In the 1991 film The Doctor, William Hurt plays a physician who experiences life as a patient in the hospital. His observations and interactions change the way he views the practice of medicine from that point forward. In 1998, this healthcare architect experienced a similar situation . . . admitted through the emergency room to an inpatient medical unit for a week of tests, intravenous feedings, and antibiotics.

Although seriously ill, I was very aware of my physical surroundings, a result of my education as an architect and more than 20 years of experience in designing hospital spaces. What I learned during this reflective period of illness and healing will strongly influence the remaining years of my career. To the extent that I may influence not only my own designs, but also those of other healthcare architects and decision-makers, I will minimize the details of my illness and emphasize the design lessons learned.

The Emergency Department
The next time you are faced with the question of enclosed or curtained treatment cubicles in the emergency department (ED), I would suggest that you take three hours and place yourself in each type of location. I found myself in a curtained bay with an inebriated and solicitous woman in the adjacent space. In addition to the physical pain I was experiencing and the anxiety associated with waiting for test results and subsequent diagnosis, I was subjected to a loud, verbally offensive neighbor in the ED. (I more fully appreciate the nonmedical patient situations that ED staffs endure every day-drug overdoses, inconsolable children, and gang-member victims of violence). Cold and lying on a stretcher, I had nothing to listen to or look at to pass the time. I lost any hope of privacy as the curtain remained partially open and members of the ED team, members of other patients' families, the police, and others walked past. I could hear conversations I didn't care to hear. After this experience, I will encourage all my clients to consider private treatment spaces with solid wall dividers and sliding glass doors.

The Patient Room: Mobility and Range-of-Motion Limitations
I was admitted to the hospital with acute infection, dehydration, and malnutrition, which translates into multiple intravenous lines and nasogastric tubes. As I lay in my bed, I found it nearly impossible to access the systems and services that, as a design architect, I believed would be at my fingertips. The bed controls were difficult to reach because of the restrictions caused by the tubes and IV lines inserted into my body. The telephone and overhead lights were equally inaccessible, requiring the assistance of a nurse or visitor. The next time your designers are involved in the selection and location of equipment, place one in a bed tethered to an IV pole to test the accessibility of the controls.

My bed was turned toward the window to accommodate both the equipment and my view, but I was unable to adjust the blinds from my bed to reduce the intrusion of healthy Florida sunshine during my frequent naps. However, the positive design aspects of the large window in the room provided a visual respite from the hospital and a clear sense of time and place. It reminded me that there was a life outside the walls of the hospital to return to after my recovery.

The Patient Room: Engineering Systems
Attention mechanical/electrical engineers! Think long and hard about fan coil units and the impact they have on the patient's comfort level. I know all the reasons we use them-insufficient floor-to-ceiling height, cost, etc.-but they create drafts and greater discomfort for the patient. They are noisy and present difficult challenges to the maintenance team. The variation in room temperature during on-off cycles creates hot-cold periods for the patient. As we work with our consulting engineers and HVAC equipment manufacturers, perhaps we can find or develop a unit that reduces drafting and is more accommodating to patients' individual control and temperature preferences.