to a newly built hospital and rehabilitation center. The hospital's changed mission coincides with the transition from 20th century medicine provided to patients by doctors, nurses and ancillary staff, to 21st century health care management, in which hospital administrators, government officials, insurance companies, efficiency experts and lawyers dictate what services "clients" should receive from the "system". The new Laguna Honda and Rehabilitation Center, circa 2010 The author also describes her study of Hildegard of Blingen, a 12th century nun, theologian and medical practitioner, who wrote a textbook about medicine that combined the "four humors" theory of premodern medicine with her own knowledge of medical botanicals. Sweet's study of Hldegard formed the basis of her PhD in the history of medicine and resulted in an award winning book, Rooted in the Earth Rooted in the Sky: Hildegard of Bingen and Premodern Medicine. In addition, Sweet also embarked on a pilgrimage from Le Puy in southwestern France to Santiago de Compostela in Spain, a 1200-mile journey based on a medieval route originally taken by St. James. She describes these two intellectual and physical journeys in detail, and how they influenced the care of her patients and her view of the ideal practice of inpatient medicine for chronically ill patients, one in which holistic and deliberate care (which she describes as "slow medicine") rather than stabilization and rapid discharge could be shown to be more cost effective, due to lower readmission rates and decreased cost of unnecessary outpatient medications. God's Hotel is a powerful rebuttal and a loving testament from a wise and sensitive doctor practicing "in the trenches", one who works diligently to provide the best care to her patients, while bemoaning the negative effects of health care reform and the influence of bureaucrats who make untoward decisions by evaluating data rather than communicating directly with patients and those who provide direct care to them.

  2. 5 out of 5

    Dianne

    This is a book to treasure. Dr. Victoria Sweet practiced medicine at Laguna Honda Hospital for 20 years, the last years of the hospital's existence in it's original iteration, as a Hotel Dieu, or almshouse for the aged, indigent, chronically ill who were without resources. Over the years, Dr. Sweet experienced the shift to the new Laguna Honda Hospital as a state-of-the-art hospital, becoming the antithesis of "slow medicine" with all the care and attention to patient needs that implies. Along t This is a book to treasure. Dr. Victoria Sweet practiced medicine at Laguna Honda Hospital for 20 years, the last years of the hospital's existence in it's original iteration, as a Hotel Dieu, or almshouse for the aged, indigent, chronically ill who were without resources. Over the years, Dr. Sweet experienced the shift to the new Laguna Honda Hospital as a state-of-the-art hospital, becoming the antithesis of "slow medicine" with all the care and attention to patient needs that implies. Along the way, she goes on the Santiago de Compostela pilgrimage, explores the word of Hildegarde of Bingen, and learns a lot from her patients and co-workers. The book is compulsively readable, and engrossing. Dr. Sweet is clear-eyed and dispassionate in discussing the transitions to the new hospital with all it implies for patients and caregivers, and there is a sweet, nostalgic quality to the telling of the tale. Highly recommended reading. I have recently learned that a great-uncle of mine lived at Laguna Honda for quite a long time, appearing on the 1920 and 1930 censuses, then disappearing without a trace. I would so love to learn who has custody of the records of the old Laguna Honda, and how genealogical researchers can access information on family members who spent time there.

  3. 4 out of 5

    Darleen

    While I found many of the stories of Sweet's interactions with patients compelling, I was deeply troubled by the lack of acknowledgement (awareness?) of the role of volunteers at Laguna Honda in creating and cultivating the community she writes about. As a Zen Hospice Project volunteer at LHH in the hospice ward, I was puzzled by her brief depictions of the hospice department as "too efficient" (p. 217) and by the lack of acknowledgement of the loving and life-filled/life-affirming community the While I found many of the stories of Sweet's interactions with patients compelling, I was deeply troubled by the lack of acknowledgement (awareness?) of the role of volunteers at Laguna Honda in creating and cultivating the community she writes about. As a Zen Hospice Project volunteer at LHH in the hospice ward, I was puzzled by her brief depictions of the hospice department as "too efficient" (p. 217) and by the lack of acknowledgement of the loving and life-filled/life-affirming community the hospice community shared especially in the old facility, but still does today in the new building. In addition, I was floored by the lack of recogniztion of so many volunteers from the community at large and from the LHH community who helped make the move-out/move-in (pp. 341-2). So many San Francisco citizens came out and served the LHH community those days of the move, it was surprising that no mention was made of it. From reading the book, one would have the sense that only the professional staff volunteers goes the extra mile in any significant way. Several comments were made about the faulty design of the new hospital, including the lack of physicians' offices. No mention was made of the lack of a morgue. This could have allowed the author to explore the touching care so many staff and volunteers had given residents and their families after death in the old facility. In addition, death is a natural part of life, and something Hildegard of Binghen, Dr. Sweet's dissertation subject, would have understood and cultivated a spirital awareness of. It could have also allowed the author to explore the mismanaged planning that went into the new facility. Finally, the book could have used a good editor. There are many redundancies throughout the book. The story told here is an important one, but there are many oversights.

