When I broke my ankle in January, I figured I had experienced my first and last serious ailment of 2024. I’m normally not prone to injury; before my ankle, I had never had major surgery bar my wisdom teeth removal. I’m a careful person. As a child, I watched with heavy judgment as my classmates arrived on crutches, showcasing casts from injuries won in sports games or daredevil shenanigans. Crowds of my peers would form in the school hallways, desperate to leave their Sharpie scrawl on one another’s ugly plaster appendage. I watched from afar, content to have all my bones intact, thank you very much.
My ankle fracture felt like a one-off in my life. I couldn’t help but marvel at my body’s ability to break, to succumb to outside pressures (i.e. the step over which I tripped and fell). I was teetering on the brink of a major depressive episode, unable to walk or exercise and obsessively picturing the following 4-6 months of limited to zero mobility, yet I felt an odd thrill when being wheeled through the hospital, my hair stuffed inside a blue surgical net. It was like I was suddenly in on some secret. Waiting to be put to sleep by my anesthesiologist before surgery, I felt in cahoots with the other patients in their beds next to me, separated by a flimsy curtain, yet undergoing the same alienating experience of the medical world.
When I came out of my corrective ankle surgery with three pins, a plate, and one screw holding things together, I felt I had amply experienced what it meant to be injured. My entire leg from the knee down was wrapped in alternating layers of papier-mâché and gauze. My cast was so hefty I had trouble lifting my leg up and down; I felt like I could clobber someone with it if I wanted. My toes just barely peeked out, still orange from the iodine they painted me with before surgery. My nurse in the recovery room jokingly called them “Cheeto toes,” an upsetting image that stayed with me for days.
A few days later, only just surfacing from a deep, lovely swimming pool of mango popsicles and Oxycodone, my stomach started to hurt. The pain was pin-pointed in the lower right quadrant, just above my hip bone, but it emanated to the rest of my stomach until I couldn’t move even to adjust my position in bed without crying. After two days spent drinking laxatives (my doctors suggested the pain was tied to constipation from the opioids) and laying in the fetal position, I was back in the hospital where a CT scan showed I had severe appendicitis.
I didn’t leave the hospital for another six days.
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As a disclaimer, I hardly think of myself as the spokesperson for hospital life and its hardships. “Six days?” the critical reader in my imagination sputters in disbelief. “Try six months!” I know, I know; I write with the privilege of being able to remember, to look back on, rather than being entrenched in the exact moment of suffering. I experienced a mere glimpse into the recumbent, bedridden life as described by Jakubisn through the lens of Jean-Dominique Bauby. And yet, as someone with an interest in architecture who happens to possess a pair of eyes, I couldn’t help but draft a mental list of grievances with my hospital room.
During my recovery from appendix removal, my doctors had instructed me to sit up in bed as much as I could.
My appendix had burst at home, and the subsequent infection in my stomach made both the surgery and the recovery much more complicated than any normal appendectomy. I was still in a large amount of pain for days following my surgery. Sitting up in bed or engaging my stomach muscles in the slightest was, at best, traumatic. But I was urged to incline my hospital bed so that I wasn’t completely horizontal, as apparently, this would benefit my healing. I sat up motionless, like a doll, scared to move an inch lest the dull pain in my abdomen increase, while my mother held a straw to my mouth and encouraged me to drink.
In my inclined state, I spent a lot of time staring ahead of me, not at the ceilings in my room but at the drab plastic furnishings, the blue and white patterned curtain separating my roommate and I. My roommate was an older woman of mysterious health complications; she was lucky to have the furthest side of the small hospital room, the only side with a window. I was closest to the door, and I seldom felt like I had complete privacy. My side became a hallway to her doctors and nurses as well as her husband, who came every day at the start of visiting hours. They would pass by me as I tearfully swallowed bites of soup, or shared a tender moment with my long-distance partner who flew across the country to see me.
