November 2008

VOL.81 NO.9 November 2008 $5.00

AN RANCISCO EDICINE S F M JOURNAL OF THE SAN FRANCISCO MEDICAL SOCIETY

Art, Design, and Medicine

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In This Issue

SAN FRANCISCO MEDICINE

Art, Design, and Medicine • November 2008 Volume 81, Number 9 FEATURE ARTICLES

MONTHLY COLUMNS

10 A New Medical Model Kate Strasburg and Traci Teraoka

4 On Your Behalf

13 Art in Stanford Medical Center Amanda Denz 16 Hospitals and Hermitages Dennis Patrick Slattery, PhD 18 The Art of Placement Deborah McDonald, PhD 20 Healing Spaces Agnes Borne

7 President’s Message Steven Fugaro, MD 9 Editorial Mike Denney, MD, PhD 39 Hospital News 41 In Memoriam Nancy Thomson, MD

22 The Creative Path to Healing Leslie Davenport, MFT 24 Art as a Therapeutic Tool Shieva Khayam-Bashi, MD

26 The Art of Seeing Tom Wootten 28 Making Time for Creative Expression Robert Rothschild, MA 30 Drawn Together Helena Keeffe

Editorial and Advertising Offices 1003 A O’Reilly San Francisco, CA 94129 Phone: 415.561.0850 ext.261

32 Less Is More—Or Less Yosaif August

Fax: 415.561.0833

35 Arts and Healing Network Tristy Taylor

Subscriptions:

36 Green Your Office Deborah Crosby, ASID, LEED, AP

Email: adenz@sfms.org Web: www.sfms.org

$45 per year; $5 per issue Advertising information is available on our website, www.sfms.org, or can be sent upon request.

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november 2008 San Francisco Medicine

On Your Behalf November 2008

A Sampling of Activities and Actions of Interest to SFMS Members

Volume 81, Number 9 Editor Mike Denney Managing Editor Amanda Denz Copy Editor Mary VanClay Cover Artist Amanda Denz Editorial Board Chairman Mike Denney Obituarist Nancy Thomson Stephen Askin

Shieva Khayam-Bashi

Toni Brayer

Arthur Lyons

Linda Hawes-Clever

Terri Pickering

Gordon Fung

Ricki Pollycove

Erica Goode

Kathleen Unger

Gretchen Gooding

Stephen Walsh

SFMS Officers President Steven H. Fugaro President-Elect Charles J. Wibbelsman Secretary Gary L. Chan Treasurer Michael Rokeach Editor Mike Denney Immediate Past President Stephen E. Follansbee SFMS Executive Staff Executive Director Mary Lou Licwinko Director of Public Health & Education Steve Heilig

Director of Administration Posi Lyon Director of Membership Therese Porter Director of Communications Amanda Denz Board of Directors Term:

Donald C. Kitt

Jan 2008-Dec 2010

Jordan Shlain

George A. Fouras

Lily M. Tan

Keith Loring

Shannon Udovic-

William Miller

Constant

Jeffrey Newman

Term:

Thomas J. Peitz

Jan 2006-Dec 2008

Daniel M. Raybin

Mei-Ling E. Fong

Michael H. Siu

Thomas H. Lee

Term:

Carolyn D. Mar

Jan 2007-Dec 2009

Rodman S. Rogers

Brian T. Andrews

John B. Sikorski

Lucy S. Crain

Peter W. Sullivan

Jane M. Hightower

John I. Umekubo

CMA Trustee Robert J. Margolin AMA Representatives H. Hugh Vincent, Delegate

SFMS Nutcracker Night

This fun, family-friendly event returns—a terrific way to unwind after the holidays! On Friday, December 26, San Francisco Medical Society members and their guests will enjoy a festive reception with sweet treats and sparkling beverages at 6:00 p.m. followed by a performance of the San Francisco Ballet’s glorious production of The Nutcracker at 7:00 p.m.

The performance lasts approximately two hours—perfect for postperformance dining in one of the many exciting nearby spots (or getting the young ones home).

Tickets are available in the Orchestra for $75 in advance (after November 21 they will be $85). Tickets in the Balcony Circle are $60 in advance (after November 21 they will be $70). The reception is included in the ticket cost. You may send a check payable to SFMS and mail to 1003A O’Reilly Avenue, San Francisco, CA 94129. You may also call or fax the Membership Department with your credit card information. Be sure to specify which section you wish to purchase tickets for.

Space is limited. This event sold out last year, so be sure to purchase your tickets early! The deadline to purchase tickets is Monday, December 15, but in order to get the “early bird” discount, reservations must be received by November 21.

If you have any questions, please contact Therese Porter in the Membership Department at (415) 561-0850 extension 269 or tporter@sfms.org.

Pay Dues Online

San Francisco Medical Society members are now able to pay their dues online. Go to www.sfms.org and click the “Pay Dues” button in the Physician Resources Menu to the left. You will be prompted for your member log-in information and guided through the process. If you have any questions or problems, contact Therese Porter in the Membership Department at (415) 561-0850 extension 268 or tporter@sfms.org.

Reimbursement Problems?

Thousands of California doctors are facing difficulties receiving payment from Medicare. The transition to NPI numbers and the switch from NHIC to Palmetto as the Medicare carrier for California have created a bureaucratic nightmare of red tape and rejected claims for doctors, delaying Medicare payments for months. CMA and SFMS can help you resolve these problems and expedite the payment of any delayed claims. The CMA Economic Services team has already helped hundreds of doctors fix their Medicare problems and get paid, so that they can get back to taking care of their patients.

If you are an SFMS member facing problems getting reimbursed from Medicare, you can get help by contacting the special CMA reimbursement hotline at (800) 7864262 for assistance. Refer your nonmember physician peers to Therese Porter in the Membership Department at (415) 561-0850 extension 268 for information on how to join SFMS/CMA and obtain help with Medicare reimbursement problems, among other member benefits.

Keep Your Contact Information Up to Date

Have you moved or changed your contact information? In August, SFMS sent out a database-update mailing to the entire membership. This annual mailing is an important means of ensuring that you receive all communications from your Medical Society, and it also provides SFMS with information to keep its database as up to date as possible. If you haven’t returned yours, take a moment to do so now.

Hold the Date!

The 2009 SFMS Annual Dinner will be Friday, January 23, 2009, at the Concordia Argonaut in San Francisco. Watch for your invitation in the mail in late December.

Robert J. Margolin, Alternate Delegate San Francisco Medicine november 2008

www.sfms.org

SFMS Medical Student Mixer

The first SFMS-UCSF Student Mixer on September 25 was a tremendous success.

The students appreciated the opportunity to meet with physicians, and SFMS members had a great time connecting with the future of the profession. There was a good turnout of SFMS members, covering a broad spectrum of specialties and modes of practice.

This is almost certainly going to become an annual event, so watch for details on the next one in the summer of 2009.

Screen Out!

At the 2008 Annual Meeting, the American Medical Association House of Delegates adopted Resolution 402, Active Support for “Screen Out!” The resolution asked that the AMA inform all state and specialty societies about “Screen Out!” and encourage them to endorse and promote this program. Its website, www.screenout. org, encourages petition and letter-writing campaigns to ask the Motion Picture Association of America to give all new movies portraying smoking an “R” rating.

By visiting the website you can access all the materials you need to promote and become actively involved in this campaign.

To sign the online petition today, please visit http://www.screenout.org/petition/index.html. Should you have any questions, contact “Screen Out” coordinator Melissa Walthers at melissa.walthers@ama-assn. org or (312) 464-5305.

Study Participants Needed

Dr. Abrams, a longtime SFMS member, is looking for subjects for his National Institute on Drug Abuse-funded study of vaporized marijuana in patients who are already using opioid medications for pain.

This is one of only two medical marijuana studies in patients currently taking place in the U.S. Dr. Abrams’s investigation was scheduled to conclude in fall 2008, but the study completion date has been extended to January 9, 2009, in order to provide more time to recruit subjects. The study was designed for twenty-four subjects, sixteen www.sfms.org

of which have completed the study. An additional eight more are needed. MAPS is supporting this study by paying for travel and lodging for participants who live outside of the San Francisco Bay Area. Subjects cannot have used marijuana within the previous thirty days, so pain patients on opiates from states without medical marijuana laws may be especially interested in volunteering for the study. If you would like more information about how you can help us recruit patients for this study, please contact randolph@maps.org.

Balance Billing Regulations Apply to Care Provided on or after 10/15

Despite the vigorous efforts of organized medicine, the Department of Managed Health Care (DMHC) regulation that prohibits “balance billing” of HMO patients for out-of-network emergency services took effect on October 15.

DMHC has indicated that the prohibition applies only to services provided on or after the regulation’s effective date. Bills sent after October 15 for services provided before October 15 are not affected.

For more information, see CMA’s Balance Billing Advocacy Toolkit, available to members only. CMA published the toolkit to help physicians deal with the uncertainty caused by this regulation and to answer any questions they have about their rights and responsibilities.

CMA and a coalition of provider groups have filed a lawsuit against DMHC arguing, among other things, that the regulation is unlawful and unenforceable not only because DMHC lacks the authority to regulate doctors but also because it violates the intent of the Knox Keene Act, which is to ensure that HMOs provide adequate physician networks to provide care for their enrollees.

For more in formation, contact Samantha Pellon at (916) 551-2872 or spellon@ cmanet.org.

Art, Design, and Lenny Leonard Shlain, MD, FACS, the man who more than eighteen years ago introduced and pioneered laparoscopic surgery at California Pacific Medical Center in San Francisco, recently underwent brain surgery to remove a glioblastoma. He is currently undergoing chemotherapy and radiation.

Lenny is a world-renowned author who has also written regularly for San Francisco Medicine. He knows a lot about the theme of this issue, Art, Design, and Medicine. His first book, Art & Physics (William Morrow, 1991), demonstrated his original observation that art precedes science by expressing new ideas in nonverbal, subjective, intuitive ways of knowing that can then be followed by mathematical and logical explanations. After a couple of other international best sellers, including The Alphabet Versus the Goddess (Viking, 1998), and Sex, Time and Power (Viking 2003), he went to work on his current project, Leonardo’s Brain, a treatise upon the genius, and the astounding right- and left-brain fusion, of da Vinci, the great artist and designer.

Lenny finds it highly ironic that while writing about Leonardo’s Brain, he himself developed a brain tumor, even experiencing the same symptoms that Leonardo developed after a stroke: weakness of the right hand and arm.

Lenny knows what it’s like to live through a life-threatening illness. In 1974, he underwent radiation therapy for a non-Hodgkins lymphoma and thus is a thirty-four-year survivor. Currently, he says he is determined to finish this book on Leonardo. His family has set up a website, www.leonardshlain. com, and they encourage you to post your thoughts, well wishes, or stories.

All of us at the San Francisco Medical Society wish him well.

november 2008 San Francisco Medicine

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Patient-Centered Design

L

ast year my partner and I were in the process of building out our new office. There were, of course, the usual technical decisions about equipment, room size, and technology, as well as the design aspects involving colors, surfaces, and furniture. The interior designer and architect had prepared design boards with samples of various possible materials. While we were pondering our choices, the architect casually mentioned he was also working on the new Northwestern University Children’s Hospital. It was an 800,000-square-foot project and clearly a much larger and more challenging job than our small office. I asked him what he considered the most difficult part of this huge plan, and I received a very surprising answer.

“Without question,” he stated, “the biggest challenge is trying to anticipate how patients will respond to the various aesthetic and design choices we make as architects.” When I explored with him further about exactly how he tries to make such predictions about the design, I became even more amazed. The architect began to describe how he spent an entire day in the current pediatric hospital being wheeled around on a gurney or wheelchair. He related making mental notes of what it was like being a child in the hospital environment and simulating the emotional reaction of viewing the health care areas either flat on one’s back or sitting in a chair. Only after such extensive research could the architect hope to create a genuinely healing and welcoming space for these vulnerable children.

At that point I began to realize even more how much the office, clinic, or hospital environment impacts a patient’s psyche.

This issue of San Francisco Medicine explores the nexus between Art, Design, and Medicine. There are articles here that discuss the healing environment, office and hospital design, feng shui, and art programs for patients. All help raise our awareness as physicians about how much we rely on medications and tests while sometimes ignoring the profound influence of design and the overall health care environment.

Patient-centered design does not apply to just the physical environment. Health systems and processes are too often driven by physician or hospital priorities—not by patient needs. This point was driven home to me last week when I visited my 99-year-old grandmother in the hospital. I spent three nights in a row sleeping www.sfms.org

in her hospital room, feeding her and providing emotional support.

Viewing our health care system from her perspective was disturbing, to say the least.

All of us are aware that hospitals are hardly restful places for our patients, particularly through the night. The need for vital signs is certainly understandable, as is the need for frequent turning of patients at high risk for decubiti. However, she was awakened each night at 3:30 a.m. to have her blood drawn. Thirty minutes later, every night, the respiratory therapist arrived with the 4 a.m. nebulizer treatment (ordered three times a day), and this intervention again awakened my already confused grandmother. When I gently inquired as to whether her blood could be drawn at 6 or 7 a.m. (certainly a more civilized hour), I was told by the nursing staff that the doctors found it more convenient to have the test results when they rounded early in the morning. The respiratory therapists also found it more convenient to give the nebulizers at 8 p.m. followed by 4 a.m., as it fit their shifts better. In both instances, the care, comfort, and healing of the patient was clearly secondary to the needs of the providers. It took some very insistent requests to make the phlebotomy time later and to rearrange the nebulizer therapy, thus allowing my grandmother slightly more uninterrupted sleep.

We at the San Francisco Medical Society hope that the spirit of this month’s issue—the interface of design and medicine—will result in continued improvement in both the physical environments and the systems employed to care for our patients. Not only will our patients be the better for it but we will be as well.

november 2008 San Francisco Medicine

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Editorial Mike Denney, MD, PhD

Hospitals and Hospitality

I

n an ancient Greek myth, Zeus, the chief god of Mount Olympus, wonders whether human beings offer hospitality to pilgrims, travelers, and strangers. To investigate, Zeus and his son Hermes disguise themselves as weary and worn human travelers and go down to earth in the region of Phrygia to walk the roads. Seeking a bite to eat and a place to rest, they knock on many doors, only to be turned away.

