Friday, March 6, 2015

God's Hotel Book Club Discussion Questions

Book:    God’s Hotel
Author:  Victoria Sweet
Edition:  Hardcover, Penguin Books, 2012

The author presents a series of vignettes around her interactions with her patients as well as delving into premodern medicine, etymologies, pilgrimages and hospital bureaucracy, all from the perspective of a doctor healing the whole patient.  I particularly enjoyed her lessons in etymology and the feeling that a word invokes.

The issues Victoria Sweet raises affect the entire ecosystem associated with the person receiving care, from the complex makeup of the human body and spirit to the numerous roles of the individuals swirling around providing care directly and indirectly.  Your book group may find a discussion of God’s Hotel particularly satisfying if your group members have participated in healthcare in different roles from caregiver to patient to doctor to administrator to policy maker.

The one downside I found in the book is the author’s reticence to present the benefits of change in a balanced view.  The doctor alludes to the many negative repercussions of change at Laguna Honda, the increase in staff who are not directly connected to patients, the reticence of the architects to get to know their clients (which, sadly, is a common problem across all business and should be the first pillar of business—get to know your customer in person: watch and listen and follow), the multitude of policy changes which took time away from being with patients. Yet she only tangentially points out some of the negatives of the old building— a patient who fell out of a window, the ongoing use of illicit drugs and frequent smoking among patients and visitors, the noise of the open ward making it more difficult to sleep. Discussing the author’s ability to manage change and how we each react to change may be a lively conversation for your group.

Internet Resources

Online resources abound for many nonfiction books, including God’s Hotel. The Laguna Honda Hospital and Rehabilitation Center has an in-depth website including a 3-minute video which summarizes the rebuilding of Laguna Honda from the perspective of policy makers, administrators, architects and even the resident council. Their perspective presents a view of intentionally creating a green and community-focused space inline with the principles Sweet cherished in the old hospital. There is also a synopsis of its history.

Sweet offers an excellent outline of The System of Fours on page 181.  Medical News Today has a summary of European Medieval and Renaissance Medicine including the four humors and the hospital system both of which align with Sweet’s writing, but may fill in some gaps for the reader or at least summarize the material all in one place.

The British Almshouse Association provides a history of almhouses in the U.K. as well as an understanding of the almshouse movement today.

Major Characters

Sweet shares vignettes about a wide variety of patients, doctors and administrators.  Here is a sampling of some. Find the stories that touched you most deeply, which may not be among those listed here.

Dr. S: the author Victoria Sweet
Hildegard of Bingen: 12th century “German mystic, theologian and, amazingly, medical practioner”
Dr. Major: the medical director when Dr. S arrives at Laguna Honda
Dr. Fintner: half-time admitting doctor with whom Dr. S job shares
Dr. Jeffers: doctor in admitting with Dr. S
Mrs. McCoy: patient who arrives on verge of death and whom Dr. S returns to wellness. Mrs. McCoy gives Dr. S a plant.
Jimmy: crazy patient who looked and sounded great once on antipsychotic medications yet who refused to take medications, got himself discharged and died.
Dr. Stein: director of public health, recommends building a new health-care facility
Dr. Curtis: assistant medical director who goes out and buys a patient shoes instead of waiting for Medicaid to approve purchase
Terry Becker: street person, heroin addict, prostitute admitted for rehabilitation following inflammation of the spinal cord with whom Dr. S successfully practices Hildegard’s prescription of fortifying her viriditas and who is discharged in good health to her family in Arkansas
Mr. Bramwell: patient admitted for dementia who dances at the Valentine’s Day Dance exhibiting anima
Lorna Mae: Mr. Bramwell’s sister-in-law from whom Dr. S realizes the true meaning of hospitality
Rosalind: traveling companion with Dr. S on pilgrimage
Paul Bennett: patient with extreme sores who needs to have both legs amputated
Radka Semonovna: Bulgarian-born patient who sees America as a generous country
Meng Tam: patient with a DNR who is "pretty much dead", with his anima half in life, half in death, and returns to the side of life with basic interactions


Discussion Topics

As with so many good book discussions, a conversation starting with God’s Hotel can easily move from stories of specific characters to extensive discussions of policy.  The following topics are intended to offer a sampling from very book-focused topics, to connections with current policy and individuals’ personal experiences with healthcare and more broadly, our reactions to change.  


