God’s Hotel. Victoria Sweet.

Sweet, Victoria. God’s Hotel. Riverhead New York 2012. NF;5/13

Another lovely book about medicine by a doctor. It veers occasionally into American medical olympianism and its associated overwrought spirituality, but it remains sincere and original. Original in its impressive ideas and also in the writing. If Dr. Sweet is a creative writing graduate she has done a great job of hiding it.

The Hotel is an old chronic-care hospital, the only surviving almshouse in the US, located on a hill in San Francisco. It serves the indigent as a sort of chronic-care step-down from acute “County”, and at the beginning of the story combines subacute and residential care, a decidedly messy mix of strokes, addicts, HIV, and obscure complexity. I was frequently surprised at the availability of consultants and technology and I haven’t seen that kind of thing anywhere in Canada.

The story is “Dr. S”‘s professional and spiritual growth, alongside the decline of the physical institution (PLOT ALERT) and its ultimate replacement with a new age gorgeous facility embodying all the euphemisms of wellness, health care, privacy, deinstitutionalization, and the disappearance of professional boundaries (END PLOT ALERT). The third story woven into the other two is of a profession changing, mostly for the worse.

Dr. S becomes fascinated with medieval medicine, which appears to her to recognize holistic and spiritual values the modern profession has long given up. She describes an autopsy where all the organs are weighed and catalogued, at the end of which she can’t account for the important missing piece: life. Anima. Helpfully guiding us with dozens of etymologic explanations, she describes working part-time on her PhD in history of medicine exploring the methods of a 14th century medical nun called Hildegard. It’s a process of returning the heart and soul to modern technical medicine. All fine.  But why is this so-often-repeated line of thinking more impressive than usual? It’s a serious doctor, a good doctor, questioning her profession and looking for an alternative.  If she were a flaky hair-transplant or chelation therapy advocate nobody would take her seriously.  But she practices no-nonsense biological middle-of-the-road internal medicine. So if we are informed we properly tend to pay attention.

She describes the ascendancy of the medical (distinct from nursing) approach during the 18th century, the time of the French, American, and industrial revolutions, with its change from an agricultural metaphor to an industrial one. Patients, and a little bit wide-eyed willingness to do the pilgrimage to Santiago de Compostela, inform several honest and valuable spiritual lessons which we presume she applies in her personal life although they are presented as professional growth. It’s the nature of the individual that’s important, she tells us on page 111 (which sounds familiar and welcome to someone struggling to loosen the iron grip of population-based evidence). Roles repeat: who- and whatever we are have been here before and will be here again. The continent between Europe and Asia didn’t exist for medievals, although they knew the world was round. Such continents are still out there to be discovered.

A bit of an American back-to-nature disingenuous innocence doesn’t diminish for me many true and badly needed insights. The intersecting metaphors of the hospital, spiritual growth, and changing and worsening ideology of healthcare don’t quite cohere, but like Dr. Sweet’s transparent diamond-in-the-rough style it’s clear they just are what they are. And they are lovely. How much diamond and how much rough is there? Doesn’t matter. It has to be either completely uncontrived or very effectively contrived.

I’d be interested to know how fearlessly she has named names. There is some merciless trashing of medical administrators and consultants.

Very nice, although I end up emotionally holding back just slightly. Hard to know whose instincts to blame for that… 8.0

About John Sloan

John Sloan is a senior academic physician in the Department of Family Practice at the University of British Columbia, and has spent most of his 30 years' practice caring for the frail elderly in Vancouver. He is the author of "A Bitter Pill: How the Medical System is Failing the Elderly", published in 2009 by Greystone Books. His innovative primary care practice for the frail elderly has been adopted by Vancouver Coastal Health and is expanding. Dr. Sloan lectures throughout North America on care of the elderly.
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