God’s Hotel

San Francisco’s Laguna Honda Hospital was 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 there. Dr. Sweet ended up there herself, as a physician. And though she came for only a two-month stay, she remained for twenty years.

At Laguna Honda, lower-tech but human-paced, Dr. Sweet had the chance to practice a kind of “slow medicine” that has almost vanished. Gradually, the place and its patients transformed the way she understood the body. Alongside the modern view of the body as a machine to be fixed, her patients evoked an older notion, of the body as a garden to be tended. God’s Hotel tells their stories, and the story of the hospital, which — as efficiency experts, politicians, and architects descended, determined to turn it into a modern “health care facility” — revealed its truths about the cost and value of caring for body and soul.

In God’s Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine Dr. Sweet lays out her evidence—in stories of her patients and her hospital—for some new ideas about medicine and healthcare in this country. In trying to get control of healthcare costs by emphasizing “efficiency,” we’ve headed down a wrong path. Medicine works best—that is, arrives at the right diagnosis and the right treatment for the least cost—when the doctor has enough time to do a good job, and pays attention not only to the patient but to what’s around the patient. Dr. Sweet calls this approach Slow Medicine, and she believes that, put into wider practice, it would be not only more satisfying for patient and doctor, but also less expensive. The New York Times calls her ideas “hard-core subversion”; Vanity Fair judges the book to be a “radical and compassionate alternative to modern healthcare,” and Health Affairs describes Dr. Sweet as a “visionary.”

Audio Excerpt of GOD’S HOTEL, read by author Victoria Sweet. (2-1/2 minutes)

Additional Info for GOD’s HOTEL

The Endnotes of God’s Hotel refer to and sometimes quote from a number of public documents. Below find links and PDFs to the available sources, listed by chapter. The Introduction and Chapter One have no such references.

Chapter Two

  1. For a copy of Hildegard’s Physica, see HildegardvonBingenSubtilitatumDiversarumNaturarumCreaturarumLibriNovemMLT (PDF format)

Chapter Three

  1. For Dee and Tee’s report, see the appendix, “Executive Summary.”

Chapter Five

  1. First DOJ letter, May 6, 1998; see lagunafindings1998 (PDF format)

Chapter Seven

  1. For Dr. Stein’s report on the hospital rebuild, see WhitePaperOnOptionsForLHHRebuild (PDF format)
  2. Proposition A, For and Against; see 99-11PropositionABallotArguments (PDF format)
  3. See the 1994 Archeological Resources Evaluation (PDF format)

Chapter Eight

  1. Second DOJ letter, April 1, 2003; see lagunahondahosp (PDF format)
  2. For the Davis Case see revisedsettlement (PDF format)
  3. For the Olmstead Decision, see http://www.law.cornell.edu/supct/html/98-536.ZS.html
  4. For an example of a TCM report, see TCMreportfor2009 (PDF format)
  5. Transcript of the LHH Admission Policy fracas: See the 0624hearingtranscript (PDF format)

Chapter Nine

  1. For Mr. Conley’s transition budget, see LHHTranstitionBudgetAugust2008
  2. For Mirene’s social rehabilitation grant, see SocialRehabGrantApplication (PDF format)
  3. For the reviewers’ response, see SocialRehabGrantReviewersConcerns
  4. For Mirene’s response, see SocialRehabGrantResponseToReviewers (PDF format)
  5. For the HMA report, see SFDPH05 (PDF format)
  6. For a copy of the LHH O6 report detailing the State’s citations, see 274-page report see LHH06Report

Chapter Ten

  1. For a copy of the Chambers suit, http://www.bazelon.org/LinkClick.aspx?fileticket=g1tdBbleA30">3d&tabid=243

Chapter Eleven

  1. For the Side Letter by the DOJ, see the DOJ Report (PDFformat)
  2. For the DOJ settlement agreement, see lagunasettlementdoj (PDF format)

Chapter Twelve

  1. For the redone organization chart, see lhhorganizationalchart (PDF format)
  2. For the Ja Report, see jareport (PDF format)
  3. For Dr. Kay and Dr. Romero’s response to the Ja Report, see jareportresponse (PDF format)
  4. For the ombudsman’s response to the Ja report, see ThoughtsonDavisJaReport (PDF format)
  5. For more on the Gift Fund, see Part 2LHHGift Fu#132741 (PDF format); also see OriginalLHHPatietGiftFundPolicy45-0109-01-93
  6. Dr. Kay did file a whistleblower suit, which was finally settled in 2013; for the settlement agreement, see here: Settlementagreement.
  7. Dr. Grace ends the book; she is one of my heroes, and if you want to understand why, take a look at the trailer for the film about her and the accident, State of Grace, here: http://www.statesofgracefilm.com.

