I’ve never liked hospitals.

Modern hospital architecture seems driven by the same creative spirit of beauty and artistic flair that inspired the construction of urban tenements in post-war Britain. Inevitably there is too much time to study their façades because finding a parking space within a mile of one is next to impossible. There are rare exceptions, of course. Centuries ago, the builders of some historic hospitals in Europe clearly understood that sick people might benefit from convalescing in tranquil, natural surroundings, but apparently this idea has not occurred since. Only a scattering of new hospitals have any kind of appeal, and that fades all too quickly with use.

I’ve never liked hospitals. Maybe I shouldn’t have chosen a career in intensive care medicine.

Twilight deepened over the city and the sultriness of the tropical air softened around me. I stumbled through the construction site that led to the hospital front door. A security guard smiled and waved hello. Too late, I flicked up my arm in a hebetudinous attempt to return his greeting but he turned away. I walked into the bracing climate of the air-conditioned lobby and hastened to the intensive care unit on the floor above. The charge nurse on duty curtly nodded her head in approval as I washed my hands.

I went to the bedside of the nearest patient and stared at the monitor for a moment before looking down at the girl, noting the endotracheal tube, arterial line, syringe drivers. The susurrant sighing of the ventilator drew my eye and I began drafting a plan of what to do if her gas exchange worsened. I had cared for hundreds of patients like this in the past but there was something different about this one. I froze as a sudden unwelcome surge of panic welled up inside of me and shattered my line of thought like a hammer hitting glass. She was my daughter.

A knot of anger and frustration tightened somewhere inside. She looked so vulnerable laying there, her chest rising and falling in time with the machine. Fathers were meant to protect their children. I was clearly not doing my part very well.

Everything had been fine yesterday. Then just before noon she had become mottled and struggled to breathe. A little later, with oxygen saturations in the high sixties, she was put on non-invasive ventilation. That didn’t work too well and she was soon intubated. I had watched helplessly as she deteriorated, faintly aware of a small voice inside proffering me hearty congratulations on doing such a fine job of holding it all together. I knew what her chances were, statistically, she’d be fine! That voice stammered and fell silent when I broke the news to my wife.

Up until then I’d managed to go through life without having someone close to me become critically ill. I’d never glimpsed the depths of the doctor–patient relationship from the other side. I had not, could not have, appreciated how exposed and vulnerable it makes you feel. What I had thought important as a doctor became nearly irrelevant to me as a parent. I didn’t give a damn about statistics or “what her chances were”, I didn’t care how many people with this problem survived, I just wanted to know whether my child would be OK. The doctor’s opinions faded into the background as I became more appreciative of the care the nurses took. Those that looked after her as gently as if she was their own daughter won my trust and respect. Trust… I had blithely assumed that patients and their families readily trusted most clinicians and thus had tacitly undervalued it. Trust was not merely important, it was vital. It needed to be nurtured. Without it I would have transferred her to a different hospital or given over to blind despair. But the principal doctor here had cared for her promptly and capably. He’d put the right tube in the right place at the right time and thereby earned my trust. He hadn’t put on a big show of strained sincerity or callow compassion either but calmly and honestly responded to my loaded questions.

After a time I stood up to leave. A nearby nurse smiled warmly and whispered goodnight. Hospital buildings might have all the aesthetic appeal of a munitions assembly line but the people who worked in them could and did transcend their cold spirit. They had to. I went down the stairs and emerged into the lobby next to a statue of St. Francis. For the first time I noticed the words ‘Sursum corda’ inscribed on the plinth. I walked outside and looked up through the equatorial haze cloaking the city. Lucent skeins of cirrus cloud half veiled the stars.

Unbidden a line from Keats’ Hyperion drifted in my mind,

“So on our heels a fresh perfection treads”.

She was my fresh perfection. And though she struggled with life, and though pain and uncertainty tempered my thoughts, I could not help but be grateful for the simple, solid fact of her existence.

I’ve never liked hospitals. Maybe it was time to reconsider.