Help is on the Way

Combine the power of nature, animal companionship and music, and you have a recipe for healing

  • By John P. Wiley, Jr.
  • Smithsonian magazine, July 1999, Subscribe
 

Once again it turns out that I was born too soon. When my children were born, fathers were not allowed in the delivery room. They were not allowed in the labor room. It was only through the generosity of hospital administrators that fathers were allowed in the building at all, banished to waiting rooms with nothing but old magazines, ashtrays and a clock on the wall. Nowadays, apparently, hospitals have birthing suites with plenty of room for the father, both grandmothers, other assorted relatives and friends, a video camera operator and, for all I know, a caterer.

For hospitals themselves, the physical plants, the revolution is only now beginning, and once again it is happening after I did my time in a number of such institutions. One change has to do with the design of the buildings. Even though the rationale for it surfaced in the 1980s, it will only slowly improve the patient's plight. It has to do with the placement of patients' rooms. Studies back then (and since) have shown that patients who can see trees and other greenery from their hospital rooms recover faster and do better than those who look out to brick walls or ventilation machinery. Edward O. Wilson's hypothesis in his book Biophilia turns out to have been true all along: there's something in us that loves a tree, whether it be in a city park, a wilderness or outside our hospital window.

The Joint Commission for the Accreditation of Healthcare Organizations once checked physical plants only for things like fire safety and doorways wide enough for beds to go through. Now it is circulating for review new guidelines that would ascertain whether patients' rooms have views of nature and how much of the view can be seen while lying flat in bed. According to Roger Ulrich, director of the Center for Health Systems & Design at Texas A&M University, designs for new hospitals are taking window views into account; university medical centers often lead the way.

Studies show that views of nature, even a painting of nature on otherwise blank walls, make a significant difference in intensive care units, many of which have no window views to the outside. Specifically, Ulrich and a Swedish colleague, Outi Lunden, were able to show that after heart surgery, patients who could see a nature picture showed less anxiety, needed fewer strong pain drugs and suffered less temporary cognitive impairment (translation: they could complete a visual/perceptual-functioning test faster than individuals with no picture). There is even some evidence that among ICUs that do have natural light, mortality rates tend to be lower in those that are sunnier.

At the other end of the procedure pipeline, views of nature benefit outpatients waiting for biopsies or cardiac catheterization, because their anxiety levels are reduced. As a patient with one or more blocked coronary arteries becomes anxious, for example, the body's demand for oxygen goes up but the heart cannot supply it. A dangerous arrhythmia can result. Just a taste of nature, however, reduces anxiety in the waiting patients. This works with nothing more than a nature scene printed on the curtains around their holding bays and earphones through which they can hear birds singing and water burbling.

So now architects can practice medicine by designing buildings with as many patient rooms as possible on the outside, looking out over landscaped grounds with gardens. The landscaping staff can know they are not only helping things grow, they are helping fellow humans get better. (In places like New York and Chicago, of course, there may be no trees to be seen no matter how inspired the design, especially from the 20th floor.)

Other changes do not require new buildings, and are happening as fast as human minds can adapt. One is the rapidly growing, completely counterintuitive practice of bringing animals into hospitals and nursing homes. To some people, animals are "dirty." The payoffs for a few stray pet hairs and the occasional drop of drool are enormous, however. Bring a dog or a cat into a patient's room, and that person's blood pressure will drop. Patients are brought out of themselves by the feel of a cat purring or the enthusiasm of a dog that offers unconditional love.

The dog does not know that part of your heart has died and that the rest of your life is filled with similar imperfections. It knows only that you and it are here, nose to nose, figuratively if not literally, living in the present moment. The dog is happy to be there with you, no questions asked.


Once again it turns out that I was born too soon. When my children were born, fathers were not allowed in the delivery room. They were not allowed in the labor room. It was only through the generosity of hospital administrators that fathers were allowed in the building at all, banished to waiting rooms with nothing but old magazines, ashtrays and a clock on the wall. Nowadays, apparently, hospitals have birthing suites with plenty of room for the father, both grandmothers, other assorted relatives and friends, a video camera operator and, for all I know, a caterer.

For hospitals themselves, the physical plants, the revolution is only now beginning, and once again it is happening after I did my time in a number of such institutions. One change has to do with the design of the buildings. Even though the rationale for it surfaced in the 1980s, it will only slowly improve the patient's plight. It has to do with the placement of patients' rooms. Studies back then (and since) have shown that patients who can see trees and other greenery from their hospital rooms recover faster and do better than those who look out to brick walls or ventilation machinery. Edward O. Wilson's hypothesis in his book Biophilia turns out to have been true all along: there's something in us that loves a tree, whether it be in a city park, a wilderness or outside our hospital window.

