n n u u GROWING PAINS AT THE MEDICAL CENTER

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l«l Paul HIMUT. Miu-.mil

Richard Ingersoll The Medical Center is a microcosm of Houston,

uring the past five years and chaos of their respective developed according to a defiant feudal logic... Houston's building cranes have metropolises. At the end of the century, migrated en masse from the once- however, hospitals were among the first booming downtown business buildings to be consciously identified as district three miles south to the functionalist; perhaps the original use of . With the the machine analogy in reference to bust in the oil-and-finance econ- architecture can be traced to Jean- omy, developers and builders Baptiste Le Roy. a scientist involved in turned their attention to the the rebuilding of the -Dicu in Paris, relative stability of the health-care who proposed in 1773 that "a hospital industries, and the majority of the 42 ward is really a machine for the treatment institutions located at the Texas of the sick."' The functionalist paradigm Medical Center have initiated major emphasized the importance of designing physical expansions costing more than from the inside out, with the unfortunate $1.5 billion. This will double the consequence that buildings were no building area within the world's largest longer conceived as parts of an urban (even though they are only 25 to40 years illness as a metaphor: to make such medical center. The name Texas Medical whole. In the 1920s, such Modernist old). The design of the new Veterans analogies is an injustice to those who arc Center refers to both a district of Hous- evangelists as Sigfricd Giedion and Administration hospital is indicative of not well. Yet to call it "Health City," as ton, known as the Medical Center, and an Richard Docker used medical buildings the attempt to mask functionalism: fancy does the TMC's president. Dr. Richard umbrella organization, which for the sake as exemplars of a new architecture. striated veneers and figural Postmodern Wainerdi, seems equally offensive to the of clarity will be called the TMC. The Hygienic regulation of light and air, corner towers cloak the highly flexible well. In some ways the area is a hospitals, research laboratories, schools, unobstructed circulation, and stripped- interior arrangement, which is based on microcosm of Houston, in whose urban and health organizations located at down simplicity for ease of maintenance interstitial floors. Mezzanine spaces eight development parts have been favored the Medical Center are federated but became axiomatic alternatives to feet high have been sandwiched between according to a defiant feudal logic with autonomous members of the TMC. The traditional architectural styles. all floors tor services and equipment so no concern for the whole. The conflict between individual institutions that adjustments for new technology- environmental anarchy for which the city and collective needs is clearly legible in Excepting the splendid machinery of the which have to be made every ten years- is famous has perhaps become too strong the uncoordinated urban pattern of an out-of-the-way Healing and Cooling can take place without interrupting day- a model, because even in the planning area that contains Houston's third most Services building, there are few external to-day operation. The static style of the circumstances of the Medical Center - significant concentration of buildings. signs of functionalism at the Medical exterior, which includes classical modil- where the TMC owns all the land and The TMC's power is negligible compared Center. Certainly the interiors of the lions and rustication, awkwardly con- requires nonprofit status of its tenants - to that of its members, and therein lies newer buildings are strictly governed by tradicts the dynamism of the interior, uncompromising, individualistic projects the chief deterrent to concerted planning functional demands, but they are vir- making the building seem clumsy. are pervasive. The member institutions, - no plan will work beyond the degree to tually unrelated to the exterior elevations. among which are 13 hospitals, two which the members themselves are medical schools, the city's department of Although the attention recently given to In general the buildings of the Medical willing to cooperate. health, and several unique institutions facades indicates some desire to address Center arc being transformed by an such as the New Age Hospice and the the public realm, the effect has not been accretive process that adds new features High School for Health Professions, are harmonious: each project competes with in response to the need for operational Some of the finest works of public in fact as much in competition with each the others in scale, material, color, and efficiency and new programmatic de- architecture in the Western world are other as they are in cooperation. style. The current batch of additions and mands, resulting in labyrinthine circula- medical buildings. The long porticos of Representatives meet with Wainerdi twice new buildings ranges in style from the tion on the inside and a confused jumble Brunetleschi's Ospedale degli Innoccnti monthly to discuss mutual problems, and slick thermometer look of Smith Tower to 'of volumes on the outside. An inchoate in Florence and Baccio Pontelli's although they arc able to concur on such the crusty. Postmodern mannerism of snarl of parking structures, unclear Ospedale di Santo Spirilo in Rome are urgent matters as storm drainage and Dunn Tower across the street, heavily points of egress, and difficult connections stunning examples of how hospital design power supplies, very little visible rusticated and trimmed with classical between structures make the Medical in 15th-century Italy contributed to the evidence of coordination results. The moldings. Both were built for Methodist Center an aesthetically and experientially orderly organization of urban space. In TMC has little authority over its powerful Hospital during the same period, yet they unpleasant place that seems to promote a the 17th century both Jules Hardouin- member institutions, nor would it want to look like rivals. Changes in medical feeling of illness rather than relieve it. Mansart's Hotel des Invalides and Sir jeopardize its tenuous standing by Christopher Wren's Royal Naval Hospital technology and hospital functions have occurred so quickly that both Ben Taub opposing their plans. Wainerdi's claim in Greenwich presented architecture of "Sick City" is, of course, an unfair that "each of the institutions is like a magnificent symmetry, geometrical and the Veterans Administration have moniker for the Medical Center, not found it more economical to build new store in a shopping center" is clearly a regularity, and hierarchical clarity that because it is imprecise, but for the reason delusion, since the management of a served as a critique of the density, filth. structures than to adapt existing ones thai Susan Sontag warns against using 6 Cite Spring-Summer 1989 New buildings in the Texas Medical Center il!