Finally, they come upon a humble thatched cottage on a hillside, the home of Philemon and Baucis, a devoted elderly couple. The door is opened and the strangers are welcomed inside.

Philemon and Baucis insist that the two men sit by the warm fire.

Then they serve a simple meal with the only food they have, some cherries, radishes, olives, eggs, and cheese, together with honey, nuts, figs, and wine. The food is served on a rustic oak table in crude clay dishes.

After the meal, Zeus and Hermes reveal themselves and say that the warm hospitality of Philemon and Baucis is a sacred act.

As a reward, Zeus offers to fulfill their wishes. When the couple says that they want to remain in service to the gods, their little hut suddenly is transformed into a beautiful, artfully designed sacred temple, with tall marble pillars and a golden roof.

In this issue of San Francisco Medicine, with our theme of Art, Design, and Medicine—the use of art and architecture in hospitals for the healing of human beings—might we find meaning in the hospitality of Philemon and Baucis? To begin with, we might notice that the words hospital and hospitality are derived from the same Latin root: hospitium—and that the original meaning was to denote places that welcome and care for pilgrims, strangers, and travelers, like the disguised Zeus and Hermes. We might also notice that in terms of art and design, the earliest art in Western culture was at least in part about healing. In the prehistoric paintings on the walls of the caves at Lascaux, Altamira, and other locations in France and Spain, the few humans represented are ancient shamans, the earliest healers who used crude medicines and surgery but primarily dealt with the sacred, venturing into the underworld to retrieve the souls of the sick. Later, the Greek Asclepieons were filled with art for healing.

Pausanias, the second-century geographer and writer, described the healing temple at Epidaurus, where there was a sacred statue of Asclepius made of ivory and gold, and behind it a carved relief of www.sfms.org

ancient heroes. The first-century historian Plutarch described how the Asclepiea were built in beautiful environmental settings that were clean and light, and others wrote about a healing temple with a white marble rotunda that contained a painting of the god Eros, and another of a woman’s face seen through a crystal goblet.

During the Middle Ages and most of the Renaissance, healing was practiced in hospitals and infirmaries that were attached to churches and cathedrals, and this was reflected in art that depicted saints, angels, cherubs, and the crucifix. Then the scientific revolution brought gradual development of high-tech medicine, as hospitals changed from primarily infirmaries into efficient facilities that housed the necessary equipment and sterile ambience for the practice of modern medicine. Art was found only in lobbies and chapels, and architecture became more utilitarian. Hospitals had lost their hospitality for art, design, and the sacred.

As reported in this issue of San Francisco Medicine, in many busy modern hospitals there is currently a renaissance of art and design as applied to the process of healing the sick. One such effort is not modern or high-tech but instead highly reminiscent of the humble little thatched cottage of Philemon and Baucis.

A few years ago, in the tiny rural mountain town of Loyalton, California, Sierra Valley District Hospital found itself in a simple and rustic kind of renaissance in art, design, and medicine. During a series of seminars about spirituality and healing attended by medical, nursing, and administrative personnel, it was remembered that religious-based hospitals always had art on the walls, in the form of paintings or icons of the crucifixion, the saints, or Mary. The staff decided to create an image of their own. They held a contest for local and nearby artists to create a less specifically religious symbol, yet one that would include everyone and still convey the sacredness of healing.

The winning image was a painting of a dove in flight. Her sacred heart is exposed and glowing, and her beak holds a flowing ribbon. The symbol was reproduced and hung throughout the little hospital, including the lobby, halls, nursing station, clinical laboratory, pharmacy, and emergency room—there as an artistic reminder to everyone that hospitality is, indeed, a sacred healing task.

november 2008 San Francisco Medicine

Art, Design, and Medicine

A New Medical Model Seeking Transcendent Meaning in Art and Design Kate Strasburg and Traci Teraoka “Meaning transfigures everything.”

—Sir Laurens van der Post

A

few years ago, we were asked to come to St. Louis to a conference of forty midwestern hospitals and address the importance of healing environments. Forty hospital CEOs sat in skeptical silence, waiting to be convinced that we were about more than pretty pastels. We pulled out our favorite statistic from the Wall Street Journal (December 3, 2002): The Barbara Ann Karmanos Cancer Institute in Detroit, Michigan, found that after its transformation into a healing environment, patients gave themselves 45 percent less selfadministered pain medication in the refurbished facility. Out in the audience, one of the hospital CEOs took out his checkbook and wrote out a $20,000 check to his staff to begin the healing environment process.

But, you ask, what exactly is a healing environment? We believe a healing environment is one that speaks to the depth of the patient experience—one that enables patients to transcend their suffering by surrounding them with beauty and meaning, placing them in a larger, supportive context.

If this concept seems lofty and esoteric, let us share with you an article we read long ago in the Journal of Holistic Nursing (March 2001). The article was entitled “Strengthening Transcendent Meaning.” Its thesis was that in order to reduce patient suffering, nurses were to aid patients in their search for transcendent meaning. It is precisely this that we attempt to do with our health care design.

Modern medicine does a very good job of treating the body, but, as my dying mother-in-law told her attending resident at a prestigious teaching hospital, “Young man!

I’m more than a piece of meat!” A great deal of needless suffering occurs because we treat the patient’s body without sufficient regard for his or her spirit.

There is abundant anecdotal evidence

“A healing environment is one that speaks to the depth of the patient experience—one that enables patients to transcend their suffering by surrounding them with beauty and meaning, placing them in a larger, supportive context.” that healing environments relieve suffering.

Last week an oncology nurse called to thank us for a family lounge adjacent to a palliative care room. A young mother in her thirties, with two small children, had spent her last week in the palliative care room, with her family in attendance. The family asked who had decorated the lounge, adding that it had been of enormous comfort to them and made it possible for them to be emotionally present for their dying loved one. Another grateful family donated a Bose sound system to a palliative care room. A third proposed a donation of $30,000 to create more healing environments in the hospital.

What does such a room look like, you ask, and how does it provide such comfort?

10 San Francisco Medicine november 2008

It is not just a matter of soothing colors and comfortable furniture, although both of these are important. Beauty alone can comfort, but meaning coupled with beauty can enable both patients and their families to transcend their suffering by connecting to a larger reality. The art in this small room included an inspiring poem about death by Tagore, the Shakespeare of India, as well as a lovely woodcut with Emily Dickinson’s poem about hope.

The average hospital is antiseptic, not only physically but also emotionally. Modern medicine is organized to heal the body, with little regard for the spirit. In fairness to hospitals, financial and time constraints often place questions of design at the bottom of beleaguered budgets. But as the Barbara Ann Karmanos Cancer Institute statistic attests, hospitals would do well to raise the importance of design.

Fortunately, there has been a shift in recent years from grey hospital walls to pretty pastels—from cold, sterile, institutional environments to warm, homelike health care settings. But we have a long way to go before we adequately address the deepest needs of the patient’s spirit.

In ancient Greek thought, Kosmos was the word for the universe, which encompassed mind, body, and spirit. There was no concept of the compartmentalization that exists today. Perhaps much of our suffering stems from our attempt to separate one from the other, when in reality no such separation exists. Modern psychoneuroimmunology teaches us that emotions are not, as previously thought, entirely localized in the brain, but rather that they spread throughout the body at the molecular level. This is the physiology of mind-body medicine.

Willis Harman, once the futurist of www.sfms.org

the Stanford Research Institute in Menlo Park, long ago gave a speech that is forever engraved upon our brains. He explained that science, before Descartes, believed in the unity of all matter. Descartes, by introducing the modern scientific method, with its concept of independent variables, deconstructed this vision of reality. Now, thanks to theoretical physics, we are beginning to reconstruct reality to be the complex, energetically interconnected and interdependent phenomenon it is. (Theoretical physics has established, for example, that instead of three dimensions, the universe contains at least ten.)

For a healing environment to be all that it can be, we need to be cognizant of this complex interdependence. We need to rely on both intuition and intention, as well as on evidence-based design. Those of you who have been hospitalized yourselves or have lost a loved one in a hospital setting will need no convincing. What is needed is a new medical model that acknowledges, as Dr. Rachel Naomi Remen emphatically states, that there may be healing without curing—that there may even be such a thing as a healing death.

We are often asked if our design relies on the Chinese art of feng shui. It does not, but it does rest on the concept of energy.

We firmly believe that patients and their families and caregivers can sense when a room has been designed with the intention of relieving suffering, and this realization brings comfort.

Let us give you a few more examples of how our philosophy extends beyond standard health care design.

The meditation room of a New England hospital had been exquisitely and expensively designed, with linen upholstered walls, indirect lighting, and stone paneling.

All the beautiful, bare bones were in place.

But the room remained largely unused, except for the occasional consult. It was the addition of plants, a fountain, nature photographs, the Tagore poem, soothing music, and a lit bookcase filled with art objects and comforting reading materials that brought it to life. These caring details made tangible the intention to heal.

The hospital chaplain shared with us that immediately after the completion of www.sfms.org

the installation, a nurse who had just lost a beloved patient spent a long time in the room, recovering. She also noted that many staff members began making a practice of both beginning and ending their day by checking into the room for a few minutes.

One staff member shared that daily visits to the room enabled her to deal with her husband’s suicide.

Which brings us to another point: We are not only designing for the patient population and their families. The professional staff require just as desperately to have their needs addressed. Patients, families, and professional staff form an interdependent triumvirate, each affecting the other. We cannot expect our doctors and nurses to continue to provide compassionate care if their own spirits are not being renewed.

Another meditation room in a hospice contained a large and exquisite stainedglass window, yet the room had remained virtually unused for eight years except for staff meetings. Once again, after adding beautiful landscape photographs coupled with such words as compassion, comfort, and hope, a beautifully carved wooden chest, poetry, lovely plants, a comfortable couch, and meaning-filled bookcase, we considered the room complete. That very night a dying father lay on the sofa, his small daughter cradled in his arms. The room held them with healing intention.

The head of the ICU in a community hospital found the response to the adjacent redesigned meditation room so positive that he asked if we could bring some of that energy into his intensive care unit. In response, we framed a meditation (frieze-size, so as to be easily visible from the beds) for his patients and their loved ones that read, “May you be free from pain. May you be free from suffering. May your heart be at peace.”

Staff and patients alike can sense when their emotional needs are being addressed.

The daughter of a dying patient in a healing palliative-care room said gratefully, “This room is so beautiful, it reminds me of the sea.” Framed nautilus shells and a soft blue color palette brought the ethereal comfort of nature to a sterile room.

In conclusion, we ask you in the medical profession to get in touch with the core of suffering—which lies as much in the

spirit as in the body. We ask you to seek to soothe that suffering by bringing the exterior environment into alignment with the innermost needs of the patient. We ask you to help us comfort the suffering by creating healing environments. Help us design with the intention to heal. Help us create rooms that heal bodies, minds, and spirits. Help us create rooms where souls can rest in peace.

Together let us comfort the suffering.

Kate Strasburg and Traci Teraoka cofounded their nonprofit Healing Environments in 1994. Its mission is to relieve the suffering of the seriously ill through beauty, art, meaning, and design. In addition to their health care design work, they have a resource center open by appointment at 3461 Sacramento Street in the Presidio Heights neighborhood of San Francisco. They send their free publication, A Light in the Mist—The Journal of Hope, to more than six thousand readers in fifty states and fifteen countries. You may visit their website at healingenvironments.org to request a free copy of their book, Healing Elements of Design, or to receive a free archival set of the issues of A Light in the Mist.

november 2008 San Francisco Medicine 11

Eric Shifrin & the In-Crowd play a midday concert in the atrium while patients and staff enjoy the music.

Art, Design, and Medicine

Art in Stanford Medical Center Humanizing a Sterile Space Amanda Denz

W

orks of art are integrated into the landscape at Stanford Medical Center in a way that makes it hard to imagine the hospital bare. From the bright paintings lining the corridors to the lush gardens, there is some type of artwork around almost every corner. The effect is a warmer, more cheerful environment for both patients and staff. This is largely due to the vibrant Art Committee that has been actively improving the hospital’s appearance since 1986.

Linda Meier, founder and chair of the committee, felt it was absolutely essential to enhance and humanize the environment and make it patient friendly, staff friendly, and family friendly. “What goes on in the hospital is extremely serious and technical,” says Meier. “This softens it a little and takes the sterility out of the environment.”

In 1986 she pulled together members of the community who were interested in art and interested in beautifying the hospital. They started with larger public spaces, such as the Atrium (pictured left), and now nearly every visible wall is adorned with some print, painting, photograph, or textile. A majority of the art is donated by members of the Art Committee, and they work in conjunction with a consultant to determine where and how to display the collection. Most of the original committee members are still active because they find this endeavor extremely satisfying.

Jill Freidenrich, a committee member since 1986, experienced the healing power of art during a personal battle with breast cancer. “I know what a difference it makes to be surrounded by art when you’re in the halls and in your bed,” she says. She also really enjoys being a part of this committee because, “the group is really enthusiastic, www.sfms.org

and the friendships that have come out of this project are incredible.”

Helen Bing, another member since the beginning, became involved because she loves to travel and learn about art from different cultures. “I find it very satisfying to support artists and at the same time provide hospitals with art for their walls,” says Bing.

Bing also brought the art program to a new

level by donating two vibrant gardens (one pictured below) and creating the music program, which provides both in-room music and the ongoing concert series.

“Now that the Bing family has expanded this beyond the visual arts to include gardens and music I feel that a certain ambiance permeates the hospital,” says Meier.

And it’s clear from patient and staff

november 2008 San Francisco Medicine 13

Above: Helen Bing stands next to a piece she donated entitled El Pueblo by R. Arias.

Right: Helen Bing enjoys the concert. Concerts take place every Wednesday and Friday at 12:30.

Far Right: A piece entitled Aunt Maude and Sally by Robert Harvey brightens up a waiting area.

Below: A piece entitled Stacked Snow, Grise Fiord, by Andy Goldsworthy decorates a hallway.

“What goes on in the hospital is extremely serious and technical ... This softens it a little and takes the sterility out of the environment.�

feedback that this ambiance touches those who spend time at Stanford.

