Hospital Design Part 3 - What works at Midcoast Hospital

Finally, I am back to writing in this blog after over a month of completing other web based projects.  Namely completing my book of photography and art, entitled, "Flash of Perception", which can be purchased online at Blurb.com and totally rebuilding my website.  Both were very time consuming but rewarding projects. So finally I get back to follow up on my discussion of the aesthetic design of hospital spaces to enhance the wellbeing of patients and workers alike.

 I took pictures a couple weeks ago of MidCoast Hospital, in Brunswick, ME.  The design of the hospital is based on the philosophy that nature, light and art all play an important part in the healing environment.  I'd spoken earlier about my experiences with Maine Medical in Portland, which is an older and very active urban hospital, that is currently going through some remodelling, but is basically still geared towards expediency and the traditional de-humanizing design for patient rooms.

So let's take a look at MidCoast and see what seems to work.  First note the tall tower at the entry to the hospital.  This is an open stairwell to the upper floor and fills the entry with light.

Indeed the entire first floor has large windows facing the drive so  the halls are filled with the natural light.

The woods, rocks and streams that surround the building are brought indoors as well with two large stone and water sculptures by Andreas Van Huene in the outpatient services waiting areas.

Rather than the cold sterility of metal and formica, the desks and entries to the departments are designed with woodwork reminiscent of Frank Lloyd Wright's designs.

Artwork plays a major role throughout the hospital from the Zorach sculpture at the main entrance

to these colorful murals in the corridor to the new emergency room wing.

This stairwell just outside the emergency room is sunny and bright  (looks almost like a grand staircase in some mansion) actually leads to the patient's rooms in the surgical ward and the family waiting areas.

The emergency room itself is cheerful with light colored wood and glass dividers between seating areas, tons of windows and a children's play area at one end.

Upstairs between the maternity ward and the surgical recovery wards is an oval room for meditation that provides a peaceful spot for reflection for those in need of it.  The entry to the space has poetry for contemplation etched on glass panels and back lit,  along with a place for visitors to write their prayers and comments.

The interior of the Meditation Room has a stone fountain and stained glass with a lovely recessed skylight bringing in the natural light and world once again for contemplation.

The upstairs waiting room was sunny and bright too with comfortable seating and views of the woods and garden.

The patient rooms were all singles with large windows and artwork on the walls, not just the stats and posters like Maine Med.

The hallways are carpeted to keep the noise down too.

Out back there is a Healing Garden for staff, patients and visitors to enjoy with seating, a small fountain and views into the woods.  All of these features add to a general sense of wellbeing that can only enhance the healing properties of the hospital.  Here is a hospital that thinks about healing the whole person not just the body.

Hospital Design Part Two: Art, Light, Nature and Healing

In a previous post I wrote about my early morning arrival at the Emergency Room of Maine Medical Center due to severe angina. The doctors determined that a heart catheterization was needed first thing that morning to see if I had a blockage in my heart.   As I headed out the door I chose to bring my camera with me to document my experience of the spaces as both artist and patient.  My interest in the design of space and how we are affected by it  was my motivation.  My business, inSite Contemplative Design, works with individuals, businesses and institutions to create uplifted environments through mindful design.
I have had several trips to the hospital over the last six years.  I was all too familiar with the de-humanizing starkness of the ER and patient rooms of Maine Medical Center.  Yet I wanted to examine why this was so and ponder if I had the opportunity to contribute to their design what would I do differently.From the stark white ER I was moved up to the 9th Floor to the cardiac unit to be prepped for the procedure.  The floor was still in the midst of remodeling, that may explain the lack of artwork on the walls.  However there were plenty of signs with useful diagrams of the heart already up on the bright peach walls.  I guess giving out information is more important.

Note the difference between the bare walls and adding a bit of art and nature to the elevator lobby where patients are wheeled down to procedures. [ I photoshop'ed one of my flower photos into the image.]

But it was the patient rooms that seemed the most bleak.  My friend's sunflower from her garden was the one bright spot.
















