to introduce our speaker Dr. Victoria Sweet. I was going to talk about her new book, God's

Hotel: a Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine. The book launched

just one month ago. I think, as Googlers, we can relate to working long and hard on

something, maybe for more than a year. You're passionate about it, you launch it, and then

you wait with some trepidation to see what's going to happen. Well, the great news is that

God's Hotel is taking off like a rocket ship. We're very privileged to have Dr. Sweet with

us here to talk about it. In its first week, it made it onto the San Francisco Chronicle

Best Sellers list. Two days ago, it was just reviewed by the New York Times' Science Times,

who called it "transcendent and a tour de force." Congratulations on that.

Dr. Sweet is both a physician and a prize-winning historian with a Ph. D. in history and social

medicine. She's also associate clinical professor of medicine at UC San Francisco, and I'm personally

happy to say that she studied mathematics and Greek at Stanford University. Go Stanford.

[laughter] There will be time for Q&A at the end, and

Victoria will sign books for those of you who would like them. Finally, just on a personal

note, I've known Victoria for many, many years. She has always been someone who was comfortable

taking the road less traveled. I think, now, with God's Hotel, she's created a whole new

road to a place and time that few of us even knew existed. And now she's here to tell us

about it. Please welcome Dr. Victoria Sweet.

[applause]

>>Victoria Sweet: Is that microphone working? Well, thank you very much, Rebecca. Thank

you all for being here today. Thanks Google for letting me speak here.

Laguna Honda Hospital was like no hospital I had ever seen or even imagined. I got there

kinda accidentally. I had decided to go back to school to get my Ph. D. in medical history

after I had been practicing medicine for many years. Laguna Honda was the only place that

would let me practice medicine part time. So I went over for my interview. When I saw

it for the first time, I was nonplussed. It was high on a hill, overlooking the ocean,

and it looked like a medieval, Romanesque monastery. It had peach colored walls, a red

tiled roof, a bell tower, and turrets. After my interview, the medical director took

me out to show me around. She showed me the long, open wards that go all the way back

to when monks took care of the sick poor in the monasteries for free. When went upstairs

and she showed me the surgery suite, which looks like where Humphrey Bogart had his face

redone in "Man Without a Face." We walked past the old-fashioned beauty salon with its

steel helmet hairdryers. She showed me the library, the auditorium, and the chapel, which

was really more like a small church with polished wooden pews, stained glass windows, and the

stations of the cross along the walls. Then we went out and she showed me the gardens.

Turned out that Laguna Honda had been the almshouse for the city, and it was on 62 acres.

It is still on 62 acres of land in the middle of San Francisco. The gardens are extensive.

She showed me the greenhouse, the aviary, and the little barnyard. So the patients could

pot plants, watch chickens hatch from eggs, and even see animals, even if they were bed-bound.

Then we walked back to her office, and she offered me the job. I didn't know. I wasn't

sure. I told her I would come for two months, but I stayed for 20 years. Turned out to be

a wonderful place to practice medicine. Part of that was the place itself. The place was

a great place to practice medicine in terms of its spaciousness, kinda ramshackle. But

what really made it incredible were the patients, because it turns out that Laguna Honda was

the original almshouse for the city. That was how we used to take care of the sick poor.

That's how we used to take care of the sick poor before there was health insurance. There

would be a free county hospital and a free county almshouse. The acutely ill would be

taken care of in the free county almshouse-- county hospital. And then, if they needed

additional care or nobody new what else to do with them, they were transferred to the

almshouse. It used to be that every county in the country had a free county hospital

and a free county almshouse, and that was how we took care of the sick poor. Starting

in the '50s, the almshouses across the United States were closed, and many of the county

hospitals, except for San Francisco, which still has its county hospital and still has

its almshouse, albeit now called a hospital. So the patients, as you can imagine, are the

bottom 0.1% of the population. What I've found is that they were two standard deviations

from the mean. Any mean. They were the tallest and the shortest, the fattest and the thinnest,

the nicest and the meanest, of any patients I ever had. They had every disease, too. They

taught me a tremendous amount about medicine and health care, cure and caring, efficiency