A patient who underwent chemotherapy at Stanford once told Bing that she decided to walk through the gardens on her way to treatment each time to gather courage.

“And several years ago, a young female pediatric resident with terminal cancer asked to have her bed pushed into the garden where, surrounded by her parents, physicians, and fellow residents, she died,” says Bing.

Then, a few years ago, a football player for the San Francisco 49ers came in for a heart transplant and was equally touched by the concert series. He said the music kept him sane while he waited for several months for his surgery. He now returns occasionally to play concerts in the atrium as he is also a musician.

“The art not only benefits the patients who come and go, hopefully in good health, but it also benefits the staff that is here on a daily basis,” says Bing.

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“Beauty is very important in a hospital,” says Linda Cork, chairman of Comparative Medicine at Stanford. “Hospitals are very sterile, but they can also be beautiful. I always make a point to walk through the gardens in the spring.”

“Some staff members have said they’ve learned a lot from the variety of art we display,” says Meier. There are several staffonly areas that have been decorated, such as the staircases. “The poster series in the staircase shows that we care about what’s going on behind the scenes,” says Meier. “Only staff members use the stairs, and we want to make them feel that this is for them as well as for the patients and the public.”

In addition to identifying where their magic touch is needed, the committee members also give careful consideration to what is acceptable for this environment.

“We look for pleasant images—nothing skeletal or frightening,” says Meier.

“You have to remember that many people are partially sedated. We don’t want any-

thing too abstract that could confuse them or anything they could read into and see something negative.”

“We learned pretty quickly to stay away from things that are too tight, tense, abstract, red, or resembling pathology, such as a cell,” says Freidenrich. “The art should be calming, bright, and cheery. We have a series of prints that look like a view out of a window. Windows are good because they take you outside. We also have a diverse array of photography from different lands. We have people from all over the world at Stanford, so we really want to have something that each person can identify with.”

And while a visitor might look around and wonder what is left for the art committee to do, renovations and the addition of new buildings always leave new spaces in need of beauty.

“This project seems to have a life of its own,” says Meier. “We will continue as long as we can since we all believe in this cause.”

november 2008 San Francisco Medicine 15

Art, Design, and Medicine

Hospitals and Hermitages Strange Bedfellows?

Dennis Patrick Slattery, PhD

A

s I rest at home these days, recovering from emergency appendectomy surgery after a pesky appendix recently chose to rupture at a most inconvenient time, I recalled lying in my hospital room one night at 2 a.m. listening to the nurses chatting in the hall, and pondering how monastic an experience I was beginning to shift into.

An existence full of medication was beginning to shift into a still life of meditation.

I have spent many months in monasteries over the years, even publishing a book recently describing my pilgrimage. But now, as I lay stapled together with clamps that made my abdominal wound a thin smile with funny teeth, to connect my bodily aching with the spirituality of hermitage life was a revelation.

Here’s how I began to see it.

First of all, there is a shared architectural design to a hospital room and monastic cell. Both contain a sparseness, an austerity, with little personal assemblage. They are uniform, mimicking in design and layout all the others of their kind, so no individual qualities display themselves. Each is a cell of healing, perhaps of both body and spirit.

In fact, St. Romuald, founder of the Camaldolese monks in tenth-century Italy, began his short instructions to his monks this way: “Sit in your cell as in paradise. Put the whole

world behind you and forget it. Watch your thoughts like a good fisherman watching for fish.” The cell for him contained all the healing properties one needed for health.

So it is with the architectural design of a hospital room, where one is confined to a healing space that is both austere and efficient, one that allows the patient to step out of his or her routine and enter an anonymous space. Romuald saw the benefits of being patient, remaining patient, stripping one’s life to a bare minimum in order to allow the spirit full play in its conversation with the Divine.

Thus, when entering a monastery, one gives up or abdicates the normal round of one’s life and surrenders oneself to something beyond oneself. And so it goes with the life of a hospital patient, where one’s will is dwarfed to the will of surgeons, nurses, orderlies, food service, and to bodily functions that may or may not be working properly. The more one abdicates control, the richer, even more complex, the experience becomes. I can still hear the man in the next room barking at nurses, calling for aids to serve him as he shouts from his bed. Clearly the patient and the penitent are at odds in his recovery.

In monastic life, one enters not just a different space, but a different time.

Hospital time and monastic time share a certain slowness, a ripening, where diver-

“Hospitals and hermitages allow one to reflect on one’s life with a deepening awareness of meaning, often revealing a method and a firm resolution to change thought patterns and habits ... ”

16 San Francisco Medicine november 2008

sions are stripped away and one is thrown back on to the mercy of surgeons (who are, I believe, supernatural creatures) or on to the mercy of God and His will. “In His will is my peace” proclaims a repentant soul in Dante’s Paradiso, saved by her willingness to give herself to God even while succumbing to the temptations of mortality. A rhythm different from that engaged in daily, in the comforts of home or the stresses of a job, begins to wrap itself around one, transforming what one thinks about, dreams of, meditates on. Here the word patient takes on added resonance.

In this time shared by both hospital and hermitage, one may begin to assess what one is doing with one’s life, as mortality, the consciousness of time’s finitude, rushes in to be remembered, revisioned, renovated. I found myself reflecting on habits I was not happy with that had crept into my life; I sought ways, through prayer and patience, to amend them, much as has occurred to me during monastic stays.

I love to think of the various rituals in which one engages in a hospital: the monitoring of temperature and pulse every two hours; the morning rounds where the surgeon, like a high priest, moves quickly, surrounded by his young novitiates all striving to please. The surgeon carries the knowledge and skill others wish to possess, a kind of secular form of grace gained from deep practice and the wisdom gained therein. In monastic life, one enters the rituals of the divine office, of Mass and singing of the Psalms; or of silent meditation, which can serve as a corridor into invisible realms.

Meals, often austere bowls of clear liquid or green Jell-O, are taken alone, in silence, by or in one’s bed. Contemplation can mesh with the meal, making the simple food more www.sfms.org

nourishing through mindful eating that promotes a fuller awareness of one’s bodily functions and well-being.

In the hospital setting, all in one’s life become lean, unadorned, even to include the silly initiate’s robe with no back, so the body’s wounds are quickly accessible. They are humbling robes to wear, especially down a hospital hall, as anyone who has been given these “fatigues” knows. One is easily recognized as a member of this monastic unit. Similarly, in the monastery, dress becomes minimal, not so important; fashion statements become fragmented sentences, because the interior life is given precedence.

It is this sharing of the interior life of the body and of the soul that makes hospitals and hermitages so wedded to one another.

For most of us, a stay in a hospital, or in a hermitage, is short-lived. These are temporary way stations, places of healing, abruptions into the ordinary life of busyness; but they are often accompanied first by some wounding, some insight, some revelation that suddenly finds the time, place, and condition to manifest, like a hierophany, less prescriptive than necessary to face and

meditate on. I have met dozens of people in monastic stays who admitted to being there in order to recover from a traumatic wound in their lives.

Hospitals and hermitages allow one to reflect on one’s life with a deepening awareness of meaning, often revealing a method and a firm resolution to change thought patterns and habits that need some modest surgery, some shift in diet, even an antibiotic, to shift one out of a toxic life.

Life’s large questions refuse to remain hidden in either postoperative pain or monastic meditation. Both places, secular and sacred—though I don’t really believe in that split—invite others to care for those who are wounded, suffering, surfacing with life’s pains now visibly stitched on the outside to provide containment and safety.

I like the idea of a hospital stay, with all its uncertainties, its huge cloud of unknowing hovering over one like the marine layer off the Pacific Ocean in southern California, as an analogue to monastic life. Both allow one to transgress, to deviate from the normative path and to find, within the folds of a blanket or a book of spiritual readings, a new

experience of grace that only woundedness seems to break open with a force sufficient to encourage change.

Now that I am home, I feel myself out of a space that nurtured me as well as did the dozens of people who had my good health and recovery as their primary goal.

Such generous souls everywhere—much like I find when I enter the unique world of monastic life. We are all wounded.

Hospitals and hermitages are places of respite where our wounds may be stitched by surgeons, salved by grace, nourished by blessedness.

Dennis Patrick Slattery, PhD, is a member of the Core Faculty, Mythological Studies, Pacifica Graduate Institute. He is the author of more than 225 articles on culture, psychology, and literature, as well as author or coeditor of thirteen books. His most recent is entitled Varieties of Mythic Experience: Essays on Religion, Psyche, and Culture (Daimon Verlag 2008), coedited with Glen Slater. He has also written Grace in the Desert: Awakening to the Gifts of Monastic Life (Jossey-Bass 2004). He can be contacted at dslattery@pacifica.edu.

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november 2008 San Francisco Medicine 17

Art, Design, and Medicine

The Art of Placement Feng Shui in the Medical Environment Deborah McDonald, PhD

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n an advertisement for ExxonMobil currently running on TV, a geoscientist can be seen describing how a new technology allows for the reading and understanding of electromagnetic waves of our planet in order to find energy, in this case oil. Similarly, for thousands of years feng shui masters have been observing and recording electromagnetic patterns in order to understand the energy of the earth.

Feng shui literally translated means “wind and water.”

An aggregate of various disciplines including physics and geology as well as psychology, feng shui is often associated with interior design and architecture. Most commonly known as the Chinese “Art of Placement,” feng shui fundamentally involves finding harmony or balance between humans and their environment, between people and nature, and it introduces a deeper and more complex system of changing human actions and the interaction of people and their environment.

Popular Western newspapers and magazines have in recent decades reported how real estate moguls like Donald Trump as well as Hollywood actors and actresses have all consulted feng shui practitioners in order to achieve personal advantage and fame. So of what benefit could feng shui be to the medical community? The possibilities are many.

Feng shui can assist health care profes-

sionals and their patients in creating healthy and healing environments. Traditionally, feng shui has been used to help site buildings as well as lay out floor plans, but simpler interventions are also often quite powerful.

Following the principles of feng shui, specific colors, materials, textures, shapes, and lighting can be used to evoke in the space particular affective and behavioral responses.

For example, a number of years ago, I was called upon to help design a facility for women who were having trouble breast-feeding. By incorporating soft, round, and warm themes in all aspects of the interior, the end result was a calm and almost womb-like place for new mothers and their infants.

Employing principles of environmental psychology and feng shui, this intervention produced a location that reduced the anxiety experienced by many of these new mothers.

In an environment promoting health, feng shui consultants can make integrative suggestions for bringing the outside in and the inside out. For instance, interior air is often compromised by toxic levels of ammonia, formaldehyde, and benzene, which become trapped by closed ventilation systems characteristic of modern office structures. Hundreds of such toxins are released by carpets, furniture, and building materials, inducing respiratory and allergic responses often as-

“Most commonly known as the Chinese ‘Art of Placement,’ feng shui fundamentally involves finding harmony or balance between humans and their environment, between people and nature ... ”

18 San Francisco Medicine november 2008

sociated with Sick Building Syndrome. By introducing fairly simple remedies like abundant fresh flowers and plants into the space and eliminating dead, dried, or artificial flora, the quality of these environments and their impact on the health of their inhabitants can be vastly altered for the better by plants that remove various pollutants. Feng shui addresses other structural issues with solutions varying from altering construction plans to more minor changes such as introducing fish tanks, bird aviaries, fountains, and ponds.

Even in these easy feng shui remedies, consultants select plants that maximally enhance oxygen and absorb the highest amount of airborne pollutants. This traditional feng shui approach to environmental air quality and human health has been borne out in recent research on the development of a closed ecological life-support system for future space residents by NASA scientist B.C. Wolverton, and cited in his How to Grow Fresh Air. Feng shui not only improves objective factors of health but can influence subjective elements, making attitudinal and affective changes by altering interior settings with selecting furnishings and artwork with specific characteristics consistent with the goals of the environment. Since recent studies estimate the inordinate amount of time Americans spend indoors to be some 90 percent, the importance of the healthpromoting qualities of the interior space— particularly for the ill, who often spend even more time indoors—is essential.

Gone are the days when doctors made house calls. Yet the need still remains to access the valuable clinical information that often was drawn from home visits. Some time ago, I was contacted to consult on the residence of a female researcher with chronic and serious health problems derived from www.sfms.org

environmental allergies. The home was like a maze, filled with stacks of papers. There was but a single small path in which to navigate through the house, with the remainder of the structure crowded with piles of papers, books, and boxes floor to ceiling. The accumulation of dust and other allergens over the years was staggering. If only her allergist had known.

Feng shui practitioners can assist physicians in the treatment of many disorders.

While an MD may prescribe a drug treatment for a condition, the feng shui consultant can collaborate with the physician in augmenting environmental changes. In working with children with ADHD, for example, feng shui consultants can help evaluate the child’s room, discern barriers to focused attention, and recommend remedies that induce attention and calm. A feng shui advisor can indicate the most soothing position for the bed and suggest the removal of distracting items from the walls and a more productive relocation of furniture, enhancing focused work and restorative sleep. Similar suggestions can be effectively implemented for patients with a bipolar disorder. For those with sleeping disorders, feng shui experts are frequently called upon to examine bedrooms and advise the necessary remedies to minimize EMF’s and promote a healthy sleeping environment.

In cases of couples trying unsuccessfully to have children in which there is no physical or anatomical explanation for the difficulty, there are intriguing clinical data.

In approximately 95 percent of such homes that colleagues and I have examined, the bedrooms of these couples all have the same electromagnetic pattern. By suggesting that the couple have sex in a better energy sector of the house or outside of the home altogether, pregnancy can often be accomplished.

The old “take a vacation” piece of advice for such couples may have real meaning.

No single topic is more crucial to any discussion of feng shui and health than that of clutter. The feng shui literature clarifies that “where the eye goes, so does the energy.”

Cluttered spaces produce unfocused, dysfunctional, and often quite unhealthy behaviors.

These data are consistent with the recent findings of environmental psychology. If an environment is characterized by clutter or there is an excess of visual cues in www.sfms.org

an area, the space cannot enhance focused attention, and those in the space can be distracted, have a hard time concentrating, and feel drained of energy. Feng shui consultants aid in creating spaces that work better for their purpose and are healthier for the people who work within them and for those who reside in them.