The Joint Commission for the Accreditation of Healthcare Organizations once checked physical plants only for things like fire safety and doorways wide enough for beds to go through. Now it is circulating for review new guidelines that would ascertain whether patients' rooms have views of nature and how much of the view can be seen while lying flat in bed. According to Roger Ulrich, director of the Center for Health Systems & Design at Texas A&M University, designs for new hospitals are taking window views into account; university medical centers often lead the way.

Studies show that views of nature, even a painting of nature on otherwise blank walls, make a significant difference in intensive care units, many of which have no window views to the outside. Specifically, Ulrich and a Swedish colleague, Outi Lunden, were able to show that after heart surgery, patients who could see a nature picture showed less anxiety, needed fewer strong pain drugs and suffered less temporary cognitive impairment (translation: they could complete a visual/perceptual-functioning test faster than individuals with no picture). There is even some evidence that among ICUs that do have natural light, mortality rates tend to be lower in those that are sunnier.

At the other end of the procedure pipeline, views of nature benefit outpatients waiting for biopsies or cardiac catheterization, because their anxiety levels are reduced. As a patient with one or more blocked coronary arteries becomes anxious, for example, the body's demand for oxygen goes up but the heart cannot supply it. A dangerous arrhythmia can result. Just a taste of nature, however, reduces anxiety in the waiting patients. This works with nothing more than a nature scene printed on the curtains around their holding bays and earphones through which they can hear birds singing and water burbling.

So now architects can practice medicine by designing buildings with as many patient rooms as possible on the outside, looking out over landscaped grounds with gardens. The landscaping staff can know they are not only helping things grow, they are helping fellow humans get better. (In places like New York and Chicago, of course, there may be no trees to be seen no matter how inspired the design, especially from the 20th floor.)

Other changes do not require new buildings, and are happening as fast as human minds can adapt. One is the rapidly growing, completely counterintuitive practice of bringing animals into hospitals and nursing homes. To some people, animals are "dirty." The payoffs for a few stray pet hairs and the occasional drop of drool are enormous, however. Bring a dog or a cat into a patient's room, and that person's blood pressure will drop. Patients are brought out of themselves by the feel of a cat purring or the enthusiasm of a dog that offers unconditional love.

The dog does not know that part of your heart has died and that the rest of your life is filled with similar imperfections. It knows only that you and it are here, nose to nose, figuratively if not literally, living in the present moment. The dog is happy to be there with you, no questions asked.

Still another wave of change is headed for hospitals and even more for nursing homes. Making music, it seems, is not only fun, it is healing. A study of retirees in Michigan and Florida demonstrates that making music increases the participant's level of melatonin, which enhances sleep; growth hormone, which alleviates aches and pains; and B-endorphin, one of the body's own painkillers. Frederick Tims, chairman of musical therapy at Michigan State University, and his colleagues taught retirees to play the organ. The subjects were continually compared with a control group not learning to play. The study found that learning to play stimulated the immune system and enabled participants to handle stress better.

And so it is that I am getting a vision, a mental preview of the possibilities should it ever happen again that the emergency room physician says: "Book 'im." From my bed I'll look out to a pond framed by trees, birds coming and going, bats fluttering in the dusk. Padding up and down the hall will be a parade of the canine world's finest, some of whom will come in to stick a cold, wet nose on mine to check that I'm OK. In one hospital, a 129-pound Great Pyrenees drops in. I defy anyone not to be cheered by such a sight. Waiting in a line of wheelchairs ("We are seventh for takeoff") for x-ray or catheterization, there will be a Frederic Church or Albert Bierstadt painting on the wall so I can slip my surly bonds. In bed, I'll have across my lap not the eating table but an electronic keyboard, and through earphones I'll hear music, my music. Adult self-teaching books these days feature baby versions of real music, up to and including the four-note riff from Beethoven's Fifth, so that beginners can do something right away. What they lack in being able to play lots of notes they make up fooling around with the timing and tempo. Up and down the corridor others may opt for "Stardust" or the "Moonlight Sonata," but I'll try to teach my left hand to get down and dirty so that, in a pale imitation, I can play boogie-woogie. It would be difficult if not impossible to be depressed if the moon was rising behind the trees, a dog in the doorway was wagging its tail and the whole place was cookin' to some barrelhouse piano.

By John P. Wiley, Jr.


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