  4. 5 out of 5

    Andy

    Some very good lessons for doctors and the health system. Don't miss the obvious. Take responsibility for making people better, as opposed to checking off some box. Look at the patient and the chart and think for yourself. Slow Medicine is better AND cheaper than modern high-tech "healthcare." Use words to mean something; avoid garbage diagnoses like "Alzheimer's." First thing, get rid of the bean counters. Listen to people. Notice what doesn't fit in the picture. Some very good lessons for doctors and the health system. Don't miss the obvious. Take responsibility for making people better, as opposed to checking off some box. Look at the patient and the chart and think for yourself. Slow Medicine is better AND cheaper than modern high-tech "healthcare." Use words to mean something; avoid garbage diagnoses like "Alzheimer's." First thing, get rid of the bean counters. Listen to people. Notice what doesn't fit in the picture.

  5. 4 out of 5

    Fran

    This book was a wonder for me. I have worked at the SF Dept of Public Health since 2000. My job allows me to be involved in many different parts of the dept; I've been lucky enough to even work at LHH and on projects related to LHH. While I have the utmost respect for all those who work at LHH, I've been puzzled at times by the high drama, the resentment toward administration (sure, natural to a point, but still it was enough to make a person curious). I was especially confused by LHH's intense This book was a wonder for me. I have worked at the SF Dept of Public Health since 2000. My job allows me to be involved in many different parts of the dept; I've been lucky enough to even work at LHH and on projects related to LHH. While I have the utmost respect for all those who work at LHH, I've been puzzled at times by the high drama, the resentment toward administration (sure, natural to a point, but still it was enough to make a person curious). I was especially confused by LHH's intense individualism. While from my perspective, they were always part of the health dept. A huge urban health dept that boasts a full system of care, which includes LHH. I took this for granted, but it didn't take long to see how deeply entrenched was (is?) the notion that bc LHH is unique (in the truest definition of the word - there is no place like it), it must remain separate & apart. The term of art was "silos" & breaking down these silos has long been a goal of central administration. (Thank you, Dr Sweet, for not using this overused term, btw.) I had heard most of these stories before, at least some part, some perspective. Now that I've read Dr Sweet's account, I have been able to answer questions like the one above. The love the staff develop for the place, the people, the style, is unparalleled, as is the fact that riding under the radar made that possible for so many years. I do not necessarily agree with every interpretation here, but I accepted & respected every one as her truth. Her honesty & the gentleness in which she treated every person, even adversaries, says volumes about Dr Sweet. I would say it also says volumes about LHH, the complexities, moral, physical, & otherwise..,well to face those for so many years must make you a better, stronger, & more understanding/accepting person. I so appreciate the chance to read this book. A wonderful history of the old LHH, a memoir of a dr learning to be the very best kind of dr (IMHO), and a collection of stories about those normally forgotten. I was also so happy to read about "Mr Conley." I worked under him for a time & found him to be a wonderful boss & human being. I always knew I'd get more than a fair shake from him. If I'd only had more time. I miss him a lot, & think about the impact of his career on his life often. Something we can all learn from as we consider how high we want to climb the ladder, & what our priorities should be. Thank you, Dr. Sweet!

  6. 4 out of 5

    Amanda

    The subject matter of this book appealed to me and I was excited to read it, but I didn't like it at all. Every chapter was formulaic and predictable. They all followed this exact formula: 1.) Lengthy description the current state of Laguna Honda Hospital usually including much extraneous administrative detail (nature of charting, forms, etc.) 2.) The author's reflection on her Ph.D. studies re: Hildegard and the history of premodern medicine 3.) Some patient anecdote and lessons learned from thi The subject matter of this book appealed to me and I was excited to read it, but I didn't like it at all. Every chapter was formulaic and predictable. They all followed this exact formula: 1.) Lengthy description the current state of Laguna Honda Hospital usually including much extraneous administrative detail (nature of charting, forms, etc.) 2.) The author's reflection on her Ph.D. studies re: Hildegard and the history of premodern medicine 3.) Some patient anecdote and lessons learned from this. It was the patient anecdotes that came across as particularly egotistical to me - like the patients' sole purpose was to teach her some valuable lesson in doctoring and medicine. After all, as she kept pointing out, one day she would become a patient too. It was in her best interest to do it right. Maybe I don't like memoirs but I felt like I was wading through pages and pages of pure ego. I also did not see the point of including her European pilgrimage. Sure, she arrived at some insights during her travels, but I didn't see the relevancy. It came across a load of narcissistic navel-gazing to me. She'd also discussed the roots of various words to excess. She'd go on and on about a word like "'Hospital' stems from the word, 'Hospitality,' which in Greek means..." It felt like I was reading a bad Valedictorian speech. I thought her comparison between premodern, agrarian society's medicine and modern, post-industrial revolution society's medicine was interesting, but this seemed better suited for an academic paper and not a memoir. She should have left it in her Ph.D. dissertation where it belonged.