Etymology

The author explains a multitude of words associated with the body and soul and care-giving.  A few of those are quoted here.

Spiritus:
“Spiritus was breath, the regular, rhythmic breathing of the live body that is so shockingly absent from the dead.  Spiritus is what is exhaled in the last breath.” page 2
Anima:
Anima is the invisible force that animates the body, that moves it, not only willfully but also unconsciously— all those little movements that the living body makes all the time.” page 3.
Viriditas:
Viriditas meant greeness… [Hildegard] used it to mean the power of plants to put forth leaves, flowers, and fruits; and she also use it for the analogous power of human beings to grow, to give birth, and to heal.” page 86
Physis:
Physis — the individual nature of each person— also gives us the word physician.  The physician is the person who studies physics, the individual nature of his patient, who understands and follows its lead.” page 100
Hospes:
“the root of hospitality is hospes, which can mean either ‘guest’ or ‘host’”… The essence of hospitality – hospes – is that guest and host are identical, if not in the moment, then at some moment. Whatever our current role, it was temporary.” page 175. 
Community:
Community comes from the Latin communio, … Communio is a verb from moon — wall — and means ‘to build a wall around.’ So a community is defined by the wall — symbolic or otherwise— around it. Everything inside the wall is the community, and everything outside the wall isn’t… But common as a noun derives from munis — gift; so common also means ‘those who share a gift in common.” page 197.
Which words did you find most intriguing?  How does thinking through the source of a word affect how you think about words and their descendants?

Vignettes

Select several of the characters Dr. S attends.  Which did you find most troubling? Which were most hopeful? How would their outcome have been different if the individual was in a community near you?

Consider the perspective of the varying nurses, policy makers, administrators, and doctors. How does Sweet present a complete picture of each individual for the reader?  Did you feel that the depictions of any of the characters were especially objective or especially biased? How can an author present the most impartial perspective in a work of nonfiction when she is a character in the writing? Do you prefer impartiality or an accounting with personal perspective?

Premodern Medicine

If you are interested in premodern medicine, the author presents the essence of how care-giving for the sick was delivered and the premodern understanding of the body and healing in a very accessible manner for someone who is not versed in medical terminology.

The four basic elements of “Earth, Water, Air and Fire. That is, with good nutrition – tasty food, vitamins, liquids, deep sleep, fresh air, and sunlight,” are a foundation of premodern medicine. Or as Hildegard framed her regimes, what Dr. Diet (eat and drink), Dr. Quiet (exercise and rest) and Dr. Merryman (emotions and sex) would prescribe.  Looking at some of the vignettes you found most appealing, which elements were most important in healing? How were the elements combined with the capabilities of modern medicine to create the most positive outcome? In what ways do you personally adhere to the essence of the four elements? In what ways do you rely on the benefits of modern medicine?

Healthcare

The transition to sterile terminology in healthcare has perhaps led or perhaps followed a transition away from personal care to streamlined, theoretically efficient care. The author challenges whether streamlined care is actually more efficient. What is your perspective on the author’s hypothesis that
“Slow Medicine provides as good a medical outcome as does Modern Efficient Health Care, while being less expensive and more satisfying for patients, families and staff.” page 315 ?
How does Mr. Rapman’s recovery represent a blending of modern medicine and premodern medicine?

Change

The themes in God’s Hotel go far beyond medicine. At the core, this is a book about the essence of care and relationships, which the author directly acknowledges, and importantly about a reticence to accept change, which the author clearly feels, though doesn't address head-on. Change is hard.  And when you are not the instigator of the change, it can be exceedingly difficult to accept the opportunity that change brings, instead focusing only on what has been discarded.   Sweet talks about Miss Lester’s involvement in encourage a “yes” vote,
“She wrote: ‘… I am convinced that Laguna Honda must forever be part of our city.  Vote Yes on Proposition A,’” page 178. 
Who else took a stand on one side or the other as the hospital was transformed? How did the author participate in the ongoing changes at Laguna Honda?

When Dr. Talley starts as the new medical director, she tells the doctors that
“it was time for medicine to say yes instead of no to change,” page 327.  
How had medicine been saying no to change? When have you been an active proponent of change?  When have you actively resisted change? When have you stayed on the sidelines? In public policy? At work? In your family? Which role was easiest?  Most difficult? Most frustrating? Most satisfying?

What do you see as some of the basic elements to create acceptance of change when you believe change is for the better?

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