Hospitality in hospitals is a 'moral obligation,' says ER doctor

Hospitality — and hospitals. Two words that share a root, but whose meanings often seem at odds with each other. IDEAS traces the tension between hospitality and discipline that has defined hospitals throughout their history, and what it means to create a hospitable hospital in the 21st century. The third episode in our series The Idea of Home.

'We really have a moral obligation to be hospitable, to make the patient our guest,' argues Dr. Kowalsky

In a time of medical crisis, seeking refuge in a hospital represents more than a need for medical attention: people are looking for hospitality. But can those two words ⁠— hospitality and hospital ⁠— ever be synonymous? (Nathan Denette/The Canadian Press)

This is the third episode in a five-part series called The Idea of Home exploring the multiple and contested meanings of home. Scroll to the bottom for other episodes in this series.

*Originally published on June 15, 2022.

Whenever we go to the hospital, we're of course seeking urgent medical attention. But we're also looking for refuge at a time of crisis — in other words: hospitality.

"The meaning of hospitality is something that we talk about a lot in emergency medicine, because we're the front door of the hospital," said Dr. Rachel Kowalsky, a pediatric emergency medicine physician at NewYork-Presbyterian/Weill Cornell in New York City. 

"We really have a moral obligation to be hospitable, to make the patient our guest," she said. "I think that the whole experience of the emergency department, from arriving at the front door and checking in to what it's like to be in your room and how people interact with you … I think those are all critically important to what that person's experience of illness or injury is going to be." 

She takes inspiration from the Latin root hospes, the foundation of the words "hospital" and "hospitality," and can mean guest, stranger or foreigner.

"So to me, the hospital is a place of caring for that stranger or foreigner," she said. 

Pediatric emergency room doctor Rachel Kowalsky is also a fiction writer. She wrote a short story called The Lion’s Tooth where she imagines a created healing space for victims of sexual assault. (Ian Londin)

"On a really basic level, what do you need? Are you freezing? I'll bring you a blanket. We've got lots of graham crackers and juice. Sometimes we even have meals."

Still, she adds, hospitals can be a conflicted space for hospitality because it's not always possible for doctors to meet the needs of their "guests."

"I reread The Odyssey this year. When Athena in disguise shows up at Telemachus's door and asks to come in, he doesn't say, 'I'm sorry, but that's just not the right thing for you.' But we have do that sometimes — not get the CT scan, not prescribe the antibiotics — in instances where these things would do more harm than good because we're making decisions that are informed not only by the desire to please, but also based on our training, the resources available to us, our own knowledge."

Serving hospitality through food

For Kowalsky, food also plays a central role in hospitality.

"The nurses always tease me because I always show up with candy, or whatever I have around. I think it's just a way to acknowledge that a person is human and has human needs and human hungers, and it kind of acknowledges that as a shared thing between a doctor and a patient," she said. 

Toronto-based chef Joshna Maharaj is on a mission to make hospitals more hospitable by improving the quality of the food served, and to re-introduce meals cooked from scratch. She says budget cuts to healthcare have forced many hospitals to serve bland, reheated food. 

"There are lots of hospitals offering excellent medical care and attention. The trick is that it is such an isolated experience. All the things that shoulder around that care is where budget cutting has started to happen. So maybe you don't get to spend as long recuperating in a bed. You don't have as many human touch points. You are not getting fed good food that you actually need to encourage the healing," she said. "So the hospitality is shockingly low." 

For chef Joshna Maharaj, the lacklustre food in hospitals isn’t just an irritation. It’s a form of inhospitality that affects people’s dignity and well-being. (Geoff George/Fridge Wars/CBC)

In an ideal world, Maharaj says, "The food has texture. Everything that's on your tray, you can see clearly how it looked when it came out of the ground. And there will be a note on that tray from the kitchen, from the farm, with a wish for good health or at least a speedy recovery, and that you enjoy this meal."

