Citizen Reader

Every now and then you read a nonfiction book that makes you say, Hey, there's some good ideas and thoughts here, why can't we talk about these things? And make the world a little better?

Victoria Sweet's God's Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine is just that kind of book, which is why I've been telling you about it all week.

It's a bit tough to describe just why it's such a great book. When I think of the "game-changing" nonfiction I've read, usually one quote or one overall idea stands out about it in my memory (for instance: I'll always thank John Bowe's book Nobodies: Modern American Slave Labor and the Dark Side of the New Global Economy, for the continuing insight that "the system isn't broke...the system is working exactly the way it was set up to work"). But for this book, just the overall experience of reading it and experiencing Victoria Sweet's work and world in her telling of it will stick with me.

None of her ideas, formed over her life's work in medicine, are all that earth-shattering on their own. Listen to people. Pay attention to the details. Consider the whole person when considering their health. Take time to pause and think.

You'll also notice that's a list of ideas that is nowhere to be seen in the practice of modern medicine.

Fairly early on in her narrative, Sweet discusses the consultants who came to find ways the hospital could economize (and they got a cut of the savings, naturally). One of their shocked findings was that one of the head ward nurses did nothing but sit at her station and knit. On the surface of it, that does seem like a rather damning charge. There was a head nurse who had vowed to knit blankets for the thirty-six patients in her care (most of whom were elderly women). And after the consultants were done, that nurse and eighteen other "head nurses" whose job was to stay on their ward and look after what needed to be done were cut, while the remaining staff were to be trained to be "nurse managers," and given additional work and beepers so that they weren't always on their assigned wards. Here's what Sweet says:

"It was a little-old lady ward, with thirty-six little old ladies--white-haired, tiny, and old--and sure enough, almost every one was wrapped in or had on her bed a hand-knit blanket...

I've thought a lot about those blankets since the disappearance of the head nurses and their well-run neighborhoods of wards. About what the blankets meant and what they signified. And here's the thing: The blankets made me sit up and take notice. Made me pay attention. Marked out that head nurse as especially attentive, especially present, especially caring. It put me and everyone else on notice.

I'ts not that the ladies for whom they were knitted appreciated them or even noticed them. Who did notice was--everyone else. Visiting family noticed...The Russian ambulance drivers noticed, when they rushed into the ward to pick up one of the ladies, that each was wrapped in a colorful identifying blanket.They also noticed the head nurse, sitting in the nursing station, answering the phones, arranging the charts, and directing them to the correct patient. Even the doctors noticed. The blankets put us all on notice that this was a head nurse who cared...

Because those blankets signified even more than attention and caring. The click of that head nurse's knitting needles was the meditative click of--nothing more to be done." (pp. 74-75.)

Sweet goes on to explain that of course the new system saved money, but it increased everyone else's stress and lowered care standards, which she referred to as "the inefficiency of efficiency."

Huh. "The inefficiency of efficiency." I guess this book left me with one huge unifying thought after all. This is a great book. Read it.

So this week we are talking about Victoria Sweet's superlative memoir, God's Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine.

As noted yesterday, this book is about Sweet's experiences as a doctor, working in a San Francisco hospital specifically designed to aid the poor. She also discusses her postgraduate studies of medieval medicine, and most particularly how taking care of the needy and the sick was approached by the well-known historical figure Hildegard of Bingen.

I stuck so many bookmarks in this one that they just look like an extra set of pages, sticking out the top. Let's see what I marked, shall we? (And here's an interesting note about this book: it's complex and interconnected without being a particularly challenging read. For most of these quotes I have to give you a little context.)

In one story, she is faced with a patient with a huge and horrendous bedsore, and she talks about how she views the sore not as something for her to fix (surgeons had already tried and failed) but something for her to help the patient's own body fix on its own. So this is what she says: "To see what else was needed, I had to start with a vision of Terry whole, complete, and healthy, in a future when all that was missing from her complete health was a pair of glasses. And walk my way back from that. Which I did. I walked past the repair of her teeth, the strengthening of her body, the strengthening of her will, the resolution of her depression, and the healing of her bedsore. I walked all the way back from the perfect future to the imperfect no, and then I organized my strategy forward." (p. 95.)