 To think someone actually designed the pattern and colors for the "johnny" (aka hospital gown I had to wear).  Where did this name come from I wondered?

The view from the bed was pretty depressing, with  the signs taped to the walls with no particular care.  Just the facts of date and time to mark the hours you are there and the names of the staff serving you.  We're talking strictly utilitarian concerns here.

And the ever present glare of the television offering  mind numbing distraction, but no healing energy, while I wait and wait for the weekend to pass. 










The doctors had found a blockage in my left main artery. Another stent would be inserted to open it up.  But not until Monday...

 With the long hours of sitting ahead of me ( and not the kind I was used to on my meditation cushion due to all the interruptions of nurses taking vital signs, drawing blood, etc.) I began to look for the beauty I could discern in the setting.  I found it in the spaces between things.





In the light at different times of day coming through the one window in the room.  I had to sit on the end of my bed to actually look out the window. The poor soul placed in the bed close to the door couldn't see out of it at all!  Here we were on the top floor of a building on top of the highest hill in Portland.  A place where one might feel they were on Mt. Olympus.  A place to reflect and maybe gain a bit of perspective on one's place in life and the world.  And we couldn't even see out once we were forced to stay in bed, as most of us were, for the hours before and after the procedure.




The quality of light and the hues of the morning sunrise brought life back into the barren space and reminded me of the larger world beyond the technology surrounding me.  For all the "life-saving" equipment around me there was so little that was "life affirming".

  Out of curiosity I took a look at the hospital's plans for their renovations to see what more they were planning to do.  I hoped it would mean more art, nature and light.  Interesting that the maternity wing was a complete contrast to the cardiac unit.  These rooms looked almost like a hotel or someone's home.  I found out later from a friend who is a doctor that the reason hospitals spend the big money on the maternity and delivery rooms is because they know that most family's first experience of a hospital is the maternity ward.  Women will shop around for the best choice and then remain loyal to the hospital that delivers their children.  But why would the experience of one's environment be any less important in the healing treatment of the aging adult in the cardiac unit?
While I was totally satisfied with the staff at Maine Med I always leave the facility feeling drained by the setting (and the poor food.) The staff are some of the best in the country, particularly for cardiac care so I continue to endure these hardships, but I will be sending this article to the hospital and my cardiologist with suggestions for how they could improve their program.


The following week as a follow up to the heart cath and stent insertion I took some bloodwork to MidCoast Hospital, a newer facility closer to home.   I immediately noticed the difference in hospital design philosophy. MidCoast Hospital emphasized the arts, nature and natural materials in its design.
 From their website:

Mid Coast Hospital is a community hospital like no other. Much thought went into designing a facility that was not just state-of-the-art but state-of-the-heart, with a healing environment that nurtures the whole patient—body, mind and spirit.
The building is sited to take full advantage of the woods, ledge and natural light. Works of art on display, from murals and paintings to water treatments and sculpture, serve as “peaceful eddies in the stream” of hospital life. They slow our pace, engage our spirit and support the healing process.

With regards to a Dahlov Ipcar mural in the hospital:

Would that all hospitals would find funds and will to invest in this level of healing, then we would all find better treatment.

Accessing the Magic in our World

"When you express gentleness and precision in your environment, then real brilliance and power can descend onto that situation.  If you try to manufacture that presence out of your own ego, it will never happen.  You cannot own the power and the magic of this world.  It is always available, but it does not belong to anyone." from Shambhala: The Sacred Path of the Warrior" by Chogyam Trungpa Rinpoche

 These words jumped out at me today as I prepare for arranging flowers for a Drala program at the Brunswick Shambhala Meditation Center this weekend. This program brings attention to the sacred energy present in the world and how to access it. "Drala is not a god or spirit, but fundamentally it is connecting the wisdom of your own being with the power of things as they are.  If you are able to connect those two things, out of that, you can discover magic in everything."
This is what I also connect with in my work in designing space for others.  My work is not about making a self-conscious statement about either my own or the client's tastes, but noting with precision and awareness the qualities of the occupant and all others who will use the space and the properties of the environment to bring them into harmony or as Chogyam Trungpa says to "make your world available to others."  That is why it was so meaningful for me this past week to have a client say,

 Neal's Office Before

"I owe you a debt! I can't believe what a difference this endeavor has made and kick myself for not thinking to do something sooner. Even my office manager recently asked "what's gotten into you?" I am doing so much more with such a lighter heart and such a greater sense of joy. People need to know what this can do!!! I'm a convert!!!

