Attentive medicine

Dr. Victoria Sweet's publisher describes God’s Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine as an account of the practice of "attentive medicine." I like that. I had been meaning to read this book ever since I'd heard of it.

Dr. Sweet's story of working and learning at San Francisco's Laguna Honda Hospital wanders through her study of (and experiments with practicing) the medieval abbess Hildegard of Bingen's medical prescriptions; a pilgrimage on foot along several sections of the Camino de Santiago in France and Spain; and always returns to the lessons in healing that her patients and community at the city's repository for its sick poor taught her over twenty years of service. I cannot recommend it too highly.

Here's a sample of the sort of wisdom Dr. Sweet offers. Summoned to the bedside of a disturbed patient, she found herself diagnosing the woman's malady without all the paraphernalia of modern scientific care. Of course she brought to the encounter her decades of medical experience. But, she reflected,

I had done so little for her ... I hadn't looked into her eyes, held her hand, or reviewed all her records. I'd done nothing at all. Except sit. But how effective that had been! ... Somehow just be sitting with her, I'd understood what was wrong.

... after Ms. Gilroy, I took the time to 'just sit' in this way with all my patients. Especially if they took a turn for the worse, or if a nurse or family was worried that something wasn't quite right. ... Not for long -- five or ten minutes. Sometimes the patient would want to chat, and we would chat, and sometimes I would study the patient's face, bedclothes, and bureau. But mostly I would just sit. And something, somehow, would happen. It would become clear what, if anything was wrong with the patient and what, if anything, I could do about it.

The book turned out to be a perfect companion for a visit to a friend whose life situation seemed to require an intervention of some sort -- just what sort I wasn't sure. (Hence the recent blog interruption.) It turned out that intervention largely meant conversation, some apparently quiet time, and hopeful silence in place. Whether anything concrete has been accomplished, only more time will reveal. ...A nice feature of this book that might escape notice is a set a chapter notes which offer suggestions for accessible reading on medical history and other topics. It would not be hard to make a course out of these suggestions -- and probably some teacher has done so....Despite having lived in San Francisco over forty years, I only visited the old, unimproved, Laguna Honda once -- on an incomprehensible mission that I am sure Dr. Sweet would appreciate. When I was part of the Martin de Porres Catholic Worker community, someone (I forget who if I ever knew) gave us a truckload of unopened, very heavy, boxes of ceramic tile. There wasn't anything wrong with the tiles -- but we had no need for ceramic tiles. Unless you wanted it, it had no value. The stuff hung around, too big for doorstops, taking up space we didn't have. Finally someone figured out she had a friend who worked at Laguna Honda -- perhaps a gardener or janitor. This individual wanted the tile -- for what purpose I never found out. So we drove the stuff up the hill, at night, covertly, and unloaded behind the building. And that was that. Perhaps the tile came in handy to some part of the Laguna Honda community somehow? It was that sort of place, as Dr. Sweet testifies.