  7. 5 out of 5

    Deena Metzger

    i read God's Hotel after the 10th ReVisioning Medicine Council. Medical people and medicine people gathered to see how we can help create (recreate or restore) medical / healing ways that sustain life and do no harm to individuals or the earth. ReVisioning Medicine tries to restore indigenous medical ways as appropriate in combination with the best of western medicine, enhanced by contemporary vision. God's Hotel describes the best of western medicine - kind, thoughtful, patient centered, healin i read God's Hotel after the 10th ReVisioning Medicine Council. Medical people and medicine people gathered to see how we can help create (recreate or restore) medical / healing ways that sustain life and do no harm to individuals or the earth. ReVisioning Medicine tries to restore indigenous medical ways as appropriate in combination with the best of western medicine, enhanced by contemporary vision. God's Hotel describes the best of western medicine - kind, thoughtful, patient centered, healing ways. Laguna Honda, where Victoria Sweet practiced medicine for 20 years was once a hospital with an aviary, a green house, conversational spaces, private getaway areas and so much of what is really needed for individuals to really heal from the inside out and the outside in. Taken over by corporate mind, intent on standardized treatment, deadly charting, and the substitution of economic efficiency for compassionate treatment, a way of medicne and a way of life came to an end - a tragedy for the patients and all of us. Still we are reminded of what once was and so can be again. Victoria Sweet is the real thing when it comes to being a doctor, is a very fine writer and a passionate advocate for sanity. Bless her articulate vision of slow medicine and its source in almost all medicine globally and, also, in this instance, the wise green ways of Hildegard of Bingen.

  8. 4 out of 5

    Valorie Hallinan

    The author, a physician, also has a Ph.D. in the history of medicine, and she studied the medical work of Hildegard of Bingen. Hildegard was a nun but also a physician of sorts and practiced medicine based on the four humors. Sweet is a fascinating woman and physician, and practices a kind of slow medicine based on compassion and a nondogmatic spirituality, which I find appealing. However, her book is too long and episodic, with sections rather like a formula - here is yet another patient sketch The author, a physician, also has a Ph.D. in the history of medicine, and she studied the medical work of Hildegard of Bingen. Hildegard was a nun but also a physician of sorts and practiced medicine based on the four humors. Sweet is a fascinating woman and physician, and practices a kind of slow medicine based on compassion and a nondogmatic spirituality, which I find appealing. However, her book is too long and episodic, with sections rather like a formula - here is yet another patient sketch, introduced with the same tired transition over and over. She writes of the last almshouse in America and its conversion to a modern day "health care facility." Fascinating, to a point, but there is too much detail about the personalities and politics. But the biggest problem I had with this book is, while she embraces the values of slow medicine, Laguna Honda where she works seems to move further and further away from it; Sweet remains ambivalent, at best, and survives all of the transitions there unscathed. I wasn't sure where she was going with the slow medicine theme and found it frustrating that she never really took a stand, however controversial that might have been. I felt she held back in her book, always trying to be politically correct. Frustrating & disappointing, for me.

  9. 4 out of 5

    Jen Marin

    God's Hotel is the story of what may have been the last almshouse in America. Dr. Victoria Sweet writes a riveting account of her experience practicing medicine in a place that exists between what she calls 'premodern medicine' and our modern health care system. In such a place, she discovers that "Tincture of Time" and a bit of attention can have a profound effect on how well the patient fares. Set up during the Gold Rush, Laguna Honda is a hospital from a different era. Wide hallways and open, God's Hotel is the story of what may have been the last almshouse in America. Dr. Victoria Sweet writes a riveting account of her experience practicing medicine in a place that exists between what she calls 'premodern medicine' and our modern health care system. In such a place, she discovers that "Tincture of Time" and a bit of attention can have a profound effect on how well the patient fares. Set up during the Gold Rush, Laguna Honda is a hospital from a different era. Wide hallways and open, separate wards from the days before antibiotics are set up in a way that would make Florence Nightingale proud. Staff was limited, and mostly used for patient care. Doctors would certainly take a patients' vital signs in person, possibly do their own x-rays, and perhaps even prepare slides in order to examine necessary fluids. Laguna Honda was a facility where people ended up who had no where else to go. Outside the modern health care customer base (and funding) the hospital was short on money but long on time. At least, that is how it was when Dr Sweet arrived. Eventually, however, the modern notions of efficiency and bureaucratic accountability caught up with Laguna Honda. Outdated architecture succumbed to the pressure of modern earthquake regulations, and a new Laguna Honda was born. Dr. Sweet came to Laguna Honda because she wished to practice as a part-time physician, a notion all but unheard of in modern times. Ironically, this was because she wanted to pursue her PhD in medical history, studying a period in which practioners of medicine were always part time, and had other roles in their communities. Like her historical counterparts, Sweet had other interests. Specifically, she was intrigued by Hildegaard of Bingen, a 12th century infirmarian who also happened to be a nun. On the journey toward her PhD, Sweet learns that Hildegaard's approach to medicine had some value and truth. She found herself approaching her more challenging cases with a new perspective that often had miraculous results. With all of our modern equipment, testing, and pharmaceuticals, today's medicine still faces many challenges in helping people find wellness in their lives. Modern medicine relies on these technologies, often to the detriment of everyone involved. A new doctor admitted to Sweet that she didn't really know how to perform a complete physical workup on a new admission; there was so much else to learn that they didn't cover that in school anymore. Considering the amount of incorrect diagnoses that Dr. Sweet discovered, this does not bode well for the delivery of appropriate care. If you are intrigued by the evolution of medicine, you will find this book fascinating. Finding the balance between modern technology and old-fashioned time and attention is essential to the future of medicine. If we can do this, we can create a better future, increasing wellness, reducing the cost of health care and most importantly, saving lives.

