The Giving Garden

Healing gardens at hospitals bring comfort to patients, parents and caregivers.

The first thing Lynn Ray remembers when he awoke from a two-month coma is playing outside in the snow. Big, fluffy white flakes fell from the sky in St. Louis that January day, and after spending months in the hospital unconscious, the 20-year-old was finally able to breathe fresh, clean winter air. While sitting in a wheelchair, he packed bitter-cold snowballs in his hand and threw them within the Olson Family Garden, an 8,000-square-foot rooftop utopia for patients, parents, siblings and caregivers at St. Louis Children’s Hospital.

Lynn, now 25, is still a patient at the hospital. He has a rare neurological condition called Sturge-Weber Syndrome, which, among other side effects, gives him seizures, life-threatening episodes that at one point were uncontrollable.

His mother, Carrie Leljedal, first took Lynn to the hospital in 1997 when he was 9, two years before the garden was installed outside of the 8th floor of the hospital. She remembers how much the garden helped comfort her.

“St. Louis Children’s Hospital practices family-centered care, because they’re not just treating the kid, they are treating the family,” says Carrie, who is on the hospital’s advisory council. “You get a whole family when you treat a child.”

The garden offers patients and siblings a place to play and escape and parents a place to cry and retreat.

Clare Cooper Marcus, professor emeritus in the Architecture and Landscape Architecture departments at the University of California, Berkeley, has studied and evaluated the design of green spaces in places such as parks, plazas, hospitals and housing projects, and the impact the design has on people since the ’60s. She calls the verdant expanse at St. Louis Children’s one of her favorites.

“I was just stunned by this garden. To do a roof garden is very, very tricky. Because of the weight of the plant materials and the soil, you’re limited. But there were full grown trees on this roof. There were probably four or five different little water features where the children could see goldfish, and they could put their hands in a pond,” she says. “There were telescopes they could look through to see downtown St. Louis. There were kaleidoscopes they could look through to see fresh flowers broken up inside.

“But it’s not a playground. In a children’s hospital, one of the tricks is you have to serve a lot of very different people’s needs. So it must be nice enough and interesting enough that if you wheel a sick child around, there are things that might intrigue them and distract them from their pain. Then there are the well siblings of sick children who want to run around and have fun, but you don’t want to turn it into a playground because another important group is very worried parents who are waiting for a child in surgery, or even those who are bereaving a child. This garden somehow magically provides for all of them.”

Carrie has found it to be a place of solace.

“It gives you such a break,” she says. “A place to find something that resembles more normal. Now you’re outside, you have fresh air. There are green things around you. Whether you’re just sitting out there reading a book or just walking around, you forget you’re at the hospital.”

Their visits have varied over the years. Once, Lynn spent five months in the hospital. Other times he’s gone a year without them having to make the 20-mile commute to St. Louis. Lynn’s condition has improved since he had brain surgery in 2004 to disconnect his right hemisphere. Only the left side of his brain is functioning, which means he has lost fine motor skills on his left side and his short-term memory is debilitated. “But, he’s alive, he’s happy and his seizures are at least manageable,” Carrie says.

Though it’s never easy for a parent to take a child to the hospital, Carrie enjoys walking around on the soft, squishy paths, sitting underneath the large, leaf-shaped awnings attached to white, trunk-like columns and feeling the cool water rush against her hand in the features and ponds throughout the hospital’s garden.

“For families like us, it’s home. Because they make it home for us,” she says. “The garden is there as much, if not more, for families than the actual patient, and the whole hospital is built that way. They keep the kids and families comfortable and take care of them.”

Behind the Scenes

When horticulturist Gary Wangler first took the job at the St. Louis Children’s Hospital in 1999 right after the Olson garden was built, he imagined his job would include planting, pruning, watering and the many other tasks it takes to maintain a rooftop garden and hospital grounds.

Gary remembers the moment he decided his role would be to nurture both plants and patients. It was in his first year, and for several weeks a small boy who had a spinal injury and wore a metal halo was wheeled out into the garden. Gary watched him from a distance for several weeks, but focused on his own tasks. Finally, the two made eye contact. Gary smiled, and the boy flashed a smile back.

“After several days I was able to approach and connect with him. I had to say, ‘Gary, put all of your emotions aside — you’re here for this child.’ I’ve never been in a situation where my boys were sick, and I’ve never been in a hospital environment, especially a pediatric environment,” says Gary, whose sons are now 28 and 25 years old. “I could have been one to say, ‘Hey I’m doing the garden, heck with these kids.’ But I think it’s very important for whoever got this job to be able to reach out and engage with the kids.”

Gary is now an entertainer, a therapist and an event organizer. Instead of only instructing children to perform painful, monotonous and frustrating exercises, doctors will allow kids to work on mobility with Gary by grabbing a trowel and digging in the dirt or controlling a hose. He directs them to the vegetable garden and encourages them to touch the plants to understand where food originates. He draws children to the garden by hosting about 40 events throughout the year, which include concerts, visits from bird experts from the city’s zoo, storytellers, crafts and more. It’s one of his favorite aspects of his job.