I want you to succeed (pardon me for saying this), not for you. . . . but for the people you will help. I think this is important."

Neal's Office near Completion

Although I provided the assistance and focus for the project, the actual energy was there in his space and continues to feed him long after my involvement is gone.  Through gentleness and precision, we worked together to uplift his world and in so doing invoked the power of the phenomenal world around him so that it could continually feed him in his work.

Heart Troubles and Hospital Design Part One: Camera in the ER

A week ago I found myself being rushed to the hospital an hour's drive away from our home with a numb left arm and gripping pain in my chest and shoulder.  It was 3:30 a.m. and my husband was amazingly cool driving me there.  Granted it wasn't our first time making the drive. The trip wasn't a total surprise as I was scheduled to go in for a catheterization that morning anyway, after experiencing angina symptoms during a stress test the day before at the doctor's office.  Still it was more than a little disconcerting to have the symptoms remain all the way to the hospital even after taking nitro tablets on the way.  I was travelling with my camera and toiletries I'd packed the night before, since I'd originally thought I would be in the hospital overnight for the cath appointment.

I was bringing the camera along because of my growing interest in the impact of thoughtful aesthetic design (or lack thereof) in aiding our wellbeing.  I wanted to study the hospital experience from the combined perspective of designer, photographer, meditator and patient.  We were driving to Maine Medical Center.  The hospital is in the midst of a major remodelling of the cardiac units. I wanted to document and study my experience of the hospital to consider what I would design, if given the opportunity.  As a patient, in a very real life threatening scenario, my perspective would be different than a designer, working in the hypothetical or even the health care professionals working on-site.  In truth, my perspective would be unique from even the other trauma patients in the Emergency Room (ER).  Yet it might be of value.

ER's are triage sites and waystations for incoming patients on their way to either quick repair or a room in the hospital, so the barest of comforts are provided. You are asked to disrobe, put on a hospital gown (that grows larger with each year as our population gets more obese) and lie down on a cold gurney with a thin blanket for warmth.  Whether it is to keep down the spread of germs or for the equipment, these spaces are always frigid. I was grateful that a heated blanket was provided when I asked for it. 

The view from the bed was white on white minimalist ceiling tiles, a sterility that added to the chilly atmosphere.  The nurses, doctors and technicians did add a warm human touch to the experience through humor and genuine concern, but in the gaps between tests and examinations, I felt the barrenness of the environment draining life away.  In addition, because of the chilly temps, every technician who handled me had ice cold hands, for which they were forever apologizing.  I kept thinking, "How pleasant could it be for them to be working in a ice cold environment all day?"

I felt a certain annoyance as the nurse and my husband continued to question me every few minutes about my symptoms, "What level of pain are you experiencing from 1 to 10?"  In spite of their concern, I felt a familiar sense of detachment creeping in as my body became a "thing" that was poked, prodded and hooked up to monitors to be statistically "read" and hopefully "fixed."  The camera was a useful tool to keep me connected with the outer world around me and not totally retreat into my shell, despite the dehumanizing environment. 

For his part, my husband, the artist/engineer was fascinated with the technology, taking pictures of the monitors and commenting on the elegance of their design.  Beauty is in the eye of the beholder.  For me, I was just grateful that they were capable of giving the doctors the info they needed to treat me.  However, his interest was another reminder that everything in our world is touched in some way by the design process.  One that incorporates some aesthetic, as well as utilitarian decisions.  Making the choices consciously not only aids in functionality, but also impacts the energetic power of the object.

