A sigh of relief for me this past week that our crazy mess of a so-called health care system is not made crazier and more mean-spirited. A break from politics here to share my story of getting lost in the medical maze. Part one of a three part (triptych). This was published last year by Columbia University’s The Intima: A Journal of Narrative Medicine. The photos are of the stranger than fiction building where I work.
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MEDICAL MAZE
Wayfinding
I work in the world’s largest university building: the Warren G. Magnuson Health Sciences Building at the University of Washington (UW) in Seattle. The building, which includes the 450-bed UW Medical Center hospital, has close to 6,000,000 square feet of space, the equivalent of more than thirty Walmart Supercenters under one roof. The building is comprised of over twenty wings, whose hallways are connected, but in an Escherian, disorienting way. Besides the hospital and its associated specialty clinics and administrative offices, the medical complex is home to five health science schools—medicine, nursing, dentistry, pharmacy, and public health. Ten thousand people work or are hospital patients in this building; many spend at least some time lost in the medical maze.
The UW medical complex is sandwiched between two busy streets and one busy ship canal. The building’s courtyards are covered in concrete, with a few scraggly rhododendrons in containers. There are numerous entrances and exits to the building. Inside, the hallways have exposed guts—tangles of wires and pipes—and metal carts filled with glass test tubes, flasks, boxes of fruit flies, and cages of rats. The air is uniformly cold, with an acrid-medicinal, disinfectant smell. The bathrooms are tiled—floors and walls all the way to the ceiling—and are painted a jaundiced yellow. Some of the oldest rooms retain remnants of the original pale “hospital green” so popular in the twentieth century.
“Spinach green” is what Harry Sherman, a surgeon in a San Francisco hospital in 1914 named his invention. Using color theory, he distilled this green to counterbalance the hemoglobin red he encountered in his operating room. He claimed that this particular tone of green helped him discern anatomical details, resulting in better surgical outcomes. At around the same time, a leading American hospital architect, William Ludlow, advocated the use of color therapy: “…the convalescent needs the positive colors that nature has spread so lavishly for her children…soft greens, pale blues…but above all, the glorious golden yellow of the sunshine.” (p. 511). Perhaps the pale yellow tiles and paint in the UW medical complex bathrooms started off the shade of sunshine, but they have not aged well.
Color-coding of medical center hallways and units helps people navigate the complex physical structure of the modern hospital and clinic. It is a form of wayfinding, which is a dynamic relationship to space, a continuous problem-solving process: knowing where you are and where you are headed, knowing and following the best route to get from here to there, and knowing when you have arrived at your destination. Large hospitals are a modern urban common space like no other. The closest are probably busy airport terminals. But in hospitals, the business is not simply travel; the business of hospitals is life, illness, and death. Susan Sontag points out that we all hold dual citizenship, “in the kingdom of the well and in the kingdom of the sick.” (p. 3). In hospitals, she states, patients are “emigrating to the kingdom of the ill.” (p. 3).
The first time I entered the UW medical complex was in February 1994. I was visiting Seattle from Baltimore, where I was finishing my doctorate in global health. As a single mother of a seven-year-old son, I needed a stable, well paying job—something global health did not offer. On a whim, I contacted the UW School of Nursing about a tenure-track academic position they had advertised. Teaching nursing was far down my list of desirable careers. I have long viewed nursing as old, stale, and a hindrance to my ambitions—yet when I am feeling more humble, I can’t imagine a higher calling than being a nurse. I was, and still am, a nurse. Despite what I term my nursing ambivalence, I was curious about this job possibility. It helped that Seattle was as exotic as a foreign country to me.
“There’s a courtyard on your right. You’ll see a sculpture of people hanging on the outside wall of a brick building—go past that and enter the doors to your right.”
These were the directions given to me by the professor with whom I’d set up an informational interview. I found her office, had a series of interviews, was offered and accepted the job. So in December of that same year, after moving across the country to start my new job and new life in a new city, I went to my first official day of work. I parked in the cavernous underground S1 parking lot behind the medical complex. I followed the cute little tooth signs out of the parking lot, through a tunnel, and into the Dental School entrance. Knowing the general direction I needed to go in order to get to my new office, I took the stairs up one floor, and then decided to take a shortcut through a small internal courtyard. I suddenly found myself locked inside a 10’x10’ barren cement courtyard that was surrounded on all sides by six stories of brick walls. I stood there for several minutes, gazing up at the walls, contemplating possible escape scenarios, contemplating the possible deeper meaning of this space, awed by its quiet peacefulness, before a woman passed by and opened the door. I have never been able to find that courtyard again—it doesn’t exist on any map.
Today, I am a tenured Associate Professor in the Department of Psychosocial and Community Health in the UW School of Nursing. No one knows what ‘psychosocial’ really means, including me, so I tell people I work in the Department of Community Health. As of December 2014, I have officially worked here for twenty years. My office is in the ugliest wing of the medical complex. The wing’s hallways are painted the same sick yellow as the bathrooms. There is a 6-inch wide grey rubber seam that bisects my office. It runs up one wall, across the ceiling, down the other wall, and across the floor. This rubber seam is the building’s earthquake shock absorber. I often wonder what it would be like to stand on the rubber fault line during an earthquake. Would I be safer there rather than under my fake-wood desk or trying to find my way out of the building?
The particular part of the Health Sciences building I work in, the T-wing, was built in the late 1960s and is a prime example of Brutalism. It is also a prime example of why Brutalism is not an architectural style suited either for Seattle weather or for being attached to a hospital. Brutalism was an architectural movement that espoused the use of exposed concrete and other functional elements. It focused on the ideals of a better future through the use of technology.
Outside and inside the T-Wing, the building appears to be made of crumbling, damp and moldy concrete. In one staircase I use frequently, there are arm-sized stalactites on the ceiling, with liquid perpetually oozing from their pointed ends down into a black and green puddle on a stair landing. It has a bizarre beauty. Every few years, someone from the maintenance crew removes the stalactites and paints the ceiling. I watch as the stalactites slowly return.
The land that the UW medical complex is built on had been salmon fishing ground for the Lakes Duwamish people before white settlers claimed it as pastureland for cows. As the town of Seattle grew, and the UW moved from its original downtown location, north to its current location, the 40-acre parcel of land became a nine-hole golf course, then the 1909 Alaska-Yukon-Pacific Exposition’s Pay Streak section with carnival rides, then briefly the site of a WWI Navy training camp, and finally it became the site of the expanding Health Sciences and University Hospital. On October 9, 1949, Governor Arthur B. Langley laid a ceremonial cornerstone for the official opening of the Health Sciences Building. Inside the cornerstone was a lead box containing a stethoscope, a set of false teeth, a nurse’s cap, and a mortar and pestle: artifacts representing the Schools of Medicine, Dentistry, Nursing, and Pharmacy, which were housed in the new building. The box with the artifacts is still there, buried in the side of the building.
Cornerstone, foundation stone, quoin-stone: the first stone set for a new building. The stone that all others are placed in reference to. The stone that determines the strength and future stability of the building. The stone that holds the genius loci, the guardian spirit, of the place.
JOSEPHINE ENSIGN 