Over the years that Victoria Sweet has been a physician, “healthcare” has replaced medicine, “providers” look at their laptops more than at their patients, and costs keep soaring, all in the ruthless pursuit of efficiency. Yet the remedy that economists and policy makers continue to miss is also miraculously simple. Good medicine takes more than amazing technology; it takes time—time to respond to bodies as well as data, time to arrive at the right diagnosis and the right treatment.
Sweet knows this because she has learned and lived it over the course of her remarkable career. Here she relates unforgettable stories of the teachers, doctors, nurses, and patients through whom she discovered the practice of Slow Medicine, in which she has been both pioneer and inspiration. Medicine, she helps us to see, is a craft and an art as well as a science. It is relational, personal, even spiritual. To do it well requires a hard-won wisdom that no algorithm can replace—that brings together “fast” and “slow” in a truly effective, efficient, sustainable, and humane way of healing.
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On the Cusp of Aquarius
It started at a particularly unusual time.
All times are unusual, of course, never to be repeated, one of a kind, but this time and place were especially unusual. A revolution was brewing and I was at the center of it, though I didn't know it. Just around the corner from my university was Xerox PARC, where Steve Jobs was being entranced by the mouse and imagining a personal computer. Thirty-five miles to the north was Haight-Ashbury, with its hippies and their counterculture, a revolution of color, scent, sex, and style. Fifty miles to the northeast was Berkeley, where students were occupying parks and making radical demands, and forty miles to the south was Santa Cruz, where the organic food movement was sprouting.
And I was in college, living in a rather strange house that would affect my point of view for the rest of my life.
I'd been in a dormitory until the university, in a first tick of that clock of revolution, rescinded its rule that women live on campus, check into their dormitories before midnight, and see male guests only downstairs. So I began to look around for a different kind of place, and I found it on a bulletin board in the Student Union:
"American family recently returned from Switzerland seeks university student for extra bedroom."
I telephoned and then went over to take a look at the room and meet the family.
The house was just five miles from the university, in the hills where the rich lived in a kind of rural simulacrum, down-to-earth and expensive. I drove down the private lane; in the field on my right, three horses were grazing; in the driveway, chickens were scratching. Jane, the wife, answered the door, and then she showed me around.
The house had been built by a student of Frank Lloyd Wright's, she told me, and it was sprawling, made of adobe and wood, with exposed beams, a heated red concrete floor, and an enormous fireplace with built-in seats. The architect had spared an old oak and built the house around it, so there was a tree growing up through the middle of the living room and out the roof to the sky. Then she took me into the garden, where zucchini and tomatoes were growing in the midst of roses, and then around to the back and I saw the extra bedroom. It had a Swedish slat bed, a sit-down shower, and a teak deck, and looked out onto the Coast Range. It was exotic and peaceful, and I took it.
In that house I would get to be a sort of hippie.
"Sort of" because it was a nice house near the fine university I attended, I was supported by my parents, and I didn't take drugs. "Hippie" because we experimented. The Neumanns had just returned from Switzerland after a twelve-year stay, and their three daughters, though in theory American, spoke English with a Swiss-German accent. They brought back with them the Swiss living they'd learned: washing on Monday, ironing on Tuesday, waxing the floors on Wednesday. Also the six-month supply of food mandated in Switzerland, which were forty-pound tins in the garage, of wheat, rye, and beans.
They also brought back with them a certain worldview. It was what the French call the longue dure, and very different from my American worldview. From its perspective, the Romans had only been passing through, and the Middle Ages were not so long ago. The Renaissance, Reformation, and Enlightenment were recent, and America was a charming, puzzling blip on the screen. It was a worldview that tried out each new period, preserved what worked, discarded what didn't, and added what worked to its older ways of being in the world. Many of those ways were remarkably similar to the new ways Americans were discovering, I would learn. Organic food. Meditative spirituality. Political rebelliousness. The congruence of right living, satisfying living, and happy living.
Jane was Mom. She was from an old California family and American through and through. She'd intended to become a biologist, but she married Walter instead and became a wife. In Switzerland she became a perfect wife, obeying the recycling the Swiss did even back then not because of laws but because of their frugal aesthetics. It was wasteful to discard anything usable, she explained to me one day. So every Swiss home had six bins-a white-glass bin, a green-glass bin, a neither-white-nor-green-glass bin, a paper bin, a compost bin, and a trash bin, and the neighbors knew just how much trash was in the trash bin. They also knew whether you washed on Monday, ironed on Tuesday, and waxed on Wednesday.