 

Selected Blog Reviews

General Blogs

Library Journal: STARRED REVIEW

“This is a remarkable, poignant portrait of a committed physician on a quest to understand the heart, as well as the art, of medicine. Laguna Honda Hospital, the last remaining almshouse in the United States—a therapeutic community that houses and cares for the chronically ill or impoverished—
offers veteran physician Sweet (clinical medicine, Univ. of California, San Francisco) a unique education in ministering to the body, heart, and soul. Her experiences there inspired her to study medieval physician, poet, and abbess Hildegard of Bingen’s alternative approach to medicine of advocating that the human body be nurtured like a garden. Ultimately, Sweet embraced the notion and practice of slow medicine, an approach at odds with the contemporary rush for efficiency, a misguided trend to which even Laguna Honda eventually succumbs. VERDICT A marvelous, arresting read for anyone interested in medical practice. Of particular appeal to aficionados of spiritual medical narratives such as Tracy Kidder’s Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World. [See Prepub Alert, 9/29/11.] (Lynne F. Maxwell, Villanova Univ. Sch. of Law Lib., PA.)

Booklist: STARRED REVIEW

“Sweet’s watershed book ambushes and transforms you with its visionary middle way between the irreplaceable skills of doctors and the benefits of holistic medical knowledge and twenty-first-century technology and standards. Vital, exquisitely written, and spectacularly multidimensional, Sweet’s clinically exacting, psychologically discerning, practical, spiritual, and tenderly funny anecdotal chronicle steers the politicized debate over health care back to medicine and compassion.” (Donna Seaman, Booklist.)

Kirkus Review

“A doctor’s experiences in a unique corner of the medical world. What was originally supposed to be a months-long stopover turned into a career spanning more than twenty years and countless life-altering realizations about the nature of medicine. The author’s compelling argument for Laguna Honda’s philosophy of ‘slow medicine’ will make readers contemplate if perhaps the body should be viewed more as a garden to be tended rather than a machine to be fixed.” Kirkus Review, Pre-Pub Alert.

Publishers’ Weekly

“To its staff, San Francisco’s Laguna Honda Hospital was a gift: a place with open wards that provided light, air, and a sense of community for its patients; where the emphasis was on “slow medicine” rather than high-speed computer time. Sweet, a physician at the hospital and a professor of medicine at UC San Francisco, says Laguna Honda’s model was the medieval French Hôtel-Dieu—God’s Hotel—which cared for everyone who couldn’t care for themselves. But this unusual model led to problems in an age of cost-efficient medicine, and to complaints and a Department of Justice investigation. Sweet chronicles the internal politics and struggles behind the remarkable turnaround of this unusual hospital—one where she was ‘able to practice medicine. . . the way I wanted.’ But if Laguna Honda felt like a gift to Sweet, the true gift was the courage of her patients, like the addled Mr. Bramwell, who demonstrated through a sweet and skillful dance with his nurses that even in such a patient, the soul, what the ancients called the ‘anima,’ remains. Sweet’s tales of her hospital, patients, colleagues, and herself offer a fresh linking of medicine past and present.” (Publishers’ Weekly.)

What Critics Are Saying

Oliver Sacks

“Victoria Sweet writes beautifully about the enormous richness of life at Laguna Honda .. and the intense sense of place and community that binds patients and staff there. Such community in the medical world is vanishingly rare now, and Laguna Honda may be the last of its kind. … God’s Hotel is a most important book. .  . . It should be required reading for anyone interested in the ‘business’ of health care—and especially those interested in the humanity of health care.” (Oliver Sacks, author of The Man Who Mistook His Wife for a Hat and The Mind’s Eye.)

Jerome Groopman

“This is a unique book about a healer and those in need of her healing. Charting her journey in God’s Hotel, Victoria Sweet shows us that medicine is still fundamentally a sacred calling. By illuminating this truth, Sweet provides comfort and inspiration.” (Jerome Groopman, M.D., Recanati Professor, Harvard Medical School, author of How Doctors Think and Your Medical Mind.)

Rachel Naomi Remen

“Victoria Sweet is a master storyteller and a consummate physician. Her beautifully written stories from the frontline of health care document the struggle of all modern-day healers to hold fast to the immortal soul of Medicine despite the pressures of economics, the self-interest of politics, and the reductionism of science. God’s Hotel reminds us of the fundamental truth that medicine is and has always been an act of love and brotherhood. . . and of the vulnerabilities we share and the compassion we aspire to.”  (Rachel Naomi Remen, MD, author of Kitchen Table Wisdom and My Grandfather’s Blessings).

