Dr. Victoria Sweet has written an intelligent and moving account of her 20 years practicing at Laguna Honda in San Francisco. It is the last American almshouse, modeled after the medieval European Hotel-Dieu, a kind of hospital founded by nuns and monks to treat the chronically ill, who were often poor, as well.
Sweet's model and mentor is the 12th-century mystic and healer Hildegard von Bingen, who wrote, among more mystical texts, a treatise on medicine. What attracted Sweet to Von Bingen, on whom she wrote a thesis for a doctorate in history and social medicine, was her vitalistic view of the body, in contrast to modern medicine's reduction of the body to a machine to be repaired with medicine and elaborate treatment. With Von Bingen, Sweet came to understand patients in the context of the practitioner as gardener. Observation and minimal interventions would encourage the body's ability to repair and heal itself.
The good doctor observes minutely and best understands and treats her patients as valuable and unique individuals in context: the conditions in which they fell ill, and those conducive to recovery.
"I would fortify [the patient] with Earth, Water, Air and Fire. That is, with good nutrition -- tasty food, vitamins, liquids (including wine and beer) -- deep sleep, fresh air, and sunlight. After that? Peace. Rest. Safety. Not much else. It might be just that simple. Oh, and time. As much time as ... needed."
This seemingly inefficient premodern approach, which Sweet calls Slow Medicine, is, she avers, more effective than medications, many of which she found to be unnecessary, and expensive interventions aimed at the quick turn-around, getting patients out as fast as possible.
Good food, quiet surroundings and the little things: repairing a patient's glasses, providing shoes to someone without, music from time to time, a glass of wine -- the little things that make a big difference to a patient's vitality, what Sweet calls Dr. Diet, Dr. Quiet and Dr. Merryman.
Here is Sweet's summary of the effective practitioner: "The good doctor makes the right diagnosis and prescribes the proper treatment. But the better doctor also walks with his patient to the pharmacy. And the best doctor waits in the pharmacy until his patient swallows the medicine."
The book has wonderful portraits of individual patients, whom Sweet came to love, no matter how difficult or obstreperous. There is street-person and drug user Terry, who after 2 1/2 years marshals the strength to get rid of her enabling druggie boyfriend.
And there is the lovely moment when a dementia patient, Mr. Bramwell, dancing with a nurse, guides her around the room with elegant flair. His mind is gone, but his anima, his soul, is still alive.
In this often lyrical book, Dr. Sweet reveals a deep spirituality and unsentimental compassion.
Brigitte Frase is a member of the National Book Critics Circle. She lives in Minneapolis.