In Switzerland they'd lived in the village of Kusnacht on Lake Zurich. Carl Jung lived up the street, and Marie-Louise von Franz, Jung's most famous disciple, had herself analyzed Jane. Jane was brilliant but diaphanous; unchallenging, vague, distant. She was like the bird that wandered into the house one day and threw itself against every window trying to get out.
What she brought to the house was a certain Way-perhaps Swiss, perhaps Jung, perhaps her grandparents', perhaps her very own. It was the way we would eventually call Slow and included Indian gurus and the first organic food I ever ate. I would get back from the university and find the newest guru sitting at the table by the oak tree, surrounded by disciples and the smell of curry, incense, floor wax, and laundry. Jane was the Queen, the Moon, a Jungian extroverted feeling type.
Naturally Walter, her husband, was an introverted thinking type. He was tall and thin, and his hair was turning white. His thick mustache was white already. He rode a bicycle to his work as the director of bioengineering at one of the first high-tech companies in Silicon Valley, which focused on electromagnetic equipment. One evening he came home and explained to us how the new technology he was working on would revolutionize agriculture. A Green Revolution would feed the world, he said, because the NMR (MRI) machine they'd invented could analyze the protein content of seeds without damaging them. Jane, the guru, and the disciples listened politely, and then went back to discussing whether the soul could exist apart from the body. Perhaps in reaction Walter became a part-time sandal maker. He would sit at his wooden bench, cut leather, and sew sandals with an awl. With his long, thin legs sticking up as he sat on his bench, he looked like Geppetto, Pinocchio's creator, and in lieu of diaphanous words you had a pair of sandals that lasted until you lost them.
Of the three daughters, Nan was the middle one, and the most frŠulein. She had a merry face with flawless skin untouched by sun and nourished by snow. She had straight black hair and observant, very blue eyes. She was tall, healthy, and young, and she gave me my first taste of Slow.
She would get into the tins of wheat, rye, and beans and make up recipes for bread. She might grind the wheat with the rye and then add nuts, cumin, even red pepper. This particular time she did not even use yeast.
I was sitting at the table and watching her as she kneaded the coarse flour with her hands. She worked the dough in a kind of abstraction, then formed it into a loaf and put it in the oven. It didn't rise, of course, without yeast, but its smell filled the kitchen and people began to appear from around the house, drawn by its fragrance.
Finally Nan took the loaf out of the oven. It was small, dense, and primitive, and I'd never seen bread like that. The only bread I knew was Wonder Bread. I watched as she sliced the loaf in the thinnest of slices and then we spread it with the butter she'd also made with the cream Jane had bought from a faraway organic dairy. I had never tasted anything like it. It was gritty, salty, peppery. It took me a long time to chew and had many flavors, and as I tasted, I suddenly understood why, in all the diets I'd ever known, bread was bad for you, and yet the Bible called bread the "staff of life." The Bible didn't mean Wonder Bread but Nan's bread. Perhaps for the dietician, the difference between the two breads is simply in price and nutritional content, but to my palate, they were not even comparable, the difference between them being so obvious, and yet indefinable.
That was my first taste of Slow.
I met Meg, daughter number one, when she decided to come home. SheÕd run off with her ex-Vietnam-medic boyfriend Peter, but then, several months into my stay, Jane announced that Meg was pregnant and was moving back into my bedroom so she could give birth on the teak deck, or, in bad weather, in bed. Which she did, soon enough.
In the meantime, I was out of a bedroom. But I didn't want to leave. That place was a master's degree in the future. There were the Indian gurus, the organic food, Walter's new technologies. There were the discussions at the dinner table about physics, time, politics; draft resisting, civil disobedience, and government propaganda. There were the marijuana brownies; there was Steve Jobs's little box where you could make phone calls for free; there were the horses, the chickens and our own eggs. We were vegetarians. Walter knew wine. So I did not want to leave.
I looked around for where else I could sleep. I started with the storage room in the horse paddock, but I finally settled on the roof, which, thanks to Frank Lloyd Wright's architect-disciple, was flat. It, too, looked onto the Coast Range and it had large eaves I could move under when it rained, and there I lived until I finished college. It turned out to be a great place to sleep because all night long, I could watch the stars moving across the sky, and I had never seen that before.