I love that. Not only do I wish all doctors did that, I wish I could do that in my own life, as a goal-setting technique. To see the whole person, or myself, in a state of wellness, and methodically list and (this is the important part) DO the hard, sometimes unpleasant work of getting there.

A bit more tomorrow. I feel like I am not doing this book justice--it is not one that really lends itself to the quick and pithy quote--but I will try.

God's Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine
by Victoria Sweet

Apologies for once again going off the radar for an extended period of time. Now that the weather is nicer it's harder to convince the Little CRs to stay in and watch Peg + Cat while I type away. I can read in the backyard while I ignore them, but it's hard to drag the laptop out there to work.

In honor of the short week, I'd like to spend the next few days on an absolutely fascinating book that you definitely should read. Yes, I am recommending this one, not just "suggesting" it, as they teach you in library school. Whatever. Screw you, library school. If I want to tell someone they should read a book from now on, I'm just going to own it and tell someone to read a book. Hilariously enough, this book was recommended to me by my sister, and even though my sister is one of my best friends and our tastes are nearly exactly the same, I still put off reading this book for a while because I am just THAT independent when it comes to my reading choices. So that's fine. Don't read this one right away just because I told you to. But read it sometime.

The book is God's Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine, by Victoria Sweet. As its subtitle says, it's a book about one of the last "almshouses"--hospitals designed solely to care for the sick poor--in America: San Francisco's Laguna Honda Hospital.

Sweet is a doctor, but is one with more than just a passing interest in the history of medicine. While working at Laguna Honda, she also pursued a Ph.D. in the History of Medicine, with a special interest in the medical knowledge and practice of the Christian mystic and nun Hildegard of Bingen. In this memoir, which encompasses a large chunk of her life, she relates her experiences working at the hospital, what she learned in her Ph.D. studies, and her take on the landscape of health care has changed over the last couple of decades.

And that should be enough to pique your interest for now; if you've had any sort of dealings with the health care "system" over the past few years, I'd imagine you have some thoughts on it (and how it's been changing) yourself. More to come...

The Storied Life of A. J. Fikry
by Gabrielle Zevin

I felt vaguely dirty upon finishing the novel The Storied Life of A. J. Fikry.

I got it from the library because I saw it getting a lot of word-of-mouth attention, and it popped up on the New York Times bestseller list, and sometimes I like to keep an eye on the current tastes in fiction. And then I started it because I heard the first chapter read on my public radio station's "Chapter a Day" program, and I thought, hey, that book's here, I should just read it. And then I kept reading it because it's about a bookseller and a bookstore.

But did I enjoy it? Well, not really. As a matter of fact, I think it was totally formulaic and manipulative, and I further think that Algonquin Books (a publisher of whom I have thought very highly in the past) should be just the tiniest bit ashamed of themselves for publishing such schlock.

The story is: small-town independent bookseller A.J. Fikry is foundering. His wife has died, his business isn't doing well, he's drinking himself to death, and his retirement plan, a first edition of a rare Edgar Allan Poe book, has just been stolen. But then: a baby is left in his store, abandoned by a mother who wants her "to grow up in a place with books." He falls in love with another book professional. Life is good, and then...well, I don't like to give spoilers. But what follows next is a tear-jerking device of the highest order. So yeah, yeah, reading is great and love is everything. I don't argue with the message. But I do not enjoy novels that purport to be gentle little things delivering that message with a sentimental sledgehammer. Consider the folksiness of an early passage:

"That Christmas and for weeks after, Alice buzzes with the news that A.J. Fikry the widower/bookstore owner has taken in an abandoned child. It is the most gossip-worthy story Alice has had in some time--probably since Tamerlane was stolen--and what is of particular interest is the character of A. J. Fikry. The town had always considered him to be snobbish and cold, and it seems inconceivable that such a man would adopt a baby just because it was abandoned in his store." (p. 69.)

I did not like this book in pretty much exactly the same way I did not like The Guernsey Literary and Potato Peel Pie Society. And do you hear much about that book anymore? Nah, pretty instantly forgettable. And I'm guessing this one will be the same way.

Other reviews: Kirkus Reviews, Washington Post