A light touch

Sun Architecture Critic

For years, a chief symbol of the University of Maryland Medical Center has been the domed image of Davidge Hall, the anatomical theater where students once gathered in secret to learn about the human body by dissecting cadavers unearthed from nearby graveyards.

Now the teaching hospital has a new symbol that features a less clandestine meeting place - the soaring, skylit atrium of the Harry and Jeanette Weinberg Building.

Part of a nine-level, $218 million addition that will be dedicated Saturday, the glass-covered atrium is the new heart and soul of the west side medical center, which admits 31,000 patients a year and trains more than half of the physicians practicing in Maryland.

In the most basic sense, this atrium is a giant, multipurpose room and pedestrian concourse containing a series of garden terraces that serve as waiting areas for visitors and patients. But its significance to the medical system goes far beyond its utility as an oversized waiting room.

Tucked inside this Lombard Street complex - hidden from passers-by - the atrium also represents the final phase of a $500 million expansion and renovation campaign to recast the medical center's image. Seen for many years as an inner-city hospital that cared for a largely indigent population, the University of Maryland Medical Center is now forging a reputation as a cutting-edge institution serving a statewide constituency that seeks the finest in health care.

The atrium may not be the Weinberg Building's most important feature from the standpoint of health-care delivery, but it's clearly the most memorable. The structure also houses a consolidated emergency department that serves adults and children, a surgical procedure and recovery floor that the medical center calls the "OR of the Future," expanded imaging areas, and a food court, among other areas.

Over the past year, as individual departments opened in phases, it hasn't always been easy to understand how each fit into the medical center's larger vision for growth. With completion of the atrium, it is finally possible for a visitor to stand in one place and see the transformation in its totality.

The atrium is the finishing touch that pulls the massive building effort together. It's also one of the most impressive new spaces in Baltimore, effectively placing the equivalent of a small city under glass. Its light and airy ambience was intended to be an antidote to the shadowy, mazelike corridors found in many hospitals - and a metaphor for the treatment administrators aim to provide.

"It's like the care process: You always want to know where you are rather than get lost in the deep, dark corners of the hospital," said medical center chief executive officer John W. Ashworth III. "I want to have a bright, open understanding of where I am when I come to get care."

Capping decades of work

Just as the atrium is a capstone for the Weinberg Building, the building tops off a 20-year effort to rebuild the medical center after it converted in 1984 from a public to a private institution.

Designed by the New York firms of Perkins and Will and Kohn Pedersen Fox (KPF), the 380,000-square-foot Weinberg Building is the most expensive single structure to be completed on the west side of downtown Baltimore, where construction projects representing a combined investment of more than $1 billion are under way or planned.

Occupying a midblock parcel on the north side of the 600 block of W. Lombard St., it builds on the pioneering efforts of former medical system president and chief executive officer Morton I. Rapoport to create a more "hospitable hospital," whose consumer-friendly atmosphere is a key part of the healing process. In fact, it grew out of a three-phase master plan developed during Rapoport's tenure to guide the medical center's growth.

The first phase included construction of the R. Adams Cowley Shock Trauma Center, which opened in 1989 near Lombard and Penn streets to treat people with the most severe injuries, including head or gunshot wounds and multiple traumas. It represented an investment of $130 million.

Phase two brought construction of the Homer Gudelsky Building, which opened in 1994 at Lombard and Greene streets. Costing $170 million, that project provided space for cancer treatment, cardiology, neurology, organ transplants and most of the hospital's intensive-care beds.

The Weinberg Building, named to honor the founders of a charitable organization that made the lead donation toward construction costs, is the third phase. Designed to incorporate the latest technological advances and increase efficiency, it brings together emergency care, diagnostic evaluation, surgical suites and clinical care units.

Its 55,000-square-foot emergency center opened last November and includes separate adult and pediatric waiting and treatment areas and expanded space for specialized services, such as a chest pain evaluation unit.

And its "OR of the Future" opened last May. It includes 19 operating rooms for adult and pediatric patients, two minor-procedure rooms, a 28-bed post-anesthesia care unit, and a "same day" surgery center. It's expected to handle more than 15,800 operations a year.

The top three floors have been reserved for construction of patient rooms that will be completed in the next several years.

