A new $1.1 billion addition to Johns Hopkins Hospital is an impressive building, not because it’s entirely beautiful, but because it is enormous and because, like all state-of-the-art hospitals, it contains an astonishing internal complexity. Its rounded facade of colored glass juts out over the sidewalk, making the building on Orleans Street a prominent new landmark in East Baltimore. With 1.6 million square feet, a parking garage, two pedestrian bridges over a major thoroughfare and a football-field-size front entrance with gardens, the addition creates a new “front door” for the prestigious medical center.
If, as Corbusier once said, a house is “a machine for living,” a hospital is a machine for healing and dying. One enters hoping for the former, but the reality of the latter lurks in the mind, even if you are visiting a hospital in rude good health. Hospitals remind us not only of our mortality but our collective dead, family and friends who entered and never left, or who left to spend a few final weeks beyond the reach of hope or revival.
The modern hospital evolved from its origins in the charitable care offered by religious organizations centuries ago. Then, the likely plan centered on a courtyard, with a prominent chapel or church. The modernist hospital of the past century, with its rectangular forms and glistening white walls, projected cleanliness and scientific confidence. Today, a new typology has taken root, and hospitals often seem like a hotel wrapped around a high-tech factory.
The new facility, designed by Perkins + Will, divides neatly into “front” and “back” of house spaces, the former more finely finished and the later clearly functional. Perkins + Will specializes in large-scale, highly complex projects, with a portfolio of airports, transit hubs, hospitals and research centers. The new Johns Hopkins center is typical of the firm’s monumentally scaled work.
Built on an eight-story base, it features two 12-story towers — one primarily devoted to children, the other to adults. Patients and visitors will encounter first a large entrance court, with manicured gardens and a rectangular water feature, then move into one of two atrium spaces at the base of each tower. Public elevators, corridors and waiting rooms are designed to soothe — as much as certain colors and natural light can allay anxiety.
But the “back” of house space is only one double-door away, where bumpers on the walls at waist level (to repel errant gurneys), institutional lighting and low drop-ceilings proclaim a no-nonsense institutional purpose.
The basic shape of the building reflects several of the essential dichotomies of health care: It is driven by compassion and the bottom line, by sensitivity to the sick and the practical need of doctors to do their work in basic, mechanical ways. One senses the same architectural dilemma that would confront a designer trying to create an upscale auto service center: No matter how you gussy up the waiting room and offices, ultimately the space must be congenial for fixing cars, which is a messy business.
A substantial budget for art has been used to enhance public spaces and private hospital rooms, where window screens feature designs that recall the Baltimore folk art tradition of “painted screens.” Walls are painted in appealing colors, and comfortable furniture reflects the consensus that family members should be near their sick kin, not restricted to drab public rooms. But there’s no effort to hide the battery of plugs and connections that keep the patient connected to monitors and other devices. Art can’t quite compensate for this inevitable but discomfiting reminder that when we are sick, our bodies are reduced to fluids, pulses and chemical states that must be scrutinized and tweaked.
Pragmatic choices lead to aesthetic consequences. To maximize natural light, patient rooms are grouped around the perimeter of the building. In a hotel, bathrooms would probably be placed near the doorway to the hall, leaving space for wider windows at the far end of the room. But nurses want ready visual access to hospital rooms, so the bathrooms in the new building have been moved to the exterior wall. That means smaller external windows, which, in turn, can create a building surface marred by relentless and depressing small window cuts.
The architects have compensated by using a large, colored facade to brighten and lighten the face that the hospital puts to the world. Perkins + Will worked with Brooklyn-based artist Spencer Finch to create an “alphabet of colors,” inspired by the Giverny paintings of Claude Monet. Applied to panels and incorporated into the skin of the hospital, these color swatches alternate with windows to create an illusion of a fully transparent glass skin. The facade also draws attention away from the masses of dull brick and the bulky, blunt massing of the building.
It is, in other words, a facade in the sense that critics often deride: a skin meant to hide or decorate a building. But as architects for thousands of years have known, a facade is a cost-efficient way to add surface delight to uninspiring geometric forms.
Aesthetics function in a unique way inside a hospital. It’s not about deep emotional or artistic engagement, but a mild, sustaining form of preoccupation. In the adult wings, nature scenes and a natural color palette predominate. In the children’s wing, the need for distraction becomes more acute. The hospital hired stage designer Robert Israel to create animal sculptures to animate the Charlotte R. Bloomberg Children’s Center (named in honor of the mother of New York’s uber-wealthy mayor). They are attractive sculptures, including a large rhinoceros in the forecourt and a school of fish, which seems to be swimming in the main stairwell. Art inspired by famous children’s books is used throughout the tower to attract and divert the patients.
It is difficult to assess the impact of these details with an adult’s skepticism and ingrained fear of mortality. Looking at a child’s crib dwarfed by equipment in an intensive-care room or at the double-height light-drenched space where children will receive chemotherapy, it’s hard not to wonder whether animals, colors and adorable pictures will have any effect. But when I dredge up memories of a week I spent in a hospital at the age of 8 (and not nearly so sick as the kids who will use the Hopkins facility), the one thing I remember clearly was the television. It was a novelty to have it in one’s room, with a remote control to change the channels. Perhaps small delights do divert young minds even when ill.
The most striking architectural detail of the hospital isn’t apparent until one enters the public cafeteria at the back of the new building. The space has been carefully and expertly integrated into the existing campus, with a garden connecting the new building to a historic structure from the early 20th century. Hospitals often eat up vast tracts in neighborhoods where land is cheap and thus become impediments to urban renewal and gentrification. That is almost surely going to be an issue with this facility.
But as with so many other things about this structure, it’s not easy to see what else can be done. If the hospital must grow, where else makes sense? In the end, one finds oneself in reluctant admiration of this structure. Perhaps, someday, the functional spaces of hospitals will be as inviting as the patient rooms and lobbies. Perhaps, someday, hospitals won’t be neighborhood killers. Perhaps, someday, health care will be affordable, equitably distributed and uniformly high-quality.
For now, compromise is inevitable. Most visitors will leave thinking ambivalently: I hope I never have to come here; but if I have to go to a hospital, I hope it looks like this one.