Walter taught me the constellations he knew, and one night he explained to me about the "precession of the equinoxes." Because of the wobble of the earth's axis, every year the sky shifts eastward-about 1 degree every 70 years, 30 degrees every 2,000 years, and 360 degrees-one complete revolution-in approximately 26,000 years, which the ancients called the "Great Year." They had measured the precessional shift by whatever zodiacal constellation was appearing on the horizon at the spring equinox. There were twelve such constellations, and each spanned about 30 degrees, a different one appearing every 2,000 years. They believed that whichever constellation that was, characterized the 2,000-year epoch. For us it was Pisces, the Fishes, right above our heads.
Walter pointed it out to me-two not-very-bright stars the ancients envisioned as two fish swimming in opposite directions. The nature of Pisces was therefore, he said, dichotomy, strife, and war-and was what gave our age, the Age of Pisces, its characteristic quality of opposition. Now, however, the constellation of Aquarius was beginning to appear on the horizon, and that would mean a new age, with different strengths and weaknesses.
Often during those nights on the roof, I would wake up and look at the sky, and so I learned for myself how the Big Dipper turns around the North Star like a clock hand, and how the planets wander along the ecliptic. I saw for myself how Venus was some years the morning star in winter and the evening star in spring, and other years the opposite, and during those years I always knew where Mars was, and Saturn, Jupiter, Mercury. I could tell the day of the month by the moon, and the time of night by the stars.
Perhaps that seems of antiquarian interest only, but it was not. Learning the sky creates a special kind of time-not linear, scientific, progressive time, but seasonal, horticultural, circular time-would be crucial for me later on, when I discovered the Middle Ages and Hildegard of Bingen and their way of understanding the cosmos. Which was circular, not linear, the time of the seasons, which we still wear on our wrists-a revolutionary time, as in the Latin revolvere, to turn back, to turn around.
Meg gave birth not on the teak deck but in my ex-bedroom.
On the morning of the birth, she got up and announced that the baby would be born that day. Then she washed my car. Then she went into my ex-room and lay down on the bed and Peter lay down next to her. We gathered around and waited, and then after about two hours, Peter had her start to push. She did, and to my complete surprise, some black thing appeared between her legs, and two pushes later, an entire whole baby, a tiny infant girl, whom Peter did not slap and who did not cry and who breathed very fine without that.
It was stunning. It was like watching a rabbit being pulled out of a hat. There was nothing and then there was something. The tiny thing was covered with a sort of dust, and Jane took her away, cleaned her up, and put her naked next to Meg.
Then the afterbirth came. Meg said she'd heard that some Berkeley vegetarians sauted and ate it-high in protein and good for your immune system-but we nixed the idea and Peter buried it in the backyard. Then she got up and we had dinner.
Later in medical school I would deliver quite a few babies, with IVs, needles and scissors, fetal scalp monitoring and epidurals. Despite the technology, there was always that same sense of sleight of hand-How did that get here? Of some amazing magician, who happened in those instances to be me. But there was never that sense of easiness of Meg's birthing, of rolling down a hill-of smoothness, inevitability, slowness.
By then IÕd finished college and I didnÕt know what to do next. Most of us didnÕt, given the times, but especially the women didnÕt. We had never thought that far ahead. We had seen that all the women we knew were wives and mothers, so presumably some kind of transformation would happen to us in college. But it hadnÕt happened. I didnÕt want to have a career as a wife. I didnÕt want to get a PhD, either, which was the only other option I could think of. So instead I went traveling. ThatÕs what we did. It wasnÕt expensive then-three dollars got you a bed and a breakfast. I bought an open-ended plane ticket, flew to Europe, and spent months adventuring.
And then in an out-of-the-way bookstore I discovered what I would do next.
Table of Contents
Introduction. Medicine without a Soul 1
1 On the Cusp of Aquarius 13
2 Dr. Gurushantih and My New White Coat 25
3 The Man with a Hole in his Head 35
4 Dr. Greg's 30 Percent Solution 45
5 A Successful Petition to the Saint of Impossible Causes 59
6 The Mantle of Hippocrates 75
7 Three Prophets, No Whale 85
8 Visiting Day at the Henhouse 105
9 A Slow Medicine Clinic Before its Time 125
10 Passing the Point of No Return 141
Intermission. In Which Fast Medicine and Slow Medicine Come Together 155
11 Turnaround 169
12 A Craft, A Science, and an Art 183
13 Upstairs, Downstairs 201
A Short Pause to Recapitulate, or the Crack in the Cosmic Egg 227
14 The Force that through the Green Fuse Drives the Flower 233
15 Nothing Is Better Than Life 249
16 A Slow Medicine Manifesto 265