  10. 5 out of 5

    Steven

    This is a fantastic book. It is an excellent memoir filled with fascinating stories of patients in Laguna Honda Hospital, one of the last Almshouses or charity hospitals in the United States. This reads well as a study of conflicting medical philosophies, but is also a well-written entry in the more difficult genre of memoir. The story of Laguna Honda--God's Hospital--is compelling in itself, as is the physician-author's relationship with the hospital and with the live-in patients and medical sta This is a fantastic book. It is an excellent memoir filled with fascinating stories of patients in Laguna Honda Hospital, one of the last Almshouses or charity hospitals in the United States. This reads well as a study of conflicting medical philosophies, but is also a well-written entry in the more difficult genre of memoir. The story of Laguna Honda--God's Hospital--is compelling in itself, as is the physician-author's relationship with the hospital and with the live-in patients and medical staff who inhabit it. I would like to see all doctors, nurses, and congressmen dictating healthcare policy read and absorb the valuable lessons in God's Hotel. But this book is also an insightful study in the value and meaning of community. During Doctor Sweet's career at Laguna Honda, the old buildings were replaced by new and a bitter battle raged over the role Laguna Honda should play in the future of San Francisco. Sweet's discussion of this battle makes this book a valuable story from the front lines in America's ongoing battle for community against the isolating tide of modernism, driven as it is by economies of scale, new technology, and so many other "conveniences" that rob us of relationships. It has often been observed that television and air conditioning allowed Americans to abandon their front porches and go inside--where genuine interaction with neighbors was replaced by voyeuristic observation of mostly make-believe characters and celebrities most of us will never meet. Similar forces have affected churches, schools, and even hospitals, where video, computers, the internet, and private rooms have taken their toll on a variety of relationships and on the community as a whole. Against such a context, GOD'S HOTEL is an invaluable contribution.

  11. 4 out of 5

    Morgan

    I was able to read "G-d's Hotel: A Doctor, A Hospital, and a Pilgrimage to the Heart of Medicine" because of the giveaways. I would like to thank goodreads and Dr. Victoria Sweet for posting this book as a giveaway. Even though "G-d's Hotel" is different from any other book that I have read, it was still interesting. I enjoyed the medical anecdotes that Dr. Sweet retells which provide an insight into the hospital. The information within the book about medical terms, medical history she learns ab I was able to read "G-d's Hotel: A Doctor, A Hospital, and a Pilgrimage to the Heart of Medicine" because of the giveaways. I would like to thank goodreads and Dr. Victoria Sweet for posting this book as a giveaway. Even though "G-d's Hotel" is different from any other book that I have read, it was still interesting. I enjoyed the medical anecdotes that Dr. Sweet retells which provide an insight into the hospital. The information within the book about medical terms, medical history she learns about and the issues within the system were very informative. However, Dr. Sweet does take a political stance on the issues and sometimes goes out of her way to bash the opposition. Generally I do not like it when books, besides the ones written by political pundits, take either side on a political issues. I personally do not like it when books 'preach' to me and authors try to push their politics onto me. All in all it was an informative read that illuminated a new sphere of medicine to me.

  12. 5 out of 5

    Janine

    I wonder if I would have liked this book more if I had removed my nurse's cap before reading. Others seem to like it a lot. What I took from it was a sense of "better than you" - regarding most of the patient stories ("look at me, helping these people who don't know enough to help themselves") and certainly regarding the other employees in the hospital. The nurse that this author seemed to like best was the one who knitted for all the patients on her ward (and, oh yeah, did some other stuff too) I wonder if I would have liked this book more if I had removed my nurse's cap before reading. Others seem to like it a lot. What I took from it was a sense of "better than you" - regarding most of the patient stories ("look at me, helping these people who don't know enough to help themselves") and certainly regarding the other employees in the hospital. The nurse that this author seemed to like best was the one who knitted for all the patients on her ward (and, oh yeah, did some other stuff too). Several derisive comments about health care teams (what the heck do nurses, physical therapists, social workers, etc. know about medical/patient care, anyway?) pretty much sealed the deal for me. There ARE a few bits of goodness scattered about, and the book is fairly well-written (smooth to read), but I just couldn't get past the ego and self-centered (elitist???) vibe.

  13. 5 out of 5

    Cheryl

    This is an unusual memoir of sorts; a memoir of the author's time at Laguna Honda Hospital in San Francisco, what she learned from her patients, about medicine-old and new-and about herself. It also documents the specifics of how the changes in medical financing of HMO's, which started in the 1970's and driven by economics, not care, impacted and changed Laguna Honda forever during her time there. It's not a political book generally but I loved the way she discusses taking her own, very pragmati This is an unusual memoir of sorts; a memoir of the author's time at Laguna Honda Hospital in San Francisco, what she learned from her patients, about medicine-old and new-and about herself. It also documents the specifics of how the changes in medical financing of HMO's, which started in the 1970's and driven by economics, not care, impacted and changed Laguna Honda forever during her time there. It's not a political book generally but I loved the way she discusses taking her own, very pragmatic and detailed "surveys" regarding what was "efficient" use of resources and staff and came to very different conclusions than the expensive consultants hired to "reconfigure" the hospital, and who never actually talked to anyone who worked there, or was a patient there-they never even set foot on the premises. When do consultants actually talk to anyone who might contradict their bean counting results! I live in the SF Bay Area but have never seen LHH. It's on my list now of places to visit. A hospice chaplain I know told me the old hospital, the building that was left standing when they rebuilt the new one, told me it is now a hospice facility, and just as beautiful as it's described in the book. The author made a curious choice in my mind not to include any dates in the book itself, and that can be a little confusing but I am certain this was a conscious decision on her part, perhaps recommended to her so as not to distract the reader from the path she was leading them on. If I ever attended an event with Dr. Sweet I would like to ask her about this. But all the dates and details can be read in the notes to each chapter in the back of the book, which are extensive, and excellent-don't miss them! Fascinating, moving and well written, an excellent read all the way around.

