February 1, 2009
The Goldberg Remedy
In a string of voluptuous hospital designs, Bertrand Goldberg rejected boxy patient floors in favor of elegant, intimate clusters. But can his curvaceous forms meet the demands of contemporary health care?
In 2007 Chicago’s Northwestern University medical center opened the doors of the new Prentice Women’s Hospital, a $550 million facility that combines state-of-the-art care with the amenities of a pretty decent hotel. Women giving birth at Prentice have private rooms with 42-inch flat-screen televisions, hair-dryer-equipped bathrooms, and sleeper sofas for family members. Instead of receiving plastic trays of cafeteria food, they order room service, available 24 hours a day. Unsightly medical equipment is kept behind the bed, out of the patient’s view—and if anyone gets nervous, wireless handsets provide instant communication with a nurse.
By all accounts, Prentice has been a big hit with patients and caregivers. But amid the fanfare for the new facility, few people stopped to contemplate the fate of the old Prentice hospital, a curvaceous seven-story concrete tower designed in the early 1970s by the Chicago architect Bertrand Goldberg. Cutting-edge at the time of its construction (if you can call anything so fluidly sculptural “cutting”), the building couldn’t keep up with rising demand; intended to handle the delivery of about 5,000 babies a year, it was seeing more than twice that amount by 2000. Because of the tower’s distinctive cloverleaf shape—its four circular wings cantilever out from a central service core—adding on to the building was pretty much impossible. Northwestern now hopes to develop a new research facility on the site. Though the university is unwilling to speculate on the details of its plans, Lisa DiChiera, the advocacy director of Landmarks Illinois, which put Prentice on its Chicagoland Watch List last September, is not hopeful. “We absolutely know they have no interest in keeping the building,” she says.
Hospitals present a particularly thorny preservation dilemma, often pitting architectural significance against cash-strapped institutions’ desire to provide the best care with limited resources. Prentice is even trickier than most. Judged purely for its architectural significance, the building is undoubtedly worth saving. It is the crown jewel in a collection of uncommonly adventurous—even sensuous—health-care architecture built by Bertrand Goldberg Associates (BGA) between 1967 and 1988. In nine completed hospitals around the country, the firm reinvented the arrangement of patient floors, drawing on Goldberg’s diverse experience—his studies at the Bauhaus, his early focus on prefabrication and personal space, his interest in cultural anthropology and the science of “proxemics”—to try to make hospitals more beautiful, more efficient, and more humane. His ideas about health-care spaces were innovative and often well ahead of their time, and they provide an ideal lens for understanding an architect whose career is ripe for reevaluation. The only problem is that those ideas now appear outmoded and largely unequal to the demands of 21st-century medicine.
From Prentice, it is about a mile through downtown Chicago to Marina City, Goldberg’s masterpiece and still his best-known work. Instantly recognizable for its pair of 60-story circular towers ringed by petal-shaped concrete porticoes, Marina City is much more than just residences. Goldberg envisioned it as a sort of antisprawl initiative, a miniature city within a city with its own 16-story office building, theaters, restaurants, and recreational facilities. After Marina City broke ground in 1960, Goldberg became a major figure in American
architecture, but by the late 1960s, funding was drying up for the sort of progressive, urban-scale projects that he wanted to pursue. (His plans for a hugely complex sequel to Marina City, called River City—a half-mile-long megastructure with several 72-story mixed-use towers connected by sky bridges—faced a decade of political setbacks before being vastly reduced in scope.)
Though Marina City made Goldberg’s name and secured his legacy, health-care architecture was in many ways the linchpin of his career. Throughout the 1960s and ’70s, hospitals and medical centers provided BGA with both a steady stream of income (by the 1970s the office had grown from ten people to more than 100) and projects of enough complexity to satisfy its principal’s grand ambitions and restless intellect. “Hospitals still required design and organization,” says Goldberg’s son, Geoffrey Goldberg, who is an architect himself and helps maintain the Bertrand Goldberg Archive. “They had a high level of density to the problems, meaning you could actually support the design work.”
Architecturally, Prentice is the most successful of these designs. Completed during a busy period in the mid-1970s when BGA juggled several major health-care projects, it was the only one to manage the engineering feat of cantilevering its curving wings from the central core without any additional structural supports. (BGA, which did its own structural engineering, won an award from Engineering News-Record for the project.) But while the engineering is exceptional, Prentice’s plan is classic Goldberg. Over and over, he applied this cloverleaf arrangement to his hospitals, which makes them hard to miss whether you’re in Chicago, Boston, Milwaukee, or Phoenix: just look for the big, sinuous concrete tower decorated with columns of porthole windows and seemingly floating above a squat rectangular base, like a spaceship moored to a gymnasium. “They don’t grow out of the ground,” says Joseph Rosa, the Art Institute of Chicago’s curator of architecture and design, who is planning a major Goldberg retrospective for 2011. “They’re like these forms that hover from stems, that project out in cantilever. There’s a kind of elegance to their massiveness.”
The cloverleaf plan gave Goldberg’s hospitals their distinctive sci-fi voluptuousness, but it was hardly an arbitrary piece of form-making. From the beginning of his engagement with the health-care industry, Goldberg conducted extensive research in the field—relying in particular on consultations with Edward T. Hall, a noted anthropologist whose 1966 book, The Hidden Dimension, examined cultural concepts of space. In the book, Hall introduced the science of “proxemics,” which measures types of personal, social, and public space, and investigated how changes in proximity can make people feel more relaxed or more anxious.