Basic principles of feng shui also dictate that if something squeaks, oil it. So, locations with prominent elements that are broken require repair or replacement. In providing for environments that are “clear, clean, and decluttered,” feng shui produces conditions in which people can pay better attention, be more focused, work more efficiently, and attain their personal goals more readily. In environmental psychology terms, feng shui alters the pre- and co-conditions necessary for the types of emotional and behavioral change that allow patients, whether with ADHD or cancer, to make the alterations necessary to their situation.

An example is that of cancer. One oncologist, a medical school researcher and clinician, turned to his psychotherapist wife several decades ago to seek treatments that would enhance the radiation and chemo he and his colleagues had long been using. Over the years, his data and those of other researchers have indicated that changing behavior, such as introducing meditation, could either enhance treatments and increase the normative time to death or alter the quality of life favorably for the patients whose lives could not be extended. Producing environments that enhance such goals has been one of my key activities, whether for

an institution that counsels the dying or for a private residence seeking a proper meditation location.

Trained as a mental health care provider, I sometimes describe feng shui as the psychology of space. Utilizing feng shui theories, an environment can be analyzed to determine what the energy is or what is it “saying” on a psychological level. Then with changes in colors, materials, textures, shapes, sounds, aromas and the placement of certain objects, furniture, and artwork, the energy can alter patterns of energy flow, evoking different feelings and perceptions. If a person desires better health and the surrounding environment reflects the promotion of health, how can that not be beneficial? Whatever one chooses to dub it, whether feng shui, the psychology of space, or environmental psychology, it just makes good sense!

Deborah McDonald received her doctoral training in counseling psychology from the University of California, Berkeley. Founder of the Feng Shui Design Group, she has appeared on local, national, and international TV citing the role of feng shui in modern Western life. She has lived and practiced both feng shui and psychotherapy in the Bay Area for nearly three decades and can be reached at fengshuidoctor@hotmail.com.

november 2008 San Francisco Medicine 19

Art, Design, and Medicine

Healing Spaces The Institute for Health and Healing Creates a Peaceful Atmosphere for Healing and Reflection Agnes Borne “Whatever you can do, or dream you can, begin it.” —Goethe

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hese are the words that greet a visitor entering the Planetree Library of the Institute for Health and Healing at California Pacific Medical Center in San Francisco. The Institute is dedicated to caring for the body, mind, and spirit. To reflect this mission, the interior spaces of the Institute were designed to comfort the senses, stimulate the mind, and refresh the spirit. The list of considerations is a long one, as these places must address issues of sight, sound, touch, smell, and even taste.

Energy flow and human contact must also be included.

Taking the library as an example, this space in a vintage building, previously used for storage, accommodates the stacks, visitor reception and services, reading, and meetings areas. The entrance foyer from the street is lined with planter boxes, giving energy to the space. Mid-height bookcases and display counters let customers know they have entered a library. Signage and

“It is important to address and control the physical atmosphere. The elements of a place include light, color, fresh air, natural and nontoxic materials, and handmade furnishings and finishes.”

natural access put people at ease. Desks for librarians and reception personnel flank the entrance, allowing visitors immediate access to assistants.

It is important to address and control the physical atmosphere. The elements of a place include light, color, fresh air, natural and nontoxic materials, and handmade furnishings and finishes. This previously dark storage area actually has large windows on three sides, allowing light to move through the rooms in a natural pattern all day long.

Additional up-lighting illuminates the research and reading rooms at night. Colors were selected to suggest a natural, outdoor atmosphere, with green carpeting, light cherry woodwork, and multiple colored, painted finishes as a background for the word-frieze above the book cases. The ceiling was painted to reflect soft light and minimize shadows. Sun-controlling natural-wood blinds modulate the natural light. Windows can be opened to allow the scents from the adjacent gardens and flowering trees to refresh the rooms.

Planter boxes have been placed in the windows for intimate viewing. All of the furniture and fabrics came from natural, handmade sources. Reading chairs and study tables can be moved to provide a variety of gathering places and enhance the activity flow.

20 San Francisco Medicine november 2008

To inspire readers and researchers, quotations from thoughtful poets and writers have been stenciled on the walls above the bookcases. These words remind us that we are not alone in the world, and that being in communication and sharing is a key element for well-being. Further, the plan of the space enhances the feeling of comfort and contact. In the center of the library, private offices with windows look out into the reading areas, keeping people in contact.

To complete the list of needs, soft surfaces and frequently divided spaces absorb the sounds from the street and from activities in the library. It is a quiet, calm place to study and find encouragement.

Part of the softening effect is achieved by several high-backed, fabric-covered wing chairs placed around the reading rooms.

They provide comfort to the touch. Finishes on other chairs and on the tables are silky-smooth. And finally, taste is satisfied by little organic snacks to keep up both www.sfms.org

energy and spirits.

Another space managed by the Institute is the Meditation Chapel, located in the center of the hospital. It is a round room entered by a small foyer off a central corridor on the ground floor of the building. The Pastoral Care offices are next door. Addressing the need for personal control of space, all the furniture is mobile, and the lighting can be controlled inside the room to suit individual desires. All natural elements are addressed by the painted finish of the room, rendered as an abstract of a grove of trees. This motif was selected by the consensus of the pastoral care students.

They were asked to suggest the most healing, meditative place they could imagine to be emulated in this space. At the entrance of the room is a fountain with stones and a gentle flow of water. In the center of the room are a table and a prayer notebook for people to write their thoughts and hopes, to be read by the chaplains during daily prayer mediations.

Summarizing the issues raised by these places, the key elements are comfort, inspiration, and care. Both visitors and employees must be considered, and jointly they naturally care for each other. Nature provides the inspiration and source for all rejuvenation. Love and joy are the ultimate result.

The quote by Goethe in the entrance of the Planetree Library is pictured on the opposite page. The Planetree Library reading area is pictured below. On the right is a photo of the Meditation Chapel.

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november 2008 San Francisco Medicine 21

Art, Design, and Medicine

The Creative Path to Healing Art in a Healing Environment Leslie Davenport, MFT

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verything is expressive. Life, by its very nature, is constantly creating expressive forms—the dance of a bird communicating its yearning for a mate, the weaving of patterned fabrics to declare the territory of a clan, the cry of an infant seeking food and the comfort of its mother.

And it’s the nonverbal communications that often speak most truthfully and carry the greatest emotional impact. If someone verbalizes, “I’m angry at you,” that may not tell you as much as seeing the flash of anger in their eyes as their body compacts with tension.

The rich language of sounds, movement, shapes, and colors is useful in a hospital environment, where patients are often overwhelmed with complex emotions not easy to articulate. The impact of illness and injury, both sudden and chronic, typically uproots a person’s sense of who they are, bringing chaos and confusion. Patients are frequently at a loss to clearly know and verbalize what they need and want or how they are truly feeling. The expressive arts provide an opportunity for patients to explore that rich inner landscape, and they give the practitioner a rapid understanding of the patient’s experience.

At the Institute for Health and Healing (IHH) at California Pacific Medical Center, as well as at Marin General and Novato Community Hospitals, expressive arts are offered to patients at the bedside, to outpatients in radiation oncology and cardiac rehabilitation, and in support groups. All of these services are provided at no cost to the patient. The expressive arts practitioners, who also blend guided imagery into their work with patients, are master’sor psychiatric doctorate-level students in psychology who are interning to become

licensed marriage and family therapists, social workers, or psychologists. Enrolled in IHH’s yearlong Integrative Medicine Education Program, the guided imagery and expressive arts interns gain training, experience, and supervision within an interdisciplinary model. The practitioners are integrated into the team of medical caregivers, participating on departmental rounds and working closely with the hospital’s full clinical team.

While expressive arts are not about creating pretty pictures, practitioners are often met with, “I can’t draw!” once the word art enters the conversation with a patient. So the expressive arts practitioners are skilled at very simple, and often fun, ways of encouraging patients to move into nonverbal expression. After cultivating a rapport, the patient may be encouraged to choose a picture from a stack of cards that best captures the feelings of the situation they were describing, or create a collage from magazine pictures whose images express their healing path, or transfer their stress and anxiety to a “worry doll.”

Even those patients deemed unlikely candidates to enter a creative mode experience relief when guided into this very natural form of expression. As children, we were all artists in the freedom of our expressiveness, and it is simply a matter of

22 San Francisco Medicine november 2008

reconnecting to this inner spirit, even in the most sophisticated adult.

Jane is just such a patient. A woman in her early forties, she is going on week twelve of hospitalization without a clear timeline for discharge, due to complications from her surgery for Crohn’s disease. Jane’s husband and daughter live seventy miles away and can only visit on the weekends.

The combination of pain, prolonged hospitalization, financial worries, and loneliness (plus, perhaps, other unknown factors) has put her into depression. The charge nurse calls in a referral, hoping that an expressive arts session will lift her spirits.

When I enter Jane’s room, the curtains are drawn, casting a grey hue to everything.

She looks up at me, a time lag in her eyes meeting mine, as though they need to reorient after a prolonged stay in a hazy inner world. My inquires into how she is doing are met with one-word replies, as though www.sfms.org

forming words requires more energy than she has available.

Starting with a slow pace to match hers, I do learn that she is an accountant, that her daughter is having her eleventh birthday party this week, and that she daydreams of being home.

Jane’s expression is neutral when she speaks of her daughter, but a red stain flushes across her cheeks and neck, and I feel a painful streak in my heart that I sense is an echo of her inner realm. The experience of missing her daughter is a bright flash in Jane’s grey hospital world, and I pick up that emotional thread, asking her if she would like to make a birthday card for her daughter. Opening my art supply box triggers in her a sense of her daughter’s delight with the glitter pens and bright papers found there.

Jane nods in agreement and selects a few pens and colored tissue paper. She begins to shape some pink tissue paper by carefully tearing it. But the visceral experience of tearing releases another wash of color into her face and neck. This time the emotions living below the surface rise so strongly that they spill into tears. She keeps her head down, ripping more quickly and strongly, the focus shifting from creating shapes to the raw impulse to shred.

“Good, keep going,” I say, to let her know that these strong feelings are understandable and acceptable.

After riding the arc of intense emotions for a few minutes, the cycle comes to a natural pause and she looks up at me, her eyes www.sfms.org

now alert and animated. A pink mountain of paper rests on her tray.

I look into her eyes, and I am considering how best to invite her to say something about her experience when she starts speaking.

“I hate of being here. This disease has ripped my life apart,” she says with a healthy edge of anger in her voice.

This session is that beginning of what becomes six meetings with Jane prior to her discharge. She speaks, for the first time in years, about the difficulties of living with her illness. She is especially impacted by the ways it has separated her from her husband and daughter. While she does later make a birthday card for her daughter, she uses the torn pink tissue paper as the first materials of a healing collage for herself. She eventually expresses not only her deep pain and frustration, but also her intentions for specific ways to commit to living well, even with a chronic disease.

In addition to bringing the healing arts directly to patients like Jane, the Institute for Health and Healing also recognizes the medical environment itself as an opportunity for fostering healing. The soft light, clean lines, and natural colors of the Health and Healing clinic express welcome and relaxation. It’s a reminder that healing can start now, even before you meet with your medical practitioner. Artist Shelly Masters was commissioned to paint impressionistic murals suggestive of sky, clouds, sunlight, and plants. These can be found in the IHH

clinic, the library and yoga studio, and several patient rooms at Coming Home Hospice (see photo below of the author standing in front of a mural in the IHH). A labyrinth (pictured on opposite page) is in the plaza outside the hospital lobby. It is an ongoing invitation to patients, staff, and visitors to take time for a simple walking meditation.

The expressive arts interns painted a healing mural on the wall of the ambulance entryway (pictured left), greeting patients who enter the hospital through that threshold.

This year, an interactive art piece entitled, “A Place for Wishes and Thanks” was installed in the pediatrics unit.

Like a magical river with a current that runs in two directions at once, the healing environments at IHH intend healing to flow from the outside in, while patients like Jane find a way for healing to flow from the inside out. So whether through environmental design, visual arts, music, or other creative processes, all are invited to tap into their own creative flow to foster deep personal growth and promote healing.

Leslie Davenport, MFT, is a psychotherapist at the Institute for Health and Healing CPMC, and also in private practice in Kentfield. She was the founding director of the Humanities Program at Marin General Hospital in 1989 and has more than twelve years of teaching experience. She is the author of the upcoming book Healing and Transformation Through Self-Guided Imagery, published by Celestial Arts, an imprint of Ten Speed Press, Berkeley, California. She can be reached through her website, www.LeslieDavenport.com.

november 2008 San Francisco Medicine 23

Art, Design, and Medicine

Art as a Therapeutic Tool Healing the Body and Soul Shieva Khayam-Bashi, MD

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s a teenager, Austin resorted to using drugs and alcohol to numb his feelings of isolation, depression, and worthlessness. Now, at twentynine years of age, he was lost, homeless, depressed, and alone. He found himself in the hospital with bacterial endocarditis, a serious infection in his heart valve, and he really did not care whether he lived or died.

He felt that death would be a final relief.

Then a nice woman in the hospital visited him and asked what he liked to do, as a hobby. He had no idea. She was the activities director in the Skilled Nursing Facility, where he had arrived to complete his course of intravenous antibiotics. It was her job to find activities to help heal the mind, heart, and soul, while antibiotics helped mend the body.

Wanting nothing to do with her, he sent her away. Still, she returned later to leave him with a paintbrush, oil paints, and a fresh canvas. Then she left him alone, with the possibilities staring back at him from his bedside table.

The following day she returned and found that he seemed very different. Here now was this same young man with a beaming smile, holding up his masterpiece—an oil painting of a peaceful, quiet pond in the

“When actively engaged in art, the anxious mind can grow peaceful, the lonely heart can feel connected, the heavy spirit can be lifted ... ”

middle of a darkly wooded forest. Proud of a talent that he hadn’t known he had, he showed his painting to his roommate, to the nursing staff, to me, and to other patients on the ward. He felt changed from the inside; now that he had found something of value inside himself, he felt less useless and unworthy. He actually felt capable, skilled, and even worthy of the many praises that his art was receiving.