Methodist I liiMtii.il, Dunn Tower, Smith Tower, Uoyd Jones Fillpol

shopping mall exercises considerably William Bertncr (the TMC's first more control over the design and use of president) with an initial $20 million its property. Closer to reality is another endowment from the foundation of Waincrdi's analogies, comparing each established by cotton-exporting magnate institution to a separate city: Methodist Monroe D. Anderson. It was conceived City. St. Luke's City, Baylor City. In the as both a charitable endeavor and an same way that Houston has been unable economic backup system for a city in to implement zoning or planning, the need of diversification. The original TMC cannot deal with most of the 134-acrc site, part of Hermann Park, was collective and urban matters that should purchased from the city in 1943. Among concern all its members. The TMC's one the TMC's charter members were claim (0 power is its control of the Hermann Hospital, on the site since majority of the parking lots and parking 1925; M. D. Anderson Hospital and structures, but this has not proven to be Tumor Institute (part of the University of the key to either urban clarity or Texas): and Baylor College of Medicine, backyard diplomacy. which was lured away from Dallas in 1943. when :he Houston Chamber of The Medical Center owes its reputation to Commerce added a $500,000 grant to the the competitive pursuit of advanced TMC's invitation to settle in Houston. medical technologies, especially in From the outset, the nonprofit institutions cancer research, organ transplants, and were looked at as businesses and infused treatment of heart ailments (more open- with a competitive spirit. The medical heart surgery is performed here than symbol of the rod of Asclepius has proven Above: Kenneth Franzheim's 1946 imagined anywhere else in the world). Its size and to bear an uncanny resemblance to ihc view of the Medical Center showing similarly complexity are seen as its major dollar sign. The enormous profits that • styled buildings, each on its own landscaped attractions to researchers and doctors. accrue to TMC members, which must j island. Left: The Medical Center, 1988, There arc three cyclotrons at the Medical dedicate 4 to 5 percent of their budgets to ~ showing the impact of the automobile and Center, and the ultimate in sophisticated charitable purposes in order to maintain | the uncoordinated collection of buildings. medical equipment, such as magnetic nonprofit status, are reinvested, which resonance imaging machines, can be partially explains their ability to expand. found in many of its buildings. In 1976 The profits of Methodist Hospital during the first helicopter ambulance services the past five years have been so healthy as were introduced, and the whirlybirds to bring its charitable status under legal scrutiny.' principle" in hospital design, which 1974 by the University of Texas, and the land daily at three of the hospitals. advocated detached buildings with more Mayfair Apartments, acquired by UT in According to Dr. Stanley Reiser, a exposure to light and air. Although 1969. Both buildings have been success- professor of medical ethics at the When the TMC was incorporated in automobiles are shown skirting the area's fully retrofitted for use as teaching or University of Texas Health Science 1945, it had a determined architectural perimeters, failure lo include the hospital suppori facilities: an awkward Center and Rice University, the latest program meant to supply "certain rules automobile is clearly the tragic flaw of elevated crosswalk was built in 1988 notions of modern medicine treat for the general guidance of the this conceptual order: most of the across Holcombc to connect the Mayfair diseases as having specific anatomical architectural design of certain buildings." buildings of the first decade - among and M. D. Anderson. A sad exception to sites that specialized technology can act Stone and brick, with a limited amount of them Baylor