by Miki Kashtan
For many hours every day for more than two of the last three weeks, I was in a hospital setting, supporting my beloved sister’s recovery from a major surgery. I have a lot of very personal experiences – of sorrow, helplessness, and moments of grace – that are now part of who I will forever be. This piece is about what I learned from all of this about why so many of us hate being in hospitals and what it would take to create hospitals that are truly designed to support healing.
Despite everything that I am about to say, I am confident that all of us who were with my sister during this time would rate the care we received as excellent. We were in a hospital ranked in the top 5% in the US. Nonetheless, my overall conclusion is that hospitals, as currently conceived and designed, are not conducive to healing. I have no research to cite for any of what I am saying, only my own deep intuitive humanity that speaks to me, my soul’s mourning about what I saw. This mourning is made especially poignant given that I have absolutely no doubt about the dedication, care, and commitment to the well-being of patients on the part of everyone we encountered while at the hospitals. I am not talking here about the rare individual whose spirit has been so damaged that they end up taking their suffering out on other people (commonly known as sadistic). I am talking about a system and a setup in which people whose hearts shine are unable to create a healing environment.
To clear up any confusion there may be, in talking about healing I am making a distinction between healing and curing. A quote from the book Choices in Healing, by Michael Lerner from Commonweal, an organization dedicated to individual and global health, might help make this distinction clearer: “A cure is a medical procedure that reliably helps you recover from an illness. Healing is an inner process through which the human organism seeks its own recovery–physically, mentally, emotionally, and spiritually.” There is no question whatsoever that hospitals are places where people’s lives are routinely saved, where multiple diseases and conditions are treated with stunning success, and where everyone is committed to supporting such processes in happening.
This remarkable success, however, is not relying on our innate, organismic capacity to heal. While everyone is aware of this almost miraculous biological and spiritual process, it is assumed and taken for granted, not nourished, not actively mobilized, and it is often interfered with in order to allow for the efficiency, reliability, and technical accuracy of the procedures that take place at the hospital. To whatever extent healing happens, it’s because life is so glorious and powerful, that healing happens despite the hospital environment, not because of it.
Choice and Agency
As I see it, part of the process of healing, especially from serious trauma like surgery, is about regaining our sense of power and efficacy, recovering from the profound helplessness of being at the full mercy of others, and unconscious. Were I to design a healing environment, I would set it up in such a way that in whatever manner the person healing could have choice, they would simply have it. I am talking here about the most elemental aspects of choice, such as who enters the room when.
While we were in the hospital, we never knew what would happen when, except for those medications that had a schedule associated with them. If a specialist was called in for a consult, or a nurse to come in and change dressings, we were never told when they would come. It was exceedingly difficult to plan anything, to have some sense of predictability, of having a life and creating the necessary conditions for healing by ourselves.
Another example is the use of language. When a medication is offered and for whatever reason the person makes the choice not to take it, their chart says that they “refused medication.” In my ear, this is a loaded word that connotes someone who is uncooperative, who is making a choice that is based in some stubbornness, who is not supporting the people who are offering care. I would so want, instead, for the chart to simply say “chose not to take medication” – more descriptive, and in that way more honoring of the person’s agency and choice. This may seem incredibly small in comparison with other things, I totally see that. Nonetheless, given that language is my specialty, I believe that words, and word choice, are reflective of a frame of mind. I remember one incident in which we called the doctor because we wanted to change how something was done to be more aligned with how we wanted it. When the nurse came with the changed order, she said something like, “the doctor decided it will now be this way” – in no way acknowledging that the change arose from our explicit request, which we had previously communicated to her and which she felt unable to agree to without the doctor’s agreement. Patients are not the only ones who operate without agency in a hospital.
Rhythm and Peace
Although it is well known that sleep and rest are absolutely essential for healing, it is next to impossible to sleep through the night in a hospital. Hospital staff enter the room often several times during the night. Sometimes they turn on the light to administer medicine and take vital signs, and in the process engage in animated conversation. At one point when I was there, one of the nurses left the light on and the door open as she went to look for something and came back thirty minutes later. It’s evident to me that this method is not the only one possible, because some of the nurses did manage to enter quietly, hang an IV bag without hardly making any noise and without turning on the light, and delay the taking of vital signs in all but the most acute conditions.
Especially following surgery, which is a profound affront to the body, resulting in parts of our bodies being exposed, touched, and manipulated in ways they are absolutely not designed for, it seems essential to me that we would need a peaceful environment for healing. Soft voices, warm light, smooth transitions. This is not the way of the hospital.