Julie Salamon

“A profoundly moving account of a remarkable hospital and the people who inhabit it, God’s Hotel reveals intimate knowledge of the shift in modern medicine, from personal tending to industrialized ‘health care.’ Author and physician Victoria Sweet embodies the traits of a persevering and compassionate doctor, while conveying the wisdom of a philosopher, and the instincts of a born storyteller.” (Julie Salamon, author of Hospital and Wendy and the Lost Boys).

Lissa Muscatine

“In this evocative, unvarnished, and brilliant writing debut, doctor and medical historian Victoria Sweet traces her own evolution as a medical practitioner caring for – and learning from – her patients at one of America’s last almshouses. Told through their stories, which are at once deeply personal and highly entertaining, she challenges us to consider new (and old) ways of diagnosing, treating, and valuing those in need of care. Richer and poorer, in sickness and in health, readers of every stripe will find their assumptions transformed by this book.” (Lissa Muscatine at Politics and Prose Bookstore, Washington, DC.)

Mark Freeman

“Here is a community as interwoven as the cast of Cheers, as varied as the inmates in One Flew Over the Cuckoo’s Nest, as well-detailed as the folks in Grover’s Corners, but tenaciously on our side of death. The Chaucer of this set of tales is a physician with the doubly apt name of Victoria Sweet. As the free market finally begins to notice Laguna Honda Hospital, it dawns on her that the new push for improved efficiency at this last example of an Hôtel Dieu (like those run by nuns since medieval times) is not proving to be more efficient, nor is it much of an improvement.  Not surprisingly, Dr. Sweet is also the protagonist of her own adventure. She is getting a second doctorate in medieval history, visiting original locations in the life and work of Hildegard of Bingen, a nun so talented that she wrote the top Gregorian chants of the XII century, and so butch that she took over the hospital of a monastery and then opened two on her own. Thus explorations of pre-modern medicine, European health care delivery, religious pilgrimages and gardening are layered through an already fun and true story.” (Mark Freeman, Documentary Filmmaker, Transgender Tuesdays: A Clinic In the Tenderloin.)

Gayle Shanks

“Just wanted to give you a rave for the book you sent me, God’s Hotel by Victoria Sweet. Not only did I think it was the best creative non-fiction book that I had read in many, many months but my niece who is an intern at Georgetown Hospital in Washington DC told me that she thought it was remarkable and helped her remember why she wanted to be a doctor. She wants to return to the Bay area where she grew up and thinks she might want to work at Laguna Honda if they will accept her there. She has always wanted to practice medicine in a humane, caring way and felt at odds with the modern medicine machine that seems to dictate so much of a doctor’s work with her/his patients. Sweet reminded her that medicine can be practiced one patient at a time and that doctors learn from their patients how to treat the whole body and mind not just the diseased organ or ailment. She said that this book, like Cutting for Stone which I had also shared with her, should be required reading for every medical school student or maybe the publisher would like to give them away to medical school graduates. If I could get her ten more copies she had ten friends who she wanted to give them to immediately.” (Gayle Shanks, Changing Hands Bookstore
, Tempe, AZ.)

Tracy Wynne

“I’d like to nominate God’s Hotel by Dr. Victoria Sweet. It’s an involving story that not only shows the fascinating and sometimes heartwrenching dramas of San Francisco’s embattled almshouse Laguna Honda Hospital, but also of Dr. Sweet’s personal pilgrimage for a more spiritual and conscientious form of medicine.” (Tracy Wynne, Books Inc.)

Bob Deloria

“This is a very enthusiastic nomination of God’s Hotel for the Indie Next List. My interest in this book about Laguna Honda Hospital in San Francisco was stirred by the fact that my bus trip to the bookstore every day takes me past its imposing and somewhat enigmatic presence on a hilltop in the westerly part of the City. The book delivered handsomely: The author, a physician at the hospital for more than twenty years, amply satisfied my curiosity about the place. But it’s much more than the story of one venerable San Francisco institution. In that time she developed an interest in the medical works of Hildegard of Bingen, eventually earning a doctorate in medical history to complement her MD. She gives us a blend of history, anecdote, compassion, and forthright opinion in prose that’s a great pleasure to read. The book has deep implications for the present state and the future of health care in our country.” (Bob Deloria, Books Inc. in the Marina)