College of Medicine, the this pattern of adaptive reuse was the upon. The classic Hippocratic concept of stucco, were recommended "no strong Jesse H. Jones Library, and the original TMC's acquisition in 1985 of the histor- health, on the other hand, is concerned yellows, reds or dark colors shall be Methodist Hospital - conformed to Kipp ically significant Shamrock Hotel, which with maintaining an equilibrium between used" - and light terra-eotta tiles were and Franzheim's scheme, but parking lots the TMC chose to demolish rather than the body and the environment, and in this recommended for the roofs, apparently in necessarily displaced the gardens and adapt as a conference center (in charac- respect is more like the Chinese approach deference to the style of the buildings on blotted out the connecting lanes. The teristic Houston fashion, however, the to medicine, based on the interaction of the neighboring Rice University campus/ landscaped islands were transformed into parking garage was retained on site). parts of the body: medicine is meant to The site was planned by Herbert A. Kipp, an immense superblock. The 1949 The recent restoration of Hermann restore the balance. Whether or not the civil engineer who laid out River extension of Fannin Street through Hospital's original 1925 Spanish-slyle Western technology is superior to these Oaks. Kenneth Franzheim. who in 1946 Hermann Park was meant to divert traffic building in lieu of demolition is a far pretechnological concepts of health, the designed both an annex lo Hermann from South Main Street, and the half- happier accommodation of a historic unbalanced urban pattern of the Medical Hospital and the Hermann Professional mile stretch that borders the Medical structure. Center accurately reflects the philosophy Building, also prepared at that lime a Center has since developed into one of of treating the anatomical site in isolation conceptual view of the Medical Center, the most densely built parts of Houston. from the rest of the body. Compared with medical centers in' showing a series of similarly styled with tall lowers for the doctors' offices on Chicago or Detroit, Houston's Medical buildings set in isolation in their own one side and hospitals for them to fill Center has had a less deleterious effect on The TMC was founded in 1942 by John landscaped parks. The scheme was with patients on the other. The symbiotic its surrounding neighborhoods, because H. Freeman. W. B. Bales, and Dr. E. consistent with the 19th century "pavilion bond is clearly expressed by the vascular it is fairly well bounded by public and aerial walkways that span Fannin. Hous- semipublic territories: Rice University, lon's equivalents to the Bridge of Sighs. Hermann Park, the Astrodomain, and Filippo Brunelleschi's State Highway 288. Only its southeastern portico for the Ospedale The TMC now owns 525 acres in eight neighbors, especially the subdivision of degli Innocenti. 1491, distinct but proximate parcels. Most Devonshire Place, have suffered ill Florence. of the land between these parcels is effects. The outer patches of TMC currently vacant, and one of the most property serve mostly for housing or important gaps, the Parkwood Apart- parking, while major public activities are ments tract beiween the Veterans conducted on the original Medical Center Administration hospital and the original site. The ever-growing work force of Medical Center site, is said to have been 52.000 and the daily visiting population, acquired by Baylor in late 1988. Over the which averages 105,000. have led to years the TMC, either independently or egregious traffic problems and inspired through its members, has absorbed several planning studies. The first, jointly numerous adjacent structures and authored by 3D/Intcrnational and CRS properties, such as Franzheim's elegant Sirrine in 1986, was quickly scuttled, Prudential Building (1952), acquired in except for a $1 million signage program. Cite Spring-Summer 1989 7