  14. 5 out of 5

    Beth

    This is my favorite nonfiction book of the year so far. I rapidly fell in love with Dr. Sweet's description of the Laguna Honda hotel, one of the last "almshouse" style hospitals in the United States, where poor people could be assured of good health care at no cost. Dr. Sweet weaves a spell of romance over the open wards, crumbling yet beautiful architecture, staff who are busy but never too hurried to sit at a patient's side and do their work thoroughly, and the pathos and humor of life on the This is my favorite nonfiction book of the year so far. I rapidly fell in love with Dr. Sweet's description of the Laguna Honda hotel, one of the last "almshouse" style hospitals in the United States, where poor people could be assured of good health care at no cost. Dr. Sweet weaves a spell of romance over the open wards, crumbling yet beautiful architecture, staff who are busy but never too hurried to sit at a patient's side and do their work thoroughly, and the pathos and humor of life on the edge of existence. Dr. Sweet weaves in her own exploration of the 11th century mystic, religious leader, herbalist and doctor Hildegarde of Bingen, and how she comes to blend Hildegard's methods with her own education in modern medicine. It's the people who really make the book, though, the "bad boys and girls" who seem to be surviving nasty illnesses and addictions on pure fierceness, the wise and passionate nurses, the ward chicken, and so many more. Great for a gift, a great read, exploration into how medicine might best be practiced, a book-club book, and more.

  15. 5 out of 5

    Kathrina

    Knocking a star for longwindedness in the last third, but an excellent if depressing look at the evolution of neoliberal healthcare, as it misses the mark in healing patients while it focuses solely on "managing health." Slow medicine seems to make quite a lot of sense, not just common sense, but economic, too, though we're probably too far entrenched in the habitus of modern institutions to make any impactful change at this point. What a sad state of affairs we are in. And precisely why my fath Knocking a star for longwindedness in the last third, but an excellent if depressing look at the evolution of neoliberal healthcare, as it misses the mark in healing patients while it focuses solely on "managing health." Slow medicine seems to make quite a lot of sense, not just common sense, but economic, too, though we're probably too far entrenched in the habitus of modern institutions to make any impactful change at this point. What a sad state of affairs we are in. And precisely why my father chose to die in a rural village in Transylvania, as far away from American medical healthcare as he could get.

  16. 4 out of 5

    Josephine Ensign

    Nauseatingly New-Age-y (Hildegard of Bingen worshiping, "What would Hildegard do?"/ Going off on year-long pilgrimages across Spain, etc). Author comes across to me as self-indulgent and lacking self-insight. It didn't help that she is mostly dismissive and belittling of the contribution of nurses to healing/health care. Nauseatingly New-Age-y (Hildegard of Bingen worshiping, "What would Hildegard do?"/ Going off on year-long pilgrimages across Spain, etc). Author comes across to me as self-indulgent and lacking self-insight. It didn't help that she is mostly dismissive and belittling of the contribution of nurses to healing/health care.

  17. 4 out of 5

    Carmen

    An interesting book about the last almshouse in the United States. Discusses "fast medicine vs. slow medicine" on the level of "fast food vs. slow food". This book doesn't only discuss the hospital, medicine, and patients, but also dives into Sweet's path of exploration of a nun's practice hundreds of years ago and also Sweet's pilgrimage Santiago de Compostela. An interesting book about the last almshouse in the United States. Discusses "fast medicine vs. slow medicine" on the level of "fast food vs. slow food". This book doesn't only discuss the hospital, medicine, and patients, but also dives into Sweet's path of exploration of a nun's practice hundreds of years ago and also Sweet's pilgrimage Santiago de Compostela.

