She smiled at this ludicrous situation. Most revealing in her account was the plural usage. She and I and our two children were in it together. Cancer patients always need someone close by to help them negotiate the very difficult terrain, someone to care for the myriad problems as they arise. As families with cancer know, it is an enveloping situation that affects all areas of life: how do you break the news to loved ones, how to get a loan, where to buy a wig when chemotherapy kicks in, and how to face death. These are the kinds of social and psychological situations that come with cancer, often drag on for months and are very good reasons for having a cancer caring centre beside every major hospital. But there was not one next to the Western General Hospital in Edinburgh, the place where Maggie was to fight her cancer and go for weekly chemotherapy treatments for the next eight weeks. Instead, we encountered a new version of that ludicrous situation. On every visit to recharge her chemo-drip we had to wait in this windowless box and avert our eyes from the other possible victims on death row, sitting opposite, just six feet away. All one could do was hide behind a well-worn copy of Hello!, another version of penitential cheer and have a nice day. The weekly visit to this cramped cell became associated in Maggie's mind with the affliction and the chemotherapy. This was Architectural Aversion Therapy banged in by celebrity-tat, and it formed our resolve. As Maggie was later to write in A View from the Front Line: waiting in itself is not so bad it's the circumstances in which you have to wait that count. Overhead times even neon) lighting, interior spaces with no views out and miserable seating against the walls all contribute to extreme mental and physical enervation. Patients who arrive relatively hopeful soon start to wilt.
She goes on to mention the need for a private area, an old-fashioned ladies' room not a partitioned toilet in a row, which supplies privacy for crying, water for washing the face, and a mirror for getting ready to deal with the world outside again. Such facilities would seem fairly obvious for a place where one confronts life and death issues, and indeed they are becoming more common near cancer wards. But the issue is deeper than an old-fashioned ladies' room, as I have heard on several occasions from patients who have used Maggies Centres. They have told me, with considerable emotion welling-up close to tears, that the centre provided a place for them to go away from their family, their business, the hospital and have a good cry. The ambiance of Ma the calm dignity, the sympathetic attitude ofthe carers in this environment, all made the difference in their fight with cancer. Their gratitude was palpable. Maggies gave them a place to confront their myriad problems one at a time, and share such experience with others so afflicted. The special kind of architecture was humorous and thoughtful, provoking but informal, contemplative and risk- taking. It allowed them a self-transformation over time from someone in a state ofcrying shock to a clear-eyed acceptance of their plight. It encouraged the kind of transformation, as I will explain, that Maggie herself went through.
Perhaps there is no typical experience of cancer. In Britain, one in three people now get it and, as life expectancy goes up, the figure is set to rise to one in two (as it already is in parts of Scotland). But there may be no typical situation because there are over 250 different types of cancer, each with its particular history and genetic profile. There are, however, several common circumstances that a patient faces, among them the mind-numbing field of choice and yet more problems to confront. Coping with any particular type of the illness is a traumatic experience, as well as a family and social problem. When one is faced with this life-threatening disease the first question is often the one that Maggie asked: "Well, how long have I got?" Or, "Will I live?' The aim of the centres is to transform such questions into the will to live, or live better: Self-transformation is at their heart.
THE POWER OF THE HYBRID BUILDING This book is primarily about the architecture of Maggie's Centres, not about cancer, but it does not make sense to separate the two completely and, as I hope to show, the metaphors that underlie them both have to be thought about deeply for they steer us in certain directions. We have created these buildings with patients in mind yet have also learned a lot from them as this strange building type developed. It is an unusual one today, radically mixed in functions and moods, a cross between several existing types. Informal, like a home, a Maggie's Centre is meant to be welcoming, domestic, warm, skittish, personal, small-scaled and centred around the kitchen or place to make coffee and tea. The centrality of food and drink allows people to enter and exit without declaring themselves, try things out, listen or leave without being noticed. You can insinuate yourself in the kitchen on any number of pretexts without having to sign up to anything, or fill out an NHS form. This primary role of informality I have termed "kitchenism to give it a kitsch and memorable tag, but it is just one more function and mood in a set of contrasting ones. For instance, there are places for different kinds of group meetings: for therapy sessions, lectures and physical activity artwork, encounter groups, relaxation, and tai chi. This kind of generic space is more of a public background than domestic foreground Then there are private spaces where economic and psychological questions are discussed: small, intense rooms
that may look out on a tiny courtyard, or have a striking set of paintings, or a collection of stones, or the kind of artifacts one finds in a home. These rooms do not look like Freud's inner sanctum with its consulting couch, but they may be the place where one confronts fundamental issues or asks existential questions that follow on from 'How long have I got?' The spiritual and occasionally religious significance of what happens here may be recognized in the ambience. Finally there are the gratuitous spaces the gardens, the architectural gestures, or sculptures, or collections of nick-nacks that exist for themselves. As Philip Johnson once opined, architecture is the art of wasting space, a quip that did not endear him to hardcore functionalists. The point is that architecture, like the other arts, must follow its own internal logic in places, and do so to create its special quality. And this architectural delight or humour or sensuality affects people in Maggies Centres; it supports more attitudes than simply the functional ones. It makes the long haul of healing and dealing with cancer a direct part ofthe rest of life, of everyday culture, not a rarefied or taboo experience. Patients tell us that the architecture makes their smashed egos
expand again, makes them feel important and light-hearted. I have heard this enough to start believing them. If one focuses on the variety of functions then the typical Maggies Centre can be seen as a kind of non-type. It is like a house which is not a home, a collective hospital which is not an institution, a church which is not religious, and an art gallery which is not a museum. At least four different building types are combined in this hybrid, and the amalgam makes them more effective in carrying forward their work. Why? For one thing it creates a sense that everyone is in it together, patients and fundraisers, carers and those who drop in for tea, staff and doctors. This informal continuity, the mixture, overcomes the sense of isolation that usually divides a business into the centre and periphery. Beyond such immediate benefits the blend of functions has also made them of more interest to architects and students, especially in a period when many building types have been reduced in scope to a single use. Surprisingly, architects now come to us and ask to design one, perhaps because of this mixed usage. They do not ask in order to make money, since the building is usually small, a mere 300 square metres (and sometimes they donate their fees). Moreover, their interest is not just a question of wishing to be associated with celebrity-architects (though this cannot hurt). Rather, I believe, it is the challenge of a meaningful and caring commission in the Age of Shopping. They deal here with an emergent building type that is not quite a museum, church, hospital or home but has aspects of each.
In this sense, maybe Maggie's Centres ofanother are typical trend, and one that particularly affects hospitals themselves This tendency is for large institutions to morph themselves into hybrid buildings, and that is because people are now spending so much time in them. The trend is ubiquitous. If we are living longer, and all diseases of aging are on the rise, then the hospital will naturally evolve towards more humane and varied building types. Most obviously it will become like the hotel, less obviously like the small village with a shrine (or a gallery), and places of entertainment. These trends are already visible in Holland, America and Japan.