Ks. 1 II ? y i 1 II * 23 i ii mm i in •••i •••i i J U U* • m •• Children's Nutrition Research Center, Texas A & M University Institute of Bioscienees Veterans Administration Medical Center. Tiifl SD/lnternational tint! Bernard Johnson. 1988. A and Technology. Bernard Johnson, to be completed ip International and Stow Murmcini and M. I). Anderson Hospital, R. Lee Clark Clinic, rare instance (if direct federal Rinding for a TMC in 1990. The first of two ll-story laboratory huild- Patterson, to be completed in 1989. This will be the Pierce Goodwin Alexander, 1987. M. D. Anderson member, underwritten in this ease by the United ings. of concrete frame with brick veneer and largest and most innovative hospital ot the new crop. was the first TMC member to break with Ihe style Slates Department of Agriculture. The patriotic use designed according to the regimented taste of its With utilities floors sandwiched between the guidelines in Ihe 1950s. The firm of MaeKic and of TL-\LIS pink sir.imiL- (loo much is never enough) client to be almost without character, will he built working floors, it will allow alterations to be made Kamrath (which was responsible for several build- and the Texas star relicts at the top were the whim of this year on the site of the Shamrock swimming to the mechanical system without interrupting ings at the Medical Center, including the City of But'ord Nichols, director of the center. The lobby is pool. A "water feature" is being planned by the service. The plan, which from the exterior appears Houston Department of Public Health) designed in one of the few in the Medical Center to feature a TMC (with funding from (he Worlham Foundation) complex due to the shifted orientation of the corner (he manner of Frank Lloyd Wright the successive visible stairway to the second level. The top-story to liven up the Main Strcel tip of the Iriungular site. towers and the jogging configuration of the bays, is stages of the hospital, first using characteristic pink greenhouses might have been a delight to observe actually based on a simple long corridor spine, 16 marble and long sun shades, then in 197ft adding hut are hardly noticeable. feel wide, running diagonally through the center of Ihe polygonal towers and eantilevered nests of the building. Ihe Lutheran Pavilion The Clark Clinic is an uninspired box.

Fannin Street looking north: professional build- ings and , left, Texas Medical Center garage and Methodist Hospital, right.

parking garage, which for all its good intentions is a reminder that the services of a Brunelleschi are needed.