The one warm spot in the ER experience (besides my husband's concerned face) was the curtain used for privacy in the glass walled room.  It was a pleasing shade of beige with a minimal horizontal tuck pattern that reminded me of grass cloth used to cover walls.  It reminded me of tropical or Asian interiors.  The combination of the texture and color felt comforting to me, while serving it's purpose of privacy.  Was it because it reminded me of something natural in the hi-tech sterility of metal and white? 

The ER is purely functional, mostly devoid of any decorative elements, let alone artwork.  Without aesthetic stimulus, I  felt a greater sense of alienation.  It made me wonder how the employees feel in this colorless and in some ways lifeless environment, when they are dedicated to saving lives.  I noticed that some of the nurses wore colorful patterned scrubs, possibly in reaction to their monochrome world. 

There is growing interest in integrating the arts into hospital settings as treatment,  both in work with patients, health care providers and hospital design.  I recently learned about Shands Hospital in Gainesville, Florida which has an Arts in Medicine program that is setting the standard for work in this field.  I met one of their artists in residence at an Applied Mindfulness Conference this summer.  I was presenting a program on designing Contemplative Space at the Conference.

After several hours in the ER, I was moved to the cardiac unit and prepped for the catheterization.  A blockage was found that explained my symptoms so I would be staying through the weekend as it was a Friday and any repair work would have to wait until Monday.  That would give me plenty of time to study my hospital room and the rest of the cardiac unit. I'll write more about the hospital stay in my next post.

Losing Touch with the Physical World

This past weekend was spent selling our cast-off stuff in a yard sale after clearing away all the clutter in our home.  Yard sales are a curious cultural phenomena where one person's trash becomes another person's treasure, but at as low a price as possible.  Lower than Wal-mart, lower than Dollar Store, lower even than the cost of the raw materials, let alone the labor involved to make it.  But these items are one step away from the landfill so any price is better than nothing.  Or is it...

Best to frame the event as an act of generosity, rather than think too long on the actual value in time, raw materials, etc., let alone price originally paid for the jade necklace that someone wants to offer you a dollar for now.  It was your mother-in-law's jewelry, nothing you would ever wear and maybe this nice old lady will actually wear it, so you say sure and take the 4 quarters offered.  But two days of transactions like these (and lots of quiet moments in between as we live on a dead-end road in the country) got me thinking about how Americans relate to 'stuff ', to our physical world today.  Needless to say any time I start generalizing I know I am immediately moving into dangerous territory at best, and yet sometimes these ideas are worth following through to see where they lead, so please bear with me on this. 

I discovered in clearing my home that reducing the quantity of things on display, led to greater appreciation of what remained.  As a maker of physical things, picture framer, artist, craftsperson and designer, I may look at my physical world differently than many people.  Working with your hands in this way makes one aware of the time and energy it takes to make something wonderful.  With the shift in our culture away from manufacturing and crafts, there are more people in careers that work with computers, ideas, or people.these days.  Working in the intangible world of ideas, often there is a disconnect with the physical world, including a lack of appreciation for the cost, the discipline and the effort needed to relate to it properly.

My latest client, who is a doctor, informed me this week that his colleagues didn't know how to relate to the redesign of his office.  Why would anyone want to pay attention to how their workspace looks?  And yet this is where all of them spend more hours than at home.  The re-design has led to greater productivity in my client's work flow and a sense of well being at work.  He has discovered that though he lives much of his days in mental constructs reading charts on a computer screen, his physical body still exists in this world of things.  It made sense to pay attention to the details of his surroundings.

With the growth of technology and the explosion of knowledge it is easy to get lost (even trapped) in the realm of ideas and presume that this is making us more in touch with our world.  But are we really?  Our children now find it easier to relate to people through technology (texting, Facebook, mySpace) than one on one conversations (even by phone).  While they are taught the latest software, they don't know how to sew on a button or make an omelet.  With our democratization of all aspects of life, we now dress casually (it is fashionable to dress with tears in jeans and seams unfinished) to all occasions and the President gets heckled while addressing Congress, by a member of Congress.  In our rush to level the playing field we have brought everyone down rather than raising everyone up with respect and dignity.  All these could be taken as signs of the erosion of the fabric of our society, a lack of appreciation for our physical world, a lack of respect for things as they are.

