By: Jean Johnson for Wounds1 Japanese gardens aren’t just for meditative strolls on Sunday afternoons any more. Rather, as 75 year old Norma Jean Lemley sits in a recliner during a five-hour chemotherapy session and looks through floor to ceiling windows, she sees a Zen-like manicured expanse instead of the former view of a grassy field bordered by an asphalt lot. (As in a reversal of Joni Mitchell’s lyrics “…paved paradise, put up a parking lot.”)
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Small Measures To Help Healing
If a loved one is healing in a hospital, try these suggestions to create a better healing environment
If the room has a window with a view, arrange the room so the patient can get the full effect of the view: Remove obstructions, angle the bed if possible.
Consider bringing potted plants, or flowers for the short-term, to brighten the room. Be sure the flowers are close enough so the patient can enjoy them.
Adjust the lighting as much as possible to let in natural light (but keep in mind the amount of heat you’re letting in)
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Lemley remembers her first round of chemotherapy back before the garden was built when she had to endure a small, sterile cubicle – “I just looked at the walls.” Now, however, with a path complete with slate pavers and an arched bridge weaving among three waterfalls, around carefully pruned Ponderosa pines and through deciduous plantings, Lemley rests much easier. “I didn’t even want the TV on,” she said. “I sat and watched the falls. Time went fast.” The garden that softens such harsh realities as cancer and promotes healing at Samaritan Lebanon Community Hospital’s Emenhiser Center, where 300 to 400 people in this rural part of Oregon come for chemotherapy each month, is the genius of Hoichi Kurisu who designed Portland’s renowned Japanese Garden in the late 60s. Since then, Kurisu has designed gardens throughout the world, but the chance to apply his ideas to a healing setting honors this gentleman.
Visionary Robert Ulrich
According to Robert Ulrich, Ph.D., professor of architecture with a specialty in environmental psychology at Texas A&M University and visiting professor at University College in London, there’s a reason people like Kurisu feel strongly about bringing their art and craft to medical settings. In 1984 after Ulrich was hospitalized with a severely broken leg and spent days flat on his back under a desert of fluorescent lights, he was motivated to develop what has become a classic study in the field of healing environments: “Biophilia, Biophobia, and Natural Landscapes.” (Biophilia is defined as a sense of place.)
“I remember how unpleasant it was to have no choice but to look at the glaring ceiling lights or the acoustic tile,” Ulrich observed. “And how much I wished I had an attractive image on the ceiling.”
Ulrich concluded from his study that if patients have half a chance with at least some semblance of pleasantries, they’ll rally much better than if you treat them like they are Dr. Spock look-alikes with nary a single emotion in sight.
Although this idea is perhaps one most agree with intuitively, it was still in need of careful study for the world of science to accept its validity. So that’s what Ulrich did: Design a thorough study that produced credible results.
“The patients were assigned essentially randomly to rooms that were identical except for window view: One member of each pair overlooked a small stand of deciduous trees, the other had a view of a brown brick wall,” wrote Ulrich. “Patients with the natural window view had shorter postoperative hospital stays, had few negative comments in nurses’ notes (‘patient is upset,’ ‘needs much encouragement’), and tended to have lower scores for minor post-surgical complications such as persistent headache or nausea requiring medication. Moreover, the wall-view patients required many more injections of potent painkillers, whereas the tree-view patients more frequently received weak oral analgesics such as acetaminophen,” wrote Ulrich
Reduced stress, faster recovery and decreased use of strong painkillers all came from looking at a natural setting as opposed to a blank façade. Ulrich felt as though he was onto to something, so even as other researchers did their own studies aimed at probing his theory, he pursued further inquiry. In 1990, for example, he worked with university lecturer Outi Lunde in Sweden to evaluate patients recovering from open-heart surgery. In this study, the team simply used pictures and found that patients who looked at ones with open, natural settings in which water was present had less post-operative anxiety than those who looked at abstract designs or pictures of closed in forested settings.
In addition to Ulrich’s results, some of which were published in the Journal of the American Medical Association, a raft of scholarly articles has appeared with similar results. From the New England Journal of Medicine to The Lancet to The Wall Street Journal, those in the know now realize that for human beings to heal optimally they need to be in soothing situations where emotional, spiritual and social needs are considered along with whatever physical condition medical teams are addressing.
Even Nominal Views from Windows Can Help
“The shadows would get long on the courtyard wall outside my aunt’s room in the afternoon,” said Clifton Hayes of Portland, Ore. “She’d study the intricate brickwork pattern of the wall across the courtyard that was softened by a flutter of leaves from nearby trees that had grown tall enough to show from the fifth-story window through which my aunt viewed the world in her last few days of life. “
“‘They spent a lot of money out there,’ my aunt would say,” said Hayes.