and inefficiency. The two months went by, and then a year or

two, and I really didn't notice that the years had gone by or that I was learning a lot from

the patients until I got to my patient, Mrs. Todd. [pause] Ms. Todd was 35 years old. She

had cancer. Her cancer was brain cancer. What made it horrible was that it was just behind

her right eye, and it had grown, in spite of surgery and radiation, right out of her

eye. The surgeons had removed the eye and sewn the eyelid down over the cancer, but

the cancer was still growing. Ms. Todd had never been beautiful, but what with the radiation,

which had caused her hair to fall out, the steroids, which had caused her face to balloon,

and the sewn eyelid, she was very hard to look at. Yet she was pleasant and quiet. She

always smiled as I passed her by. Eventually, we were on speaking terms, with a quick "Hello"

and "How are you?" from me to her and from her to me. I got used to her deformity, although

only by blocking out, in some way, my experience of her experience.

One day, I finally braved my reluctance and stopped by her bed, full stop. We looked at

each other. She at me: white coated and rushed, a bit disheveled. I looked only at her left

eye. "Is there anything I can do for you?" I asked her after we talked a bit. "Yes,"

she replied, "there is. I really don't like the food they're giving me. It's all cut up

and bland. Do you think it could be changed? And another thing. Could you arrange for me

to visit the eye doctor? I need a new pair of glasses." I was, and am to this day, floored

by her response. I was, and am, awestruck by such equanimity. She wanted, not euthanasia

or a miraculous cure, stronger pain medication, or a second opinion, but different food, a

pair of glasses. She said nothing about her terrible misfortune. She was calm, matter-of-fact.

Somehow, she'd accepted her fate. It was the small things, the little daily things, that

were important to her. We did change her diet, and we did get her new glasses. Not long after,

she moved to another ward, and there she died peacefully, 18 months later.

Ms. Todd capped my experience of those first years of Laguna Honda. She summarized it and

hinted at what I would be learning later. Even when there's nothing to do for a patient,

no cancer to discover, no paradoxical pulse to take, there is still something to do. It

doesn't have to be life saving, grandiose, and heroic. It can be as simple as a pair

of glasses or a different diet. In fact, it usually is. [pause] [clattering]

I learned a tremendous amount from the patients at Laguna Honda. If I had to summarize what

I learned in one sentence, it would be that the practice of medicine is a personal relationship

between doctor and patient. And when it's personal, it works. The best way, the easiest

way I can explain what I mean is to tell you the story of Dr. Curtis and the case of the

missing shoes. [pause] I learned a lot from Dr. Curtis, but it was in the case of the

missing shoes that he taught me the most about care and caring, time and inefficiency.

On this particular day, I met him by accident in the wide-windowed corridor that ran the

length of the hospital and connected all the wards. He was in a hurry. "Where was he going?"

I asked. "Back to the rehabilitation ward," he said, where he was covering for a few weeks.

The rehabilitation ward was its own mini hospital within Laguna Honda. It admitted the patients

with the milder strokes and the less traumatic head injuries, most of whom would recover

and be discharged back to their homes, if they had them. Although its patients, too,

were often without friends, money, or health insurance, like the admitting ward, it had

its own physicians to admit, examine, and discharge its patients. This month, Dr. Curtis

was one of them. He'd just returned from outside the hospital, he told me, and was heading

back to a patient who, having been rehabilitated after a stroke, had been ready for discharge

for months. Every day, when Dr. Curtis made his rounds, checking on the 36 patients on

the ward, this patient was still there, still zipping around in his wheelchair, still going

to therapy. Finally, Dr. Curtis said, "I asked him why, since he was able to walk, he was

still here. Why was he still in the wheelchair? Why hadn't he been discharged?" "No shoes,

doc. They ordered me special shoes, but they're waiting for Medicaid to approve them." "How

long have they been waiting?" Dr. Curtis asked. "Three months." Dr. Curtis thought a bit.

