Getting Better

If you’ve ever spent time in the hospital, you’re probably like me in having done your best to forget the experience. Not only were you recovering from some sort of serious injury or illness (or visiting a loved one who was), but you also had to endure the process in an environment that wasn’t quite hospitable.

Most likely the room you or your loved one occupied was filled by an adjustable bed surrounded by beeping instruments. The walls were putty-white and scuffed, a couple of cellblock-like doors led to the bathroom and hallway – and a worn-out television hung questionably above the bed, threatening to fall on guests sitting in the uncomfortable, motel-room-reject chairs.

Even the air smelled of antiseptic and illness – grim and depressing, to say the least.

And if you were visiting or waiting for someone in the emergency room, then your treat was to sit in a large room packed with other visitors and sick or injured people waiting to be admitted. There you enjoyed an array of five-year-old magazines, but reading wasn’t easy anyway because of the soap operas or newscasts blaring out of the television.

Just about every time I’ve been to a hospital, I just can’t help wondering: Is this really a healing environment? Is this really where we want to go to be cured of our ailments or patched up after our accidents?

ENOUGH ALREADY

Unfortunately, with rare exceptions these forlorn places are exactly where we bring our ill or injured bodies for care and comfort. We may boast the most advanced medical technology and medications and be surrounded by the most accomplished medical professionals on the planet, but the environments where all of this crucial work takes place leave much to be desired.

I’m simply amazed that anybody gets better in these places; moreover, I think it’s astonishing that medical professionals in these settings aren’t even grumpier than most tend to be. Surely we can do better. Surely we can create environments that will comfort patients and their families and help to make these stressful situations a bit more tolerable.

In my humble opinion, I believe that the entire notion of health-care facilities could stand some rethinking. There’s no escaping the fact that hospitals and other medical facilities are serious places where serious things happen, but that’s all the more reason to give some thought to the ambiance and tone that permeate every facet of a medical facility’s design.

We don’t, as watershapers and landscape professionals, have much (if anything) to offer when it comes to the insides of hospitals, but we do have the skills and talents needed to create outdoor spaces that will make life a bit more pleasant for the infirm and their families – not to mention medical professionals as well.

Why not design spaces that people can retreat to as they wait for news about their loved ones – spaces that provide fresh air, pleasant fragrances and sunshine? And while we’re at it, why not make these places where we can regenerate and heal? Why can’t they be places for families to pray or mourn or for people just to be alone? Why not make them into spaces where staff can come to catch a deep, stress-reducing breath?

We’re all instinctively aware of the healing benefits of being out in nature – and of how much more we crave being in those spaces in times of stress. What we see, what we hear, what we smell – they all soothe us and, in some well-documented cases, actually help the healing process.

In a now-famous 1984 study by Dr. Roger Ulrich of Texas A&M University, patients undergoing gall-bladder surgery were randomly placed in two different rooms, one with a view of a group of trees and the other with a view cut off by a brick wall. Not surprisingly, the patients who looked at the trees had far shorter stays in the hospital, needed less pain medication and were subjects of fewer negative comments among caregivers than were those who stared at the brick wall all day.

That’s just one study in a vast collection of similar research on the health benefits of being exposed to nature. Time after time, these studies have the same results: Patients do a better, faster job of healing when they’re given access to the natural world.

PATIENT-FOCUSED DESIGN

A few years ago, I took advantage of a wonderful opportunity and spent two weeks studying garden design for health-care settings at the Chicago Botanic Garden.

It was the first program of its kind, and we benefitted from studying under pioneers in the field including Clare Cooper Marcus, Roger Ulrich and others who took the time to explain the nuances of designing gardens specific to certain groups of patients, including (among others) people with Alzheimer’s, stroke victims, those with head injuries and residents of assisted-living centers.

One of the key points I took away from the course was an affirmation of the fact that what I do for a living benefits more than just my clients: Indeed, it benefits all who come into contact with those garden spaces. I also learned along the way that what works for one type of patient does not work for all others and that we need to tailor designs of these health-care gardens to the needs of some very specific populations.

