Hospitalitas, the Latin root for our word hospital, implies a relationship, a sharing between the visitor and caregiver. In his new book, Mending Bodies, Saving Souls, medically trained historian Guenter B. Risse traces the evolution of hospitals from their early mission as humble houses of mercy to today's role of some as arenas of nearly miraculous technical feats. Throughout the book Risse suggests that today's emphasis on extraordinarily refined diagnostic techniques and surgical specialties often overshadows and even undermines the capacity for compassionate caregiving.
Risse, MD, PhD, is professor and chair of history of health sciences at the University of California San Francisco. He was trained as a medical doctor in Peronist Argentina and later earned a doctorate in history at the University of Chicago. He brings both spheres of knowledge to his ambitious project. The chapters provide a series of portraits at the threshold of medical milestones - the discovery of the stethoscope and its role in diagnosing tuberculosis; the emergence of autopsies to help pinpoint causes of disease and bring the possibility of preventing them; the first amputation under general anesthesia; the early use of antisepsis at the Royal Infirmary in Edinburgh; the modern development of organ transplant surgery and post-operative care; and the very real drama played out on the first AIDS ward in the early 1980s.
As the history unfolds, the reader learns that the way hospitals function and who they serve reflect cultural change and help define it. After sketching their origins in Byzantium, Risse portrays hospitals in the Middle Ages as houses of refuge and dying, where moral and spiritual concerns prevailed and where caregivers were expected to fast and do penance. The house of mercy gave way during the Renaissance to the house of rehabilitation, borne by the conviction that the sick or wounded might be healed, not merely cared for. As scientific understanding grew, the house of rehabilitation became the house of cure.
In our time, Risse writes, the top hospitals focus on teaching and research, where the newest, boldest techniques are developed and proven. They have become houses of science -- a long journey from their origin as houses of mercy and refuge. He wonders if the technical gains in the "medicosurgical" era can't allow more room for the proven gifts of more compassionate caregiving. As the book reaches the present day, Risse offers a chapter chronicling the superb skill, insight and persistence of the pioneers in the field of organ transplantation. He follows three young women as they prepare for and recover from kidney transplants at the leading center for these difficult procedures, UC San Francisco. In an environment where the extraordinary life-saving skill of surgeons is prominent, mutual support among the three patients turns out to be invaluable to help them cope with pre-operative anxiety and difficult recoveries. One can't separate personal, emotional support from the healing experience, Risse seems to be saying.
The book's final chapter relates the shifting treatment strategies and innovative caregiving employed in the country's first hospital ward dedicated to treating AIDS patients, the UCSF-affiliated San Francisco General Hospital Medical Center's now legendary Ward 5B. The AIDS ward history is offered as hopeful evidence of the capacity for deeply compassionate care in a modern hospital setting.
At a time when the pace of medical understanding of the disease was slow and erratic, the SFGHMC ward focused on keeping patients informed and comfortable, and meeting their emotional and social needs. Some of the patients were suffering advanced stages of the disease, and loneliness and fear could be devastating additional burdens. The ward offered weekly informational sessions for patients and placed an emphasis on primary caregiving, privacy and psychological counseling. The staff was about half gay and lesbian, and many were strong advocates for patient education and advocacy in the face of such a bewildering and often overwhelming disease.
As Risse documents it, the spirit of the ward was extremely positive and uniquely supportive. One patient is quoted as saying, "`I know how the pioneers must have felt fearing what was ahead of them. My bed is like a covered wagon and we are all on a wagon train helping each other in a time of need.'"
This recent demonstration of strong commitment and compassionate caregiving in a modern hospital has served as a model for hospice development and for ever-increasing patient involvement in decisions about their own care. But perhaps most important, Risse suggests, Ward 5B is a modern testament to the capacity for health workers to provide loving and knowing care, and the capacity for the institution to reconnect with hospitalitas, infusing the modern, technically sophisticated hospital with the healing powers of touch, compassion and deep caring.
Editors and Reporters: To request a review copy of the book, contact Maggie Jackson, Medical Marketing, Oxford University Press. Phone: 212-726-6291; fax: 212-726-6450