After four decades of practice- and hopefully 40 to go- I am like others, a continually evolving architect searching for balance; optimistic of making things better, fearful of not doing so. The observations that follow have been formed through time, with gratitude to a large community of mentors, clients, colleagues, family, and daily encounters with the physical world. 

To be seen in some context of WG Clark’s brilliant essay, Replacement, which I recommend to any student of architecture, young or old.

Each of us, no matter what our station in life, is a rich yet imperfect collection of ever-expanding knowledge and viewpoints, forged from our upbringing, schooling, encounters and experience.

Each undertaking on earth is an assemblage of people and their collections, drawn to an increasingly urban place to create something of significance.

Each day, as we assemble, we encounter ideas and material things that have been laid down in advance before us, allowing us to congregate. Linens on beds, refrigerators, mortise locks, paths, roads, rails and offices – populated by other machines, devices and collections – all assist in our movements.  Predawn, the day laborer sits in his truck made of parts cherry-picked from around the globe, assembled in Ohio. Integrated in its vinyl dashboard made in Mexico, are drink-holders with a coffee cup made in Iowa, printed with ink from Thailand. In it is still-warm coffee brewed miles away, from beans many more miles away, propelled to this roadside by oils and gasoline that are not from here. Each moment, each movement can be traced to tens and tens of thousands of people, tens of tens of thousands of things. While it is said that good architecture is like good food, made of local ingredients, it rarely is.

Just as in medicine, where all energy is focused on the patient, Architecture is about focusing, with a carefully positioned lens for a fleeting moment in time, a vast collection of divergent energy, emotion, material and intelligence onto a singular place on earth.  I believe we all sense the complexity and cost of this assemblage. And, we see the damage all around us, the harm of spent energies and the talent that missed its mark.  Yet we also know this assemblage, if orchestrated well with true reason and true craft, can be magical, healing and restoring. The optimism of finding this place in our work is what wakes us each day.

I’ve become growingly conscious of the unsaid/unacknowledged: that each architect performs daily in an operating room, attending to the restoration and creation of civic-ness and significance. In the visioning and setting in place the lens for an operation that will impact our community for a century or more, we each have but the briefest moment in time to observe, diagnose and prescribe. Our efforts are to restore only a part, of a pre-existing larger body. The architect/physician must be ever-optimistic, but ever-cautious, as their assessment, diagnosis and prescription will either heal the patient or leave them disfigured, or worse. To compound the stakes, the architect/physician’s work is singular; there are no dry runs.

We Train

As in Medicine, we train in schools and residencies prior to being released to practice.  We are instructed to read, to research, to document. For physical confirmation, students of medicine are given cadavers as their operative body. Students of architecture are immersed -unwittingly – into their own operative world/body, their physical environment and surroundings, natural, built, urban, rural. Students of architecture – young and old – find themselves actors in their own Incredible Voyage, complete with both natural and constructed arteries and veins, tissue and vital organs.

In medicine and in architecture, lifelong learning is mandatory. We step out of our usual arena, explore new places, encounter new languages, knowledge, ideas and artifacts, which we collect for utility and inspiration. As we mature, we become sage teachers, guides to those newly arrived.

This sustained training and experience equips us to perform, like the surgeon, the intricacies of our practice.

We Observe

We first sit with the patient; at times with their family, we sense their communities. They invariably have come to us ailing and prepared to entrust us with their life and with great financial investment, to improve their mental and physical health. Some patients are in real need, some less so. Like the physician, the architect must have the ability for empathy and compassion, for stepping outside of one’s own shoes and into others. We assess each patient carefully, we are considerate of the family. We take this all in, in an endeavor to diagnose their condition.  Is it real? And to what degree is it want, or pressing need?

We Diagnose

We admit this patient and assemble our team, trusted colleagues and consultants. We reexamine the conditions, discuss historical treatments, consider and explore contemporary solutions. At times, finding ourselves in uncharted waters, we reach out to new experts and for their opinions. We further collaborate, looking to each other for wisdom and directives as we move toward the correct diagnosis.

We Prescribe

The instructions made in the writing of the prescription is where the pivotal decisions are made regarding the health of the patient. These set both the mission and the method. Hence, the architect’s studio is our operating room; our patients literally lie before us. At this critical moment, the medical team prescribes the treatment, the dosage*. Are two aspirins enough or is a more invasive procedure needed/required? What are risks, what are rewards? Like the cook, the chemist, the alchemist, we prescribe the materials, colors and textures, the histories, quotations, the nature of connections, the relations of proximities, thresholds and the underlying cadences, as well as when they enter and exit, and how strongly they are felt.

In the operating room – and in our studios – we have precious little time to do our ruminating and our thinking. When busy, we are at risk of reverting to the expedient, playing favorites, triage. With the influx of too many patients, some could be lost due to insufficient attention. At these moments, we must direct the ship to another port, both for the health of the patient and the integrity of the practice.

*Late in life Arne Jacobsen was asked “what is the secret of Design?”, and he quickly replied with one word, “proportion.” I’ve come to understand that this plays out on every level: spatially, texturally, materially, how much evolution versus revolution, how much of this history versus that history, how much community versus individual, how much levity versus weight, when to listen, when to speak and, when speaking, to what level, inflection or emphasis. 