Core of the hospital

Although it's now integral to the medical center, the atrium was not part of the original vision for the Weinberg Building. It wouldn't have taken shape at all, had a strong case not been made by the project architects.

Perkins & Will, the architect of record, specializes in health-care design. KPF, the design architect, is internationally known as a designer of campus buildings and commercial office towers such as 333 Wacker Drive in Chicago and the DG Bank headquarters in Frankfurt, Germany. This is its first project in Baltimore and one of its first completed health-care projects anywhere.

The two firms sought the University of Maryland commission separately but were asked to work together. According to Ashworth, medical center administrators valued Perkins & Wills' expertise but were intrigued by the prospect of KPF applying its talents to health care. Design Collective of Baltimore was also part of the team during the initial planning process.

The Weinberg Building is bordered roughly by the Gudelsky Building to the east, the Shock Trauma Center to the west, Lombard Street to the south and the medical center's 1933 "south hospital" to the north.

Given those boundaries, the designers had two options: They could put the surgical suites and other spaces up against the old south hospital and set back from Lombard Street. Or they could put them along Lombard Street, leaving a gap between the south hospital and the latest addition. The height of any structure was limited to 10 stories because it had to be below the path of helicopters flying toward the Shock Trauma Center's heliport.

The designers proposed a nine-level building along Lombard Street, with the lower levels containing the emergency departments and surgical suites, and upper levels containing private patient rooms.

The area between this new wing and the old hospital tower might have been left open to the sky. But the architects concluded that the space should be covered with a roof and made part of the medical center's climate-controlled interior. They further recommended that the roof be made of glass, so the new interior could be filled with natural light during the day.

This sort of large central space had not been requested by the administrators, and it added considerably to the cost of the addition. But the architects argued that the medical center would not have to spend as much to heat and cool the other buildings if walls that had been outdoors instead became part of the interior. They also pointed out that the Gudelsky Building has an atrium, which has been well received, and said the new one could be even more dramatic, providing a focal point for the entire medical center. Administrators agreed.

"That was the whole idea: To have this great surprise, this wonderful sense of place and space," said Eugene Kohn, principal in charge of the project for Kohn Pedersen Fox. "You'll go there and say, 'That's the heart and soul of the hospital.' "

Healing architecture

The Gudelsky Building - the nine-story tower east of the Weinberg Building - was designed by Eberhard Zeidler. The German-born architect pioneered what he calls the "atrium hospital" and has strong views about the relationship between architecture and health care. "The mind and the body are not two separate things," he has said. "People get well faster in places where they feel more comfortable," including environments with plants, natural light and signs of human activity.

In Baltimore, Zeidler created a more humane healing environment by adapting principles that have proven successful in the retail and hotel fields. Besides its skylit atrium, the Gudelsky Building features glass elevators, a restaurant with an outdoor cafe, and upper-level lounges overlooking the spaces below.

The architects for the Weinberg Building drew and expanded upon Zeidler's philosophy. "Everyone here really liked the Gudelsky Building and what it did for the hospital, and we did, too," Kohn said. "It was, in a way, the beginning inspiration. We felt that the next piece needed to do more to complete the sense of place."

Above all, he said, the architecture of a medical facility should give patients a feeling of hope. "The introduction of space, light, nature, hope, confidence. Those were the important issues."

Indoor atriums have become common features of office buildings, hotels, even retail centers such as Baltimore's Gallery at . The one at the Gudelsky Building has strong retail overtones. Its link to the 1933 building has even been dubbed the "Great Cookie Entrance," after the merchant located there.

If they were to design an atrium as part as of the Weinberg Building, the architects reasoned, it should offer a sense of normalcy to visitors while making clear that it was part of an urban medical center. "We wanted to make this place seem as normal as walking down Main Street - coming into the piazza, seeing a garden or fountain or gift shop. We wanted to make people feel as normal as possible, in an everyday situation," Kohn said.

The architects designed a pedestrian thoroughfare to serve as a major east-west concourse for the medical center. In contrast to the Gudelsky Building's atrium, the Weinberg atrium has primarily nonretail "storefronts" designed to serve patients, visitors and staffers. These spaces include a chapel, a "surgical prep center" for people undergoing operations within the next few days, and a resource center where patients and their families can research health problems and medical procedures.