This is why mindfulness is such a radical approach to life today because rather than chasing the speed of knowledge it is asking us to slow down and look at what really exists in front of us.  To make direct contact through our senses with what is real, what is present now.  Out of that contact comes greater appreciation, respect and understanding of the world, not simply consumption of data.

Robert Irwin once said,  

"Because it all comes down to how you answer a single question: Is the moment of perception - that first moment, before all the abstracting, conceptualizing processes that follow - is that the moment closest to or furthest from the real? Everything depends on how you answer that question?"

and Chogyam Trungpa Rinpoche spoke to this in his book, True Perception

"You have to start by paying attention to reality.  You need to learn to eat properly, to cook properly, to clean your house or your room, to work with your clothes.  You need to work with your basic reality.  Then you go beyond that, and you begin to have something much more substantial."

Details Matter

(Before) My first arrangement

(After)The arrangement refined

I received a comment from my last post that the photos of the object arrangements (before and after) " look like the test of seven errors or differences.  Massive change is more profound than the subtle" from fellow artist, Turtel Onli.  While I can see his point and agree that more people would notice massive change rather than subtle shifts,  working with the precision of subtle changes in the details of a room can sometimes be quite profound as it refines our perception, fine tuning the body or felt sense of things.  Heightened discernment and appreciation of the mundane details of life can enrich us, through loving attention (or mindfulness) to our surroundings. Often these parts of life are ignored as we speed along anticipating the high points and reacting to (or creating) the drama of our lives.

I am reminded of the artist, Robert Irwin, who spent an entire year painting 2 lines on a canvas over and over, adjusting the placement by as little as a 1/16 of an inch as he studied how this changed the nature of the composition.  Out of this intense meditation on his painting, he became aware of not only how the distance between the lines altered the overall composition, but also how the lighting and cracks on the wall next to the painting affected his perception of those lines.  His interest grew in the phenomenological experience of visual perception which ultimately led him to abandon painting on canvas and even the studio for a time to work on site-generated installations. 

Black Line Form by Robert Irwin

 Succulent Garden and Waterway of Getty Garden by Robert Irwin

When he took on the design of the Getty Garden in Los Angeles, he studied not only the seasonal growth patterns of flowers, but how the leaves look with the sun in front of them and behind, the shades of the gravel and the sounds of the water on the rocks. As a result the garden is a feast for the senses with aesthetic delights in all directions.  While some visitors may never pay attention to that level of specificity, the overall impact of the site is due in large part to the sum of all these small decisions about placement.

When I teach contemplative photography, my students are often surprised by the magic they encounter in the details of their home or an environment they have seen so often that they normally pass through it without even looking.  Yet, when they have a camera in hand and slow down through meditation, tuning into their sense perceptions, potent images arise of the most mundane things; light on a drying rack, the color of a curb, or the family dog's nose.  Ultimately it isn't that the objects have magically been altered, rather it is due to the quality of attention paid to them.  The world opens itself up to us and provides a rich display constantly, we just have to slow down enough to notice.

  Yellow Triangle by Rebekah Younger

Franz Kafka put it so well when he wrote:

"It is not necessary that you leave the house.  Remain at your table and listen.  Do not even listen, only wait.  Do not even wait, be wholly still and alone.  The world will present itself to you for its unmasking, it can do no other, in ecstasy it will writhe at you feet."

Clearing the Clutter: Space and the Power of Placement

 Our living room before clearing the clutter

Over the past two days, my husband Guy and I have been culling our collection of stuff. You know the accumulated gifts, family castoffs, treasures and sundry things that pile up in all the unused nooks and crannies of every home.  We are not big on shopping, but as two working artists, with many friends who are artists as well, we have acquired (and made) quite a collection of treasures.  Guy makes furniture and electronic sculptures, while my art graces our walls and tables. Add to that the obsolete entertainment technology (cassettes and videos) (we are still clinging to our turntable and LPs) and the living room becomes a busy and cluttered space.  Each treasure competes for attention with the work around it.

