In her book Illness as Metaphor (Farrar, Straus and Giroux, 1978), Susan Sontag reflected on her experience as a cancer patient, observing that the illness tended to be regarded as more than simply a physical ailment. Cloaked in mystique, it was subject to a variety of culturally and socially constructed metaphors, “treated as an evil, invincible predator, not just a disease.” Significantly, she noted that “Any disease that is treated as a mystery and acutely enough feared will be felt to be morally, if not literally, contagious. Thus, a surprisingly large number of people with cancer find themselves being shunned… as if cancer, like TB, were an infectious disease. Contact with someone afflicted with a disease regarded as a mysterious malevolency inevitably feels like a trespass; worse, like the violation of a taboo.”
By Sontag’s own account in an April 2000 interview posted on The Atlantic Unbound–a Web-based companion to The Atlantic Monthly magazine–attitudes toward cancer have changed significantly since the late 1970s. But a recent article by Barbara Ehrenreich–“Welcome to Cancerland,” published in the November 2001 issue of Harper’s Magazine–echoes Sontag’s earlier observations, maintaining that “cancer is our metaphor for so many runaway social processes, like corruption and ‘moral decay.'” Speaking from her experience as a breast cancer patient, Ehrenreich goes on in a different, more controversial vein, criticizing what she calls the “cult of pink kitsch” that has emerged among breast cancer organizations. For Ehrenreich, the stuffed bears and other “pink-ribbon-themed breast-cancer products” designed to mitigate the illness’ darker associations are an “infantilizing trope” that add insult to injury, supplementing cancer’s attack on her body with a parallel attack on her dignity.
While the views of these two critics hardly constitute mainstream responses to cancer and its treatment, they provide important insights into its far-reaching psychological impacts. For despite the increased success of treatment, and regardless of the outcome of individual cases, a diagnosis of cancer, as Sontag tells us, carries with it intimations of mortality. Patients and their families find themselves thrust into a state of profound vulnerability and emotional distress.
Increased awareness of the psychological and emotional needs of patients has resulted in a new approach to the design of cancer treatment facilities. And while the importance of environment as a factor in the healing process is informing a wide variety of new health care facilities, this is perhaps most important in helping to mitigate the high stress associated with serious illness. A recently completed cancer centre in Windsor, Ontario is a particularly accomplished example of this recent design phenomenon.
Designed by Vermeulen/Hind Architects of Dundas, Ontario (part of Hamilton following a recent municipal amalgamation), the Windsor Regional Cancer Centre (WRCC) replaced the existing cancer treatment facilities at the Windsor Regional Hospital, to which the new centre is joined. Compared with the hospital’s great bulk, the Cancer Centre’s three-storey, 73,000 square foot mass reads as a discreet insertion in a primarily residential neighbourhood with mature trees. A series of projecting elements–notably a cluster of supportive care spaces at the southwest corner and waiting areas along the west side–serve to further break down the building’s mass and increase its perimeter, allowing for greater access to natural light.
The building owes a clear debt to Frank Lloyd Wright, particularly in the strong horizontal expression of the projecting roof lines, the third-storey strip of windows on the west facade, the entry pergola and the use of elongated Norman brick. Wright’s influence is also evident in the handling of the entry, which is tucked discreetly behind a block of supportive care spaces on the building’s south end. The compressed spaces of the pergola and vestibule set the stage for the generous two-storey lobby, which acts as a spatial hub offering access to the centre’s various facilities. The lobby clearly establishes the centre’s character, de-emphasizing the medical nature of the facility, opting instead for a more hotel-like environment. Exposed concrete structure, generous use of wood and a working fireplace all contribute to the warmth and texture of the space, while an exposed stair and a view into a serene water garden act as enticements to the spaces beyond.
From the lobby, circulation spaces are arranged in a pinwheel motif, drawing visitors in four possible directions. Three of these–south, west and east–lead to supportive care spaces, accommodating a range of non-medical activities such as counselling, touch therapy and cosmetic services. To the north, a generously glazed passageway leads to the centre’s main waiting area, another brightly lit, two-storey space with views directly out to a landscaped garden. From this point, patients can continue north toward the radiation suites, or take the elevator to the second floor for chemotherapy treatment. The third floor houses offices and staff areas.
