Aspace of light and gentle civility can't erase the spectre of death, but it can provide a measure of grace for those doing the hard work of dying. To that end, the 16th floor of the Princess Margaret Hospital is where architecture has intervened in hushed, intelligent tones, allowing for the doctors and nurses to stay but the institution to fade away. The palliative-care unit hovers there above the rest of the hospital, connected and apart.
A visit to a hospital is always bracing. Often, it's deeply disorienting. One moment, you're on the sidewalk moving blithely through the day, the next, you're inside Princess Margaret surrounded by those who have already been exposed to the clanking facts of their own mortality.
The Harold and Shirley Lederman Palliative Care Centre is a short-term resting place that focuses on pain management and quality of life. The emphasis is on creating calm for those dying from cancer, and for their families. "It was firstly the idea of a unit dedicated to palliative care," says Dr. Gary Rodin, head of psychosocial oncology and palliative care at Princess Margaret. "And the most important part of that unit is the staff, having compassionate and well-trained staff who are trained in psychological support, physical support, support for families as well as patients around the end of life."
If sickness prevents you from staying at home or returning there ever again, what would the ideal hospital unit look like? There are lots -- especially private-care facilities in the United States -- that resemble a fancy hotel. Others try to mimic a New England bed and breakfast. Neither model was desirable, says Guela Solow-Ruda, project manager and partner at Petroff Partnership Architects, which designed this unit. Her team is the downtown offshoot of Petroff. Unlike the Markham, Ont.-based Petroff -- Canada's largest retail design house of big boxes and tenant fit-ups -- the much smaller firm is dedicated to institutional and community-driven projects. "You can't recreate a house in a 360,000-square-foot institution. The scale is wrong, the material palette is wrong, because the materials that people have in their home are not permissible in a hospital," says Solow-Ruda. "We also felt that everybody's home is different. It's not universal."
Rather than invest in a particular style of home, the architects chose to design around nature -- a theme that resonates whoever you are, or whatever your background.
Wood anchors the space. Transparency lifts it. A major column clad in the woods of the world greets visitors to the unit. A wall of glass bricks by artist Jeff Goodman with names of donors sits discreetly beside it. There are no food carts or wheelchairs in sight, no concessions to kitsch or excessive design, but an interior that looks as warm as the hollow of a tree.
The aesthetic is governed by order and clarity. A combination of maple panels and sheets of blue-frosted glass are used to clad the walls. Maple handrails detailed with thin rods of steel line the corridors. Small halogen pot lights are set into the metal tile ceiling painted in a flat, warm tone. At night, the lights that run down the central aisle can be dimmed.
The unit has only 12 beds. It measures 12,300 square feet. But, though it may be small in scale, its significance is large. Patients assigned to the special care of the 16th floor might well have been previously scattered throughout Princess Margaret Hospital among those undergoing chemotherapy or radiation treatment. About half are near death. The rest continue the battle. Every resident receives, at no extra cost, a private room. There is enough space in each of the rooms for a family member to pull out a sleeper chair and stay the night. A family room is designed to lessen the burden of families who find they are suddenly living at the hospital around the clock. It is equipped with a children's play area, a small kitchen and lounge area. The family room is named for the late lawyer, Jeremy Oliver, whose wife, father and mother were instrumental in lobbying for the palliative-care unit.
For years, an anti-wood lobby has prevailed in hospitals. That could change. Working closely with the hospital's infection-control department, the architects found conclusive studies that recommended wooden surfaces for their antimicrobial qualities. Germs and contaminants such as e. coli, listeria and salmonella are absorbed into the capillary action of dry wood and quickly disappear beneath the surface of the wood. In contrast, bacteria sit on the surface of hard plastic materials.
The architects originally specified wood for the flooring, but the grooves between the planks created concerns for the infection-control department. Instead, a product called Parterre vinyl plank floor was selected. It replicates natural maple but is in fact made up of three layers of clear, recycled vinyl, with the centre layer containing the image of a natural plank of wood. The flooring has been used in other parts of the hospital.
Princess Margaret is an internationally recognized cancer-treatment centre that also operates as a training centre for the University of Toronto. Traditionally, the hospital's palliative care has been misunderstood -- as it has in most other institutions -- as the weak link in the continuum of treatment for cancer patients. But with an aging population and a corresponding rise in the incidence of cancer, the Ontario government, for one, has demonstrated an interest in supporting end-of-life care through recent funding initiatives. Private donations have covered the $800,000 construction cost of the Lederman palliative-care unit and the start-up of an academic chair. The province has provided the operational funds as well as supplies and drugs.
Anybody who has ever done time in a hospital knows that there is a warp of time and space triggered by being inside for too long among sick people. Without corner stores or trees or whatever urban disorder that orients us on the street, the hospital starts to blur into the nondescript of the institution. Solow used large works of photography by artist Mary Pocock to help create landmarks throughout the unit, distinguishing one corridor from another. The colour works are gifts from the Earth: Ontario tulips or an Italian landscape with a sculpture of an angel are mounted behind glass walls of varying transparencies so they float in and out of view.
When I visit the palliative-care unit, Pocock, who is herself living with multifaceted cancer, has checked herself in for a short course of treatment. Her room, painted a robin's-egg blue, has views overlooking a hospital terrace and its herb garden. Her image of a luscious garden is set into the wall facing the corridor. At night, it's possible to see the image glowing from inside the room: "When it's dark, it's as if you're in a secret garden," says Pocock, "and you're safe."