92. God's Hotel

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This belonged with the previous post but that was already too long. I also reference something here from near the end of The Brothers K., but that can't be helped. I'll probably refer back to this when I finally get there. 

So here, all together, are (most of) the parts of God's Hotel that I think relate to Dostoyevsky but also to the whole Mephistophelian transformation of the world in recent centuries, resulting from our Faustian bargain with science and reason. And, of course, my thoughts on Sweet's ideas.

Laguna Honda Hospital is a San Francisco institution that was originally a traditional alms house.

God's Hotel by Victoria Sweet

Riverhead Books/Penguin edition 2012 

p111 ...By physis Hippocrates meant the “nature” of a being to grow into itself; (“a mustard seed into a mustard plant”)...

p112 ...like anima and spiritus, physis and the healing power of nature were exiled from medicine more than one hundred years ago. They were victims in the battle between two completely different conceptions of health, disease, and healing -- mechanism and vitalism.

The mechanists believed that life was mechanical, simply a series of processes that science could eventually understand and duplicate; the body was a machine that could be fixed. For the vitalists, the body was not a machine. They believed that life had something special about it that science could never duplicate. The vitalists were the romantics of medicine, and in the last decades of the nineteenth century they lost their battle with the mechanists. By the early twentieth century, any reference to vitalism or the healing power of nature was considered heretical. Yet vitalism did not disappear. Instead, it dived down into the subterranean rivers of Western medicine and reappeared in the many side streams of alternative medicine.

p118 ... Ever since the duties of the monk infirmarian had been split between doctor and nurse, and the Latin curare split into cure and care, there’d been a battle going on [in the hospital] for control. Who would be in command of the hospital? Doctor or nurse? Whose model of curare would triumph? Cure or care? And this battle was joined at the French Revolution, when the doctors tried to wrest control of the Hôtel-Dieu in Paris from its nursing nuns.

The description of the division of nursing and doctors at Laguna Honda in this book reminded me of the special status of non-commissioned officers -- or chief petty officers -- on U.S. Navy ships. Captains, and officers in general, like doctors, come and go but the Chief Of the Boat (COB) endures and, like the nursing staff, makes sure the ship runs efficiently. 

p119 For more than a thousand years the nuns ran the Hôtel-Dieu: Caring for the sick poor defined their monastic vocation. They provided food, shelter, and spiritual care; they nursed the sick; and only when necessary did they call in a physician. Until the end of the eighteenth century that was just fine with the doctors, because the sick poor at the Hôtel-Dieu did not offer them a pecuniary or any other reward.

But around the time of the French Revolution, medicine, like so much else, was changing. Doctors were beginning to believe that the best way to understand the body was to correlate their treatments with what happened to their patients. They started to keep careful records and perform autopsies on patients who died. Their records and their autopsies allowed them to relate the course of a disease to the dysfunction of internal organs, and to connect their physical examination of the living body to the pathophysiology they found inside the corpse. These were powerful innovations; they would provide much of the data for our bible, DeGowin & DeGowin. And the reason that the doctors of Revolutionary France suddenly wanted control of the Hôtel-Dieu in Paris was that the best “material” for their new approach was at the Hôtel-Dieu -- the most varied patients, the most multitudinous, and the most compliant.

p120 The doctors convinced the Revolution’s administration to remove control of the Hôtel-Dieu from the nuns and give it to them.

The nuns protested. They refused to serve under doctors... The idea of using patients -- Christ’s charges -- as experimental objects was murderous, a disastrous idea, they said... [Long story short, the nuns remained for another 150 years until France secularized the institution early in the 1900s] Then the nuns left.

This next section is here solely because of the resemblance to the Berghof in The Magic Mountain. Something that suggests The Magic Mountain to me seems to turn up in everything I read.

p169 ...The Hospital of Saint Bruno [in the French Alps], with it's arched stone entrance and wings of high, arcaded windows, was a long-lost relative of Laguna Honda. 
...
The Hospital of Saint Bruno, ... [Dr. Lapin] explained, had been built in the nineteenth century as a tuberculosis sanatorium, when the only treatment for tuberculosis was regime -- a diet of eggs, milk, and meat; and the quiet, sunlight, and fresh air of the Alps. Although that treatment had worked surprisingly well, after antibiotics against tuberculosis were discovered, the hospital had been emptied and almost torn down. But then it was realized that its out-of-the-way location, fresh air, and good diet might make the hospital suitable as a rehabilitation facility for alcoholics and drug abusers, and it was reopened.

Dr. Lapin turned and walked through the arched stone entrance, and we followed him through a hall and out into a wide corridor. On our left were floor-to-ceiling windows; they faced south, he said, for the sunlight and vitamin D that did help cure tuberculosis. On our right were the rooms of the patients. The DOJ [Department Of Justice which was pestering the Laguna Honda administration about their common wards] would have been pleased. Each one was private, with the narrow bed, small desk, and wooden closet that the French favor...
...
p170 Finally Dr. Lapin led us to lunch in the doctors' dining room.

The dining room was entirely of polished wood -- floors, walls, ceiling -- and very quiet, without windows. Its long table was set for eight, with gold place plates, silver settings, three wineglasses, and one tiny glass for liqueur. And for the rest of the afternoon we ate and drank as course after course arrived, and wine after wine was poured.

Dr. Lapin and HUG [Hôpitaux Universitaires de Genève] doctors discussed the treatment of alcohol and drug abuse, though I can't tell you what they said. I wasn't paying attention. Mostly I tasted and sipped, and looked around at the heavy, quiet walls. Especially after that third glass of wine [or could it have been Hans Castorp's porter?], they seemed to exude stability and security, with their memory of many such meals, and their expectation of many more.

