In God’s Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine, Victoria Sweet, M.D., shares stories of personal and communal discovery about sickness and wellness. She tells them well.
And in the present reign of finance monopoly capital, it is vital to have a bigger grasp of medicine than what we know from personal experience alone. To this end, Sweet introduces us to Hildegard of Bingen, a German nun who lived in the 12th century.
Why should we know about this woman? Sweet answers the question with insight and wit.
Hildegard’s “framework was based on the classic system of premodern medicine—humoral medicine—which was also known as the System of the Fours … all related: four elements, four qualities, four humors, four directions, four colors, four temperaments, four ages, four times of day, four seasons.” Sweet provides a useful diagram to clarify Hildegard’s body of work.
Hers is a treasure trove of practices and thoughts on healing and living. Suffice it to say that patriarchy didn’t keep down this woman.
Thankfully, Hildegard also left us a written record of what she knew and did for the sick in a pre-capitalist era. Her time and place of course is long gone.
What replaced it is industrial capitalism of automated and computerized production of goods and services. The provision of health-care services, as Kamran Nayeri writes, is not free from the historic arc of industrialized mechanization.
This modern process casts a shadow on the doctors, nurses and patients at Laguna Honda Hospital in San Francisco, Calif., where the lion’s share of action occurs in Sweet’s book. Under this reign of modernization, as she details, hospital managers and the medical providers they manage clash over patient care.
The root force of this conflict is the drive to slash costs. Perversely, such reform increases prices, Sweet shows, while it decreases face-to-face time that medical professional spend with their patients.
Against this backdrop, Sweet makes a pilgrimage with a comrade along a medieval route in Europe that travelers walked in the time of Hildegard. At the same time, consultants and managers move forward with the restructuring of Laguna Honda.
The contrast between medicine past and present in Sweet’s book outlines the motives and limits of “efficiency experts” that descend on Laguna Honda. Amid their rhetoric to improve health care is the drive to control the labor process. Why?
“Moments are the elements of profits,” wrote Karl Marx in Capital Vol. 1. Time is money. So it goes in the practice of medicine and other, lower-paid work stateside and in other developed nations today.
But what is current arose out of the past. That matters for history’s next phase, as the present exists as a part of the past, a theme which courses throughout Sweet’s book.
Speaking of yesteryear, in disclosure, I worked at Laguna Honda in 1979. In my heart and mind remain fond memories of doctors, nurses and patients there.
As the last almshouse in the US, Laguna Honda drips individual and social history. Sweet animates decades of that in the context of how she and fellow doctors treat and treated patients.
Inside and outside these venerable walls, she paints a picture of old and new medicine. The ebbs and flows captivate us due to Sweet’s skill at telling the stories her patients and co-workers, complex human beings all.
In this way, she helps us to understand what is at stake and why for patients, at and away from Laguna Honda. Patients there suffer from multiple conditions, the least of which is material deprivation.
Consequently, they benefit from what Sweet and her fellow physicians have the opportunity to do: practice “slow medicine.” Technology is not a substitute for doctors’ time to observe and listen to the infirm, according to Sweet, who for instance argues against “drive-by” treatments to evict patients from hospitals.
My main take-away from her story is that what makes medicine an art is the time its practitioners have to heal and observe. These minutes and hours are the human measure of medical reform.
Such a concept is easy to forget in a money society marinated with prices. Sweet’s book helps us to focus on what is the core of medicine, and thus provides a much-needed public service.
Seth Sandronsky lives and writes in Sacramento, Calif. Email firstname.lastname@example.org.
From The Progressive Populist, November 1, 2012
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