Goldberg came to believe that the most important relationship in the hospital was that between the patient and the nurse, and it was one that could be vastly improved. The typical hospital of the time was laid out as a double-loaded corridor—a long hallway with rectangular rooms projecting out on both sides. Invariably, the nursing station would be at one end of the corridor, which meant that the distance to the patient was often significant. To bring nurses closer to patients, Goldberg envisioned an alternative floor plan: four circular clusters of patient rooms, each with its own nursing station in the middle. This “village system” was supposed to ensure that no patient was more than several feet away from a nurse; moreover, nurses could see into all the patient rooms at a glance. “I loved the intimacy of Goldberg’s plan,” says Blair Kamin, the architecture critic of the Chicago Tribune, whose two children were born in the old Prentice hospital. “People say, ‘Weren’t those circular shapes arbitrary?’ They weren’t. They really created floors where the nurses were very close to the moms who had just come out of labor. You didn’t feel like you were in a vast machine. You felt like you were in a womb.”
At the same time, these circular forms are directly traceable to Goldberg’s education at the Bauhaus, which he attended in 1932–33, before the political situation in Germany became too difficult for a Jewish-American abroad. Rosa has examined the studies that Goldberg created at the Bauhaus—drawings of repetitive forms, like multiplied circles and cylinders—and says they are remarkably similar to the hospital floor plans he created decades later. Goldberg’s post-Bauhaus career was also influential: in the two decades after setting up shop in Chicago in 1937, the young architect focused on industrial-design processes and personal space. He designed furniture, residences, and a series of prefabricated structures, including the Unishelter portable housing unit and a pair of mobile medical facilities for the U.S. government. Seen in the light of his education and early career, the hospitals represent a remarkable synthesis, combining a Bauhaus appreciation for the artistic possibilities of multiplied geometries with an interest in mass-producible solutions for individual space and a pragmatic approach to the material and human-resources needs of a hospital.
Unfortunately, the elegance of the cloverleaf solution may have blinded Goldberg to its flaws. “If you don’t know anything about hospital planning, they certainly look attractive,” says Jain Malkin, an architect of health-care interiors and the author of a book on evidence-based design. “However, from the standpoint of hospital planning and delivering care to patients, they are an absolute disaster.” The wedge-shaped rooms created by the round units, Malkin says, are particularly ill-suited to the needs of a hospital—the room is at its narrowest at the entryway, where the gurney and equipment have to be wheeled in and out, and the lack of right angles wastes space and makes rooms difficult to furnish. In addition, there is a big drawback to the circular form that Goldberg didn’t seem to consider: noise. His rounded units concentrate and reflect sound in much the same way as the domed ceiling of a church, meaning that busy wards can become positively cacophonous and patients often have trouble sleeping. “I can’t think of one benefit of this layout,” Malkin says. “Not one. Tearing these things down would be the kindest thing to do, because I can tell you that they cannot be renovated for anything that is useful. The circular design is absurd.”
Jean Mah, a principal of Perkins + Will who specializes in health-care design, is a little more sanguine about Goldberg’s designs. But she agrees that the cluster layout has proved inadequate to rapid expansions in room size, equipment, and technology. “Everything has gotten larger, including the patient,” Mah says. “If you were to take the same number of beds at today’s room size and try to arrange them in that four-leaf clover, it would be so much bigger that it wouldn’t work as a geometry, because you would need a much bigger site. It would just explode exponentially.”
Nevertheless, the majority of Goldberg’s hospitals continue to function today as working health-care facilities. (The two exceptions are in his home state: Prentice’s tower sits empty, as does Goldberg’s first hospital, adrum-shaped structure he designed in 1967 for Elgin State Hospital, about 40 miles northwest of Chicago.) Completed a year after Prentice, St. Joseph Medical Center, in Tacoma, Washington, is one of the busiest hospitals in the state. The patient tower has required some structural reinforcement and a major plumbing overhaul, and the influx of new technologies has necessitated the expansion of makeshift server rooms and other awkward adaptations. But the staff reports that the building is otherwise serving its purpose pretty well. “From a nursing perspective, the teams taking care of the patients really love the design,” Linda Hoyt, the director of critical care, says. “And family members really appreciate, I think, the closeness of the patients to the care teams.”
Ultimately, Goldberg’s hospitals may simply have been too exquisite and too rigid. In his quest for the perfect solution to patient-care spaces, Goldberg left little room for caregivers and administrators to negotiate future changes. Like Buckminster Fuller, he was a total-systems thinker who sometimes let the grand gesture obscure more quotidian concerns. And the firm displayed no interest in going back and evaluating the real-world results of its ideas, preferring to reuse the cloverleaf plan (with slight adaptations) in project after project. But Goldberg, who died in 1997, was at least trying to solve the right problems. And the buildings are stunning. Whereas most hospital architects jettison aesthetics in favor of function, he insisted that it was possible to have it all.
As for the old Prentice Women’s Hospital, it is not doomed quite yet. The continuing, no-end-in-sight U.S. recession makes an expensive new building project unlikely to happen soon, giving advocacy groups like Landmarks Illinois a chance to lay the groundwork for preservation. Even if the city is unwilling to landmark the building, not everyone agrees that renovation or reuse is impossible. Rosa argues that Prentice could become the centerpiece of a larger research envelope. If achieved, that would be the final contradiction in a career that was full of them. Goldberg was a utopian thinker with a strong populist streak; a disciple of Mies van der Rohe who envisioned sensuous forms devoid of right angles; and a designer of health-care spaces whose most fully realized hospital—a project carefully tailored to the specific needs of nurses and patients—must now be reimagined for a totally different use, or risk becoming a footnote to architectural history.