  18. 5 out of 5

    David

    This was such an interesting read. The book is a gift from a physician-friend who shares my philosophies of caring for others. There were times I was completely drawn in and rather mesmerized. There were other occasions when I was less than enamored and, frankly, unpersuaded. In the balance, however, it was a good and deeply thoughtful book (personal letter?) from Dr. Victoria Sweet, a fellow soldier in the trenches of the American Healthcare Civil War. The sections pertaining to the History of M This was such an interesting read. The book is a gift from a physician-friend who shares my philosophies of caring for others. There were times I was completely drawn in and rather mesmerized. There were other occasions when I was less than enamored and, frankly, unpersuaded. In the balance, however, it was a good and deeply thoughtful book (personal letter?) from Dr. Victoria Sweet, a fellow soldier in the trenches of the American Healthcare Civil War. The sections pertaining to the History of Medicine - particularly ancient and medieval concepts and practices - are excellent. It was worth my time just to have read those portions. She speaks so eloquently of the connections within the poetic and visionary System of Fours (Elements, Humors, Qualities, Seasons and the Cosmos). And I am highly sympathetic to her opinions of how care should be delivered versus how its art is regulated and constrained by the governance of non-practitioners in management. There are lengthy discussions of this destructive conflict and the tone is honest, clear-eyed and appropriately concerned without being hectoring. Dr. Sweet's explorations of what really constitutes efficiency in health care are among my favorite parts. How long will we apply corporate algorithms and economic models to the "business" of caring for the sick, injured, impaired and needy among us? And what level of unrecognized arrogance is required to do this while simultaneously convincing ourselves and each other that it is proper and all for the good of those we supposedlly serve? The style in which the book is written understandably oscillates between the dryer tone of the academic and the more casual (and less objective) one of the imbedded correspondent. There are times when she gushes a bit with wide-eyed idealism (very occasionally crossing the border into a simpering coyness). But I find it understandable and - because of the subject matter and context - tolerable. Dr. Sweet wouldn't be having the impact she obviously is if she were any less of an enthusiast for bringing back a whole lot of The Way We Were. She does also have an episodic passion for exclamation points (!). And sentence fragments. Finally...I do take exception to some of the boundary crossings she reports as examples of "charity". It is difficult and confusing to keep track of the borders that separate patient from provider, the professional from the personal, our humanity from our function. The longer one maintains a relationship with one's patient - and the greater their need - the more likely it is that the borders will blur and the grey zone will widen. None of us make the best decisions all the time, but most of us try to do so nearly always. And Dr. Sweeet is open about her struggles with where to draw lines. But I found some of her choices were not ones I would sanction. The ultimate goal is always to transfer power from the care giver to the care receiver; to empower the infirm rather than enable them. There is a big, big difference between those behaviors and it is more than mere folly to confuse the two. Ultimately this book is not about Laguna Honda Hospital, Dr. Sweet's pilgrimage, or even the American Healthcare Crisis. It is about bringing one's humanity into the workplace, keeping the spiritual element in mind, and actively participating as a vital member of a dynamic community. We are all much better for that conversation.

  19. 5 out of 5

    Carol Bakker

    Victoria Sweet weaves several narrative threads into this delightful book: the story of San Francisco's Laguna Honda hospital, built in 1867 as an almshouse, the last functioning almshouse in America; her interactions with patients using Slow Medicine, e.g. sitting on the bed and watching the patient for ten minutes; and the life of Hildegard of Bingen, a twelfth-century Benedictine abbess who wrote about medicine and healing in Physica and in Causae et Curae. If you enjoy doctor-memoirs from Ol Victoria Sweet weaves several narrative threads into this delightful book: the story of San Francisco's Laguna Honda hospital, built in 1867 as an almshouse, the last functioning almshouse in America; her interactions with patients using Slow Medicine, e.g. sitting on the bed and watching the patient for ten minutes; and the life of Hildegard of Bingen, a twelfth-century Benedictine abbess who wrote about medicine and healing in Physica and in Causae et Curae. If you enjoy doctor-memoirs from Oliver Sacks, Atul Gawande, Paul Kalanithi, and Abraham Verghese, you will relish this read. Hildegard writes of three doctors who can help sick people: Dr. Diet, Dr. Quiet, and Dr. Merryman.

  20. 5 out of 5

    Jonna Higgins-Freese

    I loved, loved, loved this book. I've read it twice so far. In part, it's a memoir of Sweet's work as a physician at Laguna Honda, the last almshouse in America. There, she recounts how she learned the value of Dr. Diet, Dr. Quiet, and Dr. Merryman, of how the patients found healing and how the doctors and the hospital community could help or hinder that. At the same time, it's a memoir of what she learned as she completed a PhD in the history of medicine, focusing on Hildegard of Bingen and wha I loved, loved, loved this book. I've read it twice so far. In part, it's a memoir of Sweet's work as a physician at Laguna Honda, the last almshouse in America. There, she recounts how she learned the value of Dr. Diet, Dr. Quiet, and Dr. Merryman, of how the patients found healing and how the doctors and the hospital community could help or hinder that. At the same time, it's a memoir of what she learned as she completed a PhD in the history of medicine, focusing on Hildegard of Bingen and what her way of doing medicine revealed about the premodern mental models for medical practice. Her writing is like a gentle laser, exact and clear, with a wry sense of humor. Many of the stories she tells have lingered with me as I think about the experience of being a patient. I remember the story that illustrates how she learned that the "transference and countertransference" between patient and doctor are other names for love. I remember her account of the importance of time, and learning to "just sit" with her patients to see what their bodies and behavior can tell her about their illnesses, and what they need to heal. I remember her story of going on the pilgrimage to Compostela over a period of years, and how she brought that sense of pilgrimage back with her to Laguna Honda, so that each of her steps became part of that path. And I remember her nuanced and thoughtful passage on the difficulties of treating mental illness. In response to excesses and abuses in the past, few people can be forced to take their medications for mental illness, and yet their very illnesses tell them they don't need medication. The book isn't prescriptive in terms of medical policy, but it is thought-provoking.