Later that day, I went to his room to evaluate a new fever, and also to encourage and applaud his talent. I sat with him to ask how he felt. He didn’t want to talk about the fever, but, rather, he said that he had never felt better. He explained that he actually had never painted before. All of his life, he had thought he couldn’t amount to anything: “I always felt I had no talent, I never felt good enough. I felt worthless.

That is how I fell into the wrong crowd and starting using drugs.” Heavily weighted with these feelings of worthlessness, he had no hope for a life different from the one he was living.

He said that he hadn’t wanted to do

24 San Francisco Medicine november 2008

anything with the supplies that the activities director had left for him. But he remembered having seen a public television program once on how to paint. Feeling bored, he decided to “play” with the paints. Then he felt himself “really get into it,” and he felt absorbed into something that he could not explain. He felt the need to continue, and although he had felt nothing but sadness and hopelessness, something inside of him called him to imagine and paint a place where he would feel peaceful and happy.

When he was done, he realized that he had created his own “healing pond of serenity in a dark forest of despair.”

The more he spoke, the more I realized how intelligent, articulate, and insightful a young man he was. His newly found excitement, enthusiasm, and sense of accomplishment and pride were palpable; his room was filled with a new light. His newly discovered talent in painting had lit a spark of self-worth that was beginning to set the rest of his failed life ablaze. Amazingly, he seemed to be ready to take on a new form of life and healing in a much larger sense. www.sfms.org

With a new sense of self, Austin realized through the rest of his hospital stay that he had other undiscovered talents as well—writing poetry, singing karaoke, drawing, and playing table tennis. He even finally allowed us to contact his parents, and he reconnected with them after many years of estrangement. Even more important, Austin found that he was reconnecting with a part of himself that he had never really known: his own beautiful spirit. As he practiced with more art and felt the peace and serenity that came with painting, he continued to realize a greater and a deeper sense of who he was, and of who he could be; he grew to value himself for the first time. As he felt stronger in his own spirit, he felt drawn to encourage others to participate, and he became an enthusiastic Art Helper on our ward.

Austin left the hospital after six weeks of intravenous antibiotics, with a healed heart valve and, surprisingly, with a healed life. He returned many times to our ward over the following months to visit staff and other patients, and he became an official hospital volunteer. He stayed connected with his parents and stayed away from drugs and the “wrong crowd.” He began to see a therapist, continued with medication for his depression, became a drug counselor for addicted teenagers for a while, and then went back to school to complete his G.E.D. I recall that, at the end of a lecture on healing, cell biologist/psychologist Joan Borysenko said, “The gift of healing is the gift of remembrance of who we really are.”

Austin’s story of healing is an especially remarkable one, as his life was healed by remembering who he really was, and who he could still become. For Austin, art turned out to be the most effective therapeutic tool, one that actually saved his life.

There are many other stories that tell of the important healing effects of art.

www.sfms.org

There was the man who came into the hospital after a severely debilitating stroke and suffered poststroke depression. In addition to physical and occupational therapy and treatment for depression, he also healed with art.

His colored pencil drawings reflected his progress of inner healing—initially, he chose only black pencils and drew dark, uninterpretable images. We knew he was healing on a deep, emotional level when, one day near the end of his treatment course, he drew a big, fat, happy, pink and white cat that appears to be smiling (pictured below).

And there is the man who, recovering from encephalitis, painted small wooden birdhouses each day (pictured above and lower center). His healing was evident not only in the improving quality of his art but also in the look of increasing confidence and happiness on his face as he worked to paint better and brighter birdhouses.

And there was the young woman who was recovering gradually from orthopedic surgery, taking physical and occupational therapy. Asked by our activities director what art she might like to try, she decided on crochet, since she had done this years ago and remembered finding peace in the process. She created several beautiful works of usable art in the form of crocheted purses (pictured on opposite page and lower right).

She explained that recovering in a hospital can feel isolating, confining, lonely, limiting, and even depressing. The days feel terribly long, since there is not much to pass

the time except for meals and television; a patient has little control over what happens to her. She explained that having an artistic project in hospital helped her have control and focus her energy on something quietly active, productive, and beautiful. Her art has given her “something to look forward to” each day.

In the hospital, the necessary focus of attention is directed primarily on mending the body. If our goal is to realize complete healing for our patients, however, bodymending alone is not sufficient. A broader and more complete healing can happen when attention is given to the complete being, including mind, heart, and spirit.

As art accesses and engages the whole of our being, it can be a therapeutic tool to achieve this kind of true healing. When actively engaged in art, the anxious mind can grow peaceful, the lonely heart can feel connected, the heavy spirit can be lifted, the dark corners of the soul can be illuminated, and the lost sense of self can, at last, be remembered.

Shieva Khayam-Bashi, MD, is director of the short-term skilled nursing facility at San Francisco General Hospital.

november 2008 San Francisco Medicine 25

Art, Design, and Medicine

The Art of Seeing One Man’s Perspectives on Bipolarism and Depression Tom Wootten

J

ames Turrell is a most remarkable artist, whose work includes the volcanic Roden Center in Arizona, many installations of “light tunnels” that use light to create shapes that have mass and weight, and an exhibit at the Indianapolis Museum of Art. He understands light and perception perhaps more than anyone else. By using darkness and almost imperceptible light, his artwork totally changes the way we see the world.

Turrell’s amazing work with light and darkness is a perfect metaphor for trying to see psychological depression in a new light.

When you enter one of Turrrell’s installations, it is so dark that you cannot see anything, or at least not much. The amount of available light is simply too little for our eyes to use.

His artwork is not a pretty picture on the wall, it is the entire environment and includes both the perception of the audience and time as critical components. If you stay long enough, your eyes begin to adjust to the lack of light and you start to see things that were there all along but your eyes were not yet ready to perceive. When you go back out into the “real” world, you bring a new perspective and may begin to see everything in a whole new light. His work can be described as the art of seeing.

As an advocate for individuals with

bipolarism or depression, my own art is similar to Turrell’s in many ways. Like Turrell, I do not use a brush to paint a picture, instead choosing to build an environment that blocks out light and helps me to perceive. Unlike Turrell, my art is not in the physical world; it is interior of the human psyche. Instead of blocking out the physical light, I have learn to block out the thoughts and feelings that distract me from seeing the more subtle light that shines within each of us. My art is called meditation.

I have been practicing it for more than forty-five years, sometimes as much as eight hours a day.

Meditation has given me the ability to “see” things in a much deeper way. It can truly be described as the art of knowing.

I recently went through a fairly deep depression and came out thinking a lot about James Turrell. I don’t know whether he is bipolar or experiences depression, but if he does I’m sure he sees it in the way I am beginning to. When I went into depression the first time, all I saw was darkness and pain. At the time I thought it was unbearable, but looking back and comparing it to some of the far deeper states I have been to since, it was really nothing. As my perception has grown I am beginning to “see” things I never knew were there. In “seeing”

“If we learn to examine our condition instead of avoiding it, we can gain clear insight into what it is and how it affects our lives. With that insight comes understanding and the emotional maturity that gives us the ability to choose how we react to our circumstances.”

26 San Francisco Medicine november 2008

them more clearly, I notice that they don’t affect me so negatively any more. They now affect me so much more, but in a positive way, at least according to the way I have learned to “see.”

My book, The Depression Advantage, is about looking at depression in a new light.

If we learn to examine our condition instead of avoiding it, we can gain clear insight into what it is and how it affects our lives.

With that insight comes understanding and the emotional maturity that gives us the ability to choose how we react to our circumstances. Virginia Woolf said, “You can’t find peace by avoiding life.”

On a much deeper level, through meditation we can gain awareness and control of any stimulus. Mahatma Ghandi developed so much control that he was able to have surgery without anesthetic. He said we can eventually get to the point that we are free to choose our reaction to every circumstance and condition in life, including our mental states.

The mainstream meaning of mental stability is to be in remission of symptoms for an extended period with the goal of being permanently symptom free. While the tools, including medicine and therapy, are valid, we might reexamine the goal itself.

A stability that has us living a diminished life in fear of a relapse is only the beginning, not the end point in a path from disorder to advantage. If stability is the goal, perhaps we need to redefine what it means and how we measure it.

In the mental world, the dictionary defines stable as “sane and sensible; not easily upset or disturbed.” Since the extremes, mania and depression, typically accompany clear signs of being “upset or disturbed,” it is understandable how freedom from sympwww.sfms.org

toms became the standard. Unfortunately, it forces us into a predicament; if our condition changes in the slightest bit, we may become unstable because we may not be able to function under the duress. We live in fear that our condition might “turn the corner” and we will flip out.

With professional training, people who are bipolar or depressed can learn to handle the ups and downs of life and maintain real stability, remaining sane and sensible, not easily “upset or disturbed.” Limiting our life to a very narrow range and living in fear that we may have a relapse is not stability at all. Fear-based avoidance therapy will never “cure” mania or depression, and it can result in a diminished life with constant fear of relapse.

Equanimity, or evenness of mind, can be misunderstood. Many people interpret equanimity to mean being in a tranquil place that allows people to relax, to escape from the stresses and strains of everyday life and to “recharge their batteries.” Although

it is helpful to occasionally remove ourselves from the conditions that create stress, real equanimity is the ability to remain in control of our responses while the world may be crashing around us.

Equanimity as applied to depression does not mean we are never depressed. It means that although we are having all of the symptoms that indicate depression, we are unaffected by them. Equanimity means true freedom, stability in all conditions, and wisdom-guided responses to all conditions. And one cannot get to that point by avoiding it any more than you can get the meaning of Turrell’s art by walking out too early. Equanimity means that even though the symptoms are still there, the individual can still function normally and understand something that few ever will.

It takes equanimity to truly understand how bipolar disorder or depression can be seen as an advantage. Once you begin to look at depression and mania from the perspective of equanimity, the richness of

experience brings insight and understanding that is beyond the capacity for those without our condition to even imagine.

Communicated through images, it is the unique perspective of artists like James Turrell that can bring a new way of seeing.

The ability to bring light from darkness, to see things differently, is what defines the artist. Do artists have a higher incidence of depression or just a greater capacity for “seeing” it?

Author of two books, The Bipolar Advantage (2005) and The Depression Advantage (2007), Tom Wootton is CEO of Bipolar Advantage, Inc. Combining the expertise of doctors with that of patients, family, and friends, the Bipolar Advantage Program is changing the paradigm of mental illness. Through education, assessment, and treatment, its mission is to help people with mental conditions shift their thinking and behavior so that they can lead extraordinary lives.

Welcome New Members!

The San Francisco Medical Society would like to welcome the following new members.

Active Members

Gary Belaga, MD, referred by Donald Kitt, MD Lois Parkison , MD Kanan Maniar , MD, referred by Debra Phairas (Practice & Liability Consultants) Eli Merritt , MD Katherine Schmidt , MD Christopher Wong, MD, referred by Clifford Wong, MD David Greenberg, MD, referred by Richard Frankenstein, MD

From The Permanente Medical Group

Neelesh Kenia , MD, referred by Chuck Wibbelsman, MD Alicia Romero , MD Jennifer Shen , MD, referred by Chuck Wibbelsman, MD

House Officer

Krishan Soni , MD

Students

Thomas Bullock, Alexander D. Krassner, Jeff Krauss, Nili Sommovilla, Jay Salazar, Michelle L. White

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november 2008 San Francisco Medicine 27

Art, Design, and Medicine

Making Time for Creative Expression The Story of ArtThread Robert Rothschild, MA

I

t was the winter of 1973, and, having pulled a number seven in the draft lottery, nineteen-year-old college student Jay Allan Klein figured he was on his way to Vietnam. Yet when he reported for a routine draft physical, doctors didn’t send him overseas. Instead they ordered him to see a urologist.

Klein found himself on a different sort of frontline altogether—battling testicular cancer in an era when few teens diagnosed with a malignancy of any kind survived.

Three-and-a-half decades later, Klein is cancer free and keenly aware of what cancer patients experience. He is committed to easing their physical and psychological distress.

The story of ArtThread begins with Klein’s survivorship, and with his experience as a musician, which gave him firsthand experience in how creative expression can remove

the feelings of acute isolation and uncertainty that can occur after diagnosis.

Fusing his arts and science background, he started federally funded research at the University of Florida, involving the role of creative expression and online technology for cancer patients. This work spawned the ArtThread Foundation (www.ArtThread. org), whose mission is to use innovative technology to make art and creative expression more available to those impacted by illness, physical limitations, or social consequence.

“ArtThread technology gives anyone in need the freedom to take a moment for creative expression—and we are all in need,” says Pam Sullins, director of community outreach for the ArtThread Foundation. “In that moment, your distress can disappear because you are totally immersed

28 San Francisco Medicine november 2008

in the creative process.”

ArtThread uses its online technology and the power of art to build a global community that emphasizes the unique spirit in all of us while encouraging unity and support.

“In this day and age everyone knows someone, a friend, sibling, parent, or relative, dealing with cancer,” says Klein, founder and CEO of the ArtThread Foundation. “With more than twelve million new cases globally last year, there are no longer ‘have and have-nots.’ The world community and the cancer community are one and the same, so the need for solutions is greater than ever.”

The centerpiece of the Foundation’s work is the ArtThread Interactive Online Gallery. The Gallery is an innovative, inspirational, and interactive place where people can do something highly unusual with their art: They can start or join an “art thread”—an interactive art-to-art conversation with family, friends, or anyone in the world. The ArtThread Gallery makes creative expression and art available everywhere: home, work, inpatient and clinical settings, schools, and throughout community organizations.

“Making art is great, but making it and sharing it is even better,” says Klein. “Think of ArtThread as the fusion of a gallery and an infinite online graffiti wall. It is social networking with paint brushes!”

Those “paint brushes” come in a very unique form on the ArtThread website.

ArtThread’s proprietary online art-making tool, Splash!, makes it possible for everyone to make beautiful art anywhere. Splash! encourages fun and experimentation and often unpredictable results. Yet it also has great depth and is a great expressive tool www.sfms.org

for even the most skilled artist. Splash! was originally created in a partnership with the Entertainment Technology Center at Carnegie Mellon University, cofounded by “Last Lecture” professor and visionary Randy Pausch.

