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A Healing Place

the 19th-century conception of the hospital as either an almshouse or a hotel to the notion of the hospital as a village square—a model that the 1991 mall made very evident. Now, to look at the outpatient waiting areas in the new Doctors' Office Building is to see that the architectural template for DHMC has shifted again—to an airline terminal.

Not that there's anything wrong with that, to quote Jerry Seinfeld out of context. Some of the world's best contemporary architecture is found at airports, as the terminals designed by Renzo Piano (in Osaka, Japan), Cesar Pelli (in Washington, D.C.), and Jose Rafael Moneo (in Seville, Spain) clearly demonstrate. These structures are about efficiency as well as beauty. Such a philosophy is equally apt for health care in an era of cost containment and quality improvement. Getting you efficiently through Gate 7 at New Hampshire's Manchester Airport so you can catch your flight to Baltimore is not terribly different from getting your daughter through Reception Area 6M and into her appointment with a pediatric pulmonologist.

Like Piano, Pelli, and Moneo, Judge and her colleagues understand how to keep people happy while moving them around efficiently. Judge points out that Shepley Bulfinch was careful to place oak portals at important crossroads in the outpatient building, to put windows at the ends of corridors (so visitors can tell from afar where the building ends), and to keep the stairways and elevators close to each other. The entire public outpatient space is also awash in natural light, thanks to the best new design feature to hit Hitchcock since the invention of the privacy curtain: the curtain wall. [For more about "curtain walls," see the video.]

To an architect, the phrase "curtain wall" relates to the fact that once steel replaced masonry as the supporting framework for big buildings, most exterior walls lost their structural significance and could be made of

The new floors added to the Norris Cotton Cancer Center contain numerous spaces where researchers can interact—both public areas (below right) and small, secluded, glassedin conference rooms (above).

Staff can get from the inpatient towers to the outpatient clinics in total privacy by using the "basement" level. Even the more convenient route requires only a brief crossing of the East Mall's public space.

something as diaphanous as glass. This development is what enabled architect Gordon Bunshaft to dazzle the world with Lever House, the green glass skyscraper that first broke the gray stone monotony of Park Avenue in Manhattan.

That was 56 years ago. What took DHMC so long? Likely it was the fairly recent advent of glass with sufficient insulating capacity for the northern New England climate, plus the similarly recent notion that transparency is a virtue even at a facility where privacy is so crucial. Architecture is a powerful metaphor. Thus it should be no surprise that a medical

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Dartmouth Medical SchoolDartmouth-Hitchcock Medical CenterWhite River Junction VAMCNorris Cotton Cancer CenterDartmouth College