I found myself craving natural textures, wood or stone—hell, I’d even take granite—some kind of respite from the unfeeling polyvinyl chloride panels on every wall. I draped an empty pillow case over the light above my bed to make it warmer, less stark. I wanted to soften everything. I wanted to see my own humanity represented in the interiors of this place and instead I saw nothing but alienation, the same alienation I felt when being wheeled into the elevator on my way to a CT scan, my hospital bed bumping against the wall, or being asked to show my healing abdomen to a group of ten medical students making their rounds at six in the morning.
The more my strength came back, the more I noticed and was bothered by my surroundings. By the fifth day, the smell of the alcohol wipe that my nurse would use while changing my IV drip made me want to gag. I was getting a substantial amount of liquid antibiotics in my IV; they gave my urine a peculiar smell which, at first, made me wrinkle my nose, and by my last day, sent real chills up my spine. On the third day, my partner brought me a sweater of mine from home, and it was the most luxurious fabric I’d ever held.
By the end of my stay, I was able to get up and crutch around the halls outside my hospital room. People were surprised by my bad luck; I had an enormous cast on my leg, and yet it was completely unrelated to my being in the hospital. Other people, older people recovering from trauma, were also slowly doing laps of our small ward; I would pass them and wonder how long they’d been here and how much longer it would be before they left. There was one window near my room that I was able to venture to a few times in these last moments, my only glimpse of the outside. It looked out onto more hospital, the roof of the next building. I stared until my eyes watered and then some more.
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Hospital interiors have a long way to go. Projects like Jakubisn’s rotating ceiling allow us to think about what is lacking. Most people in the field are aware of the 1984 study showing that patients assigned to rooms with a window looking out onto nature experienced faster rates of recovery. I resented my neighbor at times for having the “window seat,” but she probably needed it more than me.
When I finally stepped outside on day six, the cold January air in my lungs felt like true healing.
In the quiet hum of the hospital ward, rhythmic beeps of infusion pumps and patient monitors coalesce to create a somber symphony. Here, patients from all walks of life find their respective journeys converging as time itself seems to slow to a standstill. Hospitals are meant to be a place of healing, yet their design often contradicts this purpose, sometimes making the environment more of a burden than a comfort. The healthier and more resilient are often prioritized while the sicker and fragile are left to experience the environment in a single dimension: horizontally, in the recumbent position.
“Through the frayed curtain at my window, a wan glow announces the break of day… my room emerges slowly from the gloom. I linger over every item: photos of loved ones, my children’s drawings, posters… and the IV pole hanging over the bed.”
– Jean-Dominique Bauby, The Diving Bell and the Butterfly
In this excerpt from his 1997 memoir, Jean-Dominique Bauby captures the sad beauty of seeing his world reduced to the ceiling above his hospital bed. After suffering a stroke leaving him in an extreme form of quadriplegic paralysis known as Locked-in Syndrome, he would lie supine in his hospital bed, only able to move his eyes. His bed and the direction his head faced effectively became his prison. Yet, instead of succumbing to despair, he used his imagination to transform that blank ceiling into a canvas for his thoughts and memories. Through this mental projection, the ceiling became more than just a surface; it became a space where he could express his emotions, reflect on his past, and reclaim a sense of freedom within his otherwise confined existence.
Bauby’s experience, as described in The Diving Bell and The Butterfly, is one of isolation and introspection, a reality echoed in the lives of countless patients, including my close friend Tessa. Just as Bauby was confined to the narrow view of his hospital ceiling, Tessa spent much of her life gazing upwards in a similarly restrictive environment. Others, in rooms with no windows or limited light exposure, are deprived of even a glimpse of the outside world. While I have not lived the experience myself, I gained insight into the patient’s perspective through conversations with Tessa. Born with cystic fibrosis, Tessa spent her life in hospitals, where I witnessed firsthand how the environment can affect patients—slowly eroding their resolve through the nature of their interactions with both people and their limited surroundings. Tessa’s humor, a coping mechanism in the face of her harsh reality, often highlighted the monotonous and unimaginative designs of patient rooms. Her insights left an impression on me, sparking a desire to create a design that would not only reflect her wit but also address the deeper emotional needs of patients like her.