“We asked the development team for a creative tool that would work for ages five to eighty-five, and they laughed at us,” remembers Sullins. “But they did it, and did it beautifully, and it fulfills our mission to enhance those opportunities for creativity.”

The original team from Carnegie Mellon has now formed Electric Owl Studios and continues to work on new online art-making tools for ArtThread. A new version of Splash! was just released that makes artistic collaboration possible from anywhere in the world.

ArtThread also fulfills its mission by creating partnerships with other organizations such as VSA Arts of Florida, Shriners Hospitals, and the Creative Center: Arts

www.sfms.org

in Healthcare.

“We are thrilled to be working with ArtThread,” says Robin Glazer, director of the Creative Center, a New York City community organization that brings the world of art to more than 15,000 participants each year. “Our artists in residence are using the easy-to-use art sharing tools with inpatients, and we as an organization are using ArtThread’s online auction module as a fund-raising tool.”

“Our work with these various organizations clearly demonstrates the power of the ArtThread Gallery to enhance the mission and add value to the services of a wide array of initiatives,” says Klein. “Art becomes an advocate, a messenger, a facilitator, and a fund-raising tool. It’s just one product of our mission to bring creativity, connection, and community to anyone in need.”

ArtThread interactive gallery pictured on opposite page. Art-making tool Splash! pictured below.

Two works created with Splash! by online users pictured above.

november 2008 San Francisco Medicine 29

Art, Design, and Medicine

Drawn Together Laguna Honda Hospital Patients Make Art to Beautify the Hospital Helena Keeffe

I

n 2007 I received a grant from the Creative Work Fund to collaborate with Laguna Honda Hospital on “Drawn Together,” a project I developed to engage long-term care patients in a series of drawing and printmaking workshops to result in linens and medical scrubs featuring residents’ artwork for use in the hospital facility (see photos at right and on following page).

During the workshops I taught participants how to make relief prints from yarn and rubber blocks. We made portraits based on photographs of residents and staff and images of plants based on photographs taken on the grounds of the hospital. Printmaking is a captivating process containing elements of surprise and chance, and it allows people with varying degrees of ability to have success creating unique and striking images.

The seeds for this project came from my experience working at Creativity Explored, an art studio for adults with developmental disabilities where I had the opportunity to work with individuals who lived at Laguna Honda Hospital. I began to consider what it would be like to live in an institution and have little influence over one’s aesthetic surroundings. Around the same time I had become interested in the wearing of scrubs in the medical community. Though there is relatively little variation in their style, the fabric patterns provide choice and self-expression. From the combination of these interests arose the possibility of hospital residents creating artwork that would become an integral part of their environment.

Though the finished product will be a great source of pride for all involved, the experience of the workshops was clearly a powerful part of the process. Most memorable for me was a man named Don who

regularly showed up in a state of anxiety.

He would repetitively explain that he had once been good at art but had forgotten everything and was very unsure of himself.

After fifteen minutes of patient encouragement, he could be convinced to give it a try. And then it was like a switch had been flipped—he’d ink the stamp like a pro, laying it down in perfectly spaced rows to create beautiful and complex patterns. His whole body relaxed as his mind became engrossed in the obviously familiar task at hand.

30 San Francisco Medicine november 2008

Helena Keeffe is an Oakland-based artist who works in a variety of media, incorporating audio, drawing, and sewn fabric into projects whose common thread is the participation of other people. Her work functions outside of the traditional categories of sculpture or painting and builds on ideas stemming from community-based/social art practice. “Drawn Together” will culminate this winter in a community celebration and fashion show as well as a printed booklet of photographs and text. For more information, please e-mail Helena Keeffe at hykeeffe@yahoo.com.

www.sfms.org

“Though the finished product will be a great source of pride for all involved, the experience of the workshops was clearly a powerful part of the process.”

www.sfms.org

november 2008 San Francisco Medicine 31

Art, Design, and Medicine

Less Is More—Or Less Improving Patient Experience in Hospital Rooms Yosaif August

A

s I’ve visited hospitals around the country, I’ve observed hospital personnel preparing for an anticipated (and often dreaded) JCAHO inspection visit by going through the facility and removing most posters and notices from the walls of their corridors and examination and treatment rooms. They were concerned that somehow these might raise red flags for the inspectors.

In my experience, most of these notices should indeed come off the walls. They are not needed (how many people still need to see “No Smoking” signs all over the hospital?) and contribute to visual overload for everyone, patients and providers both.

Too many examining rooms would be perfect settings for a sequel to Mel Brooks’ High Anxiety. Their walls are covered with anatomical diagrams highlighting various conditions and diseases. These are the only company that the patients, often waiting alone in this room for extended periods of time, have as they anticipate their visit with their physician. If the physician needs these materials to educate the patient, he or she can simply take out a chart from their desk.

Since physicians spend so much of their work lives in these settings, improving them would go a long way toward improving physicians’ well-being.

I recently complimented my cardiologist for the virtually bare walls in his examining room. The only notice that remained was a useful one. It encouraged patients to ask the physician if he or she had washed their hands—an awkward but critically important thing for us to do to protect everyone’s health.

In the early 1980s I had two hospitalizations—one for a detached retina, the other to surgically remove a benign parotid gland

tumor. In both cases, I received premier clinical care. And in both cases, my experiences were far more stressful than they might otherwise have been.

These experiences, and those I had as an advocate and care manager for my parents and mother-in-law, propelled me to make a major change in my professional life. I left the corporate consulting firm that I comanaged with my wife and took the leap to working full-time to help transform the experiences of patients in the health care world. (I wasn’t the only “leaper” in the family; my wife, Tsurah, also left the firm to attend rabbinical seminary and health care pastoral care training, work that she is happily doing now.)

As this work has moved forward over the past several years, I have consulted with the leadership and conducted trainings at hundreds of hospitals and health care conferences and meetings around the United States.

In speaking to health care leaders, I’ve often presented them with a list of qualities that most of us would consider vital to living a meaningful life. These include self-efficacy, control of space and time, aliveness, mobility, fun, love, spiritual practice, spontaneity, sensual/sexual pleasure, and so on. I then ask them which of these qualities they would be willing to surrender. Usually, the answer is, “None.” Then I ask them how many of these qualities are immediately compromised or negated the moment one assumes the role of “patient.” The answer is invariably, and often said resignedly, “All.” That was certainly in alignment with my own experiences in the hospital.

When I’ve spoken with the groups of health care architects and designers, I’ve asked them to think back to design school and imagine their professors giving them an

32 San Francisco Medicine november 2008

assignment to design an environment that provides both social isolation and total lack of privacy. And additionally, to design in a combination of sensory deprivation and sensory overload. As I present this, even before I’m finished with that last sentence, the room invariably breaks out into an uncomfortable roar of laughter. Yes, this is the exquisite paradoxical design of the typical American hospital room environment. Designed essentially for efficiency, this environment does what it was designed to do.

It’s these qualities that the questions of aesthetics and design must address as we focus on improving patient care areas—in patient hospital rooms and examination and treatment rooms. With all the positive trends in health care design, I still have not seen enough attention focused on improving the experiences of patients in hospital rooms.

In Modern Healthcare’s most recent annual design awards (September 22, 2008), there was only one winning design focused on patient rooms and, in my view, there didn’t appear to be anything particularly innovative or inspiring about that design.

Such improvements need not dramatic.

Nor do they need to be structural. They can focus on overcoming the paradoxes described above. Even more fundamentally, they can help patients regain their sense of equilibrium—their sense of place in the world, especially the natural world—which is so disrupted when they suddenly move from their normal lives to being a patient in a health care facility. Natural light and views, www.sfms.org

for example, are helpful here.

I was on a tour of an exemplary facility during a Planetree conference in Seattle. As you may well know, the Planetree movement, which originated in the Bay Area, has contributed significantly to the growth of patient-centered care in the United States and Europe. We were shown a new ICU environment that was gorgeously furnished and offered commanding views of the Olympic Mountains. But the patients couldn’t see these views; they were facing away from the windows. However, the views were accessible to the provider staff—whose needs for sustenance while in working in such a demanding environment are also important.

When I questioned this layout, I was told that it enabled staff to better observe and monitor the patients. However, I pointed out that if they placed the bed diagonally in the room, they could have provided the patient with this healing view while still providing staff with a sufficient view of the patient.

1984, Roger Ulrich, PhD, showed that surgery patients who were able to view nature outside their hospital room windows had better health outcomes: they needed less medication, left the hospital sooner, and were more pleasant for the staff to care for than those patients whose views were facing the bricks and mortar of the building itself (Science 1984; 224:420–21). Dr. Ulrich’s work was an application of that of E. O. Wilson’s “biophilia” theory, that we are hardwired as human beings to navigate toward natural settings that are spatially open (“prospect”) and offer a sense of safety and protection (“refuge”).

I came across Dr. Ulrich’s work as I was developing a simple innovation to help patients relax while in the hospital. The timing was serendipitous—the student finding the teacher at just the right moment.

I’d gotten the basic idea of bringing natural sights and sounds to the patient’s bedside with a low-tech multisensory system. The system, which I trademarked Bedscapes®, and which I later received several patents for, consists of a photomural that attaches to the existing conventional cubicle curtain (see photo above), plus a nature soundscape.

Up to that point, the curtain had never been used as a therapeutic device. It was designed simply to provide visual privacy. www.sfms.org

Dr. Ulrich “elbow-trained” me to select appropriate biophilic images for the Bedscapes photomurals. He later served as a principal investigator on an RCT outcomes study of the impact of Bedscapes on the anxiety of patients awaiting the cardiac catheterization procedure. Dr. Ulrich presented preliminary results of the unpublished study at several international health care venues, including an arts and health care gathering in the U.K. The latter presentation was described in an article on arts and health care in The Lancet. His unpublished findings described a dramatic reduction in the anxiety of patients who had access to the combination of the sights and sounds of the Bedscapes.

Since that time, there have been a number of subsequent outcomes studies conducted at Beth Israel Medical Center (New York), Albany Medical Center, and multiple studies at Johns Hopkins Hospital.

The first Johns Hopkins study, published in Chest (March 2003; 123/3:941–948), found that patients with Bedscapes before, during, and after bronchoscopy procedures were 43 percent more likely to report their pain management experience as “very good to excellent” and 63 percent more likely to rate their ability to breathe “very good to excellent.” A second pain management study at Johns Hopkins, of bone marrow biopsy and aspiration procedures, has been completed

and is being submitted for publication.

These studies are part of a growing body of “evidence-based design” research focused on the impact of design on health care outcomes. An organization in the forefront of this work is the Center for Healthcare Design, which helps organize demonstration projects that are rigorously studied for their health care outcomes.

Creating this data is helpful in enabling health care policy makers and decision makers use their limited resources in ways that promote patient healing.

But the most important source of wisdom for envisioning innovations and improvement and validating their impacts is obviously the patients and their families.

And it is they who will tell us when less is more—or less!

Yosaif August is CEO of the August Healthcare Consultancy, a health care consulting and training organization, and Healing Environments International, a health care product development company. His focus is on improving the experiences of patients, families, and health care providers, especially environments of care. He invented Bedscapes®, which has won several health care design awards. He coauthored Help Me to Heal (Hay House, 2003) with Bernie Siegel, MD. A Senior Scholar with the Jefferson University Medical College, he is currently involved with a project focusing on physician empathy.

november 2008 San Francisco Medicine 33

Expect Excellence.

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I initially joined CAP because of a colleague’s enthusiastic recommendation. I remained a member because of the outstanding service, excellent products and, of course, the money-saving value.

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is the only physician owned and governed company whose

core product, Mutual Protection Trust, is Rated A+ (Superior)

by A.M. Best Company. Superior physicians are dedicated

to excellence. They should expect nothing less from their medical professional liability provider.

For more than 30 years, CAP has rewarded the dedication of superior physicians with superior protection for less. We keep our costs low by keeping our standards high. Membership might not come easy, but once you get in, you know you’re in good company. To find out more, call 800-252-7706, or visit www.superiorphysicians.com.

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The Mutual Protection Trust (MPT) is an unincorporated interindemnity arrangement among physicians authorized by Section 1280.7 of the California Insurance Code. Members do not pay insurance premiums. Instead, they pay tax-deductible assessments, based on risk classifications, for the amount necessary to pay claims and administrative costs. No assurance can be given as to the amount or frequency of assessments. Members also make a tax-deductible Initial Trust Deposit, which is refundable according to the terms of the MPT Agreement.

Art, Design, and Medicine

Arts and Healing Network An Online Community for Art and Healing Tristy Taylor “The Arts and Healing Network honors and supports the emergence of healing artists and recognizes them as essential catalysts for positive change.”—Marion Weber, Founder

F

ounded by artist and philanthropist Marion Weber, the Arts and Healing Network was created in 1997 as an online resource for anyone interested in the healing potential of art. The website, www.artheals.org, serves as an international resource for anyone interested in the healing potential of art—including artists, health care practitioners, and those challenged by illness.

The site includes links to various art and healing projects, artists, funding options, and other resources, including book reviews and interviews with leaders in the field of art and healing. Below are a few Bay Area projects listed on the network.

Care for the Journey: Sustaining the Heart of Health Care

Care for the Journey is an initiative to renew health care practitioners by addressing the emotional and spiritual roots of stress, including issues around meaning and mortality. The basis of the program is bringing music together with the spoken messages of leading innovators in health care education, then delivering this platform to care providers via audio recordings and workshops. Founded by Michael Stillwater and Gary Malkin, cocreators of Graceful Passages: A Companion for Living and Dying, this work is available to staff at medical centers across the nation, and as a workshop or retreat within a health care organization. The power of the arts to cross the boundaries of the heart, particularly regarding difficult issues, makes this an www.sfms.org

ideal vehicle for helping people learn, heal, and grow.

Commonweal

This nonprofit health and environmental research institute in Bolinas conducts programs that contribute to human and ecosystem health—creating a safer world for people and for all life. They help physicians, medical students, and other health professionals who wish to restore the principles of healing to the practice of medicine and practice their work with a deeper sense of meaning, satisfaction, and lineage. This work includes faculty development trainings, healing workshops for the public, and workshops and retreats for physicians.