"What size shoe do you wear?" "Size 9." Dr. Curtis reflected for a while. He thought about

his duties, his other patients, the charts he had to dictate, the quality assurance forms

he had to fill out. Then he left the hospital, got in his car, and drove to Wal-Mart, where

he bought a pair of size 9 running shoes for $16.99. He'd just come back with the shoes

and was going over to the ward to put them on the patient and write the discharge orders.

"Was he planning to submit his receipt for reimbursement?" I asked. He laughed.

As I watched him hurry back to the rehabilitation ward, I wondered. Why had Dr. Curtis done

this, and why hadn't anyone else? It was a simple thing to do, but it never would have

occurred to me to do it. I would've been frustrated with the shoe delay, of course, and I would

have filled out a second or even a third Medicaid form. I might even have written Medicaid,

or braved its phone tree to complain about the time that pair of shoes was taking. But

it would never have occurred to me to go to Wal-Mart and buy the patient's shoes. I had

too much to do, too many forms to fill out, too many other patients to see. It would have

meant crossing an inefficiency boundary. And yet, Dr. Curtis got in his car without much

questioning and was hurrying back to the ward with the shoes to put them on the patient

himself. He reminded me of an aphorism I loved but

had never understood. "The secret in the care of the patient is in caring for the patient."

I'd always assumed that mean caring about the patient, loving or at least liking the

patient, but when I saw Dr. Curtis rushing off to put shoes on a patient he barely knew,

I thought there must be more to it than that. So I tracked down the quote and found it in

a talk by Dr. Francis Peabody to the graduating medical class of Harvard in 1927. Turned out

that Dr. Peabody didn't mean caring about a patient, but caring for a patient, which

he explained meant doing the little things, the little personal things that nurses usually

do: adjusting a patient's bedclothes, giving him sips of water. That took time, Dr. Peabody

admitted, and wasn't perhaps the most efficient way for doctors to spend their time, but it

was worth it, he told his students, because that kind of time costly caring was what created

the personal relationship between patient and doctor. And that relationship was the

secret of healing. [pause] In the meantime-- [pause] In the meantime,

I'd started my Ph. D. in medical history. I was studying the medical writings of Hildegard

of Bingen. Hildegard was a 12th century German nun. She was also a visionary, a mystic, a

composer, and, as it turned out, a medical practitioner. She'd written a book about medicine.

It was fascinating. There was not the "eye of newt, toe of frog" medicine I expected

from a medieval medical text. It was real medicine from real patients with real diseases

that I could recognize. But it was based on a completely different idea of the body than

our mechanical model. Hildegard's idea was that the body was more like a plant than a

machine. And the doctor more like a gardener than a mechanic. What's the difference? The

difference is that someone has to fix a broken machine. [pause] But a plant can heal itself.

[pause] Hildegard called the power of a plant to heal

itself its viriditas, its greening power, from the Latin "viridis", meaning "green."

She thought that human beings also had viriditas, a natural power of healing, and that the doctor,

therefore, should be more like a gardener cultivating that viriditas, removing obstructions

to it, nourishing it, than like a mechanic. I didn't really understand what Hildegard

meant by viriditas until my patient Terry Becker. Terry Becker was one of my bad girls.

Actually, the New York Times called her the "worst girl" and I thought that was actually

a good way to put it. She was homeless and lived on the street with her boyfriend, Mike.

She smoked and drank and used drugs. One day, she woke up paralyzed from the neck down.

She went to the county hospital, and they discovered that she had a rare viral disease

called transverse myelitis, that has no treatment but does tend to get better over time. They

sent her over to Laguna Honda. She was on rehabilitation, and she did pretty well. She

started to get better for about the first two weeks. But then the first of the month

rolled around, when the homeless in San Francisco get paid, get welfare cash. Mike, her cute

boyfriend, showed up, and out they went. She disappeared for about a year. Later, I found

out that during that year, she'd been seen in the emergency room at County 28 times,

and had 3 long admissions to the County. Each time, just as she was getting better, going

out on the streets. During that time, she developed a bedsore. Mike also robbed her

and beat her up. She went back and forth to the County getting very expensive operations

to cover the bedsore with a skin graft every time she went out. Finally, the bedsore was

too big to graft. County didn't know what to do, and they sent her over to Laguna Honda