  21. 4 out of 5

    Lucy Barnhouse

    I found this multifaceted book a fascinating one. Sweet is an engaging author, who recounts her practice of one specialty (medicine) and pursuit of another (medieval history) largely as a series of anecdotes. Either of these specialties could seem forbiddingly arcane, but Sweet explains them both lucidly. She also provides a vivid and moving account of her experiences as a pilgrim on the Camino de Santiago. As a historian of medieval medicine, I found the book especially interesting for the port I found this multifaceted book a fascinating one. Sweet is an engaging author, who recounts her practice of one specialty (medicine) and pursuit of another (medieval history) largely as a series of anecdotes. Either of these specialties could seem forbiddingly arcane, but Sweet explains them both lucidly. She also provides a vivid and moving account of her experiences as a pilgrim on the Camino de Santiago. As a historian of medieval medicine, I found the book especially interesting for the portrayal it provides of an almshouse, an institution I'd thought lost long before the twentieth century. Sweet makes an impassioned--and largely convincing--plaidoyer for the values of leisure and observation in practical medicine. The book also highlights some of the terrors of bureaucratic policy (and political machinations) but thanks to Hildegard von Bingen and Sweet's other colleagues, personal generosity is shown to be stronger than institutional bean-counting.

  22. 5 out of 5

    Mrs. Danvers

    I feel like I should have read this book long ago and I also feel like I waited until the exact right moment. I first became a volunteer with Zen Hospice Project in 2002, and during our training we spent a number of hours at Laguna Honda Hospital, one of two sites at which ZHP provides hospice caregiver volunteers. The hospice ward volunteer administrator, Eric Poche, is a saint, a gentle, loving, accepting, wonderful man and every volunteer who was under his care loved him with a cultlike rever I feel like I should have read this book long ago and I also feel like I waited until the exact right moment. I first became a volunteer with Zen Hospice Project in 2002, and during our training we spent a number of hours at Laguna Honda Hospital, one of two sites at which ZHP provides hospice caregiver volunteers. The hospice ward volunteer administrator, Eric Poche, is a saint, a gentle, loving, accepting, wonderful man and every volunteer who was under his care loved him with a cultlike reverence. I was at the Guesthouse so I had much less contact with Eric, but I too loved (love!) him with my whole heart. But still, my reaction to the open wards at Laguna Honda was total aversion. Thirty beds! Per room! Dormitory style! and you're dying. To me, that was a special hell realm. I believe all of the volunteers and admins who told me that everyone loved the open ward and that it was community and family and solace and love. I believe that. But I didn't experience it. I mean, the building is amazing. And I am so grateful and privileged to be living in a city that has a long term care facility for the indigent, especially one that beautiful and architecturally warm. But 30 beds in a room. After a long hiatus, I returned to Zen Hospice Project in 2017, and I experienced the new Laguna Honda during my training. Single rooms, privacy if the resident wants it, but big beautiful common rooms if the resident wants company, lots of light, lots of windows. I remarked on the changes during the training, and said that I do believe and honor all of the people who said that the open wards were wonderful, but that I couldn't myself see it. A long term volunteer who had been with ZHP before and after the move to the new building quietly told me that all of the hospice residents who moved from the old building to the new FAR preferred the new building. Now, Zen Hospice Project has closed and is selling the Guesthouse, where I have spent countless Saturday nights. It was never profitable, it was never break-even, but it was unique and it represents so much beauty and love to me that losing it is heartbreaking. But it means that I am now moving to Laguna Honda to continue my ZHP volunteer assignment. And I welcome this move and despite my sorrow at the loss of the Guesthouse, I expect that my time at Laguna Honda will be extraordinarily rewarding. So this book was just right for me right now. Sweet has captured the power of the community in her story, along with the power of presence and just sitting and relationship and open hearts. She draws every person in her book with a combination of truth and humility so that even if it turns out that she wasn't particularly fond of that person, the person is treated gently and with care. The book closes with the move to the new hospital and the closing pages are about impermanence and "don't know" mind. This is particularly relevant to me as I turn the pages to a new chapter in my own relationship to impermanence. I so deeply appreciate having read this right now, but at the same time, I can't think of a time in my life in which her review of what she learned in her experience of the old Laguna Honda wouldn't be moving and tender and welcoming.

  23. 5 out of 5

    Drew

    Elizabeth and I read this book aloud. Written by a doctor about her experience being on the staff of the last almshouse in America. Almshouses were initially founded by French nuns to carry for the indigent who needed long term care. Dr. Sweet also wrote about her experience with Hildegard and slow medicine and about her pilgrimage to Compostela. Fine book—worthy read that raises interesting issues about medical care and delivery.

  24. 4 out of 5

    Perri

    This is a hard story to rate. It's kind of rambling and the author takes a behind the scenes at city hospital. I listened to it so it was easy to log on when I was so inclined. It was interesting to see the author's enthusiasm and appreciation of Old Medicine. To listen and to take time. That's a cool concept and she shows the benefits. Kind of the opposite of modern medicine- to hurry up diagnose and treat and move the patient out . Then there's our current method of taking each ill person into This is a hard story to rate. It's kind of rambling and the author takes a behind the scenes at city hospital. I listened to it so it was easy to log on when I was so inclined. It was interesting to see the author's enthusiasm and appreciation of Old Medicine. To listen and to take time. That's a cool concept and she shows the benefits. Kind of the opposite of modern medicine- to hurry up diagnose and treat and move the patient out . Then there's our current method of taking each ill person into account without judgement and trying to help. So there's a dichotomy of efficiency vs. charity. It's a difficult balance, but an age old struggle.

  25. 5 out of 5

    Jesse Ortiz

    Beautifully written memoir, also a deeply insightful history of neoliberalism through the lens of healthcare.