Healing Environments

This organization, based in Palo Alto, aids the current movement toward holistic medicine—treating the whole patient (mind, body, spirit) and encouraging hospitals, hospices, and individuals to nourish patients, families, and caregivers with healing environments. A healing environment is defined as one that offers sustenance to the soul and gives meaning to experience, enabling those who are suffering to transcend their pain by connecting to the universal through the transformative power of beauty and art. (See feature story on page 10.)

Mothers’ Living Stories Project

This San Francisco project brings attention, compassion, support, and dignity to mothers with cancer by helping them record their life stories and personal legacies. An increasing number of women between the ages of twenty and fifty-nine are parenting while coping with breast cancer, and as one

mother explains, “My biggest fear is that my kids won’t remember me.” The living legacies recorded by the Mothers’ Living Stories Project foster communication within the family and help mothers and their children hold each other in life and in death. The project provides a healing and empowering process for the mothers at any stage of illness, fostering communication and connection with children and family members.

StoneCircle: Environments to Renew the Spirit

This consultation firm based in San Francisco specializes in the design, development, and promotion of environments that enhance health and well-being. Taking an integrated approach to design and health, the firm transforms health care and work environments into places that support physical, emotional, and spiritual well-being. The company was also the first to design and install a permanent labyrinth walk in a traditional health care facility. In the medical center setting, the labyrinth walk becomes a holistic healing tool, a mind-body-prayer path.

I invite you to explore the Arts and Healing Network, a valuable resource for anyone in the healing field, and discover new resources for your life and for your practice.

Tristy Taylor is an artist and interfaith chaplain and has worked with the Arts and Healing Network for the past three years. She feels deeply that art and creativity can help heal the ailments of the body and has dedicated her life to facilitating the conversation between art and healing, encouraging her community to bring art into daily life. Find out more at www.trismegista.com.

november 2008 San Francisco Medicine 35

Art, Design, and Medicine

Green Your Office Tips for Making Your Office Design Environmentally Friendly Deborah Crosby, ASID, LEED, AP

W

e spend about 90 percent of our time indoors. Today’s buildings are airtight and seal in harmful toxins, which affects indoor air quality.

The tighter your building is, the less the opportunity for gases released from everyday products (such as many cleaning agents, carpet, paint, or formaldehyde used in cabinets and other products) to escape. In a very well-insulated office, these gases will simply recirculate and build in concentration. Your patients and employees will appreciate your ongoing commitment to their well-being while working or visiting your office. Here are some suggestions to detox your office.

Windows

Open your windows, get some good ventilation, and consider using PVC-free window coverings. Polyvinyl chloride (PVC) is a major domestic and global pollutant, since dioxin, one of the most toxic chemicals ever synthesized, is a by-product of both its manufacture and disposal. PVC also needs phthalates to make it functional.

They are known to leach out of plastic products into the air and dust. I recommend solar shades, like EcoVeil by Mecho, which can be reclaimed and recycled. This product reduces heat gain (which saves on utility bills) and has different options of visibility.

Another choice would be Conrad window shades, which use beautiful natural fibers for a softer look.

Walls

Use only natural or no-VOC paint inside the office. Paints and finishes can release VOC emissions for years after application. AFM’s SafeCoat paint (exterior and interior) has been recommended by doctors for people with chemical sensitivi-

ties and allergies. I like Green Planet Paints, which have no toxic petrochemicals and are a clay paint. Plaster walls have a beautiful texture and improve air quality, since they absorb C02 while curing. Two brands I like are Tobias limestone plaster and American Clay plaster. My favorite decorative wall covering is by Jacobsen & Balla and is 100 percent postconsumer-waste recycled paper, is handpainted and manufactured in the San Francisco Bay Area, and has a class A fire rating. It is also moisture resistant and washable.

Flooring

Consider using natural products that come from sustainable sources such as wood, bamboo, cork, and linoleum, which are preferable to man-made products that are generally derived from oil. When the products are natural, they are usually biodegradable. Carpet is one of the worse offenders in a landfill.

Today there are many locations to drop off old carpet to be recycled. Carpet is horrible for allergies and other respiratory problems because it contributes to both particulate allergens and it off-gases VOCs. If you must have carpet, look for low-VOC types that have the Green Label Plus certification, and carpet that may have recycled content and is recyclable. Consider doormats for your entry to catch allergens and dirt before they are tracked inside.

certified or salvaged veneers that achieve a high-end look. Today, there are many options for furniture and natural fiber fabrics with natural dyes and finishes. Your choices are not limited.

Office Equipment

Most offices have plenty of computers, copiers, printers, and medical equipment that are packed with toxic synthetic chemicals. These release more gaseous pollutants into the air, and the longer the appliances are on, the hotter they get. Turn off when not in use, and buy from manufacturers committed to reducing toxic chemical content. For example, Dell is phasing out brominated flame retardants and PVC by 2009; and Nokia, Samsung, and Sony are following suit.

Cleaning Products

After installing beautiful, safe, and healthy interior finishes, the last thing you want to have happen is to spoil things with toxic cleaning solutions, used by an unaware cleaning crew. There are safe and effective cleaning agents available, and it is important to have them handy and to instruct the cleaning crew on how to safely clean your newly “greened-up” office.

Deborah Crosby, ASID, LEED AP, is a member of Green by Design, a green design consultant group, www.greenbydesign.us.

Cabinets and Furniture

Particleboard, often used in cabinets, has urea-formaldehyde resins that release formaldehyde, a known carcinogen with no recognized safe level of exposure. Choose composites and plywoods that do not have added urea formaldehyde. You can get exotic FSC (Forest Stewardship Council)-

36 San Francisco Medicine november 2008

www.sfms.org

Art, Design, and Medicine

What’s Your Office Personality?

Understanding the Personality of Each Medical Practice Jill Cresap

H

aving worked in the medical field for more than thirteen years as marketing director, physician recruiter, office manager, director of operations, administrator, and director of practice management operations, I have a theory.

The theory is that medical practices have a distinct personality, consisting of one heart, one mind, and one soul.

The “body” of the medical practice, the foundation, holds the physical state of the practice. The physical manifestation is very simple and, more often than not, Dr. Joe’s practice looks a lot like ABC Family practice down the street. Although typical practices are furnished with counters, cabinets, exam rooms, and so on, they are as varied as the human body; some are large, others tiny. There are more attractive offices than others and many have an open and inviting feel, while others are dark, cramped, or disheveled. Regardless of those differences, the same components complete the physicality of a medical office. In addition, electronic medical or health records are becoming much more prominent in the field, which allows for an improved sense of organization.

Like humans, however, doctor’s offices are so much more than their bodies, so let’s focus on the intangible aspects of one part of the practice’s body—the heart. Let’s begin with what makes a doctor’s office tick . . . its ticker. The heart of the medical practice is created from the passion that has driven its creation. That passion, whether it is still alive or not, is always the same: to help people. The individuals who work in medicine have followed a particular call, one that wants to help, to heal, and to serve. It is that drive that forces people to study tirelessly for days on end to get the best grades, to be www.sfms.org

accepted into medical school. It must be passion that sometimes forces someone to allow their education and training to come before family, friends, and sleep.

Nurses and medical assistants go

“When we look at an organization as a living and breathing entity, it makes perfect sense that a personality would be present.” through similar struggles to follow their dreams. Most MAs and nurses go into the field because they want to help people. Sure, it sounds like a good career move, with possibly decent money and maybe some stability in it. Regardless, all in all, the passion to work with and for other humans is their driving force. It is a true calling that cannot be denied. It is that calling, that vocation, that passion that creates the heart of the medical practice.

Always monitoring and directing the heart, the mind of the medical practice is based upon the operation itself. The office manager, management team, and physicians make up its think center. As defined

by Princeton, a mind is said to be, “that which is reasonable for one’s thoughts and feelings; the seat of the faculty of reason” (www.wordnet.princeton.edu/perl/webwn September 13, 2008). If we take that definition and apply it to the medical practice, it is logical to assume that the collective consciousness of the management team formulates the practices’ policies, procedures,

mission, and goals.

Even more important are the minds of the founding physician or the team of physicians that opened the practice together.

These are the thinkers, or the “brains” of the operation. So it stands to reason that the mind of the practice would be formulated by those thinkers. To further the point, I decided to look into the personality types of physicians, just to see if I was on the right track.

Using the Jungian-based typology test as a guide, which is also known as the Myers-Briggs typology indicator, one study about career and personality found physicians to be more introverted than extroverted. In addition, doctors tended to be more the sensing type as opposed to the feeling type (http://www.mypersonality. info/personality-types/careers/ August 28, 2008). If doctors are introverted and more of sensing than feeling individuals, that explains why many of us who work with and for physicians feel that we are often pulling information out of the doctor. Ironically, doctors are frequently perceived as stoic, insensitive, or even cold.

Now, if the mind is introverted, withdrawn, and reserved, and more reliant on intelligence and logic than on feelings, a practice could easily be defined as brilliant, wise, and a thinking type. This makes sense, really, doesn’t it? To be a physician, there are hours upon hours of studying, retaining information, thinking in your sleep. With all of the time dedicated to training, there is less time for social interactions, so introversion would be a natural state of being.

My personal and professional experience has enabled me to meet, work with, and even become friends with a large number of doctors and health care practitioners.

november 2008 San Francisco Medicine 37

I can honestly say that it sometimes seems easier to cuddle with a lion in the wild than it is to have a “normal” conversation with a doctor. I say this with no offense intended.

As I mentioned, I know a lot of doctors whom I would call friends. But there are some words that have been used to describe physicians by those of us who work with them: quirky, odd, and weird define some of the docs I’ve worked with. But genius, gentle, and kind are frequently spoken in the same sentence. And, more often than not, each of us would choose our employerdoctors to be our personal physicians. This is a decision, however, that is not only made by knowing their brilliance; it has a lot to do with the deeper personalities of their practices.

That depth brings us to the part of the practice that lives beyond the bodies and minds of the humans within—its soul.

What is the “soul,” anyway? As defined by the American Heritage dictionary, “The animating and vital principle, credited with the faculties of thought, action, and emotion and often conceived as an immaterial entity” and “the central or integral part” (http://education.yahoo.com/reference/ dictionary/entry/soul;_ylt=AtrwGzywV83 swfIf2YvBe8esgMMF). If we take the heart and mind and fold in spirit, we find the recipe for the soul. It is the deeper part of a practice that brings its personality to life and provides a sense of purpose.

Whether we are discussing humans or a medical practice, I believe the soul is the basis for living. It’s the sheer essence of the practice. This is the aspect of personality that, regardless of insurance reimbursement and the ever-increasing cost of malpractice coverage, keeps the practice’s doors open.

And, although the energy of each office may feel different, there is also something similar, something that lends a sense of peace to the patient, an inherent trust. There is a tangible feeling of power given to each medical practice from each patient who walks over a practice’s threshold.

In addition to power, the presence of each patient is a gift, an opportunity for everyone working in that office to help another human, but not only from the passion that the heart brings. It is from the core of the collective personalities that have no

other agenda but to try and make a difference somewhere in the world. This is what builds the practice’s soul. It is its purpose, its destiny. I believe that each practice, like each person, wants to contribute to society and be happy while doing it. The search for happiness as a medical practice is made up of everyone in the medical field who brings their passion, consciousness, and spirit into their jobs in an effort to follow their bliss.

When we look at an organization as a living and breathing entity, it makes perfect sense that a personality would be present. As people, our personalities are defined by “…the characteristic patterns of thoughts, feelings, and behaviors that make a person unique” (http://psychology.about. com/od/overviewofpersonality/a/persondef. htm September 19, 2008). Like human beings, all businesses are different and special in their own way. The medical practice is no different in that regard. It is a unique

creature within the general population of service industries. But, looking within the species of medicine, doctors’ offices carry the same personality traits; the pulses of different practices beat similarly, the mental brilliance shines with the same brightness, and the spirit of each practice carries similar dreams and desires. This is what makes up the personality unique to our industry: one heart, one mind, and one soul working toward the common goal of healing.

Jill Cresap started her own medical marketing and operations management consulting firm in Long Beach, California, in 1995. Since then she has had the opportunity to work within a variety of medical arenas including family practice, podiatry, physical therapy, surgical centers, obstetrics-gynecology, cardiology and integrative medicine, and hospital settings. She is currently pursuing a PhD in depth psychology at Pacifica Graduate Institute in Santa Barbara.

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38 San Francisco Medicine november 2008

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The width is 3.5 by 4” high

Hospital News Chinese

Joseph Woo, MD

At this time I would like to express my appreciation for the hard work that our Medical Executive Committee has been doing on behalf of our medical staff and hospital. I am finishing up my fourth of six years as our chief of staff and have the great privilege of working with so many outstanding people, including our chiefs of department Drs. Gustin Ho, Ho Tan, and Sam Kao. Also, Dr. Catherine Eng has been tirelessly chairing our credentials committee for as long as I can remember . . . and this job keeps getting harder and harder. My other committee chairs, Drs. Ervin Wong, Kenneth Chang, Mai-Sie Chan, Derrina Wu, Dexter Louie, and Rod Snow continue with their excellent work. In addition, my deepest thanks to Vice Chief Dr. Fred Hom and PI Director Dr. James Yan, who are working around the clock to keep our facility “survey ready.” Please help them by timing all your chart entries, using pathways, and washing your hands before and after all patient encounters!

Speaking of fine jobs, I also want to express my admiration, respect, and gratitude for the career of our esteemed Dr. Collin Quock. This summer Dr. Quock turned over the reigns of his office practice to his son, Dr. Justin Quock, but he assures me he is not retiring. Good luck and best wishes in your “restructuring,” Dr. Quock.

The gauntlet has again been thrown down

by Hospital Administration in anticipation of the annual holiday party. The competition is bowling, and I know Drs. Edmund Tsoi, Ho Tan, and James Yan are strengthening their games to stem the recent trend of sporting defeats by the medical staff.

www.sfms.org

Saint Francis

Kaiser

Wade Aubry, MD

Robert Mithun, MD

Kaiser Permanente as an organization has embarked on an ambitious and important journey to improve the overall care environment of our providers, employees, members, and patients. By designing “green” buildings and using nontoxic materials whenever possible, Kaiser Permanente makes the health and well-being of those who enter its facilities a top priority.