Virtually the entire western edge of the building is dedicated to waiting and circulation spaces with extensive daylighting and garden views. Double-height windows emphasize the space’s loftiness, and the waiting areas are differentiated from the rest of the building, designed as projecting limestone-clad volumes with custom-made mahogany windows, standing out from the brick cladding and aluminum frames used elsewhere. Separate children’s waiting rooms provide a degree of privacy for young patients and their families, with elements scaled to reflect this special user group.
The same loftiness characterizes the corridor accessing the radiation suites, with north-facing clerestory windows providing ample light, and extensive wood finishes and custom-designed light fixtures imparting the same refined and dignified air established in the lobby. The design of the radiation treatment rooms themselves is particularly innovative. Gone are the heavy, lead-lined doors typical of older facilities; in fact, gone are doors altogether. The rooms are separated from the public spaces by a switchback, maze-like circulation system that leads into private treatment spaces making generous use of wood finishes and including colourful stained glass elements (Wright again) that help to de-institutionalize even this most clinical of settings.
On the second floor, the chemotherapy spaces remain more clinical in character, given the inescapable presence of medical equipment. But even these enjoy extensive glazing and views to outdoors, helping to mitigate the potential harshness of a hospital environment. Internalized areas on both the first and second floors are used for private patient review, treatment planning and other support spaces.
Strategies used at the Windsor Regional Cancer Centre to de-institionalize its character are becoming familiar in contemporary health care design–more residential and hotel-like finishes, ample daylight, careful landscaping–but there’s something more fundamental at work in this building. Taken by themselves, these strategies could result in superficial, sentimental interpretations of domesticity and friendliness, the architectural equivalent of Barbara Ehrenreich’s “pink kitsch.” But there’s no danger of this at the WRCC, for in addition to the material treatment and access to daylight, a well-judged handling of scale, proportion and spatial relationships elevate it from an exemplary health care project to a sure-handed work of architecture independent of building type. The double-height spaces are particularly successful, establishing a character that is at once grand and intimate, self-contained and interconnected, not only in plan but also in section, providing second-storey circulation spaces with views into the waiting areas and lobby. Treated as a visual extension of the lobby, the water garden takes its cues from the work of Carlo Scarpa to create a gracious outdoor room. The asymmetric courty
ard section (two-storey on the north, one-storey on the south) establishes comfortable degrees of both containment and exposure, and the juxtaposition of the rhythm of the building’s brick piers with the garden’s meandering composition strikes a satisfying balance between complexity and serenity.
Similarly, the Centre’s primary interior areas straddle the line between comfortable domesticity and dignified public space, yielding two important results. In the first instance, the specialized, often oppressive language of traditional health care architecture is replaced by the psychological comfort afforded by a familiar, home-like environment. In the second, cancer patients are provided with the opportunity to be treated in a dignified public building devoid of any associations with the ostracism or taboo that often accompany serious illness.
The Windsor Regional Cancer Centre illustrates a growing awareness that health care needn’t be reduced to a clinical model: the attention paid to creating an amenable environment suggests that what’s being treated here isn’t the illness, but the patients. At a time when Canada’s delivery of public health care is undergoing serious review, this project and the institutional vision it embodies serve as reminders that there’s more going on than systemic decline.
Windsor Regional Cancer Centre, Windsor, Ontario
Windsor Regional Cancer Centre, Windsor, Ontario
Windsor Regional Cancer Centre, Windsor, Ontario
Client: Windsor Regional Hospital and Cancer Care Ontario
Architect team: Dan Austin, Steve Bury, Sandro Cipparone, Chris Harrison, Mary Jo Hind, Doug Oliver, John Pellegrino, Shar Roberts, Jennifer Timmis, Fred Vermeulen.
Structural: Yolles Partnership Inc.
Mechanical/Electrical: Vanderwesten & Rutherford Ltd.
Landscape: Elodea Landscape Architects
Interiors: Vermeulen/Hind Architects
Medicinal planting: Karen York
Perennial planting: Yvonne Cunnington
Water feature: Dan Euser Waterarchitecture Inc.
Contractor: D. Grant & Sons Ltd.
Area: 73,000 square feet
Budget: $16.8 million
Completion: May 2001
Photography: Ben Rahn/Design Archive