The Medical Center is immense, indecipherable, and chaolic. While mandating the architecture of the area has proven impossible, there may slill be time left to reorganize the parking, natural spaces, and pedestrian environments. But unless the TMC instills in its members a Another proposal, made in 1987 by a locating the station on Fannin. Each of enter buildings at the second level rather sense of greater public responsibility, team led by David Scoular, is still being the member institutions has different than renegotiate the lobbies; such a emphasizing that the Medical Center is considered.5 Scoular. director of planning interests for the site - some want to keep design provides the option of using either an urban environment that will benefit ai Baylor, warns what already works to it for parking, others hope to see it used the exposed first level or the enclosed (and even profit) from architectural work better. He labels Fannin the "front as a park or as a building site - and thus second. The design of the porticos should clarity, the confusion will continue. A door" of the Medical Center and the a compromise will be difficult to achieve. not be handled as a mere functional healthy-looking environment ought to be buildings and institutions on the interior, This inner core of the Medical Center problem - [hey could in fact become a on the agenda of an organization which are less accessible to motor traffic. desperately needs unifying elements. type of urban armature, like the ancient concerned wilh health: Sick City can be the "backyard." Methodist Hospital is Ai present Watnerdi is implementing Roman colonnade, the Renaissance cured, if it will allov. itself 10 be moving its principal automobile entry and a landscaping program that is not portico, or. more recently, the red boxes diagnosed. • lobby from the internal street of Bertner conceptually coherent. Scoular's study used by Bernard Tschumi to structure the to Fannin, an ad hoc implementation of a recommends uniform paving and lighting immense area of Pare de la Villette in strategy to enforce the perimeter as the elements and a complete signage system: Paris. In Houston the spindly porticos at Notes the TMC's recently completed signage the University of Si. Thomas are a j public facade, so that the distinction 1 Nikolaus Pevsner. A History o/Buildin/; Types between vehicular and pedestrian areas system only addresses automobile traffic successful example. Aerial walkways are (Princeton: Princeton University Press. 19761. becomes more clear. Other institutions and is less helpful for pedestrians. being buill al the Medical Center without p. 151. might be encouraged to continue this the benefit of an overall plan, as 2 Richard Docker, Das Terrassenhp (Stuttgart. 19291. trend; those located on the interior, such 3 Pete Brewton. "Methodist surplus draws lire." The major improvement proposed by witnessed on Fannin and Holcombe. If Houston Post. 30 November I9SS, p. A-l. as Baylor. Texas Woman's University, and Scoular's team is a detached second-level designed properly, these modern porticos 44 "Nations health to be bettered by S100,000.(XK> the Jones Library, would be served by M. walkway that shelters an exposed portico could greatly enhance and visually unify Texas Medical Center now under construction in D. Anderson Boulevard, a broad street below ii. This portico would follow an whal is currently a jumble of competing Houston."' Houston. August 1946. pp. 6 11 that intersects Fannin perpendicularly. irregular pattern connecting the major prospects. Scoular has himself built a 5 David Scoular. "Texas Medical Center Planning Internally one finds intense pedestrian Study" (draft). January 1987: participants included institutions in the Medical Center's timid example in (he ground-floor portico Nathaniel Firestone. Dr. Lloyd Fie. Bridgelle traffic between buildings, some of which "backyard." The strategy derives from connecting the rear of Baylor to its Schleicher. Ruscni.in Mackev, and Ronuld Shoiip occurs below ground in 12-foot-wide the oldest and finest aspects of hospiial lunnels - nasty but convenient, and for design, going back to Brunelleschi's initiates only - that connect Baylor with portico. If the most exasperating Medical Ben Taub, and Methodist with St. Luke's. Center experience is waiting for the * -. The original site of the Medical Center as Above ground a criss-cross pedestrian invariably sluggish elevators, corridors, analyzed by Scoular's plan shows the ten- pattern links Methodist to Baylor and ihe by contrast, can be somewhat pleasur- dency of the perimeter to serve as the front / UT Medical School to M. D. Anderson able: witness the active social life in the door and internal areas as the backyard Cancer Center. Bertner is currently a skyway connecting Smith Tower to C! marks the K lot). four-lane core street collecting the four Methodist Hospital. (James Sloller's special Metro lines thai connect the sites recent memoir in Architecture, December 1 of TMC members (many employees are 1988. about the "pike" at Boston's Peter required to park at a distance and com- Brent Brigham Hospital is further •x- • mute by bus to the central area). The testimony to the virtues of long corridors major site of contention in this interior as socializing spaces.) The proposed j zone is the "K lot," a large surface climate-controlled walkways would offer parking lot between Baylor. M. D. a more comfortable way to move between Anderson, and Methodist. At the moment buildings during Houston's six-month hot it is the favored site for a Metro rail sta- spells. Most people working in the tion, although another faction supports Medical Center would prefer to leave and