My friend Tanesia in Albuquerque just sent me birthday wishes. I miss her. Years ago, we became friends commuting between our MFA program at San Francisco State and our homes in Oakland. Among this eclectic crew of students, we relearned the value of human connection – each of us for her own reasons. Any night of the week, we were in some corner of the Bay, attending readings or concerts at cafes, bars and apartments. Most of the time we haunted the foggy corners of the Sunset. We often passed Laguna Honda Hospital. It was just a place. A hacienda for the mentally ill, we thought. One of the last asylums, we writers imagined.
Not true, I discovered after reading God’s Hotel, by Victoria Sweet. Laguna Honda began as an almshouse, a hospital for San Francisco’s indigent population, the last of its kind. Indigent, almshouse, these are words from centuries past. As Sweet describes her journey as a physician at Laguna Honda, she is also chronicling the journey of a hospital and of medicine from the past to the fast present. She concludes that “slow medicine” saves lives and money and that Laguna Honda as a facility supported it, until “efficiency” brought down that practice and the original hospital walls.
Connection is its own medicine. The book takes us through wards to witness Sweet and other doctors connect with patients and observes patients connect with each other. The hospital’s architecture helped create pockets of community. A wedding between patients brings the hospital together and illustrates the conditions that allowed for mental and physical healing against the odds. Sweet also takes us across continents as she studies the Jedi of slow medicine, a 12th century nun, Hildegard of Bingen. Across the years, Sweet also makes trips along the Camino de Santiago in Spain where she contemplates the connection among strangers and her own weaknesses as a practitioner, scholar and human.
She returns from each sublime pilgrimage back to California’s broken health bureaucracy. The Olmstead Decision, she and others argue, continues to keep those who need treatment from receiving it. In a strange convergence of the political Right and Left, the disabled could no longer be segregated unnecessarily. A good thing. Hailed as a civil rights win, it also happened to deregulate the mental health system (the Right liked that), and pushed many onto the streets as a result of hospital closures. In death by a thousand cuts, the “health homes” meant to house the mentally ill after deregulation, suffered their own budget cuts. The mentally ill moved to the streets. And from there, for many, to the prisons.
Another policy wrong turn, in her view, is medicine’s swerve toward “efficiency.” Sweet describes in personal and physical detail how Laguna Honda’s staff, its spaces and its patients lost the benefits of slow medicine to the bureaucracy of efficiency. Office politics escapes no place. Laguna Honda during her tenure witnessed a revolving door of administrative staff, each with a plan to excise the hospital of what Sweet regarded as vital to its care.
This is Sweet’s account, but others in the community must have agreed with its pillars. They rallied to support Laguna Honda after waves of attempts to shut it down. Neighbors, allies, former and current patients, activists and a network of public health workers connected to defend care. The book brings us into a world we would rather not witness, the sick, alcoholic, the unhygenic lives of those cycling in and off the street, the elderly and frail. These are hopeless cases, we think from afar. But Sweet forces us inside where we smell them, we get in close to their wounds and their self-destructive lives. Witnessing can be the first step in connecting.