It is no great mystery that burnout is prevalent in the field of medicine, and it almost seems as if studies and articles highlighting this sad and disturbing truth are published daily. The reality is that doctors and doctors-in-training often struggle with their profession of choice, citing disillusionment, depression, long hours, exhaustion and lack of empathy as either symptoms or causes of feeling burnt out. If one seriously considers the narrative of health care and medicine in the popular media, it is no wonder that health care professionals feel so drained: most are unable to spend enough time with their patients, which is a disappointing reality for many who cite a patient’s responsibility as the reason for pursing a career in medicine. Patients, too, are usually also dissatisfied with the amount of face time they get with their doctor, and complaints about high wait-time-to-visit ratios are extremely common.
Into this unfortunate context of modern medicine comes Dr. Victoria Sweet, a medical doctor with a PhD in the history of medicine, with her book God’s Hotel. I offer the opening narrative about burnout for two reasons: first, Dr. Sweet speaks of her own disillusionment, and offers clear and compelling reasons for why she has become disillusioned and, indirectly, suggestions for avoiding it. Second, this is an excellent book for students and physicians who are struggling to remember what it is they love about medicine.
God’s Hotel is the beautifully written story of Laguna Honda Hospital in San Francisco, California an “almshouse” (the last of its kind in the country) which provides care for the poor, needy and underprivileged. Of all the literary devices that Dr. Sweet employs, her use of imagery had the greatest effect on me. I can still picture the hospital (a modern form of a Hôtel-Dieu, or, God’s Hotel, which were common in the Middle Ages) as she described it: a huge, sprawling building atop a hill, with high-ceilinged, open wards filled with natural light, painted a shade of peach not unlike the spine of the book. She is truly a gifted communicator, and brings to life the vignettes she includes, making then both incredibly memorable as well as extremely readable.
Dr. Sweet’s skill in painting a picture with words carries over to her ability to write about people; she describes the characters with whom she interacted in the hospital with tender affection and careful attention to detail. One of the most memorable patients is a woman named Terry, to whom Dr. Sweet devotes a whole chapter. This woman had been in and out of many things in her life — a boyfriend, drugs, alcohol and health care, to name a few. Due to neglect in another facility, she develops a massive, terrible decubitus ulcer, or bedsore. As Dr. Sweet investigates how to best care for her, it is decided that they will simply give her wound time to heal on its own under supervision from the nursing staff, with special care to ensure she does not get another bedsore. Miraculously, it does heal — it takes a year and a half, but she is eventually fully healed. Dr. Sweet notes that this remarkable process of healing, with nothing more than Terry’s own life force and time, would almost certainly have been impossible at any hospital other than Laguna Honda.
This tale highlights one of the most radical things about the hospital: there is no rush in treating patients. Most patients don’t pay directly anyway, so they can stay as long as they need to; this clearly contributes to the total healing of many patients, beyond just their physical needs. Doctors spend time with their patients, getting to know them and learning about them as individuals. One notable nurse is known for her blankets and spends almost all of her time knitting them for patients. In summary, this hospital sounds like a “dreamland” — a fictional utopia which we all wish existed.
Sadly, this utopia does not exist any longer, which forms the basis for many of Dr. Sweet’s musings throughout the book. Importantly, she speaks to many relevant issues in the changing landscape of health care and the business of medicine. Her tone is unmistakably one of disappointment as she discusses the mandated changes to the hospital: decreasing the number of beds, cracking down on long patient stays, restricting doctors to make them more efficient, and releasing staff who were “unnecessary.” It is this point especially in which Dr. Sweet argues the subjective nature of “necessary,” for a staff member who is not needed on paper might be the most patient-loving person in the building. Who can quantify the positive effect this might have on outcomes? The blanket-making nurse is a great example of this; she may not have been an “effective” nurse in terms of productivity, but Dr. Sweet observes how the patients notice her absence in a tangible way – they find their feet cold more often than they did previously.
As the book unfolds, the reader is shown the hospital through its stages of transformation: how it used to be, and how it has been made to be by new regulations. Medical students and physicians will recognize the injustices of the changing system, as will anyone who has ever been a patient. Dr. Sweet argues (quite convincingly, given that she uses only simple, true anecdotes) that change is not always better, and that something essential has been lost in “modern” medicine. We can relate to what she says, though, because it is apparent in our own experiences. Most importantly, this book reminds us that a better way is possible, which is why I highly recommend it for medical students. Systems and regulations may make it harder, but ultimately, we are responsible for how we treat our patients – and it is up to us to make them feel cared for.
Prints, Pages, and Pagers aims to look closely at the lives of medical students and doctors, real or fiction, whose lives and experiences are told in novels, short stories, poetry, or any kind of writing. These book reviews are an opportunity for medical students to learn from the many fascinating stories produced by the field of medicine, and maybe to read something other than a textbook.