Project for Progress interferes somewhat with this excellent organizing principle. The compromise was inevitable, though, since the only alternative would have been to extend the original mall and its parallel service corridors to a half-mile long. The limitations of the physical site, and of common sense, would have made this the wrong choice.

Yet even so, physicians and other staff can get from the inpatient towers on the north end of the complex to the outpatient clinics in the Doctors' Office Building in total privacy by using Level 2—the "basement" level for most of the facility. And Judge points out that even the more convenient alternative—making the journey via Level 3, 4, or 5—requires only a brief crossing of the public space in the East Mall, where inconspicuous doors offer access to the back stairs and hallways of the outpatient facility.

Another unfortunate though unavoidable effect of the expansion is that the distances between the entrances and many patients' destinations, and even from one place to another within the facility, have likewise expanded. The long hikes can be invigorating for healthy Generation X parents and lively preschoolers, but busy staffers now find they have to build indoor travel time into their workdays. And the challenge is even greater for elderly or ailing patients. To mitigate the difficulty, each entrance always has a gaggle of wheelchairs that any patient or visitor is welcome to use. Although this makes these otherwise grand gateways seem a bit cluttered, the alternative—replacing the horizontal journeys with vertical ones by turning DHMC into a skyscraper—would have been infinitely more unsightly. [For insight into challenges the architects faced, see the video.]

Still another compromise required by the expansion—again the fault of neither the architects nor the clients—relates to Acton's vision for the original Lebanon facility. With his design, Acton shifted the architectur al paradigm for hospitals from

Seville Airport Photograph: María Granados, Architect

"We tried to situate the circulation on the exterior as much as possible—it really helps orient people," explains architect Carolyn Judge. The people she has in mind are people under stress—ill patients or their family members.