Beyond wanting her husband to return to health, Desirée Kettler had one wish -- to see something green.
"Having a place to go, oh my gosh, what that means to a person staying in a hospital," said Kettler, who was by her husband Dave's side during his more than 260 days at Duke University Hospital.
For diversion there was the TV, the cafeteria and the fish tank on the 5th Floor, but it wasn't enough, Kettler said. She couldn't get away to the world-class Sarah P. Duke Gardens, just three-tenths of a mile to the southeast.
Walking one day in the hospital entrance, she looked out the windows and thought, "how wonderful it would have been to be able to go to the healing space of the courtyard."
They call it a courtyard, but it is really a roof.
It's an odd, triangular void at Duke University Hospital, an open-air space with the Anylan Bed Tower on one side, a 10-story glass-and-steel elevator tower on another and the hospital's lobby on the third.
During Kettler's time there, it wasn't green, but a kind of gray - the result of roofing material used to keep rain from leaking into the basement spaces below.
That is until recently. Now, through the vision of Duke Medicine engineering and operations workers, the courtyard is fresh and inviting. Trees and flowers grow. Birds chirp. And patients, visitors and staff find benches and outdoor refreshment just steps from the hospital's frenetic corridors.
It is a garden. And it is more than that.
"It was a wasted space and now it's a place that people want to be in," said Tim Pennigar, the Engineering & Operations staffer who has led the courtyard makeover. "But the biggest change has been in our thinking - we are recognizing there is a connection between the built environment and healing."
This is just one of the many garden spots across Duke Medicine.
They are more than landscaping. And they're connected to Duke Medicine's missions of research, education and quality patient care.
And, as the health system expands, the garden spaces will grow, too.
Gardens and landscaping will be integral to the design of the $596 million Major Hospital Addition at Duke University Hospital, according to early, initial discussions.
Decades of research has shown that the hospital environment affects patient outcomes and that patients benefit from views of nature and from private, refreshing spaces.
"The idea that gardens are beneficial to patients in health care settings dates as far back as the Middle Ages, when European monasteries created elaborate gardens to provide medicines as well as fulfill the spiritual needs of the ill. Today, we know that being surrounded by nature plays a significant role in patient outcome," said Evangeline Lausier, M.D., staff physician in internal medicine at Duke Integrative Medicine in Durham. "Research shows that incorporating greenery, flowers and water into a hospital or clinic environment encourages stress reduction, elevates positive feelings and reduces negative emotions."
Research also suggests that natural settings can promote changes in blood pressure, heart rate, muscle tension and brain activity.
With spring most certainly here, let us take the Duke Medicine garden tour.
Formal and soothing
Near the Duke Comprehensive Cancer Center is the Seese-Thornton Garden of Tranquility.
Through iron gates, visitors pass from the hustle of the Duke Clinic circle to a serene space filled with flowering plants and trees and public art.
The garden, inspired by Rachel Schanberg and the Duke Cancer Patient Support Program, is intended as a place of comfort and as a place for loved ones to memorialize those touched by cancer.
Gardens grow in Raleigh
With its first phase completed last fall, the Duke Raleigh Gardens is a pristine spot on the campus of Duke Raleigh Hospital, next to the Duke Raleigh Cancer Center.
The gardens include a water feature, walking paths and native North Carolina plants. Over the coming months the gardens will grow to complete the vision of a place of enjoyment and tranquility for patients, visitors and staff.
The second and third phases are underway. Improvements will include a garden sculpture, a rose garden, a bird house garden and benches.
A spiritual path
At the Duke Center for Integrative Medicine in Durham is perhaps the health system's most unique outdoor space.
The outstretched fingers of the center's buildings create outdoor garden rooms that are connected along a winding path through the facility. The path leads outdoors to a garden, where a winding maze, or labyrinth, is set out on it in small stones.
"Whereas a maze is constructed as a means to get lost, a labyrinth is intended for the purpose of finding oneself," said the center's designer, Turan Duda of Duda/Paine Architecture. "This journey is meant to reinforce the experience one has at Duke Integrative Medicine."
A learning garden
Not all gardens are made the same. On the terrace on the west side of the Seeley G. Mudd Building is The Medical Garden, a living archive maintained by the History of Medicine Collections.
In eight tubs grow a variety of plants used by healers over the centuries - primrose and foxglove are just two examples.
A new space
Special drought resistant plants like these are growing on a roof at Duke Hospital. Photo by Tim Pennigar
Last month, a 21st century garden was installed on the roof of the lecture halls at the entrance to Duke University Hospital. The carpet of green isn't grass, but sedum - tiny succulent plants that store water.
The new vegetative roof is an experiment aiming to show how innovating thinking with plants can prevent pollution, regulate runoff and conserve energy.
But it will also provide to patients and staff a view of nature from windows on higher floors. In the summer, the sedum will flower. And in fall, amid the stone, steel and glass of the hospital, Pennigar promises, it will turn an autumnal, fiery red.