Case in point is the IV machine. Whenever anything stops flowing, for whatever reason, it starts beeping. There’s a button on it called “silence”, which creates about two minutes of silence before the beeping starts again. We discovered this button and got permission to use it. Most people are not shown how to operate this button. When the IV machine stops flowing, which happened at least once on any given shift, the current setup means calling the nurses station, and waiting for someone to come take care of it. Under the best of circumstances, this is a few minutes. Even when they do come, I was astonished to see that they don’t push this button themselves. Instead, they tend to take the actions necessary for fixing the problem while the machine beeps. I imagine that after years of hearing these sounds they tune them out. Meanwhile the patients lie in their beds hearing the beeping. Every time we walked around the department some room or another was beeping. It’s part and parcel of the hospital sound, almost, this perennial beeping.
What I am about to say here is not based on our experience of this particular hospital episode. We provided all of our own food for my sister. We chose to do this because of essentially having zero trust that hospital food would provide the necessary vital nutrients in support of her healing. Hospital food is almost a code word for something unappealing. I know I have read on many occasions about how hospital food is full of chemicals, additives, and sugar. If anyone ate hospital food indefinitely, I am confident they would not be able to maintain a state of health.
Food, when done with care and thought, is its own medicine. The internet is exploding with research about the healing qualities of so many foods. In addition, our relationship with food can itself be conducive to healing or not. Being in a hospital doesn’t have to mean dishes that lack any esthetic beauty, for example. I can easily imagine meals made from organic, wholesome ingredients, carefully chosen in support of specific illnesses, lovingly placed on plates and trays that create a pleasurable experience for those whose bodies are ailing and are striving to regain their health.
Compared to my memories of hospitals from decades ago, the conditions we encountered in terms of being able to create a loving environment for my sister were superb. We were fully welcomed to have a presence in her room around the clock. I am so grateful to whoever pioneered these changes, because I still remember the horror of being ushered out of someone’s room because visiting hours were over.
And, still, most people in the hospital, most of the time, are alone. My heart broke time and time again when I saw people who were relying only on staff for support. I try to imagine someone being alone in their room, in a moment of need, waiting, sometimes up to thirty minutes, without the company of someone that loves them to take the edge off the discomfort. It reminds me of all the many times I have seen people in cancer treatment waiting rooms, or receiving difficult treatment, without support.
If hospitals were designed to support healing and human needs, anyone who was alone would be offered someone to care for them, to be their companion, to be the first person to receive their requests, to attend to their bodies and spirits, for as long as they wanted it. Because love and connection support healing. But in our current system, they happen by accident, not by design, either because, as in our situation, family and friends exist, or because some particular nurse or even housekeeping person happens to be exceptionally loving and supportive. I wish, instead, for love to be built into everything that happens in a hospital.
We are an integral part of nature, despite incessant efforts on the part of Western civilization to change, hide, or suppress this fact. It’s no accident, to my mind, that it’s so common for people to send flowers to hospital rooms.
The windows in the room where my sister stayed, as in every room in that hospital, don’t open. Day in and day out, each person that works at the hospital or is attempting to heal in one of its rooms, is breathing artificially circulated air, without connection to any natural environment. I know that the reason for this is to prevent infections, a rampant risk in hospitals. Perhaps there can be no solution to this quandary. Or perhaps it’s more fear than reality. I cannot know.
What I do know is that I want every person who enters a hospital to have the opportunity to be in nature, even after major surgery, as soon as possible. The sounds and the sites of fresh air, plants, birds, and the occasional brave animal that manages to stay in our urban settings are all reminders to our own animal organisms that we are part of the web of life. How can they not be healing?
The word “sterile” has two meanings, and their overlap is far from accidental. In an effort to create a sterile environment as in protection from infectious pathogens, we have created a sterile environment as in absence of life. I’d like to believe that we can allow life into the hospital, bring in the passion of living, and still find ways to protect those who are extra vulnerable to infection. If we put our immense creativity, as a species, to solve this and other life promoting problems, I am confident we could.
Hospitals for People
Ultimately, I have very little to add to the grand vision of Patch Adams, who’s been fundraising for years in his efforts to build a hospital based on compassion, generosity, and fun. If you are curious, he has a vision of an entirely free hospital that I wholeheartedly support.
In conclusion, I want to invite you to imagine that all hospitals could be designed around healing and human needs, and that anyone who’s in need of medical care would not think twice before agreeing to go into a hospital because it would be so welcoming and loving. This is not only a big concept, it would also translate into the minutest details, similar to those I included here.
An IV machine would be programmed effectively such that when a person went to sleep for the night, the upcoming doses of medicine would already be entered into the machine, and would automatically start pumping when the right time came. This is elementary technology that would be easy to implement if this were the priority. Patients would be full partners with the doctors and nurses in deciding on their own care. Every morning someone would review the schedule with the patient to know who is coming when, so each person could plan. The rooms would be peaceful, decorated, lively… I could go on and on, and I imagine the message is clear. I long for a time, a place, a world, in which healing is promoted, nurtured, supported by everything and everyone in every hospital. I hope that my writing about this, in some small measure, would inspire all of us to put this vision, this longing, on the table for conversation. Nothing can happen before it’s dreamed about on a large scale.