We Educate

Our patients – and we – too often look at our role as being the specialist/technician. While this is, of course, essential throughout any discipline, it is a baseline expectation. This is not our sole responsibility or gift. Our primary responsibility is facilitating informed decision making, we educate. After listening, sensing, intuiting, researching and becoming educated ourselves along the way, we in turn educate each other of the prospects and benefits of the various paths and prescriptions. This is where we bring our real value, in building a convincing narrative of why. Only with our patients trust and acceptance can the team implement the how.

The Procedure

The process of building is not the life and death decision-making of the emergency room or the architects’ studio; rather it is the technical/surgical procedure after the patient is properly educated, willing, prepped and draped for incision.

As the physician/architect, you hope that you have composed the appropriate prescriptions, in the correct sequence and proportion. Having a limit to your skill, you now hand your instructions to a new, larger team of healthcare professionals (the constructors) to carry out.  Have you left sufficient instructions to guide them, their skills and their instruments, well? Will they respect what they see on the sheet, recognizing what they can bring to contribute to this restoration, this amplification of place? Or will they dis-engage, attending only to the required motions, yet another squandered opportunity to use their talents well? If your instructions are not clearly written – or raise doubts – the focused lens during construction slips and a cosmetically unacceptable scar is left. The “scar” of a poorly conceived or constructed building is a permanent reminder as is the scar of a poorly planned human operation. As in medicine, it is essential to communicate -personally- your teams’ concerns, intentions and ambitions are with the implementors. Everyone assembled longs to contribute and add to significance. It is important that we each know and share responsibility for what is at stake.

The clock chimes, lights are positioned, and the procedure commences. The first is cut is made. The operative site is now an electromagnetic flow of energy and material. Each professional enters and exits at a precise time. In stop-time motion, human beings and their machines distribute and place pieces and parts from distant lands and fabrication yards and shops, having traversed over and between the previously fabricated constructions, to create a singular place of authenticity. Completed, the incisions are sealed, and the surfaces are cleaned. The work site is sensitive, a tad swollen; the doctor, the patient, and the family are full of hope that the effort was successful. Time will tell.

The Recovery

 An important distinction should be noted: Medical professionals are trained to help bodies rebuild themselves. Architects are trained to build bodies – Frankensteins all, to be sure – out of parts; bones, organs, various grafts of skins, air and fluids pumped through them. While these may approximate nature, they do not repair themselves.  This said, buildings like people do age and break; components need restoring and at times replacing. If your created Frankensteins have become part of the community and are ones’ people need, admire, and frankly love, ones that have aged with character – no matter what walk of life they hail from – chances are that they will be towards the top of the list for sustained treatment. For those less embedded, less loved, for those that have aged prematurely and/or poorly, treatment may be difficult to find.

Yet our greatest sense of accomplishment comes when visiting a former patient, no longer fresh from the operation; (when the vitals [our photographs] are typically taken), but rather, ten years later, as time has aged them, and finding them well. If they are healthy, their nest and branches that support it are inseparable. They lean into each other. The nest has adjusted, now fitted with twigs and odd bits of colored twine, from various voyages. An odd chair is added, for example, but it feels right there. This is the time when your patient will have lost any memory of the recovery and is now in full body and mind. There is patina – a wonderful term not found in medicine – the evidence of natural forces and of human hands.  This is the time to take their portrait, and to ask them how they are. If they say they’ve never felt better and they thank you, you leave uplifted and reaffirmed.

Social Justice

A wise sage once told us: “Pick your client, not your project”.

We are ever-aware that we operate within a health care system, often at the pleasure of insured patrons, a fact that we should not be ashamed of, as they greatly support the work we love that sustains us and our families. This said, in this world of want where “too big to fail” and “too big to see” is becoming the norm, in this diabetic world of e-commerce, of industrial agriculture and of digitally enhanced vanities, we still need the anchor of humanness, the feel, the presence of a heartbeat.

As healthcare providers, we also operate in the world of need and the uninsured. Our patients with modest requests in goal and material, and efforts done on behalf of the greater good, connect with us. These projects are needed. They are attainable, understandable and defensible. They exclude no one from hope. Operating as Physicians without Borders, there is nothing that feeds our soul more.

Restoring our sense of worth and well-being is hard.  Architecture is hard, it should be. In the end, we must invent something to love, out of nothing. Lewerentz, and Mies, and Dieste all took two humble bricks and found something to love in their relations. Morandi moved bottles around. Quistgaard turned wood.

So, when you encounter your patient, listen to them. Take time to consider the request, have empathy; acknowledge constraints as challenges. Hopeful yet cautious, gather your team with their imperfect yet valued collections, ideas and talent. Buoyed by reason and craft, select a few materials and find their appropriate proportion, place them in balance. When you discover this place, the noise and anxiousness of doubt dissipates, and you will hear and feel a life stirring, a strengthening. The family assembles. They marvel, and there is joy.

As you step back, watching, take pride that your team has created significance and that you have restored, or built, a heartbeat.