September Last Touch from Steven L. Strongwater, MD, CEO
My Last Touch
If you haven’t done so already, I encourage you to visit one of the top floors of the Hospital or walk along one of bridges that connects the Hospital towers and the Health Sciences Center to take in the view. On a clear, crisp day you can see miles of beautiful trees and maybe even spot Connecticut just past the Long Island Sound. While patients staying in city hospitals may be able to view the city skyline or people-watch the busy streets down below, patients and guests at Stony Brook University Medical Center (SBUMC) who have the opportunity to do so can look out and see a spectacular view—one that some say could have a calming and even healing effect on our patients.
In her book, Healing Spaces: The Science of Place and Well-Being, Ester M. Sternberg, MD, describes how sights and sounds are connected to individuals’ emotional and physical well-being. She details the links between sight and sound and the brain’s interpretation, illustrating how these influence emotional and physical experiences in hospitals, providing specific examples applicable to the healing environment of SBUMC.
What effects do patterns found in nature have on us and what connection could they have on patients healing in a hospital? Dr. Sternberg summarizes numerous studies, including those by researchers from the University of Kyoto who used complex mathematics to analyze the structures of Japanese Zen gardens and, separately, a Harvard Medical School cardiology professor and researcher named Dr. Ary Goldberger who studied the effects that complex and repeating patterns (similar to those in Zen gardens) have on the human mind. These specific and repeating patterns are referred to as “fractals,” and examples can be found in snowflakes, waves, seashells and flowers. “The great nineteenth century Japanese artist Katsushika Hokusai incorporated fractals in his famous woodblock print of crashing waves with Mount Fuji in the distance (The Great Wave Off Kanagawa). Look at this image and you will find the curlicue pattern of waves repeated almost endlessly at smaller and smaller scales. Other fractal structures in nature include mountain ranges, coastlines, the veins in leaves and the cells in the human body. Nerve cells have fractal structure, with their ever-smaller branches; so, too, does the circulatory system with its many self-similar branches of vessels. The human brain is fractal, with its countless replicated folds. We don’t know why repeating patterns are pleasing to the eye, but perhaps their existence in the natural world accounts, in part, for the calming influence of nature views” (Healing Spaces, p. 34).
Science published View Through a Window May Influence Recovery from Surgery in 1984, a study conducted by Dr. Roger Ulrich, Professor of Architecture at Texas A&M University and a faculty fellow of the Center for Health Systems & Design. The study came to be referred to as the “landmark study on the healing effect of windows” (Healing Spaces, p. 6). Dr. Ulrich sought to see if there was a statistically significant difference in the health outcomes of inpatients who looked out a window and saw the beautiful, calming scenery of natural landscape versus those who looked out the window and saw, in the study case, a brick wall. There was already a school of thought that natural light and a soothing space provided a healing environment. “In the 19th century, hospitals were built with large windows and even skylights, in the days before powerful electric courses had been perfected; it was also done to help patients heal…In 1860, Florence Nightingale wrote that darkened rooms were harmful and sunlit room healthful; large airy, bright rooms were the hallmark of what came to be known as a ‘Florence Nightingale’ hospital ward” (Healing Spaces, p. 4). However, Ulrich wanted to go one step further — he wanted to measure individuals’ physical well-being and health outcomes and determine if exposure to the views of nature could help reduce patients’ stress during a hospital stay and, in turn, improve their health (Healing Spaces, p. 5). In other words, he set out to determine the effects of patients’ surroundings on their healing processes (Healing Spaces, p. 6).
In his study, he compared the records of 46 patients who had gall bladder surgery between 1972 and 1981. All were inpatients in a suburban Pennsylvania hospital, whose windows faced either a tree grove or a brick wall. There were 30 women and 16 men in the study; 23 beds had views of the landscape and 23 did not. Dr. Ulrich’s study controlled for age, sex, smoking status, year of surgery, floor the room was on and nursing care. “Ulrich had recorded each patient’s vital signs and other indicators of health, including dosages and types of pain medication and length of hospital stays. He’d found that those patients whose beds were located beside windows with views of a small stand of trees left the hospital almost a full day sooner than those with views of a brick wall. Not only that, but the patients with nature views required fewer doses of moderate and strong pain medication. The results were dramatic and statistically significant...Even doubters had to sit up and take notice” (Healing Spaces, p. 3). The landmark windows study helped establish a scientifically based connection between natural scenic imagery and patients’ healing.
Ironically, immunologist and virologist Dr. Jonas Salk never won a Nobel Prize for his work in development of the polio vaccine, but in 1992 he was the recipient of an award from the American Architectural Foundation for the conception and building of the Salk Institute. Upon accepting the award, he recounted his inspiration for the research center, having visited the Italian town of Assisi. He used the money from the March of Dimes, together with land gifted to him from the San Diego City Council to recreate the inspirational atmosphere of Assisi. The building was purposefully designed to be surrounded by natural beauty and light, and it is considered to be “one of the greatest architectural achievements of the twentieth century” (Healing Spaces, p. 22). Dr. Salk championed the collaboration between science and architecture, leading a series of gatherings at his institute to “identify the power of architecture to enrich the human experience” (Healing Spaces, p. 23). In 2003, San Diego architect Alison Whitelaw revived the partnership between the two disciplines (architecture and medicine) by launching the Academy of Neurosciences for Architecture, established on the heels of a collaborative workshop hosted by the American Institute of Architects at the National Academy of Science for scientists and architects to explore the interface between architecture and neuroscience, and at which Dr. Ulrich was a present and respected contributor.
So on a not-so-gloomy day, it might do you and our patients some good to open the blinds or take in the view from the closest window. Looking out, you may just see the repeating patterns in nature, fractals in the landscape, and perhaps the calming blue of the water and sky. By encouraging and enabling our patients and staff to enjoy the view, we could be enhancing the healing process and contributing to the overall well-being of our Stony Brook family.
I go to nature to be soothed and healed, and to have my senses
put in order.
—John Burroughs
The human spirit needs places where nature has not been
rearranged by the hand of man.
—Author Unknown
Nature is my medicine.
—Sara Moss-Wolfe
Truly it may be said that the outside of a mountain is good
for the inside of a man.
—George Wherry
This month’s “Last Touch” was written by guest author Maria Luisa Smeraldi, MPH, CPH, Administrator, Office of the Chief Executive Officer, Stony Brook University Hospital.