I thought about how, after tuberculosis was cured, the Hospital of Saint Bruno had not been torn down. Someone had recognized that there was still a need for such a place in modern France, this century for alcoholics and drug abusers. I thought how, even after a cure for alcoholism and drug abuse was discovered, there would still be some such disease without a cure, some illness whose victims could profit from the prescriptions of those old-fashioned physicians -- Dr. Diet, Dr. Quiet, and Dr. Merryman...

Ha! Back on the Magic Mountain. And wouldn’t the French serve three kinds of wine plus liqueur for lunch at a facility for alcoholics and drug abusers? 

p233 [Her pilgrimage to Santiago de Compostela] There were many stunning moments on that first section of the pilgrimage, but the one I carried back to the hospital was the day it was pouring rain. We were a long way from that evening’s shelter, and we would be walking in the rain for a long time. It was cold; I was soaking wet; and Rosalind and I were singing to keep warm. There were mud, fields, and rain; and I was chilled to the bone. Yet I didn’t want to be anywhere else than in that muddy field, or doing anything else than walking in the rain, or be anything else except chilled. I didn’t want to have arrived at our warm and comfortable destination. I didn’t want the rain to stop or the fields to stop being muddy. I didn’t want to be dry or warm, or to be one step farther along or one step farther back. I wanted to be just where I was because only by being where I was could I experience what I was experiencing. Which was pilgriming. 

Or life. 

p234 As I walked through the field, I thought about how much of my life I had spent trying to make sure I would never be in that place -- out in the cold, homeless, and without shelter. I thought of my patients who lived on stoops... Once I’d asked a patient who was eager to get discharged and back to her stoop what the attraction of her life was. From what she told me, I’d thought it was freedom -- from work, duties, responsibilities. But in the rain that day I wondered if, homeless, cold, and sheltered only by her stoop, she meant the feeling I had that day. I was happy and knew I was happy, the happiest I’d ever been. Not blissful, joyous, angels-coming-out-of-the-clouds happy, but happy as in “a feeling of great pleasure or contentment of mind, arising from satisfaction with one’s circumstances.” Happy from hap, as in what happens -- things as they turn out to be.

This train of thought is continued later, 

p272, ...The longest and hardest day turned out to be the opposite of what I’d expected. And over and over again, for the rest of that second section, that’s how things would turn out. That was the main lesson I took from the pilgrimage that year.

...Every day I awoke, ate breakfast, started walking, and things happened. People showed up; I had adventures. Some I liked, some I didn’t. Some I expected to like and did not like; others I expected not to like and did like. I began to see that the unexpected... was the only thing I could expect. One was presented with an experience, a person, whose value one did not know in advance. What seemed to be good might be bad; what seemed to be bad, good. One didn’t know; one had to wait.

I suspect the fondness many men have for their military service is related to this. Likewise the happiness of the monk or nun who has given up control of their life to their order. And while this may not be exactly what The Grand Inquisitor and Zossima were talking about, there is something of that here.

p378 Mr. Rapman was the last lesson in my schooling at the old Laguna Honda, and I knew it at the time. It was the capstone; it summarized almost everything I’d learned. There was the importance of modern medicine, with its intensive care units, transfusions, and antibiotics. Without that “medical model of care,” Mr. Rapman would never have survived his fatal liver disease. But modern medicine was not enough. Mr. Rapman also needed the Way of Laguna Honda, the Way of Hildegard and premodern medicine -- tincture of time, the little things, Dr. Diet, Dr. Quiet, and Dr. Merryman -- to heal completely. But even that had not been enough. It took Don Taylor [a hyper-active Alcoholics Anonymous sponsor who has just died], with his enactment of meaning ["I gave myself up to a Greater Power?" is the way Mr. Rapman puts it] and of love, to save Mr. Rapman’s life for good.

This is the most difficult lesson... I mean for me. I don’t like it. I don’t want it to be true. But after Ram Dass, Anne Lamott, (Dostoyevsky, specifically in “The Grand Inquisitor” but Father Zossima makes the same point) and now Victoria Sweet, I have to agree that some kind of “Greater Power” seems to be necessary for most people. And Richard Dawkins and I are just going to have to learn to deal with it.

Of all the people I've read so far, warning about this infernal new culture scientific man is creating, I think Sweet actually does the best job of showing the changes and what it has cost us. Still, it’s also interesting, when you consider Dostoyevsky’s attitude toward Claude Bernard and modern medicine [this is the bit we will have to return to much later in the book], that Mr. Rapman's process of personal growth leading to faith only takes place because of vile people like Bernard. I wonder what Dostoyevsky would have made of this. 



Lizaveta
Remember Pavel's mother?  Recently a woman like her has shown up near my supermarket. She stands either on the sidewalk or in the street and I believe her intention is to beg but she doesn't quite know how. She makes noises but, in my experience, doesn't use actual words. She reminds me of Lizaveta and of the long and very common history of the village idiot. For a village to care for such a person is really not that hard -- even with people with more extensive needs for food, clothing and shelter than Lizaveta had. But when there are a hundred or a thousand Lizavetas things get more difficult. 

Cities early on developed the almshouse to address this need, and Laguna Honda was originally an almshouse in that tradition. Now we don't even have that, and in cities today people like Lizaveta are simply left on the streets to make their way as best they can among strangers and predators. A new urban model is needed to address a situation that is clearly not going to go away, despite everyone's wanting it to. 


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