“When I have a music concert in the evening, I look around and people are smiling,” he says. “They’re in a quality environment. They’re tapping their foot, they’re engaged and they’re enjoying quality time.”

Gary also created the butterfly project, a three-week program twice a year where children get to observe the larva transform into beautiful winged creatures in each stage. Gary orders about 100 larva, and the children help with everything, including feeding the caterpillars and eventually, butterflies. Once the caterpillars transition to the chrysalis state, what Gary calls their “changing room,” the containers are hung like Christmas ornaments within “butterfly pavilions,” or netted bags near the hospital playroom and teen lounge. Once the butterflies are fully dressed, Gary and the children release them in the garden.

“There’s a number of things they can do in the hospital instead of just sitting in the bed,” Gary says. “I think the garden was built so that kids could reconnect with nature. I thoroughly believe that natural settings, garden settings, are very therapeutic, and that’s exactly what that garden is for. It’s a place for them to get away from the clinical setting, to get away from all of these doctors and nurses and these IV poles and the sterile room to get back to nature again.”

On days without events, there are plenty of places in the garden to interest and engage patients, whether they are toddlers or teens. A large, solid granite sphere the size of a medicine ball rests on pressurized water so though it is 1,500 pounds, even 3-year-olds can push it. Lynn’s mother Carrie says it’s one of her favorite features.

There are three porthole windows set into a wall, an intimate space designed so that people can sit facing each other. Gary recalls a grandfather sitting with his grandson, looking through the window at a bird’s eye view of the stunning Forest Park, the seventh largest urban park in the U.S.

The kaleidoscopes, donated three years ago in honor of the garden’s 10th anniversary, are another special feature almost everyone mentions when they talk about the Olson garden. Gary sourced the artist who created the ornate, brass viewers that hold fresh flowers scattered by the cut glass, forming beautiful shapes.

“If I’m out in the garden and planting, or watering planters or bulbs like I was today, it’s not uncommon for a child to say, can I help? And I’ll hand them the hose and hand trowels,” he says. “But it’s for the parents, too. I can only guess and imagine how these parents who are coming out here feel. They don’t know what the end result is going to be. I think it’s a great place for the parents to come out and shed a tear, say a prayer, decompress and take a break.”

Evaluating the Garden

What Clare Cooper Marcus has found in her decades of observing, evaluating and researching gardens is that the greenery and interactive features of healing gardens don’t just make people happier. They make them healthier.

She is quick to mention she does not perform medical research nor did she first discover this correlation between nature and health. It was a leading researcher in the field, Roger Ulrich.

“A famous article of his, ‘View From the Window,’ that’s actually what triggered this whole movement. He’s a colleague, and it was his work that triggered people’s thought that trees outside the windows are not some cosmetic nicety. They actually help people heal,” she says. “The medical world sat up and took notice, and realized it might save them money.”

Researchers conducted tests and found that people’s blood pressure dropped, their heart rate slowed down and their sweating palms dried when simply looking at a nature photograph.

“It’s pretty much proven now that if you move from a stressful situation, and most hospitals are stressful for people, into some kind of greenery, it is likely that your blood pressure will go down. It is possible that you will feel less pain.”

And, it’s possible you’ll go home sooner.

More of them are popping up outside and on top of hospitals across the country. However, not all gardens are created equal, Clare says.

“[Healing gardens] have become a little bit of a fad. Some of the gardens are what me and my colleagues say are minimally a healing garden. There’s a rooftop with two potted plants. That’s not what we consider a healing garden,” she says. “First and foremost, healing gardens should be predominantly green. We have a rough ratio, not proved by research but just by observation, that it should be 70 percent green and 30 percent hardscape.”

Clare’s latest book, “Therapeutic Landscapes: An Evidence-Based Approach to Designing Healing Gardens and Restorative Outdoor Spaces,” published this month, examines healing gardens that are built with the needs of patients in mind and offers suggestions for evaluating those spaces.

For example, a garden for people with dementia has different requirements than those for people who have suffered severe burns. People with Alzheimer’s disease often get disoriented and eat things they shouldn’t. A healing garden for that particular group therefore should have nothing toxic in it and paths must loop back to the facility. Chemotherapy can cause sensitivity to sunlight, so there must be many shady spots in a garden for cancer patients, she says. Gardens for veterans suffering from PTSD should avoid red and orange flowers, because the colors remind them of blood. One garden for veterans in England even has yellow lines on the bridges over water, which in combat means they’ve been checked for bombs.

The most successful gardens she sees are ones in which the architects speak to patients and their families and caregivers.

Though healing gardens at hospitals are exploding, it is still a relatively new trend. She remembers when she started evaluating gardens at hospitals in the ’90s that there weren’t many to choose from.

And what she found at that time was that the gardens mattered most to the doctors, nurses and other caregivers more than anyone else.

“I didn’t know anything about hospitals, and I looked at four hospital gardens in the San Francisco area. We were astonished by how passionate people were about the gardens, and something else we didn’t expect was that most of the users were staff, not patients,” she says. “The staff spoke about the garden with huge passion, with tears in their eyes telling us what it meant to feel the sunlight and hear the birds.”