The House We Inherited: Healthcare’s Haunted Architecture

“The wrong-doing of one generation lives into the successive ones, and... becomes a pure and uncontrollable mischief.”
— Nathaniel Hawthorne, The House of the Seven Gables

In Hawthorne’s The House of the Seven Gables, the grand Pyncheon mansion stands as both a monument and a warning. It is a house built on stolen land, shadowed by a curse that no generation can quite escape. The Pyncheons’ wealth, secured through deceit and exploitation, becomes their undoing. Each heir bears the weight of a legacy they did not choose but cannot avoid. Hawthorne’s gothic allegory is not only about a family; it is about the inheritance of injustice itself.

Our healthcare system is a house much like this one: impressive in scale, intricate in design, and haunted by the wrongs of its own foundation. The inequities that shape outcomes today—racial disparities in life expectancy, medical mistrust, misaligned incentives—are not recent arrivals. They are structural echoes of choices made generations ago. The result is a system that continues to reward the privileged, exhaust the well-intentioned, and alienate the very people it was meant to serve.

Haunted Foundations

Hawthorne’s house is literally built on dispossession. Colonel Pyncheon acquires the land by having its rightful owner accused of witchcraft, and from that theft springs generations of guilt and decay. The foundation is cursed because the injustice was never reckoned with (Hawthorne, 1851/2000). In the same way, American healthcare rests on an architecture shaped by policies that once excluded and exploited.

Throughout the 19th and 20th centuries, government and institutional policies entrenched racial and economic divides that still determine who lives longer and who dies sooner. From segregated hospitals to redlined neighborhoods and unequal insurance access, inequity was not incidental. It was engineered. The Kaiser Family Foundation’s historical analysis of racial and ethnic health disparities traces these inequities to policy decisions reaching back to the 1800s (Kaiser Family Foundation, 2023). The results are measurable: life expectancy can differ by as much as twenty years between ZIP codes in the same city (Chetty et al., 2016).

Even the daily practice of medicine bears traces of this inheritance. Studies show that racial bias continues to influence diagnostic and treatment decisions. For example, the long-debunked myth that Black patients feel less pain than White patients persists in some clinical settings (Hoffman et al., 2016). These are not personal failings so much as structural residues; they are what sociologist Ruha Benjamin calls “the afterlife of bias” coded into our institutions (Benjamin, 2019). Like the mildew creeping through the Pyncheon house, such prejudices spread quietly, difficult to root out because they are built into the walls.

Then there is the matter of money. For decades, the fee-for-service model has rewarded quantity over quality, creating what one Commonwealth Fund report calls “a chronic misalignment between incentives and outcomes” (Tikkanen & Abrams, 2020). This design ensures that the system thrives on repetition, not resolution—more tests, more billing codes, more “care” that too often fails to heal. Meanwhile, prevention, education, and continuity of care remain underfunded. The house groans under its own ornate excesses while its foundation continues to crumble.

And under it all lingers mistrust, a structural rot that began long before the Tuskegee Syphilis Study. Centuries of exploitation, from medical experimentation on enslaved people to the systemic exclusion of minority groups from research, created a generational skepticism toward medicine that data now confirm (Gamble, 1997; Alsan & Wanamaker, 2018). That mistrust is not irrational. It is, as Hawthorne might put it, “ancestral guilt living on in the air.”

Blueprints for Renewal

If Hawthorne’s first chapters belong to decay, his conclusion belongs to renewal. Phoebe Pyncheon (bright, industrious, and compassionate) arrives at the family home and changes its atmosphere simply by being kind. She opens windows, tends the garden, and brings a moral clarity that begins to heal the house. In contrast, Holgrave, a young reformer and descendant of the wronged Maule family, represents the energy of critique and transformation. Together, they embody a model for change that Hawthorne sees as both practical and moral: reform that arises not from vengeance, but from relationship.

In the novel’s resolution, Phoebe and Holgrave fall in love, bridging the chasm between the family that stole and the family that was stolen from. Their union does not demolish the house. I t redeems it. The curse lifts not through destruction but through understanding and integration (Hawthorne, 1851/2000).

There is a modern corollary here. Meaningful reform in healthcare cannot come solely from policy decrees or performance metrics; it must come through relationship, through humility and collaboration across generations of clinicians and patients alike. Just as Holgrave renounces the power of control, refusing to use his hypnotic influence even when he could, reform today requires a renunciation of dominance. It asks that we listen to the stories of those the system has harmed, and that we acknowledge our profession’s complicity in inequity without collapsing into despair.

Across the country, small models of this kind of reform already exist. Medical schools are rewriting curricula to address structural racism; hospitals are embedding equity officers and patient advocates within leadership teams. Patient navigation programs, originating in oncology and now spreading across disciplines, demonstrate measurable improvements in adherence, outcomes, and trust (Fiscella et al., 2017). They succeed precisely because they reconnect the human and the institutional, bridging the divide that has made healthcare feel haunted for so long.

Letting in the Light

At the end of The House of the Seven Gables, the surviving characters leave the old mansion behind. Not by burning it to the ground, but by stepping outside into the open air. They accept that some structures are too burdened by history to be fully restored, but they also understand that one can build something new without erasing what came before.

Our healthcare system is that house. It cannot be razed overnight, but it can be aired out. Opening the windows might mean clearer communication, accessible records, or simply a culture that invites patients to speak and be heard. It means acknowledging the ghosts in the room (the inequities, the mistrust, the fatigue) and deciding to live differently within the same walls.

At Storyline Health Navigation, we think of this as the quiet work of letting light in. Navigation, education, and patient connection are not revolutionary acts; they are restorative ones. They are the work of Phoebe Pyncheon; simple, steady, human. They do not exorcise the system’s ghosts, but they help it breathe again.

The house we inherited is flawed, but not beyond repair. Each act of clarity, each conversation that restores trust, is another window opened. The air may still be thick with history, but it is moving now. And that, perhaps, is how healing begins.

References

Alsan, M., & Wanamaker, M. (2018). Tuskegee and the health of Black men. The Quarterly Journal of Economics, 133(1), 407–455. https://doi.org/10.1093/qje/qjx029

Benjamin, R. (2019). Race after technology: Abolitionist tools for the new Jim code. Polity Press.

Chetty, R., Stepner, M., Abraham, S., Lin, S., Scuderi, B., Turner, N., Bergeron, A., & Cutler, D. (2016). The association between income and life expectancy in the United States, 2001–2014. JAMA, 315(16), 1750–1766. https://doi.org/10.1001/jama.2016.4226

Fiscella, K., Ransom, S., Jean-Pierre, P., Cella, D., & Bennett, N. (2017). Patient-reported outcome measures for improving patient navigation in cancer care. Cancer, 123(24), 4750–4758. https://doi.org/10.1002/cncr.30904

Gamble, V. N. (1997). Under the shadow of Tuskegee: African Americans and health care. American Journal of Public Health, 87(11), 1773–1778. https://doi.org/10.2105/AJPH.87.11.1773

Hawthorne, N. (2000). The house of the seven gables. Modern Library. (Original work published 1851)

Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between Blacks and Whites. Proceedings of the National Academy of Sciences, 113(16), 4296–4301. https://doi.org/10.1073/pnas.1516047113

Kaiser Family Foundation. (2023). Timeline of key events in racial and ethnic health disparities policy. https://www.kff.org

Tikkanen, R., & Abrams, M. K. (2020). U.S. health care from a global perspective, 2019: Higher spending, worse outcomes? The Commonwealth Fund. https://doi.org/10.26099/7avy-fc29