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.
I found that most of the patients could be handled very well on five medications. So I was taking them off between 10 and 15 medications, which, if you figure it out economically, is incredibly cost effective for the extra few hours of time it took me. So I was quite happy there.
And then meanwhile — of course, I’d gone back to study — so this is actually what I call the efficiency of inefficiency. Meanwhile, I’d gone back, as I had decided to do, to get my PhD in medical history with Hildegard of Bingen as my focus. And what I decided to do was to really learn Hildegard’s medicine as if I were its student, by reading her medical text in its original language and by understanding what people were doing around her.
So I took classes and learned Latin because she wrote in Latin. And I learned medieval Latin because she wrote actually in medieval Latin. I learned medieval German and German because that’s what the secondary literature was in. And learned paleography and codicology, so I could actually read the handwritten texts which they had back then.
And I also experimented. Because I figured if I’d been her student in the Middle Ages, I’d sort of have a sense of using her different recipes and prescriptions. So I planted a medieval herb garden. And I brewed up some of her potions and syrups. I tried her medicinal beers. And I baked some of her anti-depressant cookies. And what I found over time, I got more and more interested in the difference between Hildegard’s model of the body and our model of the body because they were clearly very different.
Our model of the body is fundamentally based on the idea that the body is a machine and the doctor is a mechanic, looking for what’s broken and trying to fix it, repair it, or replace it. Hildegard’s model was very different, I gradually learned over the years Hildegard’s model was much more of the body as a plant, rather than as 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. But a plant can heal itself. And Hildegard had a name for the power of a plant to heal itself. She called it “viriditas,” from the Latin “viridis,” that means green. So it was the greening power of a plant to grow, to produce seeds, and to repair itself up when it was injured. And she believed that human beings also have this power. And that the job of the doctor was more to remove what was in the way of the patient’s viriditas and to support it with the basics, than to do something to the patient. So this was a very interesting model.
And it took me years to understand how to apply it to the patients I had at Laguna Honda. But gradually, I began to see that not only could I help a patient by figuring out what diagnosis they actually had, but once I had the diagnosis, to step back and see what was in the way of viriditas and what could I do to support it.
The longer I practiced medicine at Laguna Honda, the more I realized that this was a very helpful way of looking at patients. And I began to think of it as sort of the slow medicine, as opposed to the fast medicine I also used, which was so effective for what I consider fast diseases.
So, for instance, if you come to the hospital because you have appendicitis and you need an appendectomy, or you come to the hospital, and you are having a heart attack and you need an angioplasty, or even if you have cancer, this is when, what I would call by contrast, fast medicine or modern medicine, based on the model of the body as a machine, works great.