An overcrowded home is a reflection of my overcrowded life of actvity.  I want to create some open space for reflection and fresh appreciation of what truly matters.  Clearing the clutter and clarifying our living space might aid in opening space in other parts of my life.  Working with mindfulness we identified which items we truly used or felt enhanced our life in some fashion and removed all the rest.  From there I sought to simplify further by placing objects in groupings that worked harmoniously together.  This meant storing some of our collection away much like a Japanese tea master, who would select stowed treasures for special viewings or seasonal changes rather than needing to display an entire collection all at once.  I sought a middle way approach to decoration being more selective of items on display while not emptying the room completely as they would a tearoom.  This process reminded me of a passage from "The Book of Tea" by Kakuzo Okakura.
Okakura writes:

 Japanese Tearoom Interior

"The tearoom is absolutely empty, except for what may be placed there temporarily to satisfy some aesthetic mood.  Some special art object is brought in for the occasion, and everything is selected and arranged to enhance the beauty of the principal theme.  One cannot listen to different pieces of music at the same time, a real comprehension of the beautiful being possible only through concentration upon some central motive.  Thus it will be seen that the system of decoration in our tearooms is opposed to that which obtains in the West, where the interior of a house is often converted into a museum.  To a Japanese, accustomed to simplicity of ornamentation and frequent change of decorative method, a western interior permanently filled with a vast array of pictures, statuary, and bric-a-brac gives the impression of mere vulgar display of riches.  It calls for a mighty wealth of appreciation to enjoy the constant sight of even a masterpiece, and limitless indeed must be the capacity for artistic feeling in those who can exist day after day in the midst of such confusion of color and form as is to be often seen in the homes of Europe and America."

Our living room after clearing

While our rearranged living room may still appear to be a museum by Kakuzo's standards, it does now open some space for the appreciation of individual works.  I will enjoy altering the selection and placement of objects and wall art as an opportunity to express the seasonal and personal shifts in our world.  I am increasingly aware that in our culture consciously choosing to have space is a radical thing.  That to do so opens up a new relationship with my surroundings, whether it be turning off the TV or removing clutter from a room.  In future posts I will write more about some of the Taoist principles that have guided me in this practice.  For now I will say that placement of objects and honoring the space they command in a room has the ability to enrich us, to wake us up or overwhelm us.  In Shambhala Buddhist terminology, this presence is called, "enriching presence" being fed energetically by our world.  Paying attention to the details of our living space, to the qualities our belongings evoke for us is important for mindful living.

The next day I revisited my tabletop arrangements and refined the placement of the objects for greater clarity.  I realized in the arrangement with the masks and bowls that the individual parts did not relate to each other still or the table surface as a whole.  Treating the tabletop as a stage or blank canvas, it was important to  determine what role each item played in the hierarchy of the composition.  In flower arranging and other Eastern art forms this hierarchy is referred to as heaven, earth and man.  Identifying which object represented the qualities of heaven, earth or man offers a structure for clarifying the composition.  Rather than have 8 objects on the table and windowsill fairly evenly spaced in a democratic fashion, I arranged them into 2 groupings and turned the mat under the bowls to echo the horizontal line of the table.  I removed the wooden box altogether realizing that it's presence contributed nothing to any of the other items on the table.   I'll talk more about this way of arranging in my next post.

On the table and wall behind the couch was another arrangement needing to be refined.  I initially placed my photograph of a tulip on the wall, but then realized that it was seasonally inappropriate.  I chose instead one of my extracted photographs of fire imagery, which would be suitable for the end of summer.  You can learn more about this artwork on my personal art blog.  I also opened up more space by removing the small plant stand and pot, while shifting the placement of the fan and clock on the table's lower shelf.  Minor alterations such as these can have a real impact and I have found that when the elements are finally in a placement that makes sense the body knows it, not just personally but universally.  In Shambhala Art classes we often do object arranging where each person contributes one object to the composition.  While there may be several options that will work, when the object is placed with a felt sense of "rightness" everyone in the group knows it.