"Farmers are over the moon at the idea that the food that they grow will actually be served to sick people. We don't remember how happy people are to be in a community to take care of each other."

Hospitality in the time of COVID 

As a doctor in New York City, Kowalsky was at the epicentre of the first wave of COVID-19 — and the pandemic changed what it meant to welcome people to the hospital. 

"Every person became suspect of having the virus, particularly when we didn't have a way to test … I guess people had to begin to follow the rules, whether or not they wanted to, and that's definitely in conflict with a space of pure hospitality where it's all about the guests and making that person feel comfortable and honoured," she said. 

"You could say, from a public health or epidemiology point of view, you sort of switched from the guest to the many guests and had to think about population health." 

For Kowalsky, one of the hardest parts was that could only allow one parent by a child's bedside in the pediatric ER. 
"When their child is ill or injured, parents want to be by that child. [But] they had to leave and just drive around the city or drive home and be on FaceTime. Those were some of the worst conversations I ever had," she said. 

The idea of hospitality became a lot more complicated with the advent of COVID-19. Between burnout and a low morale, healthcare workers also had to navigate the threat of catching a potentially lethal virus while treating patients, says Dr. Kowalsky. (Nathan Denette/The Canadian Press)

The stress, exhaustion and danger of the pandemic — and the difficult conversations healthcare workers had to have with patients — took a toll. 

"Every day you would get a terrifying email about, you know, so many doctors have died in Italy, and what if we run out of PPE?" she said. 

"So responding to that big decline in morale, we started a series of poetry, prose, brief videos that we would send to faculty and staff by email." Those poems and stories were also posted on a website she helped create called Our Break Room

Two of the poems they shared were about hospitality and welcome: Rumi's The Guest House" and David Whyte's The House of Belonging

"I find that so interesting. We are a house where strangers meet one another, and the belonging is, in many ways, created. It's made," said Kowlasky. 

"Towards the end of the poem, [Whyte writes] 'This is the bright home in which I live. This is where I ask my friends to come. This is where I want to love all the things it has taken me so long to learn to love.'" 

"That section really speaks to me. We do ask people to come … like: you can come here and we're going to care for you. So when guests arrive, we have to make good on that invitation. We have to honour it." 

Guests in the episode: 

Rachel Kowalsky is a pediatric emergency physician at New York—Presbyterian Weill Cornell Medicine in New York City. Alongside Dr. Sharri Platt, the Chief of Pediatric Emergency Medicine at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, she created a website called Our Break Room to share poems and stories for healthcare workers. Her short stories have appeared in Atticus Review, jmww, and Orca Literary Journal. You can read her story The Lion's Tooth, which imagines a truly welcome hospital space for survivors of sexual assault, at jmww.

Joshna Maharaj is a Toronto-based chef and activist, and the author of Take Back the Tray: Revolutionizing Food in Hospitals, Schools and Other Institutions.

Kathy Loon is executive lead for Indigenous collaboration & relations at Sioux Lookout Meno Ya Win Health Centre (SLMHC) and a member of Slate Falls First Nation. She started working for SLMHC in 2013 as the Traditional Healing, Medicine, Food and Supports Program Coordinator.

Carole Rawcliffe is professor emerita of medieval history at the University of East Anglia. She specializes in the history of medieval medicine and early hospitals. 

Kevin Siena is a professor of history at Trent University. He specializes in the history of medicine and the history of hospitals in England in the 16th, 17th and 18th centuries. 

David Goldstein is an associate professor of English at York University, where he is also the coordinator of the creative writing program. He researches food, hospitality and early modern literature, and is the co-editor of Early Modern Hospitality. 

This episode also includes a clip from a 2016 CBC Radio interview with Maureen Lux, Professor of History at Brock University and the author of Separate Beds: A History of Indian Hospitals in Canada

*This episode and The Idea of Home Series was produced by Pauline Holdsworth.

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