Alms and Houses

Alms and Houses

   It's a phrase from way back, "alms for the poor."  And while such charitable housing originated in the 1500s in England (which still has 2600 such developments), they are all but gone in the U.S., having been delegated primarily to the category, even in our dictionaries, as "poorhouses."  Dr. Victoria Sweet says that this might be a mistake, not only for society but for our health as well, all eloquently described in her book, God's Hotel.

   Working at the last and now only almhouse in the U.S., Dr. Sweet describes something so foreign to our idea of medicine, taking us on a historical journey to the time when Western medicine broke away from the days of Hippocrates and began a period of isolating not only our injuries and diseases, but ourselves as well.  So Laguna Honda, the almshouse in San Francisco, becomes a scene out of WW II when wounded soldiers in beds rested in long corridors, airy windows and light the only dividers.  Head nurses were stationed at the top (picture Nurse Ratchet from One Flew Over the Cuckoo's Nest) while other nurses and doctors made their rounds, patients freely smoking, chatting, even leaving, seeming to add chaos to the actual order that existed.  These were the patients that nobody wanted, the homeless and addicted that were "fixed" by the welfare county hospitals and handed off to Laguna Honda.  But as Dr. Sweet points out, the castoffs brought an inner treasure that few could see, primarily because there wasn't time.

   Her book emphasizes that we might be shedding much more than we know in rushing and compartmentalizing medicine, in getting ever more detailed in analyzing and limiting what's wrong medically but all on a deadline.  Move them in and move them out.  What was of the larger picture?  What had caused the infection or the mental state, and how far back would one have to go?  Even more so, what was the patient missing by being isolated in a private room or a curtained corner? 

   We've all walked through a modern hospital or a care ward where elderly and those likely to die are isolated, the only noise that of machines and monitors and the occasional television.  At Laguna Honda, there were no such barriers, so patients talked, made friends as they recovered, died peacefully or were discharged to return to their horrid lifestyle (one must remember that this is not a book of all happy endings for many of the people came from and returned to the street, some being found later, their bodies either overdosed or beaten or frozen).

   But it can't all be this way, can it, what with the spread of infection and the transmission of pathogens from one to another.  What of cancer or AIDS or tuberculosis?  Laguna Honda has had them all, and along with them, the efficiency experts, the cost cutters, the modernizers, the changers, the time watchers.  Think back on your own recent doctor's visit; how long did you have talking?  In today's world, five minutes in a room with a doctor is almost considered a luxury, not only for the doctor but for you, the patient...analysis, checkup, diagnosis, prescription, out (the checkup at Laguna Honda often took two hours).  Granted, volume is a large factor as witnessed by the full parking lots at hospitals and clinics (Laguna Honda has less than 1200 patients), and taking such a long time would back that wait and visit time even further.  But surprisingly, when Dr. Sweet visits a modern Swiss hospital, she finds their emergency room empty, the doctor telling her that they rarely have emergency patients, their system efficiently redirecting such inflow to the proper department.

   What emerges is a big question of what has happened to us overall, to our views of the poor as well as to our views of what ails us.  Something (including ourselves) is broken so fix it...now.  There's a cure somewhere or so it's believed, as my neighbor tells me; her medical research study on experimental drugs for heart patients draws all sorts of people sometimes angrily calling to participate, even if they haven't tried other recognized medications to treat their problem.  The problem might be that we partially lost our sense of direction, of the past, of what we've discarded from the past as indeed being the past and usurped by our "better" knowledge.  But is it really better?  Many acupuncturists and others believe that modern medicine can coexist with medicine from the past...and is it right to discard thousands of years of knowledge simply because an herbal remedy is now considered an old wives tale and should be replaced by something stretched and molecularly synthesized and packaged? 

   Her book makes one wonder (Laguna Honda was told by an efficiency group and the Department of Justice that it was not "up to code" and needed to quickly change some of its practices, especially the airy windows at the ends of the corridors). What direction are we taking and are we happy?  It's a question she asks doctors as well as patients...and it's an important one for at some point we will all be patients.