Currently, our facility teams design buildings with a vision of total health for all those who enter the environment. As a concept, total health addresses not only the physical but also the emotional and spiritual needs of everyone at a Kaiser Permanente facility, including providers, employees, members, and their families.

Several project objectives for an enhanced care environment include both workplace and patient safety initiatives, plus environmental awareness and education programs regarding reassigned or redeployed materials and equipment. Additionally, we respond to concerns and suggestions from not only Kaiser Permanente providers, employees, and members but also from our community partners and neighbors as well.

We have employed design innovations and improvements in lighting, flooring materials, exam room furniture, way-finding and signage concepts, parking and transportation, farmers’ market booths, and artwork standards, to name just a few. Kaiser Permanente works to ensure that walls are not left blank or white but are decorated with appropriate color palettes and art from local and national artists.

All of our efforts add up to an enhanced and humanist approach to providing care in the stressful and often unsettling world of today.

I would like to give an update on the hospital’s Cerner CareConnect EMR system, with help from Gifford Leoung, MD, who has been leading the implementation effort at Saint Francis.

It is clear that the medical profession lags behind in our use of the latest electronic wizardry.

For a variety of reasons, both private medical offices and hospitals have, for the most part, not fully embraced the concept of electronic medical records. However, there is clear evidence that computerized systems can improve the delivery of health care. In fact, the federal government is now pressing all hospitals to engage in computerized health records.

At Saint Francis, we embarked on the road to fully electronic medical records in December 2006. Now almost all medical information on patients, aside from physician progress notes, is electronically stored and retrievable on any computer inside and out of the hospital. The information is secured by a security program and passwords and allows selective access based on user category (MD, RN, etc.). Although the computerized ordering system may take some time for MDs to get accustomed to, the test and medication orders flow directly to the appropriate department and reduce the time lag for those actions to be performed, and overall efficiency has improved. While each computer system has its own quirks, there is constant monitoring in the background, and upgrades are regularly scheduled both to keep the system current and to accommodate requests for changes from the medical and hospital staffs.

The system is constantly being reevaluated, and Catholic Healthcare West feels strongly enough about its benefits to initiate the system in five more hospitals (this time in the Sacramento area) by the end of 2008. Overall, we feel that the move to the electronic system will serve Saint Francis in good stead when it comes to future patient care.

november 2008 San Francisco Medicine 39

Hospital News St. Luke’s

Jerome Franz, MD

As I write this, more than a month in advance, I have no idea how the November election will be decided, much less what effect it will have on the economic pall cast over the nation by Wall Street. So I shall celebrate local events and successes and keep hoping for the turnaround.

The Board of Directors of CPMC has approved the recommendations of the Blue Ribbon Panel for the rebuilding of St. Luke’s. The design should be final and ready for the Planning Commission by the end of the year. The plan is contingent upon city approval of the new CPMC hospital at Cathedral Hill, which was slowed by the public concern over the future of St. Luke’s.

Budget and funding are still in process.

Congratulations to our Division of Pulmonary Medicine, headed by Gordana Bjekic, for the recent HealthGrades award for superior performance. The division, under the management of Julie McKeown, has been cited many times in recent years for its childhood asthma program, with its outreach to the Baywiew/Hunters Point neighborhood.

We welcome a new Director of Nursing, filling a nearly yearlong vacancy. Kathi Barnes, who is currently the Director of Nursing Development for CPMC, will take the position in October. We have missed the full attention to the overall issues of nursing that a director can provide.

On November 19 we will have the annual fund-raising event of the Auxiliary: no fashion show and luncheon this year, but an evening at Beach Blanket Babylon, along with the usual silent and live auctions. There’s still time to get tickets.

St. Mary’s

Richard Podolin, MD

Is medicine an art? When physicians speak of “the art of medicine,” often they are referring to the need to interpolate between the pillars of our scientific knowledge. In this sense, “the art of medicine” is practiced when our evidence base is inadequate, when we have no clear guidelines and have to rely on our understanding of physiology, our experience, and our judgment. If this represents “the art of medicine,” then as our scientific knowledge expands, the “art” of medicine should diminish. Indeed, the philosophical if unobtainable goal of medical science would be the elimination of art from medicine, replaced by clear directives from empiric data.

But there is another deeper and more precise meaning of “the art of medicine.” Art may not be definable, but it involves communication accomplished with insight, honesty, and skill.

In this sense, art is intrinsic to medicine and stands apart from its scientific basis. The “art of medicine” is practiced when physicians bring the entirety of their persons into presence in the medical encounter: their scientific knowledge, their empathy, their compassion, and their fundamental understanding that we share a path of birth, growth, decline, and death, and we share the search for comfort and meaning along this journey.

So as the scientific foundation of our profession grows, the art of medicine is enhanced, as it is when physicians mature in wisdom, deepen their acceptance of themselves and others, and concentrate their hearts and their minds on the care of their patients.

40 San Francisco Medicine november 2008

UCSF

Elena Gates, MD

One of the core missions of UCSF is service to our local, regional, and global communities. I would like to share three examples: UCSF’s University Community Partnerships Program is dedicated to improving health in San Francisco through partnerships between community-based organizations and UCSF faculty, staff, and students. The program recently awarded grants to twelve organizations to improve public health and decrease health disparities within San Francisco. Recipient organizations have active volunteer participation by a UCSF faculty, staff, or student body member. One grant supports health promotion generally, and cancer education specifically, among religious organizations in San Francisco’s African American communities. Another grant will determine to what degree subsistence fishing populations in southeast San Francisco are aware of risks associated with exposure to mercury and other toxins in Bay and delta fish. UCSF’s Osher Center for Integrative Medicine, in association with the UCSF Department of Neurosurgery, has developed the Caregivers Project, which provides support and information for family members of patients with aggressive brain cancers. Project staff have created a documentary about family caregiving, which aired recently on KQED. The film follows patients and families as they struggle through an unmapped course within a complex and unfamiliar medical system, and it details the struggles of health care providers in meeting the needs of patients and their families. For more information about the Caregivers Project, please contact thecaregivers@ocim.ucsf. edu. The Ida & Joseph Friend Cancer Resource Center of the Helen Diller Family Comprehensive Cancer Center supports wellness and the healing process by providing patients and their loved ones with information, emotional support, and community resources. The CRC offers a variety of free services, including a multimedia library, access to specialized health databases, research assistance, diverse support groups and classes, and referrals to other community resources. www.sfms.org

Hospital News

In Memoriam Nancy Thomson, MD

Veterans

Diana Nicoll, MD, PhD, MPA

A one-day symposium, presented by some of the leading researchers in the fields of Posttraumatic Stress Disorder (PTSD) and traumatic brain injury (TBI), was recently held at the San Francisco V.A. Medical Center. The event was held for select national and local journalists and focused on causes, consequences, diagnoses, and treatment of PTSD, TBI, and other neurological diseases and conditions associated with modern warfare. NCIRE, the Veterans Health Research Institute, hosted “The Brain at War” symposium and brought together researchers from the San Francisco V.A. Medical Center; the University of California, San Francisco; the Department of Defense; and clinicians in neurology and related fields. Colonel Karl E. Friedl, PhD, director of the Telemedicine and Advanced Technology Research Center (TATRC) at the U.S. Army Medical Research and Materiel Command, led off the scientific presentations with an overview of PTSD, TBI, and the particular challenges of neurorehabilitation after combat in the conflicts in Iraq and Afghanistan. Michael Weiner, MD, director of the Center for the Imaging of Neurodegenerative Diseases at the San Francisco VAMC, followed with a review of the role of magnetic resonance imaging in PTSD and TBI research.

Other presenters included Charles Marmar, MD, chief of mental health at SFVAMC and one of the nation’s leading experts on PTSD; neurologist Gary Abrams, MD, director of the Polytrauma Clinic Support Team/TBI Clinic at SFVAMC and a leading researcher and clinician in TBI; and Raymond Swanson, MD, chief of neurology and rehabilitation at SFVAMC. The event was attended by nearly 100 clinicians, journalists, and members of the V.A. and UCSF research communities. Dr. Lynn Pulliam, MS, PhD, SFVAMC’s associate chief of staff for research, brought the event to a close, pronouncing it a success and remarking, “Once again, we have shown that San Francisco V.A. investigators are in the vanguard of veterans’ health research.” www.sfms.org

Ron Davis, MD

David W. Haines, MD

As this issue was going to press, the SFMS received the very sad news of the passing of Dr. Ron Davis, immediate past president of the AMA. Dr. Davis, 52, passed away November 6th at his home outside East Lansing, Michigan. He was diagnosed with pancreatic cancer last February.Dr. Davis, a preventive medicine physician, served as the 162nd president of the AMA from June 2007 to June 2008. He led the AMA’s focus on preventive medicine and had been a longtime public health and anti-tobacco advocate.

Not only a talented physician, Dr. Davis also had a flair for writing. He was the founding editor of Tobacco Control, an international peer-reviewed journal published by the British Medical Association and North American editor of the British Medical Journal. Even facing a serious illness, Dr. Davis remained a relentless advocate. He used his cancer diagnosis to educate the public about patient Web sites such as CarePages.com and CaringBridge.com, which enable patients to communicate widely about their disease and treatment while keeping extended family and friends updated on a patient’s progress.

Dr. Davis received his undergraduate degree from the University of Michigan at Ann Arbor, then his medical degree and Master’s degree in public policy studies from the University of Chicago. He completed epidemiology training and the preventive medicine residency program at the CDC. Dr. Davis’ distinguished career as a public health official includes positions as medical director for the Michigan Department of Public Health and director of the CDC’s Office on Smoking and Health. He most recently served as the director of the Center for Health Promotion and Disease Prevention at the Henry Ford Health System in Detroit. Dr. Davis received many honors throughout his career, including the Surgeon General’s Medallion, and most recently the American Public Health Association’s 2008 Lifetime Achievement Award for his career-long fight against alcohol, tobacco, and other drugs.

I know you will join the SFMS in extending our heartfelt condolences to Dr. Davis’ wife, Nadine, and their sons Jared, Evan and Connor.

Dr. David W. Haines, an oral surgeon and anesthesiologist, passed away March 2, 2008, at the age of 46. He was born in Walnut Creek on January 31, 1962, to James Haines and Lucy Davis. He received his DDS from Creighton University in Omaha, Nebraska, and his MD from the University of California at Davis. He was board certified in oral surgery and anesthesiology and practiced in San Francisco for eleven years, maintaining an office at 490 Post Street. He had been a member of the San Francisco Medical Society and was a member of the San Francisco Dental Society, the American Association of Oral and Maxillofacial Surgeons, the California Dental Association, and the American Dental Association. He is survived by his partner of seventeen years, Virgil Salzman; his brother and sister-in-law, Mark and Carol Haines; and numerous members of his extended family as well as friends.

Jerome J. Botkin, MD Dr. Jerome J. Botkin passed away in San Francisco April 15, 2008, surrounded by friends, after a courageous battle with brain cancer. Born in Yonkers, New York, on October 29, 1929, he graduated from Columbia University in 1951 as a Regent Scholar and received his medical degree from New York University. He was an intern and resident at Montefiore Hospital in the Bronx and then served two years in the U.S. Navy Public Health Service in Puerto Rico. In 1959, Dr. Botkin moved to San Francisco, where he spent a year as chief resident at Mt. Zion Hospital and began his practice of internal medicine. Dr. Botkin served on the Mt. Zion Medical Board and was chief of staff during the UCSF/Mt. Zion merger in 1997. He is survived by Meryl, his wife of almost forty-four years; daughter Deborah; son David and his wife, Lee Anna Botkin; and three grandchildren. Dr. Botkin was highly regarded and greatly respected by his many colleagues, patients, and friends and will be greatly missed.

november 2008 San Francisco Medicine 41

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Current Cardiac Research Being Done at California Pacific Medical Center n Radiofrequency Ablation and Treatment of Heart Failure: Clinical studies are in progress to evaluate the effectiveness of a catheter for the radiofrequency ablation of paroxysmal atrial fibrillation compared to standard medical therapy.

Other recent studies have focused on equipment to predict responses to therapy with bi-ventricular pacemaker implants, devices for delivering non-excitatory impulses to the left ventricle of the heart during the time of absolute refractory period and development of algorithms that can predict or detect heart failure decompensation events.

n Takotsubo cardiomyopathy (TC): In collaboration with other local hospitals, this study aims to investigate whether there is a genetic basis for the development of TC. Reported initially by Japanese authors, this reversible cardiomyopathy is usually precipitated by acute emotional stress.

Typically affecting postmenopausal women, it mimics the symptoms and signs of acute myocardial infarction. Angiography demonstrates no significant coronary artery disease.

However the heart is hypocontractile and has a balloon shape with a round (akinetic) apex and narrow (hyperkinetic) base, which resembles an octopus trap – or Takotsubo.

The mechanism of TC is unknown, but catecholamine stimulation is thought to play a major role. Participants of our study provide their saliva samples which are used for genetic analysis and investigation of potential genetic clues to this unique syndrome.

n Allomap study for assessing organ rejection: This study utilizes a test that measures molecular expression from 20 different genes that are related to the immune process to calculate a score that may be useful in identifying patients who may be having rejection following heart transplant. These genes reflect the process going on at a cellular level and may ultimately replace tissue biopsy, which is the standard technique to determine organ rejection. The Allomap test is a simple blood test, so it has a significant advantage over a biopsy, which is an invasive procedure.

n New Coronary Artery Stent Platforms: Randomized trials are ongoing in the cardiac catheterization laboratory to evaluate the performance of new generation coronary artery drug-eluting stents that employ better pharmaceutical agents to more effectively inhibit smooth muscle cell proliferation and new structural designs for increased flexibility. Several long-term registry studies are underway to determine the three- and five-year outcomes with drug-eluting stents, with special focus on the factors related to the occurrence of in-stent restenosis and very late stent thrombosis.

For more information on all the research being conducted at California Pacific Medical Center, please visit www.cpmc.org/professionals/research

www.cpmc.org