You might assume that every inch of hospitals and patient rooms has been meticulously designed, but the reality is often far from that. Consider the ceilings. Inspired by Bauby’s account, I conceptualized a ceiling-scape aimed at providing comfort to those who experience the world from a horizontal perspective. In healthcare design, the focus is typically on the physical recovery of patients, often neglecting the mental and emotional aspects of healing. Yet, the ceiling—the surface patients interact with most—remains a blank, uninspired canvas. This observation presents an opportunity to address verticality in architecture and improve the experience of those confined to bedrest.
Tessa’s life, marked by extended periods of isolation from friends and family, and extended hospital stays, was a source of both suffering and humor. She often joked about the hospital being like a rundown motel, complete with poor “room service,” awful food, and stained, unattractive dropped ceilings. Although she found brief escapes through music, drawing, books, and movies, these distractions could only do so much. Tessa’s quiet suffering inspired me to advocate for the importance of considering patients’ perspective in healthcare design projects.
Healthcare design often prioritizes the experience of upright, mobile individuals, focusing on vertical surfaces like walls. This approach overlooks the unique perspective of patients who spend much of their time in a recumbent position, lying down with their view confined to the ceiling above. Bauby’s evocative writing and Tessa’s sleepless nights spent staring at the ceiling compelled me to rethink this approach. Merging Tessa’s experiences with Bauby’s descriptions of life as a quadriplegic, I envisioned a rotating ceiling design that could stimulate the imagination and memories of patients using a technique called kit-bashing.
Kit-bashing, traditionally a model-making technique, involves creatively assembling elements from different objects to form a new, cohesive structure. In this design, it allows for the integration of diverse, meaningful shapes into the ceiling, reflecting the fragmented yet interconnected memories and thoughts of bedridden patients like Bauby. In the context of healthcare design, this technique allows for the creation of dynamic, humanistic forms merging elements from various memories described by Bauby. By integrating these forms into the ceiling design, the space becomes an evocative tapestry meant to trigger memories and offer an engaging experience. The concept of an anthropomorphic surface, where the environment comes alive with mutable forms, encourages patients to engage their imagination. For Bauby, this approach aimed to provide constant visual and mental stimulation, breaking the monotony of a static, sterile environment.
The ceiling is transformed into an interactive plane, an ever-changing landscape of humanistic forms inviting the mind to wander, like watching clouds drift across the sky. This design transforms a once blank, oppressive surface into a portal for mental escape, where patients can lose themselves in the subtle shifts of light and form. By merging the ceiling surface with the atmospheric complexity of the sky, the design blurs the lines between interior and exterior spaces, allowing patients to feel more connected to the outside world. The final design features a multi-dimensional translucent dome, inspired by Tessa’s disdain for suspended ceilings. The ceiling surface rotates slowly throughout the year, reflecting the natural rhythms of life and providing a continual sense of progression and renewal. The patient’s perspective will evolve with time, as the environment offers new visual stimuli throughout the year. Transparent and translucent materials enhance this experience by creating a dynamic interplay of light and shadow, ensuring the room remains responsive to natural light conditions.
By honoring the perspectives of bedridden patients, the project transforms the ceiling into a focal point of visual complexity. This approach to healthcare design prioritizes the patient’s experience, providing a sense of escape and engagement that is sorely lacking in conventional designs. A reimagined environment not only offers visual stimulation, but also actively supports mental well-being. By providing an engaging focal point, the design helps alleviate feelings of stagnation and isolation, which are common among long-term patients. The ever-changing ceiling serves as a soothing reminder of the world outside, offering comfort and a sense of progression, crucial for maintaining hope and emotional resilience during extended hospital stays.
Tessa’s story is not just a memory—it is a call to action. This project, dedicated to her, is more than a tribute; it is a statement that patient experiences should be at the center of every design choice in healthcare environments. By weaving Tessa’s needs and preferences into the fabric of this project, we honor her life by striving to transform the future of patient care. The principles and techniques born from this work have the power to reshape the broader field of architecture. It is time for healthcare environments to change, to reflect the voices of those who inhabit them, and to become humane and responsive. The urgency to explore and integrate overlooked perspectives has never been greater. By continuing this vital work, we can push the boundaries of what is possible, creating spaces that not only house patients, but actively contribute to their healing, comfort, and well-being.