I am constantly amazed at how different a healing garden needs to be, depending on the intended user group. In this case, for example, the needs of Alzheimer’s patients dictated the structure of the space, its simple paths and its clear sight lines.

In adopting this position, I learned that we take many things for granted in designing gardens. We all have our likes and dislikes when it comes to plants or fragrances, and we might like the idea of creating barriers to entry and any of a number of other concepts that bring life and visual interest to these spaces.

With health-care gardens, by contrast, understanding the needs of those who will be experiencing the garden is of paramount importance, and it’s absolutely critical that the spaces be designed and installed with specific conditions in mind. That may seem an exaggeration, but it’s not: Even a tiny deviation in meeting a specific need of the user will render the garden useless or, worse, can even make it dangerous.

Consider Alzheimer’s patients, for example. I learned that gardens they will use should never have pathways that will allow them to “get lost.” As a consequence, all paths must return by fairly obvious means to the places where they started – and these gardens also need landmarks that help them avoid confusion and navigate these spaces safely. Even plant choices are a factor: Imagine these patients eating what they suppose are “harmless” berries off a plant that ends up being toxic or injuring themselves on plants with thorns.

I’ve designed and installed many health-care gardens in the past 15 years, and one of the things I’ve always found to be reassuring is that even the gardens we’d designed before I took that course or had ever heard the term “healing garden” actually seemed to work.

A good while back, for example, I was asked to install a waterfeature at a center for emotionally disturbed children. Common sense dictated that we couldn’t build a pond or any form of exposed water. What we needed instead was a feature they could put their hands into without exposing them to the risks inherent even in shallow depths of water.

HEALING POWER

After a great deal of consideration, I opted to drill a one-inch hole in a pock-marked, 2,000-pound boulder and set it on top of a ground-level basin. We covered the basin with a metal mesh that we then topped with the same gravelly stone we’d used for the rest of the garden – a cost-saving measure in a project funded entirely by donations.

A small submersible pump made water emanate from the top of the boulder and gently trickle across and down its various faces – enough flow for touching and interaction but never enough accumulation at any single point to present any sort of hazard. This simple feature actually became the facility’s centerpiece – and area used not only by the counselors and their patients, but also by the families of the children being treated.

This garden, designed for a hospital near where I live and work, was intended for a more general patient/staff population and serves to beautify the grounds as well as offer a variety of spaces for contemplation and repose to anyone who uses them.

Another important point I picked up during the Chicago course is the recognition that, as watershapers and garden designers, we create spaces in which lots of people heal in one way or another – and that this is true of almost all settings that bring people in contact with the natural world.

Take the client who has a bad day at the office and comes home to enjoy a glass of wine while sitting out in the garden: By definition, that’s a healing space. The same holds true when a person who has lost a loved one goes for a solitary walk in the park: The designer may not have intended it, but that space is, by default, a healing garden.

It was widely reported that, after the World Trade Center was attacked in 2001, there were lines outside the Brooklyn Botanic Garden and that Central Park was overflowing with mourners. Faced by devastation so close at hand, all of those people felt a need to get out into nature to regroup and soothe their minds. Just knowing that, as designers, this is part of what we’re about is incredibly empowering.

In such a context, making our gardens suited to healing purposes becomes even easier when we’re fully informed as well as aware of what we’re trying to accomplish.

Doubling back to health-care facilities, we need to be sure that if we are designing for a specific type of user – that we are considering the needs of, say, the wheelchair-bound or visually impaired. That list of interests to be served gets long in a hurry, and great care is required if the space is to be used (and used safely) by those you’re trying to help.

More on that next month, when I’ll complete this discussion with a look at some of the specifics involved in designing garden spaces with various medical conditions in mind.

Bruce Zaretsky is president of Zaretsky and Associates, a landscape design/construction/consultation company in Rochester, N.Y. Nationally recognized for creative and inspiring residential landscapes, he also works with healthcare facilities, nursing homes and local municipalities in conceiving and installing healing and meditation gardens. You can reach him at [email protected].