  26. 5 out of 5

    Lilly Bakker

    I really enjoyed reading this book and learned a lot. Discussed the importance of patient care and the relationships you form with a patient. “The best doctor walks with you to the pharmacy and stands with you until you drink your medicine.” I related to a lot of what she wrote about. I didn’t enjoy the hospital dynamics and bureaucracy chapters as much as the chapters about patient care and patient stories. Happy I read it. Thanks for the suggestion Amy :)

  27. 5 out of 5

    Alice Jiang

    Went into this with no expectations as it was for a class book club. I really enjoyed her patient anecdotes, focusing more on the lessons her patients taught her rather than how she miraculously diagnosed an obscure condition like authors of many other medical texts. I also like how she ties in her PhD and pilgrimage to the practice of medicine. Great lessons for physicians on slow medicine, the importance of supplementing medication with diet/rest/the little things, and deep listening. Could ha Went into this with no expectations as it was for a class book club. I really enjoyed her patient anecdotes, focusing more on the lessons her patients taught her rather than how she miraculously diagnosed an obscure condition like authors of many other medical texts. I also like how she ties in her PhD and pilgrimage to the practice of medicine. Great lessons for physicians on slow medicine, the importance of supplementing medication with diet/rest/the little things, and deep listening. Could have done less with the hospital drama and logistics of transitioning hospitals, but overall added to her experience at LHH.

  28. 5 out of 5

    RWaggoner

    Set in the last “alms house” (charity hospital) in the US, this book chronicles one doctor’s attempts to explore pre-modern medicine and apply it to her changing world of modern medicine and the new health care system. Fascinating patient studies. In similar style to Oliver Sacks but with physical illness.

  29. 5 out of 5

    Rachel

    This book looks at life and medicine from several different directions, and pulls them together wonderfully. The author was a doctor at San Francisco's Laguna Honda Hospital for twenty years that spanned its identity as an old-fashioned almshouse through its transition into a modern hospital. At the same time, she was researching, for a PhD and for herself, the history of medicine focusing on the twelfth century nun, mystic, and medical practitioner Hildegard of Bingen. Her research included tri This book looks at life and medicine from several different directions, and pulls them together wonderfully. The author was a doctor at San Francisco's Laguna Honda Hospital for twenty years that spanned its identity as an old-fashioned almshouse through its transition into a modern hospital. At the same time, she was researching, for a PhD and for herself, the history of medicine focusing on the twelfth century nun, mystic, and medical practitioner Hildegard of Bingen. Her research included trips to Europe and a 1200-mile walking pilgrimage in France and Spain, which she did in four parts over four years. I had no idea that this existed, but apparently a number of pilgrims start the walk every day! The author managed to find much of value in the medical philosophy of Hildegard (and thus pre-modern medicine) and used it to improve her own modern medical practices. She has an open and inquiring mind, and her growth as a person and doctor is inspiring and makes excellent reading. Meanwhile, Laguna Honda was evolving in necessary but unpleasant ways. I would almost say that the book is a scathing indictment of certain of the powers that be, or were, but the author is much too nice to be scathing. Plus she is understanding of the realities that those powers are operating under, so she comes across partisan (for the right side, of course!) but evenhanded. And out of it all, she came up with ideas for a pilot project to practice a form of Slow Medicine, or Ecomedicine, that would be designed to show that it can be more cost effective than the newer models. I hope she gets to do this. As part of this journey, the author relates very interesting stories of patients. They illustrate the nature of the hospital, medical issues and practices, and her own growth. The patients had complicated medical issues and big personalities. The author pulls it all together at the end with the big realization that she came to over the years. She'd been taught not to get too involved with the patients. But she found that getting involved was not only helpful to the patients but satisfying to her. And that the extra time was actually cost effective in that problems could be solved with less medical and administrative work. She finally realized transference and countertranference are not bad things at all, and that the real name for them is love.

  30. 5 out of 5

    Zach

    This is by far one of the THE BEST books I have read. Dr. Sweet is a great writer and depicts her experiences with such elegance. This story, her story, is a microcosm of the greater changes in healthcare going on over the past 100 years, and it is nice to have someone with such knowledge, wisdom, and patience speak about them. Dr. Sweet's personal accounts show how many of the important subtleties in medicine are being left at the wayside to make room for the new models of medicine; Hospitals be This is by far one of the THE BEST books I have read. Dr. Sweet is a great writer and depicts her experiences with such elegance. This story, her story, is a microcosm of the greater changes in healthcare going on over the past 100 years, and it is nice to have someone with such knowledge, wisdom, and patience speak about them. Dr. Sweet's personal accounts show how many of the important subtleties in medicine are being left at the wayside to make room for the new models of medicine; Hospitals becoming care facilities, doctors becoming providers, patients becoming clients, the emergence of allied health workers, and the ever-increasing presence of administration and oversight. You can appreciate her resistance to these changes, yet she accepts each with an open mind and subjectively critical mindset, and writes without any attempts at imparting her views unto the reader. It is clear to the reader that her patients have immensely important and influential stories; important not only for Dr. Sweet, but other patients, the hospital, the reader, and in my opinion, the greater medical society. Reading through some of these stories, I have felt a deep visceral tug. I have wondered if the (many upon many) patients I have seen, similar to those of Dr. Sweet's, have similarly interesting, important, and influential stories; stories I have failed to uncover. Wonderful, wonderful, wonderful read!

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