To further mark this atrium as the domain of a medical center, the architects partially filled it with a series of rooms and landscaped terraces that link circulation spaces with areas related to health care, including a continuing education center for employees and a multipurpose space that may eventually serve as the medical center's museum. In three locations, the designers placed garden terraces that serve as both lookout points within the space and waiting areas for visitors and patients.

Rising gardens

As designed by Mahan Rykiel Associates of Baltimore, with Scott Rykiel as principal in charge, the three landscaped areas have distinctive characters that subtly correspond to the levels they adjoin and the people they serve.

Stepping up against the south side of the atrium, the gardens are located on the ground floor and levels three and five. Each landscaped space - like its adjacent floor - is more private than the one below. The lowest one is open to everyone. The middle garden is primarily for patients' families and friends. The top one will be used mostly by the patients themselves.

The first landscaped setting can be found just off the main concourse. Designed to evoke an urban plaza, it contains a fountain surrounded by Algerian ivy and black olive trees. The architects have dubbed it 'the piazza.'

The second garden, two levels above the first, has raised planters containing tabletop black olive trees, underplanted with calatheas, pothos ivy and peace lilies. Wide ledges on these planters double as benches. Called the "healing garden," this space sits atop a portion of the surgical floor and combines the comfort of a domestic living room with the feel of a garden. When a patient is undergoing an operation, anxious family members and friends may find it a pleasing alternative to the cramped waiting rooms found in many hospitals. It's also meant to be a "restorative" setting for health-care professionals in need of a break.

Compared with the garden below, the fifth-level terrace is a simpler setting, with bamboo-like palms and a gravel bed interrupted by boulders, as in a raked Zen garden. When patients begin staying overnight on the top three floors, they can meet doctors or visitors here. Rykiel said his idea was to create a spot for private contemplation.

The glass roof arches above everything. Supported by tubular steel trusses, it curves gently upward, alluding to the dome atop Davidge Hall. The effect is of a sturdy shelter, unifying and protecting the medical center. Yet the roof also evokes a feeling of lightness. It is the ultimate expression of the medical center's desire to be a place of hope rather than doubt or despair.

Vision for future

Much of the atrium's power lies in the way it reveals itself to visitors. Though nearly as large as a football field, it is invisible from the street. And none of the medical center's entrances lead directly to it.

To get there, visitors typically will come through one of the medical center's two entrances on Greene Street, or the emergency entrance near Penn Street, and walk along a series of corridors, as though meandering through the streets of a medieval village.

Suddenly, low-ceilinged passages give way to the nine-story atrium, filled with light and trees and people. The abrupt change underscores that this is an important destination - the heart of the medical center. And, as medical experts know, one definition for atrium is "chamber of the heart."

The layout and spatial sequence are reminiscent of another KPF atrium, inside the World Bank Headquarters in Washington. Visitors there are rewarded with an impressive indoor courtyard in the middle of that 13-story complex.

But the Weinberg Building's atrium is tailored for health care, not office use. Its architectural vocabulary is modern yet warm in character, with wood-clad walls of the continuing education area playing well off the red brick of the old south hospital. With its garden terraces and connecting stairs and balconies, it softens and humanizes what might have otherwise been an overwhelmingly sterile environment. Because it's used for many purposes other than circulation, it becomes an amenity for all users of the medical center and serves as a key transition point between its public and private realms.

Now that the Weinberg Building is open, the enormity of the medical center's transformation is as clear as its atrium's glass ceiling. Built in 1812, Davidge was first and foremost a teaching facility, designed for doctors and medical students. It dates from an era when people didn't believe in medical research and wouldn't leave their bodies to science for religious reasons - prompting a spate of grave robberies.

The Weinberg Building, by contrast, is the product of a culture that supports research and welcomes the latest advances in science and technology. It's as much for patients and visitors as it is for health-care professionals.

In today's competitive climate, the medical centers that have the best chance of success are those with patient-focused environments - places that offer visitors comfort and hope at times of stress and anxiety.

The Gudelsky Building provided an impressive model when it opened nearly a decade ago. With the Weinberg Building's more sophisticated mix of high-tech and high-touch features, capped by its light-filled atrium, the University of Maryland Medical Center is once again leading the way.

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