And the longer I practiced medicine, the more impressed I was by the logical method of writing out a diagnosis and a treatment. But I was also more and more impressed by what this medicine, modern medicine, left out, which was, of course, anything that wasn’t logical.
So after a while, I started reading alternative medicines, naturopathy, homeopathy, Chinese medicine, and Ayurvedic medicine. And for a while, I even thought about learning Chinese, so I could understand Chinese medicine from the inside; or Sanskrit, so I could understand Indian medicine from the inside. But eventually, I decided that even if I did get to that point, that I could understand them, their cultures were still too different from my own to understand their different ways of looking at the body.
It was this rather discouraging moment that I discovered the writings of a very unusual 12th century woman. Her name was Hildegard of Bingen. And she was a mystic. She was a composer. She was an artist. She was a theologian. But she also, as it turned out, was a medical practitioner. And she’d written a book on her medicine. And as I stood there and read her book, in the library again, I was impressed by the medicine that she was recounting. Because it wasn’t the medieval medicine I’d expected, the tongue of newt, eye of frog medicine I expected from a medieval medical text. It was real medicine, for real patients, with real diseases I could recognize.
But it was based on a completely different model of the body from our modern medical model. I couldn’t quite put my finger on how it was different. But I decided then and there that I was going to go back to school and get a PhD in medical history, with Hildegard as my focus. But I didn’t want to stop practicing medicine.
I wanted to do this half-time. And I spent a couple of months looking around for a half-time position, which was rather difficult at the time. Until finally I discovered — I was offered a position at a very unusual hospital in San Francisco, which was called Laguna Honda Hospital, in San Francisco. And when I drove over for the first time and saw it high on that hill, I was taken aback. This was about 20 years ago now.
It looked like a medieval monastery. It had red-tiled roofs, and cream-colored walls, and a turret, and a bell tower, where patients, it turned out, used to go up and smoke. And I went on my interview. And the medical director took me around. I had never seen a hospital like this. It was on 62 acres of land in the middle of San Francisco. It had 1,200 patients. It had enormous grounds. The patients all got taken care of on these old-fashioned wards, those open wards you see in the old movies from the 1930s. It had an X-ray department where we could take our own X-rays and a lab with a microscope where we could look at our own slides.
It had a chapel, a little small chapel, that was run by the county. It had a chapel that actually looked more like a church, with stained glass windows, and polished wooden pews, and very politically incorrect stations of the cross along the walls. And then we went out. And the medical director showed me the grounds, which were enormous. There was an aviary, so that patients could watch chickens hatch from eggs.
There was a green house, so that patients could pop plants. And there was even a barnyard, so the patients could see animals, even if they were bed-bound. Then we walked back to her office and she offered me the job. Well, I didn’t know I wasn’t sure. I had never seen a place like that before in my life. But it was only place that would let me practice medicine part-time. So I said I would stay for two months. And I ended up staying for 20 years. Because it turned out to be a fascinating place to practice.
And that was for one specific reason. It had originally been called the San Francisco Almshouse. This was the first rendition of Laguna Honda in the 1860s. And the almshouse was actually how we used to take care of the sick poor before there was health insurance. We had a way of taking care of the sick poor. And that was this system that was the big, old county hospital, where anybody could show up and get taken care of.
And then if they needed more care than that, we had someplace to send them. So this is where, in the old days, we could send people who were mentally ill, who needed more care, who were unemployed, who’d just been let out of prison. We actually had a system. And Laguna Honda was the San Francisco Almshouse. And it’s how I got the title for my last book because this is — the system that we have, came from France, and Europe in general. And in French, the word for almshouse is hotel-dieu. It’s God’s hotel. So that’s how I got the name. And the reason I ended up staying so long is because typically the almshouse would get the bottom 1/10 of 1% of patients.
So my patients were all three standard deviations from the mean, any mean. They were the tallest and they were the shortest. They were the fattest and they were the thinnest. They were the oldest, and the youngest, and the nicest, and the meanest of any patients I ever had. And, because the whole catchment area was San Francisco at the time, with 600,000 people, if a disease would occur in one in a hundred thousand, I’d see a couple.
So it was a fascinating place medically. I just went through the rare diseases in Harrison’s textbook of medicine and checked them off as they would come up. So it was a fascinating place to practice. And I ended up staying for 20 years. But it also a wonderful place to practice because health care efficiency had not yet arrived.
We were over the hill to the poorhouse literally. And people kind of left us alone. I mean, we had standards and things. People paid attention to what we did. But mostly, I had something that doctors today mostly don’t have. And that is the time to take care of my patients, to properly examine them, to figure out what was actually wrong with them, to get the right diagnosis and the right treatment.
And the longer I was there, the more impressed I was by not only how, um — how satisfying that was for me as a doc, but how efficient it was, even from a health care efficiency point of view. And I’ll give you an example. The typical patient at Laguna Honda would arrive on between 15 and 26 medications, of which they only needed about four or five. But no other doctor had had the time to go through the chart, go through the patient, figure out whether they actually needed that medicine, maybe even try taking them off that medication to see how they did.