“‘Yes. Lovely,’ I would answer her back with a soft smile. ‘Someone must have realized people like us would appreciate it,’” Hayes said.
Hayes also says that two flights below, a longtime family friend was recovering in the cardiac intensive care unit (CICU) after an emergency triple bypass. “Even after she passed the initial phase and was stable, there was no room for her on the cardiac floor so they put her in the CICU overflow. No windows. Only a view of the nurse’s station for two long weeks. Also, there was construction close by on a new wing, so she was tormented by all this banging and clanging day after day. Pretty awful to put someone recovering from heart surgery through that, I thought,” said Hayes. “She was utterly miserable – like there were times where she wished she hadn’t survived.”
Proactive Steps to Soothe Clinical Stays
Oregon’s a pretty hip place. A green place. So it’s not surprising that it is home to the Samaritan Lebanon Community Hospital’s Emenhiser Center with its innovative Japanese garden. Also, while there are other progressive healthcare institutions that understand that healing is an art as well as a science around the nation – many more are a good 10 years behind the curve.
When we become patients – particularly when we are confined to bed or even a chair for extended periods of time – we forfeit considerable control over our environments and become dependent on those around us to do what fine tuning we may have done.
The optimum, of course, would be to use only progressive hospitals and clinics that know how important healing environments are in promoting well-being – places like the St. Charles Medical Center in Bend, Ore.; Griffin Hospital in Derby, Conn.; Woodwinds Health Campus in St. Paul, MN; Children’s Hospital and Health Center in San Diego; and the Toronto General Hospital in Ontario among others. Yet, even if facilities in your community still have a way to go, there are ways to help make a loved one’s confinement less taxing.
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The clinical benefits of a greater connection to nature include:
Faster patient recovery
Reduced pain
Fewer cases of infection
Greater patient satisfaction
Reduced stress levels among staff
The attraction and retention of quality staff
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If the setting beyond the window is at all soothing, make it as accessible to the patient as possible by adjusting the blinds and tidying up hospital paraphernalia that so often is left scattered around on wide window sills. If there is no garden beyond the glass, consider bringing in a terrarium or a basket of potted plants. It’s amazing how many details patients will notice and the joy they will take from observing nature in any form. “Is that a peony bud?” Hayes’ aunt said as they sat admiring a bouquet of irises from her yard that he brought in a tall vase.
“Why, yes,” he replied. “I clipped it from your peony bush as an afterthought and stuck it in. I didn’t get more because it’s not blooming yet, and I really didn’t think you’d even notice.”
“Oh, yes,” she said. “Peony buds are so lovely, dear. So round and full of promise. After they bloom, you know, they don’t last long, those showy fluffy blossoms.” Hayes describes the way his aunt cupped both her aged hands together to show the size of the peonies, and the wistful look in the lines around her eyes as she recalled the appearance of the showy blooms. “Even when they’re just left on the bush, it’s just days it seems before they start to fade. So fleeting – peonies.”
To brighten the room consider mounting a light-weight image – as in maps of the world available for a few dollars at office supply stores or a quality art poster – on the ceiling or walls with easily removable, non-staining adhesive gum. (While large world maps seem as though they would be difficult to manage, we at Wounds1 tested this working solo. We found that by starting at one end and dotting the back with adhesive gum and working the map out slowly adding plenty more dots, it was surprisingly easy. The map stayed entirely secure and remained so for several weeks until we deliberately took it down.)
Adjust the lighting as favorably as possible by turning off glaring fluorescents and opening blinds for natural lighting. Consider the time of day and weather so that open blinds do not lead to excessive brightness or add too much heat.
Try to keep flowers where patients can easily see them rather than shunted off to a side board out of sight as can easily happen when busy hospital staff focused on medical treatments move things around. Know that hospital bedside trays usually have a second slider tray underneath the top one so that when meal time arrives, there is room for both the dinner tray and a patient’s personal items like flowers.
If a person is well enough and interested, hold flowers or plants close so that together you can admire the intricacies of the petals and the palette of color in which nature works so boldly. Think therapy animals here – only this is therapy with plants. The patient gets a double infusion, first from the lovely object itself and by talking about it with another human being.
Consider music. CDs? Ipod? A neighbor who plays a flute? Borrow a friend’s guitar and do some gentle strumming? At the very least, look for the Muzak station on the TV.
